Operasi Cangkok Hati Pertama di Indonesia Timur Sukses

[ Minggu, 25 April 2010 ]
Operasi Cangkok Hati Ramdan di RSUD dr Soetomo Sukses
Berlangsung 12 Jam 45 Menit

SURABAYA - Surabaya berhasil membuat sejarah di dunia kedokteran di Indonesia Timur. Transplantasi liver pertama di RSUD dr Soetomo kemarin (24/4) berlangsung lancar.

''The operation is successful (operasinya sukses, Red). Liver yang didonorkan sudah dicangkokkan dan tidak ada masalah dengan pembuluh darah,'' kata Prof Dr dr Shen Zhongyang, presiden Oriental Organ Transplant Center (OOTC), Tianjin, Tiongkok.

Operasi tersebut memang terlaksana atas kerja sama RSUD dr Soetomo (RSDS) dengan OOTC yang berada di bawah Tianjin First Central Hospital. Lembaga tersebut mengirimkan tujuh ahli transplantasi hati. Yakni, Prof Dr dr Shen Zhongyang dan asistennya, Ellen Wei; Prof Dr dr Du Hongyin; dr Pan Cheng; dr Jiang Wentao; dr Wang Yu; serta Li Wei, perawat spesialis kamar operasi.

Namun, tim dari pusat transplantasi organ terbesar di Asia itu hanya berperan sebagai konsultan dan advisor. Hampir seluruh tindakan dalam operasi tersebut dilakukan tim dokter RSDS. Januari lalu, sembilan dokter dan dua perawat spesialis dari RS milik Pemprov Jatim itu mendalami transplantasi liver di OOTC.

''Tim dokter di sini sangat pandai. Kerja samanya juga sangat baik. Itulah yang membuat operasi berjalan lancar,'' imbuh Shen.

Cangkok hati terhadap Ramdan Aldil Saputra; 3,5; balita asal Trenggalek, dengan donor ibu kandungnya, Sulistyowati, 43, kemarin berlangsung selama 12 jam 40 menit. Mereka masuk kamar operasi di lantai 6 Gedung Bedah Pusat Terpadu (GBPT) RSDS sejak pukul 08.00. Operasi dinyatakan tuntas sekitar pukul 19.30.

Seluruh proses operasi tersebut ditayangkan secara langsung lewat layar monitor di ruang pertemuan di lantai dasar GBPT RSDS. Dalam ruang tersebut, sebelum operasi dimulai, dilakukan doa bersama.

Jawa Pos memang mengoordinasi pihak-pihak yang ingin mendoakan Ramdan. Kemarin, ada sekitar 50 orang, baik dari kalangan pelajar maupun masyarakat umum, yang datang untuk berdoa bersama. Acara tersebut juga dihadiri ayah Ramdan, Bambang Sutondo Winarno, beserta sejumlah famili.

Sekitar pukul 09.00, Direktur Utama PT PLN Dahlan Iskan memasuki ruangan. Pria yang juga mantan chairman/CEO Jawa Pos Group itu ingin melihat secara langsung proses transplantasi liver yang didukung Jawa Pos tersebut.

Tiga tahun lalu, Dahlan juga menjalani operasi cangkok hati. Prof Shen pula yang memimpin operasi itu. Setelah menjalani ganti hati, kondisi kesehatan Dahlan jauh membaik. ''Saya pengin lihat, pengin membayangkan saya dulu seperti apa. Ini tidak lepas dari takdir Tuhan,'' kata Dahlan.

Wakil Gubernur Jatim Saifullah Yusuf juga menyempatkan diri hadir untuk melihat jalannya operasi. Dia mewakili Gubernur Jatim Soekarwo untuk melihat operasi yang Rp 1,3 miliar kebutuhan dananya dipenuhi Pemprov Jatim tersebut.

Operasi transplantasi liver itu kemarin dilakukan di dalam dua ruang operasi khusus yang letaknya berdampingan. Ramdan dioperasi di ruang 609, sedangkan sang ibu di ruang 607.

Tim dokter RSDS juga dibagi menjadi beberapa kelompok. Pemotongan liver sang ibu ditangani pakar bedah digestif dr Iwan Kristian SpB-KBD dan Dr dr Vicky Sumarki Budipramana SpB-KBD dengan konsultan dr Jiang Wentao. Pengambilan liver Ramdan di-handle ahli bedah anak dr Poerwadi SpB SpBA, dr IGB Adria Hari Astawa SpB SpBA, dan dr Kustiyo Gunawan SpB SpBA.

Ahli bedah vaskuler dr Heroe Subroto SpBTKV dan dr Ian Sembiring SpBTKV menangani penyambungan pembuluh darah antara liver yang dicangkokkan dengan pembuluh darah Ramdan. Anestesi dan perawatan di ruang intensive care unit (ICU) dikerjakan spesialis anestesi dr Arie Untariani SpAn-KIC, dr Philia Setiawan SpAn-KIC, dan dr Elizeus Hanindito SpAn-KIC.

Ada pun ketua tim liver transplant, ahli penyakit liver anak dr Sjamsul Arief SpA(K) MARS, bersama dr Urip Murtedjo stand-by di ruang tempat operasi ditayangkan secara live. Sjamsul dan Urip menjadi narator tindakan-tindakan yang dilakukan dokter selama operasi kepada masyarakat dan wartawan dalam ruangan tersebut. Sembilan di antara seluruh dokter itu adalah dokter yang dikirim ke Tianjin pada Januari lalu.

Tim dokter lebih dulu membedah Sulistyowati dan melakukan observasi untuk mengetahui letak pembuluh-pembuluh darah penting dalam liver. Yakni, vena porta dan arteri hepatika yang masuk ke liver serta vena hepatika yang meninggalkan liver. Tiga pembuluh darah itulah yang nanti disambungkan dengan pembuluh darah Ramdan.

Setelah observasi, tim dokter mulai memotong segmen kedua dan ketiga liver Sulistyowati (liver Sulistyowati dibagi menjadi 8 segmen. Segmen kedua dan ketiga itu sekitar 20 persen dari seluruh liver). Pemotongan dilakukan dengan pisau yang memakai gelombang ultrasonografi, sehingga tidak menimbulkan perdarahan.

Hampir bersamaan, tim dokter yang menangani Ramdan membedah perut bocah kelahiran 26 September 2007 itu. Setelah dibedah, tampak liver Ramdan berwarna cokelat tua. ''Itu karena sirosis. Kalau livernya sehat, warnanya merah tua, seperti punya ibunya,'' kata Sjamsul.

Dokter lantas mengobservasi liver Ramdan untuk mengetahui letak pembuluh-pembuluh darahnya. Dari observasi itu, mereka menemukan bahwa vena porta dan vena hepatika Ramdan menyempit karena terdesak kelenjar-kelenjar getah bening yang mengalami pembesaran. Kelenjar itu juga mengakibatkan perlengketan pada liver Ramdan.

Dokter akhirnya memutuskan membuang kelenjar-kelenjar tersebut sebelum membuang liver Ramdan. Total, ada lebih dari enam kelenjar yang dibuang. Setelah itu, baru liver Ramdan mulai dipotong.

Ketika pemotongan liver Ramdan hampir selesai, pemotongan liver sang ibu diselesaikan. Potongan liver itu kemudian dicuci sambil ditekan-tekan dengan cairan custodion. Setelah liver Ramdan selesai dipotong, rongga yang kosong itu dibersihkan dulu, baru kemudian potongan liver sang ibu dicangkokkan.

Dalam proses itu, dokter menghubungkan vena porta, vena hepatika, dan arteri hepatika Ramdan dengan liver dari sang ibu. Setelah seluruhnya terhubung, dokter melakukan USG Doppler untuk memeriksa posisi arteri hepatika tersebut. Kemudian, mereka memasangkan saluran empedu pada liver Ramdan yang dibuatkan dari saluran empedu sang ibu.

Sekitar pukul 20.45, seluruh proses operasi selesai dan rongga perut Ramdan ditutup. Sang ibu keluar dari ruang operasi sejak pukul 17.00. Pukul 20.00, Sulistyowati siuman dan langsung memanggil nama Ramdan. Wanita itu juga sudah bisa diajak berbicara, meski matanya masih terpejam.

Pukul 23.22, tubuh Ramdan mulai bergerak dan pukul 23.35 dipindahkan dari kamar operasi ke ICU. Pukul 23.45, gerakan bungsu di antara tiga bersaudara itu makin kuat. Namun, masa kritisnya masih belum lewat hingga 48 jam setelah operasi.

Dijamu di Hotel Sheraton

Setelah operasi, tim medis dari OOTC Tianjin dan RSUD dr Soetomo yang terlibat dalam operasi Ramdan diundang sebagai tamu kehormatan dalam acara gathering di Hotel Sheraton tadi malam.

Hadir para petinggi Jatim dalam acara tersebut. Di antaranya, Gubernur Soekarwo dan Wagub Saifullah Yusuf. Masing-masing didampingi istri. Hadir pula Dirut PLN Dahlan Iskan serta Direktur RSUD dr Soetomo dr Slamet Riyadi Yuwono.

Beberapa wakil negara sahabat di Surabaya juga hadir. Di antaranya, Konjen Republik Rakyat Tiongkok (RRT) Fu Shuigen, Konjen AS Caryn R. McClelland, dan sejumlah konsul kehormatan.

Beberapa pengusaha yang hadir, antara lain, bos Pakuwon Group pasangan Alex Tedja-Melinda Tedja, Tai Sigit Tahir (Surya Bhakti Utama), Bintoro Tanjung (Agung Gumelar Internasional), Loddy Gunadi (Sekar Alam Griya), Hasan Opek (Tiga Bhakti), Soedono Margonoto (Santo Jaya Abadi), Soeparno (Surabaya Meka Box), dan Soegeng Hendrito (Jangkar Pacific). Selain itu, Pieko Nyoto Setiadi (Fajar Mulia Transindo), Ali Soetrisno (Grande Family Views), dan William Timotius (Efrata Indah)

Acara yang dimulai pukul 18.30 itu molor karena tim dokter gabungan RSUD dr Soetomo Surabaya dan OOTC, Tianjin, baru menuntaskan operasi pada pukul 20.45. Sambil menunggu kedatangan tim transplantasi, Dirut PLN Dahlan Iskan yang malam itu juga hadir menceritakan pengalamannya ketika menjalani operasi transplantasi liver. ''Malam ini, saya ingin memperkenalkan Prof Sheng yang dulu mengoperasi saya,'' ujar Dahlan.

Pukul 21.15, beberapa dokter dari RSUD dr Soetomo yang terlibat dalam operasi tersebut hadir. Mereka adalah dr Iwan Kristian SpB-KBD, dr Heroe Subroto SpB-TKV, dan dr Ian Sembiring SpB-TKV. Sebelumnya, ada dr Sjamsul Arief SpA yang selama ini merawat Ramdan. ''Operasi memang berjalan lebih lama dari yang kami perkirakan. Mohon maaf harus menunggu kami lama,'' kata dr Iwan.

Dalam kesempatan tersebut, dia menceritakan sulitnya melakukan operasi transplantasi liver. Apalagi, ini merupakan pengalaman pertama.

Tak lama berselang, hadir dalam acara itu rombongan tim medis dari OOTC yang dipimpin Prof Dr dr Sheng Zhongyang. Ketika mendapat kesempatan memberikan sambutan, Prof Sheng menyatakan sangat terkesan pada Surabaya begitu dirinya mendarat. Apalagi, hubungan Tianjin dengan Jatim sudah terjalin baik. ''Pada 2006, wali kota Surabaya pernah ke Tianjin,'' tutur Shen.

Direktur RSUD dr Soetomo Slamet Riyadi Yuwono menilai, pencapaian sejarah ini tidak bisa lepas dari dua sosok. Yakni, Dahlan Iskan dan Direktur Jawa Pos Nany Wijaya. ''Pak Dahlan itu jadi provokatornya, sedangkan Ibu Nany merupakan korlap (koordinator lapangan),'' puji Slamet disambut tepuk tangan ratusan undangan yang memadati Ballroom Hotel Sheraton. (rum/sep/c5/kum

sumber : Jawa Pos http://www.jawapos.com/halaman/index.php?act=showpage&kat=3

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milkborne disease

The importance of milk in our diet is well established as it is considered as the best, ideal and complete food for all age groups. However, in spite of being so, milk can also serve as a potential vehicle for transmission of some diseases under certain circumstances. Moreover, by virtue of possessing almost all the essential nutritional factors, milk can also serve as an excellent source and protective medium for certain microorganisms, which may include potential pathogens capable of causing various health problems to the consumers.  
In this way, milk may serve not only as a potential vehicle of transmission of disease causing organisms, but it can also allow these pathogens to grow, multiply and produce certain toxic metabolites, thereby making itself an extremely vulnerable commodity from the public health point of view.

A variety of pathogenic organisms may gain access into milk and milk products from different sources and cause different types of food-borne illnesses. Milk and milk products may carry organisms as such or their toxic metabolites (poisons) called ‘toxins’ to the susceptible consumers. Ingestion of toxins already synthesized in the food i.e., pre-formed brings about poisoning syndromes in the consumers.

This is called ‘food intoxication’ and the toxins affecting the gastro-intestinal tract are called enterotoxins. Whereas the ingestion of viable pathogenic bacteria along with the food leads to their implantation and establishment in internal organs. This is called ‘food infection’. There are yet other types of organisms, which can infect intestine when ingested along with the food and produce toxins in situ to bring about symptoms of poisoning. This situation is called ‘toxi-infection’. 


These three categories are better covered by the term food-borne infections and intoxications. Apart from these food-borne illnesses, a number of other types of diseases whose etiological agents may be bacteria, fungi, rickettsiae and viruses can also be spread through milk and milk products. The microbiological health hazards arising from the consumption of contaminated high risk foods like milk has grown in recent years and has resulted in national and international intensification of food hygiene programs. 

Although the occurrence of incidences of food-borne illnesses has been considerably reduced in most of the developed countries chiefly due to adoption of strict microbiological quality control and sanitary practices during the production, processing and distribution of milk and milk products, the situation continues to be grim in developing countries where such practices can not be followed. This problem is aggravated when heavy expansion of dairy industry in the third world countries and this increases the risk of milk-borne intoxications and other illnesses.

Link : http://www.dairyforall.com/milkborne-diseases.php

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foodborne disease

What is foodborne disease? 

Foodborne disease is caused by consuming contaminated foods or beverages. Many different disease-causing microbes, or pathogens, can contaminate foods, so there are many different foodborne infections. In addition, poisonous chemicals, or other harmful substances can cause foodborne diseases if they are present in food.  

More than 250 different foodborne diseases have been described. Most of these diseases are infections, caused by a variety of bacteria, viruses, and parasites that can be foodborne. Other diseases are poisonings, caused by harmful toxins or chemicals that have contaminated the food, for example, poisonous mushrooms. These different diseases have many different symptoms, so there is no one "syndrome" that is foodborne illness. However, the microbe or toxin enters the body through the gastrointestinal tract, and often causes the first symptoms there, so nausea, vomiting, abdominal cramps and diarrhea are common symptoms in many foodborne diseases.  

Many microbes can spread in more than one way, so we cannot always know that a disease is foodborne. The distinction matters, because public health authorities need to know how a particular disease is spreading to take the appropriate steps to stop it. For example, Escherichia coli O157:H7 infections can spread through contaminated food, contaminated drinking water, contaminated swimming water, and from toddler to toddler at a day care center. Depending on which means of spread caused a case, the measures to stop other cases from occurring could range from removing contaminated food from stores, chlorinating a swimming pool, or closing a child day care center. 

Link : http://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm

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Types of Conventional Hemorrhoids Treatment

There are many types of hemorrhoids treatments whether it is medical or natural. The most suitable type of treatment to take varies according to the type of hemorrhoids and the severity of the condition. For many people, they do not take any medical treatment for their mild hemorrhoids and it eventually went away. Some people like to use local treatments such as warm sitz baths, using a bidet, cold compress or topical analgesic to provide temporary relief. Topical hemorrhoid cream which contain steroids can provide relief in the early stages of hemorrhoid flare ups. In some cases, these creams can be effective as a means to prevent further occurrence. However, topical steroids can bring negative side effects if it is use consistently, such as weakening the skin which can in turn cause further hemorrhoid flare ups.

For chronic and more severe hemorrhoids, the following medical treatments are commonly administered according to the varying degree of severity. These treatments listed here are in increasing order of intrusiveness and cost.

1. Rubber band ligation.

This is sometimes called Baron ligation where elastic bands are applied to the internal hemorrhoids to cut off its blood supply. The withered hemorrhoid is then passed out during regular bowel movement.

2. Hemorrhoidolysis/Galvanic Electrotherapy

This is a treatment uses a small probe to the hemorrhoid using manual pressure which result a gentle electrolysis that results in progressive and permanent shrinkage of the hemorrhoid. Usually only one hemorrhoid is treated at one time. So if you have more than one hemorrhoid site, then it will take several visits to complete the treatment.

3. Injection therapy or Sclerotherapy
This therapy involves injecting a hardening agent or sclerosant into the hemorrhoids and cause the veins to collapse. Thus the hemorrhoids will shrivel up.

4. Cryosurgery
This involves using the frozen tip of a cryoprobe to destroy the hemorrhoid tissues. This treatment is rarely used now as it brings about harmful side effects.

5. Laser, InfraRed or BICAP coagulation
Using laser or infrared beam to treat hemorrhoids, although less popular now, is readily available as non-surgical procedures in the US.

6. Hemorrhoidectomy
This the the commonly known surgery procedure to remove hemorrhoids. The post surgery pain is reported by patients as severe. It also takes a long time to recover. For this reason, this surgery is only recommended to those very serious hemorrhoids.

7. Stapled Hemorrhoidectomy
This procedure is usually used for prolapse and bleeding hemorrhoids. This method cut of the blood flow to the hemorrhoids instead of completely remove the hemorrhoids. So this procedure is less painful and faster recovery time.

8. Doppler Guided Hemorrhoidal Artery Ligation
This method is recommended for treating severe bleeding hemorrhoids as it can effectively stops bleeding. This procedure does not involve in cutting any hemorrhoid tissues. Patients do not need to stay in the hospital and usually can get back to work within the same day.

9. HAL-RAR
Recto Anal Repair, or RAR, This is a new procedure which is treat hemorrhoids without cutting any tissues. Most of these conventional medical treatments comes with much discomfort and side effects. This is why many people prefer to go for more natural treatments. Please read Bleeding Hemorrhoids Cure for more information on natural remedies for treating hemorrhoids.

from : www.bleedinghemorrhoids.org/

H E M O R R H O I D

H E M O R R H O I D

Contrary to common perception, bleeding hemorrhoids are actually more common than you think. What is bleeding hemorrhoids? Bleeding hemorrhoids can be either internal or external hemorrhoids. Hemorrhoids is a painful condition which veins in the rectal and anal area become swollen. Some have liken this condition to varicose veins which occurs with age. While some types of hemorrhoids can clear up by themselves after minimal treatment, other types such as bleeding hemorrhoids are more serious.

Bleeding hemorrhoids must be evaluated by a qualified physician and given prompt treatment before the condition becomes more serious. For those who suffer from bleeding hemorrhoids for the first time, it can be a scary and bloody experience. Oozing of fresh red blood externally or internally is a sign of bleeding hemorrhoids. Bleeding internal hemorrhoids can result in fresh blood in the stools, in the toilet bowl and toilet paper. Many patients are shock to see the river of blood from their own body. This is not a sight many can take it. This is made worse if you have constipation, when passing very large and hard stool. Bleeding hemorrhoids can cause great inconvenience to the patients and many became shy and reclusive about their condition.

Some of the common causes of bleeding hemorrhoids includes:

Very weak rectal vein walls and valves

• Serious constipation
• Too much pressure on rectal veins due to poor muscle tone or posture such as prolonged sitting. In fact, it is encouraged that patients use squatting toilet instead of the unnatural sitting ones for hemorrhoid relief.
• Hypertension in the portal vein
• Excessive consumption of caffeine and alcohol
• Pregnancy. Many pregnant women suffer from hemorrhoids due to increase straining of bowel movement and hypertension.

If you are suffering from painful hemorrhoids, you are not alone. Many are suffering of this condition silently which is affecting their lifestyle and work. However, one definite thing is that hemorrhoids are caused by your daily lifestyle and diet. It is crucial for you to seek help early so that your condition is not worsen and more painful. We will look into various options for hemorrhoids treatment, whether conventional, herbal or traditional.

Note: Hemorrhoids is a common condition and yet many of us do not know the correct spelling of the word. Here are a few variations - hemorroids, hemorroid, hemmoroids, hemmoroid, hemroids, hemroid, hemeroids, hemeroid, hemmroids, hemmroid, hemmeroids, hemmeroid, haemorrhoids, haemorrhoid, hemoroids, hemoroid, hemmoroids, hemmoroid, hemrroids, hemrroid, hemorroides, hemorroide, hemorrhoid.

from : www.bleedinghemorrhoid.org

Is Stress Making Your Eczema Worse by Chris Holloway

Increased stress at school, home, and at work can take its toll on your physical, emotional and psychological well-being. Stress can cause you to feel extremely fatigued and can make your skin act up. Red, irritated, and itchy skin can be the first signs of eczema. What is eczema? Eczema is a common skin irritation characterized by reddening of the skin which sometimes appear as small, oozing, fluid-filled bumps. There are many forms of eczema, but atopic eczema is one of the most common and severe. There is no exact known cause for eczema but doctors believe that skin allergies and the way a person's immune system reacts to things may be involved in the formation of eczema.
Although not contagious, scientists believe that some are predisposed to eczema if their parents or close family relatives also have eczema and allergies like hay fever or asthma. Some people who develop eczema are also allergic to cows milk, soy, eggs, fish, or wheat. Allergies to animal dander, rough fabrics, and dust may also trigger the condition in some people.
People who are under severe stress may find it difficult to avoid all the triggers, or irritants, that cause or worsen eczema flare-ups. These itchy patches of eczema may affect any part of the body but are usually seen where the elbow bends, on the backs of the knees, ankles, wrists, face, neck, and upper chest.
Eczema flare-up may feel hot and itchy at first, prompting the person to scratch it. Continuous scratching will eventually make the patch turn red, inflamed, and blistered. When heavily scratched, the skin becomes almost leathery in texture. Others find that their skin becomes extremely dry and scaly.
Treatment can be in the form of creams and ointments that help soothe the redness and irritation. A good moisturizing cream is essential and a natural cream containing goats milk has long been known to help.
Anti-eczema medications can be taken orally. But in cases of severe eczema, ultraviolet light therapy can help clear up the condition.
Eczema cannot be cured but its symptoms can be managed. However, there are many ways to prevent a possible eczema flare up. Use only nondrying facial cleanser or soap substitute for facial eczema. This will keep facial skin from being irritated. A non-comedogenic/oil-free facial moisturizer can also help ease the dryness and itchiness cause by eczema. Try not to apply make-up or use only hypoallergenic makeup and sunscreens.
Try to avoid substances that may stress your skin such as housesehold cleaners, drying soaps, detergents, and fragranced lotions. It is possible that too much exposure to water can dry out your skin. A brief shower with warm water is advised but it may be advisable to wear gloves if your hands will be in water for long periods of time. Pat your skin dry gently and thoroughly. Do not rub with a coarse towel which can irritate the condition.
It isn't the water that causes your skin to react it's the water evaporating if not dried soon enough. Wear clothes made from cotton fabrics. Avoid scratchy fabrics like wool which can irritate the skin.
Try not scratch no matter how itchy it gets. Scratching can worsen the eczema and cause breaks in the skin which could lead to bacterial infections. Although there is no cure yet for eczema, it usually clears up by the time you reach the age of 25. In the meantime, learn to manage the condition by avoiding anything that will trigger it.
Since stress can trigger eczema, find time to unwind and relax. Engage in different activities that will set your mind off from the itch.

How to reduce anxiety to improve cardiovascular health by Joe Keny

obesity, smoking, blood pressure and cholesterol are all issues for the management of a healthy heart. However, their concerns can also affect your heart. Studies show that chronic anxiety significantly increases your risk of heart attack .
Talk to your doctor. It is possible that your anxiety is a symptom of an underlying illness such as depression or a disorder of the thyroid. Your doctor can diagnose and, if necessary, direct treatment .
Consider medication. Your doctor can recommend prescription medications that can alleviate their anxiety .
Set a daily schedule. The timetable must allow time to eat, sleep and relax, and completing tasks for the day .
reduce as necessary. When you look at your schedule, you might find that simply have too much going on. Pick your priorities and let the rest go .
Making lifestyle changes healthy. The reduction of caffeine can make a big difference in reducing their anxiety. You should also practice meditation and breathing techniques to help you reduce .
stop aiming for perfection. It is an unrealistic goal that no one achieves success. Set realistic goals and be proud of all you achieve .
understand that it takes time. It can take weeks for you to get into the routine of relaxation. We hope that before starting the process to avoid further anxiety in the coming weeks. This article is written by Article Marketing.

Psychology Brisbane- helps you to live life happily by Jessica Thomson

Psychology Brisbane- helps you to live life happily

by Jessica Thomson

Everybody must have experienced stress somewhere in life. The fast paced modern lifestyle is highly responsible for the heavy mental stress. The heavy workload does not allow a person to relax for a while. Even when he comes home, he carries the problems along with and thinking constantly about them. Apart from the work, there are plenty other diverse type of problems always disturbs a person and gradually his life becomes reckless. Mental state gets confused largely due carrying lot of problems like increasing debts, unhappy marriage life, disappointments and failure at the work front, lose in the business, constant unbearable sickness, isolation and loneliness, conflicts and discomforts in life etc. together without any solution. He needs someone to listen to him and helps in sorting out those hammering problems.

A person is battling to come out of that confused state and at one stage he thinks he is being buried under the mountain of problems. His behavior changes without his notice, his nature goes irritative and short tempered, loss of memory and appetite and the extension of this state leads towards the nervous breakdown. His mental state gets disturbs badly and as a result he fails to perform his routine tasks. He is unable to express his thoughts and emotions and having sleepless nights. Other people are unable to understand his behavior and his disturbed mental condition leads towards anxiety. This is the time he need a services of a reputed and trusted psychologist Brisbane. Psychologist Brisbane is a person who helps to understand the patient better than others with his knowledge of psychology Brisbane. He must be a well learned person having his own developed, proven and tested methods to be applied on the patient for the successful outcome. His job is to understand the patient and observe him closely so as to predict his behavior. He should apply his efforts and knowledge to bring out those dark patches that cause mental stress and help the patient to lead his normal life on his own without the support of anybody. He helps to generate the confidence and self respect into the patient so that he can take his own decision and expresses his feelings and thought and tries to restore his mental state to live the life happily. Psychic Clinic being a highly reputed clinical psychologist Brisbane, offers various types of treatments and services to their patients like relationship counseling, marriage counseling, addiction of tobacco and alcoholic elements, weight loss, lapse of memory, sleeping problems, pain and anger management, personality and adjustment disorder, depression, anxiety, schizophrenia and many other mental related problems.

M I G R A I N

Headaches migraine pain is severe and recurring pulse, which is usually about one of the head but sometimes on both sides of the head. Pain relief can be sudden or accompanied by visual symptoms (vision), neurologis or alimentary tract.

Migraine can occur at the age of the course, but usually at the nascent age between 10-30 years old; sometimes disappear after the age of 50 years. More often attack women. Migraine headaches are more severe than the headaches due to blood pressure. In some patients, mild head pain can be eliminated and the sedative sold freely.

However, migraine is often severe and the patient does not become powerless, especially if accompanied by nausea, vomiting and dazzled eyes (fotofobia). In the case such as this, usually in addition to sedative, patients also need rest and sleep to reduce the pain of his head. Approximately 10-30 minutes before the headache started (a period called the aura or prodroma), symptoms of depression, resentful, restless, nausea or loss of appetite appear on about 20% of patients. Other people who experienced loss of vision in a particular region (or blind spot skotoma) or see the light flicker. There are also people who have experienced a change description, such as an object appear smaller or larger than Lo. Some people feel the pins or weakness in the arms and legs.

Usually these symptoms disappear shortly before the headache starts, but sometimes occur simultaneously with the emergence of headache. Because of migraine pain can be perceived on one side of the head or the whole head. Sometimes the hands and feet appear cold . In the patients who have aura, pain pattern and location of each attack head on migrants is the same. Migraine can often occur during an extended period of time but then disappeared for several weeks, months and even years. For the selection of appropriate migraine drugs have a good idea you should check up and consultation to a specialist heart doctor.

Testosterone deficiency syndrome in men

Testosteron Deficiency Syndrome (TDS) or testosteron deficiency syndrome is a condition in which the production of testosteron testis is not enough. The symptoms of TDS that appears encouraged that the low and declining sexual Libido, decreasing function ereksi, a decrease in muscle mass and strength, increased body weight, poor concentration, easily tired, depression, weight, severe physical weakness, anemia and osteoporosis. 

TDS will also be on the men's lead to medical consequences such as metabolic syndrome, such as Obesity, disregulasi insulin (which causes blood sugar levels to be abnormal), high cholesterol and mild hypertension. Ultimately, this condition can lead to the disease diabetes mellitus and heart. Men suffering from TDS considered when testosteron level in the blood under the number 12 nmol / L. Which is in the normal range of between 12-40 nmol / L. Men with the characteristics and symptoms that lead to the TDS are advised to consult with your doctor and check testosteronnya degree. Because if TDS is left as such and not treated properly, will result in the emergence of the above symptoms and decrease the quality of life in men in both age and old age.

Decrease Testosteron Testosteron is a sex steroid hormone (androgen) that men are generally produced by testis maturity occurs after the formation of male sex gland (testis). Testosteron responsible for the development of the young boy became a man in the bloom. Testoteron a role in sexuality, the establishment of physical, mental and performance of men. Testosteron is a male sex hormone is most important. Men akan kadar testosteron decreased blood active around 1.2 percent per year from the first degree when entering the age of 40 years. Meanwhile, when the reach the age of 70 years, men will experience a decrease in blood testosteron level of 35 percent of the original measure. The cause of the occurrence of TDS is a general increase in male age. Type is called the slow or low ONSET ONSET TDS. The process penuaan on men akan endokrin impact on the system, genital system, and body composition system muskular, kardiosvaskular system and nerve system.

TDS also refers to the disfungsi system endokrin (androgen production) and the system eksokrin (sperm production). Diabetes mellitus or diseases metabolik other can accelerate the decline in the occurrence of testosteron level when compared with men without contemporary Obesity and diabetes mellitus. Fat stomach or distended stomach (visceral obesity) may also accelerate the decrease in the occurrence rate testosteron. Also known that men with central obesity tend to have lower testosteron level compared with men without central obesity. Men with diabetes mellitus tended to have lower testosteron level compared with men without diabetes mellitus. In addition, other causes of TDS is a malfunction of the testis (possibly because the offspring), exposure to toxic substances, tumor, surgery, and so forth. One common phenomenon that occurs due to a decrease in TDS is ereksi function.

Men with a decrease in the likelihood function ereksi have testosteron level so low that examined the level recommended for testosteronnya. At this time emphasized the importance of screening in men with TDS reduction ereksi function. Ereksi decline in function can also be treated only with testosteron, especially when the main cause is lack of testosteron. Prevalence of men with TDS ereksi reported a decrease in function in about 20 percent. TDS Handling aims to restore the condition of the parameters metabolik normal (eugonadal), improve mass, strength and muscle function, maintain BMD (Bone Mineral Density) and fraktur reduce risk, improve the function neuropsikologis (kognisi and mood), psikoseksual increase function and improve quality of life .

Unfortunately, lack of information about the condition of TDS men exposed to lead to disease and do not ignore the symptoms of the disease as a dangerous medical condition, but it is considered as normal. This made their own attempt to treat this disease with products that are sold freely, without considering professional help in the effort to treat the causes of this disease. If the left is not treated, this disease can seriously affect the sexual health, physical, mental and men. It is therefore recommended for men with symptoms of TDS to lead the examined kadar testosteron them.

High blood pressure medicine

High blood pressure medicine antagonis than angiotensin I and II, beta-Blocker, antagonis calcium and diuretik also have high blood pressure medicine the antagonis reseptor alpha, agonis selective reseptor alpha 2, and resistor combination adrenergik nerve.

Medicine high blood pressure is often called the alpha resistor adrenoseptor alpha / alpha-Blocker. Into three groups:

• High blood pressure medicine the alpha Blocker nonselektif
• High blood pressure medicine the alfa1 Blocker Selective
• High blood pressure medicine the selective alpha 2 Blocker

In Indonesia, high blood pressure medicine antagonis alpha group is circulating a selective, such as doksazosin, burnazosin and terazosin. While high blood pressure medicine agonis the reseptor selective alpha 2 as metyldopa and klonidin. High blood pressure medicine the resistor adrenergik such as nerve reserpin.

High blood pressure

High blood pressure (hypertension) is an increase in blood pressure in the arterial. In general, hypertension is a condition without symptoms, in which the abnormal high pressure in the arterial cause increased risk of stroke, aneurisma, heart failure, heart attack and kidney damage. On examination the blood pressure will be two numbers. Number is higher at the time of acquired heart berkontraksi (sistolik), the lowest is at the heart of berelaksasi (diastolik). Blood pressure is written as a pressure sistolik virgule diastolik pressure, for example, 120/80 mmHg, read one hundred twenty per eighty. It is said high blood pressure if the pressure at the time to sit sistolik reached 140 mmHg or more, or diastolik pressure reaches 90 mmHg or more, or both. On high blood pressure, increased pressure usually occurs sistolik and diastolik. Objectives of hypertension / high blood pressure is to prevent the occurrence of disability and death due to high blood pressure. This means that the blood pressure should be taken down the lowest possible does not disrupt the function of kidneys, brain, heart, and the quality of life, carried out while controlling the risk factors kardiovaskular other. Has been that the lower blood pressure diastolik and sistolik, the better it. In general, the target blood pressure in young patients is <140/90>

DIABETES MELLITUS AND PREGNANCY Part 2

 

Clinical
Fetal morbidity with diabetes during pregnancy

*Miscarriages

• In all women with preexisting diabetes mellitus, there is a 9-14% rate of miscarriage.
• Current data suggest a strong association between degree of glycemic control prior to pregnancy and miscarriage rate. Suboptimal glycemic control has been shown to double the miscarriage rate in women with diabetes. A correlation also exists between more advanced diabetes and miscarriage rates. Patients with long-standing (>10 y) and poorly controlled (glycohemoglobin exceeding 11%) diabetes have been shown to have a miscarriage rate of up to 44%. Conversely, reports demonstrate a normalization of miscarriage rate with excellent glycemic control.

*Birth defects

• Among the general population, major birth defects occur in 1-2% of the population. In women with overt diabetes and suboptimal glycemic control prior to conception, the likelihood of a structural anomaly is increased 4- to 8-fold.
• Although initial reports demonstrated anomaly rates as high as 18% in women with preexisting diabetes mellitus,6 more recent reports with more aggressive preconception and first trimester management report anomaly rates between 5.1 and 9.8%.7, 8
• Two-thirds of anomalies involve the cardiovascular and central nervous systems. Neural tube defects occur 13-20 times more frequently in diabetic pregnancy. Genitourinary, gastrointestinal, and skeletal anomalies are also more common.
• The fact that no increase in birth defects occurs among the offspring of fathers who are diabetic and women who develop gestational diabetes after the first trimester is notable. This suggests that periconceptional glycemic control is the main determinant of abnormal fetal development in diabetic women.
• When the frequency of congenital anomalies in patients with normal or high first-trimester maternal glycohemoglobin values was compared to the frequency in healthy patients, the rate of anomalies was only 3.4% with glycosylated hemoglobin values (HbA1C) of less than 8.5%, whereas patients with poorer glycemic control in the periconceptional period (HbA1C >8.5%) had a 22.4% rate of malformations. An overall malformation rate of 13.3% was reported in 105 patients with diabetes, but the risk of delivering a malformed infant was comparable to a normal population when the glycosylated hemoglobin (HbA1c ) was less than 7%.9 More recently, in a review of 7 cohort studies, researchers found that patients with a normal glycohemoglobin (0 SD above normal), the absolute risk of an anomaly was 2%. At 2 SD above normal, this risk was 3%, with an odds ratio of 1.2 (1.1- 1.4). As the glycohemoglobin increased so did the risk for malformation in a direct relationship.10
• Because birth defects occur during the critical 3-6 weeks after conception, nutritional and metabolic intervention must be initiated well before pregnancy begins. Clinical trials of intensive metabolic care have demonstrated that malformation rates similar to those in the nondiabetic population can be achieved with meticulous preconceptional glycemic control.11 Subsequent trials comparing a preconceptional intensive metabolic program to standard treatment over 15 years duration have demonstrated lowered perinatal mortality (0% vs 7%) and reduced congenital anomaly rate (14% to 2%). In addition, when the preconceptional counseling program was discontinued, the congenital anomaly rate increased by over 50%.12

* Growth restriction

• Although most fetuses of diabetic mothers exhibit growth acceleration, growth restriction occurs with significant frequency in pregnancies in women with preexisting type 1 diabetes.
• The most import predictor of fetal growth restriction is underlying maternal vascular disease. Specifically, pregnant patients with diabetes-associated retinal or renal vasculopathies and/or chronic hypertension are most at risk for growth restriction.

* Growth acceleration

• Excessive body fat stores, stimulated by excessive glucose delivery during diabetic pregnancy, often extends into childhood and adult life.
• Approximately 30% of fetuses of women with diabetes mellitus in pregnancy are large for gestational age (LGA). In preexisting diabetes mellitus this incidence appears slightly higher, 38%.4
• Maternal obesity, common in type 2 diabetes, appears to significantly accelerate the risk of infants being LGA.

* Fetal obesity

• Macrosomia is typically defined as a birthweight above the 90th percentile for gestational age or greater than 4000 grams. In pregnant diabetic women, macrosomia occurs in 15-45% of cases, a 3-fold increase from normoglycemic controls.
• Newborns with macrosomia experience excessive rates of neonatal morbidity, as illustrated by a study by Hunter et al in 1993, which compared the neonatal morbidity among infants of 230 women with insulin-dependent diabetes and infants of 460 women without diabetes. The infants of diabetic mothers (IDMs) had 5-fold higher rates of severe hypoglycemia, a 4-fold increase in macrosomia, and a doubled increase in neonatal jaundice.13
• Birth injury, including shoulder dystocia and brachial plexus trauma, are more common among infants of diabetic mothers, and macrosomic fetuses are at the highest risk.
• The macrosomic fetus in diabetic pregnancy develops a unique pattern of overgrowth, involving central deposition of subcutaneous fat in the abdominal and interscapular areas. Skeletal growth is largely unaffected. Neonates of diabetic mothers have a larger shoulder and extremity circumference, a decreased head-to-shoulder ratio, significantly higher body fat and thicker upper extremity skin folds compared to nondiabetic control infants of similar weights. Since fetal head size is not increased during poorly controlled diabetic pregnancy but shoulder and abdominal girth can be markedly augmented, the risk of injury to the fetus after delivery of the head (eg Erb palsy) is significantly increased.
• When serial ultrasound examination findings from diabetic fetuses are plotted, the growth velocity of the abdominal circumference is often well above the growth centiles seen in nondiabetic fetuses and is higher than the fetal head and femur centiles. The accelerated growth of the abdominal circumference begins to rise significantly above normal after 24 weeks.

* Metabolic syndrome

• The adverse downstream effects of abnormal maternal metabolism on the offspring have been documented well into puberty. Glucose intolerance and higher serum insulin levels are more frequent in children of diabetic mothers as compared to normal controls. By age 10-16 years, offspring of diabetic pregnancy have a 19.3% rate of impaired glucose intolerance.14
• The childhood metabolic syndrome includes childhood obesity, hypertension, dyslipidemia, and glucose intolerance. A growing body of literature supports a relationship between intrauterine exposure to maternal diabetes and risk of a metabolic syndrome later in life.15, 16
• Fetuses of diabetic women that are born large for gestational age appear to be at the greatest risk.16

* Role of glucosa level

• Excess nutrient delivery to the fetus causes macrosomia and truncal fat deposition, but whether fasting or peak glucose values are more correlated with fetal overgrowth is less clear.
  Data from the Diabetes in Early Pregnancy project indicate that fetal birthweight correlates best with second- and third-trimester postprandial blood sugar levels and not with fasting or mean glucose levels.17
• More recent data from the ACHOIS trial demonstrated a positive relationship between severity of maternal fasting hyperglycemia and risk of shoulder dystocia, with a 1 mmol increase in fasting glucose leading to a relative risk for shoulder dystocia of 2.09 (1.03- 4.25).18
• When postprandial glucose values average 120 mg/dL or less, approximately 20% of infants can be expected to be macrosomic. When postprandial levels range as high as 160 mg/dL, macrosomia rates can reach 35%.
• In addition, there appears to be a role for excessive fetal insulin levels in mediating accelerated fetal growth. In the study by Simmons et al which compared umbilical cord sera in infants of diabetic mothers newborns and controls, the heavier, fatter babies from diabetic pregnancies were also hyperinsulinemic.19

* Role of maternal obesity

• Maternal obesity has a strong and independent effect on fetal macrosomia. Birthweight is largely determined by maternal factors other than hyperglycemia, with the most significant influences being gestational age at delivery, prepregnancy maternal body mass index (BMI), maternal height, pregnancy weight gain, the presence of hypertension, and cigarette smoking.
• When women who are very obese (weight >300 lb) were compared to women of normal weight, the obese women had more than double the risk of macrosomia compared to the women who were of normal weight. This may explain the failure of glycemic control to completely prevent fetal macrosomia in several series.

Perinatal morbidity and birth injury

* Perinatal mortality

• In diabetic pregnancy, perinatal mortality has decreased 30-fold since the discovery of insulin in 1922 and intensive obstetrical and infant care in the 1970s. Nevertheless, the current perinatal mortality rates among women who are diabetic remain approximately twice those observed in the nondiabetic population.
• Congenital malformations, respiratory distress syndrome (RDS), and extreme prematurity account for most perinatal deaths in contemporary diabetic pregnancies.

To be continue..............

DIABETES MELLITUS AND PREGNANCY

Background

Abnormal maternal glucose regulation occurs in 3-10% of pregnancies. Studies suggest that the prevalence of diabetes mellitus (DM) among women of childbearing age is increasing in the United States. This increase is believed to be attributable to more sedentary lifestyles, changes in diet, continued immigration from high-risk populations, and the virtual epidemic of childhood and adolescent obesity that is presently evolving in United States. Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy. Gestational diabetes mellitus accounts for 90% of cases of diabetes mellitus in pregnancy. Type II diabetes mellitus accounts for 8% of cases of diabetes mellitus in pregnancy, and given its increasing incidence, preexisting diabetes mellitus now affects 1% of pregnancies.
Infants of mothers with preexisting diabetes experience double the risk of serious injury at birth, triple the likelihood of cesarean delivery, and quadruple the incidence of newborn intensive care unit admission. Studies indicate that the risk of these morbidities is directly proportional to the degree of maternal hyperglycemia. For this reason, the excessive fetal and neonatal morbidity attributable to diabetes in pregnancy should be considered preventable with early diagnosis and effective treatment therapies.

Pathophysiology

Maternal-fetal metabolism in normal pregnancy

With each feeding, the pregnant woman undergoes a complex series of maternal hormonal actions (ie, a rise in blood glucose; the secondary secretion of pancreatic insulin, glucagon, somatomedins, and adrenal catecholamines). These adjustments ensure that an ample, but not excessive, supply of glucose is available to the mother and fetus. The key features of this complex interaction include the following:

• Compared to nonpregnant subjects, pregnant women tend to develop hypoglycemia (plasma glucose mean = 65-75 mg/dL) between meals and during sleep. This occurs because the fetus continues to draw glucose across the placenta from the maternal bloodstream, even during periods of fasting. Interprandial hypoglycemia becomes increasingly marked as pregnancy progresses and the glucose demand of the fetus increases.
• Levels of placental steroid and peptide hormones (eg, estrogens, progesterone, and chorionic somatomammotropin) rise linearly throughout the second and third trimesters. Because these hormones confer increasing tissue insulin resistance as their levels rise, the demand for increased insulin secretion with feeding escalates progressively during pregnancy. Twenty-four–hour mean insulin levels are 50% higher in the third trimester compared to the nonpregnant state.
• If the maternal pancreatic insulin response is inadequate, maternal and, then, fetal hyperglycemia results. This typically manifests as recurrent postprandial hyperglycemic episodes. These postprandial episodes are most significantly accountable for the accelerated growth exhibited by the fetus.
  Surging maternal and fetal glucose levels are accompanied by episodic fetal hyperinsulinemia. Fetal hyperinsulinemia promotes excess nutrient storage, resulting in macrosomia. The energy expenditure associated with the conversion of excess glucose into fat causes depletion in fetal oxygen levels.
• These episodes of fetal hypoxia are accompanied by surges in adrenal catecholamines, which, in turn, cause hypertension, cardiac remodeling and hypertrophy, stimulation of erythropoietin, red cell hyperplasia, and increased hematocrit. Polycythemia (hematocrit >65%) occurs in 5-10% of newborns of diabetic mothers. This finding appears to be related to the level of glycemic control and is mediated by decreased fetal oxygen tension. High hematocrit values in the neonate lead to vascular sludging, poor circulation, and postnatal hyperbilirubinemia.

During a healthy pregnancy, mean fasting blood sugar levels decline progressively to a remarkably low value of 74 ± 2.7 (SD) mg/dL. On the other hand, peak postprandial blood sugar values rarely exceed 120 mg/dL. Meticulous replication of the normal glycemic profile during pregnancy has been demonstrated to reduce the macrosomia rate. Specifically, when 2 hour postprandial glucose levels are maintained less than 120 mg/dL, approximately 20% of fetuses demonstrate macrosomia. Conversely, if postprandial levels range up to 160 mg/dL, macrosomia rates rise to 35%.

Frequency

United States

In the United States today, 21 million people (7% of the population) have some form of diagnosed diabetes. Another 6 million people may be undiagnosed. Approximately 3-10% of pregnancies in the United States are complicated by diabetes, of which 90% is gestational diabetes and 8% is preexisting, insulin-resistant (ie, adult-onset) diabetes. The incidence of insulin-resistant diabetes is increasing markedly in the United States, probably related to rising population obesity and shifts in ethnicity.In addition to these factors contributing to a rise in the prevalence of diabetes among reproductive aged women, medical interventions during pregnancy may increase the likelihood of developing gestational diabetes. A study reported in 2007 has demonstrated and increased incidence of gestational diabetes mellitus in women receiving prophylactic 17 alpha-hydroxyprogesterone caproate for the prevention of recurrent preterm delivery (from 4.9% in control to 12.9% in treated patients).1

Race

The prevalence of gestational diabetes is strongly related to the patient's race and culture.

• Prevalence rates are higher in African, Hispanic, Native American and Asian women than in white women.
• Typically, only 1.5-2% of Caucasian women develop gestational diabetes mellitus, while Native Americans from the southwestern United States may have rates as high as 15%.
• In Hispanic, African American, and Asian populations, the incidence is 5-8%.
• In these high-risk populations, the recurrence risk with future pregnancies has been reported to be as high as 68%.2 In addition, approximately one-third will develop overt diabetes mellitus within 5 years of delivery, with higher risk ethnicities having risks nearing 50%.3
• Race also influences many complications of diabetes mellitus in pregnancy. For instance, African Americans have been shown to have lower rates of macrosomia, despite similar levels of glycemic control. Conversely, Hispanic women have higher rates of macrosomia and birth injury than women of other ethnicities, even with aggressive management.4, 5

To be continue..............

Smoking cigarettes is a very dangerous habit

Smoking cigarettes is a very dangerous habit. Long gone are the days when smoking was cool and practically everyone smoked. Today we are all too aware of the damages cigarette smoking causes. If you are smoking now, chances are you would like to quit. Maybe you have even tried to quit, but the cigarettes have too strong a hold on you.
Well today we have new aids to help you quit smoking that can actually make the process more bearable to get you to finally quit for good. One of the easiest to get and use is the nicotine patch.
What is NRT?
When you quit smoking, your body will go through withdrawal symptoms from the absence of nicotine. One way to ease some of the symptoms is to use a nicotine replacement therapy, or NRT, program. There are a few different NRTs available: nicotine gum, lozenges, nasal sprays, inhalers and the nicotine patch.
However, not all of these products are available over-the-counter, while at least one brand of the patch is. The nicotine in the patch, unlike other NRT products, is delivered trasnsdermally, or through the skin, and in a consistent dose throughout the day. It's worn on the skin very much like a bandage and usually for about a 24 hour period.
How Can a NRT Help Me Quit Smoking?
Any NRT is designed to assist you when you decide to quit. You should not wear the patch and smoke cigarettes at the same time. Once you have put the cigarettes down for good, the NRT will still deliver the nicotine to the bloodstream, but without all the other 4,000 chemicals contained in the tobacco of your cigarettes.
In this way, you can break yourself of the habit of smoking while allowing your body a chance to wean off of the nicotine. The patches come in multiple sizes; larger patches have more nicotine and smaller ones have less. You can "step-down" your nicotine intake slowly, giving your body a chance to deal with the withdrawal in smaller doses. Quitting smoking is the important part. The chemicals in the tobacco products are highly dangerous and once you put the cigarettes down, your body can begin the process of repairing the damage caused by the act of smoking tobacco. Tobacco contains chemicals such as arsenic, formaldehyde, acetone, tar and carbon monoxide, which are all deadly in larger doses.
So, smoking for several years is essentially the same as poisoning your own body. With the NRT, you can still get the nicotine "fix" your body craves without subjecting your insides to these extremely toxic chemicals.
Make the Decision to Quit
Deciding to quit smoking is a huge step towards a healthier, happier lifestyle. Don't take it lightly; it's a very large mountain to climb. You should set a date to quit and plan a reward at your completion date to give you added motivation. And if cold turkey doesn't seem like something you can do, then look to the assistance that is available to you. The nicotine patch has helped many people achieve their non-smoking dreams and could possibly help you too.

Anti Aging

Age reversing or anti aging serums have been around for some years now and most of them claim to give the best results as far as performance, effectiveness and price. However using a few ways you can find out the best anti aging skin cream and come to a conclusion.Anything that can stop the process of aging and even reverse it has to be an innovative scientific breakthrough that stands out. There was a time when only the extremely rich could afford these marvels, but not anymore - now their prices have come down rapidly. And that is why today you will find many serums, creams, lotions and gels that are being made by cosmetic companies and they are inspired by foundations and institutes like the American Academy of Anti-aging Medicine.But before you select your anti aging skin cream do ensure that it can achieve the following… It is a good idea to check these out before deciding on your product.