By Q. Uruk. Missouri Western State College. 2018.

The maximum load measured piriformis syndrome Piriformis syndrome is a condition in which was 20% and the minimum 10% of body weight modafinil 100mg cheap insomnia problems. Patients Data reveal that ReWalk ambulation required not high load on up- with this syndrome often present with ipsilateral numbness order modafinil 200 mg with mastercard insomnia 20 faithless, tin- per limb; in fact synchronism between crutches forward advance- gling, pain in the buttocks, thigh, and leg, similar to the features ment, body transfer and lower limb swing phase allows to decrease of sciatica. Musculoskeletal ultrasound has The Mechanical and Physiological Effects of Three Di- been proven to be effective in guiding the injection needle accu- mensional Scoliosis Brace rately to the piriformis muscle. Real-time curvilinear-array ultrasound transduc- 1National Institute for the Orthopaedically Handicapped, 2West er with a bandwidth of 5. Patient was Introduction/Background: All the non-surgical treatment available placed in a prone position with a pillow or towels placed between spinal bracing is the most commonly used method for idiopathic the bed and the patient’s inguinal area to increase the pelvic tilt. Results: In ultrasound-guided pare three dimensional dynamic brace (3-D) ftted on the patient piriformis muscle injections, the needle was guided acurately to under sub classifcation of the Scoliosis research society defni- the piriformis muscle. The purpose of this study was to develop an appropriate spi- echoic band lying between the lateral edge of the sacrum and the nal orthosis in compare with regular Boston brace in the case of greater trochanter. Material When ultrasound-guided injection technique is used, the inject- and Methods: Treatment plan being done with a careful evalua- ant can be more accurately infltrated into the piriformis muscle tion of the patient’s deformity in the coronal, sagittal & transverse as compared with the conventional blind injection technique. Introduction: Epidural spinal cord stimulation is one of the thera- The above experiment is done in without brace, with Boston brace peutic choices for chronic low back pain. Few have studied cially design fexible straps which can be use as continuous and whether the stimulation affects gait. Use of rigid concave side upright and Two patients with low back pain were included (38-year-old male by the fexible straps we can apply the large or small amount of and 47-year-old female). Results: Through the application of dynamic forces pro- were implanted to the posterior epidural space by anesthesiolo- vide a new moment strategy that effects in curve correction with gists. One week after the operation, the patients visited our gait neuromuscular integration and creep force application (dynamic laboratory. The cardio-respiratory analysis done and plot graph and measured three trials without the stimulation and three trials with table established a signifcant better result in new design 3D brace the stimulation. Conclusion: the comparison between Bos- stride time and stride length before and during the stimulation. The stimulation may blunt not only pain the patient is improved with 3 dimension force application over but also other sensation including proprioception from lower ex- regular Boston brace. However, our results showed that this therapeutic choice is safe for level walking. Hesse3 4 1Charite- University Medicine Berlin, Medical Park Berlin, 2Medi- Background: Urinary incontinence is a prevalent disease in female 3 4 population that affects quality of life. Objective: To determine limb joint mobilization due to muscle stiffness and contracture. Our group therefore designed a powered device to passsively placebo-controlled study. All patients were attended as outpatient move the paretic ankle joint in combination with a vibration of female Pelvic Floor Unit located in an urban university hospital. The All subjects were randomized to receive magnetic stimulation or maximum speed was 15°/s. As vibration to lessen muscle tone, to strengthen muscle power and Outcomes measurements, a 72-hour voiding diary, King’s Health to prevent thrombosis. For the comparison be- ankle motion and the ankle muscle tone were the relevant para- tween groups the Analysis of Covariance was used and Analysis of mters. The Fisher ́s not differ signifcantly between groups, no major side effects oc- exact was used to test when the answers were ordinal in the com- curred. When the differences were statistically kle contracture to the team, the device-assisted treatment was less signifcant, a two proportion comparison test was used. But when comparing the treatment group versus placebo, there was Background: Neurocognitive rehabilitations are Complex set of no signifcant difference observed. Conclusions: The pelvic foor techniques that are designed to enhance cognitive domains among electromagnetic stimulation doesn’t show a signifcant difference individuals who are ill or disabled. Method: Neurocognitive reha- with placebo in mild to moderate stress and mixed urinary incon- bilitation therapy is science and art for restoring mental process and tinence symptoms. Results: Advancement of this science is with effectiveness interventions that it has become a priority and it has *A. A series of experimental studies have a tailored experience based on neural structure and brain function. The main objectives are to evaluate the effect of conventional Assessment, Rehabilitation, Diseases.

It is collected in the wild or Roth L buy 100 mg modafinil amex 3z sleep aid, Daunderer M 200 mg modafinil visa health aid sleep aid 60 tabs, Kormann K, Giftpflanzen, Pflanzengifte, from cultivated plants propagated by sowing seeds or 4. Not to be Confused With: The drug can be confused with WiPner W, Kating H, Botanische und phytochemische Folia melissae. Adulterations with hybrids of Marubium Untersuchung an europaischen und kleinasiatischen Arten der vulgare have been found on the market. The Horehound acts as a stimulant, antiemetic and antispasmod- bracteoles are arrow-shaped and soft. They are half as long ic; however, the mode of action has not been satisfactorily as the funnel-shaped calyx, which is downy to silky-shaggy explained. When a decoction of the fresh plant was administered intravenously, the volume of gall secre- Morus nigra tions tripled within 30 minutes. Unproven Uses: Internally, Horehound is used as a sedative in cases of hysteria and hypochondria, as a spasmolytic for Flower and Fruit: The plant is monoecious or dioecious. The stomach cramps and complaints, for whooping cough and to greenish flowers are in catkin-like inflorescences. Horehound is also used to treat nervous, flowers are ovate to cylindrical; the female flowers ovate or upset stomach, nausea and vomiting. The flowers have a 4-bract involucre, which traditionally used in the symptomatic treatment of nervous enlarges and becomes fleshy in the female flowers. The disorders in adults and children, especially for mila sleep female flowers have 2 stigmas, the male flowers have 4 disorders and for the symptomatic treatment of coughs. All of the fruit from the catkins develops into Furthermore, Horehound enemas and suppositories are used blackberry-like false berries, which are really a series of against worm infestation. Externally, Horehound is used for fleshy drupes that are edible and pleasant-tasting. No health hazards or side effects are known in conjunction sessile, unevenly lobed, and serrate with short rough hairs on with the proper administration of designated therapeutic the upper surface. Mode of Administration: The drug is used internally in the form of liquid extracts and tinctures. Saccharose (10%) Daily Dose: Single dose of the drug is 2 to 4 g (as an Pectins infusion); Liquid extract: 1 to 3 ml; Tincture: 1 to 2 ml. The active agents are sugar, acids, pectin and rutin, but there is no information available regarding their effects. Proteins (40%) Madaus G, Lehrbuch der Biologischen Arzneimittel, Bde 1-3, Phenyl propane derivatives: including sinapine (choline Nachdruck, Georg Olms Verlag Hildesheim 1979. The drug contains glucosinolates whose main constituent, sinigrin, is converted through enzymatic hydrolysis to allyl mustard oil. The flowers have 4 free poultice is applied, sometimes to achieve an antirheumatic sepals, 4 free petals, 6 stamens and 1 ovary. They are yellowish-green, usually glabrous, upright ma) or to stimulate the cardiopulmonary system (frost bite and slightly splayed. The style is thin Homeopathic Uses: Uses in homeopathy include irritation of and has a semi-globose, cushion-like stigma. It is 10 to 25 mm long and pressed onto the Use of Black Mustard is contraindicated in individuals with stem. It is almost round and conjunction with the proper administration of designated bristly-haired at the base, with a bluish bloom toward the therapeutic dosages. The stem is glabrous with upright branches almost in kidney irritation) could occur following internal administra- bushels. The leaves are petiolate, up to 12 cm long and 5 cm tion, due to fiie mucus-membrane-irritating effect of the wide. They are pinnatifid and densely dentate, with 2 sensitization; contact allergies have been observed. Habitat: Black Mustard grows in temperate regions Sneezing, coughing and possible asthmatic attacks can result worldwide. Eyes Homeopathic Dosage: 5 drops, 1 tablet, 10 globules every 30 should be protected when preparing or using the poultices to 60 minutes (acute) or 1 to 3 times daily (chronic); because the vapors can cause eye irritation.

Countless innocent women were persecuted 100mg modafinil with mastercard sleep aid japan, tortured and executed as witches buy cheap modafinil 200mg on line insomnia 9 year old, having been forced into admitting things they did not do, the majority being people who suffered from mental illness. Cases of untold suffering and despair continue to accumulate, and this is very significantly because of the influence of the Wessely School. Friedman, a medical school professor at the Department of Pharmacology and Physiology, New Jersey Medical School, said: “I have been asked to comment upon the status of Chronic Fatigue Syndrome education in the United States. What’s strikingly different about this illness is that the majority of people not only have to deal with a particularly debilitating health problem, they also have to deal with the stigma and societal reaction and disbelief and illegitimacy, and that is crushing. So what happens is that people will say ‘We can’t find anything, it must be psychogenic’. The tests they were using were inappropriate and had a real bias for psychiatric morbidity”. Abnormal findings on testing include flattened or even inverted T‐waves on 24 hour Holter monitoring; abnormal glucose tolerance curves; elevated lactate levels in the ventricular system (seen in 70% of patients); neuronal destruction and elevated choline peaks (seen in 10% of patients); punctate lesions consistent with small strokes (seen in 78% of patients); very poor oxygen transport on pulse oximetry readings (seen in 90% of patients) and an abnormal venous blood gas picture. Some 20% have progressive and frequently undiagnosed degeneration of cardiac muscle which has led, in several cases, to sudden death following exercise. Neurological problems include exhaustion, weakness and collapse following mental or physical exertion beyond the patient’s capacity. But more importantly, to be able to validate and understand the incredible suffering that many patients and their families experience in this context. We are committed to improving the awareness that this is a real illness and that people need real medical care and they deserve the best possible help that we can provide. The science has progressed (which has) helped us define the magnitude and understand better the clinical manifestations (and this has) led to a sorely needed foundation for the recognition of the underlying biological aspects of the illness. I have heard from hundreds and hundreds of people who are telling their stories – their courage, their commitment to try to live the best possible life they can (and) the tremendous impact that this is having on their ability to function”. The disability is equivalent to that of some well‐ known, very severe medical conditions. The sicker the patient when s/he first got infected, the more likely they were to have persisting chronic symptoms. There were no other factors, psychological or biological, that held up under thorough analysis”. Professor Anthony Komaroff of the Harvard Medical School: “There are now over 4,000 published studies that show underlying biological abnormalities in patients with this illness. It’s not an illness that people can simply imagine that they have and it’s not a psychological illness. Brain imaging studies have shown inflammation, reduced blood flow and impaired cellular function in different locations of the brain. Many studies have found that the immune system appears to be in a state of chronic activation (and) genes that control the activation of the immune system are abnormally expressed in patients with this illness. A number of studies have shown that there probably are abnormalities of energy metabolism in patients with this illness”. And that has certainly given it a level of 214 credibility that should be easily understood. To refer to “perceived incapacity” in these patients is not only offensive to patients but is also an insult to the many clinicians and researchers who have uncovered the reality of the incapacity through the scientific process (in which psychiatry plays no part). No‐one who is aware of this wealth of information can credibly doubt the reality, the validity and the devastation of this organic multi‐system disease. Some patients are fiercely opposed to it because they believe it suggests that if they’d just change their behaviour or their attitudes about the illness, they would get better. Consequently, we are now informing our members that they should consider taking legal action against the health professionals concerned when an inappropriate ‘exercise prescription’ causes a relapse”. Stein was outspoken: “I would never in my practice use the Wessely model of cognitive therapy. I find it disrespectful to try to convince somebody they don’t have an illness that they clearly have”. To back up his claim, and using a graph from a study by Simon Wessely, White said: “You notice a fairly straight line showing the more physical symptoms you have, the more likely you are to meet the criteria for psychiatric distress.

This procedure buy modafinil 100mg amex insomnia 9 year old, called trans- dehydrogenase order modafinil 200 mg mastercard insomnia app, allows the effusion to be classified as bronchial biopsy, is used when there is either relatively dif- either exudative or transudative (Chap. With the aid of fluoroscopic imaging, the bronchoscopist is Bronchoscopy able to determine not only whether and when the instrument is in the area of abnormality but also the prox- Bronchoscopy is the process of direct visualization of imity of the instrument to the pleural surface. Although bronchoscopy is ceps are too close to the pleural surface, there is a risk of now performed almost exclusively with flexible fiberop- violating the visceral pleura and creating a pneumotho- tic instruments, rigid bronchoscopy, generally performed rax; the other potential complication of transbronchial in an operating room on a patient under general anes- biopsy is pulmonary hemorrhage. The incidence of these thesia, still has a role in selected circumstances, primarily complications is less than several percent. These situations include the retrieval of a for- tissue adjacent to the trachea or a large bronchus. The eign body and the suctioning of a massive hemorrhage, needle is passed through the airway wall, and cellular for which the small suction channel of the broncho- material can be aspirated from mass lesions or enlarged scope may be insufficient. This procedure can facilitate the staging of lung cancer Flexible Fiberoptic Bronchoscopy by identifying mediastinal lymph node involvement and This outpatient procedure is usually performed in an in some cases obviates the need for a more invasive pro- awake but sedated patient. Other promising new techniques that are not yet through either the mouth or the nose, between the widely available include fluorescence bronchoscopy (to vocal cords, and into the trachea. The ability to flex the detect early endobronchial malignancy) and endo- scope makes it possible to visualize virtually all airways bronchial ultrasonography (to better identify and local- to the level of subsegmental bronchi. Samples from airway lesions can be foreign body may be retrieved with an instrument taken by several methods, including washing, brushing, passed through the scope, and bleeding may be con- and biopsy. Washing involves instillation of sterile saline trolled with a similarly introduced balloon catheter. A portion of the liquid is collected by bronchoscope include methods for achieving and main- suctioning through the bronchoscope, and the recovered taining patency of airways that are partially or com- material can be analyzed for cells (cytology) or organ- pletely occluded, especially by tumors. Brushing or biopsy include laser therapy, cryotherapy, argon plasma coagula- of the surface of the lesion, using a small brush or biopsy tion, electrocautery, and stent placement. In the dure involves the passage of a rigid scope with a distal case of suprasternal mediastinoscopy, a rigid medi- lens through a trocar inserted into the pleura. A high- astinoscope is inserted at the suprasternal notch and quality image is shown on a monitor screen, allowing passed into the mediastinum along a pathway just anterior the operator to manipulate instruments passed into the to the trachea. Tissue can be obtained with biopsy forceps pleural space through separate small intercostal incisions. In addition, this proce- cheal and aortopulmonary lymph nodes are not accessible dure is now used commonly to biopsy peripheral lung by this route and thus are commonly sampled by paraster- tissue or to remove peripheral nodules for both diagnos- nal mediastinotomy (the Chamberlain procedure). This much less invasive approach involves either a right or a left parasternal inci- procedure has largely supplanted the traditional “open sion and dissection directly down to a mass or node that lung biopsy” performed by thoracotomy. Defining the appro- remains an option for the diagnostic sampling of lung priate place for positron emission tomography imaging in the tissue. It provides the largest amount of material, and it diagnosis of pulmonary nodules or masses. This atlas of chest imaging is a collection of interesting tive of specific, major findings. The associated text is not chest radiographs and computed tomograms of the intended as a comprehensive assessment of the images. Also apparent on the film are an endotra- cheal tube (red arrow) and a central venous catheter (black arrow). An area of smaller cavity is in the right lower lobe (located below the consolidation associated with the cavity is seen in the right major fissure, identified with the yellow arrow) and the larger lower lobe. Note indistinct vasculature, perihilar opacities, and peripheral interstitial reticular opacities. Note the sig- Large right pneumothorax with near complete collapse nificant collapse of the right lung with adhesion to the ante- of the right lung. Note calcified pleural plaques (red arrows), pleural thickening (black arrow), and sub- pleural atelectasis (green arrows). Note the multiple, well-circumscribed Solitary pulmonary nodule on the right (red arrow) with a nodules of different sizes. Note also that the patient has had a left upper lobectomy with resultant vol- ume loss and associated effusion (black arrow). Asthmatics harbor a special type of inflam- Asthma is one of the most common chronic diseases mation in the airways that makes them more respon- globally and currently affects ∼300 million people.

Always consider a surgical mask or even a gas mask before entering a conflagration to rescue a victim buy cheap modafinil 200mg on-line insomnia las vegas. There are many portable commercially-available canisters which would be useful to get oxygen quickly into the lungs discount 100mg modafinil otc sleep aid research. Your patient will be short of breath with the slightest activity and will be very hoarse. Prevention by planning escape routes and having regular drills will allow your people to get out of dangerous situations quickly. There are few people who haven’t been in the path of a major storm at one point or another. Most of those in the path of an oncoming storm will not have planned for its arrival. If you fail to plan ways to protect yourself and your family, you may find yourself having to treat significant traumatic injuries in the immediate aftermath. Later, flooding may contaminate your water supplies and expose you to serious infectious disease. Preparing to weather the storm safely will avoid major medical problems for you, as medic, later on. A tornado is a violently rotating column of air that is in contact with both the surface of the earth and the thunderstorm (sometimes called a “supercell”) that spawned it. From a distance, tornadoes usually appear in the form of a visible dark funnel with all sorts of flying debris in and around it. A tornado (also called a “twister”) may have winds of up to 300 miles per hour, and can travel for a number of kilometers or miles before petering out. They may be accompanied by hail and will emit a roaring sound that will remind you of a passing train. There are almost a thousand tornadoes in the United States every year, more than are reported in any other country. Most of these occur in “Tornado Alley”, an area that includes Texas, Oklahoma, Missouri, Kansas, Arkansas, and neighboring states. Injuries from tornadoes usually come as a result of trauma from all the flying debris that is carried along with it. Strong winds can carry large objects and fling them around in a manner that is hard to believe. Indeed, there is a report that, in 1931, an 83 ton train was lifted and thrown 80 feet from the tracks. Tornadoes are categorized by something called the Fujita Scale, from level 0-5, based on the amount of damage caused: F0 Light: Broken tree branches, mild structural damage, some uprooted F1 Moderate: Broken windows, small tree trunks broken, overturned mobile homes, destruction of carports or toolsheds, roof tiles missing F2 Considerable: Mobile homes destroyed, major structural damage to frame homes due to flying debris, some large trees snapped in half or uprooted F3 Severe: Roofs torn from homes, small frame homes destroyed, most trees snapped and uprooted F4 Devastating: Strong- structure buildings damaged or destroyed or lifted from foundations, cars lifted and blown away, even large debris airborne F5 Incredible: Larger buildings lifted from foundations, trees snapped, uprooted and debarked, objects weighing more than a ton become airborne missiles Although some places may have sirens or other methods of warning you of an approaching twister, it is important to have a plan for your family to weather the storm. Children should be taught where to find the medical kits and how to use a fire extinguisher. If you live in a mobile home and there is time, get to the nearest building that has a tornado shelter; underground shelters are best. If you live in Tornado Alley, consider putting together your own underground shelter. Unlike bunkers and other structures built for long-term protection, a tornado shelter has to provide safety for a short period of time. As such, it doesn’t have to be very large; 8-10 square feet per person would be acceptable. Despite this, be sure to consider ventilation and the comfort or special needs of those using the shelter. If you don’t have a shelter, find a place where family members can gather if a tornado is headed your way. Basements, bathrooms, closets or inside rooms without windows are the best options. Covering up your body with a sleeping bag or mattress will provide an additional shield. Discuss this plan of action with each and every member of your family or group in such a way that they will know this process by heart. Although you may be hesitant to leave your vehicle, remember that they can be easily tossed around by high winds; you may be safer if there is a culvert or other area lower than the roadway. If there is no other shelter, however, staying in your car will protect you from some of the flying debris. Keep your seat beat on, put your head down below the level of the windows, and cover yourself if at all possible.

Signature in the lecture book will be declined if arrears exist at the end of semester cheap modafinil 100mg on-line insomnia 12 weeks pregnant. Similarly to the weekly practicals modafinil 100 mg sale insomnia 6 weeks pregnant, each student is allocated to a specified team of tutors, rotating between wards with them daily. White lab coat in clean, neat condition should be brought and worn when visiting wards or outpatient clinics. If forgotten, a limited number of spare lab coats is available against student cards. It must be arranged with the storekeeper well before (10 min) the starting time to prevent delays. Attendance at lectures is also highly recommended as certain aspects may be covered only there, and will be asked either in the written or in the oral exam. List of titles are in accordance with the current textbook, and are shown on the noticeboard in front of the lecture hall. If the student decides not to accept the offered grade, the above described oral exam can be taken as exam “A”. Information on the practical part of the exam will be spread out during the semester. Year, Semester: 4th year/1st semester Number of teaching hours: Lecture: 30 Seminar: 20 1st week: 6th week: Lecture: Introduction to autonomic Lecture: Positive inotropic drugs 1. Please, ensure that your lecture book has been submitted to the Department for signing within 1 week after finishing the semester. Please use the lecture book dropbox installed in front of the departmental door on the second floor of the Pharmacology Building. At the end of the 1st semester the students are required to take the End of Semester Examination (written and oral), based on the material taught in the semester. To know the groups of drugs with examples in all of the chapters in pharmacology is compulsory. If one question is remained properly unanswered from the three titles the student is not allowed to pass. If lethal dose, not proper or ineffective treatment is discussed the student have to be failed. Display religious affiliation is allowed (cross, abaya, burqa (niqab), chador, hijab, sartorial hijab, turban, yarmulke etc. Year, Semester: 4th year/1st semester Number of teaching hours: Lecture: 30 Seminar: 40 1st week: cardiovascular diseases and malignant neoplasm Lecture: 1. Bacteriological and mycological environmental pollution examination of water and food (lab practice for Seminar: 1. Toxicology of persistent Diagnosing occupational diseases (case studies) organic pollutants, pesticides and organic solvents 5th week: Seminar: 3. Analysis based on aggregate evaluation of the epidemiological literature statistics 26. Validity of epidemiological studies Requirements Requirements for signing the lecture book: Attendance of lectures and class seminars is highly recommended. The head of the department may refuse to sign the Lecture Book if a student is absent more than twice from practices or seminars in a semester even if he/she has an acceptable excuse. The absences at seminars should be made up with another group only during the same week. Requirements for the exam: During the last week of the first semester (on week 10, the exact date will be announced later) students are required to take a written test which will cover the topics of all lectures and seminars of the first semester. Evaluation of the written test is assessed on a five-grade scale; successful pass of the exam is a prerequisite of the commencement of the second semester. Following the daily schedule of their tutor, students are encouraged to participate in the ward activities and the outpatient care. The students are required to deposit their yellow practice book with the secretary at the beginning of the practice which they are given back signed upon completion of the requirements. Moreover, to monitor the attendance every student has to leave his/her university card with the secretary every morning and pick it up at the end of the day.

Breaking the cord due to excessive traction will require your placing your hand deep in the uterus to extract it order 200 mg modafinil mastercard insomnia hallucinations. If traction is necessary for some reason cheap modafinil 200 mg mastercard insomnia synonym, place your fingers above the pubic bone and press as you apply mild traction. This will prevent the uterus being turned inside out (a potentially life-threatening situation) if the placenta is stubborn. The “fetal” surface is grey and shiny; turn it inside out and you will see the “maternal” surface, which look like a rough version of liver. The uterus (the top of which is now around the level of the belly button) contracts to control bleeding naturally. In a long labor, the uterus may be as tired as the mother after delivery, and may be slow to contract. Gentle massage of the top of the uterus (known as the “fundus”) will get it firm again and thus limit blood loss. You may have to do this from time to time during the first 24 hours or so after delivery. In normal situations, the bleeding will become more and more watery as time progresses. This will begin the secretion of “colostrum”, a clear yellow liquid rich in substances that will increase the baby’s resistance to infection. Suckling also causes the uterus to contract; this is also a factor in decreasing blood loss. It should be noted that there are different schools of thought regarding some of the above. Remember that your goal is to have an end result of a healthy mother and baby, both physically and emotionally. If we ever find ourselves in the midst of a societal upheaval, it goes without saying that we will experience epidemics of both anxiety and depression. The stress of living off the grid will be (for most) a wrenching emotional roller- coaster. As such, an effective medic will have to be skilled in identifying those with the condition, and doing everything possible to support and treat the patient. The stability of your survival community is dependent on the stability of its members. Be mindful of group dynamics, and work to foster a sense of common purpose and caring. Those medics who can accomplish this goal will have the most well-adjusted and stable patient population. Anxiety It is a rare individual who will not experience significant anxiety when deprived of the benefits of modern civilization. Anxiety is really a hodgepodge of related symptoms, so sufferers may present to you quite differently from one another. The symptoms may be mostly emotional, mostly physical or some combination of both. Here are the various things you may notice: Emotional Symptoms: Irrational fear Difficulty concentrating Jumpiness Extreme pessimism Irritability Mental paralysis/Inability to act Inability to stand still Physical Symptoms: Shortness of breath Palpitations (rapid pulse) Perspiration Upset stomach/diarrhea Tremors/tics/twitches Tense muscles Headache Insomnia Acute anxiety attacks, also known as “panic attacks”, may occur without warning and are characterized by intense feelings of fear and impending doom. Panic attacks are usually short-lived but severe enough that a person may feel what they believe to be physical chest pain. These patients, usually young adults, will appear to be hyperventilating and may complain of chest pain or feeling faint. Patients with panic attacks have some classic complaints: Chest pain Choking sensation Feeling they are in a unreal or surreal environment Feeling the walls close in on them (“claustrophobic”) Nausea or strange “pit of the stomach” feelings Hot flashes (sensations of heat and flushing) Panic attacks may last an hour or more in severe cases, but a single episode will usually resolve without medication. Despite this, the most successful treatment of frequent attacks appears to come from a combination of medications/supplements (both anti- anxiety and anti-depressant) and behavioral therapy. Unless your patient had a history of anxiety problems pre-collapse, you won’t have stockpiled many anti-anxiety medications like Xanax. As such, you should look to your medicinal herb garden for plants that may have an effect.