Showing posts with label breathless. Show all posts
Showing posts with label breathless. Show all posts
Friday, September 19, 2008
A Simple Guide to Croup
A Simple Guide to Croup
-----------------------------------
What is Croup?
---------------------------
Croup is an acute viral disease of the upper and lower respiratory tract associated with inspiratory stridor ( whistling obstructive sound during inhalation) and respiratory distress in severe cases.
It typically affects infants and children below 6 years old.
It causes a typically barking type of cough and hoarseness of the voice due to obstruction at the vocal box.
What are the causes of Croup?
----------------------------------------
Viral infections:
--------------------
1.parainfluenza virus, primarily types 1 and 2
2.Other viral infections such as adenorhinovirnese, enterovirus and mycoplasma pneumoniae
Genetic predisposition:
------------------------
Some families are more prone than others to get the disease.
It is also more common in males than females.
What are Signs and symptoms of Croup?
---------------------------------------------
Symptoms:
1.harsh barking cough
2.sneeze
3.inspiratory stridor (a high-pitched whistling sound during inspiration),
4.nausea and vomiting
5.fever.
6.Hoarseness -usually present
7.respiratory distress due to airway obstruction
8.lethargy
Signs:
1.Reduced breath sounds - air movement is reduced in the lungs
2.Prolonged inspiration on auscultation with laryngeal stridor
3.Chest retraction
4.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
How is the diagnosis of Croup made?
------------------------------------------
1.Symptoms and signs of fever, laryngeal stridor and barking cough
2.blood tests (complete blood count, ESR and blood culture)
5.frontal X-ray of the C-spine
the presence of the the steeple sign confirms the diagnosis of croup.
What are the complications of Croup?
-----------------------------------------------
1.Respiratory distress
2.Bacterial tracheitis
What is the treatment of Croup?
------------------------------------
1.Rest, fluids and oxygen
2.Humidifiers and steam inhalations
3.Corticosteroids especially dexamethasone are the most commonly used agent as it reduces inflammation
4.Antibiotics are not useful because the cause is viral. If there is bacterial tracheitis, antibiotics may be needed
5.Bronchodilators such as theophylline, epinephrine, ventolin, bricanyl are all helpful to open the airways
6.Intubation and tracheostomy may be needed in severe cases.
What is the prognosis of Croup ?
------------------------------------------
This depends on the severity and type of infection.
Most cases, if treated early and correctly, recovered completely with return of normal lung function within 7 days.
What are the Preventive measures taken for Croup ?
--------------------------------------------------------
Vaccination against the influenza virus may help.
Wednesday, September 10, 2008
A Simple Guide to Bronchitis
A Simple Guide to Bronchitis
-----------------------------------
What is Bronchitis?
---------------------------
Bronchitis is an acute disease which causes inflammation and infection of the trachea, bronchi and bronchioles of the lungs.
The mucous membranes of the bronchi of the lungs becomes inflamed from bacterial or viral infection or irritated by fumes and dust in the air resulting in swelling of the bronchial mucosa with excess mucous discharge causing narrowing of the air passages.
Because of the congestion of the brochi there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .
What are the causes of Bronchitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus Bronchitise and Staphphylococcus may be serious and fatal in some cases.
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Viral infections:
--------------------
Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus
Fungal infections:
-----------------------
Cryptococcus neoformans
Non-infectious:
------------------
1.chemicals such as fumes can damage the lungs and cause Bronchitis
2.Othostatic Bronchitis occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs
3.Aspiration Bronchitis occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.
What are Signs and symptoms of Bronchitis?
---------------------------------------------
Symptoms:
1.cold or runny nose is usually the first symptom
2.Fever may be present
3.cough initially dry, followed by productive purulent sputum which can yellow, green or bloody
4.Breathlessness due to airway obstruction
5.chest pain especially the sides of the chest due to coughing and fever
6.Myalgia (bodyaches) and headache which may be related to the fever
Signs:
1.Moist sounds and wheezing on auscultation with sthetoscope due to narrowing of the airways(bronchi)
2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs
3.Reduced breath sounds - air movement is reduced in the lungs
4.Hyporesonance on percussion of the lungs
5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
Children and babies with Bronchitis may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
How is the diagnosis of Bronchitis made?
------------------------------------------
1.Symptoms and signs of fever, breathless and productive cough
2.blood tests (complete blood count, ESR and blood culture)
3.Sputum culture to determine the type of micro-organism
4.Chest X-rays to establish site and character of the bronchial infection
5.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.
What are the complications of Bronchitis?
-----------------------------------------------
1.Pneumonia
2.adult respiratory distress syndrome
3.Emphysema
What is the treatment of Bronchitis?
------------------------------------
1.Rest, fluids and oxygen
2.Bronchidilators such as aminophylline, ventolin, bricanyl
3.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
c.Tetracycline or erythromycin for mycoplasma and chlamydia
d.Erythromycin and rifampicin for Legionaire's disease.
3.Antivirals such as Tamiflu for Influeza infection
Acyclovir may be given for herpes virus infection
4.High dosages of antifungals may be given for Fungal Bronchitis for a prolonged period of time
5.corticosteroids is useful to reduce complications
6.Humidifiers and steam inhalations
5.cough mixtures and mucolytic agents such as bisolvon
What is the prognosis of Bronchitis ?
------------------------------------------
This depends on the severity and type of infection.
Most cases if treated early and correctly recovered completely with return of normal lung function.
In elderly and debilitated patients, breathing can be a problem and recurrence can occur.
What are the Preventive measures taken for Bronchitis ?
--------------------------------------------------------
1.Avoid smoking and dusty environment.
2.Healthy lifestyle with balanced diet and exercise.
3.Vaccination against the influenza virus may help.
-----------------------------------
What is Bronchitis?
---------------------------
Bronchitis is an acute disease which causes inflammation and infection of the trachea, bronchi and bronchioles of the lungs.
The mucous membranes of the bronchi of the lungs becomes inflamed from bacterial or viral infection or irritated by fumes and dust in the air resulting in swelling of the bronchial mucosa with excess mucous discharge causing narrowing of the air passages.
Because of the congestion of the brochi there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .
What are the causes of Bronchitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus Bronchitise and Staphphylococcus may be serious and fatal in some cases.
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Viral infections:
--------------------
Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus
Fungal infections:
-----------------------
Cryptococcus neoformans
Non-infectious:
------------------
1.chemicals such as fumes can damage the lungs and cause Bronchitis
2.Othostatic Bronchitis occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs
3.Aspiration Bronchitis occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.
What are Signs and symptoms of Bronchitis?
---------------------------------------------
Symptoms:
1.cold or runny nose is usually the first symptom
2.Fever may be present
3.cough initially dry, followed by productive purulent sputum which can yellow, green or bloody
4.Breathlessness due to airway obstruction
5.chest pain especially the sides of the chest due to coughing and fever
6.Myalgia (bodyaches) and headache which may be related to the fever
Signs:
1.Moist sounds and wheezing on auscultation with sthetoscope due to narrowing of the airways(bronchi)
2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs
3.Reduced breath sounds - air movement is reduced in the lungs
4.Hyporesonance on percussion of the lungs
5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
Children and babies with Bronchitis may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
How is the diagnosis of Bronchitis made?
------------------------------------------
1.Symptoms and signs of fever, breathless and productive cough
2.blood tests (complete blood count, ESR and blood culture)
3.Sputum culture to determine the type of micro-organism
4.Chest X-rays to establish site and character of the bronchial infection
5.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.
What are the complications of Bronchitis?
-----------------------------------------------
1.Pneumonia
2.adult respiratory distress syndrome
3.Emphysema
What is the treatment of Bronchitis?
------------------------------------
1.Rest, fluids and oxygen
2.Bronchidilators such as aminophylline, ventolin, bricanyl
3.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
c.Tetracycline or erythromycin for mycoplasma and chlamydia
d.Erythromycin and rifampicin for Legionaire's disease.
3.Antivirals such as Tamiflu for Influeza infection
Acyclovir may be given for herpes virus infection
4.High dosages of antifungals may be given for Fungal Bronchitis for a prolonged period of time
5.corticosteroids is useful to reduce complications
6.Humidifiers and steam inhalations
5.cough mixtures and mucolytic agents such as bisolvon
What is the prognosis of Bronchitis ?
------------------------------------------
This depends on the severity and type of infection.
Most cases if treated early and correctly recovered completely with return of normal lung function.
In elderly and debilitated patients, breathing can be a problem and recurrence can occur.
What are the Preventive measures taken for Bronchitis ?
--------------------------------------------------------
1.Avoid smoking and dusty environment.
2.Healthy lifestyle with balanced diet and exercise.
3.Vaccination against the influenza virus may help.
Monday, August 18, 2008
A Simple Guide to Pneumonia
A Simple Guide to Pneumonia
-----------------------------------
What is Pneumonia?
---------------------------
Pneumonia is a serious medical disease which causes inflammation and infection of the lung tissues of one or both lungs.
The alveoli of the lungs are filled with exudates and white blood cells sent by the body to contain the infection.
Because of the congestion of the lungs there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .
It is one of the top causes of death in the world.
What are the causes of Pneumonia?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus pneumoniae and Staphylococcus may be serious and fatal in some cases.
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Mycobacterium tuberculosis pneumonia are more common in developing countries and in people whose immune systems are impaired(e.g. AIDS) and are preceded by active tuberculosis infections elsewhere.
Viral infections:
--------------------
Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus
Fungal infections:
-----------------------
Cryptococcus neoformans
Non-infectious:
------------------
1.chemicals such as asbestos can damage the lungs and cause pneumonia
2.Othostatic pneumonia occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs
3.Aspiration pneumonia occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.
What are Signs and symptoms of pneumonia?
---------------------------------------------
Symptoms:
1.cold or runny nose is usually the first symptom
2.Fever is usually high
3.cough with productive purulent sputum which can yellow, green or bloody
4.Breathlessness due to congestion of the lungs
5.chest pain especially the sides of the chest due to coughing and fever
6.Myalgia (bodyaches) and headache which may be related to the fever
7.abdominal discomfort
8.lethargy especially in small children
Signs:
1.creptitation sounds on auscultation with stethoscope due to large amount of phlegm in the alveoli of the lungs
2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs
3.Reduced breath sounds - air movement is reduced in the lungs
4.Hyporesonance on percussion of the lungs
5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
Children and babies with pneumonia may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
Elderly people also do not have much symptoms except for fever and breathlessness
How is the diagnosis of Pneumonia made?
------------------------------------------
1.Symptoms and signs of fever, breathless and productive cough
2.blood tests (complete blood count, ESR and blood culture) including viral and legionaire's disease
3.Sputum culture to determine the type of micro-organism
4.Chest X-rays to establish site and character of the lung infection
5.Pleural tap may be necessary if there is pleural effusion. The pleural aspirate is then sent for culture and microscopic examination.
6.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.
What are the complications of Pneumonia?
-----------------------------------------------
1.Pleural effusion
2.septic shock,
3.adult respiratory distress syndrome
4.seizures also more in children
5.Emphysema
6.Pericarditis
What is the treatment of pneumonia?
------------------------------------
1.Hospitalization should be immediate as pneumonia can be a life threatening condition.
2.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
c.Tetracycline or erythromycin for mycoplasma and chlamydia
d.Erythromycin and rifampicin for Legionaire's disease.
3.Antivirals such as Tamiflu for Influenza infection
Acyclovir may be given for herpes virus infection
4.High dosages of anti-fungals may be given for Fungal pneumonia for a prolonged period of time
3.corticosteroids is useful to reduce complications
4.High-flow oxygen
5.intravenous fluids
What is the prognosis of pneumonia ?
------------------------------------------
This depends on the severity and type of infection.
Most cases if treated early and correctly recovered completely.
The elderly, babies and bedridden has a higher mortality.
What are the Preventive measures taken for pneumonia ?
--------------------------------------------------------
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of pneumonia.
Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumonia.
Vaccinations are recommended in:
Adults age 65 or older
Patient over two years of age
1. with diseased lungs, heart, liver, or kidneys
2. health problems like diabetes, alcoholism, AIDS
3. taking any medications or therapy that can affect the body's immune system
e.g chemotherapy
-----------------------------------
What is Pneumonia?
---------------------------
Pneumonia is a serious medical disease which causes inflammation and infection of the lung tissues of one or both lungs.
The alveoli of the lungs are filled with exudates and white blood cells sent by the body to contain the infection.
Because of the congestion of the lungs there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .
It is one of the top causes of death in the world.
What are the causes of Pneumonia?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus pneumoniae and Staphylococcus may be serious and fatal in some cases.
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Mycobacterium tuberculosis pneumonia are more common in developing countries and in people whose immune systems are impaired(e.g. AIDS) and are preceded by active tuberculosis infections elsewhere.
Viral infections:
--------------------
Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus
Fungal infections:
-----------------------
Cryptococcus neoformans
Non-infectious:
------------------
1.chemicals such as asbestos can damage the lungs and cause pneumonia
2.Othostatic pneumonia occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs
3.Aspiration pneumonia occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.
What are Signs and symptoms of pneumonia?
---------------------------------------------
Symptoms:
1.cold or runny nose is usually the first symptom
2.Fever is usually high
3.cough with productive purulent sputum which can yellow, green or bloody
4.Breathlessness due to congestion of the lungs
5.chest pain especially the sides of the chest due to coughing and fever
6.Myalgia (bodyaches) and headache which may be related to the fever
7.abdominal discomfort
8.lethargy especially in small children
Signs:
1.creptitation sounds on auscultation with stethoscope due to large amount of phlegm in the alveoli of the lungs
2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs
3.Reduced breath sounds - air movement is reduced in the lungs
4.Hyporesonance on percussion of the lungs
5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
Children and babies with pneumonia may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
Elderly people also do not have much symptoms except for fever and breathlessness
How is the diagnosis of Pneumonia made?
------------------------------------------
1.Symptoms and signs of fever, breathless and productive cough
2.blood tests (complete blood count, ESR and blood culture) including viral and legionaire's disease
3.Sputum culture to determine the type of micro-organism
4.Chest X-rays to establish site and character of the lung infection
5.Pleural tap may be necessary if there is pleural effusion. The pleural aspirate is then sent for culture and microscopic examination.
6.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.
What are the complications of Pneumonia?
-----------------------------------------------
1.Pleural effusion
2.septic shock,
3.adult respiratory distress syndrome
4.seizures also more in children
5.Emphysema
6.Pericarditis
What is the treatment of pneumonia?
------------------------------------
1.Hospitalization should be immediate as pneumonia can be a life threatening condition.
2.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
c.Tetracycline or erythromycin for mycoplasma and chlamydia
d.Erythromycin and rifampicin for Legionaire's disease.
3.Antivirals such as Tamiflu for Influenza infection
Acyclovir may be given for herpes virus infection
4.High dosages of anti-fungals may be given for Fungal pneumonia for a prolonged period of time
3.corticosteroids is useful to reduce complications
4.High-flow oxygen
5.intravenous fluids
What is the prognosis of pneumonia ?
------------------------------------------
This depends on the severity and type of infection.
Most cases if treated early and correctly recovered completely.
The elderly, babies and bedridden has a higher mortality.
What are the Preventive measures taken for pneumonia ?
--------------------------------------------------------
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of pneumonia.
Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumonia.
Vaccinations are recommended in:
Adults age 65 or older
Patient over two years of age
1. with diseased lungs, heart, liver, or kidneys
2. health problems like diabetes, alcoholism, AIDS
3. taking any medications or therapy that can affect the body's immune system
e.g chemotherapy
Monday, October 8, 2007
A Simple guide to Stress
A Simple guide to Stress
----------------------------
What is Stress?
-----------------
Stress is a very common condition characterised by exaggerated worry and tension.
People with stress worry excessively about money, health, family, or work, even though there are no signs of trouble.
They are unable to relax and may suffer from insomnia.
What are the common warning signs of stress?
------------------------------------------------------
The signs vary from person to person.
Some of them are:
1. Headaches
2. fast heartbeats
3. Muscle tension; muscle aches
4. muscle tremors
5. Inability to concentrate
6. Stomach ache
7. Diarrhoea
8. Chest pain
9. Breathlessness; hyperventilation
10.Dry mouth
11.Excessive sweating
12.Cold clammy hands
13.Under eating or overeating
14.Anxiety or panic
15.Irritability
16.Hyperactivity
17.Loss of sex drive
18.Fatigue
19.Sense of impending doom
20.Difficulty in falling asleep or frequent nightmares
Other signs may include chills, thirst, dizziness, nausea, fainting, twitches, vomiting, weakness, stuttering,shaky and strained voice,high-pitch laughter and higher blood pressure.
Even for children of school-going age, there are stress.
Symptoms include:
1.Fear of being away from the family
2.Refusal to go to school
3.Fear of strangers
4.Fear of falling asleep or having recurrent nightmares
5.Unnecessary worry
What can we do to lower our stress level?
------------------------------------------------
There are some ways to manage Stress:
1.Be more organised.
Plan your time well.
Do a list of all the things you need to do.
Arrange them in order of importance.
Decide how much time you need for each job.
Keep to your plan.
2.Give yourself time to adjust from one change to another.
Spread out the changes in your life.
Don't do too many things at one time.
3.Always do your work according to your own ability and interest.
Be realistic about what you can do.
Do not ask for the impossible.
Set goals which are achievable so that you don't feel frustrated or discouraged.
4.Think before making decisions.
Get all the relevant information first.
Don't decide blindly.
Consider all the pros and cons of each choice.
Get the people who will be affected by the decision involved in the process.
5.Learn to like yourself.
Don't worry about your external appearance and other faults.
Make the best of what you have.
Accept what you cannot change.
6.AlwaysThink positively.
Prevent negative feelings from building up.
Try to find the source of these feelings.
Always deal constructively with them.
Do not blow things out of proportion.
7.Do not keep all your problems and worries to yourself.
Remember you are not alone.
Share your problems with your spouse, friend or supervisor .
They may have had experience with similar situations.
They may be able to solve your problem.
8.Always build a happy family.
Be kind and loving to your family.
They will provide you with love and support in your times of need.
Always set aside some time each day to talk, play or relax together.
Your home should be a happy place to return to after a hard day's work.
9.Have good friends.
You also need good friends to talk to and laugh with.
They will visit you, go out with you and help you in times of need.
Treat others the way you would like them to treat you.
Respect their views and be patient with their faults.
Always try to give and take.
10.A healthy body is important to overcome stress.
Keep healthy by exercising regularly, eating wisely and getting enough sleep.
Do not smoke or drink to relieve your stress.
Smoking and drinking do not solve anything.
They will cause more problems for your health.
11.Spend some time on yourself.
Do something that you really enjoy like a hobby or an exercise.
Take a short break when you feel tensed or tired.
You deserve to have a little fun sometimes.
12.Try to learn some Relaxation Techniques:
Deep breathing exercise,
meditation,
massage and
muscle relaxation techniques
can be helpful in relieving stress.
What is the Treatment of Stress?
---------------------------------------
Stress can be treated with conventional medicine, psychotherapy and alternative approaches.
A combination of conventional and alternative methods has been shown to be effective.
Conventional Medicine
Psychotherapy and psychoanalysis helps to identify the buried conflicts and worries that may be causing the stress.
Behaviour modification, on the other hand, focuses on changing patterns of behaviour to help the patient avert stress or to cope better with it.
Cognitive therapy similarly concentrates on changing ways of thinking.
One of the best forms of treatment for stress is daily exercise and a healthy lifestyle.
Medication relieves symptoms of stress and is often prescribed in conjunction with other therapies.
Alternative Medicine:
--------------------------
music therapy,
yoga,
herbs and
aromatherapy
are some ways that have helped stress sufferers to relax.
"Remember that you are not alone.
There are always people who are willing to help you.
In this life you must always give and take.
Be happy! Don't worry unnnecessarily!"
----------------------------
What is Stress?
-----------------
Stress is a very common condition characterised by exaggerated worry and tension.
People with stress worry excessively about money, health, family, or work, even though there are no signs of trouble.
They are unable to relax and may suffer from insomnia.
What are the common warning signs of stress?
------------------------------------------------------
The signs vary from person to person.
Some of them are:
1. Headaches
2. fast heartbeats
3. Muscle tension; muscle aches
4. muscle tremors
5. Inability to concentrate
6. Stomach ache
7. Diarrhoea
8. Chest pain
9. Breathlessness; hyperventilation
10.Dry mouth
11.Excessive sweating
12.Cold clammy hands
13.Under eating or overeating
14.Anxiety or panic
15.Irritability
16.Hyperactivity
17.Loss of sex drive
18.Fatigue
19.Sense of impending doom
20.Difficulty in falling asleep or frequent nightmares
Other signs may include chills, thirst, dizziness, nausea, fainting, twitches, vomiting, weakness, stuttering,shaky and strained voice,high-pitch laughter and higher blood pressure.
Even for children of school-going age, there are stress.
Symptoms include:
1.Fear of being away from the family
2.Refusal to go to school
3.Fear of strangers
4.Fear of falling asleep or having recurrent nightmares
5.Unnecessary worry
What can we do to lower our stress level?
------------------------------------------------
There are some ways to manage Stress:
1.Be more organised.
Plan your time well.
Do a list of all the things you need to do.
Arrange them in order of importance.
Decide how much time you need for each job.
Keep to your plan.
2.Give yourself time to adjust from one change to another.
Spread out the changes in your life.
Don't do too many things at one time.
3.Always do your work according to your own ability and interest.
Be realistic about what you can do.
Do not ask for the impossible.
Set goals which are achievable so that you don't feel frustrated or discouraged.
4.Think before making decisions.
Get all the relevant information first.
Don't decide blindly.
Consider all the pros and cons of each choice.
Get the people who will be affected by the decision involved in the process.
5.Learn to like yourself.
Don't worry about your external appearance and other faults.
Make the best of what you have.
Accept what you cannot change.
6.AlwaysThink positively.
Prevent negative feelings from building up.
Try to find the source of these feelings.
Always deal constructively with them.
Do not blow things out of proportion.
7.Do not keep all your problems and worries to yourself.
Remember you are not alone.
Share your problems with your spouse, friend or supervisor .
They may have had experience with similar situations.
They may be able to solve your problem.
8.Always build a happy family.
Be kind and loving to your family.
They will provide you with love and support in your times of need.
Always set aside some time each day to talk, play or relax together.
Your home should be a happy place to return to after a hard day's work.
9.Have good friends.
You also need good friends to talk to and laugh with.
They will visit you, go out with you and help you in times of need.
Treat others the way you would like them to treat you.
Respect their views and be patient with their faults.
Always try to give and take.
10.A healthy body is important to overcome stress.
Keep healthy by exercising regularly, eating wisely and getting enough sleep.
Do not smoke or drink to relieve your stress.
Smoking and drinking do not solve anything.
They will cause more problems for your health.
11.Spend some time on yourself.
Do something that you really enjoy like a hobby or an exercise.
Take a short break when you feel tensed or tired.
You deserve to have a little fun sometimes.
12.Try to learn some Relaxation Techniques:
Deep breathing exercise,
meditation,
massage and
muscle relaxation techniques
can be helpful in relieving stress.
What is the Treatment of Stress?
---------------------------------------
Stress can be treated with conventional medicine, psychotherapy and alternative approaches.
A combination of conventional and alternative methods has been shown to be effective.
Conventional Medicine
Psychotherapy and psychoanalysis helps to identify the buried conflicts and worries that may be causing the stress.
Behaviour modification, on the other hand, focuses on changing patterns of behaviour to help the patient avert stress or to cope better with it.
Cognitive therapy similarly concentrates on changing ways of thinking.
One of the best forms of treatment for stress is daily exercise and a healthy lifestyle.
Medication relieves symptoms of stress and is often prescribed in conjunction with other therapies.
Alternative Medicine:
--------------------------
music therapy,
yoga,
herbs and
aromatherapy
are some ways that have helped stress sufferers to relax.
"Remember that you are not alone.
There are always people who are willing to help you.
In this life you must always give and take.
Be happy! Don't worry unnnecessarily!"
Saturday, September 22, 2007
A Simple Guide to Lung Cancer
A Simple Guide to Lung Cancer
---------------------------
What is Lung Cancer?
--------------------------
Lung Cancer is the uncontrolled growth of abnormal cells in one or both lungs.
The cells lining air passages grow and divide until an abnormal mass or tumour is formed. The cells then grow and spread to the rest of the body.
What are the types of Lung Cancer?
------------------------------------------
There are 2 main types of Lung Cancer:
1. small cell lung cancer (SCLC) has the most aggressive clinical course of any type of pulmonary tumor, with poor survival rate from diagnosis of only 2 to 4 months.
2. non-small cell lung cancer:
a.Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales.
b.Large cell carcinoma: Cancer that may begin in several types of large cells.
c.Adenocarcinoma: Cancer that begins in the cells that line the alveoli and make substances such as mucus.
d.Other less common types of non-small cell lung cancer are: pleomorphic, carcinoid tumor, salivary gland carcinoma, and unclassified carcinoma.
These types are diagnosed based on how the cells look under a microscope.
The Non-small cell Lung cancer may take up to 10-30 years to develop. Thus it is often seen in middle aged and elderly persons.
Once developed Lung cancers tend to spread quickly because the lungs are richly supplied by blood and lymph vessels.
In the travel through the lymph vessels, it can cause enlarged lymph nodes.
If it enter the blood , the cancer cells can spread to the liver, bone, brain or other parts of the body.
What are the causes of Lung Cancer?
-------------------------------------------
1.Cigarette smoking is the main cause of lung cancer.
2. Cigar and pipe smoking is also a source of lung cancer though less than those who smoke cigarettes.
3. Passive smoking in a family where one member smokes has been to increase the risk of lung cancer by 35%
4. Industrial hazards such as chemicals and smoke emitted at work[place also increase the risk of lung cancer. Examples are asbestos, coal gas,chromates,uranium.
5.Being treated with radiation therapy to the breast or chest.
What are the symptoms of Lung Cancer?
------------------------------------------------
1.Persistent cough which does not improve
2. shortness of breath and wheezing dut to the pressure of the tumour on the airway
3.Production of blood stained sputum
4. chest pain especially together with a chronic cough
5.Sudden unexplained loss of weight
6. Loss of appetite
7. General weakness and tiredness
8.Recurrent chest infections and fever
9. hoarseness of voice
How do you diagnose Lung Cancer?
-----------------------------------------
1. History & Medical examination especially history of smoking and exposure to chemicals
2. Chest X-ray to check for lung shadows
3. Sputum cytology- sometimes the cancer cells may be detected in the sputum
4. Bronchoscopy- a bronchoscope is passed into bronchi to study the airway while the patient is under general anesthesia.
Suspicious growth can be taken for biopsy(examination under microscope for cancer cells)
5.CT Scan & MRI produce 3D mages of the lung
6.Ultrasound or another imaging procedure is used to locate the abnormal tissue or fluid in the lung.
7.Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision is made between two ribs, and a thoracoscope is inserted into the chest. Tissue samples and lymph nodes may be removed for biopsy. This procedure may be used to remove parts of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.
What is the Treatment of Lung Cancer?
----------------------------------------------
As usual the treatment consists of Surgery, Radiotherapy and chemotherapy.The choice of treatment depends on the size, extent of cancer , the type of lung cancer and the general health of the patient.
Surgery:
Part or whole of the lung can be removed in the treatment of lung cancer.
After surgery the patient may required assisted ventilation for a short period.
Physical activity may be limited for a while.
If the remaining lung is in good condition, the patient may be able to live a normal life.
Chemotherapy:
Certain type of lung cancer( small cell) are sensitive to chemotherapy. It is used in combination with surgery and radiotherapy.
Radiotherapy:
Radiation may be used in conjunction with surgery or to relieve pressure symptoms or pain caused by the lung cancer.
What is the prognosis of Lung Cancer?
---------------------------------------------
The prognosis (chance of recovery) depend on the following:
The stage of the cancer (the size of the tumor and whether it is in the lung only or has spread to other places in the body).
The type of lung cancer.
Whether there are symptoms such as coughing or trouble breathing.
The patient’s general health.
For most patients with non-small cell lung cancer, current treatments do not cure the cancer.
Small cell lung cancer has a greater tendency to be widely disseminated by the time of diagnosis but is much more responsive to chemotherapy and radiation therapy.
Because patients with small cell lung cancer tend to develop distant metastases, localized forms of treatment, such as surgical resection or radiation therapy, rarely produce long-term survival. With use ofchemotherapy regimens in the treatment program, however, survival is much prolonged.
Added 4th October 2008
---------------------------------
Lung Cancer
------------------
1. Lung cancer is still the biggest cancer killer in the world.
2. Every 30 seconds someone dies of lung cancer
3. About 40% of smokers who continues smoking from their early teens risk early death from lung cancer
4. 1 in 10 people with lung cancer lives for more than 5 years after diagnosis
5. Women smokers are twice as likely to get lung cancer than male smokers.
---------------------------
What is Lung Cancer?
--------------------------
Lung Cancer is the uncontrolled growth of abnormal cells in one or both lungs.
The cells lining air passages grow and divide until an abnormal mass or tumour is formed. The cells then grow and spread to the rest of the body.
What are the types of Lung Cancer?
------------------------------------------
There are 2 main types of Lung Cancer:
1. small cell lung cancer (SCLC) has the most aggressive clinical course of any type of pulmonary tumor, with poor survival rate from diagnosis of only 2 to 4 months.
2. non-small cell lung cancer:
a.Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales.
b.Large cell carcinoma: Cancer that may begin in several types of large cells.
c.Adenocarcinoma: Cancer that begins in the cells that line the alveoli and make substances such as mucus.
d.Other less common types of non-small cell lung cancer are: pleomorphic, carcinoid tumor, salivary gland carcinoma, and unclassified carcinoma.
These types are diagnosed based on how the cells look under a microscope.
The Non-small cell Lung cancer may take up to 10-30 years to develop. Thus it is often seen in middle aged and elderly persons.
Once developed Lung cancers tend to spread quickly because the lungs are richly supplied by blood and lymph vessels.
In the travel through the lymph vessels, it can cause enlarged lymph nodes.
If it enter the blood , the cancer cells can spread to the liver, bone, brain or other parts of the body.
What are the causes of Lung Cancer?
-------------------------------------------
1.Cigarette smoking is the main cause of lung cancer.
2. Cigar and pipe smoking is also a source of lung cancer though less than those who smoke cigarettes.
3. Passive smoking in a family where one member smokes has been to increase the risk of lung cancer by 35%
4. Industrial hazards such as chemicals and smoke emitted at work[place also increase the risk of lung cancer. Examples are asbestos, coal gas,chromates,uranium.
5.Being treated with radiation therapy to the breast or chest.
What are the symptoms of Lung Cancer?
------------------------------------------------
1.Persistent cough which does not improve
2. shortness of breath and wheezing dut to the pressure of the tumour on the airway
3.Production of blood stained sputum
4. chest pain especially together with a chronic cough
5.Sudden unexplained loss of weight
6. Loss of appetite
7. General weakness and tiredness
8.Recurrent chest infections and fever
9. hoarseness of voice
How do you diagnose Lung Cancer?
-----------------------------------------
1. History & Medical examination especially history of smoking and exposure to chemicals
2. Chest X-ray to check for lung shadows
3. Sputum cytology- sometimes the cancer cells may be detected in the sputum
4. Bronchoscopy- a bronchoscope is passed into bronchi to study the airway while the patient is under general anesthesia.
Suspicious growth can be taken for biopsy(examination under microscope for cancer cells)
5.CT Scan & MRI produce 3D mages of the lung
6.Ultrasound or another imaging procedure is used to locate the abnormal tissue or fluid in the lung.
7.Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision is made between two ribs, and a thoracoscope is inserted into the chest. Tissue samples and lymph nodes may be removed for biopsy. This procedure may be used to remove parts of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.
What is the Treatment of Lung Cancer?
----------------------------------------------
As usual the treatment consists of Surgery, Radiotherapy and chemotherapy.The choice of treatment depends on the size, extent of cancer , the type of lung cancer and the general health of the patient.
Surgery:
Part or whole of the lung can be removed in the treatment of lung cancer.
After surgery the patient may required assisted ventilation for a short period.
Physical activity may be limited for a while.
If the remaining lung is in good condition, the patient may be able to live a normal life.
Chemotherapy:
Certain type of lung cancer( small cell) are sensitive to chemotherapy. It is used in combination with surgery and radiotherapy.
Radiotherapy:
Radiation may be used in conjunction with surgery or to relieve pressure symptoms or pain caused by the lung cancer.
What is the prognosis of Lung Cancer?
---------------------------------------------
The prognosis (chance of recovery) depend on the following:
The stage of the cancer (the size of the tumor and whether it is in the lung only or has spread to other places in the body).
The type of lung cancer.
Whether there are symptoms such as coughing or trouble breathing.
The patient’s general health.
For most patients with non-small cell lung cancer, current treatments do not cure the cancer.
Small cell lung cancer has a greater tendency to be widely disseminated by the time of diagnosis but is much more responsive to chemotherapy and radiation therapy.
Because patients with small cell lung cancer tend to develop distant metastases, localized forms of treatment, such as surgical resection or radiation therapy, rarely produce long-term survival. With use ofchemotherapy regimens in the treatment program, however, survival is much prolonged.
Added 4th October 2008
---------------------------------
Lung Cancer
------------------
1. Lung cancer is still the biggest cancer killer in the world.
2. Every 30 seconds someone dies of lung cancer
3. About 40% of smokers who continues smoking from their early teens risk early death from lung cancer
4. 1 in 10 people with lung cancer lives for more than 5 years after diagnosis
5. Women smokers are twice as likely to get lung cancer than male smokers.
Thursday, September 6, 2007
A Simple Guide to Asthma
A Simple Guide to Asthma
-------------------------------
What is asthma?
-------------------
Asthma is a common long-lasting (chronic) inflammatory disease of the lungs and airways (bronchi) that affects 5 % adults and 20% children and causes narrowing of the airtubes.
What happens during an asthma attack?
---------------------------------------
When your airtubes are exposed to trigger factors, inflammation of the airway results.
The breathing tubes become narrowed and clogged up with mucus making breathing difficult. Inflammation may continue even though there is minimal or no symptom of asthma.
What are the symptoms of Asthma?
-------------------------------------------
Asthma is characterised by attacks of
-------------------------------
What is asthma?
-------------------
Asthma is a common long-lasting (chronic) inflammatory disease of the lungs and airways (bronchi) that affects 5 % adults and 20% children and causes narrowing of the airtubes.
What happens during an asthma attack?
---------------------------------------
When your airtubes are exposed to trigger factors, inflammation of the airway results.
The breathing tubes become narrowed and clogged up with mucus making breathing difficult. Inflammation may continue even though there is minimal or no symptom of asthma.
What are the symptoms of Asthma?
-------------------------------------------
Asthma is characterised by attacks of
1. breathlessness,
2.tight chest,
3.wheezing sounds and
4.coughing
These symptoms are caused by the airways becoming narrowed and inflamed.
Some people may have these symptoms all of the time.
Some people may have these symptoms all of the time.
Others may be normal between attacks.
Who is at risk of developing asthma?
----------------------------------------------
Anybody can get it at any age but it tends to run in families.
They also have an inherited tendency to develop other allergic conditions such as eczema and allergic rhinitis.
Most children, particularly those with mild asthma will be attack free by adolescence.
A small number continue to have symptoms as adults.
Yet others have their asthma symptoms reappearing only when they reach adulthood.
What causes asthma attacks?
-------------------------------------
Asthma results from sensitive airways that react to certain trigger factors.
These triggers may be different for different people.
Avoidance of trigger factors is important.
Some common triggers are:
1.Allergens such as house-dust mites, cockroaches, animal danders, pollen, indoor moulds and foods particularly those containing sulphite.
2.Infections such as the common cold and sinus infection
Who is at risk of developing asthma?
----------------------------------------------
Anybody can get it at any age but it tends to run in families.
They also have an inherited tendency to develop other allergic conditions such as eczema and allergic rhinitis.
Most children, particularly those with mild asthma will be attack free by adolescence.
A small number continue to have symptoms as adults.
Yet others have their asthma symptoms reappearing only when they reach adulthood.
What causes asthma attacks?
-------------------------------------
Asthma results from sensitive airways that react to certain trigger factors.
These triggers may be different for different people.
Avoidance of trigger factors is important.
Some common triggers are:
1.Allergens such as house-dust mites, cockroaches, animal danders, pollen, indoor moulds and foods particularly those containing sulphite.
2.Infections such as the common cold and sinus infection
3.Weather changes due to change in temperature or humidity
4.Air pollution e.g. from tobacco smoke and haze
5.Strong odours or sprays e.g. paints, varnishes, cleaning solvent fumes, perfumes, cooking fumes
6.cold air,
7.vigorous exercise
8.stress.
4.Air pollution e.g. from tobacco smoke and haze
5.Strong odours or sprays e.g. paints, varnishes, cleaning solvent fumes, perfumes, cooking fumes
6.cold air,
7.vigorous exercise
8.stress.
Attacks may be more frequent or severe in people who have a chest infection.
Avoidance of trigger factors
1.Animal dander (fur, skin of cats or dogs) Give away pet if possible. If not, prevent pet from entering the bedroom. Bathe pet weekly.
2.House-dust mites Use protective air-tight mattress covers and pillow cases. Wash bedsheets and pillow cases weekly in hot water
3.Cockroaches Do not leave garbage uncovered. Use poison baits. Use pesticide spray only when the asthmatic is out of the house.
4.Indoor moulds Reduce dampness in the house.
5.Outdoor pollens Close doors and windows and stay indoors when pollen count is highest in the afternoon.
6.Tobacco smoke and haze Avoid tobacco smoke and haze as far as possible.
7.Medication Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and beta-blockers should be avoided.
8.Food Certain foods containing sulphites should be avoided such as shellfish and preserved foods.
What to do during an asthma attack?
--------------------------------------------
1.Stay calm. Family members or caregivers should be calm, positive and encouraging.
2.Use 2 puffs of your reliever inhaler immediately as previously instructed by your doctor.
If asthma symptoms are not relieved or wheezing returns within 4 hours, give another 2 puffs of the reliever.
3. take your asthma medications with warm water.
4. consult your family doctor if there is no improvement.
If necessary, go to the nearest hospital for help.
How serious is Asthma?
----------------------------
Asthma is not generally considered by doctors to be a serious illness in most people who have it, mainly due to the mildness of symptoms and the range of very effective medicines that control these symptoms and stop asthma worsening.
Asthma does, however, have an effect on quality of life because attacks can be unpleasant and distressing and can restrict activity. Whilst most sufferers learn to live with and manage their condition, for some it can be disabling.
In exceptional cases, asthma can be life-threatening, particularly if it is not treated adequately or promptly. For some of these, an attack is so severe that it results in death.
How long does Asthma last?
-----------------------------------
Asthma attacks come and go, with wide variation in the symptoms at different times.
Many people with asthma have problems only occasionally but others struggle with it every day. Modern medicines control and relieve symptoms and so attacks may only last a few hours or minutes, but without treatment this may go on for several days.
Some children grow out of asthma and some people are only affected at different times of the year.
However, the period of time during which people may have asthma attacks can last for many years or throughout life.
How is Asthma treated?
----------------------------
There is no cure for asthma, but there are different types of medicines that will help to keep it under control and relieve symptoms.
1.Most sufferers must be given a type of medicine called a preventer, which is usually an anti-inflammatory steroid (of the glucocorticosteroid type) that treats the underlying causes of the asthma. These are usually given from an inhaler.
Even if symptoms are not present, sufferers should keep taking the preventer medicines, as this will greatly decrease the risk of suffering asthma attacks. This will help many asthmatics to live a normal active life.
Steroids can also be taken as tablets but have many side effects.
2.Another sort of medicine is called a reliever that is used during an asthma attack and may be contained in an inhaler. This contains a bronchodilator medicine that opens up the bronchial tubes of the lungs and works in a few minutes. It can also be taken as tablets. Side effects may be rapid heart beats and tremors of hands.
Can asthma be cured?
---------------------------
No, there is currently no known cure for asthma.
If necessary, go to the nearest hospital for help.
How serious is Asthma?
----------------------------
Asthma is not generally considered by doctors to be a serious illness in most people who have it, mainly due to the mildness of symptoms and the range of very effective medicines that control these symptoms and stop asthma worsening.
Asthma does, however, have an effect on quality of life because attacks can be unpleasant and distressing and can restrict activity. Whilst most sufferers learn to live with and manage their condition, for some it can be disabling.
In exceptional cases, asthma can be life-threatening, particularly if it is not treated adequately or promptly. For some of these, an attack is so severe that it results in death.
How long does Asthma last?
-----------------------------------
Asthma attacks come and go, with wide variation in the symptoms at different times.
Many people with asthma have problems only occasionally but others struggle with it every day. Modern medicines control and relieve symptoms and so attacks may only last a few hours or minutes, but without treatment this may go on for several days.
Some children grow out of asthma and some people are only affected at different times of the year.
However, the period of time during which people may have asthma attacks can last for many years or throughout life.
How is Asthma treated?
----------------------------
There is no cure for asthma, but there are different types of medicines that will help to keep it under control and relieve symptoms.
1.Most sufferers must be given a type of medicine called a preventer, which is usually an anti-inflammatory steroid (of the glucocorticosteroid type) that treats the underlying causes of the asthma. These are usually given from an inhaler.
Even if symptoms are not present, sufferers should keep taking the preventer medicines, as this will greatly decrease the risk of suffering asthma attacks. This will help many asthmatics to live a normal active life.
Steroids can also be taken as tablets but have many side effects.
2.Another sort of medicine is called a reliever that is used during an asthma attack and may be contained in an inhaler. This contains a bronchodilator medicine that opens up the bronchial tubes of the lungs and works in a few minutes. It can also be taken as tablets. Side effects may be rapid heart beats and tremors of hands.
Can asthma be cured?
---------------------------
No, there is currently no known cure for asthma.
The good news is that modern medicine is extremely effective in controlling symptoms.
You can lead a relatively normal life if you seek to understand how to control your asthma and prevent attacks from occurring.
Asthma attacks may be prevented at a reasonable cost.
It usually requires long term treatment with 'preventer medication'.
What you can do to control asthma?
-------------------------------------------
ASTHMA MANAGEMENT PLAN
Asthma is a chronic disease requiring continuous management and appropriate treatment.
If you follow your prescribed asthma management plan, you can expect to live an active, normal lifestyle.
It usually requires long term treatment with 'preventer medication'.
What you can do to control asthma?
-------------------------------------------
ASTHMA MANAGEMENT PLAN
Asthma is a chronic disease requiring continuous management and appropriate treatment.
If you follow your prescribed asthma management plan, you can expect to live an active, normal lifestyle.
Successful treatment of asthma is a partnership between you and your doctor.
You and your doctor should work out an asthma management plan.
This should include:
1.understanding what asthma is all about
2. having clear goals of management
3. knowing the severity of your asthma;
patients with mild asthma can do with just reliever medications to stop the attacks.
On the other hand, patients with severe asthma or those with frequent attacks should go on regular medications to prevent attacks
4.being able to recognise symptoms suggesting worsening of asthma
5.knowing your medicines (preventers and relievers) and how to use them correctly
6.using the right inhaler technique and practicing it until you get it right
7..recognising and avoiding trigger factors
8.knowing what to do during an asthma attack
9..arranging regular follow-up visits with your doctor
This should include:
1.understanding what asthma is all about
2. having clear goals of management
3. knowing the severity of your asthma;
patients with mild asthma can do with just reliever medications to stop the attacks.
On the other hand, patients with severe asthma or those with frequent attacks should go on regular medications to prevent attacks
4.being able to recognise symptoms suggesting worsening of asthma
5.knowing your medicines (preventers and relievers) and how to use them correctly
6.using the right inhaler technique and practicing it until you get it right
7..recognising and avoiding trigger factors
8.knowing what to do during an asthma attack
9..arranging regular follow-up visits with your doctor
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