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By D. Fadi. Ouachita Baptist University.

Carrithers JA buy 20mg cialis soft amex erectile dysfunction treatment implant video, Williamson DL purchase cialis soft 20mg with mastercard impotence statistics, Gallagher PM, et al: Effects of postexercise carbohydrate-protein feedings on muscle glyco- SUMMARY gen restoration. Nutrition for Sport A balanced diet that provides the proper amounts of and Exercise. This is especially impor- College of Sports Medicine position stand: Exercise and fluid tant for the athlete who might be training intensely or replacement. The three primary Coyle EF, Coggan AR, Hemmert MK, et al: Muscle glycogen uti- energy systems used during running are the power, lization during prolonged strenuous exercise when fed carbo- speed, and endurance systems. Coyle EF, Jeukendrup AE, Wagenmakers AJ, et al: Fatty acid oxi- used and energy requirements will vary for each indi- dation is directly regulated by carbohydrate metabolism during vidual depending on such factors as mode of activity, exercise. To aid Davis JM, Jackson DA, Broadwell MS, et al: Carbohydrate in peak performance it is recommended that the ath- drinks delay fatigue during intermittent, high-intensity cycling lete pay special attention to preevent, event, and in active men and women. This will help ensure Deuster PA, Day BA, Singh A, et al: Zinc status of highly trained adequate hydration, glucose intake, and recovery. Am J Clin Nutr Finally, the use of such methods as glycogen loading 49:1295–1301, 1989. National Academy of Sciences: Recommended Dietary Allowances, Fogelholm M: Indicators of vitamin and mineral status in ath- 10th ed. National Academy of Sciences: Dietary reference intakes for cal- Helge JW, Richter EA, Kiens B: Interaction of training and diet cium, phosphorus, magnesium, vitamin D, and fluoride. National Academy of Sciences: Dietary Reference Intakes for Houtkooper L: Food selection for endurance sports. Med Sci thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, Sports Exerc 24:S349–59, 1992. Washington, DC, Hurley BF, Nemeth PM, Martin WH, III, et al: Muscle triglyc- National Academy Press, 1998. J Appl National Academy of Sciences: Dietary reference intakes for vita- Physiol 60:562–67, 1986. Nicklas BJ: Effects of endurance exercise on adipose tissue Janelle KC, Barr SI: Nutrient intakes and eating behavior scores metabolism. Jeejeebhoy KN: Vegetable proteins: Are they nutritionally equiva- Pasman WJ, van Baak MA, Jeukendrup AE, et al: The effect of lent to animal protein. Jentjens RL, van Loon LJ, Mann CH, et al: Addition of protein and Int J Sports Med 16:225–30, 1995. Jeukendrup A, Brouns F, Wagenmakers AJ, et al: Carbohydrate- Romijn JA, Coyle EF, Sidossis LS, et al: Regulation of endoge- electrolyte feedings improve 1 h time trial cycling perform- nous fat and carbohydrate metabolism in relation to exercise ance. Schena F: Iron status in athletes involved in endurance and in American College of Sports Medicine, American Dietetic prevalently anaerobic sports, in Kies C, Driskell JA (eds. Kleiner SM, Bazzarre TL, Ainsworth BE: Nutritional status of Sherman WM, Costill DL, Fink WJ, et al: Effect of exercise- nationally ranked elite bodybuilders. Int J Sport Nutr 4:54–69, diet manipulation on muscle glycogen and its subsequent uti- 1994. Int J Sports Med 2:114–18, Kleiner SM, Bazzarre TL, Litchford MD: Metabolic profiles, 1981. Latzka WA, Montain SJ: Water and electrolyte requirements for Gaithersburg, MD, Aspen, 1998, p 45. Sugiura K, Kobayashi K: Effect of carbohydrate ingestion on Lemon PW, Tarnopolsky MA, MacDougall JD, et al: Protein sprint performance following continuous and intermittent exer- requirements and muscle mass/strength changes during intensive cise. Tarnopolsky MA, Atkinson SA, MacDougall JD, et al: Ma J, Betts NM: Zinc and copper intakes and their major food Evaluation of protein requirements for trained strength ath- sources for older adults in the 1994–96 continuing survey of letes. J Nutr 130:2838–43, Tsintzas OK, Williams C, Singh R, et al: Influence of carbohy- 2000. Martin WH, III: Effect of endurance training on fatty acid metab- Eur J Appl Physiol Occup Physiol 70:154–60, 1995. Med Sci Sports Exerc Turcotte LP: Role of fats in exercise: Types and quality. Millard-Stafford M, Sparling PB, Rosskopf LB, et al: Fluid van der Beek EJ, van Dokkum W, Schrijver J, et al: Thiamin, intake in male and female runners during a 40-km field run in riboflavin, and vitamins B-6 and C: Impact of combined the heat. Am J Clin Montain SJ, Coyle EF: Fluid ingestion during exercise Nutr 48:1451–62, 1988. BENEFITS OF PHYSICAL ACTIVITY Walberg-Rankin J: Dietary carbohydrate as an ergogenic aid for prolonged and brief competitions in sport.

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Another important reason for the parents’ concern may be the experience from their own childhood cheap cialis soft 20 mg on line which antihypertensive causes erectile dysfunction, i discount cialis soft 20 mg with mastercard erectile dysfunction green tea. An intoeing gait, for example, would be treated by »breaking and rotating the fe- mur«, children with knock-knees or bow legs were forced to wear leg splints for years, and growing up without shoe insoles was only permitted to a few eccentrics. The parents hope that a forceful word from the orthopae- dist or pediatrician will bring the children (and the shoes) to their senses. Some parents consult the doctor to obtain a second, third or even ▬ Follow-up after a treatment or for monitoring a child’s higher opinion... While parents certainly do seek the opinion of another doctor when the first has not provided treat- One frequently asserted – but in reality non-existent ment, the reason is not the lack of treatment, but the – motivation for consulting the orthopaedist is the par- fact that they felt that the first doctor did not take them ents’ »desire for treatment«. This is due to the inappropriate con- repeatedly justify the provision of treatment for a peri- duct of the first doctor. Of course, he can very probably patellar pain syndrome, for example, by arguing that if make a diagnosis on the basis of the medical history. But 4 Chapter 1 · General he must still examine the patient with meticulous care: 1 Firstly, in order to avoid missing some other possible diagnosis, and secondly, to give patients and parents the feeling that they are being taken seriously. The next occa- sion for pushing parents into the arms of another doctor is when, after the examination, the doctor flatly states: »There’s nothing wrong with your child! The child hurts and has been experiencing pain for a long time and it’s getting worse all the time. The correct response in such situations is to explain to the patient and the parents that the pain is due to a very unpleasant problem connected with growth that cannot be influenced by treatment, but one that will not leave any permanent damage after the child has stopped growing. Patients will fully understand that the growing body is defending itself against overexertion and that a temporary reduction in sporting activity may be needed. The parents may still ask: »And can nothing be done to treat the condition? The parents may still insist on treatment, however, because, as ambitious parents, they are unwill- accurately whether you are also being honest with them. Why didn’t you say to the child: »This will hurt just for a moment, but it will The pediatric orthopaedic consultation soon be over! You should always remind yourself of this Behavior of patients need for honesty. Infants Children are quick to notice when you are talking Infants generally don’t care whether you’re a doctor, an about them with their parents but don’t want them to hear uncle or an aunt. The parents sometimes feel that the child would not unless the infant is feeling hungry or thirsty. But if the mediate reaction of some infants is to reject unknown child has a malignant tumor, who will subsequently have individuals, they just don’t take to strangers, but even with to cope with all the unpleasant treatment, if not the child these babies the odds will be in your favor if you flash itself? Even if they don’t understand or take Children in everything at the initial consultation, it is extremely important from the psychological standpoint that you » Children have no concept of time, hence their should include even small children in the discussion so protracted and detailed observations. Children are extremely diverse creatures and differ funda- Incidentally, adults find it far more difficult to cope mentally in the way they communicate with the environ- with such news than the children themselves, because ment of adults. They are not simply »adults on a small they have a much better idea of what the children will scale«. If you give an adult an injec- paedists rarely have to administer injections, children tion and then ask him whether it hurt, he will probably don’t categorize them as »bad doctors«. But pediatric say: »No, not at all«, and look at you in the expectation orthopaedists do occasionally have to cause children pain, of receiving a medal for bravery. But it wouldn’t occur for example when removing transcutaneously inserted to a child to react in this way at all, it simply yells out in Kirschner wires from bones or applying a plaster cast to pain. In most deal with the honesty of the child is that we have cases, they have previously received an injection that learned so efficiently how to lie. But children are unable to do this (yet); they pense with the identifying feature of the »medicine have a very finely-tuned sense that tells them man«, i. In my experience, however, whether someone is telling them the truth or not, children are still able to identify the doctor in the even though they may not usually be able to express sweater disguise as a person that can cause potential directly their feelings about the truthfulness of what hurt. Especially anxious children hide their face in from children in the long term without negative the mother’s lap and, when asked to walk while hold- consequences. The surest meth- jump at your command, stand straight like soldiers, od of making any further examination impossible bend down when asked and not show any opposition is to look at your watch and think about your busy to even the most adventurous contortions of the legs. Even though you may not say it out loud, In fact, most children act in this way and no great skill the child can sense the sentence forming in your head: is required to examine them, but even well-behaved »Must you behave so stupidly just at this particular children will also appreciate a joke, a smile or a little time!

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