April 2013: Bell's Palsy

Bell's palsy is a common diagnosis. In the April 2013 issue of The American Journal of Medicine, you can read about new treatment options. In this video, Editor-in-chief Dr. Joseph S. Alpert discusses this new research.

Herbalife International has a wide array of organic vitamin supplements, beauty and weight loss products

 Many satisfied consumers vouch for the credibility of the company's wellness product range. The articles must be able to adequately promote the products that you selling. Each article must focus on online spreadsheet one particular product. You can even compare it to other products of the same line, expounding on its supremacy over such product. You can also discuss about the price of the product in question, stating its affordability when compared to products from other companies. You can also include promos and discounts in order to entice potential clients or customers to buy your more of your Herballife Nutrition Network. You first introduce the name of the product that you are marketing. You gain levels by selling products and gaining volume points. Volume points for most products are equal to the manufacturers recommended selling price of the product and are based upon the US dollar value of the products.

Herbalife scores high in this category. More importantly, as a marketing professional, you can rest assured that the company's products have rocketed them to vast success. Companies like Herbalife are able to survive because of their independent contractors. High upfront commissions draw people like you to the company and it is the ever-growing residual income that makes them stay.
How is one to sell a product- even the greatest thing ever made- without proper marketing and advertising in place? Stocks of Herbalife (HLF) currently sell for over forty dollars per share.
With the right marketing plan, you can reach people in any, or all of those locations.

Herbalife's Family Foundation (HEF) was formed by the company's founder, Mark Hughes, in 1994. The children at risk count on the participation of companies like Herbalife for their survival. Training In this category, Herbalife falls middle of the road. It will be up to you to create your marketing system. First pro of the business, Herbalife has an easy start up system. Next, Herbalife has numerous quality product lines for inner and outer nutrition. Herbalife also has compensation with great potential for substantial income. As it is designed from a multi-level marketing structure you grow your business by teaching other business owners within your down line to run a successful business. Cons of the business, Herbalife has high startup costs due to inventory. To begin with Herbalife you must buy into the company by purchasing inventory. The amount of inventory you purchase indicates your level with the company. 

The level in the company governs your commission percentage with each sale and leaves you with the responsibility of selling the corresponding inventory amount. The marketing plan relies heavily on your local market and the problem there is nobody's local market is the same. You may not have the influence required to sell things like a business opportunity or nutrition products to your market. In addition, your warm market may not be a qualified market, which means not interested in or have the money to spend on the product or the opportunity. In the network marketing arena, the type of products run the gamut. Vitamins, nutritional supplements, cosmetics, tonics, cleaning products, and Internet programs just to name a few. You have got to identify with the products in order to represent them well and build a business. It just doesn't make much sense to invest in a company whose products don't excite you. You must value the products before you put a value on the business in your life.

In searching for the right home based business opportunity, assess the core mission and objectives of the companies you put on a short list. What do the companies stand for? As a strong advocate of environmental responsibility and stewardship, Barnett was immediately attracted to the company's safe, clean and environmentally friendly product line. It's about the ability of the company to create new products, bolder business initiatives, and reach beyond the current status quo. Most distributors in Herbalife and other network marketing companies struggle for this very reason. Here's the reason: to make good money in Herbalife or any network marketing company, you have to have a big, growing distribution network. Treat your business like a million dollar business by utilizing the MLM tools that will help you create those kinds of results.

If there is a history of milk allergies in your family, you may need a lactose free baby Formula 1. Most formulas are sold according to stages. Do your best to stick to the correct formula stage. As well as coming in three forms, baby formula comes in different types: the main ones being cow's milk and soybean. In addition to these basic formula types, you can also find lactose free formula, formula supplemented with DHA and ARA, and formula for preemies.
 

All baby milk formulas are fortified with iron and Vitamin D (these can be lacking in breast milk) and contain lactose (milk sugar). Soy based formula is now becoming more popular. Unlike cow's milk it does not contain lactose. If your child has lactose intolerance then soy formula milk may be right for your child.

Don't Forget the Thyroid

Don't Forget the Thyroid: Graves' Disease

An atypical presentation can confound the diagnosis, and that is what happened when a 33-year-old African-American woman presented to another hospital with a 3-month history of worsening abdominal pain. She had been in good health until she started experiencing persistent abdominal pain and distension associated with nausea, vomiting, loose stools, decreased appetite, and weight loss. Her past medical history was significant for an episode of deep venous thrombosis during pregnancy and an unevaluated thyroid nodule. She had no history of heavy alcohol or intravenous drug use, and her family history was unremarkable. Unemployed, she was taking classes at the local community college. Her clinical picture at the outside hospital was consistent with liver disease.

The patient's initial physical examination showed jaundice, abdominal distension and tenderness, and a positive fluid wave. Her work-up at the first hospital revealed a persistently-elevated international normalized ratio (INR) despite several units of fresh frozen plasma and vitamin K. In addition, she had an increased alkaline phosphatase level; other liver enzyme levels were normal. Viral hepatitis and autoimmune antibody panels were negative. Sinusoidal congestion suggestive of Budd Chiari syndrome was evident after a hepatic biopsy, but a hepatic duplex scan revealed normal blood flow and an overall impression of a liver within normal limits. Because her physicians were concerned that she was in acute liver failure, she was transferred to our hospital for further evaluation of hepatic failure and possible liver transplant.

To read this article in its entirety, please visit our website.

-- Aroop Pal, MD, Margaret Le, BS, Leland Graves, MD

This article originally appeared in the March 2013 issue of The American Journal of Medicine.

Digging Deeper

Digging Deeper into Dyspnea 

A 49-year-old homeless woman was admitted for worsening shortness of breath and lower extremity edema. Two weeks prior she was hospitalized for appendicitis and underwent successful laparoscopic appendectomy. Her history was notable for severe obesity, with a body mass index of 59.9 kg/m2, bipolar disorder, hypertension, impaired fasting glucose, asthma, and difficult-to-control chronic lower extremity edema for 2 years, managed with diuretics. For 2 years she complained of progressive weight gain of 40 kg and progressive dyspnea limiting her from performing daily activities. These symptoms had been attributed to her severe obesity. There was no history of tuberculosis or rheumatic disease, although she had a severe pneumonia 2.5 years prior with associated empyema. She denied recent fever, cough, or hemoptysis.

On physical examination her weight was 159 kg, temperature 36.3°C, pulse 94 beats per minute, respirations 16 breaths per minute, blood pressure 116/90 mm Hg, and oxygen saturation 98% on room air. She had a very large body habitus and no scleral icterus. Her jugular venous pressure could not be seen. Auscultation revealed clear lungs, a normal S1 and S2 with no murmurs, gallops, or rubs. The abdomen was obese soft, and nontender with healing laparoscopy incisions. The lower extremities showed 2+ pitting edema and multiple superficial skin ulcerations on the lower legs at various stages of healing.

Due to the recent appendectomy, a computed tomography (CT) scan of the abdomen was obtained, demonstrating normal postsurgical changes with marked hepatic congestion. An included portion of the lower thorax revealed a markedly thickened pericardium measurinf >6 mm in multiple locations (Figure, panel A). A transthoracic echocardiogram, although limited by suboptimal image quality, showed a subtle interventricular septal bounce, mild respiratory changes in the mitral E velocity, increased mitral medial annulus e′ velocity of 0.15 m/s (Figure, panel B), and dilated inferior vena cava with expiratory flow reversals in the hepatic veins. Subsequent tuberculin skin test and QuantiFERON-TB tests were negative, and sputum samples were negative for acid-fast bacilli.

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-- Mackram F. Eleid, MD, Barry A. Borlaug, MD, Sharon Mulvagh, MD

This article originally appeared in the March 2013 issue of The American Journal of Medicine.

Restless Legs

Is Restless Legs Syndrome Associated with Cardiovascular Disease?

Restless legs syndrome is a common condition characterized by a strong urge to move the limbs that is usually worse during the evening and nighttime hours, that is worsened by rest, and that improves with activity. However, the prevalence has varied in different studies, primarily depending on the criteria chosen to define this disorder. Prior studies using the International Restless Legs Syndrome Study Group criteria (1) have placed the prevalence between 3.9% and 14.3%.(2) Restless legs syndrome is associated with diverse adverse consequences.(3, 4) Health-related quality of life is reduced in those with restless legs syndrome and is lower in those with more severe disease. Restless legs syndrome also can lead to an increased prevalence of insomnia, depression, and anxiety.(3, 4, 5)

Several large epidemiologic studies have suggested a causal association between restless legs syndrome and cardiovascular disorders and hypertension after controlling for confounders such as age, witnessed apneas, and smoking.(6, 7, 8) Furthermore, a recent study using prospectively obtained data from the Nurses' Health Study found an increased risk of incident nonfatal myocardial infarction in those with a history of restless legs syndrome for 3 years or more (hazard ratio, 1.80; 95% confidence interval [CI], 1.07-3.01).(9) The increased risk of coronary heart disease persisted after adjustment for blood pressure, diabetes duration, and use of diabetes medications. However, not all studies have observed an association between restless legs syndrome and cardiovascular disease.(10, 11)

In this issue of the Journal, additional evidence from 2 studies is presented relating to the putative association between restless legs syndrome and hypertension and cardiovascular disease. In the first study by Winter et al,(12) 22,786 male participants of the US Physicians' Health Studies I and II were studied. The mean age of the participants was 67.8 years. Restless legs syndrome was present in 7.5% of the participants, and the prevalence increased significantly with age. Furthermore, the odds of restless legs syndrome were higher in those with a history of diabetes. Conversely, frequent exercise and alcohol consumption of 1 or more drinks per day reduced the odds of restless legs syndrome. Of note, those with prevalent stroke had higher odds of a positive history of restless legs syndrome (odds ratio [OR], 1.41; CI, 1.05-1.86), whereas those with a history of myocardial infarction had lower odds of restless legs syndrome history (OR, 0.73; CI, 0.55-0.97).

The second study by Winter et al(13) analyzed data from 30,262 female health professionals (mean age, 63.6 years) participating in the Women's Health Study. The prevalence of restless legs syndrome was 12.0% and more likely with severe obesity and smoking. Exercise≥4 times/week was associated with lower odds of restless legs syndrome (OR, 0.84; CI, 0.74-0.95). However, there was no association between restless legs syndrome and prevalent major cardiovascular disease defined as nonfatal myocardial infarction or stroke. Women who underwent coronary revascularization had increased odds (OR, 1.39; CI, 1.10-1.77) for restless legs syndrome compared with those with no intervention. However, this relationship also was no longer significant after excluding those with potential causes of restless legs syndrome.

To what extent do these new observations improve our understanding of restless legs syndrome?

To read this article in its entirety, please visit our website.

-- Rohit Budhiraja, MD, Stuart F. Quan, MD

This article originally appeared in the March 2013 issue of The American Journal of Medicine.

Related articles:

Vascular Risk Factors, Cardiovascular Disease, and Restless Legs Syndrome in Women

Vascular Risk Factors, Cardiovascular Disease, and Restless Legs Syndrome in Men