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Medicine is to heal from the inside

The Control of Post-Operative Pain

Humans are he most exquisite devices ever made for experiencing pain: the richer our inner lives, the greater the varieties of pain there are for us to feel, and the more resources we have for dealing with the pain.

Pain has a complex association with our body, If we have pain, most of us will have a discomfort situation that put them into psychological stress. While, people with psychological problems, may also have pain, that may not correlated with tissue injury, but pain is pain, it's discomfort, unpleasant, stressful experience.

Thus, diagnosis and management of pain is important in daily practice. The fact is human can't live without the pain, because it's natural signal of tissue injury. But to relieve pain, is really helpful for those, in order to alleviate their suffering and improving their quality of life. Most of the research is demanding on survival rates, but it is not about the quantity, but about the quality of life.

It's different between people who live longer but experience unpleasant situation, compare to people who live shorter but have a joyful life.

Never forget how painful pain is, nor how fear magnifies pain.

Why is pain control so important?
In addition to keeping a person comfortable, pain control can help someone recover faster and may reduce the risk of developing certain complications after surgery, such as pneumonia and blood clots. If your pain is well controlled, you will be better able to complete important tasks such as walking and deep breathing exercises.

Kinds of Post-Operaitive Pain
Often times the incision itself is not the only area of discomfort. A person may or may not feel the following:
* Muscle pain - feeling of muscle pain in the neck, shoulders, back, or chest from lying on the operating table.

* Throat pain - something like a sore throat or scratchy.
* Movement pain - Sitting up, walking, and coughing are all important activities after surgery, but they may cause increased pain at or around the incision site.

Pain is Subjective
There is an agreement that the experience of pain is different between everyone, or more subjective. So, we need an objective tools to measure the quality of pain thus can be use in monitoring of pain control. There are several scales that have been developed as pain scales, often to be used is Numeric Pain Scale.

While you are recovering, your doctors and nurses will frequently ask you to rate your pain on a scale of 0 to 10, with "0" being "no pain" and "10" being "the worst pain you can imagine." Keep in mind that your comfort level (ie, ability to breathe deeply or cough) is more important than absolute numbers (ie, pain score).
Live without Pain

Types of Pain-Control Treatments
Pain control is varies between patients, and it determine by many things, the doctor and you will discuss which modality that suits your condition.
You may receive more than one type of pain treatment, depending on your needs and the type of surgery you are having. All of these treatments are relatively safe, but like any therapy, they are not completely free of risk. Dangerous side effects are rare. Nausea, vomiting, itching, and drowsiness can occur. These side effects are usually easily treated in most cases.

Intravenous Patient-Controlled Analgesia (PCA)
Patient-controlled analgesia (PCA) is a computerized pump that safely permits you to push a button and deliver small amounts of pain medicine into your intravenous (IV) line, usually in your arm. There is no injection of needles into your muscle. PCA provides stable pain relief in most situations. Many patients like the sense of control they have over their pain management.

The PCA pump is programmed to give a certain amount of medication when you press the button. It will only allow you to have so much medication, no matter how often you press the button, so there is little worry that you will give yourself too much.

Patient-Controlled Epidural Analgesia
Many people are familiar with epidural anesthesia because it is frequently used to control pain during childbirth. Patient-Controlled Epidural Analgesia uses a PCA pump to deliver pain-control medicine into an epidural catheter (a very thin plastic tube) that is placed into your back.

Epidural analgesia is usually more effective in relieving pain than intravenous medication. Patients who receive epidural analgesia typically have less pain when they take deep breaths, cough, and walk, and they may recover more quickly. For patients with medical problems such as heart or lung disease, epidural analgesia may reduce the risk of serious complications such as heart attack and pneumonia.

Nerve Blocks
You may be offered a nerve block to control your pain after surgery. Whereas an epidural controls pain over a broad area of your body, a nerve block is used when pain from surgery affects a smaller region of your body, such as an arm or leg. There are several potential advantages of a nerve block. It may allow for a significant reduction in the amount of opioid (narcotic) medication, which may result in fewer side effects such as nausea, vomiting, itching, and drowsiness.

Oral Pain Medications
During the phase of recovery from surgery, after evaluating the overall health condition, your doctor will order pain medications to be taken by mouth (oral pain medications). These may be ordered to come at a specified time, or you may need to ask your nurse to bring them to you. Most oral pain medications can be taken every 4 hours. But it doesn't mean that you only can take medication every 4 hours, when you feel the pain is severe and not relieve by the drug, you call a nurse or doctor, they will give you an extra-medication.

There are many kinds of oral pain medications such as NSAIDs, Opiods, and Paracetamol, etc. Each drug has its own benefits and side effects, and it is used according to pain scale or the quality of pain, more severe the pain, the stronger pain relief such as opiod.
Pain Relieve Medication

Are there ways to relieve pain without medication?
Yes, there are other ways to relieve pain and it is important to keep an open mind about these techniques. When used along with medication, these techniques can dramatically reduce pain.

Relaxation tapes or Guided Imagery is a proven form of focused relaxation that coaches you in creating calm, peaceful images in your mind -- a "mental escape." While at home, heat or cold therapy may be an option that your surgeon may choose to help reduce swelling and control your pain.

If you have an abdominal or chest incision, you will want to splint the area with a pillow when you are coughing or deep breathing to decrease motion near your incision.

Take home message
Lastly, make sure you are comfortable with your treatment plan. Talk to your doctor and nurses about your concerns and needs. This will help avoid miscommunication, stress, anxiety, and disappointment, which may make pain worse. Keep asking questions until you have satisfactory answers. You are the one who will benefit.
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Traumatic Brain Injury at a Glance

Traumatic Brain Injury (TBI) is a form acquired brain injury, occurs when a sudden trauma causes damage to the brain. The damage can be focal - confined to one area of the brain - or diffuse - involving more than one area of the brain.

TBI can result from a closed head injury or a penetrating head injury. A closed injury occurs when the head suddenly and violently hits an object but the object does not break through the skull. A penetrating injury occurs when an object pierces the skull and enters brain tissue.

Facts about Brain Injury
TBI is a major public health concern, the incidence of traumatic brain injury increases nowadays, mostly related to transportation accidents involving automobiles, motorcycles, pedestrians, etc. TBI has been replacing heart attack for leading cause of death for young adults, especially among male adolescents and young adults ages 15 to 24. The probable explanation about this condition is the young adults tend to drive furiously, ignore the safety for themself and others.

While for the elderly population, TBI also can be found both sexes 75 years and older, most of the case related to falls.

The cause of the TBI plays a role in determining the patient's outcome. For example, approximately 91 percent of firearm TBIs (two-thirds of which may be suicidal in intent) result in death, while only 11 percent of TBIs from falls result in death.

Other statistics dramatically tell the head injury in the United States. Each year:
· approximately 1.4 million people experience a TBI,
· approximately 50,000 people die from head injury,
· approximately 1 million head-injured people are treated in hospital emergency rooms, and
· approximately 230,000 people are hospitalized for TBI and survive.
Traumatic Brain Injury
Traumatic Brain Injury

Prevention
TBI is a form neurological disorders that devastating, deathliest but can be prevented. Based on the statistics, TBI mostly related to transportation accident, thus certain precaution such as wearing a helmet when riding a bicycle or motorcycle and wearing a seatbelt when driving or riding in a car, greatly reduce the risk of TBI.

Not only using head-protector, but also our attitude in driving or riding vehicle is important, we should think about safety whether for ourselves and others.

General Trauma
Most TBI patients also have injuries to other parts of the body in addition to the head and brain. These traumatized patients require immediate and specialized care, that give comprehensive treatment and manage the recovery from the TBI.

Other medical complications that may accompany a TBI include pulmonary (lung) dysfunction; cardiovascular (heart) dysfunction from blunt chest trauma; gastrointestinal dysfunction; fluid and hormonal imbalances; and other isolated complications, such as fractures, nerve injuries, deep vein thrombosis , excessive blood clotting, and infections.

Those comorbidities have to be managed simultantly and comprehensively, since it will determine the patient conditions later.

Signs and Symptoms of TBI
Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. Some symptoms are evident immediately, while others do not surface until several days or weeks after the injury.

A mild TBI person may remain conscious or may experience a loss of consciousness for a few seconds or minutes. The person may also feel dazed or not like himself for several days or weeks after the initial injury. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.

While a person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and/or increased confusion, restlessness, or agitation.

Small children with moderate to severe TBI may show some of these signs as well as signs specific to young children, such as persistent crying, inability to be consoled, and/or refusal to nurse or eat. Anyone with signs of moderate or severe TBI should receive medical attention as soon as possible.

Management of TBI patient
Traumatic Brain Injury usually result from an accident, most of the cases are emergency. Thus proper management of TBI patients should emphasized and be done from the scene of the accident, transportation of the patients and at the hospital.
Mechanism of TBI

Usually the settings are very dramatical, since the accident may so destructive and there are multi-trauma to the patient body. When facing with this situation, the emergency medical services must be activated such as calling 911 in US.

Because little can be done to reverse the initial brain damage caused by trauma, medical personnel try to stabilize the patient and focus on preventing secondary brain injury. Primary concerns include insuring proper oxygen supply to the brain and the rest of the body, maintaining adequate blood flow, and controlling blood pressure.

Emergency medical personnel may have to open the patient's airway or perform other procedures to make sure the patient is breathing. They may also perform CPR to help the heart pump blood to the body, and they may treat other injuries to control or stop bleeding. Because many head-injured patients may also have spinal cord injuries, medical professionals take great care in moving and transporting the patient. Ideally, the patient is placed on a back-board and in a neck restraint. These devices immobilize the patient and prevent further injury to the head and spinal cord. Medical professionals take great care in moving and transporting head-injured patients. Often back-boards and neck restraints are used to immobilize patients and prevent further injury.

As soon as TBI's patient stabilized, the next steps are assessing patient condition by measuring vital signs and reflexes and by performing a neurological examination. Paramedics or emergency medical personell will check the patient's temperature, blood pressure, pulse, breathing rate, and pupil size in response to light. They assess the patient's level of consciousness and neurological functioning using the Glasgow Coma Scale, a standardized, 15-point test that uses three measures - eye opening, best verbal response, and best motor response - to determine the severity of the patient's brain injury.

Imaging tests help in determining the diagnosis and prognosis of a TBI patient. Patients with mild to moderate injuries may receive skull and neck X-rays to check for bone fractures or spinal instability. The patient should remain immobilized in a neck and back restraint until medical personnel are certain that there is no risk of spinal cord injury.

For moderate to severe cases, the gold standard imaging test is a computed tomography (CT) scan. The CT scan creates a series of crosssectional X-ray images of the head and brain and can show bone fractures as well as the presence of hemorrhage, hematomas, contusions, brain tissue swelling, and tumors. Magnetic resonance imaging (MRI) may be used after the initial assessment and treatment of the TBI patient. MRI uses magnetic fields to detect subtle changes in brain tissue content and can show more detail than X-rays or CT. Unfortunately, MRI is not ideal for routine emergency imaging of TBI patients because it is time-consuming and is not available in all hospitals.

Approximately half of severely head-injured patients will need surgery to remove or repair hematomas or contusions. Patients may also need surgery to treat injuries in other parts of the body. These patients usually go to the intensive care unit after surgery.

Sometimes when the brain is injured swelling occurs and fluids accumulate within the brain space. It is normal for bodily injuries to cause swelling and disruptions in fluid balance. But when an injury occurs inside the skull-encased brain, there is no place for swollen tissues to expand and no adjoining tissues to absorb excess fluid. This increased pressure is called intracranialpressure (ICP) .

Medical personnel measure patients. ICP using a probe or catheter. The instrument is inserted through the skull to the subarachnoid level and is connected to a monitor that registers the patient's ICP. If a patient has high ICP, he or she may undergo a ventriculostomy , a procedure that drains cerebrospinal fluid (CSF) from the brain to bring the pressure down. Drugs that can be used to decrease ICP include mannitol or barbiturates, although the safety and effectiveness of the latter are unknown.
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Diabetic Neuropathy, A Problematic Disease

Introduction
Diabetic neuropathies are group of nerve disorders caused by diabetes. Diabetes is complicated disease, can be said as the mother of others diseases, since diabetes brings lot of diseases associated with long-term hyperglycemia such as neuropathy, retinopathy, nephropathy, heart disease, and stroke. Neuropathy or nerve involvement in diabetes can develop over time throughout the body.

Diabetes neuropathy is the most common complication of diabetes, about 60-70% people with diabetes have some form of neuropathy. Persons with diabetes can develop nerve problems at any time, but the risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Another risk factors for having diabetic neuropathy are uncontrolled blood glucose, high levels of blood fat and blood pressure and those who are overweight, smoking, and alcohol consumption.

Poor managed diabetic neuropathic could leads to foot ulcers, charcot joints and amputation, therefore awareness and proper care is needed for management of diabetic neuropathy.

Pathogenesis
The development of diabetic neuropathy is believed to be caused by microvascular abnormalities in the vessels that supply the nerves. The microvascular abnormalities leads to insufficiency blood supply to the nerves. The nerves functions then impaired, causing neurological symptoms such as numbness, tingling, pain, etc.
Diabetic Neuropathy

Nerve damage is likely due to a combination of factors: metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nerves
autoimmune factors that cause inflammation in nerves mechanical injury to nerves, and lifestyle factors, such as smoking or alcohol use.

Types of Diabetic Neuropathy
Diabetic neuropathy can be classified as peripheral, autonomic, proximal, or focal. Each affects different parts of the body in various ways.

- Peripheral neuropathy, the most common type of diabetic neuropathy, causes pain or loss of feeling in the toes, feet, legs, hands, and arms.

- Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes. Autonomic neuropathy can also cause hypoglycemia unawareness, a condition in which people no longer experience the warning symptoms of low blood glucose levels.

- Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs.

- Focal neuropathy results in the sudden weakness of one nerve or a group of nerves, causing muscle weakness or pain. Any nerve in the body can be affected.

Symptoms of Diabetic Neuropathy
Symptoms that occur depend on the type of diabetic neuropathy and which nerves are affected. Most common type of neuropathy is Peripheral Neuropathy, the nerve damage will give symptoms such as numbness, tingling, or pain in the feet. Symptoms are often minor at first, and because most nerve damage occurs over several years, mild cases may go unnoticed for a long time.

Symptoms of nerve damage may include:
- numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
- wasting of the muscles of the feet or hands
- indigestion, nausea, or vomiting
- diarrhea or constipation
- dizziness or faintness due to a drop in blood pressure after standing or sitting up
- problems with urination
- erectile dysfunction in men or vaginal dryness in women
- weakness

Diagnosis
In establishing the diabetic neuropathy, a doctor needs to do history taking about your complaints and physical examination. During the exam, your doctor may check blood pressure, heart rate, muscle strength, reflexes, and sensitivity to position changes, vibration, temperature, or light touch.

Experts recommend foot examination for people with diabetes each year to check for peripheral neuropathy. While people with peripheral neuropathy need more frequent foot exams. A comprehensive foot exam assesses the skin, muscles, bones, circulation, and sensation of the feet. People who cannot sense pressure from a pinprick or monofilament have lost protective sensation and are at risk for developing foot sores that may not heal properly. The doctor may also check temperature perception or use a tuning fork, which is more sensitive than touch pressure, to assess vibration perception.

Another supporting examination that is needed in establishing the diagnosis such nerve conduction studies. Nerve conduction studies or electromyography are sometimes used to help determine the type and extent of nerve damage. Nerve conduction studies check the transmission of electrical current through a nerve. Electromyography shows how well muscles respond to electrical signals transmitted by nearby nerves.
Foot Ulcer

Treatment
The treatment of diabetic neuropathy is a part of diabetes therapy, thus controlling blood glucose levels within the normal range is important in order to help prevent further nerve damage and prevent any complication of diabetes.

Additional treatment depends on the type of nerve problem and symptoms.
Painful diabetic neuropathy usually treated with oral medications, although other types of treatments may help some people. People with severe nerve pain may benefit from a combination of medications or treatments.

Medications used to help relieve diabetic neuropathic pain include:
- tricyclic antidepressants, such as amitriptyline, imipramine, and desipramine
- other types of antidepressants, such as duloxetine, venlafaxine, paroxetine
- anticonvulsants, such as pregabalin, gabapentin, carbamazepine.
- opioids and opioid-like drugs, such as controlled-release oxycodone, an opioid; and tramadol

All medications have side effects, and some are not recommended for use in older adults or those with heart disease. Because over-the-counter pain medicines such as acetaminophen and ibuprofen may not work well for treating most nerve pain and can have serious side effects, some experts recommend avoiding these medications.



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Neuropathic Pain, a Problematic Disease

Introduction
Talking about pain, what is pain by definition? Pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage.

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Stroke at a Glance

Definition
Stroke is a disease that caused by the interruption of the blood supply (arteries) to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue.

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Walking Lower Women Stroke Risk

In April 2010, US researchers published their study about healthy lifestyle and stroke risk, in this case is walking and related to women stroke risk. Women who walked two or more hours a week or who usually walked at a brisk pace (3 miles per hour or faster) had a significantly lower risk of stroke than women who didn't walk, according to a large, long-term study reported in Stroke: Journal of the American Heart Association.
Walking woman

This study is a long term observational study with a nearly 12-year follow-up, women who walked two or more hours per week had a significantly lower risk of stroke than women who didn’t walk. Also reported that women who walked at a brisk pace also had a significantly lower risk of stroke than non-walkers


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VItamin E increase risk of Stroke. Fact or Hoax?

Introduction
Dietary supplementation is very common in United States, it's estimated about more than half of adult population consume dietary supplements. And about 12.7% from those, consume vitamin E supplement.
Vitamin E supplement become popular, since publications from observational studies that showed Vitamin E may protect against cardiovascular disease and offers others health benefits such as fertility, lowering cancer risk, and for skin usage


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