PRIMARY HEALTH CARE

IMPORTANCE OF PRIMARY HEALTH CARE IN SINGAPORE

by Kenneth Kee 1991

A Dissertation Presented in Partial Fulfilment of the Requirements for the Degree of Master of Science with a Major in Health Management and approved in 1991

ABSTRACT OF DISSERTATION

Health care is divided into:

1.Primary Health Care (Government Outpatient Doctors, General Practitioners)

2.Secondary Health Care ( Specialist Doctors and Clinics)

3.Tertiary Health Care (Hospital Doctors and Institutional Clinics)

In the past, secondary and tertiary health care have always been the most important agenda in the Singapore Government Health Care Plan.

There has upgrading of specialist clinics and hospitals in Singapore.

In stark contrast the Primary Health Care sector has remained rather stagnant and even comparatively underdeveloped.

Perhaps this is because hospital and specialist health care carry a glamor about it unlike the Primary Health Care doctor who works in the community outsides the confines of the hospital setting.

It is therefore important that the Primary Health Care should be emphasized as the foundation of any good Health Care System.

Unlike the specialist and hospital medicine which represents only the tip of the iceberg of morbidity in a whole community, Primary Health Care covers the whole spectrum of undifferentiated illnesses with its continuing care and management of the whole person from infancy to death.

The WHO at the Alma Ata conference has adopted the objective of "Health For All" which is a rallying call to the international community to enable attainment by all the citizens of the world of a level of health that will permit them to lead a socially and economically productive life.

"Primary Health Care address the main health problems in the community providing promotive, preventive, curative and rehabilitative services accordingly.Since these services reflect and evolve from the economic conditions and social values of the country and community but will include at least:
promotion of proper nutrition and adequate supply of safe water,
basic sanitation,
maternal and child care including family planning,
immunization against the major infectious illnesses.
prevention and control of local endemic diseases,
education concerning prevailing health problems and the methods of preventing and controlling them,
and appropriate treatment of common diseases and injuries."

REIKI

DOC WHAT IS REIKI

Reiki developed in 1922 by Japanese Buddhist Mikao Usui is a form  of complementary and alternative medicine using palm healing to transfer healing energy in the form of ki through the palms.

There are two main forms of Reiki:
1.Traditional Japanese Reiki
2.Western Reiki.

Reiki teachings claim that Reiki is inexhaustible and that it can be used to induce a healing effect.

Within both forms of Reiki, there are three forms of degrees:
1.The first degree Reiki course teaches the basic theories and procedures.
Students learn hand placement positions on the recipient's body that are thought to be most conducive to the process in a whole body treatment.
Having completed the first degree course, a Reiki practitioner can then treat himself and others with Reiki.

2.In the second degree Reiki course, the student learns the use of a number of symbols that are said to enhance the strength and distance over which Reiki can be exerted.

Having completed the second level, the student can work without being physically present with the recipient - a practise known as distant healing.

Students in Japan sometimes only attained the Second Degree after a period of 10, sometimes 20, years of practice.

3.Through the third degree, or "master training", the student becomes a Reiki Master.
The new Reiki Master can attune other people to Reiki and teach the three degrees.
The duration of the master training can be anything from a day to a year or more, depending on the school and philosophy of the Reiki Master giving the training.

There are commonly two types of Master:
Master Teacher  -a Master Teacher is a Master of Reiki and also has the ability teach Reiki
Master Practitioner - Master Practitioner is a Master of Reiki but does not teach Reiki.

Practice
The seven major chakras.
A schematic diagram of the human body's meridians.

In Western Reiki, it is taught that Reiki works in conjunction with the meridian energy lines and chakras through the use of the hand-positions, which normally correspond to the seven major chakras on the body. These hand-positions are used both on the front and back of the body, and can include specific areas

Healing
The Reiki practitioner touched the diseased parts of the body, he massaged them, tapped them lightly, stroked them, blew on them, fixed his gaze upon them for two to three minutes, and specifically gave them energy, and used a technique commonly referred to as palm healing

Whole body treatment
The Reiki practitioner instructs the recipient to lie down, usually on a massage table, and relax. Loose, comfortable clothing is usually worn during the treatment.

The treatment proceeds with the practitioner placing the hands on the recipient in various positions.
However, practitioners may use a non-touching technique, where the hands are held a few centimetres away from the recipient's body for some or all of the positions.
The hands are usually kept in a position for three to five minutes before moving to the next position.
Overall, the hand positions usually give a general coverage of the head, the front and back of the torso, the knees, and feet.
Between 12 and 20 positions are used, with the whole treatment lasting anywhere from 45 to 90 minutes.

Many Western practitioners use a common fixed set of 12 hand positions,

The use of the 12 hand positions energise on many levels by,

1.physical level through the warmth of the hands,
2.mental level through the use of the Reiki symbols,
3.emotional level through the love that flows with the use of the symbols,
4.energetic level though the presence of the Reiki practitioner as well as the Reiki power itself.

The recipient often feels warmth or tingling in the area being treated, even when a non-touching approach is being used.

A state of deep relaxation, combined with a general feeling of well-being, is usually the most common immediate effect of the treatment although emotional releases do occur.

The Reiki treatment is believed to stimulate the body's natural healing processes.

In a 2008 systematic review of randomised clinical trials assessing the evidence basis of Reiki,there is no proof Reiki had been effective for any condition.

SEXUAL HEALTH

DOC WHAT IS SEXUAL HEALTH?

Sex is the need for intimacy ,affection and emotional bond between a man and woman.

It is not just a physical relationship between 2 persons but an emotional tie between the two people called love.

A person's hunger for affection, intimacy, and emotional bond with another person is limitless.

Sexual health refers not only to reproductive sex and organs, but also the physical, emotional and social aspects of the sex act.

It is important to have a positive and respectful approach to sexuality and sexual relationships.

Any couple who has sexual health also feels well emotionally, mentally and socially when talking about sexual matters.

Here are some ways to achieve sexual health:

1. Understand sexuality

Sexuality is defined by the attitudes and values of a couple regarding sexual matters.

It represents a range of issues - from sexual thoughts and actions, to gender identity and roles.

Many factors,from biological,economic,and psychological factors, to social, ethical and religious ones.make up the complete entity of sexual attraction between a couple.

2. Understand that every one have sexual rights

The laws protect every person against sexual violations and discrimination.

Every person have the right to choose whether to be sexually active or not, and  have control over whom he/she wish to have sex with and how it is done.

3. Understand the partner’s sexuality

Because everyone is different, he/she have attitudes, feelings and desires that are different from his/her partner.

Once both partners understand and respect each other’s sexuality, he or she can improve their sexual health and pleasure.

It is therefore important to communicate each person's views to his or her partner and vice versa.

Once a person share what he or she is comfortable with and what he or she want in sex, they are both better prepared for sex.

4. Develop a healthy self-esteem for each other

A healthy self-esteem means to feel good about each other and be comfortable with whom each other are.

If every partner in a sexual relationship have a healthy self-esteem, the acceptance and enjoyment in each other’s presence is increased.

On the other hand, poor self-esteem often leads to unhealthy or even abusive relationships.

5.Always practice safe sex

Sexually Transmitted Infections (STIs) are contracted during unprotected sex and their symptoms vary widely.

The risk of contactiing STI is by practising safe sex, through the use of condoms.

Condoms however do not offer 100% protection so the best option is for a couple to be in a monogamous and faithful relationship.

With no fear of contracting STIs, the couple can relax and enjoy a pleasurable, healthy sexual relationship.

Some common STIs are:

HIV, the virus that causes AIDS

Chlamydia

Gonorrhoea

Herpes

Syphilis

Genital warts

It is important to treat STIs early to reduce complications and stop the spread of infection to others. Some STIs can be cured, while for AIDS, there is no cure.

6. Reproductive health is part of sexual health

Sexual health includes being able to have children, and planning when to have them.

Checkups on reproductive health means a regular visit to the gynaecologist.

Family planning is important so that the couple will never have to deal with an unwanted pregnancy or about passing an infection to the child.

7. Children should be educated about sexual health

There has been an increase in cases of teenage sex in the past few years.

This has resulted in a rise in unwanted pregnancies, abortions and STIs.

Being a parent it is important to keep the children safe from such consequences by educating them on sexual health.

It is important to start when they are young and just beginning to form their values and attitudes towards sex.

In summary, to be in good sexual health, the couple must pay attention not only to physical health.

Mental, emotional, spiritual and sexual health are equally important to achieve overall sexual health.

ANGER MANAGEMENT

DOC HOW DO I MANAGE MY ANGER

Anger is an emotion which is experienced by kids and adults alike as a normal response to interference by others in a negative manner.
Anger is a normal response to such a situation.

Anger can be classed as a mild or intense irritation.
It depends on the individual, the circumstance and their emotions.
1.Some people tend to keep their anger to themselves, bottling up their negative emotions and hurt.
2.Others lash out or become extremely defensive and even abusive.

Anger may be a healthy, normal emotion.
Regular episodes of angry or reckless behavior in a person can a problem, one that needs to be dealt with.
Anger can be also intense to the point of violence.
However when the anger takes over an individual's life, it can making them destructive to themselves and everyone around them. 

Controlling anger is considered anger management.
1.Most important to controlling anger is to admit there is a problem.
2.people who have major anger issues cannot see it.
3.They will continue down a path where they are constantly angry
4.Anger prevents them from seeking the help they require
5.The angry individual will likely experience loss of their family, their job and their own identity.
 
Anger management is designed to :
1.help the individual work out their problems,
2.help them figure out why they become so angry.
3.teach the person techniques which prevent them from getting angry as often or for very long.
4.help them have a better quality of life and live a healthy, normal life..

Anger management strategies are programs created specifically to help those with anger issues.
These programs address different people, kids, teens, adults, couples and families.
These programs are there to teach or help people to work on their anger.
Teaching people strategies to work out their problems and control their anger is important in anger management.
Every program is intended to help people who are hot-tempered and frequently have fits of rage.
Anger management strategies are designed to help an individual return to a healthy, normal existence.

1.Taking a time-out is considered a healthy management strategy.
Removing oneself from a situation or person that makes a person angry is practicing time-out.
This anger management strategy might simply require a ride in the car or a walk on the beach.
Playing sports or working out will help an individual to use up some of the extra energy without involving
Some other suggestions for time-out are reading, listening to music or sitting alone in silence.
Each of these activities are healthy anger management strategies.

2.A second example of a healthy anger management strategy is owning up to the anger.
Although the anger is usually brought on by an irritating situation or a confrontation with another individual, the anger actually belongs to the troubled person.
Only the person who's experiencing the anger issues can control their fits of rage.
He mustlearn anger management strategies and how to deal with his emotions in a healthy way.
When an individual becomes mad or upset he or she need to try to disclose the reasons for the anger whether it is hurt, fear, frustration sadness, confusion , jealousy or whatever seems to bring unleash the rage.

3.Another healthy anger management strategy is to look back on those situations that upset an individual and try to find ways to make changes.
Learning the cause of the anger may help the individual to avoid those situations.
Not only might the person learn to avoid these incidents but they might also choose to take what they've learned and attempt to deal with the situation without bursting into a frenzy.

4.A fourth suggestion regarding healthy management strategies is to confront the situation or person.
Talk to the person or people involved, calmly of course, to try to determine the root of the problem.
The angry individual might actually discover that the whole thing was a mix-up, a misunderstanding.
The individual might also try asking the person or people in the situation to think about their behavior and perhaps even change it.
It may be surprising what people would be willing to do to help the person who is attempting to deal with their problems with anger.
Hopefully everything will work out for the best.
If not there has to be room for acceptance.
Sometimes a person must simply accept the situations and people they cannot change and either deal with it or walk away.

Learning healthy anger management strategies should be considered by those with anger problems.

VEGETARIAN

DOC I AM A VEGETARIAN

A Vegetarian Diet is important for those people who opt for Optimal Personal and Environmental Health.

It’s been well documented through the years that vegetarians are healthier than people who eat meat.

Vegetarians are less likely to :
1.be obese
2.have high blood pressure,
3.diabetes,
4.rheumatoid arthritis
5.colon cancer
6.less likely to die from heart disease.

Vegetarians have lower blood pressure even when they eat the same amount of salt as meat eaters and exercise less.

Many studies show that vegetarians have less instances of colon cancer, due in large part to the differences in the bacterial flora that is present in the colon.

There are many factors in the vegetarian diet that contribute to better health.
1.Vegetarians consume two to three times as much fiber as do meat-eaters, which has been shown to reduce cholesterol and blood glucose levels, and protect against colon cancer.

2.They also consume more antioxidants, which are found in a wide variety of plant foods and protect cells from oxygen-induced damage and reduce the risk for heart disease, arthritis, cancer, and other diseases.

3.Vegetarians eat more isoflavones than do meat eaters. These compounds, found mostly in soy foods, are a type of phytochemical. Research shows that isoflavones may reduce the risk for prostate cancer and may improve bone health.

4.Vegetarians also consume much less saturated fat and cholesterol than do meat eaters, resulting in significantly lower levels of blood cholesterol, decreased instances of heart disease and possibly for diabetes and cancer.

5.And, since vegetarians do not eat meat, they are not exposed to heme iron, a type of iron found in meat that may increase the risk of heart disease and cancer.

6.Lastly, being a vegetarian is not only optimally healthy for your body, but also for your your environment and the planet’s animals.

It allows you to live more harmoniously with the world around you, which improves mental and emotional health accordingly.

MASSAGE THERAPY

DOC WHAT IS MASSAGE THERAPY?

What is Massage Therapy?

Massage therapy is a form of therapy that a licenced massage therapist or physiotherapist does massage of painful muscles or the body to improve blood circulation in a patient.

Besides being able to help relieve sore muscles, massaging a body needs a massage therapist who know what are the risks, if there are any side effects and how it supplements conventional medicine for stress and improving blood flow in the body.

Types of Massage Therapy include:

1.reflexology,

2.shiatsu,

3.back massage,

4.hot stone,

4.deep tissue,

5.aromatherapy

6.Swedish.

7.Thai

Risks with  massage therapy  can be avoided if you take the proper precautions.

The best thing to do will be to consult with your doctor to see if it is safe for you to see a masseuse.

Patients who have the following conditions should not undergo massage therapy. These include 1.deep vein thrombosis that happens to be a blood clot in a deep vein, usually in the legs,

2.bleeding disorder or taking blood-thinning drugs such as warfarin,

3.damaged blood vessels

4.weakened bones from osteoporosis,

5. recent fracture,

6.cancer.


7.fever, 

8.open injury,

9.damaged nerves, 

10.an infection or acute inflammation.

Certain conditions could also be dangerous if you decide to have a massage. These include 1.pregnancy,

2.cancer,

3.fragile skin,

4. dermatomyositis

5.heart problems,

Side effects associated with massage therapy include:

1.temporary pain or discomfort,

2.bruising,

3.swelling

4.sensitivity or allergy to massage oils.

Massage therapy should not be used a substitute for regular medical care.

If your doctor tells you that you can see a massage therapist, do some research about the person.

You should check on their credentials or licenses, years of experience and training.

If you need massage therapy to help cure medical condition, find out beforehand if they have specialized training in this field.

It would not hurt to also ask if they use other practices aside from massage therapy to help their patients.

Some examples of these include the use of herbs and requiring the patient to go on a special diet.

Some people may even ask for a free ten minute test to see how well they perform.

The best part about massage therapy is that it can provide relief without the need to ingest pain killing drugs and knowing some facts about it is good so you know what you are getting yourself into once you visit the place.

As long as there is no dangers or side effects, going for a session of massage therapy by a licenced massage therapist to relieve some stress or pain may be beneficial for your health

PHYSIOTHERAPY

DOC WHAT IS PHYSIOTHERAPY

Physiotherapy is also known as physical therapy of medical conditions. That answers the question of what is physiotherapy for many people.

As a supplementary type of health care, physiotherapy concerns itself with providing physical healing methods for many different kinds of injuries and illnesses.

Therapy at a Physiotherapy Clinic:

When a patient is referred to the physiotherapy clinic, he or she will be evaluated by a physiotherapist.

After this initial evaluation, he or she will be scheduled for treatments like ultrasound or acupuncture etc as recommended by the doctors in conjunction with the physiotherapists.

They will be assigned exercises to do at the clinic. A good physiotherapist will begin treatment right away.

The different types of Physiotherapy:

1.massage or manipulation (hands-on) of the musculo-skeletal system when the muscles and tissues are injured.

2.Traction of the skeletal system to lengthen the spaces between bones so that nerves or tendons are pressed on by the bones

3.Strengthening of the muscular system helps the patient to recover from surgery as well as prevention of tightening of the muscles and tendons and making them more flexible.

4.Heat (heat pads, infra-red light, shortwave diathermy) help the blood circulating after injuries and help earlier recovery

5.ice (cold compress) help to reduce swelling and tissue damage

6.ultrasound treatment, radiofrequency waves , are all useful to relieve pain and stiffness.

7.Hyperbarbaric treatment: Increase in oxygen pressure can improve the faster healing of injuries and recovery from surgery.

All these methods tend to promote better health, both physical and psychological.

The importance of physiotherapy equipment:

Equipment for helping patients regain their strength and mobility are a part of what is physiotherapy. This equipment may allow a person who is partially paralyzed to get the most exercise possible. This is crucial in maintaining the integrity of their spines and muscles.

The importance of Education in Physiotherapy:

Besides the methods used in Physiotherapy, education is a part of what is physiotherapy. A physiotherapist will teach a patient how to care for their injuries. He will teach exercises to do at home so that therapy can continue beyond the walls of the clinic or hospital. He will teach ways to overcome difficulties that cannot be cured.

Rehabilitation is another part of Physiotherapy treatment:

Patients have injuries from sports, car accidents, or assault. These injuries can be treated through physiotherapy. Given the right treatments and an injury that will respond to treatment, much progress can be made. Full functioning may be regained. It may even be possible for them to go back to work rather than being laid up at home.

Physiotherapy is a carefully planned and executed treatment strategy.

It is based upon assessments of the conditions that patients suffer. If all goes well, the patient will return to their original condition. If this is not possible, the goal is for the patient to reach a goal that is the best movement and lack of pain that is possible.

The preventative side of the field of physiotherapy is very important in the overall holistic treatment of a patient.

It is a part of the work of practitioners of physiotherapy to encourage exercises and postures that will help patients avoid physical injuries and conditions requiring their services.

An excellent physiotherapist will have fewer return patients, but the flow of people needing physiotherapy continues.

YOGA

DOC WHAT ARE THE HEALTH BENEFITS OF YOGA

Yoga is a physical, mental, and spiritual discipline, originating in ancient India,whose goal is the attainment of a state of perfect spiritual insight and tranquility.

The goals of yoga are varied and range from improving health to achieving Moksha which is liberation from all worldly suffering and the cycle of birth and death .

The more technical sense of the term "yoga", describing a system of meditation or contemplation with the aim of the cessation of mental activity and the attaining of a "supreme state" .

"Ashtanga Yoga" ("Eight-Limbed Yoga").

The Eight Limbs are:
1. Yama (The five "abstentions"):
non-violence,
non-lying,
non-covetousness,
non-sensuality,
non-possessiveness.

2. Niyama (The five "observances"):
purity,
contentment,
austerity,
study,
surrender to god.

3. Asana: means "seat", and refers to the seated position used for meditation.

4. Pranayama ("Suspending Breath"):
interpreted as control of the life force.

5. Pratyahara ("Abstraction"):
Withdrawal of the sense organs from external objects.

6. Dharana ("Concentration"):
Fixing the attention on a single object.

7. Dhyana ("Meditation"):
Intense contemplation of the nature of the object of meditation.

8. Samadhi ("Liberation"):
merging consciousness with the object of meditation.

Types of Yoga are:
1. Raja Yoga: the first yoga the path of meditation
2. Karma yoga: The yoga of action.
3. Bhakti yoga: The yoga of devotion,
4. Jnana yoga: The yoga of knowledge.
5. Hatha Yoga: the purification of the physical body as leading to the purification of the mind.

The Hatha Yoga is generally the yoga accepted by the western world as the yoga which they practiced .

Health benefits of yoga:
Yoga came to the attention of an educated western public in the mid 19th century as a form of purely physical system of health exercises :
1.meditation
2.breathing
3.concentration

Yoga is used for treatment of cancer patients :
1.to decrease depression,
2.reduce insomnia,
3.relieve pain, and fatigue
4.control anxiety.

stress.
Treatment with yoga reported significantly :
1.less mood disturbance and
2.reduced stress
3.positive effects on sleep anxiety,
4.better quality of life,

Schizophrenia:
Yoga's ability to
1.improve cognitive functions
2.reduce stress
makes it appealing in the treatment of schizophrenia because of its association with cognitive deficits and stress related relapse.

Heart disease.
studies of the effects of yoga on heart disease suggest:
1. yoga may help reduce high blood pressure,
2.improve symptoms of heart failure,
3.enhance cardiac rehabilitation,
4.lower cardiovascular risk factors.

Other health benefits:
1. musculoskeletal and mental health improvements,
2.reduced symptoms of asthma in asthmatics.
3.improve mood and anxiety more than other exercises, such as jogging or walking.

MEDITATION

DOC WHAT IS MEDITATION?

Meditation is a method to make the mind calmer and more focused.

Meditation can also help to understand body and mind interaction.

Meditation can help to transform the mind:
1.from negative to positive,
2.from disturbed to peaceful,
3.from unhappy to happy.

Overcoming negative minds and cultivating constructive thoughts is the purpose of the transforming meditations found in the Buddhist tradition.

There is the need for Meditation because:
1.many people feel stressed and over-worked as the result of the hectic pace and stress of modern life
2.there appears to be insufficient time in the day to get everything done.
3.The stress and tiredness make people unhappy, impatient and frustrated.
4.Loss of self confidence in achievements can cause despondency or irritation.

The Purpose of Meditation is:
1.The purpose of meditation is to make the mind calm and peaceful.
2.If the mind is peaceful, there will no worries and mental discomfort and true happiness will be achieved
3.Meditation training will help the mind to gradually become more and more peaceful and a purer form of happiness will be obtained.
4.Eventually the person will be able to stay happy all the time even during the most difficult circumstances.
5.Training in meditation creates an inner space and clarity that enables the person to control our mind regardless of the external circumstances.
6.Gradually the person develop mental equilibrium, a balanced mind that is happy all the time.
7.In this way the person will come to experience a permanent inner peace known as nirvana where day and night in life after life there will be only peace and happiness.

The Benefits of Meditation are:
1.Meditation will remove all distracting thoughts and there will a sense of inner peace and relaxation.
2.When the otherwise incessant flow of distracting thoughts is calmed through concentrating on the breath, the mind becomes unusually lucid and clear.
3.The mind will feel lucid and clear and the body will feel refreshed.  
4.It is possible to experience inner peace and contentment just by controlling the mind without having to depend at all upon external conditions.
5.Much of the stress and tension comes from our mind
6.When the turbulence of distracting thoughts subsides and their mind becomes still, a deep happiness and contentment naturally arises from within.
7.This feeling of contentment and well-being helps the mind to cope with the busyness and difficulties of daily life.
8.Many of the problems in life including ill health are caused or aggravated by this stress and can be overcome with meditation.
9.Difficult situations will become easier to deal with.
10.The mind will naturally feel warm and well disposed towards other people, and the relationships with others will gradually improve.

A Simple Breathing Meditation

1.The first stage of meditation is to stop distractions and make the mind clearer and more lucid. This can be accomplished by practising a simple breathing meditation.
2. Choose a quiet place to meditate and sit in a comfortable position.
The most important thing is to keep the back straight to prevent the mind from becoming sluggish or sleepy.
3.First stop distractions and make the mind clearer and more lucid.
4.Sit with our eyes partially closed and turn the attention to the breathing.Breathe naturally, preferably through the nostrils, without attempting to control the breath.Be aware of the sensation of the breath as it enters and leaves the nostrils.
5.remain focused single-pointedly on the sensation of the breath
6.Slowly by focusing on the breathing, the mind becomes relaxed and that is the essence of meditation .

TINNITUS TREATMENT

DOC I NEED TINNITUS TREATMENT

Treatment depends on the type of hearing loss and degree of tinnitus.
A.Medicines and others
1.antianxiety or antidepressant medication

2.relaxation techniques help when stress is a factor.

3.Avoiding caffeine which may worsen symptoms.

4.Biofeedback may  diminish tinnitus in some patients.

5.Avoid aspirin  in large quantities

6.protection of hearing and avoiding loud noises

B.Non-invasive.
The treatment can be in the form of
1.hearing aid,
Hearing Aid  may have dual functions. It helps to improve hearing acuity, clearer speech understanding as well as to cover the tinnitus effect. However, it may be unsuitable for people with a reduced sound tolerance level, and sensitivity to loud, unpleasant sounds .

2.Tinnitus Retraining Therapy (TRT),
Tinnitus Retraining Therapy (TRT) has been widely used for many years.
The approach is to desensitize the tinnitus via a broadband tinnitus masker (such as the sound of a fan, radio, or white noise machine) along with a specific course of counselling to retrain the brain of sufferers until they are habituated to the tinnitus and it is no longer disturbing.

The therapy may be long-term and time-consuming.

3.Neuromonics tinnitus treatment -very successful in ‘desensitizing’ patients towards their tinnitus.
The sound stimulus is transmitted at specific intervals coordinated with embedded music  2-3 hours a day when the tinnitus is most disturbing.
The idea is to desensitize the brain’s limbic system until patients becomes used to it and get relief.
The treatment can occur while reading, relaxing, doing house chores, computer work or before going to bed. During the treatment process, patients are guided through an interactive and progressive programme of care with the audiologist, as they adjust to each stage of treatment. The audiologist will then assess the patients’ progress.

It is a 6 months program involving the following stages:
1.Pre-conditioning stage (first 2 months) – use of special shower sound to interact with the tinnitus.
2.Active stage (subsequent 4 months) – constant interaction with the tinnitus.

At the end of 6 months program, the sufferer enters the maintenance stage when he/ she can manage without clinical support.
Generally, the treatment involves stimulating the hearing pathways affected by tinnitus or hearing loss with a customized music therapy.

Over 90% reported:
a.A relief from their tinnitus
b.Ability to sleep well
c.A sense of control over their tinnitus
d.A decreased sound disturbance from tinnitus

4.Counselling & Educational Support
If the tinnitus is not serious, the patients can see a counsellor or a psychologist for direct counselling program, and educational support. The purpose is to provide :
a.advice and information about tinnitus;
b.explain what self-help strategies are available for patients and how they work;
c.current medical treatment and management,
d.availability of group support and facilities.

C.Surgery
Surgery of the acoustic nerve to block the tinnitus only for individuals who're becoming or definitely deaf.

Other surgeries may be used when the tinnitus is caused by a tumor across the ear,  the tumor is usually eliminated.

Prognosis:
Depending on the type of tinnitus, symptoms will tend to recur over time.
Stress level, diet, and  noise exposure can worsen tinnitus.
Many people find their tinnitus annoying but can learn to adapt without difficulty.

Prevention:
1.Protect your hearing at work.
2.When around any noise that bothers your ears (a concert,  hunting), wear hearing protection or reduce noise levels.
3.Everyday noises such as blow drying the hair or using a lawnmower can require noise protection.Keep ear plugs or earmuffs handy for these activities.

TINNITUS

DOC I HAVE TINNITUS

Tinnitus is the symptom of perception of sound in the human ear or head in the absence of external sounds.
It is not a illness.
The sound is sometimes accompanied by hearing loss and dizziness in a syndrome known as Meniere's diseas

It affects a large proportion of adult population.
Almost 12 percent of men who are 65 to 74 years of age are affected by tinnitus.
1.Construction site workers
2.MP3 player users
3.Rock concert goers
4.Gun and rifle users

The causes of Tinnitus are:
1.hearing loss is the most common cause.
Age or trauma to the ear (through noise, drugs, or chemicals)cause the damage of the portion of the ear for hearing (the cochlea) becomes damaged.
Because the cochlea do not send the normal signals to the brain, the brain becomes confused and essentially develops its own sound (the tinnitus) to make up for the lack of normal sound signals.

2.ear trauma is usually noticed in both ears, because both ears are usually exposed

3.the harmful effects of excessively loud noise from firearms, high intensity music, or other sources is a very common cause of tinnitus because of  hearing damage

4.ear infection or excess wax in the ear can affect  the ear.

5.drugs such as aspirin (if overused), aminoglycoside antibiotics and quinine may damage the hearing nerve.

6.brain tumor known as an acoustic neuroma which grow on the nerve that supplies hearing can cause tinnitus.
This tinnitus usually affects one ear unlike  the hearing loss  seen in both ears.

Signs & Symptoms
The sound that they perceive in the ear or head has been described as:
1.ringing,
2.whistling,
3.vacuuming,
4.hammering,
5.buzzing
6.humming sounds.

About 2% of tinnitus sufferers have:
1.Disturbed sleeping patterns.
2.Anxiety and depression.
3.Inability to relax and concentrate.
4.Sensitivity to loud sounds and noises.
5.A negative impact on work, family and social life.

An ENT doctor may be consulted for tinnitus:

1.When medical and/or surgical contraindications are not present.
2.family members are worried or concerned about the “non-stop” tinnitus.
3.Your sleep, concentration and general health is affected.

Exams and Tests
1.complete history and physical examination of the head and neck
2.A complete hearing test (audiogram)
3.auditory brainstem response
4.brain scan such as a computerized tomography (CT) scan or magnetic resonance imaging (MRI) may also be required.
5.blood tests for hyperthyroidism may be taken.
6.spinal tap may be rarely performed to measure the fluid pressure in the skull and spinal cord.

EATING DISORDERS

DOC I HAVE EATING DISORDERS

Eating disorders is defined as the persistent refusal of a person to eat resulting in marked loss of weight.


It is a psychological problem with patient becoming obsessed with his or her so called obesity with intent to lose weight as a result  


This condition is more prevalent in women than in men.


Onset usually occur in puberty.

Eating disorders include:
1.anorexia nervosa - refusal to eat or eating very minimally
2.bulimia - eating followed by vomiting
3.binged eating with induced vomiting

The most common cause is obstensible fear of obesity resulting in excessive dieting.

There is this distorted image of the body size related to social norms and psychosexual conflicts.

Other causes are:
1.anxiety


2.depression


3.low self esteem


4.troubled family and personal relationships


5.history of physical or sexual abuse


6.cultural and social norms that value people on basis of physical appearance and not inner qualities and strength


7.sometimes may be hereditary - It may run in families

Symptoms of eating disorders are:
1.progressive and excessive weight loss


2.loss of muscle mass (thin stick like)


3.loss of bone mass with osteopenia, osteoporosis , possible fractures,


4.Damage to esophagus, lining of stomach, gastritis, bloating from gas


5.Associated induced endocrine changes (amenorrhea, hirsutism)


6.Stunted growth due to  insufficient growth hormones as a result of  malnutrition


7.Weakened immune system with icy hand and excess hairs on the skin (body too cold)


8.Anemia and Induced vitamin deficiency due to poor nutrition


9.Fainting spells, sleep disruptions, mental confusion, seizures due to insufficient nutrients to the brain


10.Low blood sugar with chills, giddiness, shaking and restlessness from insufficient absorption of sugars


11.Disruption of body fluid mineral balance especially potassium can affect the heart with irregular heart beat , cardiac arrest and death


12.general organ failure resulting in kidney and liver damage from insufficient nutrients to the body's organs


13.Constipation, urinary and anal incontinence, resulting from weakened perineal muscles of the pelvis

14.Mental development and psychological development may be affected from the lack of nutrients to the brain

Treatment of eating disorders:
1.Hospitalization is necessary when the condition becomes life threatening


2.Weight restoration to improve mood and health of patient

3.Correction of nutrition and metabolic deficiency in patient


4.Psychotherapy and counseling of individual to develop healthy ways of controlling one's life


5.Use of antidepressant and serotonin blockers and other newer medications for depression and anxiety


6.Support groups to help family and nutritional counseling

Prognosis of eating disorders:
1.Good in mild cases


2.Poor in severe cases,may be fatal

FOOD ALLERGIES

DOC I HAVE FOOD ALLERGIES One of the most common types of the allergy is food allergy. Your immune system believes that food proteins which you enter in your body are harmful, so it reacts with attack. Your immune system make mistake so it recognizes substances of the food as harmful. Immune system makes amounts of the antibodies which try to fight these substances. The causes of Food Allergy are: Every food may cause allergy, but the most foods that are cause of allergy are: 1.tree nuts, peanut,and hazelnut 2.milk, 3.Eggs are rare food allergy, but this food may trigger anaphylaxis 4.fish,seafood like shellfish, prawns, crabs,lobsters or squids 5.duck 6.soy, wheat . Majority of people outgrow their food allergies, but there are people who are allergic on certain food for whole life. In that case the best solution is to avoid these foods. So, before you have to eat something, it is recommended to read all ingredients in the food. If you find that food contain ingredients on which you are allergic, you shouldn't eat it The symptoms of Food Allergy are: Food allergy symptoms may vary from mild to total collapse of the body, followed in the worst cases with the death. These severe symptoms of food allergy are known as anaphylaxis. Anaphylaxis is followed with violent allergic reaction from certain types of the food. Most common symptoms of the food allergy are:   1.Feeling of tingling in the mouth   2.Tongue and throat swelling   3.Problem with breathing, difficult breathing   4.Hives   5.Vomiting   6.Cramps in the stomach   7.Diarrhea   8.Low Blood pressure   9.In the worst cases death Usually these symptoms appear within minutes to two hours after you have entered certain food to which you are allergic. The Treatment of Food Allergy is: Medical treatment may be urgent in severe cases of food allergy. 1. One of the medical treatment is also known as epinephrine or also known as adrenaline. This medication is only for most severe cases. 2.Antihistamines are used to counter the histamine in the food causing the allergy 3.Corticosteroids may be given to counter the immune reactions from the food allergy Prevention of food allergy is by: If you are allergic on certain food, it doesn't mean that you should stop with eating food on which you are not allergic. It is recommended to write a food diary and make a list of the food on which you are allergic. If you got some reaction to certain food, you need to write in your diary the food that cause allergy. This food diary will help the doctor  know which food you are allergic to.

PANIC ATTACKS

DOC I HAVE A PANIC ATTACK

Panic attacks are sudden feelings of terror occuring without warning.
These episodes can occur at any time even while asleep

Most people with panic attacks may experience:
1.Fast heart beats
2.Feeling weak, giddy or faint
3.Tingling or numbness in the hands and fingers
4.Sense of terror of impending doom or death
5.Having cold sweats
6.Chest pains
7.Breathing difficulties
8.Feeling loss of control

Panic attacks are generally short lasting less than ten minutes

People with one panic attack are at greater risk for having another panic attacks than those who never had a panic attack.

Panic Disorder is when the attacks occur repeatedly .

The causes of Panic attacks are:

A.Panic attacks may be symptoms of an anxiety disorder.


Panic attacks occur twice as often for women than men.


The peak age of a person's first panic attack (onset) is 15-19 years.

Unlike other anxiety forms, panic attacks are very sudden and often unexpected, unprovoked, and are often disabling.

B.Panic attacks can also occur in:
1.posttraumatic stress disorder (PTSD),
2.schizophrenia,
3.intoxication (alcohol or drugs)
4.thyroid abnormalities
5.anemia,
6.certain medications such as:
a.stimulants like methylphenidate (Ritalin),
b.diabetes medications like metformin and insulin,
c.antimalarial medications like quinine,
d.food additives like aspartame
7.withdrawal from certain drugs of abuse.
8.corticosteroid withdrawal, such as withdrawal from dexamethasone (Decadron).

The types of Panic attacks are:

During a panic attack he or she may develop irrational fears called phobias,
At this stage, the person is said to have panic disorder with agoraphobia.

The  symptoms and signs of Panic Attacks are:
The symptoms of a panic attack appear suddenly, without any apparent cause.
1.racing or pounding heartbeat (palpitations);
2.chest pains;
3.stomach upset;
4.dizziness, lightheadedness, nausea;
5.difficulty breathing, a sense of feeling smothered;
6.tingling or numbness in the hands;
7.hot flashes or chills;
8.trembling and shaking;
9.dreamlike sensations or perceptual distortions;
10.terror, a sense that something unimaginably horrible is about to occur and one is powerless to prevent it;
11.a need to escape;
12.nervousness about the possibility of losing control and doing something embarrassing;
13.fear of dying.

The duration of a panic attack typically lasts for more than 10 minutes,

The Complications from a Panic Attack are:
individuals with panic disorder seem to be at higher risk of having a heart valve abnormality called mitral valve prolapse (MVP)which needs special precautions to be taken when treated for any dental problem.

Anxiety attacks while asleep called nocturnal panic attacks affect about 40%-70% of those who suffer from daytime panic attacks.
People who suffer from panic symptoms while sleeping tend to
1.have more respiratory distress associated with their panic.
2.experience more symptoms of depression and other psychiatric disorders
3.to wake suddenly from sleep in a state of sudden fear or dread for no apparent reason.

The duration of nocturnal panic attacks tends to be less than 10 minutes.

Treatment of Panic Attacks:
1.Reassurance from Doctors that it is not dangerous.ECG is done to exclude heart conditions.

2.Rest


3.Psychotherapy and counseling


4.Mild tranquilliser may be given if necessary


5.Avoid drinking alcohol, smoking, and stimulant drugs

Panic attacks in children may result
1.in the child's grades declining,
2.avoiding school and other separations from parents,
3.substance abuse,
4.depression, and
5.suicidal thoughts, plans, and actions.

AGING

DOC I AM AGING

Aging is the process where the human body accumulate damage to its cells. tissues and organs as it grows older.

This accumulated damage is believed to be the result of oxidation damage to the cell contents from free radicals.

Average and maximum lifespans:
The maximum life span for humans is currently maximized at approximately 120 years
Average lifespan in a population is lowered:
1.infant and child mortality is frequently linked to infectious diseases or nutrition problems.

2.accidents and age-related chronic disease such as cancer or cardiovascular disease play an increasing role in mortality.

 Extension of lifespan can often be achieved by:
1.improved medical care,
2.vaccinations,
3.good diet,
4.exercise
5.avoidance of bad habits such as smoking.

Maximum lifespan is determined by
1.the rate of aging inherent in its genes and by environmental factors.
2.calorie restriction.
3.breeding from only older members.

Anti-aging medicine is the study of slowing down or reversing the processes of aging to extend both the maximum and average lifespan.

In Theory extension of maximum lifespan could be achieved by
1. reducing the rate of aging damage,
2. periodic replacement of damaged tissues,
3. molecular repair or rejuvenation of deteriorated cells and tissues
4. enhancement of telomerase enzyme activity.

 Diets and supplements
1.nutrition—diets or supplements—as a means to extend lifespan
2.antioxidant supplements, such as Vitamin C, Vitamin E, Q10, lipoic acid, carnosine, and N-acetylcysteine, may extend life if the free radical theory of extending life is to be believed
3.oxytocin, insulin, human chorionic gonadotropin (hCG), and erythropoietin (EPO).
4.Resveratrol is a sirtuin stimulant that appears to extend lifespan in simple organisms

Hormone treatments
1.low-dose GH treatment for adults with GH deficiency changes the body composition by
a.increasing muscle mass, decreasing fat mass,
b.increasing bone density and muscle strength,
c.improves cardiovascular parameters (i.e. decrease of LDL cholesterol)
d.affects the quality of life without significant side effects.

Nanotechnology
nanomedicine could give rise to life extension through the repair of many processes thought to be responsible for aging.

Cloning and body part replacement
therapeutic cloning and stem cell research could one day provide a way to generate cells, body parts, or even entire bodies  that would be genetically identical to a prospective patient.

Cryonics
1.storing the body at low temperatures after death may provide an entry into a future in which advanced medical technologies may allow resuscitation and repair.
2.cryogenic temperatures will minimize changes in biological tissue for many years, giving the medical community ample time to cure all disease, rejuvenate the aged and repair any damage that is caused by the cryopreservation process.

Strategies for Engineered Negligible Senescence (SENS)
combine existing and predicted future biochemical and genetic techniques to a cure for cancer, stem cell treatments, addition of new enzymes to the human body and moving mitochondrial DNA to the cellular nucleus.

Genetic modification
artificial genes are integrated with an organism to replace mutated or otherwise deficient genes,
Targeting catalase to the mitochondria resulted in a 20% lifespan increase in mice, and improved performance in therapeutically infected mice.

Fooling genes
an approach to life-extension that involves fooling genes into thinking the body is young
The basic idea is that our bodies are composed of genes that activate throughout our lifetimes, some when we are young, and others when we are older.
These genes are activated by environmental factors and the changes caused by these genes activating can be fatal.

PREGNANCY TRIMESTERS

DOC I AM PREGNANT 2

Pregnancy is typically broken into three periods, or trimesters, each of about three months.
First Trimester:
The first 12 weeks of pregnancy are considered to make up the first trimester.
The first two weeks are the two weeks before conception.
The third week is the week in which fertilization occurs.
In the 4th week, the fertilized egg reaches the uterus and burrows into its wall which provides it with the nutrients it needs. At this point it is called an embryo which connects via the umbilical cord to the placenta in the wall of the womb.
The 5th week marks the start of the development of the embryo.
This is the time when the embryo's brain, spinal cord, heart and other organs begin to form.

At this point the embryo is made up of three layers,
1.the top one (called the ectoderm) will give to the embryo's layer of skin, central and peripheral nervous systems, eyes, inner ear, and many connective tissues
2.the middle layer (the mesoderm) will give rise to the heart and the beginning of the circulatory system as well as the bones, muscles and kidneys.
3.the inner layer (the endoderm) will give rise to the development of the lungs, intestine and bladder.

In the 6th week, the embryo will be developing basic facial features
Its arms and legs also start to grow.
In the 7th week, the brain, face and arms and legs quickly develop.
In the 8th week, the embryo starts moving
In the next 3 weeks, the embryo's toes, neck and genitals develop as well.
By the end of the first trimester, the fetus will be about 3 inches (76 mm) long and will weigh approximately 1 ounce(28g).

Second trimester
Weeks 13 to 28 of the pregnancy are called the second trimester.
Most women feel more energetic in this period, starting to put on weight as the symptoms of morning sickness fade away.
The movement of the fetus, often referred to as "quickening", typically happens in the fourth month, and can be felt in the 20th to 21st week, or earlier if the woman has been pregnant before.
The placenta fully functions at this time and the fetus makes insulin and urinates.
The reproductive organs differentiate the fetus as male or female.

Third trimester
Final weight gain takes place from the 29 to 40 weeks of pregnancy.
The fetus will be growing the most rapidly gaining up to 28 g per day.
The woman's belly will transform in shape as the belly drops due to the fetus turning in a downward position ready for birth.
Fetal movement can become quite strong and can be uncomfortable to the woman.
This period of her pregnancy can be uncomfortable, causing symptoms like weak bladder control and backache.
Movement of the fetus becomes stronger and more frequent.
There is head engagement ( the fetal head descends into the pelvic cavity) so that only a small part  can be felt abdominally.
The perenium and cervix are further flattened and the head may be felt vaginally.
Because the head engagement severely reduces bladder capacity, increases pressure on the pelvic floor and the rectum,the
mother may experience the perpetual sensation that the fetus will "fall out" at any moment.

Childbirth
This is the process whereby an infant is born.
It is considered to be the beginning of the infant's life.
A woman is considered to be in labour when she begins experiencing regular uterine contractions, accompanied by changes of her cervix — primarily effacement and dilation. There may be waterbag bursting or blood(show)
Most childbirth is widely regarded as painful, some women do report painless labours
Most births are successful vaginal births, but sometimes complications arise and a woman may undergo a cesarean section.

During the time immediately after birth, both the mother and the baby are hormonally cued to bond, the mother through the release of oxytocin, a hormone also released during breastfeeding.

PREGNANCY

DOC I AM PREGNANT
Pregnancy is the carrying of a fetus or embryo in the womb of a woman. 

The term embryo is used to describe the developing offspring during the first 8 weeks following conception while the term fetus is used from about 2 months of development until birth.

Human pregnancy is divided into three trimester periods:
1.The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus).
2.The second trimester, the development of the fetus can be more easily monitored and diagnosed.
3.The third trimester often approximates the ability of the fetus to survive outside of the uterus.

 Fertilization
The process leading to pregnancy occurs earlier usually in the fallopian tube when the female egg is penetrated by the male spermatozoon following the act of sexual intercourse.
This process is referred to as fertilization or conception.
The fertilized egg then travel down the fallopian and implants itself into the inner lining of the womb or uterus.
Once implanted in the uterus the embryo will grow to become a fetus at 2 months before coming out of a normal pregnant mother's womb at 38 weeks from conception to become a newborn baby.
After implantation into the lining of the womb, the embryo secretes a hormone named human chorionic gonadotropin which in turn stimulates the corpus luteum in the woman's ovary to produce progesterone.
The progesterone act to maintain the lining of the uterus so that the embryo will continue to be nourished by the glands in the lining of the uterus.
The capillaries will be stimulated to grow from the wall of the uterus to form the placenta which allow the embryo to receive vital nutrients from the woman's blood supply.The umbilical cord is the connecting cord from the embryo or fetus to the placenta and allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply.

The expected date of delivery is 40 weeks counting from the first day of the last menstrual period and birth usually occurs between 38 and 42 weeks.Even though pregnancy begins at conception, it is more convenient to date from the first day of a woman's last menstrual period.

Diagnosis of pregnancy:
The beginning of pregnancy may be detected by a pregnant woman without medical testing through a number of symptoms of pregnancy:
1. nausea and vomiting,
2. excessive tiredness and fatigue,
3. cravings for certain foods
4. frequent urination particularly during the night.

Signs of pregnancy include:
1.the presence of human chorionic gonadotropin (hCG) in the blood and urine can be detected as early as 12 days after implantation
2.missed menstrual period,
3.implantation bleeding during the third or fourth week after last menstrual period,
4.increased basal body temperature sustained for over 2 weeks after ovulation,
5.Chadwick's sign (darkening of the cervix, vagina, and vulva),
6.Goodell's sign (softening of the vaginal portion of the cervix),
7.Hegar's sign (softening of the uterus isthmus),
8.pigmentation of linea alba – darkening of the skin in a midline of the abdomen, caused by hyperpigmentation resulting from hormonal changes, usually appearing around the 22nd week of pregnancy
9.Breast tenderness and darkening of the nipples is common
10.an early obstetric ultrasonography can determine the age of the pregnancy fairly accurately based on the last menstrual period.

LASIK SURGERY

DOC I HAVE LASIK SURGERY

LASIK (an acronym for laser-assisted in situ keratomileusis) is a type of refractive surgery done by ophthalmologists for correcting myopia, hyperopia, and astigmatism using excimer laser.

The LASIK technique use of the laser was to change the surface shape of the cornea first done in 1991.

The operation itself involves creating a thin flap on the eye, folding it to enable remodeling of the tissue beneath with a laser.
The flap is repositioned and the eye is left to heal in the postoperative period.

Preoperative:
Patients who are wearing soft contact lenses are instructed to stop wearing them 5 to 21 days before operation.

The patient's corneas are examined with a pachymeter to determine their thickness and to measure their surface contour.

This process also discover astigmatism and other irregularities in the shape of the cornea.

With this information the eye surgeon calculates the amount and the locations of corneal tissue to be removed during the operation.

The patient typically is given a course of antibiotic beforehand to minimize the risk of infection.

Operation:
The operation is performed when the patient is awake and mobile although he/she is sometimes given a mild sedative (such as Valium) and anesthetic eye drops.

LASIK is performed in three steps.
A corneal suction ring is applied to the eye, holding the eye in place.
1.create a flap of corneal tissue.

Once the eye is immobilized, the flap is created with a mechanical microkeratome using a metal blade, or a femtosecond laser microkeratome that creates a series of tiny closely arranged bubbles within the cornea.
A hinge is left at one end of this flap.
The flap is folded back, revealing the stroma, the middle section of the cornea.

2.remodeling of the cornea underneath the flap with the laser.
An excimer laser (193 nm) is used to remodel the corneal stroma.
The laser vaporizes tissue in a finely controlled manner without damaging the adjacent stroma.

3.the flap is repositioned.
After the laser has reshaped the stromal layer, the LASIK flap is carefully repositioned over the treatment area by the surgeon and checked for the presence of air bubbles, debris, and proper fit on the eye.
This flap stays in position by natural adhesion until healing is completed.

Postoperative care:
Patients are usually given a course of antibiotic and anti-inflammatory eye drops.
Patients are usually told to sleep much more and are also given a darkened pair of shields to protect their eyes from bright lights and protective goggles to prevent rubbing of the eyes when asleep and to reduce dry eyes.
They also are required to moisturize the eyes with preservative-free tears.
Proper post-operative care is important to prevent the risk of complications.

LASIK surgery results:
The surveys determining patient satisfaction with LASIK have found most patients satisfied, with satisfaction range being 92–98 percent.

Complications:
Intraoperative complications
1.flap complications
2.slipped flap (a corneal flap that detaches from the rest of the cornea) is one of the most common complications.
3.Flap interface particles

Early postoperative complications
1.dry eye symptoms at 6 months period post surgery.
2.diffuse lamellar keratitis (DLK),
3.infection responsive to treatment.Infection under the corneal flap is possible.

Late postoperative complications
1.A subconjunctival hemorrhage
2.Surgery induced dry eyes or in severe cases chronic dry eye.Due to 70% of corneal nerves that are severed during the Lasik operation , the lubrication system of the eye is affected and nerves may never recover to pre-operative condition.
3.Overcorrection or undercorrection
4.Vitamin D deficiency from Sun sensitivity
5.Visual acuity fluctuation
6.Halos or starbursts around light sources at night
7.Light sensitivity
8.Ghost images or double vision
9.Wrinkles in flap (striae)
10.Decentered ablation
11.Debris or growth under flap
12.Thin or buttonhole flap
13.Induced astigmatism
14.Corneal Ectasia -decrease in the number of corneal keratocytes (fibroblasts) after LASIK.
15.Floaters
16.Epithelium erosion
17.Posterior vitreous detachment
18.Macular hole.
19.flap dislocations have been reported 1–7 years post-LASIK.
20.intraocular pressure, essential in glaucoma screening and treatment.
21.retinal detachment
22.choroidal neovascularization
23.uveitis
24.keratomileusis effected at a later age increases the incidence of corneal higher-order wavefront aberrations.
25.Microfolding -an almost unavoidable complication of LASIK usually negligible
26.Blepharitis,  with crusting of the eyelashes can lead to infection or inflammation of the cornea after LASIK.

Newer methods like Femtosecond laser intrastromal vision correction via all-femtosecond correction (like Femtosecond Lenticule Extraction, FLIVC, or IntraCOR), or other techniques that avoid permanently weakening the cornea with incisions and deliver less energy to surrounding tissues will replace LASIK Surgery.

CONGESTIVE HEART FAILURE

DOC I HAVE CONGESTIVE HEART FAILURE

Congestive Heart failure occurs when the heart can not pump enough blood to the rest of the body.

This condition may affect either the right side or the left side of the heart. Often both sides of the heart are involved.

The Causes of Congestive Heart failure are:

When the heart is unable to pump enough oxygen-rich blood out to the rest of the body, blood may back up in other areas of the body.

Fluid builds up in the lungs, liver, gastrointestinal tract, and the arms and legs.

This is called congestive heart failure.

The main causes are:
1.coronary artery disease (CAD) a narrowing of the small blood vessels that supply blood and oxygen to the heart.

2.cardiomyopathy-Heart failure can also occur when an infection weakens the heart muscle and the heart muscle enlarges to compensate.

3.Congenital heart disease -defects in the heart of the newborn affects the pumping action of the heart

4.Heart valve disease - abnormal valves affects the blood flow through the heart

5.Some types of abnormal heart rhythms(arrhythmias) affects efficiency of blood flow through the heart

6.Emphysema - chronic lung disease affect the heart lung circulation

7.Overactive thyroid - fast heart beat affects the heart pumping action

8.Severe anemia -insufficient blood affects the blood flow in the heart

9.Underactive thyroid - slow heart beats also affects the heart

Symptoms:

Symptoms of heart failure usually begin slowly.
1.breathing problems occurs even while resting.

2.Cough worse at night

3.Fatigue, weakness, faintness

4.Loss of appetite

5.Need to urinate at night

6.Pulse that is fast or irregular, or palpitations(feeling of fast heart beats)

7.Shortness of breath when active or lying down

8.Swollen (enlarged) liver or abdomen

9.Swollen feet and ankles

10.Waking up from sleep as a result of shortness of breath

11.Weight gain

Heart failure symptoms can also begin suddenly; for example, after a heart attack or other heart problem.

Signs

1.Fast or difficult breathing

2.Irregular or fast heartbeat and abnormal heart sounds

3.Leg swelling (edema)

4.Neck veins that stick out (distended)

5.Sounds (creps) from fluid buildup in lower parts of the lungs

6.Swelling of the liver or abdomen

Diagnosis:
An echocardiogram (ultrasound) is the best test to diagnose, find the cause of, and monitor the heart failure because it can check on the blood flow through the heart.

Imaging tests are useful:
1.Cardiac stress tests
2.Heart catheterization
3.MRI of the heart
4.Nuclear heart scans

Laboratory tests are done to check on:
1. kidneys condition (BUN, creatinine, creatinine clearance, urinalysis)

2.low blood count or anemia -- full blood count (FBC)

3.Test for brain natriuretic peptide (BNP)

4.sodium and potassium levels in your blood

Treatment:

MONITORING

1.Follow-up appointments to check the heart function.

2.Knowledge of symptoms indicating heart failure is getting worse
a.changes in your heart rate,
b.pulse rhythm
c.blood pressure,
d.weight.

3.Weight gain within a day or two may be a sign of extra fluid in the body and the heart failure is getting worse.

4.reduce the salt eaten and limit the fluid taken during the day.

5.Avoid alcohol

6.Avoid smoking

7.Keep active walking or riding a stationary bicycle. Avoid exercise on days when there is increased fluid or weight.

8.Lose weight if overweight.

9.Lower your cholesterol by diet

10.Rest is needed for the heart .

MEDICATIONS

Medicines treat the symptoms, prevent the heart failure from getting worse, and prolong life

Medicines like diuretics,aspirin and digoxin will:
1.Help the heart muscle pump better

2.Keep the blood from clotting

3.Lower the blood pressure

4.Open up the blood vessels or slow the heart rate

5.Replace potassium

6.Rid your body of excess fluid and salt (sodium)

Surgery:
1.Coronary bypass surgery (CABG) and angioplasty may help improve blood flow to the damaged or weakened heart muscle.

2.Heart valve surgery may be done if damages to the heart valve are causing heart failure.

3.A pacemaker can help treat slow heart rates or help both sides of the heart contract at the same time.

4.A defibrillator sends an electrical pulse to stop life threatening abnormal heart rhythms.

SEVERE HEART FAILURE
Severe heart failure occurs when treatments no longer work.
Certain treatments may be used when a person is waiting for a heart transplant:
1.Intra-aortic balloon pump (IABP)
2.Left ventricular assist device (LVAD)

Prognosis:

Very often the heart failure can be controlled by taking medicine, changing to a healthy lifestyle, and treating the underlying condition.

Heart failure can suddenly get worse due to:
1.Angina
2.Eating high-salt foods
3.Heart attack
4.Infections or other illnesses
5.Not taking medicines correctly

Heart failure is usually a chronic illness, which may get worse over time.
Some people develop severe heart failure, in which medicines, other treatments, and surgery no longer help.

ANTIOXIDANTS

DOC WHAT ARE ANTIOXIDANTS

Antioxidants are substances that may protect the  cells in the body against the effects of free radicals.

Free radicals are molecules produced by:

1. Oxidation—one of the body's natural chemical processes—can produce free radicals which are highly unstable molecules that can damage cells.

Free radicals are produced when the body breaks down foods like carbohydrates, proteins and fats for use as glucose, amino acids or fatty acids or storage in the body

2.environmental exposures like tobacco smoke, radiation, and environmental contaminants can produce free radicals from chemical reactions in the environment .

These free radicals can start  chain reactions which can occur in a cell resulting in  damage or death to the cell.

Free radicals can damage  the cells in the body and therefore may play a role in Alzheimer's disease, cancer, eye disease, heart disease, Parkinson's disease, and rheumatoid arthritis.

Antioxidants are found in many foods.

1.fruits and vegetables, nuts, grains

2. meats, poultry and fish.

Antioxidants are substances that may protect the cells  of the body from potentially disease-producing cell damage that can result from natural bodily processes and from exposure to certain chemicals.

The body can produce its own antioxidants and also obtain them from food.

Antioxidants are abundant in vegetables and fruits and are also found in grain cereals, teas, legumes, and nuts.

Antioxidant substances include anthocyanins, beta-carotene, catechins, coenzyme Q10, flavonoids, lipoic acid, lutein, lycopene, selenium, and vitamins C and E

People take antioxidant supplements in an effort to improve their health and to prevent various diseases

Systematic reviews of the research literature have concluded that there is not enough evidence to support the use of antioxidant supplements for preventing cancer, cardiovascular disease, and eye disease, and reducing overall mortality in healthy people and people with various diseases

One exception is the combination of antioxidants and zinc reduced the risk of developing advanced stages of age-related macular degeneration (AMD) by 25 percent in people who had intermediate AMD or advanced AMD in only one eye. Antioxidant supplements used alone reduced the risk by about 17 percent.

Safety of Antioxidants

Antioxidants in foods are generally considered safe.
However beta-carotene supplements have been found to increase the risk of lung cancer in smokers.
vitamin E supplements may increase the risk of bleeding in certain people.

Use of Antioxidants

Do not use antioxidant supplements:

1.as a replacement for a healthful diet

2.as conventional medical care,

3.to postpone seeing a doctor about a medical problem.

SCHIZOPHRENIA

DOC I HAVE SCHIZOPHRENIA

Schizophrenia is a complex mental disorder characterized by symptoms involving:
1.personality
2.Thinking non logically
3.emotionally unstable responses,
4.Behaving abnormally in social situations
5.tendency to withdraw from reality to a private personal world

Schizophrenia is a complex illness.
The cause is yet unknown.
1.genetic factors - schizophrenia has a history of
a family member with the disease.
2.environmental events may trigger schizophrenia in people who are genetically more at risk for it.
3.Schizophrenia affects both men and women equally.
4.It usually starts in the teen years or young adulthood, but may start later in life.
It usually begin later in women, and is milder.
5.Childhood-onset schizophrenia begins after age 5. Childhood schizophrenia is rare.

Schizophrenia symptoms develop slowly over months or years.
1.difficulty keeping friends and working.
2.anxiety,
3.depression,
4.suicidal thoughts or behaviors.

Early symptoms are:
1.Irritable or tense feeling
2.Difficulty sleeping
3.Problem concentrating
4.problems with thinking, emotions and behavior develop, including:
a. Lack of emotion (flat affect)
b. Strongly held beliefs not based in reality (delusions)
c. Hearing or seeing things that are not there (hallucinations)
d. Problems paying attention
e. Thoughts jump between unrelated topics ( loose associations)
f. Bizarre behaviors
g. Social isolation

Paranoid schizophrenia symptoms include:
1.Anxiety
2.Anger or argumentative
3.False believes that people are trying to harm him(paranoia).

Disorganized schizophrenia symptoms include:
1.Difficulty with thinking and expressing ideas clearly
2.Childlike behavior
3.Showing little emotion

Catatonic schizophrenia symptoms include:
1.Lack of activity
2.Muscles and posture rigidity
3.Grimaces or odd expressions on the face
4.No response to other people

Chronic:
All types of Schizophrenia tend to have the following:
1.blunting of affect or emotion
2.incoherant thought
3.delusions
4.hallucinations
5.apathy or withdrawl from society

Diagnosis
1.thorough interview of the person and family

members:
a.length of the symptoms
b.ability to function whether it has changed
c.Developmental background
d.Genetic and family history
2.Brain scans (such as CT or MRI) and blood tests to rule out other disorders

Complications
Having schizophrenia increases the risk for:
1.alcohol or drugs abuse:
Using alcohol or other drugs increases the risks of recurrence.
2.Physical illness:
People with schizophrenia may become physically sick due to an inactive lifestyle and side effects
from medication.
3.Suicide

TOOTHACHE

DOC I HAVE TOOTHACHE

Toothache is the pain around the teeth or jaws usually following a tooth problem.

Toothache can be very severe and may cause the sufferer many sleepless nights.

The causes of Toothache are:

Tooth Problems such as :
1.Dental caries which is caused by the action of the bacteria that lives in plague, a sticky coating of saliva and food debris that forms on the surface of the teeth.

2.a broken tooth

3.an exposed tooth root

4.dental abscess

5.gum disease

Disorders of the temporo-mandibular joints such as:
1.temporomandibular joint arthritis

2.injuries to the jaw or joint

The Symptoms of Toothache is basically pain.
However the pain can be mild to severe or excruciating and chronic.
The toothache may be made worse by chewing on hard food or cold or even heat.

The symptom of toothache and its causes can only be determined by a  professional dental examination which includes X-rays .

the most common cause of toothache is

1.the dental caries and abscess,
a.sensitivity of the tooth to hot/ cold foods and drinks.
b.Pain occurs when the dentin is damaged.
c.Visible pits or holes appear on the enamel

2.Gum disease is the second most cause ot toothache.
Gingivitis or infection of the gums can cause the erosion of gum and bone tissue that surrounds and keep the tooth in place.
As a result of the gum infection and destruction of the bone of the tooth, the nerve of the tooth is affected and send pain signals to indicated the severity of the gum and tooth infection.

3.Tooth roots that are exposed are no longer protected by the gums aand bone of the tooth. The exposed tooth roots can be become very sensitive to cold hot or sour foods.

4.Broken tooth means a fracture of the bone of the tooth. Biting on the bone fracture can severe excruciating pain.

5.Impacted tooth such as wisdom tooth can cause pain if the tooth is pressing against the gums and the nerve surrounding the gums.

6.Temporo-mandibular joints inflammation caused by habitual clenching of teeth
or grinding of teech can caused irritation of the temporo-mandibular joints resulting in spasm of muscles and jaw pain.

Treatment of Toothache:
1.scrape the teeth to remove plague
A flouride gel may be applied to protect the teeth from plague

2.If a cavity is present, the dental surgeon may fill the tooth with fillings made of dental amalgam in molars and premolars and composite resins for the front teeth.

3.in the case of a large cavity or a broken tooth, the dentist will drill the decayed portion of the tooth, fill the cavity and cover the tooth with an artificial crown.

4.root canal treatment involves removal of the tooth’s pulp and replacing it with an inert material.

5.The entire tooth is taken out if the decay is very advanced

6. Brufen or other NSAID pain killers are given for temporo-mandibular joints inflammation and also to relieve toothache in general.

7.Local anesthetic cream or clove oil has been used to apply to tooth with relief of pain

Preventing Decay
Tips for preventing caries include:
1.diet low in sugar
2.good oral hygiene:

a.Brushing teeth twice a day with fluoride toothpaste.
b.Cleaning between teeth daily with floss.

3.regular dental visits and assessment.

4.a protective plastic coating that can be applied to the chewing surfaces of the back teeth where decay often starts.

BIRTH CONTROL METHODS

DOC I NEED BIRTH CONTROL METHODS

Hormonal Methods:

1.Birth control pills

Birth control pills is taken daily.

Effects are reversible;

lessens menstrual cramps; makes the periods regular; reduces acne; reduces risks of developing ovarian and endometrial cancer;

no protection against STIs; may interfere with other medications

2.Hormonal Injections:

Depo-Provera is an injection that costs a little bit more than the pill but may prevent pregnancy
for 3 months.

Lunelle injection is a monthly progesterone injection but  can only prevent pregnancy for up to one month.

Effects are reversible;

only 4 times a year;

reduces the risk of developing endometrial cancer   

 May cause irregular bleeding or spotting;

no protection against STIs.

3.The Nuva Ring

The Nuva Ring or vaginal ring is a flexible ring that is inserted into the vagina for three weeks
before removal .
The ring contains chemicals such as estrogen and progesterone that releases this into the body.


The birth control patch releases hormones into the body like the the oral pill.

Other methods of birth control are:

1.The Intra Uterine Device

The Intrauterine Device or IUD is a small plastic device that contains hormones and copper.
It thickens the cervical mucus to decrease the chances of an egg from fertilizing as well
physically prevent the sperms from entering the uterus easily.
The device is long-lasting (up to 5 years); no interruption to intercourse;may cause irregular
bleeding or spotting; no protection against STIs; IUD rarely may fall out; a physician is required to insert and remove the IUD

2.Withdrawal Method

The withdrawal method is removal of the male penis out of the girl’s vagina before ejaculation. Effectiveness is 80%.no protection against STIs

3.Sterilization of women and Male reproductive tubes

Sterilization or tubal ligation closes the fallopian tubes permanently and prevent the sperms
from entering the fallopian tube to fertilize the egg.
Men can also have their spermatic duct ligated.
This is called a vasectomy.
Effectiveness is 99.5%;No interference with intercourse;Usually Irreversible; surgery risks; no
protection against STIs

4.Rhythm Method

Natural family planning is using the Rhythm method when sexual intercourse is avoided during the fertile period. Effectiveness is 70-80%; no protection against STIs


5.Abstinence

Abstinence is not engaging in sexual intercourse at all .Effectiveness is 100%.NO STIs.

How to choose your birth control method:

Factors such as  
1.age,
2.frequency of sexual activity,
3.family history regarding genetic disease
4.comfort level when using a particular method,
5.level of desire to be pregnant in the future
are important when choosing an appropriate birth control method.

The usage of a condom has the advantage of  protection against most STIs while hormonal method
is more effective as birth control.

BIRTH CONTROL

DOC I NEED BIRTH CONTROL

Birth Control or Contraception is a term used to prevent pregnancy and control births.

There are different ways of preventing pregnancy:
1.men - includes:
a.condoms
b.withdrawal before ejaculation
c.abstinence during the fertile period
d.vasectomy

2.women - includes:
a.female condom
b.diaphragm
c.cervical cap
d.contraceptic sponge
e.spermicides
f.oral contraceptives
g.birth control patch
h.Progesterone injections
i.Nuva ring
j.IUD
k.sterilization by tubal ligation
l.Rhythm method

Basically there are two major methods of birth control :
1. barrier
2. hormonal.

Other birth control methods include
1.sterilization otherwise known as surgery,
2.withdrawal,
3.natural family planning
4.abstinence which is the simplest method.

In the barrier method , the male or the female uses

1.the condom to prevent the sperm from ever entering the female’s uterus.
The male condom comes in many brands, color and flavors and is usually made of latex rubber.
The condom is placed over the penis when it is erect prior to intercourse.

The female condom on the other hand is made of polyurethane and is seven inches long.
This protect the cervix, vaginal canal and the  areas surrounding the vagina.
The female condom is inserted into the woman’s vagina also prior to intercourse.
Effectiveness is 95%;Protection against certain STIs;May break or slip; makes noises during
intercourse

2. Another barrier method is to use spermicides which is a chemical designed to kill sperm.
The spermicide is available as foam, jelly, foaming tablet or vaginal suppository.
Effectiveness 82% is greatly increased when it is used with a condom, diaphragm or cervical cap;May provide lubrication; can be used by women who breastfeed or smoke;No protection against STIs; may cause allergic reactions in some people

3.the diaphragm that is a soft rubber dome which stretches over a flexible ring that contains
spermicides in the form or cream or jelly.This is inserted inside the woman’s vagina and
placed over the cervix.
The diaphragm should not stay inside the vagina for more than 3 hours prior to intercourse.
Effectiveness 94%;Protection against certain STIs;  Proper insertion is required; may dislodge during intercourse; may cause allergic reactions in some people (due to the spermicide used)

4.The cervical cap is a small cup made of polyurethane just like the condom.
The cup is filled with spermicidal cream and inserted into the girl’s vagina and placed over the
cervix.Effectiveness is 91% (for women who have not given birth) 74% (for women who have given birth before)     Protection against certain STIs; can be fitted 24 hours before intercourse;Proper insertion is required; may dislodge during intercourse; may cause allergic reactions in some people (due to the spermicide used); may cause vaginal discharge and odour

5.the contraceptive sponge is a soft saucer shaped device made from polyurethane like the female
condom.

Besides the above Barrier methods, there are the hormonal birth control methods.

1.Hormonal birth control method can be in the form of an implant, patch, pill or injection.
The purpose is to a.prevent the woman’s ovaries from releasing an egg monthly
b.thicken  the cervical mucus so the sperm will have a difficult time penetrating the egg

c.thin the lining of the uterus so that the chances of a fertilized egg implanting on the uterus wall
is reduced.
d.effectiveness is 98-99%