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Management of Common Symptoms in Terminally Ill Patients: Part I.
Fatigue, Anorexia, Cachexia, Nausea and Vomiting:"Physical symptoms other than pain often contribute to suffering near the end of life. In addition to pain, the most common symptoms in the terminal stages of an illness such as cancer or acquired immunodeficiency syndrome are fatigue, anorexia, cachexia, nausea, vomiting, constipation, delirium and dyspnea. Management involves a diagnostic evaluation for the cause of each symptom when possible, treatment of the identified cause when reasonable, and concomitant treatment of the symptom using nonpharmacologic and adjunctive pharmacologic measures. Part I of this two-part article discusses fatigue, anorexia, cachexia, nausea and vomiting."
American Academy of Family Physicians
P.O. Box 11210
Shawnee Mission, KS 66207-1210
Telephone
Toll free: 800-274-2237
Local: 913-906-6000
http://www.aafp.org/afp/20010901/807.html
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Weight loss and body-composition changes in men and women infected with HIV, American Journal of Clinical Nutrition:"In men with HIV-associated weight loss, the weight lost as fat-free mass depends on the initial percentage of body fat at low levels of body fat but appears to be independent of initial percentage of body fat at high levels of body fat. In women with HIV-associated weight loss who have normal-to-high body fat stores, loss of fat-free mass is independent of the initial percentage of body fat."
AJCN Editorial Office
3247 Meyer Hall
University of California
One Shields Avenue
Davis CA 95616-8790
(530) 752-8363
Fax: 530-752-8371
E-mail: AJCN@UCDAVIS.EDU
http://www.ajcn.org/cgi/content/abstract/76/6/1428
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Use of Steroids for Wasting and Lipodystrophy Syndromes in HIV/AIDS, American Foundation for AIDS Research:"Significant cachexia or inanition (also called physical-metabolic wasting or, more succinctly, wasting syndrome) ultimately developed in most HIV-positive patients whose disease progressed to AIDS. This stage of malnutrition was either the direct cause of death or contributed significantly to AIDS mortality."
WASHINGTON DC, amfAR
1828 L Street, NW, #802
Washington, DC 20036-5104
(202) 331-8600 (tel)
(202) 331-8606 (fax)
TOLL-FREE NUMBER: 1-800-39-amfAR
http://www.amfar.org/cgi-bin/iowa/programs/researchc/record.html?record=120
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FacialWasting.org:"Welcome to the home page of FacialWasting.org. This page was brought to you by PoWeR, Program for Wellness Restoration. PoWeR is a 501 (c) 3 non profit organization that disseminates information about side effect management, wasting, and lipodystrophy in HIV disease for patients and clinicians. We provide seminars around the country and published the book "Built to Survive " (link below). We also assist clinicians in the design of metabolic related research protocols. Furthermore, we provide free technical advise to non-profit organizations that want to create wellness programs for people living with HIV and other debilitating diseases."
Program for Wellness Restoration
P.O. Box 980741
Houston, TX 77098
United States
Phone Number: 713-520-6630
Fax Number: 713-526-5883
powertx@aol.com
http://www.facialwasting.org/pages/869164/index.htm
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Management of Wasting Syndrome in Late-Stage HIV Infection, HIVNEWSLINE.COM:"Malnutrition is a common development in HIV infection. It clearly affects survival and is believed to cause substantial morbidity in the more advanced stages of HIV infection. Malnutrition may have adverse effects on immune function, disease progression, quality of life, and the need for either hospitalization or custodial care. As a result, malnutrition leads to increased use of health care resources, and to stress on the nation’s health care delivery system.
Although there are still substantial gaps in our understanding of the role that nutrition plays in HIV infection, progress is being made. In the last few years we have acquired considerable knowledge about the nutritional alterations that occur with advancing HIV infection, and this expanding knowledge base has enabled us to improve the evaluation and management of AIDS-related cachexia."
http://www.hivnewsline.com/issues/Vol1Issue5/care.html
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Medical Marijuana, Appetite Stimulation/Cachexia, What research has been done and what is known about the possible medical uses of marijuana? hivpositive.com:"It has been shown that there is a strong relationship between smoking marijuana and increased frequency and amount of eating.
Survey data on appetite stimulation (Haines and Green 1970) (N = 131) showed that 91 percent of marijuana users eat every time they smoke. Tart (1970) found that 93 percent of marijuana users (131) reported that marijuana made them enjoy eating very much and that they consequently ate a lot more. Foltin and colleagues (1986) reported that marijuana users eat more often. A study by Farrow and associates (1987) reported no hematologic changes or signs of nutrient deficiencies in marijuana users."
http://www.hivpositive.com/f-Nutrition/MedicalMarijuana/MM-Appetite.html
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CATABOLIC WASTING, References for Protocol, Life Extension Foundation:"Catabolic wasting or cachexia is a clinical wasting syndrome that is characterized by unintended and progressive weight loss, weakness, and low body fat and muscle. At least 5% of body weight is lost. Cachexia is not caused by poor appetite and nutritional intake, but rather by a metabolic state in which a "breaking down" rather than a "building up" occurs in bodily tissues no matter how much nutritional intake occurs. Additionally, whether a patient receives nutrition orally or intravenously makes no difference. The patient simply cannot gain weight, so eating more is not an answer."
Life Extension Foundation
P.O. Box 229120
Hollywood, FL 33022, USA
Toll Free Phone (Customer Service) - 800-678-8989
Direct Phone - 954-766-8433
fax - 954-761-9199
http://www.lef.org/protocols/prtcl-029.shtml
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How to Manage Side Effects: A Survivor’s Perspective:"People with HIV are living longer since the advent of HAART (highly active anti-retroviral therapy). However, drug-related side effects are now the primary issues that compromise quality of life and productivity of HIV(+) survivors. Hyperglycemia, elevated cholesterol and triglycerides, fat redistribution (lipodystrophy), lean tissue wasting, fatigue, diarrhea, neuropathy, bone loss and joint aches, are common complaints. There are more questions than answers in the field of side-effect management. There are also no standard of care guidelines for the treatment and prevention of many of these side effects. Fortunately, some emerging options are being used and investigated by clinicians around the world to deal with them. This seminar reviews and explains these options from a consumer/survivor perspective."
Phone 713-539-1978. Email: Powertx@aol.com
http://www.medibolics.com/seminarPRsummary.htm
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Body Mass Index Calculator:
http://www.mylifepath.com/topic/bmicalc;$sessionid$LXT3FOIAAASYHWCYSYVCFEQ
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Metabolic Syndromes Associated With HIV
Mitigating the Side Effects of Drug Therapy, The Physician And Sportsmedicine:"HIV infection and highly active antiretroviral therapy (HAART) are associated with a variety of metabolic disorders such as AIDS wasting syndrome, cachexia, sarcopenia, metabolic dysregulation, lipodystrophy, abnormalities of serum lipids, and lactic acidosis. Adjunctive therapies (eg, diet, antilipid therapy), risk-factor modification (eg, smoking cessation, blood pressure control), aerobic exercise, and anabolic treatments can be used to mitigate the effects of HIV infection and the adverse effects of HAART, thereby improving long-term health in individuals infected with HIV."
http://www.physsportsmed.com/issues/2001/12_01/stringer.htm
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How Many Calories Do You Really Need?:"If you've ever looked at a table of recommended daily allowances (RDAs), you've probably seen a ballpark figure that tells you how many calories you should be getting. But since your caloric needs vary with age, height, activity level, and other factors, this number is likely to be too high or low for you. To find out how many calories you should actually be getting, just fill in the fields below and hit "Calculate.""
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Paraneoplastic syndromes, urotext.com:"Cachexia is based on the Greek words "kakos", meaning bad, and "hexis", meaning state of being. The cancer cachexia syndrome encompasses a wide range of metabolic, hormonal, and cytokine-related abnormalities that result in a wasting syndrome. The clinical manifestations, including anorexia, early satiety, weight loss, weakness, easy fatigue, impaired immune function, tissue wasting, and poor performance status. Insulin resistance state is characterised by a decreased uptake and use of glucose, especially in muscle, and a tendency towards gluconeogenesis and lipolysis. Anorexia may result from pain, mechanical obstruction of the GIT, from nausea induced by chemotherapeutic drugs, or from psychological factors."
http://www.urotext.com/pages/PNSs.html
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A Biochemical Mechanism That May Explain Wasting Syndromes Discovered, Vidayya.com:"Department of Veterans Affairs (VA) researchers and colleagues have discovered a biochemical mechanism that may explain wasting syndrome, a condition that causes severe weight loss and weakness in patients with chronic inflammatory diseases and often hastens their death.
The findings, published in the December 3 issue of the European Molecular Biology Organization Journal, may lead to new drugs to ease the debilitating effects of cancer, AIDS, and other serious degenerative illnesses.
Scientists in San Diego pinpointed the biological chain of events that caused wasting in mice, then identified the same process in liver tissue from cancer patients. They said the striking similarity between the condition in mice and humans will expedite the development of new treatments."
Susan Boyer, RN, Editor - Vidyya
6545 Manor Creek Drive
Douglasville, GA 30135
Phone: 1 770 949 3778
Fax: 1 801 760 1100
E-Mail: susan.boyer@ramex.com
http://www.vidyya.com/today/v3i240_2.htm
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Unexplained Weight Loss, Etiologies:
If You Have Any Of These Symptoms,
You May Be At Risk For Infection
Of HIV And Should Be Tested:
http://www.rainbow-akron.com/ahsp/symptoms.htm
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HIV-related Weight Loss and Wasting, Gay Men's Health Crisis "Treatment Issues.":"HIV-associated weight loss, or wasting syndrome, is a major cause of illness and death in patients with late-stage HIV infection. It can be divided into two categories: acute weight loss, which often rebounds after an opportunistic infection is brought under control, and chronic weight loss, which is more difficult to reverse. Either decreased nutrient intake or alterations in metabolism can lead to weight loss. These factors can arise directly from HIV infection as well as from opportunistic infections, cancers or pre-existing gastrointestinal disease."
http://www.aegis.com/pubs/gmhc/1994/gm080802.html
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Pathogenesis Of Wasting In Aids,
National Institute of Diabetes and Digestive and Kidney Diseases:"The National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK) invites investigator-initiated research grant applications to
investigate the pathogenesis of wasting syndromes in acquired immune
deficiency syndrome (AIDS) and to develop new approaches for the
prevention or reversal of wasting in AIDS. Applications will be
encouraged for both basic science and clinical experiments that will
provide direction for future treatment."
http://grants.nih.gov/grants/guide/rfa-files/RFA-DK-94-006.html
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Signs & Symptoms Of Drug Use:
http://www.oakhouse.com/signs_drug.htm
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The Hunger Hormone? An appetite stimulant produced by the stomach may lead to treatments for obesity and wasting syndromes, Science News Online:"Perhaps you skipped breakfast this morning. It's nearly noon and your stomach is starting to rumble. Or maybe you're working late and developing a headache because you haven't had dinner yet. In both of these cases, your body is sending a clear signal: Give me food, right now. Figure out how that signaling works and the world will beat a pathway to your door. Controlling weight, after all, is important for cosmetic."
http://www.sciencenews.org/20020216/bob10.asp
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