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Toledo, Ohio: Ask the Diet Doctor: Butea Superba Extract Powder

Q: What’s the deal with butea superba powder?

A: Butea Superba is a plant from Thailand that is of the mustard family. It was used traditionally in Thailand to treat infertility and imbalances in female hormones, and has since made its way onto health food store shelves and eCommerce shops across the world where its flagship benefits of boosting sexual function and vitality in men and women are touted. It is also boasted for being able to alleviate symptoms of menopause.

Despite the aggressive marketing for lots of supplements in this category, the scientific support for these marketing claims generally comes up impotent. Let's look at what some of the research says about Butea Superba.

Butea Superba and Sexual Function

A 2003 study in men found daily supplementation with Butea Superba had no effect on any of the sex hormones measured, and research performed three years later also found that when isolated, compounds in Butea Superba were not able to bind sex hormone receptors. More recently in 2010, scientists who reviewed the effects of Butea Superba on sexual function in BMC Complementary and Alternative Medicine concluded that Butea Superba may be effective at improving sexual function in post menopausal women after six weeks of use. But the quality and rigor of the research studies was brought into question, and the adverse effects (or lack of) were not measured or monitored in these studies Herbolab.

Getting to the Root of Butea Superba Based on the current research regarding the effects of Butea Superba on sexual function and reduction of menopausal symptoms in humans, I do not see any reason to supplement with Butea Superba (unless you think you will be susceptible to the placebo effect). Because adverse effects were not consistently monitored (or monitored at all), it is prudent to bring into question the safety of Butea Superba supplementation aside from straw man argument that you will hear in the aisle of your local health food store that "people have been using it for centuries so it has to be fine."

In case you needed one more reason to pass on Butea Superba, I should tell you that Butea Superba root powder tastes horrible and is hard to mask. The only way that I found it somewhat palatable was to add it to a smoothie made with chocolate protein powder and dark sweet cherries.

While Butea Superba doesn't seem to provide any benefit in reducing symptoms of menopause, the authors of the Butea Superba review make a very good point about Butea Superba's use for the treatment of menopausal symptoms that is applicable to supplement use in general: "Many women turn to alternatives such as herbal supplements, which, whether correct or incorrect, are often perceived as natural and therefore free of adverse effects."

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Orlando, Florida: Here’s What Actually Happens When You Wake Up During Surgery Let’s talk about the bizarre thing that can happen on the operating table.

BuzzFeedNews

1. It's a clinical phenomenon called anesthetic awareness.

'Anesthetic awareness, also known as intraoperative recall, occurs when a patient becomes conscious during a procedure that is performed under general anesthesia, and they can recall this episode of waking up after the surgery is over,' Dr. Daniel Cole, president-elect of the American Society of Anesthesiologists, tells BuzzFeed Life. Patients may remember the incident immediately after the surgery, or sometimes even days or weeks later. But rest assured, doctors are doing everything they can and using the best technology available to make sure this doesn't happen.

2. One to two people out of 1,000 wake up during surgery each year in the United States.

"It's not a huge number, but it's enough people that it's definitely a problem," says Cole. Plus, the true rate could be even higher. "The data is all over the place because it's mostly self-reported." "Ideally, the anesthesiologist would routinely see the patient post-operation and ask them about intraoperative awareness," he says. But this opportunity is often lost because patients are discharged or choose to go home as soon as they can after surgery. "Even if they remember three, five days later, they might feel embarrassed and don't want to make a big deal so they don't mention it to their surgeon. So there can be underreporting of awareness."

3. It happens when general anesthesia fails.

General anesthesia is supposed to do two things: keep the patient totally unconscious or 'asleep' during surgery, and with no memory of the entire procedure. If there is a decreased amount of anesthesia for some reason, the patient can start to wake up. The cocktail of medication in general anesthesia often includes an analgesic to relieve pain and a paralytic. The paralytic does exactly what it sounds like — it paralyzes the body so that it remains still. When the anesthesia does fail, the paralytics make it especially difficult for patients to indicate that they're awake.

4. And it's not the same as conscious sedation.

Conscious sedation, sometimes referred to as "twilight sleep" is when you're given a combination of a sedative and a local or regional anesthetic (which just numbs one part or section of the body) for minor surgeries, and it's not intended to knock you out completely or cause deep unconciousness. It's typically what you would get while getting your wisdom teeth out, having a minor foot surgery, or getting a colonoscopy. With conscious sedation, you may fall asleep or drift in and out of sleep, but this isn't the same as true anesthetic awareness, says Cole.

5. Contrary to popular belief, it doesn't usually happen right in the middle of surgery.

"The anesthesiologist is very aware that this can happen and never relaxes or lets down their guard at any point during the surgery, no matter how long," says Cole. "Awareness tends to occur on the margins, when the procedure is starting and you don't have the full anesthetic dose or when you're waking up from anesthesia, because it's safest to decrease the amount of anesthesia very slowly and gradually toward the end." However, this also depends on the surgery and patient... which we'll get to in a little bit.

6. Patients often report hearing sounds and voices. "The most common sensation is auditory," says Cole. Patients will report that they were aware of voices, and even conversations that went on in the operating room — which can be especially terrifying if loud tools are involved. "If you look at the effects of anesthetics on the brain, the auditory system is the last one to shut down, so it makes a lot of sense."

And opening your eyes to see the surgeons operating on you? Basically impossible. "First of all, the anesthesia puts you to sleep, so your eyelids shut naturally. Even if you regain consciousness, the anesthesia still restricts muscle movement so your eyes will stay shut," Cole explains. "But there's still 10–20% eye opening when you sleep. So during surgery, we will cover the patient's eyes or tape them shut to prevent injury and keep the eyes clean."

7. Few patients experience pressure (and rarely pain) during anesthetic awareness.

Less than a third of patients who report anesthetic awareness also report experiencing pressure or pain, says Cole. "But that's still one too many, because the patient is kind of locked in and aware of what's happening to them but unable to move, which is terrifying." Typically, sufficient analgesic (pain reliever) is given, so that even if you wake up you won't feel pain. "More often, we use an anesthetic technique which includes a morphine-type drug to reduce pain. But this is really required for when the patient wakes up and they no longer have anesthetic so they are conscious and aware of pain," Cole says.

Even if the analgesic wears off, there should be sufficient anesthesia to keep the patient unconscious and pain-free. "It's rare. You'd have to both have insufficient anesthesia and insufficient pain medicine at the same time to feel prolonged pain during awareness," Cole says.

8. Anesthetic awareness can cause anxiety and PTSD.

"The potential psychological effects of awareness range greatly," says Cole. "It can cause anxiety, flashbacks, fear, loneliness, panic attacks — PTSD is the worse. It's been reported in a small minority of patients, but it can be very severe." says Cole. If doctors hear about someone having intraoperative awareness, they will try to get the person into therapy as early as possible, before memories can be embedded in a harmful or stressful way to patients. "If you were in the hospital for a week and on day two we heard that you woke up during surgery, we'd get a therapist in the same day. We always want to mitigate so we can try to reduce the severity of symptoms," Cole says.

9. It's most often caused by an equipment malfunction.

General anesthesia can either be given intravenously (where all or most is given through an IV) or more commonly as a gas, which you breathe in through a mask. If the equipment in either of these were to malfunction, and the anesthesiologist wasn't aware of it because the signal that gas is too low doesn't work, for example, then patients would stop receiving medication and start to wake up. Again, this is terrifying but rare.

"The anesthesia equipment is like an airplane," Cole says. "The anesthesiologist will do a pre-flight check and go over all equipment to make sure it works. But sometimes, that equipment can malfunction as short as an hour later so it won't show up before taking off." Likewise, there is equipment used to monitor the patient's vitals and brain activity, which can also fail to signal to doctors that the patient is waking up.

10. Less commonly, it's the physician or anesthesiologist's fault.

"Any time humans are involved, human error is always a possibility — but it’s more common that technology fails," says Cole. "Physicians and anesthesiologists are well-trained to look out for signs of awareness during surgery, which obviously includes any movement of muscles and changes in vitals." Since paralytics are often involved, doctors also closely monitor other signs like heart rate, blood pressure, tears, or brain electrical activity for any red flags. However, sometimes patients can be on medications that suppress the body's responses and inhibit the monitoring systems from effectively picking up warning signs of light anesthesia and awareness. These incidences can make it difficult to detect awareness, so physician anesthesiologists must closely watch an array of signs.

11. It is more likely to happen during surgeries that require "light" anesthesia.

Anesthesia also comes with risk factors, and can be harmful depending on the surgery or patient's risk. "Awareness can occur when there is too light of anesthesia, which we often do deliberately for high-risk situations," says Cole. According to the American Society of Anesthesiologists, high-risk surgeries include heart surgery, brain surgery, and emergency surgeries in which the patient has lost a lot of blood or they can easily go into shock. Or the patient may need a lower dose of anesthesia due to risk factors such as heart problems, obesity, a genetic factor, or being on narcotics or sedatives. "For instance, anesthesia depresses the heart, so a normal dose could be life-threatening to someone with heart problems," Cole explains.

"Sometimes you have to make a trade off," says Cole. "Would you rather have a high level of anesthesia which threatens your body's life functions, or a low level which ensures safety but increases the risks of waking up during the procedure?"

12. ...But if that's the case, your doctor will talk to you about it first.

Patients often feel better knowing that the decreased amount of anesthesia is for their own safety. "We tell the patient that there's an increased chance that you may hear some voices or fuzziness, but if it gets uncomfortable we can tell and will increase the dose," says Cole. "Patients are more understanding and happy when they understand that the risk of waking up is for their own safety."

Also, you should know that if you've had a previous incidence of awareness, that puts you at higher risk for another episode. Cole explains that in this case, doctors will spend a lot of time with the patient and anesthesiologist describing exactly what to expect, so that hopefully they won’t experience it again.

13. ALL THAT BEING SAID, the chances of this happening are slim, and medical professionals are doing everything they can to ensure that this does not happen.

According to Cole, it's always helpful to spend some time pre-operatively with the surgeon and physician anesthesiologist going over the procedure and how they'll get you through it safely and comfortably.

"I do something called 'patient engagement' and 'shared decision-making' so I can make sure the patient understands literally everything. Some patients don't want to talk about awareness because it will give them more anxiety, and they just trust us," says Cole. However, even if you aren't at risk, your doctors will be happy to answer any questions you have about anesthesia before the procedure.

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Khmer Rouge terror in Cambodia ---

San Jose, California: "I've been dying to post this" Terminally ill dad-of-three's final Facebook message before ending his life at Dignitas

Ex-soldier Nigel Casson - who once arrested IRA commander Martin McGuinness - chose to end his life after a 10-year battle with Motor Neuron Disease

Mirror

Even in the moments before he ended his life at the Dignitas clinic, “inspirational” dad-of-three Nigel Casson found the strength to keep smiling and cracking gags.

The 62-year-old former soldier’s family told how he was telling jokes until the end. And he signed off on Facebook by saying: “I’ve been ‘dying’ to post this. Ha ha ha ha ha. Thank you and goodbye.”

He had battled motor neurone disease for 10 years, needing round-the-clock care as he was no longer able to carry out even the most basic tasks himself.

His Facebook post added: “I wanted to die with dignity instead of being tortured. Some people may think it’s the easy way out but believe me it’s not easy to leave your loving family and friends.”

The businessman asked wife Julie to post the message online shortly before he died at the clinic in Switzerland.

He never got to see the hundreds of comments because he didn’t want to be “glued to Facebook” in his final hours.

The Brit spent the time with his wife of 39 years and their three children Craig, 42, Eleanor, 38, and Rebecca, 33. Julie, 58, told yesterday how the family spent two “special” days in Switzerland before they gathered at his side as he pressed the button to administer the fatal drugs in a room at the clinic near Zurich.

Julie said: “He was making jokes right up to the point, and he was smiling.”

About his wish to die, she added: “You have got to respect people’s decisions but it was still heartbreaking when he told me this is what he wanted to do.

“He joked and laughed every day. He was an inspiration and helped the rest of us cope with the heartbreaking effects of motor neurone disease.”

The illness wrecks the victim’s muscles, eventually leaving them unable to move, speak, eat or breathe.

Nigel said it is wrong that assisted suicide is illegal in Britain.

Explaining why he chose to die now, he said in the Facebook post: “I wanted to take back control of my life and take the victory of killing me away from this disease. I wanted to die while I am happy and can still smile and not be controlled by this wicked disease any longer.”

In response, family and friends paid tribute to the “finest man” they knew. His sister Tracey Casson said: “I salute you and love you always.”

Nigel served in the Army as an infantryman in the Duke of Wellington’s Regiment during the 1970s.

He served in Northern Ireland. Julie said he once arrested Irish republican and Sinn Féin politician Martin McGuinness, who died in January.

Nigel, from Scarborough, North Yorks, left the Army after a three-year stint and then started up a scaffolding firm and a removal business.

He was diagnosed in 2007 with the debilitating disease and was given three to five years to live.

Wheelchair-bound and becoming increasingly weak, Nigel decided last August that he would go to Dignitas.

“By the end he needed help with everything,” said Julie.

“We had a team of carers giving him round-the-clock care. He relied on a wheelchair for the last seven years.

“His limbs were becoming extremely weak. He needed help with everything such as feeding, showering and going to the toilet.

“He was completely disabled but managed to keep his spirit.

“Because of his immobility and disability he found comfort in using Facebook. It kept him in touch with the world. He could still manage to touch the screen but also had eye-gaze technology to help him.”

But she added that near the end: “He was having days where he was becoming dispirited.

“He was conscious that if he didn’t go while he physically could, he would miss an opportunity.

“He didn’t want to get to a stage where he was unable to speak or unable to communicate his feelings and frustrations, and feel entombed within his own body.”

The family said they decided to speak about the ordeal to encourage the Government to change the law.

Assisting someone to commit suicide is illegal in England and Wales. It carries a potential jail sentence of 14 years.

But in 2010 the Director of Public Prosecutions issued guidelines that tried to clarify what would happen to families who go to places such as Dignitas with dying loved ones.

It was indicated that anyone acting with compassion to help end the life of someone who does not want to live would be unlikely to face charges.

The latest proposal to reform the Suicide Act 1961 was rejected in the Commons in 2015. The assisted dying bill proposed to enable “competent adults who are terminally ill” to choose to be helped to die “with medically supervised assistance”.

In Scotland there is no specific crime of assisting a suicide but helping someone die could lead to a prosecution for culpable homicide.

Switzerland allows euthanasia in certain circumstances. It is understood that last year 47 Britons went to assisted dying clinic Dignitas to end their lives, with families saying they spent thousands of pounds. Assisted dying has also been legalised in nations such as the Netherlands.

Motor neurone disease affects up to 5,000 adults in the UK. About half of sufferers die within 14 months of being diagnosed. Nigel, whose first name was David but was known by his middle name, died last week.

Julie said her husband supported the Dignity in Dying campaign, which believes terminally-ill adults should have the option of assisted dying.

She added that even though Nigel died as he wanted, the family is devastated. Julie said: “Nigel was a very realistic man and did not moan about his fate. He decided to keep a positive attitude throughout.

“He embraced what was to be the rest of his life with exceptional good humour, maintaining good spirits to the end. We are a close family and are grief-stricken by the loss of Nigel.?

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