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Most Frequent Operating Room Procedures Performed in U.S. Hospitals, 2003-2012

SURGERYAmong hospitalizations for nonmaternal and nonneonatal conditions in 2012, more than one-fourth of stays and half of hospital costs involved stays that included operating room (OR) procedures.

■ The most common inpatient OR procedures in 2012 involved the musculoskeletal system: knee arthroplasty, laminectomy, hip replacement, and spinal fusion.

■ Between 2003 and 2012, the inpatient OR procedures with the greatest change in rate of occurrence overall were gastrectomy (+10.9 percent) and transurethral prostatectomy (TURP) (–10.4 percent).

■ Comparing age groups—Spine and joint procedures were common among all age groups except infants. Brachytherapy (internal radiation therapy) among adults aged 45–84 years had the greatest change in rate of any inpatient OR procedure in any age group, decreasing by about 26 percent annually between 2003 and 2012.

■ Comparing men and women—Musculoskeletal procedures were common among both men and women. The OR procedure with the greatest change in rate among men was brachytherapy (–30.2 percent) and among women was gastrectomy (+14.9 percent).

■ Comparing payer groups—Knee arthroplasty was the most common OR procedure for stays paid by Medicare and by private insurance. Cholecystect-omy was most common for stays paid by Medicaid and for uninsured stays.

 

Hospital re-admissions

In 2012, there were approximately 847,000 hospital stays for mood disorders and 383,000 stays for schizophrenia.

■ Within 30 days, 9.0 percent of initial inpatient stays for mood disorders were readmitted with a principal diagnosis of mood disorders, 12.6 percent were readmitted with any diagnosis of mood disorders, and 15.0 percent were readmitted for any cause.

■ Within 30 days, 15.7 percent of initial inpatient stays for schizophrenia were readmitted with a principal diagnosis of schizophrenia, 18.6 percent were readmitted with any diagnosis of schizophrenia, and 22.4 percent were readmitted for any cause.

■ Only 1.0–1.6 percent of stays for mood disorders or schizophrenia involved home health care following discharge compared with 14.1 percent of stays for conditions other than mental or substance use disorders (M/SUDs).

■ Average hospital costs for mood disorders and schizophrenia were lower than average costs for non-M/SUD stays, for the initial stay and for 30-day readmissions.

■ Compared with initial stays for mood disorders, average hospital costs were higher for readmissions involving mood disorders and for readmissions for any cause ($7,100 and $7,200, respectively, vs. $5,800).

■ Patients covered by Medicare or Medicaid had higher rates of 30-day readmission involving mood disorders or schizophrenia than did privately insured and uninsured patients (approximately 40–75 percent higher).

readmissions.JPG

Sepsis, the most expensive health condition

Sepsis is a life-threatening condition that arises when the body’s response to infection injures its own tissues and organs.[1] Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion.[2] There may also be symptoms related to a specific infection, such as a cough with pneumonia, or painful urination with a kidney infection. In the very young, old, and people with a weakened immune system, there may be no symptoms of a specific infection and the body temperature may be low or normal rather than high.[3] Severe sepsis is sepsis causing poor organ function or insufficient blood flow. Insufficient blood flow may be evident by low blood pressure, high blood lactate, or low urine output. Septic shock is low blood pressure due to sepsis that does not improve after reasonable amounts of intravenous fluids are given.[4]

Sepsis is caused by an immune response triggered by an infection.[3][5] The infection is most commonly bacterial, but it can be from fungi, viruses, or parasites.[3] Common locations for the primary infection include lungs, brain, urinary tract, skin, and abdominal organs. Risk factors include young or old age, a weakened immune system from conditions such as cancer or diabetes, and major trauma or burns.[2] Diagnosis was based on meeting at least two systemic inflammatory response syndrome (SIRS) criteria due to a presumed infection.[3] In 2016 screening by SIRS was replaced with qSOFA which is two of the following three: increased breathing rate, change in level of consciousness, and low blood pressure.[6] Blood cultures are recommended preferably before antibiotics are started; however, infection of the blood is not required for the diagnosis.[3] Medical imaging should be done to look for the possible location of infection.[4] Other potential causes of similar signs and symptoms include anaphylaxis, adrenal insufficiency, low blood volume, heart failure, and pulmonary embolism among others.[3]

Sepsis is usually treated with intravenous fluids and antibiotics. Antibiotics are typically given as soon as possible. This is often done in an intensive care unit. If fluid replacement is not enough to maintain blood pressure, medications that raise blood pressure can be used. Mechanical ventilation and dialysis may be needed to support the function of the lungs and kidneys, respectively.[2] To guide treatment, a central venous catheter and an arterial catheter may be placed for access to the bloodstream. Other measurements such as cardiac output and superior vena cava oxygen saturation may be used. People with sepsis need preventive measures for deep vein thrombosis, stress ulcers and pressure ulcers, unless other conditions prevent such interventions. Some might benefit from tight control of blood sugar levels with insulin.[4] The use of corticosteroids is controversial.[7] Activated drotrecogin alfa, originally marketed for severe sepsis, has not been found to be helpful and was withdrawn from sale in 2011.[8]

Disease severity partly determines the outcome with the risk of death from sepsis being as high as 30%, severe sepsis as high as 50%, and septic shock as high as 80%.

hospital conditions

The term “σήψις”[79] (sepsis) was introduced by Hippocrates in the fourth century BC, and it meant the process of decay or decomposition of organic matter.[80] In the eleventh century, Avicenna used the term “blood rot” for diseases linked to severe purulent process. Though severe systemic toxicity had already been observed, it was only in the 19th century that the specific term – sepsis – was used for this condition.

The terms septicemia, also spelled septicaemia, and blood poisoning referred to the microorganisms or their toxins in the blood and are no longer commonly used.[12][11]

By the end of the 19th century, it was widely believed that microbes produced substances that could injure the mammalian host and that soluble toxins released during infection caused the fever and shock that were commonplace during severe infections. Pfeiffer coined the term endotoxin at the beginning of the 20th century to denote the pyrogenic principle associated with Vibrio cholerae. It was soon realised that endotoxins were expressed by most and perhaps all gram-negative bacteria. The lipopolysaccharide character of enteric endotoxins was elucidated in 1944 by Shear.[81] The molecular character of this material was determined by Luderitz et al. in 1973.[82]

It was discovered in 1965 that a strain of C3H/HeJ mice were immune to the endotoxin-induced shock.[83] The genetic locus for this effect was dubbed Lps. These mice were also found to be hypersusceptible to infection by gram-negative bacteria.[84] These observations were finally linked in 1998 by the discovery of the toll-like receptor gene 4 (TLR 4).[85] Genetic mapping work, performed over a period of five years, showed that TLR4 was the sole candidate locus within the Lps critical region; this strongly implied that a mutation within TLR4 must account for the lipopolysaccharide resistance phenotype. The defect in the TLR4 gene that led to the endotoxin resistant phenotype was discovered to be due to a mutation in the cytoplasm.[86]

Society and culture

Economics

Sepsis was the most expensive condition treated in U.S. hospital stays in 2011, at an aggregate cost of $20.3 billion for nearly 1.1 million hospitalizations.[87] Costs for sepsis hospital stays more than quadrupled since 1997 with an 11.5 percent annual increase.[88] By payer, it was the most costly condition billed to Medicare, the second-most costly billed to Medicaid and the uninsured, and the fourth-most costly billed to private insurance.[

There is hope when you have no medical insurance

What to do if you have no health insurance but still need medical care”…. This subject is very near and dear to my heart.

As a nurse, I know how important it is to do whatever you have to do to stay healthy. Neglecting to stay on top of a “small” medical condition like a simple cough that won’t seem to go away can turn into a life-threatening pneumonia.

But I also know that paying for medical care is very expensive. When you have to decide whether to pay for your blood pressure pills verses food for your family or gas for your car, trying to do the right thing can become blurred.

There is hope!

There are a growing number of assistance programs to help those with no health insurance, or those who need assistance paying their premiums or co-payments. Hopefully, the resources and recommendations provided here will help make the decision to stay on top of your health clearer and easier.

    • CoverageforAll.org provides a state-by-state directory which answers many of your insurance questions and provides contact information. Some of the topics it addresses include considerations with COBRA and if alternatives are better for your circumstances, determining eligibility in programs based on the Federal Poverty Level, are you and your family eligible for Medicaid, how to apply for children’s healthcare coverage and more.To find out more go to: http://coverageforall.org/resources.
    • If you have children but have no health insurance, Insure Kids Now is a wonderful resource.Insure Kids Now is a state and Federal government program which provides medical, dental and psychological care for children through the Children’s Health Insurance Program (CHIP).Their website includes how to apply for coverage, finding healthcare providers in your area and more. To learn more, go to their website at www.insurekidsnow.gov or to find how to apply for coverage go to http://www.insurekidsnow.gov/state/index.html.
    • In 1993, legislation was passed to allow states to create a safety net for individuals who had been, or could be, denied healthcare coverage due to pre-existing conditions. Many states now have their own High Risk Pool (http://www.naschip.org/states_pools.htm) for those with no health insurance or those who are facing high insurance costs due to pre-existing conditions.States contract with major insurance carriers to manage the high risk pool programs and offer plans that are similar to individual policies offered by these carriers. You can even choose your own deductible.The plans are created to be affordable while providing you with comprehensive healthcare coverage.To see if your state participates in the High Risk Pool program you can go to http://www.naschip.org/states_pools.htm or, to learn more about the High Risk Pool program you can go to: http://www.naschip.org/portal/.
    • Free clinics are also an option if you have limited health coverage or no health insurance. The United States Department of Health and Human Resources provides a list of free clinics in your area. To find a health center in your area go to: http://www.hrsa.gov/gethealthcare/affordable/index.html. If you are a member of a federally-recognized American Indian or Alaska Native Tribe, services are also available through the Indian Health Service.
  • No health insurance? This is not a problem for most urgent care facilities. Most facilities are able to offer cash paying patient 20% off of their services and will work with you to provide you with the care you need.
  • Some urgent care facilities will offer a family package. Your package would include basic exams plus any urgent care you or your family may have throughout the year.My husband and I have been very impressed with the compassion and high quality care provided by the urgent care facilities near our home.Check with your local urgent care provider to see what they have to offer.
  • Nonprofit hospitals must provide you with emergency medical care regardless of your ability to pay. Often times these facilities are able to write off a certain portion of your bill and/or help you set up low payment plans if you are able to provide them with proof of your income.Some physicians may be willing to negotiate a lower rate for uninsured, cash-paying patients. This website, written by 2 doctors, should give you good reason to ask for a lower rate if you have no health insurance. It’s becoming more widely known about the disparity in the charges for healthcare costs for those with insurance and those without.Whether you are negotiating rates with a lab or healthcare provider, the Healthcare Blue Book is a wonderful resource to help you determine the cost of medical services in your area. Having an idea of how much things cost can help you with your negotiations. The Healthcare Blue Book includes the cost of basic labs, dental services and more.For a percentage of your bill, you can hire a medical negotiating company to assist you in evaluating whether or not you have been over-charged and help you with the negotiating process.

    If you would prefer to use one of these agencies or you just want to see what they have to offer, you can find a list of medical negotiation companies at www.billadvocates.com.

  • There are more and more financial assistance programs available to those with no health insurance in need of help with dental care, prescription coverage, medical care, mental health needs, and even vision.I have listed quite a few resources located at the bottom of this page and will continue to add to them as I find more and more.If you would like to find some resources on your own and share them with others, you can Google® “patient assistance programs”.Don’t forget that Schools of Dentistry and Medical Schools can often provide you with free care!

    Some church organizations can also be a resource for individuals in need of counseling and support.

  • Prescription assistance and numerous $4 generic drug programs are popping up everywhere! The $4 generic drug programs are available to those without healthcare or those without prescription coverage on their health plan. Some of the bigger $4 programs include Target, Kroger, Safe-way and Sam’s Club/Wal-Mart.Many of the larger pharmacies such as CVS, Target, Walgreens and others offer American Automobile Association club members (AAA) prescription discounts.RxAssistance (www.rxassist.org) is run by pharmaceutical companies. The program provides free medications to those who cannot otherwise afford their prescription drugs.
  • “Millions of patients with rheumatoid arthritis, psoriasis and inflammatory bowel disease can be excited today because new research in the Annals of Internal Medicine shows that biosimilars are just as safe and effective as many of the expensive brand biologics prescribed for these conditions.

    The Biosimilars Council is pleased to see more science-based evidence that patients can trust biosimilars and that providers can confidently prescribe these medicines. This data reinforces the importance of core scientific principles such as bioequivalence and can help inform policymaker efforts to encourage patient access and promote biosimilar competition.”

    Other prescription programs include: RxHope (www.Rxhope.com), NeedyMeds (www.needymeds.org) and RxOutreach Assistance Program for Discount Prescription Drugs (www.rxoutreach.com).

    Many pharmaceutical companies such as Pfizer, and Merck also provide patient assistance programs. You can always check with the pharmaceutical manufacturer of brand name drugs to learn more about their programs for those with no health insurance, or if you need help with health coverage.

    While we are all facing challenging times, the good news is, with the growing number of assistance programs available your health does not have to suffer!

  • Older Americans with no health insurance can check for those resources and long-term care benefits and help with paying for food at BenefitsCheckup.org and Eldercare.gov.

Resources

www.naschip.org/states_pools.htm The National Association of State Comprehensive Health Insurance Plans provides this link for a state-by-state break down. If you would like to know more about the high risk program you can go to their site at www.naschip.org.

http://www.nlm.nih.gov/medlineplus/financialassistance.html The National Library of Medicine (NLM) and National Institute of Health is a great “one-stop shopping” site which provides you with links for Medicaid, Children’s health assistance programs, disease-specific assistance and more.

http://www.nmha.org/ go to the “Affiliate Search“ section of Mental Health America’s website to find treatment, support groups and a host of other resources available to low income individuals or individuals with no health insurance who find themselves in need of counseling or support.

http://www.hrsa.gov/gethealthcare/affordable/index.html The Health Resources and Services Administration (HRSA) provides a link to help you find a community health center in your area. Your local community health center can help address not only you physical, but your mental health issues as well.

http://www.thebody.com/index/hotlines/other.html The Body provides a state-by-state directory of resources available to those with HIV.

http://kidney.niddk.nih.gov/kudiseases/pubs/financialhelp/ The National Kidney and Urological Disease Information Clearing House provides listings of patient assistance programs (PAP’s) for those with kidney disease who are in need of medical and prescription coverage in addition to links to Medicare and Medicaid.

http://www.needymeds.org/ Needy Meds is a non-profit organization which provides resources for those who cannot afford medical care or prescriptions. Their website provides links to SCHIP, Medicaid, patient advocacy groups and other programs.

http://www.pparx.org/en/prescription_assistance_programs Partnership for Prescription Assistance provides links to co-payment programs in addition to links for financial assistance for prescription medications.

http://www.1dental.com/discount-dental-plans/ Carington Dental Plan provides affordable dental, vision and prescription coverage.

I was happy to see that there are quite a few dentists who are participating in this program including my dentist! HURRAY! Now I can get my teeth taken care of too!

http://www.eyecareamerica.org/ Eye Care America provides links for resources (financial assistance and more) for seniors, patients with diabetes, glaucoma, medication assistance and more for those with vision care needs.

http://www.aoa.org/visionusa.xml Vision USA is another organization which helps provide eye care to those who do not qualify for Medicaid.

http://insurekidsnow.gov/index.html You can go directly to the website for the Children’s Health Insurance Program (CHIP) to learn more about the program including how to apply for dental and medical care for your child.

http://www.cnn.com/2009/HEALTH/02/12/ep.health.insurance.help/index.html CNN has provided a wonderful article entitled “No Health Insurance? Get help here” This is a wonderful article which provides ideas on ways you can lower your healthcare costs if you have limited coverage or no health insurance.

http://www.healthwellfoundation.org/ HealthWell Foundation is a non-profit organization that assists those with insurance who are unable to afford their co-payments.

www.familywize.com FamilyWiz is a non-profit organization that provides free prescription discount cards. The cards can be used by those with no health insurance, and for those with healthcare coverage during deductible. This site will tell you more about the program and where to find the cards!

www.copays.org Patient Advocate Foundation (PAF) Co-Pay Relief (CPR) program provides financial assistance for those who meet the medical and financial qualifications. PAF covers a vast array of healthcare conditions. Go to their website to see if you qualify.

http://nccam.nih.gov/health/financial/#financialsources The National Center for Complimentary and Alternative Medicine (NCCAM) provides information about sources for financial assistance for complementary and alternative medicine.

https://www.usa.gov/health Health Resources from the Government is an absolute treasure chest of information!! Information on childcare, health insurance, vaccines and immunization, doctors and medical facilities, health issues, medication and food and nutrition can be found here.

Islets of Hope provides an extensive list of resources for persons with diabetes, including state-by-state resources, Canadian and New Zealand resources, charitable and private resources (including those for pump supplies), etc. An extensive source, especially if you have no health insurance and are trying to pay for diabetic supplies.

An additional page of resources can be found at ‘Insurance Resources’, which provides links to other organizations and government agencies.

Motherhealth – Health Mobile Outpatient application (in development) is inviting all doctors to join and provide video chat with patients and simple out-of-pocket costs for patients. Email motherhealth@gmail.com

 

How do you think about the news that a commonly used anti-inflammatory drug may be able to treat Alzheimer’s disease?

My answer to How do you think about the news that a commonly used anti-inflammatory drug may be able to treat Alzhe…

Answer by Connie b. Dellobuono:

Meds may alleviate some of the inflammation in AD (caused by toxins/inflammation) but acidic meds can create more unwanted bacteria in the gut, causing mental health issues. One study should be duplicated/validated by many more researchers.
Brain Damage from HIV, Alzheimer's May Involve Inflammation
December 14, 2001
 News Office: Kevin Boyd (415) 476-8429
Both HIV and Alzheimer's disease can damage the brain, but most people think the similarity between the two ends there. Recent research from San Francisco Veterans Affairs Medical Center (SFVAMC) suggests a closer connection — the brain damage from both diseases appears to involve inflammation, suggesting that anti-inflammatory drugs could help.
 The latest findings to support this link show that AIDS dementia, like Alzheimer's, may now be a chronic condition. The study, published in the latest issue of the journal AIDS, shows that immune cell markers of AIDS dementia remain even after a patient is treated with anti-retroviral drug cocktails.
 These same markers are elevated in patients with Alzheimer's disease, said lead author Lynn Pulliam, chief of microbiology at SFVAMC and UCSF professor of laboratory medicine and medicine.
 "The brain wages an immune response against HIV infection. We believe that the brain is damaged by inflammatory toxins that are released as part of the brain's immune response. The amyloid plaques of Alzheimer's are also believed to cause a toxic inflammatory response," Pulliam said.
 Certain anti-inflammatory drugs may be able to reduce the damage from these toxins, according to cell culture studies published earlier this year in the journal Brain Research by Pulliam's group. The brains of AIDS dementia patients have increased numbers of immune cells called monocyte/macrophages, which secrete chemicals that are toxic to cultured brain cells. The study found that treatment with an experimental anti-inflammatory drug developed by Centaur Pharmaceuticals prevented this toxicity.
 The same drug, called CPI-1189, has been tested on patients with AIDS dementia in preliminary Phase II clinical trials, and it appears to improve patients' performances on tests of psychomotor and cognitive function, according to Centaur Pharmaceuticals.
 "It would be very exciting if anti-inflammatory drugs turn out to be an effective additional treatment for AIDS dementia, or for Alzheimer's disease, because it would be a relatively simple approach that we already understand to some degree," Pulliam said.
 Recent research from other investigators has suggested that non-steroidal anti-inflammatory drugs, such as ibuprofin, may help to delay the onset of Alzheimer's disease, further supporting the importance of inflammation in both AIDS dementia and Alzheimer's, Pulliam said.
 The new study from Pulliam's group focuses on a subset of monocyte/macrophages that are more numerous in both AIDS dementia and in Alzheimer's disease.
 Monocyte/macrophages that display a surface molecule called CD69 are much more prolific in the blood of AIDS dementia patients and patients with Alzheimer's disease than in healthy people.
 The study found that after AIDS dementia patients were treated with a complete anti-AIDS drug regimen, their levels of CD69 cells were somewhat lower but still higher than non-demented AIDS patients and similar to those of patients with Alzheimer's disease.
 "It appears that HIV-associated dementia has evolved into a more protracted disorder. Although treatment with anti-retroviral drugs appears to cause macrophages monocyte/macrophages to secrete lower levels of toxins, a more subtle neurotoxicity continues to disable neurons," Pulliam said.
 This neurotoxicity appears to alter levels of important structural and functional proteins in the brain, she said.
 Co-authors on the paper in AIDS included Leonard Kusdra, staff research associate; and Dr. Dawn McGuire, UCSF assistant clinical professor of neurology and medicine.
 This study was supported by a grant from the National Institute of Mental Health.
 The San Francisco Veterans Affairs Medical Center has been a primary affiliate of University of California, San Francisco since 1974. The UCSF School of Medicine and the SFVAMC collaborate to provide education and training programs for medical students and residents at SFVAMC. SFVAMC maintains full responsibility for patient care and facility management of the medical center.

How do you think about the news that a commonly used anti-inflammatory drug may be able to treat Alzheimer’s disease?

How do you treat stomach bloating?

My answer to How do you treat stomach bloating?

Answer by Connie b. Dellobuono:

Chew food well. Take digestive enzymes in the morning (and probiotics 3hrs before a meal ) or eat pineapple /papaya after a meal (20min). Drink water 15min after meal. Walk after a meal. Do not chew gums on empty stomach. The carbohydrates found in some vegetables can produce gas, bloating and flatulence:
•Artichokes
•Asparagus
•Beets
•Broccoli
•Brussel sprouts
•Cabbage and sauerkraut
•Carrots
•Cauliflower
•Celery
•Corn
•Green peppers
•Leeks
•Legumes (i.e. black-eyed peas, bog beans, broad beans, field beans, lima beans,
 mung beans, pinto beans, red kidney beans, baked beans, bean salads, chickpeas,
 chili, lentils, lentil soup, peanuts, peanut butter, peas, dried peas, split-pea
 soup, soybeans, soy milk, tofu, and other soy products). Note: Soak beans overnight, remove white frothy bubbles on top of the boiling beans.
•Onions
•Parsley
•Potatoes
•Radishes
•Sweet peppers
Other gas/flatulence producing vegetables include,
•Cucumbers
•Kohlrabi
•Lettuce
•Rutabaga
•Turnips
•Zucchini
Breads, grains, cereals, and nuts:
Some people can’t digest wheat properly which can lead to fermentation and gas build-up when eating wheat and wheat products such as,
•Bagels
•Breakfast cereals
•Whole grain breads
•Whole wheat flour
•Pastries
Other difficult to digest grains and nuts include,
•Barley
•Granola
•Oat bran
•Oat flour
•Pistachios
•Rice bran
•Rye
•Sesame flour
•Sorghum
•Sunflower flour
•Wheat bran

How do you treat stomach bloating?

Why you need a second opinion, second doctor?

Sometimes, two sets of eyes are needed to identify all areas in your body that might be contributing to your health issues.  Some families have children who are doctors or scientists while some do not have those advantage.

What to do? In our mobile health app, Motherhealth – Health Mobile Outpatient, you get to video chat with as many doctors to identify your team as you need a team or a village to care for your demanding health concerns.

We welcome all doctors to join our cause of reducing chronic health care costs via  a mobile application that will match providers with patients, monitor and engage every team, and report health data both patient generated and doctor generated.

Email motherhealth@gmail.com , 408-854-1883

We also welcome mobile app developers and data scientists to join our cause.

Together we can have an impact on the health care delivery where access can be that easy using a mobile health app. More doctors listening to your health concerns and build a team that will help you get through the challenges in your health from internist, neurologist, nutritionist, health coach, physical therapist, caregivers and other allied health from the comfort of your home.

What are the side effects of dopamine and serotonin antagonists?

My answer to What are the side effects of dopamine and serotonin antagonists?

Answer by Connie b. Dellobuono:

Dopamine antagonists: Parkinsonism, stiff muscles; the major adverse neuropsychiatric effects seen with these medications are acute dystonias, akathisia, parkinsonian symptoms, and neuroleptic malignant syndrome
Serotonin antagonists: changes in electrical conduction of the heart, disturbance of live function, stomach pain, headaches, dizziness
Constipation is the most common side effects of most antagonists meds.

What are the side effects of dopamine and serotonin antagonists?

In Sympathetic Nervous System Why the digestion of food is slow? Where as in fight or flight we need more energy.?

My answer to In Sympathetic Nervous System Why the digestion of food is slow? Where as in fight or flight we need m…

Answer by Connie b. Dellobuono:

There are hormones involved in preparation (norepineprine), during and after (acetylcholine) the fight/flight reaction.
Preparation
The effect of norepinephrine on each target organ is to modify its state in a way that makes it more conducive to active body movement, often at a cost of increased energy use and increased wear and tear.
After the fight:
The acetylcholine-mediated effects of the parasympathetic nervous system, which modifies most of the same organs into a state more conducive to rest, recovery, and digestion of food, and usually less costly in terms of energy expenditure.
——
During
The fight and flight reaction begins in the amygdala, which triggers a neural response in the hypothalamus. The initial reaction is followed by activation of the pituitary gland and secretion of the hormone ACTH. The adrenal gland is activated almost simultaneously and releases the hormone epinephrine. The release of chemical messengers results in the production of the hormone cortisol, which increases blood pressure, blood sugar, and suppresses the immune system. The initial response and subsequent reactions are triggered in an effort to create a boost of energy. This boost of energy is activated by epinephrine binding to liver cells and the subsequent production of glucose.
Additionally, the circulation of cortisol functions to turn fatty acids into available energy, which prepares muscles throughout the body for response.
Preparation:
Catecholamine hormones, such as adrenaline (epinephrine) or noradrenaline (norepinephrine), facilitate immediate physical reactions associated with a preparation for violent muscular action. These include the following:
– Acceleration of heart and lung action
– Paling or flushing, or alternating between both
– Inhibition of stomach and upper-intestinal action to the point where digestion slows down or stops
– General effect on the sphincters of the body
– Constriction of blood vessels in many parts of the body
– Liberation of metabolic energy sources (particularly fat and glycogen) for muscular action
– Dilation of blood vessels for muscles
– Inhibition of the lacrimal gland (responsible for tear production) and salivation
– Dilation of pupil (mydriasis)
– Relaxation of bladder
– Inhibition of erection
– Auditory exclusion (loss of hearing)
– Tunnel vision (loss of peripheral vision)
– Disinhibition of spinal reflexes
– Shaking
Function of physiological changes
The physiological changes that occur during the fight or flight response are activated in order to give the body increased strength and speed in anticipation of fighting or running. Some of the specific physiological changes and their functions include:
– Increased blood flow to the muscles activated by diverting blood flow from other parts of the body.
– Increased blood pressure, heart rate, blood sugars, and fats in order to supply the body with extra energy.
– The blood clotting function of the body speeds up in order to prevent excessive blood loss in the event of an injury sustained during the response.
– Increased muscle tension in order to provide the body with extra speed and strength.
—–

Norepinephrine is the main neurotransmitter used by the sympathetic nervous system, which consists of about two dozen sympathetic chain ganglia located next to the spinal cord, plus a set of prevertebral ganglia located in the chest and abdomen.[10] These sympathetic ganglia are connected to numerous organs, including the eyes, salivary glands, heart, lungs, liver, gallbladder, stomach, intestines, kidneys, urinary bladder, reproductive organs, muscles, skin, and adrenal glands. Sympathetic activation of the adrenal glands causes the part called the adrenal medulla to release norepinephrine into the bloodstream, from which, functioning as a hormone, it gains further access to a wide variety of tissues.

The sympathetic effects of norepinephrine include:
In the eyes, an increase in production of tears, making the eyes more moist.,[12] and pupil dilation through contraction of the iris dilator.
In the heart, an increase in the amount of blood pumped.
In brown adipose tissue, an increase in calories burned to generate body heat.[14]
Multiple effects on the immune system. The sympathetic nervous system is the primary path of interaction between the immune system and the brain, and several components receive sympathetic inputs, including the thymus, spleen, and lymph nodes. However the effects are complex, with some immune processes activated while others are inhibited.[15]
In the arteries, constriction of blood vessels, causing an increase in blood pressure.[16]
In the kidneys, release of renin and retention of sodium in the bloodstream.[17]
In the liver, an increase in production of glucose, either by glycogenolysis after a meal or by gluconeogenesis when food has not recently been consumed.[17] Glucose is the body's main energy source in most conditions.
In the pancreas, increased release of glucagon, a hormone whose main effect is to increase the production of glucose by the liver.[17]
In skeletal muscles, an increase in glucose uptake.[17]
In adipose tissue (i. e., fat cells), an increase in lipolysis, that is, conversion of fat to substances that can be used directly as energy sources by muscles and other tissues.[17]
– In the stomach and intestines, a reduction in digestive activity. This results from a generally inhibitory effect of norepinephrine on the enteric nervous system, causing decreases in gastrointestinal mobility, blood flow, and secretion of digestive substances.
Source: Wiki

In Sympathetic Nervous System Why the digestion of food is slow? Where as in fight or flight we need more energy.?

How do I get rid of bad breath? Where do bad breath came from?

My answer to How do I get rid of bad breath? Where do bad breath came from?

Answer by Connie b. Dellobuono:

Wash mouth and tongue properly. Add 3% hydrogen peroxide in your mouth wash (homemade, add salt), peppermint essential oil drops, eucalyptus oil drops and eat red colored fruits (strawberries,berries) and apples.
Take probiotics, eat pickled veggies and eat raw cilantro and carrots. Chew your food well. Eat papaya and pineapple 20min after a meal. Breath through your nose. Exercise.
https://clubalthea.com/2016/07/12/dry-mouth-and-bad-breath-by-dr-mercola/
https://clubalthea.com/2016/07/22/what-causes-bad-breath-and-how-can-it-be-avoided/

How do I get rid of bad breath? Where do bad breath came from?

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