Bonding — Otherwise known as adhesion, this process bonds an enamel-like resin to a tooth’s surface, sculpted to an ideal shape, hardened and polished. Often used to close gaps (diastema) in teeth. (One office visit: $200 to $950 per tooth. Lasts three to eight years.)

Composite resin — Tooth-colored filling made of resin reinforced with silica or porcelain particles.

Crown — A cap, cover or restoration to replace missing portion of a tooth. $450 to $2,000.

Gum lifting — Surgical resculpting of a gummy smile, one that shows as much gum or more gum than teeth. Can be done in one visit. (One visit: $985 to $4,000. Lasts forever.)

Laminate veneer — Thin porcelain resin shell bonded to the enamel of front teeth. $550 to $3,000

Veneers — Ultra-thin laminates (porcelain or composite) which are bonded to the teeth. Especially used for repairing chipped, cracked or worn teeth. (Two visits: $650 to $3000 per tooth. Lasts five to 12 years.)

The decision to operate in Crohn’s disease should take into consideration the high risk of disease recurrence after a surgical procedure, especially near the site operated upon. This is in contrast to another inflammatory disease of the colon, ulcerative colitis, in which removal of the colon usually cures the disease.

Nevertheless, in cases in which medical therapy doesn’t help or in which large doses of steroids are needed to control the disease, surgery may be the best choice. In every case, it is important that doctors discuss the full range of treatment options, both medical and surgical, with the Crohn’s patient.

Among the support groups you may find helpful in learning about and coping with your disease is the Crohn’s & Colitis Foundation of America.

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K.H.

A.Crohn’s disease can involve any area of the digestive tract from the mouth to the anus, but it typically involves the last segment of the small intestine (known as the ileum) and/or the colon.

A. Typical symptoms include diarrhea, abdominal pain, fever, weight loss and rectal bleeding. Although the cause is unknown, many drugs are available to treat this disease. All work by decreasing the body’s inflammatory response, thus reducing the symptoms and the severity of the intestinal inflammation.

In many cases, the medications given to combat the disease are not sufficient to entirely eliminate the inflammation The end result is a scarred intestine that can lead to obstruction. In other cases, the inflammation in adjacent loops of bowel may coalesce, and abnormal connections between these loops may form. These abnormal connections, called fistulas, are extremely difficult to treat. The most common reasons for surgical intervention in Crohn’s disease are obstruction and fistulas.

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There is no one single test for asthma. Your doctor may diagnose asthma by clinical examination, especially if it is very obvious. The doctor may order pulmonary function testing (spirometry), in which your child breathes into a tube connected to a computerized analyzer. In general, spirometry can be done only on children around 4 years or older.

A chest X-ray may be in order in some situations, to be sure that there is no pneumonia or other cause for the coughing and wheezing. If the asthma is severe, your pediatrician may measure the blood-oxygen saturation to be sure your child’s lungs are able to exchange air normally.

Allergy testing can help identify what specific allergens the asthmatic child may have.

How is asthma treated?
It is imperative that children with asthma are not exposed at all to tobacco smoke. Parents of children with asthma are very strongly encouraged to stop smoking completely; if smoking continues, it must be done outdoors and never in a car when a child is present.
If allergens like animal hair, dust and pollens are identified, your pediatrician or allergist will have specific suggestions on ways to minimize your child’s exposure to these. Allergy shots (immunotherapy) have been shown to be very helpful for some asthmatic patients.

The mainstay of asthma treatment is medications, which are often given by inhalation. Bronchodilators like albuterol are given in metered-dose inhalers or by a nebulizer machine once to several times daily, for asthma episodes, and also to control mild or intermittent asthma, or exercise-induced asthma.

Inhaled corticosteroids (such as flunisolide, beclomethasone, fluticasone, triamcinolone) given two or three times a day help reduce the inflammation of asthma and are very helpful in preventing future episodes.

New asthma medications, taken orally or by inhaler, are very effective for asthma that is difficult to control. Excellent asthma treatment is available and easy to give, and it can make the difference between a child who coughs and wheezes often, misses school, and needs frequent doctor visits and hospital stays, and one who rarely has difficulties with asthma. Your pediatrician will help you tailor an asthma treatment regimen that works best for your child and your family.

Asthma is a chronic lung disease that involves allergy, inflammation, infection and recurrent episodes of breathing problems. These breathing

problems are caused by an over-reaction of the breathing tubes (bronchi) to allergic or environmental irritants or to respiratory infections,

which is why asthma is also sometimes called RAD, or reactive airway disease.

Bronchial over-reactivity leads to swelling of the lining of the bronchi and a tightening of the muscles around them (bronchospasm), which

narrows the breathing tubes and requires more effort to breathe. Asthma causes the bronchi to produce extra mucus, which also causes more

breathing problems and more coughing.

Symptoms of Asthma
Children with asthma:
Usually wheeze when they exhale.
Usually cough a great deal, often with every deep breath or with activity.
Usually breathe faster than normal.
May experience shortness of breath (a feeling that they can’t take a deep breath).
May have chest tightness (a feeling of being unable to empty air from the chest).
May have retractions (obvious movement of the rib muscles or the muscles of the abdomen or the upper chest with each breath, because of extra

work of breathing).
Childhood asthma may be difficult to diagnose, especially if it is mild. Asthma can look like bronchitis, bronchiolitis, viral pneumonia, croup or just a bad cold. Sometimes the only symptom of asthma is a night cough that persists over weeks or months. Many children (and adults) who have asthma have had recurrent episodes of bronchitis or pneumonia following colds. These children improve greatly when they begin medications that control asthma.

The tendency to develop asthma is inherited, but environmental factors play a great role, too. The most common triggers for asthma include exposure to
Allergens, such as cat or dog hair, dust, pollens or molds.

Environmental pollutants, such as tobacco smoke, strong perfumes, smog, paint fumes and other chemical products.
Respiratory infections, such as cold viruses and sinus infections.
Weather changes, such as an increase in humidity, rain and cold air.
Exercise, especially in children and adults with exercise-induced asthma.

Once testing has been performed, ask your physician to go over your blood tests with you so you can get some idea of whether your thyroid is mildly or more severely overactive. Also, ask if your physician is sure you have Graves’ disease, or could you have some other form of hyperthyroidism.

Some forms of hyperthyroidism last only a few weeks, and then they get better by themselves. These do not require treatment with antithyroid drugs, radioactive iodine, or surgery, though beta-blockers are often helpful.

Remember that you have the final say about your treatment. If you are considering medications and your physician recommends PTU, ask about taking methimazole. It is just as effective as PTU, and you can usually take half the number of pills every day.

For example, taking three tablets (10 milligrams each) of methimazole each morning is equivalent to taking two tablets (50 milligrams each) of PTU three times each day. Neither medication is very expensive.

If you are considering surgery, be sure that you are referred to a surgeon who is experienced in performing thyroidectomies and who continues to do them frequently. When you talk to the surgeon, ask whether many of his or her patients have had problems after surgery with hoarseness or low calcium levels. It is also important that the anesthesiologist who puts you to sleep for surgery has had experience working with hyperthyroid patients.

Many primary care physicians do a good job of caring for patients with Graves’ disease. However, if your questions are not being answered to your satisfaction, or if you feel as though you are not making progress with your therapy, then ask for a second opinion from a physician who specializes in treating thyroid problems and other hormonal conditions.

Such specialists are called endocrinologists. Referrals to an endocrinologist and an eye specialist (ophthalmologist) are also important if you have Graves’ eye disease.

If you have severe eye disease that may require surgery, then you will need to see an ophthalmologist who specializes in the treatment of Graves’ eye disease. Most ophthalmologists do not have experience with this type of surgery.

On rare occasions when a patient’s vision is threatened, such a referral needs to be made on an urgent basis.

Contrasts
1. Tramadol hcl 50mg is made with ingredients identical to Tramadol, but the way it works is unique. Tramadol is available on the market in 50 or 100 mg size. The daily dosage maximum is 400 mg, with tablets administered at 4-6 hour intervals. The extended release formula called Tramadol HCL is administered one time per day. It is available in dosages ranging from 100 to 400 mgs. A single tablet will take effect all through a 24 hour period.

Application
2. Tramadol and Tramadol HCL both are prescribed to treat pain. Tramadol HCL is used for ongoing pain relief and taken at the same time daily. Tramadol is used to treat acute pain. When over the counter pain relievers won’t do the trick, Tramadol and Tramadol HCL are commonly prescribed.

Price Comparison
3. Tramadol is the generic version of Ultram and it is very affordable in its regular and time release medicine. Tramadol HCL, which is the pricier of the two versions, can be bought for $20.00 per 30 pills. Remember that each Tramadol HCL pill lasts for one day but a Tramadol pill is only effective for four to six hours.

Factor
4. Tramadol HCL would be a better option for enduring pain with conditions such as fibromyalgia, chronic back pain and osteoarthritis. The effect is long lasting, so it is not necessary to take a lot of pills or wait until a pill begins to take effect. If pain only last a short while or originates from surgery or being injured, Tramadol is a better option since the dose can be changed every four to six hours.

Warnings
5. There are some risks involved with Tramadol as well as Tramadol HCL. Caution should be used when taken with muscle relaxers, as well as specific nausea and antidepressant medicines. This applies as well to supplement products such as St. John’s Wort that may have an antidepressant effect. Since Tramadol raises the incidence of seizures, patients prone to seizure should not take it. Tramadol is habit forming (though not addicting). Therefore, it should only be used by prescription and under supervision.

But when your child becomes old enough to understand, explain why you have set certain rules — particularly if he or she challenges you on them.

Gently but firmly explain that “Seven o’clock is bedtime because by that time each day, you’ve had lots of fun activity and you become so tired.

Your body needs a lot of rest, so you can be healthy and happy, and have more fun the next day.”

Right then and there, things began to change. Doctors were able to save his foot and today Furst — who has slimmed down to 175 pounds from 320 pounds — is on a mission to spread the importance of diabetes management. He has teamed up with the American Diabetes Association, for which he is a spokesman and fund-raiser, to release a new video, “D4G.”

Standing for “Diabetes For Guys,” the video is particularly aimed at men, who are the least compliant.

Furst, who you may also remember as Dr. Elliot Axlerod in “St. Elsewhere” or Vir Cotto in “Babylon 5,” says the film “tells my life story through funny movies that everybody would instantly recognize.” It was directed and narrated by Furst, who today is a film director.

“It’s kind of like a ‘Saturday Night Live’ takeoff. For instance, there’s a scene where you see James Bond get out of a Z-3, wearing a tux with this beautiful girl at his side and they go into a restaurant. Then my character comes out the restaurant and his tux is too small and he can’t fit in the Z-3 because he over ordered at dinner.,” said Furst. Actor Stuart Pankin, of “Not Necessarily the News” and “Fatal Attraction” fame, mimics Furst’s former life as a couch potato who stuffs himself with pizza and beer.

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Furst, made famous in his role as Flounder in “Animal House,” had spent 23 years as a non-compliant diabetic. He had experienced foot problems before, the worst being an infection that led to removal of part of a bone in his toe. Still, it wasn’t enough to scare him into managing his diabetes.

“I thought I was bigger than the disease. I thought ‘big deal, a floppy toe, I can live with that.’ Then I’d think, ‘a little blurry vision, no problem.’”

It was a simple thing that landed Furst back in the hospital, this time with the threat of amputation. On Christmas Day 1999, he was walking barefoot in his kitchen when he stepped on a small piece of glass. Having neuropathy, Furst didn’t feel the glass and only realized what had happened when he saw blood. Though he cleaned the wound, he didn’t remove all the glass. Three days later, he was hospitalized.

Even as Furst lay in his hospital bed while doctors were making a decision that could alter his life, he remained in denial. Slowly, that began to change.

“People, other patients, kept coming by and looking in at me,” Furst said. Could it be they just wanted a peek at the celebrity? “No, that wasn’t it. They wanted to see this person who had ordered the Chinese food, [look] at a person who would do something like that at a time like this. It was humiliating,” he said.

While everyone else in the world was preparing for the new millennium, Furst spent New Year’s Eve contemplating his own future.

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