Allergy

Mengenai Alergi secara keseluruhan

Barbara P. Homeier, MD

Debu, kucing, kacang dan kecoa, merupakan pengelompokan yang aneh tetapi merupakan salah satu ancaman alergi yang paling umum, penyebab utama dari penyakit. Lebih dari 50 juta orang termasuk jutaan anak-anak, mengidap beberapa tipe alergi. Kenyataannya, jumlah meninggal karena alergi diperkirakan sekitar 2 juta masa sekolah per tahunnya.

Apa itu alergi ?

Suatu alergi merupakan suatu reaksi berlebihan dari sistim imun terhadap zat kimia yang tidak berbahaya pada kebanyakan orang. Tetapi pada seseorang yang alergi, sistim imun tubuh menghilangkan zat kimia (disebut allergen) sebagai suatu pencetus dan bereaksi dengan tidak benar, mengakibatkan gejala-gejala yang dapat terjadi dari yang menganggu sampai dengan kemungkinan menyakitkan terhadap manusia. Dalam suatu usaha melindungi tubuh, sistim imun dari seorang pengidap alergi menghasilkan antibodi yang disebut immunoglobulin E (IgE). Antibodi ini kemudian mengakibatkan sel mast (yaitu sel alergi dalam tubuh) untuk melepaskan bahan kimia, termasuk histamine, kedalam aliran darah untuk menjaga melawan serangan allergen. Pelepasan bahan kimia ini yang menyebabkan reaksi alergi, mengakibatkan mata, hidung, tenggorokan, paru-paru, kulit atau sistim pencernaan manusia karena tubuh berusaha untuk menghilangkan sendiri alergen yang menyerang. Penyebarannya selanjutnya terhadap allergen yang sama (benda-benda seperti kacang atau serbuk yang dapat membuat anda alergi) akan memancing reaksi alergi kembali. Hal ini berarti setiap saat orang tersebut makan makanan tertentu atau telah kena terhadap allergen khusus, dia akan memiliki reaksi alergi.

Siapa saja yang terkena alergi?

Kecenderungan akan timbulnya alergi sering merupakan turun temurun, yang berarti dapat diturunkan melalui gen anda. Akan tetapi, meskipun anda dan pasangan anda atau salah satu dari anak anda mungkin memiliki alergi, tidak berarti semua dari anak anda akan memiliki alergi juga. Seorang manusia tidak mewarisi alergi khusus, seperti mungkin sekali memiliki alergi. Tetapi beberapa anak memiliki alergi meskipun tidak ada anggota keluarga yang alergi. Jika seorang anak alergi terhadap salah satu bahan kimia, kemungkinannya dia akan alergi terhadap yang lainnya juga.

Alergen apa yang paling umum ada diudara ?

Beberapa hal yang paling umum manusia alergi adalah yang terdapat diudara (dibawa oleh udara) Debu, tungau merupakah salah satu penyebab alergi yang paling umum. Serangga yang sangat kecil ini hidup diantara kita dan memakan jutaan sel kulit mati yang jatuh dari tubuh kita setiap hari. Debu tungau merupakan komponen alergi utama dari debu rumah, dimana terbuat dari banyak partikel dan dapat mengandung benda-benda seperti fiber kain dan bakteri seperti allergen bintang yang sangat kecil. Rangkaian tahun saat ini pada banyak bagian dari dunia (meskipun mereka tidak hidup pada ketinggian), debu tungau hidup pada selimut, kain pelapis dan karpet. Serbuk merupakan penyebab utama alergi yang lainnya (banyak orang mengetahui alergi serbuk sebagai demam jerami atau demam bunga mawar), Pohon, rumput liar dan rumputan melepaskan partikel kecil ini ke udara untuk memupuk tanaman lainnya. Alergi serbuk merupakan musiman dan tipe serbuk yang di alergi oleh anak-anak tergantung ketika mereka memiliki gejala-gejala. Sebagai contoh, pada negara bagian Atlantik tengah, penyerbukan pohon dimulai pada bulan Februari dan Maret, rumput pada Mei sampai Juni dan pemotongan rumput liar pada Agustus sampai Oktober, maka orang dengan alergi ini biasanya mengalami peningkatan gejala-gejala selama jangka waktu itu. Jumlah serbuk mengukur berapa banyak serbuk yang ada diudara dan dapat membantu orang pengidap alergi untuk menentukan seberapa parah kemungkinan gejala-gejala yang akan mereka hadapi. Jumlah serbuk biasanya lebih tinggi pada pagi hari dan pada udara yang hangat, kering dan berangin lembut, dimana akan rendah ketika dingin dan basah. Meskipun mereka tidak selalu tepat, laporan cuaca lokal atas jumlah serbuk dapat membantu ketika anda merencanakan kegiatan luar. Jamur, merupakan allergen umum lain, merupakan jamur yang berkembang diantara pintu dan diluar lingkungan yang hangat dan lembab. Jamur diluar dapat diketemukan pada daerah pembuangan yang buruk seperti pada tumpukan daun yang membusuk atau tumpukan kompos. Didalam, jamur berkembang pada tempat yang gelap, ventilasi yang buruk seperti pada kamar mandi dan ruangan bawah tanah yang lembab dengan air yang bocor atau banjir. Bau pengap membuat jamur berkembang. Meskipun jamur cenderung musiman banyak yang dapat tumbuh sepanjang tahun terutama yang didalam ruangan. Alergen binatang peliharaan dari binatang berbulu hangat dapat menyebabkan masalah bagi anak-anak dan orangtuanya. Ketika binatang, biasanya binatang peliharaan rumah tangga, menjilat dirinya, air liurnya mengenai bulunya. Ketika air liur mengering, partikel protein menjadi berada diudara dan bekerja menurut caranya pada kain-kain dalam rumah. Kucing merupakan pelaku yang buruk karena protein dari air liurnya sangat kecil dan mereka cenderung untuk menjilat diri sendiri lebih sering daripada binatang lainya sebagai bagian dari perawatan diri sendiri. Kecoa juga merupakan allergen rumah tangga, terutama di pusat-pusat kota. Penyebaran kecoa yang menempati gedung-gedung mungkin merupakan masalah utama dari tingginya penyakit asthma pada anak-anak di pusat-pusat kota.

Apa yang merupakan Allergen makanan yang paling umum?

Akademi alergi, asthma dan ilmu imun memperkirakan diatas 2 juta atau 8% anak-anak telah terpengaruh oleh alergi makanan dan delapan makanan merupakan makanan yang paling memiliki reaksi alergi pada anak-anak, telor, ikan, susu, kacang, kerang, kecap, biji-bijian tumbuhan dan gandum.

Susu sapi (protein susu sapi)
antara 1 dan 7.5 % anak bayi alergi terhadap protein yang terdapat pada susu sapi dan susu sapi formula. Sekitar 80% formula yang dijual berasal dari susu sapi. Alergi protein susu sapi (juga disebut alergi protein formula) berarti anak bayi (atau anak-anak atau dewasa) memiliki reaksi sistim imun yang tidak normal terhadap protein yang ditemukan pada susu sapi yang digunakan untuk membuat formula bayi standar.

Telur
Salah satu makanan alergi yang paling umum pada anak bayi dan anak kecil, alergi telur dapat memberikan banyak tantangan bagi orang tua. Karena telur banyak digunakan pada banyak makanan yang dimakan anak-anak dan dibanyak kasus merupakan bahan yang “tersembunyi”, suatu alergi telur sangat sukar untuk di diagnosa.Suatu alergi telur biasanya dimulai ketika anak-anak masih sangat kecil tetapi kebanyakan pertumbuhan alergi terjadi pada umur 5. Kebanyakan anak-anak dengan alergi telur alergi terhadap protein dalam putih telur, tetapi beberapa dapat menerima protein dalam kuning telur.

Ikan dan kerang
Protein dalam ikan dapat menyebabkan beberapa tipe reaksi alergi yang berbeda termasuk reaksi pencernaan yang menyebabkan diare dan muntah. Anak-anak juga memiliki reaksi kulit terhadap ikan yang menyebabkan gatal dan kekeringan. Alergi ikan juga merupakan salah satu makanan alergi yang lebih umum pada dewasa.

Kacang-kacangan dan biji-bijian tumbuhan
Kacang-kacangan merupakan salah satu makanan yang paling keras allergennya, sering menyebabkan reaksi yang membahayakan jiwa. Sekitar 1.5 juta orang alergi terhadap kacang-kacangan (dimana bukan merupakan kacang yang sebenarnya, merupakan keluarga yang sama seperti kacang polong dan miju-miju). Setengah yang mengalami alergi kacang-kacangan juga alergi terhadap biji-bijian tumbuhan seperti almond, biji kenari, kemiri, kacang mede dan sering juga bunga matahari dan wijen.

Kecap
Seperti kacang-kacangan, kacang kedelai merupakan tumbuhan polong. Alergi kecap lebih merata diantara anak bayi daripada anak-anak yang lebih besar, sekitar 30% sampai 40% anak bayi yang mengidap alergi terhadap susu sapi juga alergi terhadap protein dalam formula kecap.

Gandum
Protein gandum ditemukan pada banyak makanan yang kita makan, beberapa lebih jelas daripada yang lainnya. Seperti pada alergi yang lain, suatu alergi gandum dapat terjadi pada cara dan tingkat yang berbeda. Meskipun alergi gandum sering membingungkan dengan penyakit celiac, tetapi ada perbedaannya. Penyakit Celiac disebabkan kepekaan permanen terhadap zat perekat yang terdapat pada macam-macam gandum. Jenis ini berkembang antara 6 bulan sampai 2 tahun umurnya dan kepekaan menyebabkan kerusakan terhadap usus kecil.

Apa beberapa allergen umum lainnya?

Sengatan serangga
Pada kebanyakan anak-anak, disengat oleh suatu serangga berarti bengkak, merah dan gatal pada tempat terjadi gigitan, sebagai tambahan cucuran air mata. Tetapi untuk anak dengan alergi bisa serangga, gigitan suatu serangga dapat menyebabkan beberapa gejala-gejala berat. Meskipun beberapa dokter dan orang tua percaya bahwa pada sebagian besar anak-anak kecil kemungkinan alergi bisa serangga, penelitian terakhir menemukan bahwa alergi bisa serangga biasanya bertahan hingga dewasa.

Obat-obatan
pengobatan menggunakan antibiotik untuk mengobati infeksi merupakan tipe pengobatan yang paling umum yang menyebabkan reaksi alergi. Banyak pengobatan lainnya, termasuk pengobatan dengan obat bebas, juga dapat menyebabkan reaksi alergi.

Bahan kimia
Beberapa kosmestik atau sabun cuci dapat menyebabkan keluarnya suatu ruam yang gatal pada manusia. Biasanya, hal ini karena seorang manusia memiliki raksi terhadap bahan kimia dalam produk ini. Bahan celup, pembersih alat rumah tangga dan pestisida yang digunakan halaman rumput atau tanaman dapat juga menyebabkan reaksi alergi. Sebagai contohnya, anak-anak yang alergi terhadap serbuk sejenis pohon dapat memiliki reaksi ketika mereka makan apel karena apel tersebut terdiri dari protein yang mirip dengan salah satu dalam serbuk tersebut. Contoh yang lainnya yaitu anak-anak yang alergi terhadap latex (seperti pada sarung tangan atau peralatan kesehatan tipe tertentu) kemungkinan akan alergi terhadap buah kiwi atau pisang.

Apa tanda-tanda dan gejala-gejala alergi?

Tipe dan kekerasan gejala-gejala alergi bermacam-macam dari alergi ke alergi dan dari anak ke anak. Gejala-gejala dapat diatur dari gangguan musiman minor ke gangguan mayor (sebagai contoh dari serbuk atau jamur tertentu) sepanjang tahun. (bentuk alergi seperti tungau debu atau makanan). Karena allergen berbeda lebih merata pada negara bagian dan dunia yang berbeda, gejala-gejala alergi juga berbeda-beda tergantung dimana anda tinggal. Sebagai contoh, alergi kacang tidak diketahui di Skandinavia dimana mereka tidak makan kacang, tetapi umum, dimana kacang tidak hanya suatu makanan terkenal tetapi juga ditemukan banyak macam yang kita makan.

Gejala-gejala alergi udara.

Allergen di udara dapat menyebabkan sesuatu yang dikenal sebagai alergi radang selaput lendir hidung, yang terjadi sekitar 15% sampai 20%. Tipe ini berkembang pada umuran 10 tahun dan mencapai puncaknya pada umur awal 20-an dengan gejala-gejala kadaing menghilang pada umur antara 40 dan 60. Gejala-gejala ini termasuk bersin-bersin, gatal di hidung dan atau suara serak pada tenggorokan, hidung tersumbat, batuk. Gejala-gejala ini biasanya diikuti oleh gatal-gatal, berair dan atau mata merah, disebut alergi yang berhubungan. (Ketika lingkaran gelap terlihat disekitar mata, disebut sebagai alergi “mata bengkak”). Mereka yang beraksi terhadap allergen udara biasanya memiliki alergi radang selaput lendir hidung dan atau alergi yang berhubungan. Jika seseorang memiliki gejala-gejala ini, termasuk juga bunyi mendengik dan nafas pendek, alergi mungkin telah berkembang menjadi asthma.

Gejala-gejala alergi makanan

Gejala-gejala keras dari alergi makanan dan ketika alergi berkembang tergantung pada : berapa banyak makanan yang telah dimakan, jumlah yang telah diterima oleh anak akan makanan, kepekaan anak terhadap makanan. Gejala-gejala alergi makanan dapat termasuk : gatal pada mulut dan tenggorokan ketika makanan ditelan (beberapa anak hanya memiliki gejala ini disebut “sindrom alergi oral”), rasa gatal, bintik-bintik merah dan bengkak (meningkat, merah dan benjol gatal), ruam basah, gatal di hidung, kram perut diikuti oleh mual dan muntah atau diare (karena tubuh berusaha mengeluarkan allergen makanan).

Gejala-gejala alergi bisa serangga

Tersengat oleh seekor serangga dimana seorang anak alergi dapat menyebabakan beberapa gejala dibawah, tenggorokan membengkak, rasa gatal, bintik-bintik merah dan bengkak diseluruh tubuh, kesulitan untuk bernafas, mual dan diare.

Apakah Anaphylaxis?

Dalam contoh yang jarang terjadi, jika kepekaan terhadap sesuatu allergen terjadi ekstrim, seorang anak mungkin mengalami anaphylaxis (atau shock anaphlastic) suatu reaksi alergi yang tiba-tiba hebat melibatkan bermacam-macam sistem dalam tubuh (seperti kulit, sistim pernafasan, sistim pencernaan makanan dan sistim jantung). Gejala-gejala atau reaksi hebat terhadap sesuatu allergen dari makanan tertentu sampai gigitan serangga, membutuhkan pertolongan kesehatan segera dan dapat termasuk kesulitan pernafasan, membengkak (terutama pada wajah, tenggorokan, bibir dan lidah dalam kasus alergi makanan) penurunan darah dengan cepat menekan pusing, hilang kesadaran dan rasa gatal, bintik-bintik merah dan bengkak, kesesakan tenggorokan, suara serak, mual, muntah, sakit pada perut, diare, pusing ringan. Anaphylaxis dapat terjadi beberapa detik setelah terserang oleh bahan kimia yang memicunya atau dapat tertunda sampai dengan 2 jam jika reaksi dari makanan. Ini dapat mempengaruhi bermacam-macam bagian tubuh. Untungnya, meskipun keras dan mengancam jiwa alergi terjadi pada kelompok kecil anak-anak. Kenyataannya, kejadian tahunan dari reaksi anaphylactic kecil sekitar 30 per 100,000 orang, meskipun pada mereka yang mengidap asthma, enzim atau demam ringan merupakan resiko terbesar berdasarkan pengalaman mereka. Banyak sampai 80% reaksi anaphylactic disebabkan oleh kacang-kacangan atau biji pohon.

Apakah alergi dapat diketahui?

Beberapa alergi agak mudah dikenali karena pola dari gejala-gejalanya mengikuti penyebaran allergen tertentu yang sukar untuk dilewati. Tetapi alergi yang lain lebih sedikit terlihat karena dapat menyamar sebagai kondisi yang lain. Jika anak anda memiliki gejala pilek lebih dari seminggu atau dua atau meningkatnya pilek pada waktu yang sama setiap tahun, konsultasikan dengan dokter anda yang kemungkinan sekali akan bertanya pertanyaan tentang gejala-gejala anak anda dan kapan timbulnya. Berdasarkan jawaban dari pertanyaan ini dan pemeriksaan fisik, dokter anda mungkin dapat membuat diagnosa dan menuliskan resep obat pengobatan atau menyarankan anda untuk ke ahli alergi untuk test alergi kulit dan terapi lebih intensif. Untuk menentukan penyebab dari suatu alergi, seorang ahli alergi kemungkinan sekali akan melakukan test kulit untuk allergen lingkungan yang paling umum dan makanan. Test kulit dapat dilakukan pada anak bayi tetapi lebih dapat diandalkan pada anak-anak diatas umur 2 tahun. Suatu test dapat dilakukan dengan satu dari dua cara : Suatu tetesan dari cairan yang dimurnikan di teteskan pada kulit dan areanya di jepit dengan alat tusukan kecil. Sejumlah kecil allergen disuntikan dibawah kulit. Test ini menyengat sedikit tetapi tidak terlalu menyakitkan. Setelah sekitar 15 menit, jika suatu bengkak dengan kemerahan disekitarnya muncul (seperti gigitan nyamuk) pada bagian yang disuntikan, testnya positif. Jika reaksi terhadap allergen makanan atau yang lainnya hebat, test darah dapat digunakan untuk mendiagnosa alergi untuk mencegah penyebaran terhadap allergen yang menganggu. Test kulit sedikit murah dan lebih sensitif daripada test darah untuk alergi. Tetapi test darah mungkin dibutuhkan pada anak-anak dengan kondisi kulit atau mereka yang sangat sensitif terhadap allergen tertentu. Test darah juga bermanfaat dalam memutuskan apakah seorang anak memiliki alergi makanan yang meningkat, karena test kulit tetap positif meskipun setelah alergi makanan telah menghilang. Meskipun jika suatu test kulit dan atau test darah menunjukan suatu alergi, seorang anak harus memiliki gejala-gejala yang pasti didiagnosa dengan suatu alergi. Sebagai contoh, seorang anak kecil yang baru belajar berjalan yang memiliki hasil test positif terhadap tunggau debu dan sering bersin-bersin ketika bermain di lantai dapat dianggap alergi terhadap tunggau debu.

Bagaimana alergi diobati?

Tidak ada pengobatan yang benar-benar untuk alergi tetapi mungkin untuk mengurangi gejala-gejalanya pada anak. Salah satu cara untuk mengatasinya sehari-hari yaitu dengan mengurangi atau menghilangkan mendapatkan alergen. Hal ini berarti orang tua harus mendidik anaknya di awal dan sesering mungkin, bukan hanya tentang alergi itu sendiri tetapi juga mengenai reaksi apa yang akan mereka dapatkan jika mengkonsumsi atau berhubungan dengan allergen yang menganggu. Memberitahukan sedikit atau semua perawatan yang diberikan (dari perawatan sendiri oleh anak sampai dengan gurunya diperluas pada anggota keluarga sampai orang tua teman anak anda) tentang alergi anak anda yang sama pentingnya untuk membantu menjaga gejala-gejala alergi anak anda ke tingkat minimum. Jika pengurangan penyebaran tidak memungkinkan atau tidak efektif , obat dapat diresepkan termasuk antihistamine (yang dapat anda beli secara bebas pula) dan steroid hirup dan semprot hidung. Pada beberapa kasus, suatu alergi dapat direkomendasikan terapi imun (suntikan alergi) untuk membantu anak anda tidak terlalu sensitif. Dan berikut adalah beberapa hal yang dapat membantu anak anda terhindar dari allergen udara : Jaga binatang peliharaan keluarga jauh dari ruangan tertentu, seperti kamar tidur anak anda dan mandikan mereka jika dibutuhkan. Lepaskan karpet atau permadani dari kamar tidur anak anda (lantai dengan permukaan yang keras tidak mengumpulkan debu sebanyak karpet). Jangan menggantungkan gorden yang berat dan hilangkan barang-barang lain yang memungkinkan terkumpulnya debu. Bersihkan sesering mungkin. Gunakan penutup khusus untuk menutup bantal dan matras jika anak anda alergi terhadap tunggau debu. Jika anak anda alergi terhadap serbuk, tutup jendela anda ketika musim serbuk sedang berlangsung hebat, gantilah baju anak anda setelah melakukan aktifitas luar dan jangan biarkan anak anda menyimpan rumputan. Jauhkan anak anda dari area pembuangan, seperti ruang bawah tanah, jika di alergi terhadap jamur dan pelihara kamar mandi dan area dimana jamur mudah terdapat, bersih dan kering.

Apakah suntikan Epinephrine dapat lakukan?

Alergi makanan biasanya tidak berumur panjang (meskipun pada kacang-kacangan dan biji pohon dan makanan laut dapat terjadi). Menghindari makanan adalah salah satu cara untuk terhindar dari gejala-gejala ketika kepekaan berlangsung lama. Jika anak anda sangat peka terhadap makanan tertentu atau jika dia mempunyai asthma selain alergi makanan, dokter anda mungkin menyarankan anda untuk membawa epinerphirine (adrenaline) yang dapat disuntikan untuk menetralkan reaksi alergi apapun. Dia mungkin juga akan menyarankan untuk membawa epinephrine yang dapat disuntikan jika anak anda alergi terhadap bisa serangga. Suntikan epinephrine, tersedia dalam kotak yang mudah dibawa terlihat sebagai sebuah pena, dibawa oleh jutaan orang tua di seluruh negara bagian kemanapun mereka pergi. Dengan satu suntikan pada paha, alat administer epinephrine menurunkan reaksi alergi. Suatu resep epinephrine yang dapat disuntikan biasanya termasuk dua auto injeksi pasir suatu pelatih yang tidak termasuk jarum suntik atau epinephrine, tetapi memberikan anda dan anak anda (jika dia tidak cukup dewasa) untuk berlatih menggunakan alat. Sangat penting bahwa anda terbiasa sendiri dalam melatih dengan pelatih. Dokter anda juga dapat memberikan instruksi bagaimana menggunakan dan menyimpan epinephrine yang dapat disuntikan. Jika anak anda berumur 12 tahun atau lebih tua, pastikan dia menyimpan epinephrine yang dapat disuntikan selalu tersedia sepanjang waktu. Jika anak anda berumur dibawah 12 tahun, bicarakan pada perawat di sekolah, guru anak anda dan penjaga anak anda tentang menyimpan epinephrine yang dapat disuntikan pada tempat darurat. Sangat penting juga untuk dipastikan bahwa alat epinephrine yang dapat disuntikan tersedia dalam rumah anda juga pada rumah teman anak anda dan anggota keluarga jika anak anda menghabiskan waktu ditempat mereka. Dokter anda juga akan mendorong anak anda untuk memakai suatu gelang peringatan kesehatan. Ini merupakan ide yang bagus untuk membawa antihistamine yang dapat dibeli bebas, yang dapat membantu mengurangi gejala-gejala alergi pada sebagian orang. Tetapi antihistamine tidak boleh digunakan sebagai pengganti pena epinephrine. Anak yang harus mendapatkan suntikan epinephrine harus pergi secepatnya ke fasilitas kesehatan atau bagian gawat darurat rumah sakit, dimana pengobatan tambahan dapat diberikan jika diperlukan. Sampai dengan sepertiga reaksi anaphylactic dapat memberikan gejala-gejala gelombang kedua beberapa jama setelah serangan awal, maka anak-anak ini mungkin memerlukan pengamatan pada sebuah klinik atau rumah sakit selama 4 sampai 8 jam setelah reaksi meskipun kelihatannya baik. Berita baiknya adalaha hanya sedikit kelompok anak-anak yang akan mengalami alergi hebat atau mengancam jiwa. Dengan diagnosa yang benar, ukuran pencegahan dan pengobatan, banyak anak-anak akan dapat menjaga alergi yang terkontrol dan hidup bahagia, sehat. (AAFP)

Pelvic Inflammatory Disease (PID)

What is pelvic inflammatory disease (PID)?
Pelvic inflammatory disease (PID) is an infection in the female reproductive organs (uterus, fallopian tubes and ovaries). Normally, the cervix (opening to the womb) prevents bacteria in the vagina from spreading up into these organs. However, if the cervix is exposed to a sexually transmitted disease (STD) such as gonorrhea or chlamydia, it becomes infected. This can allow
bacteria to travel up into the internal organs, making them inflamed and infected. If this occurs, the woman's fallopian tubes may be damaged, making it difficult for her to become pregnant.

How does a woman get PID?
There are several ways women can get PID. The most common way is by having sex with a person who has gonorrhea or chlamydia. These diseases are carried in the semen and other body fluids of infected people. During sexual contact, the germs spread to the woman's cervix. The germs can also infect the glands at the opening of the vagina, the urethra (passageway for urine) or the anus.
Sometimes women get PID without being exposed to gonorrhea or chlamydia. In these cases, doctors aren't sure why the bacteria in the vagina spread into the uterus, fallopian tubes and abdomen, causing PID. PID can also occur if bacteria infect your internal organs as a result of
giving birth, or having a miscarriage, an abortion or a procedure to take a sample from the inside of the womb for laboratory testing. Sometimes PID can occur after the cervix is treated because of an abnormal Pap smear or after the insertion of an intrauterine device (IUD). However, this isn't common.

How do I know if I have PID?
PID causes different symptoms in different women. These may include the following:

• A "stomachache, " or dull pain and tenderness in the lower abdomen.
• Vaginal discharge that is usually yellow or green and may have an unpleasant smell.
• Irregular menstrual periods, such as extra long periods, spotting or cramps throughout the month.
• Severe illness, including chills, high fever, nausea and vomiting.
• Pain during sex.
  

Some women who have PID do not have any of these symptoms and don't know they have it.

What should I do if I have symptoms of PID?
Women who have these symptoms or who think they have been exposed to an STD should see their doctor right away. Your doctor can only diagnose PID by doing a pelvic exam, and swabbing the area and having the sample tested. The sooner you see your family doctor, the better. Waiting even 1 or 2 days can allow the infection to spread and cause more pain and damage.

How is PID treated?
There is no over-the-counter treatment for PID. Usually, PID can be cured with antibiotics. Most women can have outpatient treatment. If you are treated as an outpatient, you must take your medicine just the way your doctor tells you to. If you don't take all the pills, your symptoms will get worse and you may have to go to the hospital. A few days after you start
taking the medicine, your doctor will want to see you for a checkup. Hospitalization may be recommended if you are very sick with PID, or if you are pregnant, under the age of 18 or have the human immunodeficiency virus (HIV).

Should my partner be treated if I have PID?
If you are treated for PID, especially if it's caused by an STD, your partner must also be treated. Unless your partner is treated, you may be infected again. Making good choices about sexual contact is important. If you think you might have PID, talk to your family doctor right away.

What are the risk factors for PID?
The same things that put you at risk for STDs put you at risk for PID. Risk factors for PID include sexual contact with multiple partners and unsafe sexual habits. Both men and women can carry STDs and not have any symptoms. They can expose their sex partners to a disease without knowing it.

How do I practice safe sex?
Avoid sexual contact with people who are at risk of infection. If you decide to have sex, first ask your partner if he or she has any risks for infection. A male partner should always wear a condom. Even though the condom will not prevent 100% of STDs, it will greatly reduce your chances of getting infected. Remember, only a condom can provide some protection against STDs. Other forms of birth control don't provide this protection.

What can happen to my body if I get PID?
Early and complete treatment can help prevent complications of PID. However, if PID isn't treated, it can cause permanent damage to your internal organs. Scar tissue can form in the fallopian tubes and around the abdomen. This tissue can prevent pregnancy or cause the pregnancy to form in the fallopian tube (called a tubal or ectopic pregnancy). Scarring can cause pain that lasts for months, or even years. Occasionally, the effects of PID can be so severe that surgery is required to remove pus, get rid of scar tissue or remove damaged organs.
PID is more likely to come back if you are exposed to STDs again. Each time you have PID causes more damage and a greater possibility of complications. (AAFP)

Preventing the Flu

What is influenza?
Influenza (also called "the flu") is a viral infection in the nose, throat and lungs. About 10% to 20% of Americans get the flu each year. Some people get very sick. Each year, about 130,000 people go to a hospital with the flu, and 20,000 people die because of the flu and complications.
The flu may cause fever, cough, sore throat, a runny or stuffy nose, headache, muscle aches and tiredness. Some people describe the flu as being like the worst cold of their life. Most people feel better after 1 or 2 weeks. But for some people, the flu leads to serious, even life-threatening,
diseases, such as pneumonia. Influenza vaccine (the flu shot) is recommended for people who are more likely to get really sick to protect them from the flu.

Who is at higher risk?
Some people have a higher risk of flu complications, like pneumonia. If you are in any of these groups, you should get the flu vaccine every year:
* All children aged 6 to 59 months
* All adults aged 65 years and older
* All women who are or will be pregnant during the flu season
* Residents in nursing homes and long-term care facilities
* Individuals who have long-term health problems
* Children aged 6 months to 18 years who are on chronic aspirin therapy
* Health care workers who have direct contact with patients
* Caregivers and household contacts of children less than 6 months of age

How can I avoid getting the flu?
The best way to avoid getting the flu is to get the influenza vaccine each fall, before the flu season. The vaccine is available by shot or by nasal spray. The vaccines work by exposing your immune system to the flu virus. Your body will build up antibodies to the virus to protect you from getting the flu. The flu shot contains dead viruses. The nasal-spray vaccine contains live but weakened viruses. You cannot get the flu from the flu shot or the nasal-spray vaccine.
Some people who get the vaccine will still get the flu, but they will usually get a milder case than people who aren't vaccinated. The vaccine is especially recommended for people who are more likely to get really sick from flu-related complications.

Is there anyone who shouldn't get the flu shot?
Yes. The following people should talk to their doctor before getting the flu shot:

• People who have had an allergic reaction to a flu shot in the past
• People with an allergy to eggs
• People who previously developed Guillain-Barré Syndrome (a reversible reaction that causes partial or complete loss of movement of muscles, weakness or a tingling sensation in the body) within 6 weeks of getting a flu shot
  

Is there anyone who shouldn't get the nasal-spray vaccine?
Yes. The following people should talk to their doctor before getting the nasal-spray vaccine:
* Children less than 5 years of age
* Adults 50 years of age and older
* People with long-term health problems
* People with weakened immune systems
* Children aged 6 months to 18 years who are on chronic asprin therapy
* People with a history of Guillain-Barré syndrome
* Pregnant women
* People who have had an allergic reaction to a flu vaccine in the past or to eggs

If I get the flu vaccine, can I still get the flu?
Yes. Even with a flu vaccine, you aren't 100% protected. Each year, the flu vaccine contains 3 different strains (kinds) of the virus. The strains chosen are those that scientists believe are most likely to show up in the United States that year. If the choice is right, the vaccine is 70% to 90% effective in preventing the flu in healthy people under 65 years of age. If you're older than 65, the vaccine is less likely to prevent the flu. Even if you get the flu after being vaccinated, your flu symptoms should be milder than if you didn't get the vaccine. You'll also be less likely to get complications from the flu.

Is the vaccine safe?
Yes. The flu vaccine is safe. There are very few side effects. If you got the flu shot, your arm may be sore for a few days . You may have a fever, feel tired or have sore muscles for a short time. If you got the nasal-spray vaccine, you may have a runny nose, headache, cough or sore throat.

Can I get the flu vaccine if I am pregnant or nursing?
If you are pregnant during flu season, you cannot get the nasal-spray vaccine. However, it is recommended that women who will be pregnant during flu season get the shot. Pregnancy can increase your risk for complications from the flu. It is also safe to get the flu shot while breast feeding your baby. The flu shot cannot cause you or your nursing baby to get sick.

What are antiviral flu drugs?
Antiviral flu drugs are prescription medicines that can be used to help prevent and/or treat the flu. There are four antiviral flu drugs: amantadine, oseltamivir, rimantadine and zanamavir. All 4 of these antiviral drugs have been approved to treat the flu. If you take one of these drugs
within 2 days of getting sick, it can lessen your symptoms, decrease the amount of time you are sick and make you less contagious to other people. However, most healthy people who have the flu get better without using an antiviral flu drug. Your doctor will decide whether one of these medicines is right for you.
Three of the antiviral flu drugs have also been approved to prevent the flu. These drugs are not a substitute for the influenza vaccine. They are most often used for flu prevention in institutions where people at high risk for flu complications are in close contact with each other, such as nursing homes or hospitals. For example, during a flu outbreak in a nursing home, residents and staff might be given the flu vaccine and an antiviral drug to prevent the flu until the vaccine takes effect. (AAFP)

Do Supplements Prevent Cancer and Chronic Disease?

C. Kripke

Approximately one third of adults in the United States take dietary supplements. Many of these people take supplements to ensure adequate nutrition and to prevent or treat disease. Huang and colleagues analyzed the literature on the effectiveness of multivitamin and mineral supplements in the general population for the primary prevention of cancer and chronic disease as well as the safety of these supplements in adults and children. The Agency for Healthcare Research and Quality was contracted to study these questions.
A multivitamin and mineral supplement was defined as containing three or more vitamins or minerals without herbs, hormones, or drugs. For the literature search, the authors included randomized controlled trials (RCTs) on the effectiveness of these supplements and also looked at observational studies and RCTs on the safety of these supplements. They found five trials,
one each on the effectiveness of multivitamin and mineral supplements for the prevention of cancer, cardiovascular disease, hypertension, cataracts, and age-related macular degeneration; however, no RCTs on other chronic diseases were found. The overall study quality was fair. Most studies followed patients for five years or more.
For the primary prevention of cancer, cardiovascular disease, cataracts, age-related macular degeneration, and hypertension, the authors found that the strength of the evidence supporting the effectiveness of multivitamin and mineral supplements was very low. However, it was suggested that supplementation may slow the progression of age-related macular degeneration
in patients who are at a higher risk of the disease's advanced stages. Four trials and three case reports were found that addressed the safety of multivitamin and mineral supplementation, but there was not a consistent pattern of increased adverse events.
The authors conclude that it is not clear if multivitamin and mineral supplementation is efficacious for primary prevention of hypertension, cardiovascular disease, or cataracts in the general population. There also are no data comparing a healthful, balanced diet to dietary supplementation.
Although it is unlikely that there are serious adverse effects from multivitamin and mineral supplementation, physicians should be aware that there are few data to ensure the safety of their patients. (AAFP)

Types of OTC Medicines and How They Work

You'll learn what you need to know to make wise choices about over-the-counter (OTC) medicines for you and your family.

Do you know what's in the medicines you take?
Many OTC medicines contain the same ingredient found in prescription medicines. By combining your prescription medicine with an OTC medicine, you may be getting more than the recommended daily dose of the active ingredient. This medication chart can help you sort out what medicines have the same ingredient so you can avoid taking too much. If you have any
questions, ask your pharmacist or family doctor.

What does OTC mean?
OTC is short for over-the-counter. These are medicines you can buy without a prescription from your doctor. Chances are, you've used OTC medicines many times to relieve pain and treat symptoms of the common cold, the flu, and allergies. In this section, you'll learn about four of the most common types of OTC products and how each works.

• Pain relievers
• Antihistamines
• Decongestants
• Cough medicines
  

Pain Relievers
The OTC products that relieve your headache, fever, or muscle aches are not all the same. That's because the pain relievers you see in the aisles of your local drug store or pharmacy are either nonsteroidal anti-inflammatory drugs (called NSAIDs), which include aspirin, ibuprofen, naproxen and ketoprofen, or paracetamol/ acetaminophen. Each of these drugs has a different way of working:
Aspirin and NSAIDs relieve pain by stopping the production of prostaglandins, which are natural chemicals in the body. Prostaglandins irritate nerve endings, triggering the sensation of pain. Commonly used NSAIDs include Aspirin, Ibuprofen, Naproxen, Ketoprofen.
Acetaminophen relieves pain and reduces fever. We don't completely understand the way acetaminophen relieves pain. We do know that unlike aspirin and NSAIDs, which work in the skin, muscles, and joints, acetaminophen blocks painful sensation in the brain and the spinal cord.

Antihistamines
Antihistamines work by blocking the receptors that trigger itching, nasal irritation, sneezing, and mucus production. The three types of antihistamines are Diphenhydramine, Brompheniramine, Chlorpheniramine.

Decongestants
Decongestants work by narrowing blood vessels in the lining of the nose. As a result, less blood is able to flow through the nasal area, and swollen tissue inside the nose shrinks. Pseudoephedrine is the only decongestant used in OTC products.

Cough Medicines
Cough medicines are grouped into two types: antitussives and expectorants. Antitussives, or cough suppressants, block the cough reflex. Dextromethorphan is a common antitussive.
Expectorants, on the other hand, are thought to thin mucus and make coughing more productive in clearing the mucus from the airway. Guaifenesin is the only expectorant used in OTC products.

Timeline of Symptoms Associated with the Common Cold
There is no cure for the common cold. Medicine can only make your symptoms less bothersome until your body can fight off the virus. Medicine won't make your cold go away completely. The following are tips to help you feel better when you have a cold:

• Stay home and rest, especially while you have a fever.
• Don't smoke and avoid secondhand smoke.
• Drink plenty of fluids like water, fruit juices and clear soups.
• Don't drink alcohol.
• Gargle with warm salt water a few times a day to relieve a sore throat. Throat sprays or lozenges may also help relieve the pain.
• Use salt water (saline) nose drops to help loosen mucus and moisten the tender skin in your nose.
  

Many cold medicines are available over-the-counter (without a prescription from your doctor).
Fatigue, mild sore throat: Acetaminophen or nonsteroidal anti-inflammatory drug (ibuprofen)
Runny nose: Antihistamine (diphenhydramine, chlorpheniramine)
"Stopped up" nose: Decongestant (pseudoephedrine)
Dry cough: Antitussive (dextromethorphan)
Moist, productive cough: Expectorant (guiafenesin)

Voice "breaks" or disappears altogether: No medicine will help your voice
come back sooner. Resting it is the only thing that will help.

How to Read an OTC Drug Label
You don't need a prescription to buy OTC medicine. But like prescription drugs, OTC medicines can also cause unwanted and sometimes dangerous side effects. Before you buy an OTC medicine, it's important to read and thoroughly understand the information on the drug label. Use the following as a guide. If you have questions about a medicine, ask your pharmacist or
family doctor.

1. Active Ingredient
• The active ingredient is the chemical compound in the medicine that works to relieve your symptoms. It is always the first item on the label. There may be more than one active ingredient in a product. The label will clearly show this.
2. Uses
• This section lists the symptoms the medicine is meant to treat. Food and Drug Administration Agency must approve these uses. Uses are sometimes referred to as indications.
3. Warnings
• This safety information will tell you what other medicines, foods, or situations (such as driving) to avoid while taking this medicine.
4. Directions
• Information about how much medicine you should take and how often you should take it will be listed here.
5. Other Information
• Any other important information, such as how to store the product, will be listed here.
6. Inactive Ingredients
• An inactive ingredient is a chemical compound in the medicine that isn't meant to treat a symptom. Inactive ingredients can include preservatives, binding agents, and food coloring. This section is especially important for people who know they have allergies to food coloring or other chemicals.
  
7. Questions or Comments
• Customer service departement telephone number or e-mail address is provided to address any questions or comments you may have about the medicine.

How to Get the Most from Your Medicine
OTC medicines can help you feel better. But if they are taken the wrong way, they can actually make you feel worse.

Talk to your family doctor
If there is something you don't understand about a medicine you're taking or are planning to take, ask your doctor or pharmacist. If you still don't understand, ask him or her to explain things more clearly. If you are taking more than 1 medicine, be sure to ask how the medicines will work together in your body. Sometimes medicines cause problems when they are taken together (called a drug interaction) .

Below is a list of questions you can ask your doctor to learn how to use each medicine correctly and safely:

• What does the medicine do?
• When and how should I take the medicine?
• What are the possible side effects (reactions your body may have to the medicine)?
• Will the medicine react to any other medicines, foods or drinks?
• Should I avoid any activities while I'm taking the medicine?
• How will I know if the medicine is working?
  

Know about the medicine you take
You should know the following things about each medicine you take:

• Name (generic name and brand name)
• Reason for taking it
• How much to take and how often to take it
• Possible side effects and what to do if you have them
• How long to continue taking it
• Special instructions (taking it at bedtime or with meals, etc.)
  

Know what to avoid while taking the medicine
Some foods can cause side effects, such as stomach upset, if you are taking medicine. Drinking alcohol is generally not a good idea while you are taking medicine. Some medicines cause reactions such as sun sensitivity (getting a sunburn or sun rash), so you may have to limit your outdoor activities or protect your skin from the sun.
Read the label to see what to avoid while you are taking an over-the-counter medicine. Follow the instructions just as you would with a prescription medicine. If you have questions, ask your doctor or pharmacist.

Follow these dos and don'ts

• Do read the label carefully.
• Do take your medicine exactly as your doctor tells you to.
• Do make sure that each of your doctors (if you see more than one) has a list of all of the medicines you're taking.
• Do make sure everyone you live with knows what medicine you're taking and when you're supposed to take it.
• Don't combine prescription medicines and OTC medicines unless your doctor says it's OK.
• Don't stop taking a medicine or change how much you take or how often you take it without first talking to your doctor.
• Don't take someone else's medicine.
• Don't use medicine after its expiration date.
• Don't crush, break or chew tablets or capsules unless your doctor tells you to. Some medicines won't work right unless they are swallowed whole.
  

Understand generic vs. brand name
Just like foods, some medicines come in both brand names and generics. Generic medicines are generally cheaper. Compare the list of ingredients. If the generic has the same ingredients as the brand name, you may want to consider using it. But be careful: The generic may contain different amounts of certain medicines. Ask your doctor or pharmacist if you have questions
about which medicine to choose.
Follow these tips for choosing medicines

• If you have questions, ask your doctor or pharmacist.
• Although it can seem overwhelming, take the time to look at all the choices.
• Read the label carefully and note what symptoms the medicine will treat.
• Look for a medicine that will treat only the symptoms you have. For example, if you only have a runny nose, don't pick a medicine that also treats coughs and headaches.
• Note how much medicine you should take, and what side effects it may cause.
• Note what medicines or foods you should not take with the medicine.
• Check to see if the medicine causes problems for people with certain health problems (such as asthma or hypertension) .
  

Know when to call your doctor
If you're taking an OTC medicine and it doesn't seem to be helping, call your doctor. Your sickness can get much worse if you wait too long to get treated by your doctor.
You should also call if you have side effects or any concerns about the medicine you're taking

Potential Side Effects of OTC Medicines in Adults
While OTC medicines have a low risk of side effects when used occasionally by healthy adults, they can pose risks for very young children, the elderly, people with kidney problems, and people taking more than one medicine. These people have an increased risk of side effects when they take OTC medicines.
Potential side effects are described below. More information about special groups such as these is listed below.

Aspirin and NSAIDs
The main side effect associated with aspirin and other NSAIDs is gastrointestinal (GI) problems. These problems can range from upset stomach to GI bleeding, a serious event that is more likely to occur in older people. The chances of experiencing GI problems from NSAIDs or aspirin
increase the larger the dose you take and the longer you take them.
NSAIDs can cause a variety of side effects related to kidney function. These side effects range from reversible inflammation to permanent kidney damage. Aspirin and NSAIDs may make high blood pressure worse or interfere with blood pressure medicines.
High doses of aspirin pose a risk of liver damage for people who have liver disease, juvenile arthritis, or rheumatic fever.

Paracetamol/ Acetaminophen
Although safe in the majority of users, long-term use of high doses of acetaminophen, especially in products that also contain caffeine or codeine, has been shown to cause a form of kidney disease called analgesic nephropathy. This serious condition may develop after years or decades of daily use.

Antihistamines
Antihistamines can cause sedation or drowsiness and, therefore, can significantly impair a person's ability to drive or operate machinery. The sedative effects of antihistamines may increase the risk of falling. Antihistamines can also cause temporary dry mouth or eyes.

Decongestants
Pseudoephedrine can temporarily cause nervousness, dizziness and sleeplessness. It can make you lose your appetite or retain urine. It can also cause heart palpitations, high blood pressure, or high blood sugar levels.

Cough Medicines
Codeine, when used as a cough suppressant, can temporarily cause nausea, sedation and constipation. Dextromethorphan, the medicine in Drixoral, Pertussin CS and Robitussin, has a lower risk of sedation and GI side effects. It can, however, cause feelings of confusion, agitation,
nervousness, or irritability.

Drug-Drug Interactions
The body processes -- or metabolizes -- every drug differently. If drugs are used together, their metabolism and effect on the body can change. When this happens, the chance that you will have side effects for each drug may become greater.

Alcohol and OTC Medicines

Pain Relievers
If you drink more than 1 alcoholic beverage per week and use NSAIDs, including aspirin, you may be at increased risk of GI bleeding. People who consume 3 or more alcoholic beverages each day should consult their physician before using any pain reliever.
Acetaminophen is much less likely than NSAIDs to be associated with GI problems, including bleeding. But to minimize the risk of serious liver injury, you should never take more than the recommended daily dose (4g per day).

Antihistamines, Decongestants, and Cough Medicines
The combination of OTC antihistamines and alcohol can increase drowsiness, especially in elderly people. In addition, alcohol makes the drowsiness, sedation and impaired motor skills associated with the cough suppressants dextromethorphan and codeine worse.

Special Groups
Some groups of people may be particularly liable to have the side effects associated with OTC products. The sections below include tips for using OTC medicines in the following special populations:

• Children
• Older adults
• Pregnant or breastfeeding women
• Other groups
  

Children
When used properly, OTC medications pose little risk to children. However, children metabolize drugs differently than adults. You should know how OTC drugs will affect your children before you use them. Talk with your family doctor if you have any questions about giving your child OTC medicines.

• Acetaminophen is generally considered the treatment of choice for children's pain relief.
• Children who are allergic to aspirin are also likely to have problems using ibuprofen. Ibuprofen can make your child's asthma worse, for example.
• Avoid using aspirin in children under the age of 18 because of the risk of Reye's syndrome (a drug reaction that can lead to permanent brain injury).
• It's very easy to accidentally give too much of a decongestant to a young child. Use these medicines with extreme care, if at all, and talk with your doctor first.
• Don't use cough suppressants that contain codeine in young children. Talk to your doctor before using other cough medicines.
  

It can be helpful for parents and other caregivers to keep track of the medicine a child is taking. One way to do that is with a medication log. Using a log can help avoid "double dosing" -- giving too much medicine or giving it too often. It can also provide important information to your
family doctor if there is a problem.

Medicine and Your Child: How to give the right dose
Here are some tips on giving the right dose:

• When your doctor says to give the medicine "every 6 hours" that generally means the medicine is taken 4 times a day (for example, at breakfast, lunch, supper and bed time). It doesn't generally mean to wake the child up in the night to take medicine. And "take every 8 hours" generally means the medicine should be taken 3 times a day.

• Pay close attention to the dosage given on the label. Labels for liquid medicines give measurements in both teaspoons (tsp) and in milliliters (mL). Your pharmacist can give you a measuring device -- a spoon that's made especially for measuring medicine, a syringe or a cup -- that's labeled with both tsp and mL. Your pharmacist should also show you how to use it. One tsp is not the same as 1 mL -- read the label carefully and make sure you give the right amount of medicine to your child. An ordinary kitchen teaspoon may not hold the right amount of medicine.

• Measure the medicine carefully. If you're using a measuring cup, set it on a level surface such as a countertop and then pour the medicine in it.

• "If a little medicine is good, a lot is better (or will work quicker)" is wrong. Giving too much medicine can be harmful. Be sure you only give the recommended dose of each medicine.

• If you use a syringe-type measuring device to give liquid medicine to your child, first throw away the small cap of the syringe. Children can choke on these caps.

• If your child has a bad reaction to a medicine or is allergic to a medicine, tell your doctor right away. Also, keep a record of the following information at home: the name of the medicine, the dosage directions, the illness the medicine was used for and the side effects the medicine caused.

Older Adults
The elderly use a number of medications at the same time and therefore need to pay careful attention to drug-drug interactions between OTC medications and prescription medications. See the drug-to-drug interaction chart. Older adults talk with their doctor about the medications they take and potential interactions with OTC medicines.

• There is a relatively high risk of kidney disease and GI bleeding in elderly patients who use NSAIDs. Discuss this risk with your family doctor.
• Pseudoephedrine can increase blood pressure and the pressure in your eyethat can lead to glaucoma. It can also make existing blockages in theurinary tract worse. Pseudoephedrine interacts negatively with many otherdrugs such as beta-blockers, antidepressants, insulin, and some medications that treat low blood sugar.
• If you use a monoamine oxidase inhibitor (MAOI), a type of prescription antidepressant, or take any medication for a seizure disorder, you should avoid using pseudoephedrine. Pseudoephedrine can change the way these drugs work in your system. Some common MAOIs include Marplan, Nardil and Parnate.
• If you use a MAOI, you should not use dextromethorphan. Dextromethorphan interferes with the way MAOIs work.
  

Pregnant or Breastfeeding Women
Pregnant or breastfeeding women should talk with their doctor before using any medicine. Some can affect your baby. The following are some general guidelines.

Pregnancy

• Acetaminophen is generally considered safe for short-term pain relief during pregnancy.
• Avoid using aspirin during pregnancy. It can cause abnormalities in the baby or problems during delivery.
• Avoid using other NSAIDs, especially during the third trimester of pregnancy. They can cause heart abnormalities in the baby.
  

Breastfeeding

• Acetaminophen and NSAIDs such as ibuprofen provide safe pain relief for women who are breastfeeding.
• Avoid using aspirin because is excreted in breast milk and can cause rashes and bleeding problems in nursing infants.
• Limit long-term use of antihistamines. Antihistamines are excreted in breast milk, and may cause side effects such as sedation, irritability, crying, and sleep disturbances in nursing infants. Antihistamines may also interfere with the production of milk.
  

General Tips
These steps can help minimize the risk of side effects during pregnancy and breastfeeding:

• Talk to your doctor about possible alternatives to medicine.
• Avoid the use of medications during the first trimester.
• Take oral medications after nursing or before the infant's longest sleep period.
• Avoid the use of extra-strength, maximum-strength, or long-acting medications.
• Avoid "combination" products.
• Watch your infant for possible side effects, such as a rash, difficulty breathing, headache or other symptoms that your child didn't have before taking the medicine.
  

Other Groups
People with health problems such as kidney disease, heart disease, diabetes, asthma, blood clotting disorders, or gout may be at increased risk of side effects associated with OTC medicines. (AAFP)

PMS: What You Can Do to Ease Your Symptoms

What is PMS?
Premenstrual syndrome (PMS) is the name of a group of symptoms that start 7 to 14 days before your period (menstruation) . The symptoms usually stop soon after your period begins.
Most women feel some discomfort before their periods. But if you have PMS, you may feel so anxious, depressed or uncomfortable that you can't cope at home or at work. Some of the symptoms of PMS are listed below. Your symptoms may be worse some months and better others.

Symptoms of PMS
* Acne
* Bloated abdomen
* Constipation
* Crying spells
* Depression
* Fast heartbeat
* Feeling hungry
* Feeling irritable or tense
* Feeling tired
* Feeling anxious
* Headache
* Joint pain
* Mood swings
* Not feeling as interested in sex
* Tender and swollen breasts
* Trouble concentrating
* Trouble sleeping
* Swollen hands or feet
* Wanting to be alone
* Weight gain

What causes PMS?
No one knows for sure. But PMS seems to be linked in part to changes in hormone levels during the menstrual cycle. PMS is not caused by stress or psychological problems, though these may make the symptoms of PMS worse.

How is PMS diagnosed?
Your doctor may ask you to keep track of your symptoms on a calendar. If your symptoms follow the same pattern each month, you may have PMS. Your doctor may want to examine you and do some tests to rule out other problems. He or she may also want to talk to you about your eating and exercise habits, your work and your family.

How is PMS treated?
There is no cure for PMS, but eating a healthy diet, exercising regularly and taking medicine may help. Your doctor will talk to you about whether you need to change your diet and exercise habits. He or she may also prescribe medicine for you, depending on what your symptoms are.
You may need to try more than one medicine to find the treatment that works for you. Many medicines are available over-the-counter, but some require a doctor's prescription. Medicines that can be prescribed include diuretics, antidepressants and birth control pills. Other medicines for PMS are being studied.

What are diuretics?
Diuretics help your body get rid of extra sodium and fluid. They can ease bloating, weight gain, breast pain and abdominal pain. Diuretics are usually taken just before you would normally have these symptoms.

Do antidepressants help?
Antidepressants can help with the severe irritability, depression and anxiety that some women with PMS have. These medicines are usually taken every day.

What about birth control pills?
Your doctor may talk to you about taking birth control pills (sometimes called "the pill") to help ease some of your PMS symptoms. Birth control pills help by "evening out" your hormone levels throughout your cycle. Some women's PMS symptoms get a lot better when they take birth control pills. However, the pill can also cause side effects of its own, and it doesn't help all women.

What about medicines I can buy without a prescription?
You can buy medicines without a prescription to help with the symptoms of PMS. These medicines usually combine aspirin or paracetamol/ acetaminophen with caffeine, antihistamines or diuretics.
Some over-the-counter pain relievers can also help. These include ibuprofen, ketoprofen and naproxen. These medicines can work quite well for mild or moderate PMS. Talk to your doctor before you try one of these drugs.

Can I do anything to ease my symptoms?
Yes. Know what your PMS symtoms are and when they happen. Then you can change your diet, exercise and schedule to get through each month as smoothly as possible.
Try not to get discouraged if it takes some time to find tips or medicine that help you. Treatment varies from one person to another. Your doctor can help you find the right treatment.

Tips on controlling PMS
* Eat complex carbohydrates (such as whole grain breads, pasta and cereals), fiber and protein. Cut back on sugar and fat.
* Avoid salt for the last few days before your period to reduce bloating and fluid retention.
* Cut back on caffeine to feel less tense and irritable and to ease breast soreness.
* Cut out alcohol. Drinking it before your period can make you feel more depressed.
* Try eating up to 6 small meals a day instead of 3 larger ones.
* Get aerobic exercise. Work up to 30 minutes, 4 to 6 times a week.
* Get plenty of sleep--about 8 hours a night.
* Keep to a regular schedule of meals, bedtime and exercise.
* Try to schedule stressful events for the week after your period.

What about vitamins and other home remedies?
You may have read that some vitamins and other supplements, such as vitamin B6, vitamin E, magnesium, manganese and tryptophan, can help relieve PMS.
There haven't been many studies about these treatments, and it's possible that they could do more harm than good. For example, vitamin B6 and vitamin E can cause side effects if you take too much. Talk to your doctor if you're thinking of trying any of these vitamins or supplements.
On the other hand, taking calcium pills may reduce symptoms of water retention, cramps and back pain. Taking about 1,000 mg of calcium a day probably won't be harmful, especially because calcium has so many other benefits, such as being good for your bones. (AAFP)

Brain Tumors

A brain tumor is a noncancerous (benign) or cancerous (malignant) growth in the brain, whether it originates in the brain or has spread (metastasized) to the brain from another part of the body.
Brain tumors are equally common among men and women, but some types are more common among men and others are more common among women. Brain tumors are occurring with increasing frequency among older people.
Brain tumors may be primary or secondary. Primary brain tumors originate in the cells within or next to the brain. These tumors may be cancerous or noncancerous. Secondary brain tumors are metastases originating in another part of the body and thus are always cancerous.
Noncancerous tumors are named for the specific cells or tissues in which they originate. For example, hemangioblastomas originate in blood vessels ("hema" refers to blood vessels, and hemangioblasts are the cells that develop into blood vessel tissue). Some noncancerous tumors that originate in embryonic cells may be present at birth.
Most commonly, cancerous brain tumors are metastases from cancer that started in another part of the body. Metastases may grow in a single part of the brain or in several different parts. Many types of cancer-including breast cancer, lung cancer, cancer in the digestive tract, malignant melanoma, leukemia, and lymphoma-can spread to the brain. Lymphomas of the brain are common among people who have AIDS and, for unknown reasons, are becoming more common among people who have normal immune systems. The most common type of primary cancerous brain tumor is a glioma.

Symptoms
Symptoms occur whether a brain tumor is noncancerous or cancerous. A brain tumor can cause many different symptoms, and symptoms may occur suddenly or develop gradually. Which symptoms develop first and how they develop depend on the tumor's size, growth rate, and location. In some parts of the brain, even a small tumor can have devastating effects. In other parts of the brain, tumors can grow relatively large before any symptoms appear. At first, the tumor pushes and stretches nerve tissue, which can compensate for these changes very well, so symptoms may not develop at first. Symptoms develop when brain tissue is destroyed or the pressure within the skull (intracranial pressure) increases, compressing the brain. Pressure may increase because the tumor is enlarging. Eventually, any brain tumor can increase pressure within the skull.
When the brain tumor is a metastasis from cancer in another part of the body, a person may also have symptoms related to that cancer. For example, a person with a metastasis from lung cancer may have a cough that brings up bloody mucus in addition to symptoms of a brain tumor.
A headache is often the first symptom, although most headaches are not caused by brain tumors. A headache due to a brain tumor usually recurs more and more often as time passes. It eventually becomes constant without relief. It is often worse when the person lies down and may awaken the person from sleep. A gradually growing tumor causes a headache that typically is worse when the person first awakens. If headaches with these characteristics start in a person who has not had headaches before, a brain tumor may be the cause.
Brain tumors may produce a change in personality. For example, a person may become withdrawn, moody, and, often, inefficient at work. A person may feel drowsy, confused, and unable to think. Such symptoms are often more apparent to family members and co-workers than to the person. Depression and anxiety, especially if either develops suddenly, may be an early symptom of a brain tumor. Bizarre behavior is unusual. In older people, certain brain tumors cause symptoms that may be mistaken for those of dementia.
Other common symptoms of a brain tumor include dizziness, loss of balance, and incoordination. Later, as the pressure within the skull increases, nausea, vomiting, lethargy, drowsiness, intermittent fever, and even coma may occur. Some brain tumors cause seizures.
Depending on which area of the brain is affected, a tumor can cause an arm, a leg, or one side of the body to become weak or paralyzed or can impair the ability to feel heat, cold, pressure, a light touch, or sharp objects. The ability to express or understand language may be lost. Tumors can also affect hearing, smell, and sight (causing such symptoms as double vision and loss of vision). For example, a pituitary tumor may press on the nearby optic nerves (cranial nerve II), which are involved in vision, and thus impair peripheral vision. If the tumor compresses the brain stem, the pulse and breathing rate may become abnormally fast or slow. Any of these symptoms suggests a serious disorder and requires immediate medical attention.
If a tumor blocks the flow of cerebrospinal fluid through the spaces within the brain (ventricles) , fluid may accumulate, causing the ventricles to enlarge (a condition called hydrocephalus) . As a result, pressure within the skull increases. In addition to other symptoms of increased pressure, hydrocephalus causes difficulty turning the eyes upward. In infants, the
head enlarges.
If the pressure within the skull is greatly increased, the brain may be pushed downward because the skull cannot expand. Herniation of the brain (brain under pressure) may result. There are two main types. In a transtentorial herniation, the upper part of the brain (cerebrum) is forced through the narrow opening (the tentorial notch) in the relatively rigid tissue that separates the cerebrum from the lower parts of the brain (cerebellum and brain stem). In people with this type of herniation, consciousness is reduced. The side of the body opposite the tumor may be paralyzed.
In a tonsillar herniation, a tumor that originates in the lower part of the brain pushes the lowest part of the cerebellum (the cerebellar tonsils) through the opening at the base of the skull (the foramen magnum). As a result, the brain stem, which controls breathing, heart rate, and blood
pressure, is compressed and malfunctions. If not diagnosed and treated immediately, a tonsillar herniation rapidly results in coma and death.

Common Symptoms of Some Brain Tumors Astrocytomas and Oligodendrogliomas
Some astrocytomas and oligodendrogliomas grow slowly and may initially cause only seizures. Others (anaplastic astrocytomas and anaplastic oligodendrogliomas) grow fast and are cancerous; they can produce various symptoms of brain dysfunction. Glioblastoma multiforme, a type of astrocytoma, grows so fast that it increases pressure in the brain, causing headaches and slowed thinking. If the pressure becomes high enough, drowsiness, then coma may result.
Symptoms vary depending on the tumor's location. Tumors in the frontal lobes (located behind the forehead) can cause weakness and personality changes. If they develop in the dominant frontal lobe (the left lobe in most people and the right lobe in some lefthanders) , they can cause speech disturbances.
Tumors in the parietal lobes (located behind the frontal lobes) can cause loss of or changes in sensation; sometimes vision is lost in the eye on the side opposite the tumor. Tumors in the temporal lobes (located above the ears) can cause seizures and, if they develop on the dominant side, the inability to understand and use language. Tumors in the occipital lobes (toward the back of the head) can cause partial loss of vision in both eyes.
Tumors of or near the cerebellum (above the back of the neck), especially medulloblastomas in children, can cause alterations in eye movements, incoordination, unsteadiness in walking, and sometimes hearing loss and dizziness. They can block the drainage of cerebrospinal fluid, causing fluid to accumulate in the spaces within the brain (ventricles) . As a result, the ventricles enlarge (a condition called hydrocephalus) , and pressure within the skull increases. Symptoms include headaches, nausea, vomiting, difficulty turning the eyes upward, lethargy, and coma with herniation of the brain. In infants, the head enlarges.

Meningiomas
Meningiomas are usually noncancerous but may recur after they are removed. They occur more often in women and usually appear in people aged 40 to 60, but they can begin growing in childhood or later life. They may cause weakness or numbness, seizures, an impaired sense of smell, and changes in vision. If they become very large, they may cause mental deterioration, including memory loss, much like dementia.

Pineal Tumors
Pineal tumors usually develop during childhood and often cause early puberty. They can obstruct the drainage of cerebrospinal fluid around the brain, leading to hydrocephalus. The most common type of pineal tumor is a germ cell tumor.

Pituitary Gland Tumors
The pituitary gland, located at the base of the skull, controls much of the body's endocrine system. Tumors of the pituitary gland (pituitary adenomas) are usually noncancerous. They secrete abnormally large amounts of pituitary hormones. Effects vary depending on which hormone is secreted in large amounts.
For growth hormone, extreme height (gigantism) or disproportionate enlargement of the head, face, hands, feet, and chest (acromegaly) For corticotropin, Cushing's syndrome For thyroid-stimulating hormone (TSH), hyperthyroidism For prolactin, the cessation of menstrual periods (amenorrhea) in women, production of breast milk in women who are not breastfeeding (galactorrhea), and, in men, erectile dysfunction and enlargement of the breasts (gynecomastia)
Pituitary gland tumors can also destroy the tissues in the pituitary gland that secrete hormones, eventually resulting in insufficient levels of these hormones in the body. Headaches commonly occur. If the tumor enlarges, peripheral vision in both eyes is lost.

What Is Pseudotumor Cerebri?
In pseudotumor cerebri (also called benign intracranial hypertension) , the pressure within the skull (intracranial pressure) increases without any evidence of a cause, such as a tumor, an infection, or a blockage that prevents the cerebrospinal fluid around the brain from draining. It is most common among women aged 20 to 50, especially those who are overweight.
In most people, neither the development nor the eventual disappearance of pseudotumor cerebri can be traced to a particular event. In about one third of people, the cause is blockage of the large veins (venous sinuses) that carry blood from the brain. In children, pseudotumor cerebri sometimes develops after corticosteroids are withdrawn or after a child has taken excessive amounts of vitamin A or the antibiotic tetracycline.
Pseudotumor cerebri usually begins with a headache, which is often mild at first but becomes severe. Late in the course of the disorder, about 5% of people lose their vision, partially or completely, in one or both eyes. The increased pressure within the skull may cause the optic nerve to swell near the eyeball-a condition called papilledema. Doctors can observe the swelling by looking at the back of the eye through an ophthalmoscope.
When evaluating people with pseudotumor cerebri, doctors first rule out any possible treatable cause of the increased pressure within the skull. The results of computed tomography (CT) are usually normal, but spaces within the brain may appear slightly compressed. A spinal tap (lumbar puncture) is performed to measure pressure of the cerebrospinal fluid, which is usually increased, and to analyze the fluid, which is usually normal in content. Pseudotumor cerebri often disappears without treatment within 6 months. Nonetheless, overweight people should lose weight. Aspirin or paracetamol may relieve the headache. If the increased intracranial pressure is not relieved within a few weeks, doctors may prescribe the drug acetazolamide to help reduce the pressure.
Pseudotumor cerebri recurs in about 10% of people. It becomes chronic and progressively worse in some people, eventually causing blindness. Once vision is lost, it may never return, even if the pressure around the brain is relieved. However, vision need not be lost. People with the chronic form of the disorder should check their vision daily by reading small print and immediately report any changes in vision to their doctor or go to the emergency department. If vision is threatened, several procedures can reduce intracranial pressure.
Spinal taps can be performed daily or weekly to remove cerebrospinal fluid. Or, surgery on the optic nerve sheath (fenestration) may be performed. In this procedure, slits or patches are cut in the covering of the optic nerve behind the eyeball, allowing cerebrospinal fluid to escape into the tissues around the eye, where the fluid passes into veins. If the disorder persists, a permanent drain (shunt) can be surgically placed so that excess fluid can be removed.

Diagnosis
Doctors consider the possibility of a brain tumor in people who have had a seizure for the first time or who have the characteristic symptoms. Although doctors can often detect brain dysfunction by performing a physical examination, other procedures are needed to diagnose a brain tumor.
Standard x-rays of the skull can detect tumors that erode bone (such as a meningioma or pituitary adenoma). However, magnetic resonance imaging (MRI) and computed tomography (CT) are more useful because they can detect all types of brain tumors. They can also show the tumor's size and exact position in great detail. When a brain tumor is detected, more diagnostic
procedures are performed to determine the particular kind.
Sometimes a spinal tap (lumbar puncture) is performed to obtain cerebrospinal fluid for examination under a microscope. This procedure is performed when doctors suspect that the tumor has invaded the meninges, is compressing the cranial nerves, and is blocking the flow of cerebrospinal fluid. The procedure may also help when the diagnosis or the type of tumor is unclear. Cerebrospinal fluid may contain cancer cells. However, a spinal tap cannot be performed in people who have a large tumor that is increasing pressure within the skull. The removal of cerebrospinal fluid during a spinal tap may cause the tumor to move, resulting in herniation of the brain.
A biopsy of the tumor (removal of a sample of the tumor for examination under a microscope) is usually needed to identify the type of tumor, including whether it is cancerous. A biopsy may be performed during surgery in which all or part of the tumor is removed. If a tumor is difficult to
reach, a biopsy may be performed using three-dimensional needle placement (stereotactic biopsy) with CT.

Treatment and Prognosis
Treatment of a brain tumor depends on its location and type. When possible, the tumor is removed surgically. Some brain tumors can be removed with little or no damage to the brain. However, many grow in an area that makes removal difficult or impossible without destroying essential structures.
Surgery sometimes causes brain damage that can lead to partial paralysis, changes in sensation, weakness, and impaired intellect. Nevertheless, removing a tumor-whether cancerous or noncancerous- is essential if its growth threatens important brain structures. Even when a cure is impossible, surgery may be useful to reduce the tumor's size, relieve symptoms, and help
doctors determine whether other treatments, such as radiation therapy or chemotherapy, are warranted.
Removal of noncancerous tumors is often safe and cures the person. However, very small tumors and tumors in older people may be left in place as long as they are not causing symptoms. Sometimes radiation therapy is given after surgery to destroy any remaining tumor cells. Radiosurgery is used to treat tumors that are small and not readily accessible with traditional surgery.
It is also used to treat meningiomas. Radiosurgery uses focused radiation to destroy a tumor rather than an incision to remove it. With radiosurgery, treatment is completed in 1 day.
Most cancerous brain tumors are treated with a combination of surgery, radiation therapy, and chemotherapy. As much of the tumor as can be removed safely is removed, and then radiation therapy is begun. Radiation therapy is given over a course of several weeks. It rarely cures but may shrink a tumor enough to keep it under control for many months or even years. Chemotherapy is used to treat some types of cancerous brain tumors. Chemotherapy appears
to be particularly effective in treating anaplastic oligodendrogliomas.
Radiosurgery is also used to treat cancerous brain tumors. Increased pressure within the skull is extremely serious and requires immediate medical attention. Drugs such as mannitol and corticosteroids are usually given by injection to reduce the pressure and prevent herniation.
Corticosteroids can often restore function within days, even if the tumor is large. If the tumor is blocking the flow of cerebrospinal fluid through the spaces within the brain, a device may be used to reduce the risk of herniation by draining the cerebrospinal fluid. The device consists of a
small tube (catheter) connected to a gauge that measures the pressure within the skull. The tube is inserted through a tiny opening drilled in the skull.
This procedure may be performed using a local anesthetic (usually plus a sedative) or a general anesthetic. The tube is removed or converted to a permanent drain (shunt) after a few days. During this time, doctors surgically remove all or part of the tumor or use radiosurgery or radiation therapy to reduce the size of the tumor and thus relieve the blockage.
Treatment of metastases to the brain depends largely on where the cancer originated. Radiation therapy directed at the metastases in the brain is often performed. Surgical removal may benefit people who have only a single metastasis. In addition to traditional treatments, radiosurgery and some experimental treatments, involving chemotherapy and radioactive implants in the tumor, are being tried.
The prognosis for people who have a brain tumor ranges from complete recovery to death, depending on the type and location of the tumor.

End-of-Life Issues: Because people with cancerous brain tumors have a limited life expectancy, establishing advance directives is advisable.
Advance directives can help a doctor determine what kind of care people want if they become unable to make decisions about medical care. Many cancer centers, especially those with hospice facilities, provide counseling and home health services.

Understanding Tumor Treatment Craniotomy:
After part of the scalp is shaved, an incision is made through the skin. A high-speed drill and a special saw are used to remove a small piece of bone above the tumor. The tumor is located and removed. Usually, the bone is then replaced and the incision stitched closed. A scalpel may be used to cut out the tumor; a laser (using heat) may be used to vaporize the tumor; or a device that emits ultrasound waves may be used to break the tumor apart, so that the pieces can be suctioned out (aspirated). Lasers and ultrasound devices are used to remove tumors that would be difficult to cut out.

Stereotactic techniques:
Computers are used to produce a three-dimensional image of the tumor and thus to precisely locate a tumor and determine its relationship to other structures in the brain. The three-dimensional image can be obtained by attaching a metal imaging frame with a series of rods to the person's skull.
The rods appear as dots on a CT scan, providing reference points, which help locate the tumor. Other devices, such as a viewing wand or compass system, do not involve attaching a frame and may be used instead. Stereotactic techniques can be used to biopsy or remove tumors or to insert implants containing a chemotherapy drug or radioactive pellets.

Radiosurgery:
Radiosurgery is not really surgery because no incision is required. Focused radiation is used to destroy a tumor. Because the radiation is focused, a smaller dose can be used. Several machines, including a gamma knife and a linear accelerator, can produce this type of radiation.
When a gamma knife is used, an imaging frame is attached to the person's skull. The person lies on a sliding bed, and a large helmet with holes in it is placed over the frame. The head of the bed is then slid into a globe that contains radioactive cobalt. Radiation passes through the holes in the helmet and is aimed precisely at the tumor.
A linear accelerator circles the head of the person, who lies on a sliding bed. The linear accelerator aims radiation precisely at the tumor.

Implants:
After a tumor is removed and before the skull and incision are closed, wafers soaked with a chemotherapy drug may be placed in the space where the tumor was. As the wafers gradually dissolve, they release the drug to destroy any remaining cancer cells.
A thin tube called a catheter may be inserted through an incision and used to place radioactive implants directly into the tumor. The implants may be removed after a few days or months or may be left in place. Unlike people who have externally applied radiation therapy, people who have radioactive implants are radioactive for a time and need to take precautions as advised
by their doctor. After this procedure, surgery may be necessary to remove dead cancer cells.

Shunts:
If a tumor causes pressure within the skull to increase, a shunt may be surgically placed. A shunt is a thin piece of tubing that is inserted into one of the spaces of the brain (ventricles) or sometimes into the space around the spine that contains cerebrospinal fluid (subarachnoid space). The other end of the tubing is threaded under the skin from the head usually to
the abdominal cavity. Excess cerebrospinal fluid is drained from the brain and is absorbed in the abdominal cavity. The shunt contains a one-way valve that opens when there is too much fluid in the brain. Shunts may be temporary (until the tumor is removed) or permanent. (Merck)

History of Neuro-Linguistic Programe (NPL)

Sekitar tahun 1970-an, Richard Bandler lulus dari Universitas California Santa Cruz sebagai sarjana matemateka. Dia banyak menghabiskan waktunya ergelut dengan kerumitan ilmu computer dan fisika. Tak heran, banyak orang yang menjulukinya “anak ajaib” , ia memiliki minat lain, psikologi. Terilhami sahabat-sahabatnya, dari keluarga ahli terapi terkenal seperti Milton Erickson, Virgina Satir dan Fritz Perl, ia terdorong untuk mempelajari psikologi. Ia membatasi penelitiannya. Dan pada akhirnya

Setelah mempelajari pola-pola tingkah laku yang dibuat oleh mereka, Bandler mencoba membuat modelnya. Dia menjiplak strategi-statergi pribadi dan tingkah laku, lalu mencobanya pada beberapa orang. Hasilnya sangat memuaskan. Penemuannya menjadi landasan Program Neuro-Linguistik atau disebut juga Program Pembentukan Manusia Sempurna

Tidak lama kemudian, dia bertemu Dr. John Grinder, Seorang Profesor Linguistik. Grinder memiliki latar belakang keilmuan serupa dengan Bandler. Dia memperoleh gelar Ph.d Linguistik Spesialis teori-teori lingustik Noam Chomsky, seorang ahli bahasa Amerika yang tersohor. Keahlian Grinder sangat menonjol dalam berasimilasi dengan bahasa-bahasa, menelaah aksen-aksen dan membuat model perilaku budaya penutur bahasa tertentu dengan cepat dan tepat. Kemanpuannyas semakin terasah setelah bergabung dalam misi pasukan keamanan amerika di eropa era 1960-an. Saat perang dingin memanas, Grinder memfokuskan penelitiannya untuk memuka “tata bahasa tersembunyi” dari setiap gerakan dan pemikiran.

Berdasarkankesamaan minat, Bndler dan Grinder memutuskan untuk mensinergikan keahlian mereka dibidang komputerisasi, linguistic dan kemanpuan luar biasa mereka dalam membuat model perilaku non-verbal manusia. Mereka menciptakan “bahasa perubahan” yang baru. Penelitian mereka meruncing pada studi “pembentukan manusia sempurna”. Teori-teori yang mendasarinya diperoleh setelah melakukan setudi mendalam terhadap pemikiran tiga tokoh ternama. Pertama terapi yang terkenal berhasil menyelematkan sejumlah rumah tangga yang berada di ambang perceraian. Kedua seorang filosof dan ahli antropologi Ingrgris Gregory Bteson. Ialah penggagad “cara berpikir sistematik” proses beruntun pikiran sadar dan bawah sadar dalam membuat keputusan. Terakhir Dr. Milton Erikson, pendiri masyarakat gipnose untuk kesehatan di amerika. Ia dijuluki “sang penyembuh” setelah berhasil menunjukkan prestasi luar biasa melampau cacat mental dan fisik (kelumpuhan tubuh akibat polio)

Bandler dan Grinder mengakhiri observasi mereka pada penelitian Dr. Fritz Perl, pendiri Lembaga terapi Gestalk, setelah melewati sejumlah obsevarsi dan penelitian, mereka yakin telah menekan cara memahami dan mewujudkan bagian terbaik dari diri manusia. Selama beberapa waktu, mereka memberikan kuliah-kuliah tentang topic ini dan mendapat sambutanb antusiaS. Lalu bersama mereka mendirikan NLP (Neuro-Linguistic-Programe) pertama yang dikenal sebagai masyarakat pembelajat NLP.

Dewasa ini, NLP (Neuro-Linguistic-Programe) menjadi jantung bagi berbagai pendekatan komunikasi dan perubahan, menjiwai setiap aspek kehidupan manusia. Teknik-teknik dan strategi NLP dipakai untuk keperluan terapi manajemen, pendidikan, kesehatan dan penjualan. Peran terbesar NLP adalah membantu manusia berkomunikasi lebih baik dengan diri mereka sendiri. Mengurangi ketakutan tanpa alas an, mengontrol emosi negative dan kecemasan. NLP berurat berakar pada segala sesuatu yang mendasari terjalinnya hubungan keselaran dengan siapa saja bahkan dengan pribadi.

Metoda NLP berkembang dengan pesatnya dan membantu jutaan orang hidup lebih berbahagia. Kesuksesan banyak orang tersebut cukup membuktikan, mereka dapat menjalanin kehidupan yang seimbang lepas dari keterbatasan dan perasaan negative.


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Hemoglobin

Hemoglobin

What is hemoglobin?

Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues to the lungs. The iron contained in hemoglobin is responsible for the red color of blood.

How is hemoglobin measured?

Several methods exist for measuring hemoglobin, most of which are done currently by automated machines designed to perform several different tests on blood. Within the machine, the red blood cells are broken down to get the hemoglobin into a solution. The free hemoglobin is exposed to a chemical containing cyanide which binds tightly with the hemoglobin molecule to form cyanmethemoglobin. By shining a light through the solution and measuring how much light is absorbed (specifically at a wavelength of 540 nanometers), the amount of hemoglobin can be determined.

What are normal hemoglobin values?

The hemoglobin level is expressed as the amount of hemoglobin in grams (gm) per deciliter (dl) of whole blood, a deciliter being 100 milliliters.

The normal ranges for hemoglobin depend on the age and, beginning in adolescence, the sex of the person. The normal ranges are:

• Newborns: 17-22 gm/dl
• One (1) week of age: 15-20 gm/dl
• One (1) month of age: 11-15gm/dl
• Children: 11-13 gm/dl
• Adult males: 14-18 gm/dl
• Adult women: 12-16 gm/dl
• Men after middle age: 12.4-14.9 gm/dl
• Women after middle age: 11.7-13.8 gm/dl

All of these values may vary slightly between laboratories. Some laboratories do not differentiate between adult and "after middle age" hemoglobin values.

What does a low hemoglobin level mean?

A low hemoglobin is referred to as being anemic. There are many reasons for anemia. Some of the more common reasons are loss of blood (traumatic injury, surgery, bleeding colon cancer), nutritional deficiency (iron, vitamin B12, folate), bone marrow problems (replacement of bone marrow by cancer, suppression by chemotherapy drugs, kidney failure), and abnormal hemoglobin (sickle cell anemia).

What does a high hemoglobin level mean?

Higher than normal hemoglobin levels can be seen in people living at high altitudes and in smokers. Dehydration produces a falsely high hemoglobin which disappears when proper fluid balance is restored. Some other infrequent causes are lung disease, certain tumors, a disorder of the bone marrow known as polycythemia rubra vera, and abuse of the drug erythropoietin (Epogen) by athletes for blood doping purposes.