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Marvin A.Chinitz, MD, FACG Oren Kahn, MD Jane Geders, MD, PhD Gastroenterologists, Mount Kisco Medical Group 90 South Bedford Rd. Mount Kisco, NY 10549 Phone: 914 241-1050 Fax: 914 242-1373 Colonoscopy Examination Introduction A colonoscopy is an examination in which a flexible thin video electronic instrument called a colonoscope is inserted into your rectum and guided through your entire colon about five or six feet long ; . The major purpose of a colonoscopy is to search for and remove benign colon and rectal polyps. If polyps are removed, colon and rectal cancer can be prevented, as most colon cancers start as these benign polyps. Colonoscopy procedures have saved thousands of lives by removing these polyps and preventing cancer. Colonoscopy requires a cleansing preparation before the procedure that will give you much diarrhea. We have made this a virtually painless procedure by having an anesthesiologist present. The anesthesiologist will administer an intravenous anesthetic called propofol that will make you fall asleep during the procedure. If you are allergic to eggs or soy, propofol cannot be used, and alternative sedatives will be given. Because propofol is short acting, expect to feel wide-awake within one hour of the end of the procedure. You are not allowed to drive for the entire day, so someone must be present to take you home. Going home by taxi without a companion ; is not advisable. Colonoscopy is now recommended to everyone to look for and remove colon polyps beginning at age 50. Colonoscopy may be started much earlier than age 50 if a person has colon symptoms or there is a strong family history of colon problems. Colonoscopy also may detect colon cancer at an early stage when the cancer may be cured by surgery. Colonoscopy is the best procedure for evaluating the cause of blood in the stool, and is also used to evaluate people with diarrhea and or colitis. Colonoscopy is also recommended for people with any of the following: Occult blood in the stool found on Hemoccult card s ; or finger exam ; Past history of polyps or cancer of the colon rectum Family history of colon rectal cancer or polyps Intestinal bleeding Iron deficiency Chronic diarrhea or other colon related symptoms Colonoscopy is a very commonly performed procedure. At the Mount Kisco Medical Group, the three board certified Gastroenterologists, Dr. Marvin A Chinitz, Dr. Oren Kahn and Dr. Jane Geders, perform well over 3000 colonoscopies per year. The procedure may be performed either in the office endoscopy suite third floor of 90 South Bedford Rd. ; , or at Northern Westchester Hospital. This brochure will serve as an informed consent. Please read it carefully. Speak to Dr. Chinitz, Dr. Kahn or Dr. Geders if you have any questions. You will be asked to sign a copy of this brochure before the procedure begins.

Catapres for anxiety Before taking methylphenidate, tell your doctor if you are using any of the following drugs: blood pressure medications; a blood thinner such as warfarin coumadin clonidine catapres seizure medicine such as phenytoin dilantin ; , phenobarbital luminal ; , primidone mysoline or antidepressants such as amitriptyline elavil, etrafon ; , amoxapine ascendin ; , citalopram celexa ; , escitalopram lexapro ; , clomipramine anafranil ; , desipramine norpramin ; , doxepin sinequan ; , fluoxetine prozac, sarafem ; , fluvoxamine luvox ; , imipramine janimine, tofranil ; , nortriptyline pamelor ; , paroxetine paxil ; , protriptyline vivactil ; , sertraline zoloft ; , or trimipramine surmontil. Who have developed influenza pneumonia are at higher risk to develop staphylococcal pneumonia. 9 Intravenous drug users can develop septic emboli in the lungs from tri-cuspid endocarditis. The term "atypical pneumonia" refers to a lung infection characterized by cough, fever, and at times sore throat. Mycoplasma pneumoniae is the prototype for atypical pneumonia, but it can present like pneumococcus, leading many to abandon the term atypical altogether. Next to S. pneumoniae, it is one of the most common causes of CAP in previously healthy patients under 40. 10 Common symptoms include a prodrome with fever, headache, chills, and sore throat followed by a dry cough. 11 Initially influenza, Chlamydia, and Legionella were included pneumonias exclusively under this category, but it is now known these organisms can present in either a typical or atypical pattern. Chlamydia pneumonia previously known as TWAR was initially named for the two strains from which it was identified tw 183 and ar 89 ; . This organism usually causes a mild sub-acute pneumonia, but in hospitalized patients it can be found as a coinfection with S. pneumoniae. 12 Legionella is noted to cause 2 to 6% of infections in a hospital based series, with mortality as high as 25%. 13 Legonnaire's Disease is described as pneumonia ranging from cough to mutisystem organ dysfunction. Legionella also causes Pontiac Fever, a self-limited flu like illness without pneumonia. Epidemiologic risk factors identified by the IDSA for Legionella include: renal failure, immune compromise, and changing of household plumbing. One study notes the presence of high fever, hyponatremia, abnormal mental status, and LDH 700 u ml as being predictive of legionosis. 14 Other pneumonia pathogens identified by the IDSA and the American Thoracic Society ATS ; include: Moraxella catarrhalis, Klebsiella pneumoniae, and Pseudomonas species. Moraxella catarrhalis is frequently seen in patients with COPD. It is also frequently seen as a co-infection with haemophilus influenzae or streptococcus pneumoniae. 15 Fortunately M. catarrhalis generally responds to the same antibiotics as its co-infectors. Klebsiella pneumoniae rarely causes pneumonia in the immunocompetent host, but can cause severe pneumonia in patients with COPD, alcoholism, or diabetes. There is rising resis. To Whom It May Concern: The following are Laser Spine Institute, LLC guidelines for patient deposits. 1 ; Patients who are scheduled for surgery at least 14 business days before their surgery must cancel their appointment a MINIMUM of 10 business days before their first appointment date. 2 ; Patients who are scheduled within 14 business days of their surgery must cancel a minimum of 7 full business days before their appointment. 3 ; Patients who are scheduled within 7 business days of their surgery must cancel a minimum of 72 hours before their first appointment Patients with extenuating circumstances must reschedule at the time of cancellation if their cancellation falls outside of the limits stated above. In order to reschedule or cancel your appointment, you must speak with the patient coordinator that you have been assigned to. This will allow us to reserve your future surgery time and to eliminate any confusion that has resulted in a change in appointment. I understand that if I cancel outside of the limits stated above, I may be charged a cancellation fee of $1000. However, this statement serves as written notice to all patients that they will not be charged a $1000 cancellation fee if their appointment is cancelled due to medical circumstances. This includes potential cancellations on the same day as appointments for medical reasons. If the above policy is followed, there will be no cancellation fee. By signing the above statement, I agree that I have been explained and fully understand the above statement. I also agree to the terms of the above rescheduling policy and cefaclor.

Catapres tts 1 Krassas et al., Thessaloniki and Athens, Greece, did 2 semen analysis at intervals of 23 weeks in a prospective study in 23 thyrotoxic patients at baseline and 6 months after euthyroidism by treatment with methimazole only or in combination with I-131. The results were compared with semen analysis of 15 healthy males. At baseline, mean semen volume was normal between patients and controls. Sperm density was lower in patients but did not reach significance. Mean motility was significantly lower in patients without significant differences in morphology. After treatment, sperm density and motility improved and restoration of parameters was independent of type of treatment. Ceccarelli et al., Pisa, Italy, did a similar study. They performed semen analysis in 20 patients with hyperthyroidism and found a somewhat lower sperm count that was not statistically different from controls. However, of the patients, 3 were oligospermic, 13 had asthenospermia, and 19 had teratospermia. Comment: Unfortunately no semen analysis was reported after euthyroidism was achieved. Matejkova-Behanova et al., Prague, Czech Republic, did spectral analysis of heart rate variability in 10 women with subclinical hyperthyroidism, mean age 46.9 years, and compared results with controls. There was no difference in mean R-R intervals in patients and controls. Power of high frequency band HF ; , that is associated with parasympathetic tone, was significantly lower in patients but no difference was found in power of low frequency band LF ; which is modulated by sympathetic tone. The LF HF ratio was significantly higher in patients, both in upright and supine positions. The results are interpreted as caused by a decreased vagal tone or less sensitivity to parasympathetic stimuli of cardiac muscle when exposed to increased thyroid hormone levels. It is especially important that you consult with your doctor before taking elavil in combination with the following: airway-opening drugs such as sudafed and proventil, antidepressants that raise serotonin levels, such as paxil, prozac, and zoloft, other antidepressants, such as amoxapine, antihistamines such as benadryl and tavist, barbiturates such as phenobarbital, certain blood pressure medicines such as catapres, cimetidine tagamet ; , disulfiram antabuse ; , drugs that control spasms, such as bentyl and donnatal, estrogen drugs such as premarin and oral contraceptives, ethchlorvynol placidyl ; , major tranquilizers such as mellaril and thorazine, mao inhibitors, such as nardil and parnate, medications for irregular heartbeat, such as tambocor and rythmol, painkillers such as demerol and percocet, parkinsonism drugs such as cogentin and larodopa, quinidine quinidex ; , seizure medications such as tegretol and dilantin, sleep medicines such as halcion and dalmane, thyroid hormones synthroid ; , tranquilizers such as librium and xanax, warfarin coumadin and cefuroxime. Accepted for publication October 25, 2001. Address correspondence and reprint requests to Donna M. Rajchert, MD, Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, 9th Floor Main Bldg., 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399. Address e-mail to rajchert email.chop . Presented, in part, at the Society for Pediatric Anesthesia meeting, San Diego, CA, Saturday February 24, 2001 and at the Annual Meeting of the American Society of Anesthesiologists, October 16, 2001. Catapres b1

Materials and RIMMSG contact information were disseminated to the multitudes in attendance. The event was a wonderful opportunity for the RIMMSG to network with the larger Rhode Island cancer community, as well as to raise public awareness about myeloma and the IMF. Free Online Access to The Merck Manuals In 1899, the American drug manufacturer Merck & Co. Inc. began publishing The Merck Manual of Diagnosis and Therapy, an important reference tool for healthcare professionals. Since 1997, The Merck Manual of Medical Information Home Edition ; has been available to people interested in medical care who do not have a medical degree. The Merck Manual, The Merck Manual of Medical Information Second Home Edition ; , The Merck Manual of Geriatrics, The Merck Manual of Health & Aging, and The Merck Veterinary Manual are available on Merck's Internet site at merck . Merck & Co. Inc. provides all of The Merck Manuals on a not-for-profit basis as a service to the community. AACR Publishes New Advocates Newsletter The American Association for Cancer Research AACR ; has begun publishing the Survivor and Patient Advocacy e-Newsletter, a new electronic magazine about people and progress in cancer. There is a fee associated with a subscription but if you visit CRmagazine and click on MAGAZINE in the navigation bar, you will be able to read selections from the newsletter free of charge. IMFer and myeloma support group leader Jim Omel is a contributor to the Summer edition, sharing the personal account of his myeloma diagnosis. New Online Patient Guide to Side Effects The Cure Magazine website has added A Patient's Guide to Side Effects to its roster of guides for the newly diagnosed. Please visit curetoday and click on "Patient Guides" along the right side of your screen. The publication addresses the issues associated with fatigue, hair loss, pain, nausea and vomiting, anemia, neutropenia, depression, oral mucositis, and skin reactions. mt and citalopram.

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