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Abdominal Development

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* Remove grains from the diet ( Breads) , also whole grain doesn't make it much better because most of the fiber has still been taken out. * You generally want to stick with slow digesting foods (Low GI foods) during every part of the day except around strenuous activity like a workout, where you should have a fast digesting carb (High GI food) mainly after and during a workout. * Low GI Foods - most dairy products, most fruits and vegetables, whole unrefined grains and sprouted grains, sweet potatoes, barley, beans, and most other higher fiber carbohydrate sources. * High GI Foods - white rice, white bread, white potatoes, low fiber cereals such as corn flakes and crispy rice cereals, sugars (except fructose), ice cream, bananas, cooked carrots, candy, cakes and other baked goods, and any other refined carbohydrates where the fiber has been removed. * After workout have a shake with whey protein isolate & some frozen fruit as your carb source, or if you don't have time a dextrose blend. * Adding a higher GI food with healthy fats and protein sources will slow down the speed at which that sugar is broken down, as opposed to if it was eaten on its own. * The more fiber that the food contains, the slower it will digest. * You want to eat products that contain at least 2 grams or more of fiber per each 10 grams of total carbohydrates. * Eliminate pasta & rice from your diet and instead eat a protein source with a fibrous vegetable source. * Eating healthy fats will actually help you to lose fat, as long as proportion sizes are not over done. * Wild caught fish, and organic grass fed meats are always the best option, as the animals haven't been feed grains, an antibiotics etc. * If you can’t order grass-fed meats from the site above, and you don’t have access to wild game, your next best options for healthier meats are organic and/or free range meats * Try to minimize milk as much as possible if you’re not going to be able to get raw milk. * Great sources of monounsaturated fat are extra virgin olive oil, avocados, pecans, macadamias, and almonds. * One of the best sources of fish oil I’ve found is a carefully extracted Krill Oil, which has been tested as having up to 47x more antioxidant power than standard fish oil. * Freshly ground flax seeds, fish oil, walnuts, wild salmon and other fatty wild fish, and grass-fed meats are the best natural sources of omega-3’s helping to bring you back to a normal balance of omega-6 to omega-3 polyunsaturated fatty acids. * The best fats to cook or fry with are actually saturated fats such as coconut oil, palm oil, or butter * However, to reduce calories, keep in mind that you can also cook without oils by methods such as steaming, baking, or boiling instead of frying.

* Examples of healthy fats to include in your diet are nuts, preferably raw if you can find them (pecans, walnuts, almonds, macadamias, cashews, etc.), seeds (pumpkin seeds, de-shelled sunflower seeds, flax seeds, sesame seeds), avocados (or guacamole), extra virgin olive oil, coconut (coconut milk and/or virgin coconut oil), “natural” or “organic” peanut butter (or other natural nut butters like almond butter, etc), fish and fish oils (including the highest antioxidant containing fish oil – krill oil), and even cocoa butter (from dark bittersweet chocolate – look for chocolate with 70% or greater cocoa content as this has much lower sugar levels than milk chocolate or standard dark chocolate).

* Add raw nuts and seeds to your diet are to add them to yogurt, cold cereal, hot cereal, and salads. * Each meal you consume throughout the day generally should contain some kind of protein in it, as you will be needing the amino acids. * Here are the foods that should comprise the majority of your diet in order to promote a lean healthy body for life:

Any and all vegetables, any and all fruits, healthy white and red meats (preferably free range, organic, and/or grass-fed), wild fish, dairy (preferably raw, organic and/or grass-fed), whole eggs (including the yolks where almost ALL of the nutrition is located), whole unrefined grains, legumes (peas, beans, peanuts), whole grain or sprouted grain bread, high fiber cereals (avoid low fiber cereals, even if they are unsweetened; they are acceptable only as a post-workout meal), any and all nuts (if you’re not allergic to any), seeds, nut butters (peanut, almond, cashew butters, etc), tubers (sweet potatoes, whole potatoes), and non-hydrogenated minimally processed oils (such as extra virgin olive oil, Udo’s Choice oil, and virgin coconut oil). * Try to avoid drinking fruit juices. ( Main reason is that juices don't contain the fiber) * Eating 5-6 small meals per day means eating approximately every 3 waking hours throughout the day. * Make sure to eat breakfast every morning, as this helps to speed up your metabolism, if you were to skip it your metabolism would slow and you would store fat easier. * When using sweetners, make sure to use natural honey, organic maple syrup or stevia. * Higher dietary calcium intake promotes a leaner body, and the best sources of calcium are dairy products like raw milk, yogurt, cottage cheese, ricotta cheese, and other cheeses (preferably raw if you can find them). * Several types of tea contain other compounds that can significantly enhance your fat loss efforts. * Green tea and oolong tea are the best for fat loss. * Brewing batches of a mixture of green, oolong, black and white teas and refrigerate this as iced tea, will assure all of the fat loss benefits, and to sweeten you can add some stevia. * Drinking a glass of the iced tea mixture with each of your first three meals of the day (no later than mid-afternoon, so as not to interfere with your sleep at night).

* Adding some extra chili or cayenne pepper to your eggs, meat dishes, and other meals is a good idea because it will help with fat loss and give you some much needed antioxidants. * Hops in beer contain a lot of estrogen which is not good when you are trying to lose weight, therefore limit consumption to once a week or an alternative would be red wine or vodka and soda water as it doesn't have to much sugar in it. * The most highly estrogenic foods to try to avoid:
 Any soy-based foods
 Foods that are fried in or made with soybean oil
 Beer (or hops in anything else)
 Licorice
 Try to avoid foods highly laden with pesticides (choose organic over conventional when possible)

* The best foods to fight against excess estrogenic compounds:
 Cruciferous vegetables - broccoli, cauliflower, cabbage, and brussel sprouts
 Citrus fruits – oranges, grapefruit, lemons, limes
 Raw honey (you can find raw honey at http://healthygrassfed.2ya.com )
 Chamomile and passionflower (can find in teas)
 Onions and garlic
 Green tea (yet another reason to drink green tea)
 Leafy greens (lettuce, spinach, etc)
 Berries (blueberries, blackberries, strawberries, raspberries…organic is best)
 Extra virgin olive oil
 Wild fatty fish (salmon, trout, etc)
 Raw nuts and seeds (pecans, almonds, walnuts are some of the best)
 Grass-fed meat and dairy
 Spices such as turmeric (and curry), oregano, thyme, rosemary, ginger, and sage.

Summary of Dietary Strategies to Reduce Body Fat

* Eat 5-6 small meals per day of relatively equal proportions; you should try to eat a meal about every three waking hours * Plan all of your meals for each entire week; only choose the items you need for your planned meals when you’re at the grocery store (if you don’t have junk around the house, you most likely won’t eat junk) * Calculate your daily caloric requirements to lose weight; don’t obsess over calories, but try to stay approximately where you need to be to lose weight * Eat a portion of lean protein at each meal, along with a portion of fibrous healthy carbohydrates, and a portion of healthy fats * Focus on unrefined, unprocessed foods in their natural state * Focus on lower glycemic index carbohydrate sources for the majority of your meals, but don’t worry about avoiding healthy higher glycemic index choices like bananas, raisins, and carrots; these foods have beneficial nutrients and the glycemic response can be controlled if the portions are kept low and combined properly with other foods * Eat higher glycemic index carbohydrate sources (sugars and lower fiber complex carbs) along with protein immediately after your intense workouts to replenish muscle glycogen and start the muscle repair process; a 2:1 to 4:1 ratio of carbs to protein immediately following your workouts best facilitates the recovery process * Avoid fad diets or “crash” diets

* Do not cut calories too low such that you create an energy deficit exceeding 1000 calories per day (i.e. if your maintenance caloric intake is 3000 cal/day, never go below 2000 cal/day); a 500-750 calorie/day energy deficit is best for fat loss while maintaining muscle; as a general rule, it is never recommended that females go below 1200 calories/day and males should never go below 1600 calories/day * Try to incorporate an overfeeding day once per week to stimulate your metabolism and to help you stay on a focused diet for the other six days per week * Avoid refined oils, trans fats, and high fructose corn syrup at all costs * Try to include green, oolong, black, and white teas into your daily diet to promote a slight edge in thermogenesis and fat burning; try the suggestion of mixing all four of these teas into an iced tea mixture and drinking it throughout the first half of each day * If you can handle spicy food, don’t be afraid to include chili and cayenne pepper in your foods to benefit from the slight metabolic boost and antioxidant benefits of capsaicin * As long as you’re not lactose intolerant, include at least 3-4 servings of dairy (raw grass-fed dairy is best) and other sources of dietary calcium into your daily plan to promote fat loss * Choose organic foods as often as you can to avoid the possible fat-storing effects of pesticides in your body * To help get rid of your stubborn belly fat, make sure to minimize (as best as possible) soy products, beer, and other estrogenic foods and try to focus on the estrogenic-fighting foods as listed in section 4.11

Abdominal Training

* Do abdominal training on a separate day, perhaps combined with a cardio-only day. * Also when doing abdominal exercises try not to arch your back, if anything round your back a touch and this will make your abdominals work harder, and use less hip flexor. * I recommend inserting a tough 5-10 minute ab routine into your workouts 2-3 times per week. * core of your ab training workouts will consist of exercises that are initiated with your lower body. In any given workout, once you’ve fatigued the abs with challenging exercises initiated with the lower body, then you can finish off with the easier exercises that are initiated with your upper body. * So that your body doesn't get used to the exercises you're doing you can change the order of exercises, the amount of resistance, the volume of work (sets and reps), the rest periods, the rep speed, or even try a different angle of a certain exercise for variety.
The Good Exercises (focus on these)

 Hanging leg raises (with hunched back)
 Hanging knee raises (with hunched back)
 Lying leg thrusts (hip thrusts)
 Decline bench leg thrusts (hip thrusts)
 Reverse crunches (crunching hips off floor)
 Ab bicycles (alternating knees to elbows)
 Ab scissors
 Stability ball crunches (weighted for progression)
 Bench crunches
 Alternating (oblique) crunches
 Weighted cable rope crunches (with hunched back)
 Ab wheel
 Stability ball hip flexion (knee tucks)
 Stability ball plank holds
 Floor side plank holds
 Abdominal vacuums (transversus abdominis development)

Core-strengthening and functional warm-up exercises into your routine such as:

 Straight leg bridge with double leg curl on stability ball
 Straight leg bridge with single leg curl on stability ball
 Mountain Climbers
 Mountain Jumpers
 Opposite raise from four point position
 Opposite raise from push-up position
 Medicine ball or cable lateral chopping on stability ball
 Reverse back/hip extensions on stability ball
 Breakdancers

* These core-strengthening exercises are a great addition to your routines as part of a “functional warm-up” in the beginning of your workout instead of or in addition to a traditional brief cardio warm-up.

Level 1 * Lying leg thrusts – 2 x 5 * Reverse crunches – 2 x 5 * Ab bicycles – 1 x 20 (each knee to elbow counts as one rep) * Alternating crunches – 1 x 15 * Bench crunches - 1 x15 * Abdominal vacuums

Level 2 * Lying leg thrusts – 3 x 8 * Reverse crunches – 3 x 6 * Ab bicycles – 1 x 24 * Stability ball crunches – 1 x 10 * Alternating crunches - 1 x 18 * Stability ball plank holds - 1 x 30-60 seconds * Abdominal vacuums * www.TruthAboutAbs.com * 80

Level 3 * Decline board leg thrusts - 2 x 8 * Lying leg thrusts – 2 x 10 * Reverse crunches – 1 x 10 * Ab scissors – 1 x 8 * Stability ball hip flexion – 1 x 12 * Ab bicycles – 1 x 30 * Stability ball crunches – 1 x 12 * Alternating crunches – 1 x 20 * Stability ball plank holds – 1 x 45-60 seconds * Abdominal vacuums

Level 4 * Hanging knee raises – 2 x 8 * Decline board leg thrusts – 1 x 10 * Lying leg thrusts – 1 x 12 * Stability ball hip flexion – 1 x 15 * Ab bicycles – 1 x 30 * Stability ball crunches with arms straight over head – 1 x 10 * Stability ball plank holds – 1 x 45-60 seconds * Alternating crunches 1 x 20 * Floor side plank holds – 1x 30 seconds each side * Abdominal vacuums

Level 5 * Hanging leg raises – 2 x 5 * Hanging knee raises – 2 x 10 * Ab wheel – 1 x 6 * Decline board leg thrusts – 1 x 12 * Lying leg thrusts – 1 x 15 * Ab scissors – 1 x 10 * Stability ball crunches holding light weight straight over head – 1 x 10 * Stability ball plank holds – 1 x 60-70 seconds * Floor side plank holds – 1x 30-40 seconds each side * Abdominal vacuums

Level 6 * Hanging leg raises – 3 x 6 * Hanging knee raises – 3 x 8 * Lying leg thrusts – 2 x 15 * Ab wheel – 1 x 8 * Ab bicycles – 1 x 30 * Stability ball crunches holding light weight straight over head – 1 x 12 * Stability ball hip flexion – 1 x 15 * Abdominal vacuums * www.TruthAboutAbs.com * 81

Level 7 * Hanging leg raises – 4 x 8 * Hanging knee raises – 1 x 10 * Decline board leg thrusts – 1 x 15 * Ab bicycles – 1 x 30 * Ab wheel – 1 x 10 * Stability ball plank holds – 1 x 70-80 seconds * Floor side plank holds – 1 x 40-50 seconds each side * Weighted cable rope crunches – 1 x 12

Level 8 * Hanging leg raises - 4 x 10 * Hanging knee raises – 1 x 12 * Decline board leg thrusts – 1 x 15 * Lying leg thrusts – 1 x 15 * Ab scissors – 1 x 20 * Stability ball plank holds – 1 x 80-90 seconds * Floor side plank holds – 1 x 40-50 seconds each side * Ab wheel – 2 x 10 * Ab bicycles – 1 x 30 * Alternating ab crunches – 1 x 20 * Weighted cable rope crunches – 1 x 15

* At this point, if you’ve worked up to level 8, and can complete all of the prescribed sets and reps in level 8, there is no way that you don’t have a well developed set of abs. At this point, if you still can’t see a defined six-pack, then your body fat % is still too high, and you must look again at your diet and your full body training routine as a whole.

* You need to create approximately a 3500-calorie deficit to lose 1 lb of body fat/weight)

Daily Caloric Needs:

Multiply your calculated RMR (below) by 1.3 (sedentary), 1.4 (moderately active), or 1.5 (very active). If you work out intensely 4-5 days/week or are active in sports or outdoor activities, use 1.5 as the multiplying factor.

RMR expressed in calories (kcal)/day
Height expressed in inches
Weight expressed in pounds
Age expressed in years

For men: RMR = 66 + (12.7 x height) + (6.27 x weight) – (6.8 x age)
For women: RMR = 655 + (4.57 x height) + (4.36 x weight) – (4.7 x age)

Example: A 190-lb male, 6’0” tall, 28 yrs old, very active
Daily caloric requirements for weight maintenance =
1.5 x (66 + (12.7 x 72) + (6.27 x 190) – (6.8 x 28)) = 2972 calories/day

Generally, it is considered safe and more effective in the long term to lose only 1-2 lbs per week. If you lose the weight slower, you will generally be able to maintain more muscle.

You need to create approximately a 3500-calorie deficit to lose 1 lb. Hence, if the male in the example above would like to lose 1-lb per week, he could reduce his daily caloric intake by about 500 calories/day to around 2472, or any other combination to create a 3500-calorie deficit per week.

As you saw in section 4.5, I recommend a slightly different approach to reach that calorie deficit, which actually involves a day of overfeeding. Yes, you can actually purposely overeat once a week and still get lean! ( With this basically get most of your food sources from carbohydrates, but still stay away from the bad foods).

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...Draft of Intern’s Project Penetrating Abdominal Injuries at Georgetown Public Hospital Corporation (GPHC). Investigator: Hemraj Ramcharran Supervisors: Dr Shilendra Rajkumar Dr Madan Rambaran Abstract Many cases of penetrating abdominal injuries present to the Georgetown Public Hospital all of which are managed by the department of Surgery. No audit has been conducted on the management of these injuries and their success rates. Hence this prospective study “Penetrating abdominal Injuries at Georgetown Public Hospital (GPHC)” seeks to shed some light in these areas in terms of percentage of abdominal injuries managed surgically or conservatively and diagnostic adjuncts used in the management of these patients. Studies done in other countries clearly show that there is a steady and progressive movement away from surgical management of penetrating abdominal wounds towards conservative management. The study is a prospective one that will extend over the period (April 01 – Sept 31). The study population will consist of persons over 12 years old and admitted for penetrating abdominal injury. Data will be collected by means of a form shown in appendix 2. This form has three parts which are biodata, immediate management and subsequent management. These forms will be in the accident and emergency room and the surgical wards. On admission of the patient, the on call surgical GMO or Intern will fill out the...

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Hall V Hilbun

...against Dr. Hilbun, a general surgeon who performed surgery on Terry Hall. She was complaining about abdominal pain. He consulted and operated on her for a small bowel obstruction, which she consented to. After he observed her in the recovery room, he left for the night. Throughout the night, she started having more and more pain and her vital signs were abnormal, but Dr. Hilbun was never notified of such pain. He was notified about another patient of his and failed to check up on Mrs. Hall and she later died of respiratory failure in the morning. The nurses at the hospital were never ordered to call him if things changed with Mrs. Hall. An autopsy was done and it showed that a sponge had been left in her abdominal cavity but it did not cause her death. Mrs. Hall's husband filed a malpractice/wrongful death case against Dr. Hilbun stating that he failed to follow-up after the operation and give post-operation instructions to the nursing staff. At the trial, Hall's husband called Dr. Hoerr as a witness but was disqualified because he was not familiar with the local standard of care, only the national one. After reading about this case, I believe that Dr. Hilbun was at fault for the four D's of negligence. The first D is duty, which there was a patient and physician relationship. He did perform an exploratory laparotomy on her for a bowel obstruction after she came in for abdominal pain. The second would be derelict, which means the patient would have to prove the physician failed...

Words: 279 - Pages: 2