Tobias Medical and Diagnostic Center

TOBIAS MEDICAL AND DIAGNOSTIC CENTER
HEARTBURN
Heartburn is a burning sensation in your chest, just behind your breastbone. Heartburn pain is often worse when lying down
or bending over.
...Occasional heartburn is common and no cause for alarm. Most people can manage the discomfort of heartburn on their own
with lifestyle changes and over-the-counter medications.
More frequent heartburn that interferes with your daily routine may be a symptom of something more serious that requires
help from a doctor.
SYMPTOMS:
Symptoms of heartburn include:
-A burning pain in the chest that usually occurs after eating and may occur at night
-Pain that worsens when lying down or bending over
When to see a doctor

Seek immediate help if you experience severe chest pain, especially when combined with other signs and symptoms such as
difficulty breathing or jaw or arm pain. Chest pain may be a symptom of a heart attack.
Make an appointment with your doctor if:
-Heartburn occurs more than twice a week

-Symptoms persist despite use of over-the-counter medications
-You have difficulty swallowing
CAUSES:
Heartburn occurs when stomach acid backs up into your esophagus.
Normally when you swallow, your lower esophageal sphincter — a circular band of muscle around the bottom part of your
esophagus — relaxes to allow food and liquid to flow down into your stomach. Then it closes again.
However, if the lower esophageal sphincter relaxes abnormally or weakens, stomach acid can flow back up into your
esophagus, causing heartburn. The acid backup is worse when you're bent over or lying down.
RISK FACTORS:
Certain foods and drinks can trigger heartburn in some people, including:
Alcohol
Black pepper
Chocolate
Coffee
Fatty food
Fried food
Ketchup
Mustard
Orange juice
Peppermint
Soft drinks
Tomato sauce
Vinegar
COMPLICATIONS:
Heartburn that occurs frequently and interferes with your routine is considered gastroesophageal reflux disease (GERD).
GERD treatment may require prescription medications and, occasionally, surgery or other procedures.
GERD can also cause serious complications.

See your doctor if your heartburn becomes more frequent or no longer responds to over-the-counter medications. Your doctor
can determine if your heartburn is likely to be a symptom of GERD.
TREATMENT:
Many over-the-counter medications are available to relieve the pain of heartburn. Options include:
Antacids that neutralize stomach acid.

Antacids, such as Maalox, Mylanta, Gelusil, Rolaids and Tums, may provide quick relief.
Medications to reduce acid production.
Called H-2-receptor blockers, these medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid
AR) or ranitidine (Zantac 75). H-2-receptor blockers don't act as quickly as antacids, but they provide longer relief.
Medications that control acid and heal the esophagus.

Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal. Proton pump inhibitors
available over-the-counter include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC).
Read and follow the instructions on over-the-counter medications. If you find over-the-counter treatments don't work or you
rely on them often, make an appointment with your doctor.
LIFESTYLE AND HOME REMEDIES:

You may find heartburn relief by making small changes. Consider trying to:
Maintain a healthy weight.

Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus. If
your weight is healthy, work to maintain it. If you are overweight or obese, work to slowly lose weight — no more than 1 or 2
pounds (0.5 to 1 kilogram) a week. Ask your doctor for help devising a weight-loss strategy that will work for you.
Avoid tightfitting clothing.

Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.
Avoid foods and drinks that trigger heartburn.

Everyone has specific triggers, such as alcohol or tomato sauce. Avoid foods you know will trigger your heartburn.
Eat smaller meals.

Avoid overeating by eating smaller meals.
Delay lying down after a meal.

Wait at least two to three hours after eating before lying down or going to bed.
Elevate the head of your bed.

An elevation of about six to nine inches puts gravity to work for you. Place wood or cement blocks under the feet of your bed
at the head end. If it's not possible to elevate your bed, you can insert a wedge between your mattress and box spring to elevate
your body from the waist up. Wedges are available at drugstores and medical supply stores.
Stop smoking.
Smoking decreases the lower esophageal sphincter's ability to function properly.
ALTERNATIVE MEDICINE:
Anxiety and stress can worsen heartburn symptoms. Some complementary and alternative treatments may help you cope with
anxiety and stress. If your heartburn is worsened by anxiety and stress, consider trying:
Aromatherapy
Gentle exercise, such as walking or riding a bike, but avoid vigorous exercise, which can worsen heartburn
Hypnosis
Listening to music
Massage
Relaxation techniques, such as guided imagery
until next time, keep safe.‫مشاهدة المزيد‬

STRESS FRACTURE
Stress fractures are tiny cracks in a bone. Stress fractures are caused by the repetitive application of force, often by overuse —
such as repeatedly jumping up and down or running long distances. Stress fractures also can arise from normal use of a bone
that's been weakened by a condition such as osteoporosis.
Stress fr...actures are most common in the weight-bearing bones of the lower leg and foot. Track and field athletes are
particularly susceptible to stress fractures, but anyone can experience a stress fracture. If you're starting a new exercise
program, for example, you may be at risk if you do too much too soon.
SYMPTOMS:
-If you have a stress fracture, you may experience:
-Pain that increases with activity and decreases with rest

-Pain that occurs earlier in your workout in each successive workout
-Pain that increases over time
-Pain that persists even at rest
-Swelling
A specific spot on the involved bone that feels tender or painful to the touchAt first, stress fractures may be barely noticeable.
But pay attention to the pain. Proper self-care and treatment can keep the stress fracture from worsening.

Stress fractures aren't always obvious. They develop over time, so it's difficult to tell exactly when they start to require a
doctor's care. Go to your doctor if running or playing hurts your foot or leg even after you've stopped the provoking activity
and given yourself time to rest.
CAUSES:
Stress fractures are caused by the repetitive application of a greater amount of force than the bones of your feet and lower legs
normally bear. This force causes an imbalance between the resorption and growth of bone, both of which go on all the time.
Repetitive force promotes the turnover of bone cells, but you add new bone cells when you're at rest.
If your bones are subjected to unaccustomed force without enough time for recovery, you'll resorb bone cells faster than you
can replace them. As a result, you develop "bone fatigue." Continued, repetitive force causes tiny cracks in fatigued bones.
These cracks progress to become stress fractures.
RISK FACTORS:
You may be at increased risk of stress fractures if you:
♥ Are an athlete who participates in high-impact sports such as track and field, basketball, tennis or gymnastics
♥ Are a female athlete with abnormal or absent periods
♥ Suddenly shift from a sedentary lifestyle to an active training regimen — such as a military recruit subjected to intense
marching exercises — or rapidly increase your exercise length and intensity
♥ Have flat feet or high, rigid arches
♥ Have osteoporosis or other conditions that lead to weakened bones or decreased bone density
COMPLICATIONS:
Some stress fractures don't heal properly. This may lead to chronic pain.
TEST AND DIAGNOSIS:

Stress fractures may not be apparent on regular X-rays until about three to four weeks after signs and symptoms begin. If
your doctor suspects a stress fracture, the diagnosis may be confirmed with a magnetic resonance imaging (MRI) study or, in
some cases, a bone scan, which tracks a radioactive tracer material through your bone after you have an injection of a tiny
amount of the tracer.
TREATMENTS AND DRUGS:

Treatment varies depending on the location of the stress fracture and on how quickly you need to resume activity.
Medications
If needed, take acetaminophen (Tylenol, others) to relieve pain. Some research suggests that nonsteroidal anti-inflammatory
pain relievers — such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) — can interfere with bone
healing.
Therapies
To reduce the bone's weight-bearing load until healing occurs, you may need to wear a walking boot or brace, or use crutches.
In severe cases, the doctor may need to immobilize the affected bone with a splint or cast. Although it's unusual, surgery is
sometimes necessary to ensure complete healing of some types of stress fractures, especially those that occur in areas with a
poor blood supply.
It's important to give the bone time to heal. This may take four to 12 weeks or even longer. In the meantime:
Rest.
Stay off the affected limb as directed by your doctor until you are cleared to bear normal weight.
Ice.
To reduce swelling and relieve pain, your doctor may recommend applying ice packs to the injured area as needed — up to
three to four times a day for 10 minutes at a time.
Resume activity slowly.

When your doctor gives the OK, slowly progress from non-weight-bearing activities — such as swimming — to your usual
activities. Return to high impact activities, such as running, on a gradual basis, with careful progression of time and distance.
PREVENTION:
Simple steps can help you prevent stress fractures.
♥ Start any new exercise program slowly, and progress gradually. Don't exercise too hard or too long.Avoid sudden changes in
intensity or type of exercise.
♥ Use proper equipment and footwear appropriate for your activity.
♥ Cross-train with low impact activities to avoid repetitively stressing a particular part of your body.
♥ If you have flat feet, ask your doctor about arch supports for your shoes.
Nutrition counts, too. To keep your bones strong, make sure your diet includes plenty of calcium and other nutrients.
until next time, keep safe‫مشاهدة المزيد‬

PANCREATIC CANCER
Pancreatic cancer begins in the tissues of your pancreas — an organ in your abdomen that lies horizontally behind the lower
part of your stomach. Your pancreas secretes enzymes that aid digestion and hormones that help regulate the metabolism of
sugars.
Pancreatic cancer often has a poor prognosis, even when diagnosed ...early. Pancreatic cancer typically spreads rapidly and is
seldom detected in its early stages, which is a major reason why it's a leading cause of cancer death. Signs and symptoms may
not appear until pancreatic cancer is quite advanced and surgical removal isn't possible.
CAUSES:
It's not clear what causes pancreatic cancer.
Understanding your pancreas

Your pancreas is about 6 inches (15 centimeters) long and looks something like a pear lying on its side. The pancreas is a
crucial part of your digestive system. It secretes hormones, including insulin, to help your body process sugar. And it produces
digestive juices to help your body digest food.
How pancreatic cancer forms Pancreatic cancer occurs when cells in your pancreas develop genetic mutations. These
mutations cause the cells to grow uncontrollably and to continue living after normal cells would die. These accumulating cells
can form a tumor.
Types of pancreatic cancer The types of cells involved in a pancreatic cancer help determine the best treatment. Types of
pancreatic cancer include:
Cancer that forms in the pancreas ducts (adenocarcinoma).

Cells that line the ducts of the pancreas help produce digestive juices. The majority of pancreatic cancers are
adenocarcinomas. Sometimes these cancers are called exocrine tumors.
Cancer that forms in the hormone-producing cells.

Cancer that forms in the hormone-producing cells of the pancreas is called endocrine cancer. Endocrine cancers of the
pancreas are very rare.
SYMPTOMS:
Signs and symptoms of pancreatic cancer often don't occur until the disease is advanced. When signs and symptoms do
appear, they may include:
Upper abdominal pain that may radiate to your back

Yellowing of your skin and the whites of your eyes (jaundice)
Loss of appetite
Weight loss
Depression
Blood clots
RISK FACTORS:
-Factors that may increase your risk of pancreatic cancer include:
-Increasing age, especially over age 60Being black

-Being overweight or obese
-Chronic inflammation of the pancreas (pancreatitis)
-Diabetes
-Family history of genetic syndromes that can increase cancer risk, including a BRCA2 gene mutation, Peutz-Jeghers
syndrome, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM)Personal or family history of
pancreatic cancer
-Smoking
COMPLICATIONS:
As pancreatic cancer progresses, it can cause complications such as:
-Jaundice.
Pancreatic cancer that blocks the liver's bile duct can cause jaundice. Signs include yellow skin and eyes, dark-colored urine,
and pale-colored stools.
Your doctor may recommend that a plastic or metal tube (stent) be placed inside the bile duct to hold it open. In some cases a
bypass may be needed to create a new way for bile to flow from the liver to the intestines.
-Pain.
A growing tumor may press on nerves in your abdomen, causing pain that can become severe. Pain medications can help you
feel more comfortable. Radiation therapy may help stop tumor growth temporarily to give you some relief.
In severe cases, your doctor may recommend a procedure to inject alcohol into the nerves that control pain in your abdomen
(celiac plexus block). This procedure stops the nerves from sending pain signals to your brain.
-Bowel obstruction.
Pancreatic cancer that grows into or presses on the small intestine (duodenum) can block the flow of digested food from your
stomach into your intestines.
Your doctor may recommend a tube (stent) be placed in your small intestine to hold it open. Or bypass surgery may be
necessary to attach your stomach to a lower point in your intestines that isn't blocked by cancer.
-Weight loss.
A number of factors may cause weight loss in people with pancreatic cancer. Nausea and vomiting caused by cancer
treatments or a tumor pressing on your stomach may make it difficult to eat. Or your body may have difficulty properly
processing nutrients from food because your pancreas isn't making enough digestive juices.
Pancreatic enzyme supplements may be recommended to aid in digestion. Try to maintain your weight by adding extra
calories where you can and making mealtime as pleasant and relaxed as possible.
TEST AND DIAGNOSIS:

Diagnosing pancreatic cancer If your doctor suspects pancreatic cancer, you may have one or more of the following tests to
diagnose the cancer:
Ultrasound.
Ultrasound uses high-frequency sound waves to create moving images of your internal organs, including your pancreas. The
ultrasound sensor (transducer) is placed on your upper abdomen to obtain images.
Computerized tomography (CT) scan.

CT scan uses X-ray images to help your doctor visualize your internal organs. In some cases you may receive an injection of
dye into a vein in your arm to help highlight the areas your doctor wants to see.
Magnetic resonance imaging (MRI).

MRI uses a powerful magnetic field and radio waves to create images of your pancreas.
Endoscopic retrograde cholangiopancreatography (ERCP).

This procedure uses a dye to highlight the bile ducts in your pancreas. During ERCP, a thin, flexible tube (endoscope) is gently
passed down your throat, through your stomach and into the upper part of your small intestine. Air is used to inflate your
intestinal tract so that your doctor can more easily see the openings of your pancreatic and bile ducts. A dye is then injected
into the ducts through a small hollow tube (catheter) that's passed through the endoscope. Finally, X-rays are taken of the
ducts. A tissue or cell sample (biopsy) can be collected during ERCP.
Endoscopic ultrasound (EUS).

EUS uses an ultrasound device to make images of your pancreas from inside your abdomen. The ultrasound device is passed
through an endoscope into your stomach in order to obtain the images. Your doctor may also collect a sample of cells (biopsy)
during EUS.
Percutaneous transhepatic cholangiography (PTC).

PTC uses a dye to highlight the bile ducts in your liver. Your doctor carefully inserts a thin needle into your liver and injects
the dye into the bile ducts. A special X-ray machine (fluoroscope) tracks the dye as it moves through the ducts.
Removing a tissue sample for testing (biopsy).

A biopsy is a procedure to remove a small sample of tissue from the pancreas for examination under a microscope. A biopsy
sample can be obtained by inserting a needle through your skin and into your pancreas (fine-needle aspiration). Or it can be
done using endoscopic ultrasound to guide special tools into your pancreas where a sample of cells can be obtained for testing.
Staging pancreatic cancer

Once a diagnosis of pancreatic cancer is confirmed, your doctor will work to determine the extent, or stage, of the cancer.
Your cancer's stage helps determine what treatments are available to you. In order to determine the stage of your pancreatic
cancer, your doctor may recommend:
Using a scope to see inside your body. Laparoscopy uses a lighted tube with a video camera to explore your pancreas and
surrounding tissue. The surgeon passes the laparoscope through an incision in your abdomen. The camera on the end of the
scope transmits video to a screen in the operating room. This allows your doctor to look for signs cancer has spread within
your abdomen.
Imaging tests.
Imaging tests may include chest X-ray, CT and MRI.
Blood test.
Your doctor may test your blood for specific proteins (tumor markers) shed by pancreatic cancer cells. One tumor marker test
used in pancreatic cancer is called CA19-9. Some research indicates that the more elevated your level of CA19-9 is, the more
advanced the cancer. But the test isn't always reliable, and it isn't clear how best to use the CA19-9 test results. Some doctors
measure your levels before, during and after treatment. Others use it to gauge your prognosis.
Stages of pancreatic cancer

Using information from staging tests, your doctor assigns your pancreatic cancer a stage. The stages of pancreatic cancer are:
Stage I.
Cancer is confined to the pancreas.
Stage II.
Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes.
Stage III.
Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph
nodes.
Stage IV.
Cancer has spread to distant sites beyond the pancreas, such as the liver, lungs and the lining that surrounds your abdominal
organs (peritoneum).
TREATMENT:
Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your age, overall health and
personal preferences. The first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. When that isn't
an option, the focus may be on preventing the pancreatic cancer from growing or causing more harm. When pancreatic cancer
is advanced and treatments aren't likely to offer a benefit, your doctor may suggest ways to relieve symptoms and make you as
comfortable as possible.
Surgery
Surgery may be an option if your pancreatic cancer is confined to the pancreas. Operations used in people with pancreatic
cancer include:
Surgery for tumors in the pancreatic head.

If your pancreatic cancer is located in the head of the pancreas, you may consider an operation called a Whipple procedure
(pancreatoduodenectomy). The Whipple procedure involves removing the head of your pancreas, as well as a portion of your
small intestine (duodenum), your gallbladder and part of your bile duct. Part of your stomach may be removed as well. Your
surgeon reconnects the remaining parts of your pancreas, stomach and intestines to allow you to digest food.
Whipple surgery carries a risk of infection and bleeding. After the surgery, some people experience nausea and vomiting that
can occur if the stomach has difficulty emptying (delayed gastric emptying). Expect a long recovery after a Whipple
procedure. You'll spend 10 days or more in the hospital and then recover for several weeks at home.
Surgery for tumors in the pancreatic tail and body.

Surgery to remove the tail of the pancreas or the tail and a small portion of the body is called distal pancreatectomy. Your
surgeon may also remove your spleen. Surgery carries a risk of bleeding and infection.Research shows pancreatic cancer
surgery tends to cause fewer complications when done by experienced surgeons. Don't hesitate to ask about your surgeon's
experience with pancreatic cancer surgery. If you have any doubts, get a second opinion.
Radiation therapy
Radiation therapy uses high-energy beams to destroy cancer cells. You may receive radiation treatments before or after
cancer surgery, often in combination with chemotherapy. Or, your doctor may recommend a combination of radiation and
chemotherapy treatments when your cancer can't be treated surgically.
Radiation therapy can come from a machine outside your body (external beam radiation), or it can be placed inside your body
near your cancer (brachytherapy). Radiation therapy can also be used during surgery (intraoperative radiation).
Chemotherapy
Chemotherapy uses drugs to help kill cancer cells. Chemotherapy can be injected into a vein or taken orally. You may receive
only one chemotherapy drug, or you may receive a combination of chemotherapy drugs.
Chemotherapy can also be combined with radiation therapy (chemoradiation). Chemoradiation is typically used to treat
cancer that has spread beyond the pancreas, but only to nearby organs and not to distant regions of the body. This
combination may also be used after surgery to reduce the risk that pancreatic cancer may recur.
In people with advanced pancreatic cancer, chemotherapy may be combined with targeted drug therapy.
Targeted therapy
Targeted therapy uses drugs that attack specific abnormalities within cancer cells. The targeted drug erlotinib (Tarceva)
blocks chemicals that signal cancer cells to grow and divide. Erlotinib is usually combined with chemotherapy for use in
people with advanced pancreatic cancer.
Other targeted drug treatments are under investigation in clinical trials.
Clinical trials
Clinical trials are studies to test new forms of treatment, such as new drugs, new approaches to surgery or radiation
treatments, and novel methods such as gene therapy. If the treatment being studied proves to be safer or more effective than
are current treatments, it can become the new standard of care.
Clinical trials can't guarantee a cure, and they may have serious or unexpected side effects. On the other hand, cancer clinical
trials are closely monitored by the federal government to ensure they're conducted as safely as possible. And they offer access
to treatments that wouldn't otherwise be available to you.
Talk to your doctor about what clinical trials might be appropriate for you.
New treatments currently under investigation in clinical trials include:
-Drugs that stop cancer from growing new blood vessels.

Targeted drug treatments that work by stopping cancer from growing new blood vessels are called angiogenesis inhibitors.
Without new blood vessels, cancer cells may be unable to get the nutrients they need to grow. Blood vessels also give cancer
cells a pathway to spread to other parts of the body.
Pancreatic cancer vaccines.

Cancer vaccines are being studied to treat cancer, rather than prevent disease, as vaccines are traditionally used. Cancer
treatment vaccines use various strategies to enhance the immune system to help it recognize cancer cells as intruders. In one
example, a vaccine may help train the immune system to attack a certain protein secreted by pancreatic cancer cells. Studies of
pancreatic cancer vaccines are still in the very early stages.
PREVENTION:
Although there's no proven way to prevent pancreatic cancer, you can take steps to reduce your risk, including:
Quit smoking.
If you smoke, quit. Talk to your doctor about strategies to help you stop, including support groups, medications and nicotine
replacement therapy. If you don't smoke, don't start.

If you currently have a healthy weight, work to maintain it. If you need to lose weight, aim for a slow, steady weight loss — 1
or 2 pounds (0.5 or 1 kilogram) a week. Combine daily exercise with a diet rich in vegetables, fruit and whole grains with
smaller portions to help you lose weight.
Exercise most days of the week.

Aim for 30 minutes of exercise on most days. If you're not used to exercising, start out slowly and work up to your goal.
Choose a healthy diet.

A diet full of colorful fruits and vegetables and whole grains may help reduce your risk of cancer.
THANK YOU SO MUCH, TMDC

keep safe......‫مشاهدة المزيد‬

BROKEN RIBS
A broken rib, or fractured rib, is a common injury that occurs when one of the bones in your rib cage breaks or cracks. The
most common cause of broken ribs is trauma to the chest, such as from a fall, motor vehicle accident or impact during contact
sports.
Many broken ribs are merely cracked. While still painful, cracked ri...bs aren't as potentially dangerous as ribs that have been
broken into two or more pieces. In these situations, a jagged piece of bone could damage major blood vessels or internal
organs.
In most cases, broken ribs usually heal on their own in one or two months. Adequate pain control is important, so you can
continue to breathe deeply and avoid lung complications, such as pneumonia.
CAUSES:
Broken ribs can be caused by direct impact or repetitive trauma.
-Direct impact
-Motor vehicle accidents

-Falls
-Child abuse
-Contact sports
Repetitive trauma
-Sports such as baseball, basketball, golf or rowing

-Severe and prolonged coughing spells
SYMPTOMS:
Symptoms of a broken rib may include:
-Pain when you take a deep breath

-Pain that gets worse when you press on the injured area, or when you bend or twist your body

See your doctor if you have a very tender spot in your rib area that occurs after trauma or is present with deep breaths or
hinders your breathing.
If you experience pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes, pain
that extends beyond your chest to your shoulder or arm, and increasing episodes of chest pain, get medical attention
immediately. These symptoms may indicate a heart attack.
RISK FACTORS:
The following factors can increase your risk of breaking a rib:
-Osteoporosis.
Having osteoporosis, a disease in which your bones lose their density, makes you more susceptible to a bone fracture.
-Sports participation.
Participating in contact sports, such as hockey or football, increases your risk of trauma to your chest, which can result in a
rib fracture.
-Cancerous lesion in a rib.
A cancerous lesion can weaken the bone, making it more susceptible to breaks.
COMPLICATIONS:
Broken ribs that are in more than one piece, as opposed to just being cracked, can injure blood vessels and internal organs.
The risk increases with the number of broken ribs. Complications vary depending on which ribs have been broken. To aid in
identification, ribs are numbered sequentially from the top down.
-Upper ribs
It takes more force to break any of your first three ribs, because they're protected by your collarbone and shoulder blades.
But if one of these upper ribs is broken, a jagged edge can pierce a major blood vessel, such as the aorta.
-Middle ribs
Your middle ribs are the most likely to be broken by blunt trauma. The broken ends of these ribs can cause bleeding or
puncture your lung and cause it to collapse.
-Lower ribs
Your bottom two ribs are less likely to break, because they aren't attached to your breastbone (sternum) and this makes them
more flexible. But if any of your lower ribs do break, the broken ends can cause serious damage to your spleen, liver or
kidneys.
DIAGNOSIS:
A. X-ray
Using low levels of radiation, X-rays are a good tool to visualize bone. But X-rays often have problems revealing fresh rib
fractures, especially if the bone is merely cracked. X-rays are also useful in diagnosing a collapsed lung.
B. Computerized tomography (CT)

CT scans can often uncover rib fractures that X-rays might miss. Injuries to soft tissues and blood vessels are also easier to see
on CT scans. This technology takes X-rays from a variety of angles and combines them to depict cross-sectional slices of your
body's internal structures. The test is painless and usually takes less than 20 minutes.
C. Bone scan
This technique is good for viewing stress fractures, where a bone is cracked after repetitive trauma — such as long bouts of
coughing. During a bone scan, a small amount of radioactive material is injected into your bloodstream. It collects in the
bones, particularly in places where a bone is healing, and is detected by a scanner.
TREATMENT AND DRUGS:

Medications
It's important to obtain adequate pain relief because if it hurts too much to breathe deeply, you may develop pneumonia.
-Over-the-counter drugs.
Acetaminophen (Tylenol, others) and nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen (Advil, Motrin,
others) and naproxen (Aleve) — may help relieve discomfort as you wait for the fracture to heal.
-Other pain medications.
If NSAIDs or acetaminophen don't work well enough, your doctor may prescribe stronger pain medications.
-Nerve blocks.
If the pain is severe, your doctor may suggest injections of long-lasting anesthesia around the nerves that supply the ribs.
Therapy
In the past, doctors would use compression wraps — elastic bandages that you can wrap around your chest — to help "splint"
and immobilize the area. Compression wraps aren't recommended for broken ribs anymore because they can keep you from
taking deep breaths, which can increase the risk of pneumonia.
PREVENTION:
Protect yourself from athletic injuries.
Wear protective equipment when playing contact sports.
Take steps to decrease your risk of household falls.

Remove clutter from your floors and clean spills promptly, use a rubber mat in the shower, keep your home well lit, and put
skid-proof backing on carpets and area rugs.
Decrease your chance of getting osteoporosis.

Getting enough calcium in your diet is important for maintaining strong bones. Aim for about 1,200 milligrams of calcium
daily from food and supplements.
until next time. keep safe‫مشاهدة المزيد‬
Medical Profession, wow I Love it.
Here is a simple mnemonics for delirium: DELIRIUM(S)
D Drugs, Drugs, Drugs

E Eyes, ears
L Low O2 (MI, ARDS, PE, CHF, COPD) **
...I InfectionR Retention (of urine or stool), RestraintsI Ictal
U Underhydration/Undernutrition
M Metabolic
(S) Subdural, Sleep deprivation
Delirium is one of the most hidden and deadly enemy in ICU. It increases mortality, it cost money and its hard to recognise.
**"Low O2 states" does NOT necessarily mean hypoxia, rather it is a reminder that patients with a hypoxic insult (e.g. Ml,
stroke, PE) may present with mental status changes with or without other typical symptoms/signs of these diagnoses.‫مشاهدة‬
‫المزيد‬

ACL KNEE INJURY (anterior cruciate ligament injury)
An ACL injury is the tearing of the anterior cruciate ligament in your knee. An ACL injury may make your knee feel unstable
or loose, and your knee may "give way" if you return to your sport too quickly.
Although an active lifestyle benefits your overall health, exercise isn't always e...asy on your knees.
The anterior cruciate ligament is especially susceptible to the demands of certain sports, such as volleyball, gymnastics,
basketball, soccer and football.
Treatment of an ACL injury may include surgery to replace the torn ligament, along with an intense rehabilitation program.
As for prevention, if your favorite sport involves pivoting or jumping, a proper training program can help you avoid an ACL
injury.
CAUSES:
Ligaments are strong bands of tissue that attach one bone to another. The ACL, one of two ligaments that cross in the middle
of the knee, connects your thighbone (femur) to your shinbone (tibia) and helps stabilize your knee joint.
Most ACL injuries happen during sports and fitness activities. The ligament may tear when you slow down suddenly to
change direction or pivot with your foot firmly planted, twisting or overextending your knee.
Sports that involve running, turning sharply, pivoting and jumping — especially basketball, soccer and gymnastics — put
your knee at risk. The ACL can also tear when the tibia is pushed forward below the femur, such as during a fall in downhill
skiing. A football tackle or motor vehicle accident also can cause an ACL injury. However, most ACL injuries occur without
such contact.
SYMPTOMS:
At the time of an ACL injury, signs and symptoms may include:
-A loud "pop" sound

-Severe pain
-Knee swelling that usually worsens for hours after the injury occurs
-A feeling of instability or "giving way" with weight bearing
Once the swelling subsides, your knee may still feel unstable. It may feel as if it's going to "give way" during twisting or
pivoting movements.

If you experience any of the signs and symptoms of ACL injury — a popping sound, severe knee pain, a swollen knee or a
feeling that your knee is giving out — see a doctor. Also see your doctor if your knee feels loose or unable to support your
weight. In general, the longer you wait to start treatment, the longer it will take to get better.
RISK FACTORS:
ACL injuries are most common among:
1. Athletes.
If you engage in certain sports, such as those that rely on cut-and-run techniques (basketball, soccer, football) you're more at
risk of an ACL injury.
2. Women.
Women are significantly more likely to have an ACL tear than are men participating in the same sports. Women tend to have
imbalanced thigh muscles, with stronger muscles at the front of the thigh (quadriceps), compared with those at the back of the
thigh (hamstrings). The hamstrings help protect the shinbone from sliding too far forward. When landing from a jump, some
women may land in a position that increases stress on the ACL.
COMPLICATIONS:
In the short term, you'll have to stop doing the activities that cause pain until your injured ligament has healed. You may have
to take time off work, school and sports.
Other complications may include:
Torn meniscus. (my injury in badminton)

In many cases, an ACL injury also results in a tear of the meniscus — the cartilage in your knee between the thighbone and
shinbone. A cartilage tear increases the risk of future joint problems.
Arthritis. (common for me)

A common long-term complication is the early onset of knee osteoarthritis, in which joint cartilage deteriorates and its smooth
surface roughens. About half the people with an ACL tear develop osteoarthritis in the involved joint 10 to 20 years later.
Arthritis may occur even if you have surgery to reconstruct the ligament.
TEST AND DIAGNOSIS:

To diagnose a torn ACL, your doctor first wants to know as much as possible about the injury, such as whether you heard or
felt your knee pop, whether your knee swelled up afterward and if you were able to continue being physically active.
Swelling that occurs shortly after the injury usually means there's blood in the joint from torn blood vessels in the damaged
ligament. Your doctor may decide to draw the blood out with a needle and syringe. This can reduce pain and make it easier to
examine the knee joint.
Your doctor examines your knee in a variety of positions to assess whether or not your ACL is torn. Two common exams are:
Lachman's test.
In this test you lie on your back on the exam table with your injured leg bent at a 30-degree angle and your foot flat on the
table. Your doctor then moves the lower portion of your injured leg forward from the knee. If your leg moves freely without
reaching a firm endpoint, you have a tear in your ACL.
Pivot shift test.

For this test, your injured leg is extended, and your doctor rotates your foot at the same time he or she applies pressure to the
outside of your knee and bends your knee. Signs of instability in your shinbone suggest an ACL tear.
Often the diagnosis can be made on the basis of the physical exam alone, but you may need X-rays to rule out a bone fracture.
If your doctor has questions about the cause or extent of your injury, he or she may order a magnetic resonance imaging
(MRI) scan, a painless procedure that uses magnetic fields to create an image of the soft tissues of your body. An MRI can
show the extent of ACL injury and whether other knee ligaments or joint cartilage also are injured.
TREATMENT:
Initial treatment for an ACL injury aims to reduce pain and swelling in your knee, regain normal joint movement and
strengthen the muscles around your knee. You and your doctor will then decide if you need surgery plus rehabilitation or
intense rehabilitation alone.
Which option is right for you depends on several factors, including the extent of damage to your knee and your willingness to
modify your activities. When a young child whose bones are still growing injures his or her ACL, doctors may recommend
postponing surgery until the child's bones have stopped growing.
Short term
To treat the acute injury:
-Use ice. When you're awake, try to ice your knee at least every two hours for 20 minutes at a time.
-Elevate your knee.
-Take pain relievers such as ibuprofen (Advil, Motrin, others) as needed.
-Wrap an elastic bandage around your knee.
-Use a splint or walk with crutches if needed.
-Work with a physical therapist on range-of-motion and muscle-strengthening exercises.
Surgery
A torn ACL can't be sewn back together. The ligament is reconstructed by taking a piece of tendon from another part of your
leg and connecting it to the thighbone and shinbone (autograft). If your own tendons don't provide the best replacement for
the injured ligament, your doctor may recommend using a tendon from a cadaver (allograft). The cadavers used for allografts
have been carefully screened and tested for diseases.
You may consider surgery if:
-Your knee is unstable and gives way during daily activities or sports
-You're very active and want to resume heavy work, sports or other recreational activities
-Other parts of your knee, such as the meniscus or other ligaments, were also injured
-You want to prevent further injury to your knee
ACL reconstruction surgery is an outpatient procedure using arthroscopic techniques. The surgeon inserts a thin instrument
(arthroscope) with a light and a small camera into one or two small incisions. This allows your surgeon to see the inside of
your knee joint and make the repairs.
After surgery you'll go through a rehabilitation program. In addition to working with a physical therapist, you may wear a
knee brace and you'll need to avoid activities that put undue stress on your knee. Most people can return to their sports about
six months after surgery. About nine in 10 people who undergo ACL reconstruction report good to excellent results and
satisfactory knee stability, according to the American Academy of Orthopaedic Surgeons.
Nonsurgical rehabilitation
A rehabilitation program without surgery involves physical therapy, modifying your activities and knee bracing. This
approach can be effective as long as you're willing to give up the sports and other activities that place extra stress on your
knee. You may want to consider rehabilitation alone if:
-You have a partial tear

-You don't participate in sports that involve cutting, pivoting or jumping
-Your knee isn't painful or unstable during normal activities
-You lead a fairly sedentary life
-Your knee cartilage hasn't been damagedYou have advanced knee arthritis
PREVENTION:
To reduce your chance of an ACL injury, follow these tips:
1. Improve your conditioning.

Training programs that have been shown to be effective in helping to prevent ACL injuries typically include stretching and
strengthening exercises, aerobic conditioning, plyometric exercises, "jump training" and risk-awareness training. Exercises
that improve balance also can help when done in conjunction with other training exercises.
2. Strengthen your hamstrings (women).
Women athletes should take care to strengthen and stretch their hamstring muscles as well as their quadriceps.
3. Keep fit year-round.
If you're on a seasonal sports team, stay conditioned all year. This will help with your balance, strength and coordination
when the next season starts.Use proper techniques when playing sports or exercising. If your sport involves jumping, learn
how to land safely. Learn to do cutting maneuvers in a crouched posture with a slight bend at the knee and hip.
4. Check your gear.
In downhill skiing, make sure your ski bindings are adjusted correctly by a trained professional so that your skis will release
when you fall.
Using a knee brace during sports doesn't reduce your risk of injury - and may provide a false sense of security.
until next time, keep safe‫مشاهدة المزيد‬

DISLOCATED SHOULDER
Your shoulders are your body's most mobile joints. But the ability to move in many directions can leave your shoulders prone
to injury.
A dislocated shoulder is an injury in which your upper arm bone pops out of the cup-shaped socket that's part of your
shoulder blade. A dislocated shoulder is a more extensive injury... than a separated shoulder, which involves damage to
ligaments of the joint where the top of your shoulder blade meets the end of your collarbone.
If you suspect a dislocated shoulder, seek prompt medical attention. Most people regain full shoulder function within a few
weeks after experiencing a dislocated shoulder. However, once you've had a dislocated shoulder your joint may become
unstable and be prone to repeat dislocations.
CAUSES:
The shoulder joint is the most frequently dislocated joint of the body. Because it can move in many directions, your shoulder
can dislocate forward, backward or downward, completely or partially. In addition, fibrous tissue that joins the bones of your
shoulder (ligaments) can be stretched or torn, often complicating the dislocation.
When your shoulder dislocates, a strong force, such as a sudden blow to your shoulder, pulls the bones in your shoulder out of
place (dislocation). Extreme rotation of your shoulder joint can pop the ball of your upper arm bone (humerus) out of your
shoulder socket (glenoid), which is part of your shoulder blade (scapula). Partial dislocation (subluxation) — in which your
upper arm bone is partially in and partially out of your shoulder socket — also may occur.
A dislocated shoulder may be caused by:
1. Sports injuries.
Shoulder dislocation is a common injury in contact sports, such as football and hockey, and in sports that may involve falls,
such as downhill skiing, gymnastics and volleyball.
2. Trauma not related to sports.
A hard blow to your shoulder during a motor vehicle accident is a common source of dislocation.
3. Falls.
You may dislocate your shoulder during a fall, such as from a ladder or from tripping on a loose rug.
SYMPTOMS:
-Dislocated shoulder signs and symptoms may include:
-A visibly deformed or out of place shoulder

-Swelling or discoloration (bruising)
-Intense pain
-Inability to move the joint
Shoulder dislocation may also cause numbness, weakness or tingling near the injury, such as in your neck or down your arm.
The muscles in your shoulder may spasm from the disruption, often increasing the intensity of your pain.

It can be difficult to tell a broken bone from a dislocated bone. If you or your child appears to have a dislocated shoulder, get
medical help right away.
While you're waiting for medical attention:
*Don't move the joint.

Splint or sling the shoulder joint in its current position. Don't try to move the shoulder or force it back into place. This can
damage the shoulder joint and its surrounding muscles, ligaments, nerves or blood vessels.
*Ice the injured joint.

Applying ice to your shoulder can help reduce pain and swelling by controlling internal bleeding and the buildup of fluids in
and around your shoulder joint.
RISK FACTORS:
Dislocated shoulders are most common in people between the ages of 18 and 25 because these people tend to have a high level
of physical activity. Older adults (26 and above) also are more susceptible to shoulder dislocation because their joints and
surrounding ligaments are weaker. In addition, older people tend to fall more frequently, which can increase their risk of a
dislocated shoulder.
COMPLICATIONS:
-Complications of a dislocated shoulder may include:
-Tearing of the muscles, ligaments and tendons that reinforce your shoulder joint
-Nerve or blood vessel damage in or around your shoulder joint
-Susceptibility to re-injury (shoulder instability) if you have a severe dislocation or repeated dislocations
If ligaments or tendons in your shoulder have been stretched or torn, or if nerves or blood vessels surrounding your shoulder
joint have been damaged, you may need surgery to repair these tissues.
TEST AND DIAGNOSIS:

Besides physically examining your shoulder, your doctor may order the following tests:
1. X-ray.
An X-ray of your shoulder joint will show the dislocation and may reveal broken bones or other damage to your shoulder
joint.
2. MRI.
Magnetic resonance imaging (MRI) uses a magnetic field to create cross-sectional images of the body. These images help your
doctor assess damage to the soft tissue structures around your shoulder joint.
3. Electromyography (EMG).
An EMG is a procedure that measures the electrical discharges produced in your muscles. An instrument records the
electrical activity in your muscle at rest and as you contract the muscle. Analyzing the electrical signals may help your doctor
evaluate nerve damage caused by severe or repeated shoulder dislocation.

Dislocated shoulder treatment involves putting your shoulder bones back into place. Your doctor may try some gentle
maneuvers to help your shoulder bones back into their proper positions — a process called closed reduction. Depending on the
amount of pain and swelling, you may need a muscle relaxant or sedative or, rarely, a general anesthetic before manipulation
of your shoulder bones.
When your shoulder bones are back in place, any severe pain should improve almost immediately. However, your doctor may
immobilize your shoulder with a special splint or sling for several weeks. How long you wear the splint or sling depends on the
nature of your shoulder dislocation. Your doctor may also prescribe a pain reliever or a muscle relaxant to keep you
comfortable while your shoulder heals.
Regaining your strength

After your shoulder splint or sling is removed, you'll begin a gradual rehabilitation program designed to restore range of
motion and strength to your shoulder joint. Avoid strenuous activity involving your injured shoulder until you've regained full
movement and normal strength and stability in your shoulder.
If you've experienced a fairly simple shoulder dislocation without major nerve or tissue damage, your shoulder joint likely will
return to a near-normal or fully normal condition. But trying to resume activity too soon after shoulder dislocation may cause
you to injure your shoulder joint or to dislocate it again.
Surgery
If your doctor can't move your dislocated shoulder bones back into position by closed reduction, surgical manipulation (open
reduction) may be necessary. You may need surgery if you have a weak shoulder joint or ligaments and tend to have recurring
shoulder dislocations (shoulder instability). In rare cases, you may need surgery if your nerves or blood vessels are damaged
due to the dislocation.
HOME REMEDIES:
Try these steps to help ease discomfort and encourage healing after being treated for a dislocated shoulder:
1.Rest your shoulder.

Don't repeat the specific action that caused your shoulder to dislocate, and try to avoid painful movements. Limit heavy lifting
or overhead activity until your shoulder starts to feel better.
2. Apply ice and heat.

Putting ice on your shoulder helps reduce inflammation and pain. Use a cold pack, a bag of frozen vegetables or a towel filled
with ice cubes for 15 to 20 minutes at a time. Do this every couple of hours the first day or two. After about two or three days,
when the pain and inflammation have improved, hot packs or a heating pad may help relax tightened and sore muscles. Limit
heat applications to 20 minutes.
3. Take pain relievers.

Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others)
or naproxen (Aleve), may help reduce pain. Acetaminophen (Tylenol, others) also may help relieve pain. Follow label
directions and stop taking the drugs when the pain improves.
4. Maintain the range of motion of your shoulder.

After one or two days, do some gentle exercises as directed by your doctor or physical therapist to help maintain your
shoulder's range of motion. Total inactivity can cause stiff joints. In addition, favoring your shoulder for a long period of time
can lead to frozen shoulder, a condition in which your shoulder becomes so stiff you can barely move it.
Once your injury heals and you have good range of motion in your shoulder, continue exercising. Daily shoulder stretches and
a balanced shoulder-strengthening program can help prevent a recurrence of dislocation. Your doctor or a physical therapist
can help you plan an appropriate exercise routine.
PREVENTION:
To help prevent a dislocated shoulder:
-Take precautions to avoid falls

-Wear protective gear when you play contact sports
-Exercise regularly to maintain strength and flexibility in your joints and muscles
Once you've dislocated your shoulder joint, you may be more susceptible to future shoulder dislocations. To avoid a
recurrence, follow the specific strength and stability exercises that you and your doctor have discussed for your injury.

HIV/AIDS
AIDS is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging
your immune system, HIV interferes with your body's ability to fight the organisms that cause disease.
HIV is a sexually transmitted disease. It can also be spread by contact with infected blood, or from mothe...r to child during
pregnancy, childbirth or breast-feeding. It can take years before HIV weakens your immune system to the point that you have
AIDS.
There's no cure for HIV/AIDS, but there are medications that can dramatically slow the progression of the disease. These
drugs have reduced AIDS deaths in many developed nations. But HIV continues to decimate populations in Africa, Haiti and
parts of Asia.
CAUSES:
Scientists believe a virus similar to HIV first occurred in some populations of chimps and monkeys in Africa, where they're
hunted for food. Contact with an infected monkey's blood during butchering or cooking may have allowed the virus to cross
into humans and become HIV.
How does HIV become AIDS?

HIV destroys CD4 cells — a specific type of white blood cell that plays a large role in helping your body fight disease. Your
immune system weakens as more CD4 cells are killed. You can have an HIV infection for years before it progresses to AIDS.
To be diagnosed with AIDS, you must have a CD4 count under 200 or experience an AIDS-defining complication, such as:
-Pneumocystis jiroveci pneumonia

-Cytomegalovirus
-Tuberculosis
-Toxoplasmosis
-Cryptosporidiosis
How HIV is transmitted

To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. You can't become infected
through ordinary contact — hugging, kissing, dancing or shaking hands — with someone who has HIV or AIDS. HIV can't be
transmitted through the air, water or via insect bites.
You can become infected with HIV in several ways, including:
During sex.
You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal
secretions enter your body. The virus can enter your body through mouth sores or small tears that sometimes develop in the
rectum or vagina during sexual activity.
Blood transfusions.
In some cases, the virus may be transmitted through blood transfusions. American hospitals and blood banks now screen the
blood supply for HIV antibodies, so this risk is very small.
Sharing needles.
HIV can be transmitted through needles and syringes contaminated with infected blood. Sharing intravenous drug
paraphernalia puts you at high risk of HIV and other infectious diseases such as hepatitis.
From mother to child.

Infected mothers can infect their babies during pregnancy or delivery, or through breast-feeding. But if women receive
treatment for HIV infection during pregnancy, the risk to their babies is significantly reduced.
SYMPTOMS:
The symptoms of HIV and AIDS vary, depending on the phase of infection.
Within the first few weeks

When first infected with HIV, you may have no signs or symptoms at all, although you're still able to transmit the virus to
others. Many people develop a brief flu-like illness two to four weeks after becoming infected. Signs and symptoms may
include:
-Fever
-Headache
-Sore throat
-Swollen lymph glands
-Rash
Years later
You may remain symptom-free for years. But as the virus continues to multiply and destroy immune cells, you may develop
mild infections or chronic symptoms such as:
-Swollen lymph nodes — often one of the first signs of HIV infection
-Diarrhea
-Weight loss
-Fever
-Cough and shortness of breath
Progression to AIDS
If you receive no treatment for your HIV infection, the disease typically progresses to AIDS in about 10 years. By the time
AIDS develops, your immune system has been severely damaged, making you susceptible to opportunistic infections —
diseases that wouldn't trouble a person with a healthy immune system. The signs and symptoms of some of these infections
may include:
-Soaking night sweats

-Shaking chills or fever higher than 100 F (38 C) for several weeks
-Cough and shortness of breath
-Chronic diarrhea
-Persistent white spots or unusual lesions on your tongue or in your mouth
-Headaches
-Persistent, unexplained fatigue
-Blurred and distorted vision
-Weight loss
-Skin rashes or bumps

If you think you may have been infected with HIV or are at risk of contracting the virus, seek medical counseling as soon as
possible.
RISK FACTORS:
When HIV/AIDS first surfaced in the United States, it predominantly affected homosexual men. The type of HIV found in
many African nations is more easily spread through heterosexual sex. Anyone of any age, race, sex or sexual orientation can be
infected, but you're at greatest risk of HIV/AIDS if you:
1. Have unprotected sex.

Unprotected sex means having sex without using a new latex or polyurethane condom every time. Anal sex is more risky than
is vaginal sex. The risk increases if you have multiple sexual partners.
2. Have another STD.
Many sexually transmitted diseases (STDs) produce open sores on your genitals. These sores act as doorways for HIV to enter
your body.
3. Use intravenous drugs.
People who use intravenous drugs often share needles and syringes. This exposes them to droplets of other people's blood.
4. Are an uncircumcised man.
Studies indicate that lack of circumcision increases the risk for heterosexual transmission of HIV.
COMPLICATIONS:
HIV infection weakens your immune system, making you highly susceptible to all sorts of infections and certain types of
cancers.
Infections common to HIV/AIDS:
1. Tuberculosis (TB).
In resource-poor nations, TB is the most common opportunistic infection associated with HIV and a leading cause of death
among people living with AIDS. Millions of people are currently infected with both HIV and tuberculosis, and many experts
consider the two diseases twin epidemics.
2. Salmonellosis.
You contract this bacterial infection from contaminated food or water. Symptoms include severe diarrhea, fever, chills,
abdominal pain and, occasionally, vomiting. Although anyone exposed to salmonella bacteria can become sick, salmonellosis is
far more common in people who are HIV-positive.
3. Cytomegalovirus (CMV).
This common herpes virus is transmitted in body fluids such as saliva, blood, urine, semen and breast milk. A healthy immune
system inactivates the virus, and it remains dormant in your body. If your immune system weakens, the virus resurfaces —
causing damage to your eyes, digestive tract, lungs or other organs.
4. Candidiasis.
Candidiasis is a common HIV-related infection. It causes inflammation and a thick white coating on the mucous membranes of
your mouth, tongue, esophagus or vagina. Children may have especially severe symptoms in the mouth or esophagus, which
can make eating painful and difficult.
5. Cryptococcal meningitis.
Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). Cryptococcal
meningitis is a common central nervous system infection associated with HIV, caused by a fungus that is present in soil. It may
also be associated with bird or bat droppings.
6. Toxoplasmosis.
This potentially deadly infection is caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass the
parasites in their stools, and the parasites may then spread to other animals.
7. Cryptosporidiosis.
This infection is caused by an intestinal parasite that's commonly found in animals. You contract cryptosporidiosis when you
ingest contaminated food or water. The parasite grows in your intestines and bile ducts, leading to severe, chronic diarrhea in
people with AIDS.
Cancers common to HIV/AIDS
1. Kaposi's sarcoma.
Kaposi's sarcoma is a tumor of the blood vessel walls. Although rare in people not infected with HIV, it's common in HIV-
positive people. Kaposi's sarcoma usually appears as pink, red or purple lesions on the skin and mouth. In people with darker
skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect the internal organs, including the digestive
tract and lungs.
2. Lymphomas.
This type of cancer originates in your white blood cells. Lymphomas usually begin in your lymph nodes. The most common
early sign is painless swelling of the lymph nodes in your neck, armpit or groin.
Other complications
1. Wasting syndrome.
Aggressive treatment regimens have reduced the number of cases of wasting syndrome, but it does still affect many people
with AIDS. It is defined as a loss of at least 10 percent of body weight and is often accompanied by diarrhea, chronic weakness
and fever.
2. Neurological complications.
Although AIDS doesn't appear to infect the nerve cells, it can still cause neurological symptoms such as confusion,
forgetfulness, depression, anxiety and trouble walking. One of the most common neurological complications is AIDS dementia
complex, which leads to behavioral changes and diminished mental functioning.
TEST AND DIAGNOSIS:

HIV is most commonly diagnosed by testing your blood or saliva for the presence of antibodies to the virus. Unfortunately,
these types of HIV tests aren't accurate immediately after infection because it takes time for your body to develop these
antibodies — usually up to 12 weeks. In rare cases, it can take up to six months for an HIV antibody test to become positive.
A newer type of test checks for HIV antigen, a protein produced by the virus immediately after infection. This test can confirm
a diagnosis within days of infection. An earlier diagnosis may prompt people to take extra precautions to prevent transmission
of the virus to others.
Tests to tailor treatment

If you receive a diagnosis of HIV/AIDS, several types of tests can help your doctor determine what stage of the disease you
have. These tests include:
CD4 count.
CD4 cells are a type of white blood cell that's specifically targeted and destroyed by HIV. A healthy person's CD4 count can
vary from 500 to more than 1,000. Even if a person has no symptoms, HIV infection progresses to AIDS when his or her CD4
count becomes less than 200.Viral load. This test measures the amount of virus in your blood. Studies have shown that people
with higher viral loads generally fare more poorly than do those with a lower viral load.
Drug resistance.
This type of test determines if your strain of HIV is resistant to any anti-HIV medications.Tests for complicationsYour doctor
might also order lab tests to check for other infections or complications, including:
-Tuberculosis
-Hepatitis
-Toxoplasmosis
-Sexually transmitted diseases
-Liver or kidney damage
-Urinary tract infections

There is no cure for HIV/AIDS, but a variety of drugs can be used in combination to control the virus. Each of the classes of
anti-HIV drugs blocks the virus in different ways. It's best to combine at least three drugs from two different classes to avoid
creating strains of HIV that are immune to single drugs. The classes of anti-HIV drugs include:
A. Non-nucleoside reverse transcriptase inhibitors (NNRTIs).

NNRTIs disable a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence)
and nevirapine (Viramune).
B. Nucleoside reverse transcriptase inhibitors (NRTIs).

NRTIs are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and
the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir).
C. Protease inhibitors (PIs).

PIs disable protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz),
darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir).
D. Entry or fusion inhibitors.

These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).
E. Integrase inhibitors.
Raltegravir (Isentress) works by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells.
When to start treatment

Current guidelines indicate that treatment should begin if:
-You have severe symptoms

-Your CD4 count is under 500You're pregnant
-You have HIV-related kidney disease
-You're being treated for hepatitis B
Treatment can be difficult

HIV treatment regimens may involve taking multiple pills at specific times every day for the rest of your life. Side effects can
include:
-Nausea, vomiting or diarrhea

-Abnormal heartbeats
-Shortness of breath
-Skin rash
-Weakened bones
-Bone death, particularly in the hip joints
Treatment response
Your response to any treatment is measured by your viral load and CD4 counts. Viral load should be tested at the start of
treatment and then every three to four months while you're undergoing therapy. CD4 counts should be checked every three to
six months.
HIV treatment should reduce your viral load to the point that it's undetectable. That doesn't mean your HIV is gone. It just
means that the test is not sensitive enough to detect it. You can still transmit HIV to others when your viral load is
undetectable.

Although it's important to receive medical treatment for HIV/AIDS, it's also essential to take an active role in your own care.
The following suggestions may help you stay healthy longer:
Eat healthy foods.

Emphasize fresh fruits and vegetables, whole grains and lean protein. Healthy foods help keep you strong, give you more
energy and support your immune system.
Avoid certain foods.

Food-borne illnesses can be especially severe in people who are infected with HIV. Avoid unpasteurized dairy products, raw
eggs and raw seafood such as oysters, sushi or sashimi. Cook meat until it's well-done or until there's no trace of pink color.
Get immunizations.
These may prevent infections such as pneumonia and the flu. Make sure the vaccines don't contain live viruses, which can be
dangerous for people with weakened immune systems.
Take care with companion animals.

Some animals may carry parasites that can cause infections in people who are HIV-positive. Cat feces can cause
toxoplasmosis, while pet reptiles can carry salmonella.
PREVENTIONS:
There's no vaccine to prevent HIV infection and no cure for AIDS. But it's possible to protect yourself and others from
infection. That means educating yourself about HIV and avoiding any behavior that allows HIV-infected fluids — blood,
semen, vaginal secretions and breast milk — into your body.
To help prevent the spread of HIV, you should:
A. Use a new condom every time you have sex.

Condoms, condoms, condoms...If you don't know the HIV status of your partner, use a new condom every time you have anal
or vaginal sex. Women can use a female condom. Use only water-based lubricants. Oil-based lubricants can weaken condoms
and cause them to break. During oral sex use a condom, dental dam &madsh; a piece of medical-grade latex — or plastic
wrap.
B. Use a clean needle.

If you use a needle to inject drugs, make sure it's sterile and don't share it. Take advantage of needle-exchange programs in
your community and consider seeking help for your drug use.
C. Tell your sexual partners if you have HIV.

It's important to tell anyone with whom you've had sex that you're HIV-positive. Your partners need to be tested and to
receive medical care if they have the virus. They also need to know their HIV status so that they don't infect others.
D. If you're pregnant, get medical care right away.

If you're HIV-positive, you may pass the infection to your baby. But if you receive treatment during pregnancy, you can cut
your baby's risk by as much as two-thirds.
FROM THE CONTRIBUTOR'S POINT OF VIEW...

Receiving a diagnosis of any life-threatening illness is devastating. But the emotional, social and financial consequences of
HIV/AIDS can make coping with this illness especially difficult — not only for you but also for those closest to you.
Fortunately, a wide range of services and resources are available to people with HIV. Most HIV/AIDS clinics have social
workers, counselors or nurses who can help you with problems directly or put you in touch with people who can. They can
arrange for transportation to and from doctor appointments, help with housing and child care, deal with employment and
legal issues, and see you through financial emergencies.
Coming to terms with your illness may be the hardest thing you've ever done. For some people, having a strong faith or a sense
of something greater than themselves makes this process easier. Others seek counseling from someone who understands
HIV/AIDS. Still others make a conscious decision to experience their lives as fully and intensely as they can or to help other
people who have the disease.
until next time. keep safe‫مشاهدة المزيد‬
HERNIATED DISK
When you experience back pain that shoots down your leg, everyday activities become
difficult or even intolerable. One cause of back pain is a herniated disk, sometimes called
a slipped disk or a ruptured disk.
Your spine is made up of bones (vertebrae) cushioned by small oval pads of cartilage or
disks consisting of a tough outer layer (annulus) and a soft inner layer (nucleus).
When a herniated disk occurs, a small portion of the nucleus pushes out through a tear in
the annulus into the spinal canal. This can irritate a nerve and result in pain, numbness or
weakness in your back as well as your leg or arm.
A herniated disk generally gets better with conservative treatment. Surgery for a
herniated disk usually isn't necessary.
CAUSES:
Your spinal column is made up of bones (vertebrae) cushioned by small oval pads of
cartilage or disks consisting of a tough outer layer (annulus) and a soft, jelly-like inner
layer (nucleus). These disks act as springs, absorbing shock and allowing bending
movements of your spine. They assist your spinal muscles in protecting your spine from
the stress of everyday tasks and heavy lifting.
When a herniated disk occurs, a small portion of the nucleus pushes out through a tear in
the annulus into the spinal canal. This situation can cause irritation of one of the spinal
nerves.
Disk herniation is most often the result of a gradual, aging-related wear and tear called
degeneration of the disks. As you age, your spinal disks lose some of their water content.
That makes them less flexible and more prone to tearing or rupturing with even a minor
strain or twist.
Most people can't pinpoint the exact cause of their herniated disk. Sometimes, using your
back muscles instead of your leg and thigh muscles to lift large, heavy objects can lead to
a herniated disk, as can twisting and turning while lifting. Rarely, a traumatic event such
as a fall or a blow to the back can cause a herniated disk.
SYMPTOMS:
You can have a herniated disk without knowing it — herniated or bulging disks
sometimes show up on spinal images of people who have no symptoms of a disk
problem. But some herniated disks can be painful. The most common signs and
symptoms of a herniated disk are:
1. Sciatica — a radiating, aching pain, sometimes with tingling and numbness, that starts
in your buttock and extends down the back or side of one leg
2. Pain, numbness or weakness in your lower back and one leg, or in your neck, shoulder,
chest or arm
3. Low back pain or leg pain that worsens when you sit, cough or sneeze

If you experience back pain that is disabling for more than a week, call your doctor to be
evaluated. Back pain often interferes with your normal activities for a week to three
weeks. Usually the pain and disability improves significantly in four to six weeks. If
you're able to engage in limited activity but see no improvement in three weeks, then call
your doctor for an appointment. If the pain increases when you're sitting, coughing or
sneezing, a herniated disk might be the cause.
Seek prompt medical attention if:
-You lose control of your bladder or bowels

-Your pain increases rather than staying about the same or decreasing over time
-You develop numbness or weakness in one or both legs
A disk herniation or a spinal tumor may be compressing several nerve roots in your spine.
This compression, known as cauda equina syndrome, is rare but potentially disabling. It
may require emergency surgery.
RISK FACTORS:
Several factors make you more susceptible to a herniated disk:
1. Age.
Herniated disks are most common in middle age, especially between 35 and 45, due to
aging-related degeneration of the disks.
2. Smoking.
Smoking tobacco increases your risk of disk herniation because it decreases oxygen
levels in your blood, depriving your body tissues of vital nutrients.
3. Weight.
Excess body weight causes extra stress on the disks in your lower back.
4. Height.
Being tall increases your risk of disk herniation. Men taller than 5 feet 11 inches (180
centimeters) and women taller than 5 feet 7 inches (170 centimeters) appear to have a
greater risk of a herniated disk.
Occupations that strain your spine. People with physically demanding jobs have a greater
risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting
also may increase your risk of a herniated disk. Jobs that require prolonged sitting or
standing in one position also may increase your risk of disk herniation.
COMPLICATIONS:
While it can be painful, a herniated disk isn't typically a medical emergency. Rarely, disk
herniation can cause cauda equina syndrome, which is the compression of spinal nerve
roots. Relieving the pressure that causes cauda equina syndrome often requires
emergency surgery, because it can cause permanent weakness or paralysis if it's not
corrected. The following signs and symptoms, which suggest cauda equina syndrome,
warrant a trip to the emergency room:
-Significant or increasing pain, numbness or weakness spreading to one or both legs

-Bladder or bowel dysfunction, including incontinence or difficulty urinating even with a
full bladder
-Progressive loss of sensation in areas that would touch a saddle (inner thighs, back of
legs and area around the rectum)
TEST AND DIAGNOSIS:

To determine whether you have a herniated disk, your doctor reviews your medical
history and performs a physical examination, including these tests:
Straight-leg-raising test.
You lie flat and your doctor raises your symptomatic leg.
Cross straight-leg-raising test.

You lie flat and the doctor raises your unaffected leg.
Screening neurological examination.

Your doctor will perform this test if the leg-raising tests cause pain in your leg or back,
which may indicate a herniated disk. This thorough screening includes testing your
reflexes, muscle strength, walking ability and sensation. The doctor may include a test for
sensation in the area around the rectum, because this area can be affected by a herniated
disk.
Additional possible tests

In most cases of herniated disk, the physical exam is all that's needed to make a
diagnosis. If your doctor suspects another condition or needs to see which nerves are
affected, or if there is no symptom improvement after four weeks of conservative
treatment, one or more of these diagnostic tests may be performed:
1. Magnetic resonance imaging (MRI) scan.

A magnetic field is used to create images of your body. This test can be used to confirm
the location of the herniated disk and to see which nerves are affected.
2. Computerized tomography (CT) scan.
An X-ray unit creates cross-sectional images of your spinal column and the structures
around it.
3. Myelogram.
A dye is injected into the spinal fluid, and then X-rays are taken. This test can show
pressure on your spinal cord or nerves due to multiple herniated disks or other
conditions.X-rays. Plain X-rays don't detect herniated disks, but they may be performed
to rule out other causes of back pain, such as an infection, tumor or a broken bone.
TREATMENTS AND DRUGS:

Conservative treatment — mainly avoiding painful positions and following a planned
exercise and pain-medication regimen — relieves symptoms in nine out of 10 people
with a herniated disk, according to the American Academy of Orthopaedic Surgeons.
Many people get better in a month or two with conservative treatment. Imaging studies
show that the protruding or displaced portion of the disk shrinks over time, corresponding
to the improvement in symptoms. Depending on your symptoms, your doctor may
recommend:
Modified activity.
Take it easy when you have severe back pain. Try to stay away from activities that
aggravate your symptoms, such as improper reaching, bending and lifting, using a rowing
machine, and prolonged sitting. Intermittent activity to maintain fitness and minimize
stiffness is very important, so physical therapy and exercises to increase flexibility and
strength may be prescribed. A herniated disk isn't a fragile spine problem, so don't avoid
physical activity altogether. In fact, staying at work is best, even if you need to reduce
your workload or assume lighter duties. Work with your doctor or a physical therapist to
find the right combination of rest and activity. Eventually, your activity level can
gradually increase until you're comfortable with everyday tasks.
Physical therapy.
A physical therapist can apply heat, ice, traction, ultrasound and electrical stimulation for
pain relief. Physical therapists can also show you positions and exercises designed to
minimize the pain of a herniated disk. As the pain improves, physical therapy can
advance you to a rehabilitation program of core strength and stability to maximize your
back health and help protect against future injury.
Heat or cold.
Initially, cold packs can be used to relieve pain and inflammation. After a few days, you
may switch to gentle heat to give relief and comfort.
Pain medication.
If your pain is mild to moderate, your doctor may tell you to take an over-the-counter
pain medication, such as aspirin, ibuprofen (Advil, Motrin, others), acetaminophen
(Tylenol, others) or naproxen (Aleve, others). NSAIDs carry a risk of gastrointestinal
bleeding, and in large doses acetaminophen may damage the liver.
Muscle relaxants such as diazepam (Valium) or cyclobenzaprine (Flexeril) may also be

prescribed if you have back or limb spasms. Sedation and dizziness are common side
effects of these medications.
If your pain doesn't improve with these medications, your doctor may prescribe narcotics,
such as codeine or a hydrocodone-acetaminophen combination (Lortab, Vicodin) for a
short time. Sedation, nausea, confusion and constipation are possible side effects from
these drugs.
Neuropathic pain medications or "nerve pain" pills, such as gabapentin (Neurontin,
others) also have been prescribed for this type of pain. Alternatively, inflammation-
suppressing corticosteroids may be given by injection directly into the area around the
spinal nerves.
Bed rest.
Constant, severe back pain from a herniated disk sometimes requires one or two days on
bed rest. Strict bed rest for more than a day or two, however, can inhibit recovery by
causing loss of muscle tone.
Time.
Herniated disk symptoms generally take four to six weeks to significantly improve.

Standard conservative treatment for a herniated disk is to limit your activity, apply cold
and heat, and do careful exercises to build back your strength and flexibility. Specific
core-strengthening exercises are designed to condition your trunk muscles and stabilize
your spine. Your doctor may recommend exercises such as the bridge position, which
works many of the core muscles in combination. To perform the bridge position:
Lie on your back with your knees bent.

Keep your back in a neutral position — not overly arched and not pressed into the floor.
Avoid tilting your hips up.
Cough to activate your core muscles.

Holding the contraction in your abdominal muscles, raise your hips off the floor.
Align your hips with your knees and shoulders.

Hold this position and take three deep breaths — or for about five to eight seconds.
Return to the start position and repeat.

For a challenge, try alternately extending one knee while maintaining the bridge position.
It's important to follow your treatment plan closely. Let your doctor know if you're
unsure of any part of the plan, or if you need additional information to perform the
recommended self-care activities.
PREVENTION:
To help prevent a herniated disk:
Exercise.
Regular exercise slows aging-related degeneration of the disks, and core-muscle
strengthening helps stabilize and support the spine. Check with your doctor before
resuming high-impact activities such as jogging, tennis and high-impact aerobics.
Maintain good posture.

Good posture reduces the pressure on your spine and disks. Keep your back straight and
aligned, particularly when sitting for longer periods. Also, lift heavy objects properly,
making your legs — not your back — do most of the work.

Excess weight puts more pressure on the spine and disks, making them more susceptible
to herniation.
Quit smoking.
Smoking increase your risk of back problems.
until next time. keep safe
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TOBIAS MEDICAL AND DIAGNOSTIC CENTER MELANOMA
Melanoma, the most serious type of skin cancer, develops in the cells that produce
melanin — the pigment that gives your skin its color. Melanoma can also form in your
eyes and, rarely, in internal organs, such as your intestines.
The exact cause of all melanomas isn't clear, but exposure to ultraviolet (UV) rad...iation
from sunlight or tanning lamps and beds increases your risk of developing melanoma.
Other factors, such as your genetic makeup, likely also play a role.
Limiting your sun exposure and avoiding tanning lamps and beds can help reduce your
risk of melanoma.
And making sure you know the warning signs of skin cancer can help ensure that
cancerous changes are detected and treated before the cancer has a chance to spread.
Melanoma can be treated successfully if it is detected early.
CAUSES:
Melanoma occurs when something goes awry in the melanin-producing cells
(melanocytes) that give color to your skin. Normally, skin cells develop in a controlled
and orderly way — healthy new cells push older cells toward your skin's surface, where
they die and eventually are sloughed off. But when some cells develop DNA damage,
new cells may begin to grow out of control and can eventually form a mass of cancerous
cells.
Just what damages DNA in skin cells and how this leads to melanoma isn't clear. It's
likely that a combination of factors, including environmental and genetic factors, causes
melanoma. Still, doctors believe exposure to ultraviolet (UV) radiation from the sun and
from tanning lamps and beds is the leading cause of melanoma.
UV light doesn't cause all melanomas, especially those that occur in places on your body
that don't receive exposure to sunlight. This indicates that other factors may contribute to
your risk of melanoma.
SYMPTOMS:
Melanomas can develop anywhere on your body, but they most often develop in areas
that have had exposure to the sun, such as your back, legs, arms and face. Melanomas can
also occur in areas that don't receive much sun exposure, such as the soles of your feet,
palms of your hands and on fingernail beds. These hidden melanomas are more common
in people with darker skin.
The first melanoma symptoms often are:
1. A change in an existing mole

2. The development of a new, unusual-looking growth on your skin
Melanoma doesn't always begin as a mole. It can also occur on otherwise normal-
appearing skin.
Normal moles
Normal moles are generally a uniform color, such as tan, brown or black, with a distinct
border separating the mole from your surrounding skin. They're oval or round and usually
smaller than 1/4 inch (6 millimeters) in diameter — the size of a pencil eraser.
Most people have between 10 and 40 moles. Many of these develop by age 40, although
moles may change in appearance over time — some may even disappear with age.
Unusual moles that may indicate melanoma

Characteristics of unusual moles that may indicate melanomas or other skin cancers
follow the A-B-C-D-E guide developed by the American Academy of Dermatology:
A is for asymmetrical shape.

Look for moles with irregular shapes, such as two very different-looking halves.
B is for irregular border.
Look for moles with irregular, notched or scalloped borders — characteristics of
melanomas.
C is for changes in color.
Look for growths that have many colors or an uneven distribution of color.
D is for diameter.
Look for new growth in a mole larger than about 1/4 inch (6 millimeters).
E is for evolving.
Look for changes over time, such as a mole that grows in size or that changes color or
shape.
Moles may also evolve to develop new signs and symptoms, such as new itchiness or
bleeding.
Other suspicious changes in a mole may include:
Scaliness
Itching
Spreading of pigment from the mole into the surrounding skin
Oozing or bleeding
Cancerous (malignant) moles vary greatly in appearance. Some may show all of the
changes listed above, while others may have only one or two unusual characteristics.
Hidden melanomas
Melanomas can also develop in areas of your body that have little or no exposure to the
sun, such as the spaces between your toes and on your palms, soles, scalp or genitals.
These are sometimes referred to as hidden melanomas, because they occur in places most
people wouldn't think to check. When melanoma occurs in people with darker skin, it's
more likely to occur in a hidden area.
Hidden melanomas include:

Melanoma under a nail.
Subungual melanoma is a rare form that occurs under a nail and can affect the hands or
the feet. It's more common in blacks and in other people with darker skin pigment. The
first indication of a subungual melanoma is usually a brown or black discoloration that's
often mistaken for a bruise (hematoma).
Melanoma in the mouth, digestive tract, urinary tract or vagina.

Mucosal melanoma develops in the mucous membrane that lines the nose, mouth,
esophagus, anus, urinary tract and vagina. Mucosal melanomas are especially difficult to
detect because they can easily be mistaken for other, far more common conditions. A
melanoma in a woman's vagina can cause itching and bleeding. Anal melanoma can
cause anal bleeding and pain during bowel movements. Melanoma that occurs in the
esophagus can cause difficulty swallowing.
Melanoma in the eye.

Eye melanoma, also called ocular melanoma, occurs in the uvea — the layer beneath the
white of the eye (sclera). An eye melanoma may cause vision changes and may be
diagnosed during an eye exam.

Make an appointment with your doctor if you notice any skin changes that seem unusual.
RISK FACTORS:
Factors that may increase your risk of melanoma include:
Fair skin.
Having less pigment (melanin) in your skin means you have less protection from
damaging UV radiation. If you have blond or red hair, light-colored eyes, and you freckle
or sunburn easily, you're more likely to develop melanoma than is someone with a darker
complexion. But melanoma can develop in people with darker complexions, including
Hispanics and blacks.
A history of sunburn.
One or more severe, blistering sunburns as a child or teenager can increase your risk of
melanoma as an adult.
Excessive ultraviolet (UV) light exposure.

Exposure to UV radiation, which comes from the sun and from tanning beds, can increase
the risk of skin cancer, including melanoma.
Living closer to the equator or at a higher elevation.

People living closer to the earth's equator, where the sun's rays are more direct,
experience higher amounts of UV radiation, as compared with those living in higher
latitudes. In addition, if you live at a high elevation you're exposed to more UV radiation.
Having many moles or unusual moles.
Having more than 50 ordinary moles on your body indicates an increased risk of
melanoma. Also, having an unusual type of mole increases the risk of melanoma. Known
medically as dysplastic nevi, these tend to be larger (greater than 1/5 inch or 5
millimeters) than normal moles and have irregular borders and a mixture of colors.
A family history of melanoma.

If a close relative, such as a parent, child or sibling, has had melanoma, you have a
greater chance of developing it too.
Weakened immune system.

People with weakened immune systems have an increased risk of skin cancer. This
includes people who have HIV/AIDS and those who have undergone organ transplants.
TEST AND DIAGNOSIS:

Skin cancer screening
Ask your doctor whether you should consider periodic screening for skin cancer. You and
your doctor may consider screening options such as:
Skin exams by a trained professional.

The American Cancer Society (ACS) recommends periodic skin exams as part of your
usual checkups with your doctor. During a skin exam, your doctor conducts a head-to-toe
inspection of your skin.
Skin exams you do at home.

In addition, the ACS and the American Academy of Dermatology recommend occasional
self-exams. A self-exam may help you learn the moles, freckles and other skin marks that
are normal for you, so you can notice any changes. It's best to do this standing in front of
a full-length mirror while using a hand-held mirror to inspect hard-to-see areas. Be sure
to check the fronts, backs and sides of your arms and legs. In addition, check your groin,
scalp, fingernails, your soles and the spaces between your toes.
Other groups don't recommend skin cancer screening exams because it's not clear
whether screening saves lives. Instead, finding an unusual mole could lead to a biopsy,
which, if the mole is found to not be cancerous, could lead to unnecessary pain, anxiety
and cost. Talk to your doctor about what screening is right for you, based on your risk of
skin cancer.
Diagnosing melanoma
Sometimes cancer can be detected simply by looking at your skin, but the only way to
accurately diagnose melanoma is with a biopsy. In this procedure, all or part of the
suspicious mole or growth is removed, and a pathologist analyzes the sample. Biopsy
procedures used to diagnose melanoma include:
Punch biopsy.
During a punch biopsy, your doctor uses a tool with a circular blade. The blade is pressed
into the skin around a suspicious mole and a round piece of skin is removed.
Excisional biopsy.
In this procedure, the entire mole or growth is removed, along with a small border of
normal-appearing skin.
Incisional biopsy.
With an incisional biopsy, only the most irregular part of a mole or growth is taken for
laboratory analysis.
The type of skin biopsy procedure you undergo will depend on your situation.
Melanoma stages
If you receive a diagnosis of melanoma, the next step is to determine the extent, or stage,
of the cancer. To assign a stage to your melanoma, your doctor will:
Determine the thickness.

The thickness of a melanoma is determined by carefully examining the melanoma under
a microscope. The thickness of a melanoma helps doctors decide on a treatment plan. In
general, the thicker the tumor, the more serious the disease.
See if the melanoma has spread.

To determine whether your melanoma has spread to nearby lymph nodes, your surgeon
may use a procedure known as a sentinel node biopsy. During a sentinel node biopsy, a
dye is injected in the area where your melanoma was removed. The dye flows to the
nearby lymph nodes. The first lymph nodes to take up the dye are removed and tested for
cancer cells. If these first lymph nodes (sentinel lymph nodes) are cancer-free, there's a
good chance that the melanoma has not spread beyond the area where it was first
discovered.
Melanoma is staged using the Roman numerals I through IV. A stage I melanoma is
small and has a very successful treatment rate. But the higher the numeral, the lower the
chances of a full recovery. By stage IV, the cancer has spread beyond your skin to other
organs, such as your lungs or liver.

The best treatment for you depends on your stage of cancer and your age, overall health
and personal preferences.
Treating early-stage melanomas

Treatment for early-stage melanomas usually includes surgery to remove the melanoma.
A very thin melanoma may have been entirely removed during the biopsy and require no
further treatment. Otherwise, your surgeon will remove the cancer as well as a small
border of normal skin and a layer of tissue beneath the skin. For people with early-stage
melanomas, this may be the only treatment needed.
Treating melanomas that have spread beyond the skin

If melanoma has spread beyond the skin, treatment options may include:
1. Surgery to remove affected lymph nodes.

If melanoma has spread to nearby lymph nodes, your surgeon may remove the affected
nodes. Additional treatments before or after surgery may also be recommended.
2. Chemotherapy.
Chemotherapy uses drugs to destroy cancer cells. Chemotherapy can be administered
intravenously, in pill form or both, so that it travels throughout your body. Or
chemotherapy can be administered in a vein in your arm and leg in a procedure called
isolated limb perfusion. During this procedure, blood in your arm or leg isn't allowed to
travel to other areas of your body for a short time, so that the chemotherapy drugs travel
directly to the area around the melanoma and don't affect other parts of your body.
3.Radiation therapy.
This treatment uses high-powered energy beams, such as X-rays, to kill cancer cells. It's
sometimes used to help relieve symptoms of melanoma that has spread to another organ.
Fatigue is a common side effect of radiation therapy, but your energy usually returns
once the treatment is complete.
4. Biological therapy (immunotherapy).
Biological therapy boosts your immune system to help your body fight cancer. These
treatments are made of substances produced by the body or similar substances produced
in a laboratory. Biological therapies used to treat melanoma include interferon and
interleukin-2. Side effects of these treatments are similar to those of the flu, including
chills, fatigue, fever, headache and muscle aches.
Experimental melanoma treatments

Clinical trials are studies of new treatments for melanoma. Doctors use clinical trails to
determine whether a treatment is safe and effective. People who enroll in clinical trials
have a chance to try evolving therapies, but a cure isn't guaranteed. And sometimes the
potential side effects aren't known.
Some melanoma treatments being studied in clinical trials include:
Combining chemotherapy and biological therapy.

Combining chemotherapy and biological therapy drugs may increase the success of both
of these treatments. However, combining treatments can make severe side effects more
likely.
Targeted therapy.
Targeted therapies interrupt a specific process in cancer cells in order to control cancer.
For instance, targeted drugs designed to stop melanoma from attracting blood vessels
have been tested. Melanoma needs blood vessels to deliver nutrients and it uses blood
vessels to spread cancer cells throughout the body. A drug that stops this process could
cause a melanoma to remain small and localized. In another approach, specific chemicals
that stimulate cancer cells to grow rapidly could be inactivated.
Vaccine treatment.
Vaccines for treating cancer are different from vaccines used to prevent diseases. Vaccine
treatment for melanoma might involve injecting altered cancer cells into the body to draw
the attention of the immune system.
PREVENTION:
The best news about melanoma is that many cases of skin cancer can be prevented by
following these straightforward precautions:
Avoid midday sun.

Avoid the sun when its rays are the strongest. For most places, this is between about 10
a.m. and 4 p.m. Because the sun's rays are strongest during this period, try to schedule
outdoor activities for other times of the day, even in winter or when the sky is cloudy.
You absorb UV radiation year-round, and clouds offer little protection from damaging
rays.
Wear sunscreen year-round.

Choose a broad-spectrum sunscreen that has a sun protection factor (SPF) of at least 15.
Use a generous amount of sunscreen on all exposed skin, including your lips, the tips of
your ears, and the backs of your hands and neck. Apply sunscreen 20 to 30 minutes
before sun exposure and reapply it frequently while you're exposed to the sun. Be sure to
reapply it after swimming or exercising.
Wear protective clothing.

Sunscreens don't provide complete protection from UV rays, so wear tightly woven
clothing that covers your arms and legs, and a broad-brimmed hat, which provides more
protection than a baseball cap or visor does. Some companies also sell photoprotective
clothing. Your dermatologist can recommend an appropriate brand. Don't forget
sunglasses. Look for those that block both types of UV radiation — UVA and UVB rays.
Avoid tanning beds.

Tanning beds emit UV radiation, which can increase the risk of skin cancer.
Become familiar with your skin, so you'll notice changes.

Examine your skin so that you become familiar with what your skin normally looks like.
This way, you may be more likely to notice any skin changes. With the help of mirrors,
check your face, neck, ears and scalp. Examine your chest and trunk, and the tops and
undersides of your arms and hands. Examine both the front and back of your legs, and
your feet, including the soles and the spaces between your toes. Also check your genital
area, and between your buttocks. If you notice anything unusual, point it out to your
doctor at your next appointment.
until next time. keep safe

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TOBIAS MEDICAL AND DIAGNOSTIC CENTER

When to see a doctor

-Heartburn occurs more than twice a week

GERD can also cause serious complications.

Antacids that neutralize stomach acid.

Medications that control acid and heal the esophagus.

LIFESTYLE AND HOME REMEDIES:

Maintain a healthy weight.

Avoid tightfitting clothing.

Avoid foods and drinks that trigger heartburn.

Eat smaller meals.

Delay lying down after a meal.

Elevate the head of your bed.

until next time, keep safe.‫مشاهدة المزيد‬