First Aid For Back Pain

First Aid For Back Pain

Many people are having back pain acutely sometime for one or two days. It is not just moving carefully; you don’t need to do anything because this will cure with self. But, for some people got very bad pain that limit the daily activities and working ability. In many cases we cannot know what is the cause of back pain. It could be some p in joints, muscles, or another soft tissues, but mostly the doctor cannot know what exactly the cause. But don’t worry most of back pain gone it self, and mostly back pain patient just need mild treatment, such as:

1.       Drink pain killer medicine such as Parasetamol and Ibuprofen. These medicine are suggested because have less side effect. You will need a stronger side effect from the doctor only if that is really needed.

2.       Get to sleep for a while is very helpful, but too much sleep sometime makes worst. After have a rest in your bed, moving carefully before you are back to your activity.

3.       Cold compress maybe helpful for decreasing the pain on your back. Another way is putting warm compress on your back or having a hot bathing. But these method sometime will not makes any different, just for a while of pain relief.

4.       Doing some mild exercise.

Those are tips for first aid backs pain treatment, after that you must back to activity for prevent the next pain attack.

If you have a back pain until four weeks or six weeks later, you need to meet your therapist:

1.       Doctor with special ability of back pain treatment.

2.       Physiotherapist expert.

3.       Osteopathy expert.

4.       Back pain treatment expert.

Physiotherapist is trained to manipulate your movement and power. Usually the physiotherapist will do physical movement treatment, mild massage, and warm therapy. Osteopathy expert will manipulate the joints. A back pain treatment expert is using a special pushing technique, fast and smooth, but osteopathy expert is using slowly movement and more general technique. Base of those treatment are same physical movement and exercise.

Some patient with Sciatica (nerve pressure) using painkiller, takes some rest, and move slowly will helpful, but in late improvement. In some cases, patient with sciatica need to have operation for decreasing the nerve pressure. Surgery operation is rarely needed, because only work for sciatica with legs pain, not pain on the back.

Physical exercise is good for the back, but don’t do strong and suddenly movement.

Dr. Agung         

Mesothelioma

Mesothelioma is a disease because of the growing and the divide abnormally and uncontrolled of mesothelium cells. The growth will invade and damage tissues and organs around it. Mesothelium is a membrane that covers and protects most of internal organs. The most of the abnormal growth is in Pleura, the membrane that cover the lung, most of because of asbestos.

There are three major histological type of mesothelioma: sarcomatous, epithelial and mixed. Pleural mesothelioma usually begins as discrete plaques and nodules that coalesce to produce a sheetlikeneoplasm. Tumor growth usually begins at the lower part of the chest. The tumor may invade the diaphragm and encase the surface of the lung and interlobar fissures.

The tumor may also grow along drainage and thoracotomy tracts. As the disease progresses, it often extends into the pulmonary parenchyma, chest wall, and mediastinum. Pleural mesothelioma may extend into the esophagus, ribs, vertebra, brachial plexus, and superior vena cava.

Asbestos, amphibole asbestos, asbestos-crocidolite, and amosite asbestos in particular, is the principal carcinogen implicated in the pathogenesis. Exposure to chrysotile asbestos is associated with a lower incidence of mesothelioma. The industries associated with asbestos exposure include mining, ship building involving the use of asbestos, asbestos cement manufacture, ceramics, paper milling, auto parts (asbestos brake lining), railroad repair, and insulation. In Turkey, the use of the fibrous substance erionite (similar to amphibole asbestos) in building construction has led to an epidemic of pulmonary mesothelioma. Environmental exposure to asbestos in areas polluted by the substance may increase the incidence of mesothelioma.

Most malignant mesotheliomas have complex karyotypes, with extensive aneuploidy and rearrangement of many chromosomes. A loss of a single copy on chromosome 22 is the most common abnormality.

Causes:

·          A substantial proportion of patients were exposed to asbestos in asbestos mills, shipping yards, mines, or their homes.

·          The crocidolite in asbestos is associated with mesothelioma in miners, manufacturers (using asbestos), and heating and construction workers. The rod-shaped amphiboles are more carcinogenic than the chrysotile.

·          Malignant mesothelioma has also been linked to therapeutic radiation using thorium dioxide and zeolite, a silicate in the soil.

·          An etiological role for simian virus 40 in malignant mesothelioma has also been suggested. Asbestos exposure alone was associated with malignant mesothelioma, but simian virus 40 alone was not; thus, some epidemiological evidence exists that simian virus 40 is a possible cocarcinogen. Its direct role at this point is still controversial.

·          Interleukin 8 has direct growth-potentiating activity in mesothelial cell lines.

·          Loss of one copy of chromosome 22 is the single most common karyotypic change in malignant mesothelioma. Other chromosomal changes commonly observed include 1p, 3p, 9p, and 6q. Several changes in the tumor suppressor gene p16 (CDKN2A) and p14 (ARF) and loss of function of neurofibromin 2 (NF2) or merlin are altered.

Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritonealmesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.

A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform athoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, andchemotherapy. Sometimes, these treatments are combined.

Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.

Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).

To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is calledthoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.

Heart Failure

Heart failure happens when the heart cannot pomp enough blood volume for body metabolism demand. In clinically, there is left and right heart failure but very rare it is happen without involving the other side. Heart failure is almost always a chronic, long-term condition, although it can sometimes develop suddenly.

Heart failure is often classified as either systolic or diastolic.

·          Systolic heart failure means that your heart muscle cannot pump, or eject, the blood out of the heart very well.

·          Diastolic heart failure means that your heart's pumping chamber does not fill up with blood.

The most of etiology of heart failure is heart ischemic disease. It is very important to indicate the cause of heart failure for preventing from losing management of the real problem. 

Other problems that may cause heart failure are:

·          Congenital heart disease

·          Heart valve disease

·          Some types of abnormal heart rhythms (arrhythmias)

·          Hypertension

·          Lung emboli

·          Anemia

·          Thyroids toxicity

·          Myocarditic

·          Infectious Endocarditic

·          Cardiomyophaty

·          Thiamine deficiency  

Diseases such as emphysema, severe anemia, hyperthyroidism, or hypothyroidism, may cause or contribute to heart failure

In left ventricle heart failure we found symptoms: breathe difficulty in activity, orthopne and nocturnal dispne paroxysmal.

In right ventricle heart failure we found symptoms: edema on feet and felling discomfort on upper right quadrant.

The general symptoms are: exhausted and lethargy.

The sigs are: edema on feet and sacrum, increasing of jugular vein pressure, basal crepitating, larger size of liver (hepatomegali) and heard of three and four heart sounds.

The Stages of Heart Failure – NYHA Classification

In order to determine the best course of of therapy, physicians often assess the stage of heart failure according to the New York Heart Association (NYHA) functional classification system. This system relates symptoms to everyday activities and the patient's quality of life.

Class	Patient Symptoms
Class I (Mild)	No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea (shortness of breath).
Class II (Mild)	Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.
Class III (Moderate)	Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea.
Class IV (Severe)	Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.

Investigation:

1.       Chest X-ray: bigger size of heart (kardiomegali), lung vain stretching, Kerley B line, alveolar edema, and plural effusion.

2.       ECG: hypertrophy of left ventricle, p-mitral in mitral steno tic or evidences of ischemic heart.

3.       Echocardiograph, we can look the heart problem clearly from monitor.

If you have heart failure, your doctor will monitor you closely. You will have follow up appointments at least every 3 to 6 months and tests to check your heart function. For example, an ultrasound of your heart (echocardiogram) will be done once in awhile to see how well your heart pumps blood with each beat.

You will need to carefully monitor yourself and help manage your condition. One important way to do this is to track your weight on a daily basis. Weight gain can be a sign that you are retaining fluid and that your heart failure is worsening. Make sure you weigh yourself at the same time each day and on the same scale, with little to no clothes on.

Other important measures include:

·          Take your medications as directed. Carry a list of medications with you wherever you go.

·          Limit salt intake.

·          Don’t smoke.

·          Stay active. For example, walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan based on your degree of heart failure and how well you do on tests that check the strength and function of your heart. DO NOT exercise on days that your weight has gone up from fluid retention or you are not feeling well.

·          Lose weight if you are overweight.

·          Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest as well. Keep your feet elevated to decrease swelling.

Here are some tips to lower your salt and sodium intake:

·          Look for foods that are labeled “low-sodium,” “sodium-free,” “no salt added,” or “unsalted.” Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A nutritionist can teach you how to understand these labels.

·          Don’t cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG).

·          Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese.

·          Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese.

·          Use oil and vinegar, rather than bottled dressings, on salads.

·          Eat fresh fruit or sorbet when having dessert.

Your doctor may consider prescribing the following medications:

·          ACE inhibitors such as captopril, enalapril, lisinopril, and ramipril to open up blood vessels and decrease the work load of the heart

·          Diuretics including hydrochlorothiazide, chlorthalidone, chlorothiazide, furosemide, torsemide, bumetanide, and spironolactone to help rid your body of fluid and salt (sodium)

·          Digitalis glycosides to increase the ability of the heart muscle to contract properly and help treat some heart rhythm disturbances

·          Angiotensin receptor blockers (ARBs) such as losartan and candesartan to reduce the workload of the heart; this class of drug is especially important for those who cannot tolerate ACE inhibitors

·          Beta-blockers such as such as carvedilol and metoprolol, which are particularly useful for those with a history of coronary artery disease

Certain medications may make heart failure worse and should be avoided. These include nonsteroidal anti-inflammatory drugs, thiazolidinediones, metformin, cilostazol, PDE-5 inhibitors (sildenafil, vardenafil), and many drugs that treat abnormal heart rhythms.

Valve replacements or repair coronary bypass surgery (CABG), and angioplasty may help some people with heart failure.

The following devices may be recommended for certain patients:

·          A single or dual chamber pacemaker to help with slow heart rates or certain other heart signaling problems

·          A biventricular pacemaker to help the left and right side of your heart contract at the same time.

·          An implantable cardioverter-defibrillator to correct or prevent severe arrhythmias (abnormal heart rhythms)

Severe heart failure may require the following treatments:

·          Intra-aortic balloon pump (IABP), a temporary device placed into the aorta

·          Left ventricular assist device (LVAD), which takes over the role of the heart by pumping blood from the heart into the aorta; it's most often used by those who are waiting for a heart transplant.

Note: These devices can be life saving, but they are not permanent solutions. Patients who become dependent on circulatory support will need a heart transplant.

Heart failure symptoms may be improved with biventricular pacemaker or cardiac resynchronization therapy. Ask your provider if you are a candidate for this type of treatment.

An innocent child can infect by HIV. How can they infected and how to prevent it

Andy (not the real name) is two years old child, looks happy playing with boxes as car toys. The body is thin, fungus marks on his skin, arms, legs, and face. In two months he is normal. In third months, his weights decrease drastically and got many times illness. Eva (not the real name), the mother, said he got HIV infection and tuberculosis that infected by her husband. Andy is not alone; Indonesian Health Department has data that HIV in Indonesia is about 28,260 counted in June 2009. From this number, 2.5% is child under five years old. These innocent children got infected from the mother, that the husband whom like to playing with hookers and using injection drugs.

Professor Djayakusumah the chief of HIV/AIDS team Hasan Sadikin Hospital said the possibility of infection when still in the womb is 5 – 10%, because of delivery 10 – 20 %, and from breastfeeding is 10 – 12%. If has known the mother infected, must giving treatment to the mother for preventing the child being infected.

Children under five years that infected by HIV so far only can survive until 8 years old. But how people with HIV need to have a child? But don’t want the child to be infected by HIV. They can have a child with prevention from the mother to child transmition program. Doctor Sumantri the vice chief of HIV/AIDS team Hasan Sadikin Hospital said the HIV patient can have a child with some special rules. Infected males with immunity indicator increasing more then 500 mmõ CD4. The Viral in blood stream are being checked and also any wound or scratch in genital. The fertility of the female checked, and only the doctor can decide its okay. And, the mother is giving ARV (antiretroviral) when 7^th months of pregnancy until delivery. The delivery method is Caesar operation. The ARV is giving to the baby for some weeks until the blood test show there is no virus in baby body. The mother cannot give breast-feeding to the baby.

They whom infected can survive if consumes the ARV regularly and free from the side effect. The children whom has infected by HIV must takes ARV in whole of their life.

People should concern for being checked because of the high risk. Before married, pregnant, employees’ recruitment, student recruitment, police and army recruitment, and working abroad should check. But it is cannot be done because violated the human right. HIV and AIDS knowledge must always spread to every working places, schools, and communities. Hope there is no children again like Andy.

Dr. Agung