OSTEOARTHRITIS OR DEGENERATIVE JOINT DISEASEOsteoarthritis, also called degenerative joint disease, is the most common form of arthritis. It has been given the mistaken image of an “old-age disease,” because it is the result of a wearing away of the cartilage in the joints, often due to many years of use. This erosion results in stiffness, and because it usually leaves behind a jagged area rather than a smooth surface, pain results that can be mild but is sometimes severe. Some degree of erosion is present in most elderly individuals and is generally accepted as an inherent part of the aging process. X-ray surveys in the United States and Great Britain indicate that 40 to 50 percent of the adult population has osteoarthritic changes in the hands or feet. It is estimated that 5 to 10 million Americans have symptoms due to these changes. But even this form of the “old-age disease” is not limited to the old: some people as young as forty (especially women) are afflicted with osteoarthritis, and as it often can be the result of improperly treated injuries or overuse, it can afflict anyone of any age who leads an active athletic life without taking appropriate precautions.Osteoarthritis affects weight-bearing joints, especially the knees and hips. Although popularly referred to as osteoarthritis, this term is inaccurate because itis implies a disorder that is basically inflammatory, and this disease is in fact characterized by progressive deterioration of joint cartilage and the formation of dense bone and bony projections at the margins of the affected joints.In its early stages the joint cartilage is softened and roughened; as the disease progresses, this cartilage may be destroyed. The exposed underlying bone no longer has its necessary protective cover of smooth cartilage that permits the articulating ends of the bones within the joint to glide smoothly over each other. The exposed, bared bone becomes more dense, and changes occur with the formation of new bone as the body tries to repair the local damage with regeneration of destroyed tissue.The function of the relatively soft bone under the cartilage is to cushion the joint from the frequent mechanical stresses that result from the repeated impact of one bone against another during physical activities. With the passing of time, this softer shock-absorbing bone will have sustained numerous microscopic impact fractures that harden it. The reduced cushioning effect of the harder bone causes the initial damage to the overlying cartilage.In addition to the aging process, there are local joint factors and a number of predisposing conditions that are important in the location and severity of the degeneration of joint cartilage. These include excessive wear and tear due to activities and occupation, injury, structural abnormalities, increased weight bearing with overweight, disorders of the cartilage, bleeding into the joint and hereditary factors.*3/295/5*

DIGESTIVE PROCESSFood provides the chemicals we need for energy and body maintenance. Because our bodies cannot synthesize or produce certain essential nutrients, we must obtain them from the foods we eat. Even though we may take in adequate amounts of foods and nutrients, if our body systems are not functioning properly, much of the nutrient value in our food may be lost. Before foods can be utilized properly, the digestive system must break the larger food particles down into smaller, more usable forms. The process by which foods are broken down and either absorbed or excreted by the body is known as the digestive process.Even before you take your first bite of pizza, your body has already begun a series of complex digestive responses. Your mouth prepares for the food by increasing production of saliva. Saliva contains mostly water, which aids in chewing and swallowing, but it also contains important enzymes that begin the process of food breakdown, including amylase, which begins to break down carbohydrates. Enzymes are protein compounds that facilitate chemical reactions but are not altered in the process. From the mouth, the food passes down the esophagus, a 9- to 10-inch tube that connects the mouth and stomach. A series of contractions and relaxations by the muscles lining the esophagus gently move food to the next digestive organ, the stomach. Here food mixes with enzymes and stomach acids. Hydrochloric acid begins to work in combination with pepsin, an enzyme, to break down proteins. In most people, the stomach secretes enough mucus to protect the stomach lining from these harsh digestive juices.Further digestive activity takes place in the small intestine, a 20-foot coiled tube containing three sections: the duodenum, the jejunum, and the ileum. Each section secretes digestive enzymes that, when combined with enzymes from the liver and the pancreas, further contribute to the breakdown of proteins, fats, and carbohydrates. Once broken down, these nutrients are absorbed into the bloodstream to supply body cells with energy. The liver is the major organ that determines whether nutrients are stored, sent to cells or organs, or excreted. Solid wastes consisting of fiber, water, and salts are dumped into the large intestine, where most of the water and salts are reabsorbed into the system and the fiber is passed out through the anus. The entire digestive process takes approximately 24 hours.*1/277/5*

HOW WE DIAGNOSE A SEIZURE AND DECIDE WHAT IT WILL MEAN FOR YOUR CHILD: JANE’S CASE STORYJane is thirteen years old, and the nurse is cleaning her arm with alcohol in preparation for taking the blood tests ordered by her physician. The nurse takes out the syringe and needle and Jane says, “Wait a minute, I don’t feel well.” She looks pale and sweaty, then collapses in the chair. She stiffens and has jerking of her arms and legs that lasts perhaps a minute. Was that a seizure? “Yes,” the physician says. “That is what is called ‘convulsive syncope.’ Jane fainted, just as many people faint when blood is taken. In some people, fainting is enough to trigger a brief seizure. It’s nothing to worry about. She’ll be fine.”That diagnosis was easy. Jane’s seizure occurred because of fainting. The episode was witnessed from the start by people trained to observe carefully. They heard Jane say she didn’t feel well. They saw her become pale and sweaty before losing consciousness. It was clear to them that Jane fainted and then had a seizure. The episode occurred in a situation where fainting is not uncommon. But suppose Jane had been sitting in the hot sun with her friends at a baseball game when the episode occurred? Could she have been drinking beer or taking drugs? Would her friends have noted the paleness and sweating before she fainted, became stiff, and had the brief jerking movements? If they hadn’t noticed the fainting and had only seen the jerking, your doctor might not have known why the seizure occurred and would have been concerned that it might recur. He could not have been as confident in saying that it was convulsive syncope.*17\208\8*