How do I know if my dog is infected with heartworm?

It is very difficult to get a hint of the infection if the disease is in its developing stages. However if your dog is found to be suffering from cough, difficulty in breathing, sluggishness and tired all the time, consult a veterinarian as soon as possible. These symptoms are directly linked to heart, lungs, and other internal organs that are causing the symptoms. In severe cases the dog may faint. The veterinarian would need to take a blood sample to check for the presence of heartworm infection and perform test at laboratories to confirm the presence of heartworm antigen. The veterinarian night also need to perform other tests to confirm the presence of infection.

When and how to give Heartgard to the dog?

As it is not certain when the dog would be infected with mosquito bite, you may talk to your veterinarian to start the medication as a preventive measure. However if the dog has already been infected the treatment is very difficult and risky if the dog has already started to show the clinical symptoms of heartworm.

Heartgard is available in the form of chewable for dogs. They can be directly fed in to the mouth of the dog. The dosage depends on the extent of the infection and should be decided by the veterinarian. Make sure you consult your veterinarian in case you suspect heartworm or if you choose to start your dog with the medication.

Treatment methodology using Heartgard

After having confirmed that the dog has contracted the infection and that the worm presence is there in the major arteries of the god, your doctor might ask to admit the dog in hospital. Heartgard Heartworm Medication would kill the worm and there is a risk of blood clot or the blood vessels of the dog being blocked due to the dead remains of the worm. Along with the cleaning of the adult the medication also takes care of the growing larvae in the blood stream. The entire treatment may take anywhere between 4-6 weeks for the entire treatment to complete.

Precautions to take while using Heartgard

Monitor the health of dog during the treatment. Ensure that that the dog takes the entire dose as recommended by the doctor. Talk to your doctor and check if hospitalization is required as should be pursued if needed. There is very little that can be done to prevent the heartworm disease in pets as that would require ensuring that the habitat of your pet is free of mosquitoes or would require to actively monitoring the blood for heartworm infection.

Israel is the only “western” country in the Middle East.  With a population of 7.4 Million, it is well known for innovation, both from developing & export, & for technology adoption.  The high level of medical care is led by a few university hospitals in the 4 major cities. Being a small country, one may feel that everybody knows everyone.

A few tips that may help a company considering entering the Israeli market:

Regulatory – if you have CE or FDA approvals you shall not have regulatory difficulties. Reimbursement – Define the procedures of your product, most of the products don’t need special reimbursement (especially if they are a part of the procedure), if you need special reimbursement – it could take 1-3 years, but it does not prevent penetration of the products to the Israeli market to some extent. Procedures opportunities – Define the KOL (Key opinion leaders) by the number of procedures, their activity and/or by number of patients that they see, not by their name. The use of media for personal PR may bias one away from the real high volume clinicians. Define the market segment -

The Israeli market offers great opportunities for all the product segments:

ü  Low cost products – The health expenditure in Israel is one of the highest worldwide. The MOH and hospitals try to reduce the expenditure on the medical devices.

ü  New technologies: The regulatory and the reimbursement allow fast penetration to the market. However, pricing may pose a problem sometimes .But the private market (35% of the procedures) could be a great solution as a first penetration step.

Allocate the distributors – In Israel you will find  a large number of medical distributors.  You have to be careful, because Israeli people are very ambitious. You have to check their background, their products portfolio and receive recommendation from the KOL. Also, you have to manage a close and friendly relationship with them, while checking the opportunities all the time. It is recommended to allocate distributors  who are familiar with the MOH and sick fund system, having a deep understanding in regulatory and reimbursement issues, having a good presence in the private market. Define early adapters – most of the KOL in Israel are early adapters . But for innovative medical device, one has to define the relevant KOL, with commitment for the products and should have willingness for a long standing commitment, since the chances of moving away are high in case of Innovators. High end technologies – If you have new technologies (and not “me-to” technologies that compete only in terms of price) divide your target for private market and public market. Technologies are found to grow faster, if penetration is performed via the private market first. Rabbis– Israel is mainly a Jewish country. Although most of the peoples are not religious, a fair number of people consult with special rabbis known as “medical professionals”. Rabbis are giving second opinion regarding the treatment, regarding the doctors  & the technologies. In case of innovative, pioneering technologies, after getting the support of the right doctors, it’s highly recommended to inform this group of influential people.

Our body has mechanism to eject out harmful or unnecessary chemicals out of the body through urinary system. These chemicals are filtered to urine in kidney. A malfunction in kidney may impair it from the ability to filter these waste chemicals. These chemicals when not urinated out of the body keeps accumulating in the kidney. This then takes the form of crystals that harden and forms stones in kidney.

Types of stones:

Calcium stones
Uric acid stones
Struvite stones
Cystine stones

Calcium stones are common in people with high intake of calcium in diet. The excessive calcium combines with oxalate and phosphates in the body and forms calcium oxalate and calcium phosphate. Calcium phosphate dissolves in uric acid present in the urine however the oxalates do not and take up the form of stones later. Uric acid stones are formed due to accumulation of uric acid on the inner walls of kidney when the concentration of uric acid is high in urine. Struvite stones are caused due to infection by bacteria in kidney. These bacteria convert urea in urine into ammonium. This ammonium combines with phosphate and magnesium and forms stones. Cystic stones are prominently due to inheritance. These types of stones are created when the genes in the body do not let the amino acids to absorb properly which consequently leads to cystine stones.

Causes and Symptoms

The exact cause of stones is not known however it is believed that the symptoms are closely related to age, sex, diet, hereditary, urinary tract infections, water deficiency, bowel and endocrine disturbances, renal disorders, gout, arthritis, excess of vitamin C and D, calcium rich diet or medications and alcohol consumption.

Stones are considered the most painful disorders. The pain is shooting in nature and occurs in lower abdomen or groin region. It may induce vomiting and nausea. The patient feels like urinating more than often, burning sensation while urinating and have strong pungent smell. It may also show symptoms like fever, shivering or in extreme cases blood or puss in urine.

Test and Diagnosis

The various tests that can be performed to ascertain the presence of stone are urine test, blood test, Kidney-Ureter-Bladder (KUB) test, Intravenous pyelogram (IVP), CT scan, X-Ray and Ultrasound

Treatment and Precautions

While choosing the test the doctor will consider the size of stone, passage of sample of stone in urine, its frequency and extent, pain, Urinary Tract infection and damage to kidney tissues if any. Your doctor may choose one or more of the treatment methodology

Medicinal
Surgical
Life style changes

As the name suggests medicinal treatment is done by intervention of medicines. Thiazides and phosphates are recommended for calcium stones. Acetohydroamic Acid (AHA) and antibiotics are used in combination to treat struvite stones. For uric stones allopurinol is the most popular drug. Thiola is used extensively to treat cystine stones.

Surgical methods of treatment of stones include extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PNL), Ureteroscopic Stone Removal and open surgery.

The safest of all methods is by bringing changes in the life style of patients. This not only help cure the stones faster but if inculcated in healthy person, his chances of contracting stones are greatly reduced. Few of the habits are drinking at least 2 liters of water a day, avoiding food that has very high calcium composition, avoiding excessive animal protein, limiting salt intake, keeping the ingestion of vitamin C and D in the body and staying away from alcohol

Anxiety

It is normal to be anxious about certain things. However if the anxiety crosses the line and starts to interfere with the behavior, thinking, work, relation and family, it must be checked. People suffering from General Anxiety disorder show excessive symptoms of anxiety with no reason. Their thinking becomes very negative and they tend to worry a lot about things around them or things in their mind.

Symptoms

A person with anxiety disorder may show a variety of mental and physical symptoms. They tend to show excessive worry or may continue to worry about something that has long been taken care of. You will always find such person in tension. They also show unrealistic approach to problem solving. They are very easily irritated and restless. Besides these symptoms the patient may also show symptoms like headaches, sweating, shivering hands, tiredness and they get alarmed very easily. This also affects their sleep and they find difficult to concentrate. Besides these symptoms, other diseases like panic disorder, phobias, depression, and drug abuse may also cause depression

Factors Causing Anxiety

The real causes behind the disease are not known. However there are number of factors that have been found common in almost all patients suffering from this disorder. It may be caused to due to inherited genes that were present in the either or both of the parents. Abnormal level of chemicals in brain also has been found in the patients. There have been suppressed or excessive levels of chemicals in brain like neurotransmitters that inhibit the normal response to stimuli by brain or spinal cord. Other environmental and social factors like pressure or tension at work, sudden loss of a loved one, loss or frequent change of job, excessive drug abuse, and high intake of caffeine and nicotine or during the days of worry are also known to have caused the disease.

Treatment and Medication

If there are no physical anxiety symptoms then a psychiatrist or psychologist are the best resources to help treat the anxiety disorder. Treatment of Anxiety disorder with medication alone would not help. The patient would also need to go through cognitive behavioral therapy as well. Common medications that may be used for treating anxiety disorder are Xanax, Librium, Valium, Ativan, Paxil, Effexor, Prozac, Lexapro and Zoloft.

Cognitive behavior therapy helps the patient by looking more realistic at the problems of day to day life that are likely to make them anxious. They are also taught to recognize and divert their minds in the event of a negative thought in mind.

Exercising, morning breathing, morning walks, soothing music, body message etc are also known to help the symptoms to some extend momentarily.

ENTOCORT EC (BUDESONIDE) is a prescription medication (the only drug approved by FDA )used to treat mild to moderate Crohn’s disease affecting the ileum and/or ascending colon. Entocort EC drug works mainly in a part of the small intestine called the ileum and part of the large intestine called the ascending colon as, Crohn’s disease is commonly found in those areas.

Entocort works by decreasing inflammation (one of the problems in Crohn’s disease).As a type of corticosteroid, Entocort works by decreasing inflammation in the intestines. Entocort medication is only available by prescription and comes in the form of a capsule that is generally taken once a day in the morning.

Entocort steroid is specifically designed to be released in the intestine (not in the stomach). When Entocort is absorbed into the body the liver changes most of it into other compounds that do not have steroid side effects. Entocort EC mostly works when it comes in contact with the intestines and so it does not need to circulate throughout the body to work.

Entocort dosage should be determined by your healthcare provider and will vary depending on a number of factors like: the severity of Crohn’s disease in an patient, body weight and other medical conditions that the patient might have. Entocort dosage should not be adjusted unless the doctor specifically instructs to do so.

Entocort Strengths: Entocort EC capsules come in one strength — Entocort EC 3 mg.

Entocort  Generic Version :The generic version of Entocort is BUDESONIDE

Some general considerations for when and how you should take Entocort EC for optimum results are:

Entocort EC comes in the form of a capsule and should be taken by mouth once a day in the morning.
Entocort EC can be taken with food or on an empty stomach but if it seems to bother your stomach, try taking it with food.
Entocort EC capsules should be swallowed whole. You should not chew, crush, or open the capsules.
You should not drink grapefruit juice or eat grapefruit while you are taking Entocort EC
For Entocort EC to work properly, it must be taken as prescribed

Side effects are possible with Entocort EC usage but not everyone who takes the drug will have problems. It has been seen that most people tolerate it quite well. If side effects do occur, in most cases, they are minor and either require no treatment or can easily be treated by you or your healthcare provider. Serious side effects are less commonly known. Some of Entocort side effects include: Headaches, Respiratory infections and Nausea.

Entocort EC should be stored at room temperature, away from moisture and heat.

Entocort EC should be kept out of the reach of children