If your self-esteem is quite low purchase 7.5 mg meloxicam free shipping rheumatoid arthritis diet soda, you probably spend time judging yourself harshly and negatively cheap meloxicam 15mg on line fungal arthritis in dogs. Your energy probably suffers buy generic meloxicam 15mg online arthritis pain while sleeping, and you may feel quite anxious about your perceived deficiencies. Too much ego or self-esteem, however, is like a balloon that’s tightly stretched and so full of air that it’s about to explode. If your self-esteem balloon is too full of itself, those threats can appear especially ominous. On the other hand, a balloon with just the right amount of air is pretty tough to break. The balloon with the right amount of air doesn’t worry so much about crashing or bursting. In a sense, both the deflated balloon and the one close to the bursting point worry plenty about their own state: their condition, worth, and vulnerability. The key to having just the right amount of ego — air in the balloon — is to have less concern with yourself (along with more concern for others) and less worry about how you stack up against others. When you can accept both your positive and negative qualities without being overly concerned for either, you’ll have the right amount of air in your ego balloon, but that isn’t always so easy to do. It takes a solid focus on learning, striving, and working hard — though not to excess. Chapter 13: Mindful Acceptance 209 The seductive power of positive thinking In the 1950s, self-help gurus began a movement Hardly. Today, school achievement lags sig- by encouraging everyone to pump up their self- nificantly behind where it was in 1960. School violence is cles were written on the topic of self-esteem in much higher than 50 years ago, and the rates professional journals; however, in the past ten of depression and anxiety among today’s youth years alone, more than 8,000 such articles have are higher than ever. An incredible number of recent research tion, literally thousands of self-help books have studies show a strong link between the over- promoted the unquestioned value of nurturing abundant focus on the self and violence, poor self-esteem. The self-esteem movement now school achievement, and emotional problems permeates parenting magazines, school cur- of all sorts. It seduced a gen- to be bad for you, but studies suggest that an eration of parents, teachers, and mental-health overly inflated self-esteem is even worse. The workers into believing that the best thing that answer appears to lie in having less focus on they could do for kids was to pump up their self- the almighty self. So has more than a half-century of promot- ing self-esteem (also known as ego) paid off? Appreciating your imperfections All too often, anxious people feel that they must be perfect in order for others to like and accept them. Kelly always wears exactly the right fashionable clothes, the right colors, and her accesso- ries always match. She always knows just what to say, never stumbling over a single word or swearing. Does she seem like someone you’d like to hang out at a pool with on a summer weekend? Picture that person in your mind and recall some of the good times that you’ve spent together. Think about how much you appreciate this person and how your life has been enriched by the relationship. Realize that you’ve always known about your friend’s negative qualities and imperfections, yet you’ve continued to appreciate your friend. In the second column, describe a couple of negative qualities or imperfections that your friend has. Following this exercise, realize that your friends probably have a similar pic- ture of you. Curtis fills in the “Appreciating Flawed Friends” exercise in Table 13-1 while thinking about his buddy Jack. In the respective columns, he writes about Jack’s positive qualities and imperfections. There’s no one that Curtis would rather spend time with, and Jack is the first person he would turn to in a crisis. If your friend filled out the same form on you, no doubt she would write about both wonderful qualities and some less-than-wonderful traits. And yet, your friend wouldn’t suddenly give up the friendship because of your imper- fections. Perhaps even more difficult is finding out how to drop defensive barriers in response to criticism from others. Instead of put- ting up barriers to communication and problem solving, admitting to some flaws brings people closer. Table 13-1 Appreciating Flawed Friends Positive Qualities Negative Qualities and Imperfections Jack is one of the funniest guys I know. Even though he’s smart, sometimes Jack makes stupid decisions, espe- cially about money.
If that doesn’t seem to be happening discount 15 mg meloxicam amex arthritis knee range of motion, discuss it with the therapist and con- sider getting a second opinion best 7.5 mg meloxicam arthritis in fingers and feet. Also generic 7.5mg meloxicam with mastercard arthritis in the knee medication, be sure to take a look at the ten indications that you may need pro- fessional help. Finally, we include an appendix where we recommend books and Web sites that you can turn to for more help in dealing with your anxiety. Chapter 21 Ten Ways to Stop Anxiety Quickly In This Chapter ▶ Talking away your anxiety ▶ Jumping (jacks) into action ▶ Making whoopee ometimes you need quick, temporary relief from anxiety. With that in Smind, this chapter describes ten assorted therapies from our anxiety/ stress reduction first-aid kit. And rapid, shallow breathing has a way of increasing anxiety — not a useful cycle. Try this quick, easy-to-learn breathing technique to restore a calming pattern of breathing. Slowly let your breath out through your lips while making a slight sound — hissing, sighing, or whatever. Talking with a Friend Anxiety is a lonely feeling, and loneliness increases anxiety. Research shows that social support helps people deal with almost any type of emotional distress. You may think that no one would want to hear about your troubles, but we’re not talking about whining and complaining. Adrenaline, a chemical produced by your body, causes your heart to beat faster, your muscles to tighten, and various other body sensations that feel distressing. Good examples include jogging; a long, fast walk; dancing; rope jumping; and tennis. Soothing the Body The most distressing aspect of anxiety is the way that it makes your body feel — tense, queasy, racy, and tight. Quick ways to temporarily break through the tension include the following: ✓ Soaking in a hot bath for a good while. Of course, if your budget allows for a longer massage performed by a professional masseuse, that’s great too! Chapter 21: Ten Ways to Stop Anxiety Quickly 307 Challenging Your Anxious Thinking The way you think strongly influences the way you feel. Anxious people inevita- bly think about things in ways that increase their anxiety. One of the best ways of dealing with anxiety is to examine the evidence for your anxious thoughts. Afterwards, ask yourself some questions about those thoughts, such as ✓ Is this worry truly as awful as I’m thinking it is? After answering these questions, try to write down a more realistic perspec- tive. See Chapter 5 for discovering more about how to write out your anxious thoughts, analyze them for distortions, and replace them with more realistic, calmer thoughts. But until you discover better ways of dealing with it, sometimes distractions can help. On the other hand, some anxious people get anxious about their sexual perfor- mance. If that’s you, don’t try this strategy — at least until you overcome your anxiety about this issue. And, if you don’t have an available, willing partner, we don’t recommend hiring one. And if it does occur, it rarely ends up being as catastrophic as the worriers predict. If you accept feeling just a bit anxious, the feelings abate more quickly than if you tell yourself that you must get rid of them at once. Chapter 22 Ten Ways to Deal with Relapse In This Chapter ▶ Realizing that anxiety happens ▶ Understanding the process of change ▶ Getting a booster shot f you’re reading this chapter, you’ve probably made some headway with Iyour anxiety. Maybe, after all your hard work, you’ve experienced a set- back, or perhaps you’re worried about one. Expecting Anxiety Perhaps you’ve worked hard to overcome your anxiety, and now your hard work has paid off. Counting the Swallows The proverb “One swallow doesn’t make a summer” reflects the fact that a single sign doesn’t necessarily indicate that something more is inevitable. You figured out how to handle some of your anxiety, and that knowledge can still help you.
She predicts that if she commits to the relationship discount 15mg meloxicam overnight delivery arthritis vinegar treatment, her companion will ulti- mately reject her buy meloxicam 7.5mg overnight delivery rheumatoid arthritis toes, and she couldn’t stand that buy meloxicam 15 mg on-line arthritis bursitis diet. Martha identiﬁes her most malicious thought as, “I’d rather be alone forever than risk the pain of rejection again; I don’t think I could deal with that. A year from now, I suspect I’ll be sad, but I think I’ll be getting over the worst of the rejection. If this relationship doesn’t work, I think I’ll volunteer to work with Habitat for Humanity in another country. Now, Martha’s ready to devise a more realistic replacement thought (see Worksheet 6-24). Now I feel more like taking the risk, committing myself to this relationship, and seeing what happens. Take one of your most malicious thoughts and use the Worst-Case Scenario strategy to devise an effective response to that thought. When you ﬁnd yourself thinking of a worst-case scenario that you think you can’t cope with, write down your most malicious thought. Rehabilitate your malicious thought with a replacement thought written in Worksheet 6-26. Reflections on Chapter 6 This chapter is full of exercises and ideas for overcoming anxious and depressed thinking. After completing the exercises and looking at your thoughts in new and different ways, take time to reﬂect on your new insights using the space in Worksheet 6-27. Some folks grab glasses off the nightstand, others need to get up and put in their contacts to see better. What most people don’t know is that everyone’s vision of reality is altered by special life- lenses. Life-lenses are strongly held beliefs or assumptions that you have about yourself, your relationships with others, and your world. Life-lenses powerfully inﬂuence how you respond to, interpret, and feel about events, but you may not be aware that you look through them. On the other hand, you probably know a few folks who view the world through dark, gloomy shades. Your views of people, events, and even your self-image depend upon which lenses you look through. This chapter helps you realize whether your lenses are dirty, cracked, smoky, colored, or clear. A quiz shows you which lenses you look through and how they may cause you emotional trouble, and the exercises demonstrate how to change problematic life-lenses. For example, it’s not a bad idea to assume that day follows night, taxes must be paid, food is located at grocery stores, most drivers stop at red lights, and hard work usually pays off. Think about how snarled trafﬁc would be if no one assumed that red means stop and green means go. Or just consider how much time you’d waste if you searched for food in department stores, schools, and libraries rather than assuming that you’d ﬁnd it in grocery stores. These assumptions or beliefs color the way you feel about yourself and the things that happen to you. Or perhaps you have a vulnerable life-lens and thus assume that the world is a dan- gerous place. As we explore assumptions (that is, life-lenses) such as these, you can see that they form the foundation of your most distressing emotions, such as depression, anxiety, worry, irritability, apprehension, and even anger. These themes directly inﬂu- ence the kinds of thoughts you have and, in turn, how you feel about what happens to you. Although Susan and Diane are both well qualiﬁed, a nurse from another hospital gets the job. Susan reacts with anger and comments, “I deserved that job; the administration had no right to give that job away. She feels gloomy and says, “I’m sure they made the right deci- sion picking someone else. She believes that she always deserves the best; Susan feels that the world owes her and that if she wants something, it should be hers. She thinks that she’s not good enough and that others have more skill and talent than she does. Diane assumes that she couldn’t do the job even though her supervisor told her she has the appropriate ability and background. Susan’s entitled life-lens makes her prone to tension and anger when her needs aren’t met. Diane’s inadequacy life-lens steers her in the direction of depression when her adequacy is called into question.
Diagnosis and Treatment Overview: Dysphagia and chest pain are the dominant presenting symptoms trusted meloxicam 15mg rheumatoid arthritis diet therapy cure, with chest pain occurring in 80% to 90% of patients and dysphagia in 30% to 60% buy 7.5 mg meloxicam with visa rheumatoid arthritis zija. Before the widespread availability of esophageal motility testing cheap 7.5 mg meloxicam rheumatoid arthritis grants, many patients carried psy- chiatric diagnoses before their esophageal condition was identiﬁed. Often, the diagnosis of a spastic esophageal disorder becomes one of exclusion as cardiac causes or acid reﬂux explanations for the symptom complex are ruled out. Esophageal manometry remains the gold stan- dard for diagnosing spastic esophageal disorders. Approaches to the treatment of esophageal spastic disorders are aimed at ameliorating symptoms. After a thorough workup and exclu- sion of other conditions, a trial of pharmacotherapy with smooth muscle relaxants (calcium channel blockers, nitrates, and anticholiner- gics) is reasonable. Patients complain of chest pain and dysphagia and may have had extensive cardiac evaluation. Barium esophagogram demonstrates a normal upper esophagus with a corkscrew pattern in the distal esophagus (Fig. Esophageal manometry is diagnostic, but the classic pattern of diffuse spasm is uncommon in patients presenting with chest pain. Diffuse esophageal spasm has similarities to spastic bowel, and psy- chiatric abnormalities are present in up to 80% of patients. Nutcracker Esophagus: Nutcracker esophagus is characterized by hyperperistalsis of the distal esophagus with esophageal contraction pressures at least 2 standard deviations above normal. Function: single swallows of low-density barium every 20 to 30 seconds to assess esophageal function in a patient with diffuse esophageal spasm and an epiphrenic diverticulum (arrowhead). Nonspeciﬁc Motor Disorder: Despite all attempts to classify motility dis- orders, many patients present with functional abnormalities of the esophageal body or sphincters that do not follow patterns. These are classiﬁed as nonspeciﬁc motility disorders and should not be assumed to be part of a named abnormality in order to avoid a false dia- gnosis and incorrect therapy. Esophageal Manifestations of Scleroderma Scleroderma, a systemic collagen-vascular disease, impinges upon esophageal function in approximately 80% of patients. Fibrosis, colla- gen deposition, and patchy smooth muscle atrophy can be identiﬁed. Swallowing Difﬁculty and Pain 231 Esophageal Strictures Diagnosis Injury or destruction of the esophagus can result in narrowing that restricts swallowing and produces dysphagia. The patient may not perceive difﬁculty swallowing until the esophageal lumen is one-half the normal 20 to 25mm diameter. Because the obstruction is structural, dysphagia associated with esophageal stricture is constant, repro- ducible, and predictable. Barium esophagogram is the initial investigative tool in the evalua- tion of dysphagia and suspected esophageal stricture. Barium esopha- gogram provides a guide for esophagoscopy, which is the crucial invasive investigation in the diagnosis of esophageal strictures. For benign dilatable strictures, the injuring agent must be removed and the stricture treated by dilatation as necessary. Nondilatable benign strictures and resectable malignant strictures are treated by resection and reconstruction. Most peptic strictures are located in the distal esophagus above a hiatal hernia and are smooth, tapered areas of concentric narrowing. Occurrence of the stricture well above the esophagogastric junction is predictive of Barrett’s mucosa. Barrett’s mucosa has been reported in 44% of patients with peptic esophageal strictures. Aggressive control of acid reﬂux and dilatation are applied for long- term control of peptic strictures. The most potent acid suppression medica- tions (proton pump inhibitors) also are the most successful and provide the best results in the medical treatment of peptic strictures. Surgery should be considered in young patients who will require lifelong medication and in patients who cannot tolerate medication. Summary The patient presenting with swallowing problems represents a signiﬁ- cant challenge to the clinician. The complex physiology and diverse etiologies of swallowing disorders require a thorough history and a physical examination, as well as physiologically based investigations of the esophageal and upper gastrointestinal tract function. Thorough investigation should provide information sufﬁcient to make a decision about the initiation and/or continuation of medical therapy or the need for surgical intervention. Barrett’s oesophagus: effect of anti- reﬂux surgery on symptom control and development of complications. Long-term results of classic antireﬂux surgery in 152 patients with Barrett’s esophagus: clinical, radiologic, endo- scopic, manometric, and acid reﬂux test analysis before and late after oper- ation. Value of Nissen fundoplica- tion in patients with gastro-oesophageal reﬂux judged by long-term symptom control. Outcome 5 years after 360 degree fun- doplication for gastro-oesophageal reﬂux disease. Collis-Nissen gastroplasty fundoplication for complicated gastroesophageal reﬂux disease.
Whilst in some rare cases 7.5mg meloxicam with visa arthritis knee surgery recovery, I have treated the disease most successfully with aconite and belladonna 7.5mg meloxicam overnight delivery rheumatoid arthritis guidelines. In many forms of disease buy 15 mg meloxicam with visa arthritis of the eye, especially in the advanced stages, we find an impaired innervation, preventing functional activity, or its restoration and continuance by the use of remedies. It is essential to success that innervation be increased, not temporary by the use of stimulants, but somewhat permanently. Even here, we find it necessary to observe the rules for its administration already noticed - the patient must be prepared for its use. It favorably influences the nutrition of the nerve centers, and hence is employed in the treatment of chronic disease with enfeebled innervation, with marked advantage. There are two classes of chronic disease in which it is useful - the one in which there is a malarial influence, with obscure periodicity, and the other the enfeebled innervation, as named above. Its general tonic and stomachic influence (when obtained), is most certainly from its action upon the nervous system - the influence extending to the sympathetic ganglia, as well as to the cerebro-spinal centers. In some cases this action is very important, improving digestion and blood-making, and nutrition, as well as waste and excretion - aiding “the renewal of life. King reports the cure of nursing sore mouth by its internal administration in small doses in infusion. It has also been employed as a stimulant to the vegetative processes with reported good results. Dose, from the fraction of a drop to two to five drops, largely diluted with water. Buckthorn berries have been employed as a cathartic, but their activity, attended with nausea, dryness of the throat, thirst and tormina, made their use limited. The tincture of the berries in small doses may be tested for its influence on the digestive apparatus, in diseases of the nose, throat, and respiratory organs, and as a stimulant to the vegetative processes. It is claimed that a preparation from the bark gives one of the most efficient alteratives of the materia medica. William Goltry claimed that a tea made of the bark or berries would cure cancer and scrofulous diseases generally. Knight writes, “I have been using the Rhamnus Catharticus in all forms of scrofulous disease for the last two years (1866) with good effect. I make an infusion from the bark, and let the patient drink as much as he well can during the day, so as not to act too much upon the bowels. Prepared in the form of a tincture, either of them is quite as good as the extensively advertised Rhamnus Purshiana, and probably not quite so nasty. It is probably slightly milder than the other species, and not so inclined to produce tormina. All the varieties, if used in moderate doses, leave the bowels in a soluble condition, and they may thus overcome habitual constipation, and the dyspepsia that is sometimes associated with it. If the American species proves better than the others, it will be well, for as it is very abundant, it will furnish a cheap cathartic medicine for those who must have drugs of this class. It is not necessary to speak of the common use of Rhubarb, as there is no remedy better known and more used. But it will be noticed that we have recommended a wholly different preparation, and we propose to dispense it in the small doses for its direct action. In children it is especially useful, where there is nervous irritability, manifested by restlessness, screams, and convulsive contraction of muscles. In the same doses, less frequently repeated, it will prove an excellent tonic, strengthening the functions of both stomach and intestines, giving improved digestion. In indigestion, with some diarrhœa of a papescent character, it will be found a good remedy. In some cases it will prove our best remedy in the treatment of obstinate constipation. The cases are those in which there is an unnatural sensation of constriction in stomach and bowels, and contraction of the abdominal muscles. I prescribe it in these cases in doses of ten drops to a large glass of water, on rising in the morning. In the severer cases it is associated with thorough fatty inunction over the abdomen, and friction. I employ it as a restorative, where there is special need of increased nutrition of nerve tissue. It is thus associated with the preparations of phosphorus, and with cod liver oil. The influence of the Rhododendron on the circulation is very marked, It undoubtedly acts like veratrum and aconite, stimulating the circulatory apparatus through the sympathetic, and diminishing the frequency of the pulse by increasing the power of the heart, and removing capillary obstruction.
Improves slowly buy 7.5mg meloxicam visa rheumatoid arthritis and zostavax, and the third day from this buy meloxicam 7.5mg on line arthritis in feet during pregnancy, drop the Acetate of Potash and give him Apocynum and Macrotys cheap 7.5mg meloxicam mastercard arthritis nodules feet. Have treated him myself, and been assiduous in attention, using all the remedies recommended in such cases. Medicine has invariably made him worse, feels more comfortable when nothing is taken. It is many years since, and just at that time Lemon Juice was recommended for rheumatism. Concluded to try it, but without any faith in its virtues, and gave it as freely as the patient could take it. There was amendment from the first, and before the end of the week he was very comfortable, and made a good recovery. There is slight œdema of the feet, and general puffiness of the skin, which presents a peculiar glistening appearance. Two weeks since he applied for treatment for pain in the chest - costal rheumatism. The pain in the chest was removed with four doses of medicine, but the last attack required three days treatment. I will not attempt to illustrate the treatment of chronic rheumatism, because it would be occupying space without advantage to the reader. It is especially difficult to describe a case of chronic disease, occupying some weeks of time, so that the reader can see the relation between symptoms and remedies. In addition to what has been pointed out, I may say, that we especially study the function of digestion and blood-making, and retrograde metamorphosis and excretion, for in some lesion of one of them we will probably find the disease constantly reproducing itself. See that the act of digestion is properly performed, and that no morbid product is introduced into the circulation from the digestive apparatus. Then see that the waste of tissue goes on in a normal manner, and that all its products are removed as speedily as possible. The first day seemed to have a bad cold, the second had a chill, followed for two or three hours by fever. The third had a chill, followed by fever, which has continued up to the present in a remittent form. Both lungs are involved to a considerable extent, and the cough is harassing, sputa slightly “rusty. Convalescent with four days of treatment, the inflammatory action being arrested the first twenty-four hours. Now seems very much prostrated, pulse small and frequent, no hardness; when the fever is on the child is very restless, when it goes off it seems exhausted. Give in small doses (¼ teaspoonful) every few minutes at first, then at intervals of an hour. Now I very frequently add the Tincture of Lobelia Seed to water, and give it in the same manner as Veratrum and Aconite. Skin very dry and harsh, hot; pulse 130, small and sharp; tongue contracted and dry; a very persistent, dry, hacking cough; crepitation over a greater part of both lungs. This is a very common plan of treatment with me in these cases, and it is rare to find one that does not yield readily. Disease commenced with a well marked chill, fever of an asthenic character following. The child is semi-comatose, sleeps with the eyes part open, eyes dull and pupils dilated; the toes are cold; pulse 120, soft and easily compressed; cough in paroxysms, rattling, but no expectoration; an unpleasant rattling, blowing sound heard over the larger portion of the chest - the posterior part of the lung on right side is free. The comatose symptoms were removed the first twelve hours, the chill of the third day was lighter, and the child was convalescent by the fifth day. Found the skin hot - not dry, pulse 140, sharp, mouth not dry but very red, eyes bright, intolerant to light, pupils contracted to a point. A very harassing hacking cough, respiration somewhat labored and abdominal, small blowing sounds when the ear was applied to the chest. The unpleasant symptoms gradually yielded, and the child was convalescent on the fourth day of treatment. I think these cases will illustrate pretty well the more frequent departures from the ordinary standard of infantile pneumonia, and the treatment necessary for the special forms of the disease. I have employed these remedies in this way for the ten years past - some of them for a longer time - and as they have not failed me when I have done my part to make a correct diagnosis, I recommend them to others with great confidence. A rare symptom in this disease, the pulse is very full and strong, ranging from 100 to 110 beats per minute. I take the condition of the pulse as the key-note of the treatment, and prescribe - ℞ Tincture Veratrum, gtts. Ordered Quinine inunction once daily, and up to this time, the fourth week, there has been no return of the disease. A milk diet, care being used that the milk be sweet and good, and to which is added about ten grains of Phosphate of Soda in the twenty-four hours. The child made a good recovery in two weeks, the amendment dating from the second day of treatment. I say the child made a recovery - for it is now eating well, gaining flesh, is walking, and plays with spirit, yet there is no doubt but it will have occasional slight attacks until cold weather.
A 19-year-old man came to the emergency Answers to Questions 1–3 department with severe joint pain discount 15 mg meloxicam visa arthritis knee x ray, fatigue discount 15mg meloxicam arthritis treatment homeopathy, cough cheap meloxicam 15 mg line rheumatoid arthritis in back and hips, and fever. Answers to Questions 4–5 Which section of the scatterplot denotes the number of monocytes? The scatterplot represents B A the relationship between volume (x axis) and light scatter (y axis). Monocytes account for the dots in V section A, neutrophils are represented in section B, eosinophils in section C, and lymphocytes are O denoted in section D. D Hematology/Apply basic principles to interpret results/ Automated cell counting/2 5. Based on this ﬁnding and the results provided, what automated parameter of this patient is most likely inaccurate and what follow-up test should be done to accurately assess this parameter? Hgb/perform serum:saline replacement Hematology/Apply knowledge to identify sources of error/Instrumentation/3 1. A Lymphocytosis with numerous atypical lymphocytes Hematology/Apply knowledge of fundamental is a hallmark ﬁnding consistent with the diagnosis biological characteristics/Normal values/2 of infectious mononucleosis. However, on peripheral smear examination, 60 atypical lymphocytes and only 6 monocytes were noted. Atypical lymphocytes are often misclassiﬁed by automated cell counters as monocytes. Therefore, the automated analyzer diﬀerential must not be released and the manual diﬀerential count must be relied upon for diagnostic interpretation. Review the following scatterplot, histograms, and Answers to Questions 8–9 automated values on a 61-year-old woman. D All of the automated results have R or review ﬂags indicated; none can be released without veriﬁcation procedures. Review the automated results from the previous Additionally, the platelet count must be veriﬁed by question. None of the automated counts can be released without follow-up veriﬁcation Hematology/Apply knowledge to identify sources of error/Instrumentation/3 1. Refer to the following scatterplot, histograms, and Answer to Question 10 automated values on a 45-year-old man. A The platelet clumping phenomenon is often induced before releasing these results? Redrawing a sample from the patient using a sodium citrate tube usually corrects this phenomenon and allows accurate platelet enumeration. Platelet clumps cause a spurious decrease in the platelet count by automated methods. Warm specimen at 37°C for 15 minutes; rerun specimen Hematology/Apply knowledge to identify sources of error/Instrumentation/3 36 Chapter 1 | Hematology 11. Refer to the following scatterplot, histograms, and Answer to Question 11 automated values on a 52-year-old woman. D The presence of a high titer cold agglutinin in a before releasing these results? The patient’s red blood cells will quickly agglutinate in vitro when exposed to ambient temperatures below body temperature. Warm the specimen at 37°C for 15 minutes; rerun the specimen Hematology/Apply knowledge to identify sources of error/Instrumentation/3 1. Refer to the following scatterplot, histograms, and Answer to Question 12 automated values on a 33-year-old woman. C The rule of thumb regarding the Hgb/Hct correlation before releasing these results? This rule is violated in this patient; therefore, a follow-up veriﬁcation procedure is indicated. To correct for the presence of lipemia, a plasma Hgb value (baseline Hgb) should be ascertained using the patient’s plasma and subsequently subtracted from the original falsely elevated Hgb value. Warm the specimen at 37°C for 15 minutes; rerun the specimen Hematology/Apply knowledge to identify sources of error/Instrumentation/3 38 Chapter 1 | Hematology 13. Refer to the following scatterplot, histograms, and Answers to Questions 13–14 automated values on a 48-year-old man. To increase the yield and thereby facilitate counting, diﬀerential smears should be prepared using the buﬀy coat technique. Similarly, the patient’s age and the lack of atypical lymphocytes make infectious mononucleosis unlikely. Myelodysplastic syndromes may involve the erythroid, granulocytic, or megakaryocytic cell lines but not the lymphoid cells.