Friday, May 23, 2014

Diabetes Ulcer/Sore – Don’t Amputate, Restore

What is a foot ulcer?

A skin ulcer is where an area of skin has broken down and you can see the underlying tissue. Most skin ulcers occur on the lower legs or feet. The skin normally heals quickly if it is cut. However, in some people with diabetes the skin on the feet does not heal so well and is prone to developing an ulcer. This can be even after a mild injury such as stepping on a small stone in your bare feet.

Why are people with diabetes prone to foot ulcers?

Foot ulcers are more common if you have diabetes because one or both of the following complications develop in some people with diabetes:

Reduced sensation of the skin on your feet

Your nerves may not work as well as normal because even a slightly high blood sugar level can, over time, damage some of your nerves. This is a complication of diabetes, called peripheral neuropathy of diabetes.

The nerves that take messages of sensation and pain from the feet are commonly affected. If you lose sensation in parts of your feet, you may not know if you damage your feet. For example, if you tread on something sharp or develop a blister due to a tight shoe. This means that you are also more prone to problems such as minor cuts, bruises or blisters. Also, if you cannot feel pain so well from the foot, you do not protect these small wounds by not walking on them. Therefore, they can quickly become worse and develop into ulcers.

Narrowing of blood vessels (arteries) going to the feet

If you have diabetes you have an increased risk of developing narrowing of the arteries (peripheral arterialdisease). This is caused by fatty deposits called atheroma that build up on the inside lining of arteries (sometimes called furring of the arteries). This can reduce the blood flow to various parts of the body.

The arteries in the legs are quite commonly affected. This can cause a reduced blood supply (poor circulation) to the feet. Skin with a poor blood supply does not heal as well as normal and is more likely to be damaged. Therefore, if you get a minor cut or injury, it may take longer to heal and be prone to becoming worse and developing into an ulcer. In particular, if you also have reduced sensation and cannot feel the wound.

What increases the risk of developing foot ulcers?

  • If you have reduced sensation to your feet (see above). The risk of this occurring increases the longer you have diabetes and the older you are. Also, if your diabetes is poorly controlled. This is one of the reasons why it is very important to keep your blood sugar level as near normal as possible.
  • If you have narrowed blood vessels (arteries) - see above. The risk of this occurring increases the longer you have diabetes, the older you become and also if you are male. Also, if you have any other risk factors for developing furring of the arteries. For example, if you smoke, do little physical activity, have a high cholesterol level, high blood pressure or are overweight.
  • If you have had a foot ulcer in the past.
  • If you have other complications of diabetes, such as kidney or eye problems.
  • If your feet are more prone to minor cuts, grazes, corns or calluses which can occur:
    • If you have foot problems such as bunions which put pressure on points on the feet.
    • If your shoes do not fit properly, which can put pressure on your feet.
    • If you have leg problems which affect the way that you walk, or prevent you from bending to care for your feet.

Are foot ulcers serious?

Although foot ulcers can be serious, they usually respond well to treatment. However, foot ulcers can get worse and can take a long time to heal if you have diabetes, particularly if your circulation is not so good. In addition, having diabetes means you are more likely to have infections and an infection in the ulcer can occur. Occasionally, more serious problems can develop, such as tissue death (gangrene).

What can I do to help prevent foot ulcers?

Have your feet regularly examined

Most people with diabetes are reviewed at least once a year by a doctor and other health professionals. Part of this review is to examine the feet to look for problems such as reduced sensation or poor circulation. If any problems are detected then more frequent feet examinations will usually be recommended.

Treatment of diabetes and other health risk factors

As a rule, the better the control of your diabetes, the less likely you are to develop complications such as foot ulcers. Also, where appropriate, treatment of high blood pressure, high cholesterollevel and reducing any other risk factors will reduce your risk of diabetic complications. In particular, if you smoke, you are strongly advised to stop smoking.

Foot care

Research has shown that people with diabetes who take good care of their feet and protect their feet from injury, are much less likely to develop foot ulcers.

Good foot care includes:

  • Looking carefully at your feet each day, including between the toes. If you cannot do this yourself, you should get someone else to do it for you:
    • Looking is particularly important if you have reduced sensation in your feet, as you may not notice anything wrong at first until you look.
    • If you see anything new (such as a cut, bruise, blister, redness or bleeding) and don't know what to do, see your doctor. You can also see a person qualified to diagnose and treat foot disorders (a podiatrist - previously called a chiropodist).
    • Do not try to deal with corns, calluses, verrucas or other foot problems by yourself. They should be treated by a health professional such as a podiatrist. In particular, do not use chemicals or acid plasters to remove corns, etc.
    • Use a moisturising oil or cream for dry skin to prevent cracking. However, you should not apply it between the toes, as this can cause the skin to become too moist which can lead to an infection developing.
    • Look out for athlete's foot (a common minor skin infection). It causes flaky skin and cracks between the toes, which can be sore and can become infected. If you have athlete's foot, it should be treated with an antifungal cream.
  • Cut your nails by following the shape of the end of your toe. But, do not cut down the sides of the nails, or cut them too short, or use anything sharp to clean down the sides of the nails. These things may cause damage or lead the nail to develop an ingrown nail. If you cannot see properly do not try to cut your nails, as you may cut your skin. You should ask someone else to do it.
  • Wash your feet regularly and dry them carefully, especially between the toes.
  • Do not walk barefoot, even at home. You might tread on something and damage your skin.
  • Always wear socks with shoes or other footwear. However, don't wear socks that are too tight around the ankle, as they may affect your circulation.
  • Shoes, trainers and other footwear should:
    • Fit well to take into account any awkward shapes or deformities (such as bunions).
    • Have broad fronts with plenty of room for the toes.
    • Have low heels to avoid pressure on the toes.
    • Have good laces, buckles or Velcro® fastening to prevent movement and rubbing of feet within the shoes.
  • When you buy shoes, wear the type of socks that you usually wear. Avoid slip-on shoes, shoes with pointed toes, sandals and flip-flops. Break in new shoes gradually.
  • Always feel inside footwear before you put footwear on (to check for stones, rough edges, etc).
  • If your feet are an abnormal shape, or if you have bunions or other foot problems, you may need specially fitted shoes to stop your feet rubbing.
  • Tips to avoid foot burns include: checking the bath temperature with your hand before stepping in; not using hot water bottles, electric blankets or foot spas; not sitting too close to fires.

What if I develop a foot ulcer?

You should tell your doctor or a person qualified to diagnose and treat foot disorders (a podiatrist - previously called a chiropodist) straightaway if you suspect an ulcer has formed. Treatment aims to dress and protect the ulcer, to prevent or treat any infection and also to help your skin to heal.

  • The ulcer is usually covered with a protective dressing.
  • A nurse or podiatrist will normally examine, clean and re-dress the ulcer regularly.
  • A podiatrist may need to remove any hard skin that prevents the ulcer from healing. Also, depending on the site and size of the ulcer, they may protect it from further injury by using padding to take the pressure off the area.
  • You may also be advised to wear special shoes or have a cast made for your foot to keep the pressure off the ulcer.
  • Antibiotics will be advised if the ulcer, or nearby tissue, becomes infected.
  • Sometimes a small operation is needed to drain pus and clear dead tissue if infection becomes more severe.
  • In some cases, the arteries in the legs are very narrow and greatly reduce the blood flow to the feet. In these cases an operation to bypass, or widen, the arteries may be advised.

Many foot ulcers will heal with the above measures. However, they can take a long time to heal.

In some cases, the ulcer becomes worse, badly infected and does not heal. Sometimes infection spreads to nearby bones or joints, which can be difficult to clear, even with a long course of antibiotics. Occasionally, the tissue in parts of the foot cannot survive and the only solution then is to surgically remove (amputate) the affected part.

What care can I expect if I am admitted to hospital with a diabetic foot problem?

If you have a diabetic foot problem, you will be able to get most of the treatment you need from your GP or other health professionals working in the community. However, there are some problems which may require you to go into hospital for treatment. The National Institute for Health and Care Excellence (NICE) has released some guidance as to what you can expect if this should happen:

  • You should expect to be treated by a team which deals especially with people who have diabetic foot problems. This team usually includes:
    • A specialist in diabetes.
    • A surgeon who deals with diabetic foot problems.
    • A person qualified to diagnose and treat foot disorders (a podiatrist - previously called a chiropodist).
    • A diabetes nurse specialist.
    • A tissue viability nurse (who assesses whether the skin and underlying tissues of your feet have been affected by circulation changes due to diabetes).
  • You should be given information about your foot condition.
  • You will have your diabetes assessed and checks will be made to make sure you have not developed complications such as kidney disease (or if you have already developed complications, to make sure they are not getting any worse).
  • You will have an examination of both feet to check for ulcers, cuts and abrasions to the feet, signs of poor circulation, areas of numbness and the development of Charcot's arthropathy. This is a condition in which the sensation of pain is reduced because of the diabetes, resulting in damage to bones, such as tiny fractures.
  • You will have a general examination to make sure you do not have a high temperature (fever) or any other signs of a severe generalised infection.
  • If you have an ulcer, this will be checked for infection and baseline measurements of the size and depth will be taken.
  • You may be asked to have an X-ray or scan of your foot to make sure the bones have not been affected by your condition

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Thursday, May 22, 2014

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Wednesday, May 21, 2014

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Heart Disease and Angina Pectoris

The most common symptom of coronary artery disease is angina or "angina pectoris," also known simply as chest pain. Angina can be described as a discomfort, heaviness, pressure, aching, burning, fullness, squeezing, or painful feeling due to coronary heart disease. Often, it can be mistaken for indigestion.

Angina is usually felt in the chest, but may also be felt in the shoulders, arms, neck, throat, jaw, or back.

Recommended Related to Heart Disease

"Does your bra really go up that high?" the TSA officer asked, running her hands along my chest. My boyfriend, Adam, and I were headed for a romantic getaway, and being held at airport security wasn't on our itinerary. "I have a pacemaker.  That's a scar, not my bra," I said. "You're too young for that," she said. While I'm not the only 26-year-old with a pacemaker, I'm the only one most security officers have seen. Of the pacemakers installed yearly, 84% are for people older than age 65. Only 6%...

If you experience these symptoms, take notice. If you've never been diagnosed with heart disease, you should seek treatment immediately. If you've had angina before, use your angina medications as directed by your doctor and try to determine if this is your regular pattern of angina or if the symptoms are worse.

What Causes Angina?

Angina is caused when blood flow to an area of the heart is decreased, impairing the delivery of oxygen and vital nutrients to the heart muscle cells. When this happens, the heart muscle must use alternative, less efficient forms of fuel so that it can perform its function of pumping blood to the body. The byproduct of using this less efficient fuel is a compound called lactic acid that builds up in the muscle and causes pain. Some medications used to treat angina work by inhibiting the use of this fuel source.

What Are the Types of Angina?

The types of angina are:

·         Stable angina. The pain is predictable and present only during exertion or extreme emotional distress, and it disappears with rest.

·         Unstable angina. This may signal an impending heart attack. Unstable angina is angina pain that is different from your regular angina pain or pain that occurs while at rest. The angina may occur more frequently, more easily at rest, feel more severe, last longer, or come on with minimal activity. Although this type of angina can often be relieved with medication, it is unstable and may progress to a heart attack. Usually more intense medical treatment or a procedure is required.

·         Prinzmetal's angina. This is when angina occurs at rest, when sleeping, or when exposed to cold temperatures. In these cases, the symptoms are caused by decreased blood flow to the heart muscle from a spasm of the coronary artery. The majority of people with this type of angina also have coronary artery disease. These spasms occur close to the blockage.

Can Angina Occur Without Coronary Disease?

Angina can occur in the absence of any coronary disease. Up to 30% of people with angina with a heart valve problem called aortic stenosis, which can cause decreased blood flow to the coronary arteries from the heart. People with severe anemia may have angina because their blood doesn't carry enough oxygen. People with thickened heart muscles need more oxygen and can have angina when they don't get enough.

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Tuesday, May 20, 2014


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Sunday, May 18, 2014

Lumbar Spondylosis

Lumbar Spondylosis - Why does this happen?
The lumbar spine is made up of 5 vertebrae stacked on top of each other. The vertebrae have small joints on either side, the facet joints, which allow movement between the vertebrae. There is a fibrous disc between each vertebrae which act as a shock absorber and allow the spine to be more flexible. Nerves pass from the spinal cord to the legs through a narrow space between the vertebrae.
Lumbar Spondylosis, osteoarthritis of the spine, is a degenerative condition which affects the surface of the facet joints and discs. There is a reduction of joint space as the cartilage wears away and the disc becomes thinner. Bony spurs, osteophytes, grow on the edges of the vertebrae causing the space within the joint to narrow. The ostephytes can cause pressure on the nerves which pass through the narrow gap between the vertebrae.
Lumbar Spondylosis is a common part of the ageing process and can occur from the age of 40+. Repetitive weight bearing activities, poor posture, previous injury and excess weight all contribute to developing Lumbar Spondylosis.
What are the symptoms?
  • Pain in the lower back, buttock or leg.
  • Restricted movement in the back, particularly in the morning and after periods of rest.
  • Disturbed sleep due to pain.
  • Pins and needles or loss of sensation in the leg or foot.
  • In more severe cases a weakness in the leg or foot.
  • It is common to experience back stiffness particularly in the morning.
Diagnosing Lumbar Spondylosis
Your GP or Physiotherapist can usually diagnose Lumbar Spondylosis by simply by examining your spine and hearing where the pain is and how it started.
X-rays and other tests are not usually necessary.
What is the treatment?
Pain due to Lumbar Spondylosis will usually improve with some simple changes to activity and exercise. Try to avoid or reduce the activity which aggravates your pain such as repeated bending. Stay active but balance rest with activity. Changing activities to ones which involve less weight bearing on the spine, such as swimming instead of running, are important to reduce the stress placed on the spine. Managing your weight is important as any extra weight places additional stress on the spine.
To help reduce the symptoms a ‘hot pack’ can be placed on the painful area for 15 - 20 minutes twice a day. Wrap the 'hot pack’ in a towel before placing on the painful area to ensure you do not burn the skin.
During the initial painful stages it is important to manage the pain.
Painkillers and anti-inflammatory medications - These may be prescribed by your GP if the pain is costant. This is a temporary measure to break the pain cycle, but can continue as required.
Exercise - Exercise is important to help regain and maintain back movement. Once the pain has settled it is important to strengthen the surrounding muscles and work on your balance to help reduce stress placed on the spine.
Posture - It is important to reduce the stress on the joints as they heal by ensuring you have a good posture during day to day activities. Check your sitting posture, particularly when using a computer or reading you should ensure your ears are in line with your shoulders and hips. Placing a cushion or rolled up towel behind your lower back may help improve your posture and reduce the stress on the spine.
Physiotherapy - If exercise alone does not improve symptoms then physiotherapy treatment may be required. A physiotherapist can use specific treatments including, ultrasound, deep friction, massage, interferential, acupuncture or taping to help relieve pain and aid recovery.
Injections - In some cases your GP or Consultant may recommend an injection. These can be used to reduce inflammation and pain when the symptoms are severe and constant. This is not a 'cure' and it is important to follow the exercises and modify activities. A 'Cortisone Injection' can help reduce inflammation in the joints.
Surgery - This is not common for Lumbar Spondylosis. In some cases when symptoms are persistent surgery may be considered.

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Saturday, May 17, 2014

Motor neurone disease - What is it?

Motor neurone disease is the name for a rare condition where parts of the nervous system become damaged. This causes progressive weakness, usually with muscle wasting.
Motor neurone disease occurs when specialist nerve cells in the brain and spinal cord called motor neurones stop working properly. Motor neurones control important muscle activity, such as:

·         gripping

·         walking

·         speaking

·         swallowing

·         breathing

As the condition progresses, people with motor neurone disease will find these activities increasingly difficult - and eventually impossible - to do.

Exactly what causes motor neurones to stop working properly is unclear, but there is not currently thought to be a link with factors such as race, diet and lifestyle.

In about 5% of cases there is a family history of either motor neurone disease or a related condition called frontotemporal dementia. In most of these cases faulty genes have been identified as contributing to the condition.

There is no single test to diagnose motor neurone disease and diagnosis is based mainly on the opinion of a neurologist. Sometimes specialised tests are needed to rule out other possible conditions.

 Motor neurone disease - Symptoms of motor neurone disease

The symptoms of motor neurone disease can be varied to begin with before getting progressively more widespread.
The symptoms usually follow a pattern that falls into three stages:

·         the initial stage

·         the advanced stage

·         the end stage

Initial symptoms
The initial symptoms of motor neurone disease usually develop slowly and subtly over time. It can be easy to mistake early symptoms for those of several unrelated conditions that affect the nervous system.

Limb-onset disease

In about two-thirds of people with motor neurone disease, the first symptoms occur in the arm or leg. This is sometimes called limb-onset disease.

Bulbar-onset disease

In the other one-third of cases, problems initially affect the muscles used for speech and swallowing. Increasingly slurred speech (dysarthria) is usually the first sign of this type of motor neurone disease.

As the condition progresses, it may become increasingly difficult to swallow. The medical term for swallowing difficulties is dysphagia.

Respiratory-onset disease

In very rare cases, motor neurone disease starts by affecting the lungs. This is called respiratory-onset disease. In some cases the initial symptoms are obvious, such as breathing difficulties and shortness of breath.

Advanced symptoms

As motor neurone disease progresses to an advanced stage, the differences between the various types of disease are less noticeable as more parts and functions of the body are affected.

Muscle weakness

The limbs become progressively weaker and the muscles in your limbs begin to waste away. As a result, you'll find it increasingly difficult to move your affected limbs.

Muscle spasms

Certain muscles in your limbs may become unusually stiff. This type of muscle stiffness is known as spasticity.


Muscle wasting and stiffness can cause joint aches and pains.

Difficulties speaking and swallowing

About two-thirds of people with motor neurone disease eventually find the ability to speak and swallow increasingly difficult as the disease progresses. However, this is rarely fatal.

Saliva problems

Reduced swallowing can cause excessive or constant drooling of watery saliva. Sometimes, thicker saliva may be harder to clear from the chest or throat because of weakened cough muscles.

Excessive yawning

Some people with motor neurone disease have episodes of uncontrollable, excessive yawning, even when they're not tired. This can sometimes cause jaw pain.

Emotional changes

Motor neurone disease doesn't usually affect a person's intelligence, but it can lead to changes in their ability to control their emotions.

One of the most common signs is when a person has episodes of sudden uncontrollable crying or, more rarely, laughter. Doctors may call this emotional lability.

Changes to mental abilities

Occasionally, people with motor neurone disease may have difficulties with planning, language and concentration. This is known as cognitive change and overlaps with a condition called frontotemporal dementia.

Typically the changes are quite subtle, making it difficult to tell them apart from the normal ageing process, and do not usually affect a person's capacity to make their own decisions.

About 10% of people with motor neurone disease develop more profound frontotemporal dementia, typically soon after their first muscle symptoms.

Breathing difficulties

As the nerves and muscles that help control the lungs become progressively more damaged, your breathing will become increasingly difficult.

End-stage symptoms

As motor neurone disease progresses to its final phase, a person with the condition will probably experience:

·         increasing body paralysis, meaning they need help with most normal daily activities

·         significant shortness of breath

Eventually, non-invasive breathing assistance won't be enough to compensate for the loss of normal lung function. At this stage, most people with motor neurone disease become increasingly drowsy before falling into a deep sleep. They usually die peacefully in their sleep.

Motor neurone disease - Causes of motor neurone disease

Motor neurone disease occurs when motor neurones progressively lose their function. It is not clear why this happens.

In most cases, a person with motor neurone disease will not have a family history of the condition. This is known as sporadic motor neurone disease. Researchers believe that the cause is probably a combination of genetic and environmental factors that build up throughout life.

However, about 5% of people with motor neurone disease have a close family relative who also has the condition or the related condition frontotemporal dementia. This is called familial motor neurone disease and is more closely linked to a problem with genes.

Possible causes of motor neurone disease

It's still unclear why the motor neurones begin to lose function. Most experts believe that the loss of function is caused by a combination of interrelated factors that affect your cells, some of which are outlined below.


Nerve cells use special "messenger chemicals" called neurotransmitters to transmit information from one cell to another. One of the neurotransmitters is called glutamate. There is evidence that the motor neurones in people with motor neurone disease may have become more sensitive to glutamate, resulting in damage to these cells. However, this is not linked to dietary intake of glutamate.

Cell disruption

All cells contain transport systems that move nutrients and other chemicals into the cell while moving waste products out of the cell. Research suggests that the transport systems in motor neurones become disrupted in motor neurone disease. This may contribute to the loss of normal nerve function.


Aggregates are abnormal clumps of protein that develop inside motor neurones. They have been found in most cases of motor neurone disease. The clumps may disrupt the normal working of the motor neurones.

Toxic waste

Toxic waste can build up in cells over time as a natural by-product of normal cell activity, just as using a cooker repeatedly can cause grease to build up inside it. The body gets rid of the toxic waste by producing substances known as antioxidants. Research suggests that in motor neurone disease the motor neurones may be deficient in antioxidants, but there is no evidence that this is because of poor dietary intake.


Mitochondria are the "batteries" of cells. They provide the energy that a cell needs to carry out its normal function. Research has shown that the mitochondria in the motor neurones of people with motor neurone disease appear to be abnormal.

Lack of nutrients

Like all living tissue, motor neurones need a regular supply of nutrients. Motor neurones receive nutrients from a group of proteins known as neurotrophic factors. There's evidence that in motor neurone disease neurotrophic factors are not produced in the correct way. This may make the motor neurones more vulnerable to damage and affect their function.

Glia cells

Glia are cells that surround and support motor neurones and help provide them with nutrients. Glia cells also help relay information from one nerve cell to another. Some cases of motor neurone disease may be caused by problems with the glia cells, which means that the motor neurones no longer receive the support and nutrition that they require to function normally.

Motor neurone disease - Treating motor neurone disease

There is no cure for motor neurone disease, but treatment can help relieve symptoms and slow the progression of the disease.

Your care team

If you're diagnosed with motor neurone disease, you'll be introduced to a team of health professionals who will be involved in your care. This team is often called a multidisciplinary team because it contains experts from many different healthcare disciplines.

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