What are some of the potential uses of cardiac MRI?

Once certain limitations are overcome - and that day seems to be rapidly approaching - the uses of cardiac MRI will greatly increase.

MRI has the potential (and has been used in the research setting) to diagnose heart attacks in patients presenting with chest pain. Not infrequently, a patient coming to the emergency room with chest pain will not have the typical ECG changes seen with myocardial infarctions, and the doctors end up waiting for an hour or two for the results of cardiac enzyme tests. If a heart attack is actually occurring, critical time is thus lost before therapy can begin. MRI can detect myocardial infarction immediately, and can reduce the time it takes to begin definitive treatment.

Strides are being made toward being able to diagnose coronary artery disease with MRI. A new MRI processing technique called "black-blood" MRI (so called because it produces an image of an artery in which the blood appears black, and the wall of the artery appears white) seems to be able to distinguish very nicely between normal and atherosclerotic coronary arteries. While further refinements are necessary, such techniques are bringing us very close to the day in which MRI will be able to replace cardiac catheterization for diagnosing coronary artery disease.

MRI can help distinguish between "stable atherosclerotic plaques and "vulnerable" plaques. Vulnerable plaques are those that are prone to rupture, thus suddenly occluding a coronary artery and causing a myocardial infarction. If vulnerable plaques can be identified (and this is something the cardiac catheterization cannot do), those particular plaques can be targeted for intervention (angioplasty, stent, or bypass surgery), while leaving the stable plaques alone. MRI has already proven useful in the research setting for identifying restenosis after angioplasty. MRI might thus prove an accurate, noninvasive means of following patients after angioplasty.

MRI has the potential of detecting changes in the tiny blood vessels of the heart the microvascular circulation that are completely missed by cardiac catheterization. Detecting such changes seem to be useful in predicting the outcome of patients after a heart attack, and may prove to be useful in assessing patients with cardiac syndrome x, diabetes, and certain other conditions.

Ultimately, MRI may replace the x-ray tube in both diagnostic and therapeutic situations. Research is already being done in animals using MRI to image the coronary arteries instead of using x-rays for angioplasty procedures. The technology that allows these potential uses of cardiac MRI is presently being tested and refined. Within a few years, at least some of these uses will come into widespread clinical application.

Treating Gallstones and Bile Duct Stones

Gallstones and bile duct stones may be treated first with antibiotics to help control infection. They also can be treated at the time of diagnosis with miniaturized surgical instruments inserted through an ERCP. Alternatively, stones may be treated with medications that dissolve them, with lithotripsy that uses sound waves to break them up, or with surgery to remove the gallbladder.

ENDOSCOPIC TECHNIQUES
When a stone has been identified on x-ray, ultrasound or MRI imaging as blocking a bile or pancreatic duct, it can be removed with miniaturized instruments inserted through the ERCP. These surgical instruments gently enlarge the ductal opening that then allows the stone to be removed.

MEDICATIONS
Medications can be given that dissolve gallstones but they are not always effective and are not indicated in all cases. The most common medication is a bile salt (ursodiol) that slowly dissolves cholesterol within the stones. However, the stones can return when the medication is discontinued.

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
This treatment employs high-frequency sound waves to break up gallstones. Patients then take bile salt tablets, sometimes indefinitely, to dissolve the pieces and to ensure that the stones do not return. Only a minority of patients are candidates for this type of treatment, however. The best candidates have a single small stone. If an infection (cholangitis) or inflammation (cholecystitis) of the gallbladder is present, lithotripsy is not an option. Extracorporeal (meaning outside of the body) shock wave lithotripsy is performed by directing pulsating, high-intensity sound waves at the area where the stone is located, identified first by ultrasound. The procedure takes about 45 minutes and patients are usually lightly sedated before treatment.

SURGERY
Surgery to remove the gallbladder, called cholecystectomy, is a common procedure in the United States for individuals with symptoms caused by gallstones. Virginia Mason was one of the first medical centers in the country to remove the gallbladder by the minimally invasive laparoscopic approach, called laparoscopic cholecystectomy.

This minimally invasive surgery for removing the gallbladder is one of the most common procedures performed at Virginia Mason and is, in fact, the preferred approach today for removal of the gallbladder. In cases in which a gallstone or bile stone has blocked a bile duct - a situation that can lead to infection or inflammation of organs within the biliary tract - surgeons will likely recommend removal of the gallbladder.
Laparoscopy
During laparoscopy, the surgeon makes several ¼ to ½ inch incisions in the abdomen. He or she then inserts miniaturized endoscopic and surgical instruments, and a small camera, through these "ports." Images from the camera are sent to a video monitor that allows the surgeon to "deflate" and then remove the gallbladder through one of the ports. Individuals return to their regular activities often within a few days.

Open surgery
Sometimes the surgeon must revert to an open surgical procedure during a scheduled laparoscopy to remove the gallbladder. These occurrences happen infrequently and are most often caused when the gallbladder is found to be infected or when the gallbladder lining is hardened, making it more difficult for the organ to be removed laparoscopically.

At other times, the surgeon may make the decision that the open surgical procedure is the best option for the patient based on the severity of the individual's gallbladder disease. Open surgery involves making a large incision in the abdomen and removing the gallbladder. Recovery time is longer, five to seven days in the hospital, and there is a longer return to daily activities: two to three weeks, for example.

Symptoms of Gallstones and Bile Duct Stones

Gallstones can be miniscule in size or as large as a ping-pong ball. You may have one stone or develop many of them. Not all gallstones or bile stones cause symptoms. Some are discovered incidentally during imaging studies for other reasons.

The most common symptom is upper abdominal pain on the right side of the body, where the liver and gallbladder are situated. The pain may start suddenly and be intense. Or it may be a slow, dull pain or occur intermittently. The pain may shift from the abdominal area to the upper back or shoulder.

Prolonged blockage of a bile duct can cause a buildup of waste products in the biliary tract and in the bloodstream, leading to an infection called cholangitis. It also can prevent the release of bile into the small intestine to help digest food or cause a serious bacterial infection in the liver called ascending cholangitis.

A blocked bile duct may result in inflammation of the gallbladder, called cholecystitis. A gallstone or bile stone in the common bile duct may block the pancreatic duct, causing painful inflammation of the pancreas or pancreatitis.  

If a stone completely blocks the ducts of the gallbladder, liver, common bile duct or pancreas, other symptoms may include:

• Nausea
• Fever
• Chills
• Yellow skin or eyes (from the build up of bilirubin, a waste product in blood)
• Dark urine
• Itching
• Fatigue
• Weight loss
• Night sweats
• Loss of appetite
• Greasy or light-colored stools

Patients who develop gallstones are at a slightly increased risk of developing gallbladder cancer, called cholangiocarcinoma. However, this is a rare disease and most people with gallstones do not go on to develop cancer.

സെക്‌സിന് ശേഷം

പങ്കാളിയുമൊത്തെ സെക്‌സ് ആസ്വദിച്ചശേഷം നിങ്ങള്‍ എന്ത് ചെയ്യും? സെക്‌സിലൂടെ പങ്കാളിയെ സന്തോഷിപ്പിക്കുകയെന്നത് പോലെ തന്നെ പ്രധാനപ്പെട്ടതാണ് സെക്‌സിന് ശേഷവും ആ സന്തോഷം നിലനിര്‍ത്തുകയെന്നത്.
സെക്‌സിന് ശേഷം മനപൂര്‍വമല്ലെങ്കിലും നിങ്ങള്‍ ചെയ്യുന്ന ചില കാര്യങ്ങള്‍ പലപ്പോഴും പങ്കാളിയുടെ മനസിന് വേദന നല്‍കുന്നതാണ്. അത് പങ്കാളിയുടെ സെക്ഷ്വല്‍ മൂഡ് തന്നെ ഇല്ലാതാക്കും.
സെക്‌സിന് ശേഷം മറ്റെന്തെങ്കിലും ജോലിയില്‍ മുഴുകുന്ന പങ്കാളികളില്‍ പലരും സെക്‌സിനെ ഒരു കടമയായാണ് കാണുന്നതെന്ന് സെക്‌സ് തെറാപ്പിസ്റ്റായ ഡോ. പുഷ്‌കര്‍ ഗുപ്ത കുറ്റപ്പെടുത്തുന്നു. ലൈംഗികബന്ധം ആസ്വദിക്കാനുള്ളതാണ്. സെക്‌സിന് ശേഷവും ആ മാനസികാവസ്ഥ നിലനിര്‍ത്താന്‍ പലകാര്യങ്ങളും ചെയ്യാമെന്നിരിക്കെ പലരും സീരിയസായ ജോലികളില്‍ മുഴുകുകയാണ് പതിവ്. ഇത് തങ്ങള്‍ ചെയ്യുന്ന വലിയ തെറ്റുകളിലൊന്നാണെന്ന് പലരും തിരിച്ചറിയില്ലെന്നും പുഷ്‌കര്‍ ഗുപ്ത വ്യക്തമാക്കി.
പങ്കാളിയുടെ ഈ പ്രവൃത്തി മറ്റെയാളെ അപമാനിക്കുന്നതിന് തുല്യമാണെന്നാണ് അമിത് മിശ്ര ചൂണ്ടിക്കാണിക്കുന്നു.
സാധാരണയായി പല ദമ്പതികളും ആവര്‍ത്തിക്കാറുള്ള ‘സെക്‌സിന് ശേഷമുള്ള തെറ്റ്’ ഇവയാണ്.
കിടന്നുറങ്ങുക:
പല ദമ്പതികള്‍ക്കിടയിലും ഈ പ്രശ്‌നം കാണാം. ഒന്നുകില്‍ പങ്കാളികളില്‍ ഒരാള്‍ അല്ലെങ്കില്‍ രണ്ടുപേരും സെക്‌സിന് ശേഷം കിടന്നുറങ്ങും. ഇന്ന് ലൈംഗിക ബന്ധത്തിന്റെ ആനന്ദം കെടുത്തും.
വൃത്തിയാക്കാന്‍ പോകുക: ശാരീരിക ബന്ധം കഴിഞ്ഞാലുടന്‍ വാഷ്‌റൂമിലേക്ക് പോകുന്ന ശീലം ചിലര്‍ക്കുണ്ട്. പലപ്പോഴും പങ്കാളി സെക്‌സ് ആസ്വദിക്കുന്ന മൂഡിലാവും ഉണ്ടാവുക. നിങ്ങള്‍ ഉടന്‍ തന്നെ വാഷ്‌റൂമിലേക്ക് പോകുമ്പോള്‍ മറ്റേയാളില്‍ അത് വിഷമമുണ്ടാക്കും. തന്റെ ഭാഗത്തുനിന്നുണ്ടായ മോശമായ പ്രവൃത്തിയാണ് ഇതിന് കാരണമെന്ന തോന്നല്‍ അവരിലുണ്ടാകും. ഇത് സെക്‌സിന്റെ സന്തോഷം ഇല്ലാതാക്കും.
സുഹൃത്തിനെ വിളിക്കുക:
പലപ്പോഴും ഔദ്യോഗിക കാര്യങ്ങള്‍ക്കും മറ്റുമാകും നിങ്ങള്‍ സുഹൃത്തിനെ വിളിക്കുന്നത്. എങ്കിലും അതിന് പിറ്റേദിവസം രാവിലെ വരെ കാത്തിരുന്നുകൂടെ? സെക്‌സ് ആസ്വദിക്കാനുള്ള സമയത്ത് നിങ്ങളുടെ മൊബൈല്‍ ഫോണിലെ മെസേജില്‍ നിന്നും മിസ്ഡ് കോളില്‍ നിന്നും കണ്ണെടുക്കണം. അല്ലാത്തപക്ഷം നിങ്ങള്‍ക്ക്  സംതൃപ്തി നല്‍കാനായില്ലെന്ന തോന്നല്‍ പങ്കാളിയിലുണ്ടാക്കും.
പഠനത്തിലോ ജോലിയിലോ മുഴുകുക:
സെക്‌സിന് ശേഷം പങ്കാളിയെ തനിച്ചാക്കി പഠനത്തിനോ അല്ലെങ്കില്‍ ജോലിയിലോ മുഴുകുന്ന ശീലം ചിലര്‍ക്കുണ്ട്. ഇത് ഒരിക്കലും നല്ല ലൈംഗികബന്ധത്തിന് യോജിച്ചതല്ല.
രണ്ടിടത്ത് ഉറങ്ങുക:
സെക്‌സിന് ശേഷം ചിലര്‍ ഗസ്റ്റ് റൂമിലോ, ടെറസിലോ പോയി കിടന്നുറങ്ങും. ഈ ശീലവും ആരോഗ്യകരമായ ലൈംഗികജീവിതത്തിന് യോജിച്ചതല്ല.
കുട്ടികളെ അടുത്ത് കൊണ്ടുവന്ന് കിടത്തുക:
സെക്‌സിന് ശേഷം നിങ്ങളുടെ സ്വകാര്യതയിലേക്ക് മറ്റാരെയെങ്കിലും കൊണ്ടുവരുന്നത് ഒരിക്കലും നല്ലതല്ല. ചില അമ്മമാര്‍ കുഞ്ഞുങ്ങളെ അടുത്തെടുത്ത് കിടത്താറുണ്ട്. എന്നാല്‍ ഇതെല്ലാം പങ്കാളിയുടെ ആനന്ദത്തെ തകര്‍ക്കും.
ഭക്ഷണം കഴിക്കുക:
നിങ്ങളുടെ പങ്കാളിയുമൊത്ത് ഭക്ഷണം കഴിക്കുന്നത് നല്ലകാര്യമാണ്. എന്നാല്‍ സെക്‌സിന് ശേഷം നേരെ അടുക്കളയിലേക്ക് പോയി എന്തെങ്കിലും തിന്നുന്നത് മോശമായ കാര്യമാണ്. നിങ്ങള്‍ വിശപ്പ് കാരണം സെക്‌സ് ആസ്വദിച്ചില്ലെന്ന തോന്നല്‍ ഇത് പങ്കാളിയിലുണ്ടാക്കും.

Myasthenia Gravis

Myasthenia gravis is a disease of the junctions where nerves that control muscle function meet the muscles themselves (the neuromuscular junction).  In myasthenia gravis patients, antibodies form within the neuromuscular junction that make the transmission of nerve impulses from nerve to muscle less efficient.  This creates a variety of problems which may include weakness of the peripheral muscles (usually worsening with repetitive contraction of the muscles), droopy eyelids (ptosis), double vision, and swallowing or breathing difficulties.

Drug therapy, which usually is initiated with pyridostigmine (mestinon) alone, often helps these symptoms of myasthenia gravis. Other, immunosuppressive drugs, such as prednisone or azathioprine, are added in some cases.

Surgical removal of the thymus gland (thymectomy) has had a role in the management of patients with thymoma for over 70 years.  Although it has never been studied versus medical therapy in a randomized trial (where patients are “randomized” to either have surgery or have no surgery),  many non-randomized studies suggest that the operation is beneficial.  While very few patients have a complete remission of the disease without thymectomy, 30-40% of patients will have a complete remission after surgery.

At Stanford, we are able to perform thymectomy for most myasthenia gravis patients through a single, 5 cm long incision at the base of the neck. This operation, called transcervical thymectomy can be performed with very little risk or discomfort. Patients return home the day of surgery or the following day, and they generally return to their usual activities within a week. The alternative procedure – thymectomy through a median sternotomy – has a substantially increased complication rate in patients with myasthenia gravis, who are susceptible to lung and other complications due to their muscle weakness.

Before coming to Stanford, Division Chief Dr. Joseph Shrager published the world’s largest series of extended transcervical thymectomy. This study demonstrated that the operation provides very similar remission rates to those achieved by thymectomy by median sternotomy, with far less complications and faster recovery. We are among the centers that has the greatest experience with this operation, and we are pleased to be able to offer it to myasthenia gravis patients in the greater San Francisco Bay Area as well as those from around the country.

Robotic Surgery for Prostate Cancer

Dr. Michael Stifelman provides an overview of robotic surgery for prostate cancer in this video interview.

Robotic Surgery for Prostate Cancer

Robot-assisted radical prostatectomy involves the surgical removal of the entire prostate and seminal vesicles in men with prostate cancer. The procedure is done primarily when there is a good likelihood the disease is confined to the prostate, with the intent of curing the cancer. Thanks to recent advances in robotic surgical technology, robotic prostatectomy is emerging as an increasingly desirable alternative to traditional open prostate surgery. The outcomes of robotic prostatectomyappear comparable to open surgery in terms of both tumor removal and minimizing the likelihood of post-operative side effects, including impotence or incontinence. Robot-assisted prostatectomy also offers the potential for improved vision and dexterity on the surgeon’s part, and reduced blood loss and rapid recovery for the patient.

How is Robotic Prostatectomy Performed?

After the patent is anesthesized, five small incisions (about an inch wide) are made across the abdomen and ports are placed in them, four forthe robot’s camera and instrument arms and a fifth for passing needles in and out during surgery. An additional, smaller incision is made for the passing of instruments.

Since the prostate sits outside the abdominal cavity in the pelvis, the surgeon must reach it by cutting through the abdominal cavity’s lining (the peritoneum) from the inside. In the process, the bladder is released from its abdominal attachments to allow access to the prostate.Once the prostate is exposed, the surgeon frees the attachments surrounding the prostate, and the dorsal vein complex (a large vein network running over the prostate) is tied to avoid bleeding. The bladder neck is then cut and the bladder rolled away, after which the vas deferens (the tubes carrying sperm from the testicles) are cut, and the adjacent seminal vesicles (the sacs that hold the semen expelled during ejaculation) are freed along with the prostate.

Next, the surgeon develops a separation between the rectum and the prostate, and the blood supply to the prostate is then cut. The surgeon must be very careful at this point not to injure the nerve bundles that allow erections, which lie in a groove between the prostate and the rectum and resemble a fine spider web. The surgeon protects them by rolling the web of nerves away from the prostate, taking care not to damage its structures.

Finally, the dorsal vein complex and the urethra are cut, completely freeing the prostate, which is placed in a plastic bag for removal. In most cases, the lymph nodes are then removed for sampling, in order to guide future treatment. Robotics is ideally suited to this important staging procedure, since it allows the delicate dissection of the lymph nodes from important nerves and blood vessels with minimal blood loss and high accuracy.  Finally, the bladder neck is reattached to the urethra. Multiple steps are taken in this part of the operation to ensure a tension-free, water-tight closure between the bladder and the urethra.

Advantages of Robotic Prostatectomy

Less scarring with robotic prostatectomy.

Much smaller incisions are utilized for the robotic approach than with the traditional open approach. Also, these incisions are located across the abdomen, rather than vertically on the lower abdomen as with open surgery.

Less post-operative pain with robotic prostatectomy.

In general, patients undergoing roboticprostatectomy utilize less pain medication during recovery than those undergoing open surgery. While they are usually discharged on oral pain medications, many men don’t need to use such medications for more than afew days.

Less blood loss with robotic prostatectomy.

While the percentage of patients needing transfusions with open radical prostatectomy at the Smilow Center has historically been very low (3 to 5%), nationally the transfusion rate has been as high as 20 to 30%. For robot-assisted radical prostatectomy, however, transfusion rates nationwide have been quite low (2 to 3%), with less blood loss per case also reported. This means there is generally no need for pre-operative blood donation by thepatient or administration of drugs to increase the blood count prior to surgery. Additionally, while it’s hard to measure, patients discharged after surgery with higher blood counts may feel stronger and recover more easily than those with low blood counts. This may contribute to the rapid convalescence observed with robot-assisted prostatectomy.

The visual approach of robotic prostatectomy offers certain potential advantages.

1. The magnification of the da Vinci Si's 3-D, high-definition camera offers enhanced visualization of small blood vessels, nerves, and other structures around the prostate gland during dissection.
2. When approaching the prostate from the abdomen, the mobile camera view allows the surgeon to easily look behind the prostate, where nerve fibers are located, and to visualize specific structures from various vantage points.
3. The dexterity and visualization of the robot allow the surgeon to perform a tension-free, water-tight closure of the bladder and the urethra.  Finally, the ability of the surgeon to control the camera personally (unlike laparoscopic surgery) allows the instrument movement to be synchronized with the camera.

Robotic Prostatectomy at the Smilow Center

The urologic surgeons at the Smilow Center in New York City are among the most experienced in the world at performing both robotic and open prostatectomies. Our surgical team performed over 1,000 open procedures prior to taking up the robotic approach. The successful treatment of prostate cancer is our overriding goal at Smilow, and our utilization of robotic prostatectomy reflects our firm conviction that robotic technology and surgical techniques have advanced to the point where the outcomes of robotic prostatectomy are equivalent to those of open prostatectomy.

In addition, having now performed robotic prostatectomies for a number of years, we believe the robotic approach, with its magnified, 3-D visualization and general absence of blood loss, allows for a better view of the structures being dissected than open surgery, and also appears to result in an easier convalescence for patients. As established leaders in this surgical area, we also know that the techniques utilized in this procedure will become increasingly refined in the years ahead, as our own experience grows and as robot-assisted surgical technology continues to improve.

Avoiding Exposure in Pregnancy

No law or professional standard requires that radiologists determine in advance whether a patient of childbearing-age is pregnant [1]. However, it is clearly good practice to implement the following guidelines:

Signs should be prominently displayed in all radiology departments asking each patient to notify a technologist or physician if she is, or thinks she could be, pregnant.
All technologists should ask women of childbearing-age if they might be pregnant prior to performing a radiologic procedure.
Radiology requisition forms filled out by referring physicians should include a section dealing with the possibility of pregnancy.
No radiological procedure involving exposure to the pelvis should be undertaken in a patient who declares she may be pregnant without consultation with a radiologist. The radiologist should discuss risks and benefits with the patient, and determine if it is appropriate to proceed, perform an alternative procedure, or delay the study to allow performance of a pregnancy test.

It should be noted that current recommendations do not recognize a safe period during the menstrual cycle, and so the concept of the "ten day rule" is obsolete. A patient who thinks she may be pregnant should be discussed with the referring physician, in order to determine the appropriate course of action (e.g., rescheduling after pregnancy testing, proceeding with the test after counseling, or changing to another modality).

Key point: It is the responsibility of the patient to disclose any possibility of pregnancy, although appropriate signage and questioning of all women of reproductive age is also critical. The supervising radiologist should discuss any cases of possible pregnancy with the referring physician.

Scanner for security an radiation

In our frightening new world, x-rays and CTs have become as important for airports as for hospitals.  Hand luggage is put through x-ray scanners; because one pass exposes your items to only a tiny fraction of the energy used in a chest x-ray, these scanners are safe for photographic film — and for the security personnel who use them all day long.  But checked baggage is passed through CT scanners that are far more powerful; they will damage your film but not your medications.

The new full-body scanners have raised concerns about privacy and safety.  The privacy issue is personal, but the safety issue is a scientific matter — and scientists agree that scanners are safe.  Two types are in use.  Millimeter wave scanners use radio waves to generate images, and they don’t expose travelers to any ionizing radiation.  Backscatter scanners do use low-intensity x-rays, but they bounce off the skin without penetrating the body.  They deliver only a tiny amount of radiation, about the same amount as you get in three to nine minutes of daily living, or about 1/1000 as much as an ordinary chest x-ray.  A person would need to have 2,500 to 5,000 backscatter scans a year to reach the established annual safety limit.

KIDNEY STONE TREATMENT

Treatment of a kidney stone that is causing obstruction depends upon the size and location of the stone, as well as your pain and ability to keep down fluids. If your stone is likely to pass, your pain is tolerable, and you are able to eat and drink, then you can be treated at home.

If you have severe pain or nausea, you will need to be treated with stronger pain medications and IV fluids, which are often given in the hospital. In addition, patients with stones and who also have a fever should be treated in the hospital as soon as possible to avoid a life-threatening infection. (See "Options in the management of renal and ureteral stones in adults".)

Home treatment — You can take non-prescription pain medication until the stone passes. This includes nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) or naproxen (Aleve), but it is important to check with your doctor first.

Other medications, such as tamsulosin, may also be recommended to speed the passage of stones.

You will probably be asked to strain your urine to recover the stone; after you retrieve it, you should bring it to your doctor so it can then be analyzed in a laboratory to determine the composition of the stone (eg, calcium oxalate, uric acid, etc). Knowing what type of kidney stone you have is important in planning treatments to prevent future stones. (See 'Kidney stone prevention' below.)

If the stone does not pass — Stones larger than 9 or 10 millimeters rarely pass on their own and generally require a procedure to break up or remove the stone. Some smaller stones also do not pass. Several procedures are available.

Shock wave lithotripsy (SWL) — Lithotripsy is a reasonable treatment option in many patients who need help passing a stone. Lithotripsy is particularly good for stones 1 cm or less in the kidney and upper ureter. Lithotripsy is not effective for treating large or hard stones. You may require medication to make you sleepy and reduce pain during lithotripsy treatment, although this depends upon the type of lithotripsy equipment used.

Lithotripsy is performed by directing high-energy shock waves toward the stone. These sound waves pass through the skin and bodily tissues and release energy at the stone surface. This energy causes the stone to break into fragments that can be more easily passed in the urine.

Percutaneous nephrolithotomy (PNL) — Extremely large or complex stones, or large stones resistant to shock wave lithotripsy, may require a minimally invasive surgical procedure to remove the stone. In this procedure, a small endoscopic instrument is passed through the skin (percutaneously) of the back into the kidney to remove the stone.

Ureteroscopy — Ureteroscopy is a common endoscopic procedure that uses a thin scope, which is passed through the urethra and bladder, into the ureter and kidney. This endoscope allows the urologist to see the stone and remove it, or to break up the stone into smaller pieces that can pass more easily. Ureteroscopy is often used to remove stones blocking the ureter, and sometimes for small stones in the kidney.

Treatment of asymptomatic stones — If you have a kidney stone that is causing no symptoms, you may or may not need to remove the stone. The decision is based upon the size and location of your stone, as well as your ability to be treated quickly if symptoms were to develop. If there is a chance that you would not be able to get treatment quickly (eg, if you travel frequently), you are more likely to be advised to have the stone removed.

Regardless of the decision to treat or not, you should be evaluated for underlying health conditions that can increase the risk of kidney stones 

3D Mammograms May Actually TRIPLE Your Radiation Dose

Just how much more radiation are you getting with these new 3D mammograms? There are different estimates in circulation, partly because some folks are not including the radiation exposure from the standard mammogram into the total. When you add the 2D and 3D scans together, utilizing tomosynthesis at least doubles your radiation exposure, and some estimates have your exposure tripling, such as this 2011 study published in Radiology Today,2 which states that:

"Because the digital breast tomosynthesis (DBT) exam requires two additional exposures over a standard mammogram, the total radiation dose from the combined 2D and tomosynthesis examination is three times that of a standard mammogram."

The authors note that both scans (2D and 3D) are required because studies done prior to FDA approval failed to conclusively show better sensitivity of 3D alone, compared to 2D imaging.3 They also state that it’s too early to know how useful this new breast imaging technology will be. Some insurance companies—Aetna4 for one—have rejected it, citing “insufficient evidence of its effectiveness.”

The bottom line is, the industry reports tomosynthesis has 1.5 to 2 times the radiation dose. The FDA reports it has double the dose. And the radiologists, who are looking at total exposure, report triple the dose over conventional mammograms. You can see this comparison in a chart on page 8 of an FDA Executive Summary, “Average Glandular Dose per Breast.”5

Tomosynthesis is being touted by the industry as being particularly helpful for identifying cancer in women with dense breast tissue. However, these women already have a four to six times greater risk of developing breast cancer. Knowing that ionizing radiation is a direct cause of cancer, how can a test that triples your radiation exposure be of any benefit if you have potentially cancer-prone breasts to begin with?

Did You Know That 30 Percent of Breast Tumors Go Away on Their Own?

Getting back to breast cancer, it is important to realize that, if your immune system is healthy and strong, it’s capable of ridding your body of tumors—even cancerous ones. According to breast surgeon Susan Love of UCLA, at least 30 percent of tumors found on mammograms would go away if you did absolutely nothing.7 These tumors appear to be destined to stop growing on their own, shrink, and even go away completely. Nearly everyone has cancerous and pre-cancerous cells in their bodies by middle age, but not everyone develops cancer. The better you take care of your immune system, the better it will take care of you.

One way to strengthen your immune system is to minimize your exposure to mammograms and other sources of ionizing radiation, especially mega sources such as these new 3D scans and CTs. But you can also build up your immune system DAILY by making good diet and lifestyle choices.

അധ്യാപികയെ മൂന്ന് വിദ്യാര്‍ത്ഥികള്‍ ചേര്‍ന്ന് ബലാത്സംഗം ചെയ്തു; ദൃശ്യങ്ങള്‍ പകര്‍ത്തി ഭീഷണിപ്പെടുത്തി

മുസാഫര്‍നഗര്‍: രാജ്യത്തെ ഞെട്ടിച്ചുകൊണ്ട് ഉത്തര്‍പ്രദേശില്‍ വീണ്ടും ബലാത്സംഗം. മുസാഫര്‍നഗറിലാണ് സംഭവം. ട്യൂഷന്‍ കഴിഞ്ഞ് വീട്ടിലേക്ക് മടങ്ങുകയായിരുന്ന ഇരുപത്തിമൂന്ന്കാരിയായ അധ്യാപികയെ മൂന്ന് കോളേജ് വിദ്യാര്‍ത്ഥികള്‍ ചേര്‍ന്ന് ബലാത്സംഗം ചെയ്യുകയായിരുന്നു.

കഴിഞ്ഞ ദിവസം വൈകിട്ട് ട്യൂഷന്‍ കഴിഞ്ഞ് വീട്ടിലേക്ക് തിരിച്ചുപോയ അധ്യാപികയെ മോഹിത് എന്ന വിദ്യാര്‍ത്ഥി പുറകിലൂടെ വന്ന് വായ മൂടിക്കെട്ടി ആള്‍പാര്‍പ്പില്ലാത്ത കെട്ടിടത്തിലേക്ക് കൊണ്ടുപോയി. തുടര്‍ന്ന് ബലാത്സംഗം ചെയ്യുകയും ഇത് മൊബൈലില്‍ പകര്‍ത്തുകയും ചെയ്തു. ആരോടും പറയരുതെന്നും അല്ലെങ്കില്‍ ദൃശ്യങ്ങള്‍ പുറത്തുവിടുമെന്നും ഭീഷണിപ്പെടുത്തി.

പൊലീസ് മൂന്ന് വിദ്യാര്‍ത്ഥികളെയും അറസ്റ്റുചെയ്തു.

http://www.reporterlive.com/

ഗര്‍ഭകാലവും ലൈംഗികബന്ധവും - SEX DURING PREGNANCY

ഗര്‍ഭകാലത്തെ ലൈഗികബന്ധത്തില്‍ പ്രത്യേകം ശ്രദ്ധിക്കണം.
മറ്റു കുഴപ്പങ്ങളൊന്നിമില്ലെങ്കില്‍ ഗര്‍ഭ-കാലത്ത് 9-ാം മാസം വരെ സെക്‌സ് ആകാം. പക്ഷേ താഴെ പറയുന്ന കൂട്ടര്‍ ഗര്‍ഭകാലത്തു ലൈംഗികബന്ധം  ഒഴിവാക്കണം.
*ഇതിനു മുമ്പ് മാസം തികായാതെ കുഞ്ഞുങ്ങളെ പ്രസവിച്ചവര്‍
*ഡൈലേറ്റഡ് സെര്‍വിക്‌സ് ഉള്ളവര്‍ *ഒന്നര കി.ഗ്രാമില്‍ കുറഞ്ഞ വെയ്റ്റുള്ള ഭ്രൂണത്തെ വഹിക്കുന്നവര്‍ *ഇതിനു മുമ്പ് ഗര്‍ഭംഅലസിയവര്‍
പൊസിഷന്റെ കാര്യം പറഞ്ഞാല്‍ പ്രധാനമായു ശ്രദ്ധിക്കേണ്ട് ഇതാണ് :പുരുഷന്റെ ഭാരം സ്ത്രീയുടെ വയറ്റിലേക്കു വര രുത്.ചെരിഞ്ഞു കിടന്നു ബന്ധപ്പെടാം.ഭാര്യ മെത്തയില്‍ മുട്ടുകുത്തി നിന്നും ഭര്‍ത്താവ് പുറകില്‍ കൂടി പ്രവേശിക്കുന്ന പൊസിഷനും ആകാം.ഇനി ഭാര്യ മെത്തയ്ക്കു കുറുകെ കിടന്നുകൊണ്ടും ഭര്‍ത്താവ് കട്ടിനിന്റെ അരികെ നിന്നുംകൊണ്ടുമാകാം.ഭാര്യ ഭര്‍ത്താവിന്റെ മടിയില്‍ ഇരിക്കണം(രണ്ടു പേരും ഒരു കസേരയില്‍ ഇരിക്കണം.)ബന്ധത്തില്‍ ഏര്‍പ്പെടാം.പക്ഷേ എല്ലാറ്റിനും പ്രത്യേകം ശ്രദ്ധിക്കണം.

SEX DURING PREGNANCY-Sex is typically safe during all stages of a normal pregnancy unless yourOBGYN tells you otherwise. Of course you may not always be in the mood for sex. You and your partner should keep the lines of communication open and talk about ways to satisfy your needs for intimacy.

According to Hitched Magazine, “sex keeps mommy and daddy emotionally and physically connected, as you both experience the joys, doubts, and fears that pregnancy brings.”

Try cuddling, kissing or showering together to get the heat going. Communicate with each other about what feels best during intercourse; and remember that oral sex is always an option, if intercourse becomes painful or complicated during the late stages.

സ്ത്രീകള്‍ക്കും ആസ്വദിക്കാം സ്വയംരതി

സ്ത്രീകള്‍ക്കും ആസ്വദിക്കാം സ്വയംരതി.....

സ്വയം ആനന്ദിക്കാന്‍ കഴിയുന്നത് മഹാഭാഗ്യമാണ്. സ്വയം ശരീരത്തിനെയും മനസിനെയും സന്തോഷിപ്പിക്കാന്‍ കഴിയുമെങ്കില്‍ നന്നായി മറ്റുളളവരോട് ഇടപെടാനും പെരുമാറാനും കഴിയുമത്രേ. പലപ്പോഴും സ്വയം സന്തോഷിക്കാനറിയാത്തതു കൊണ്ടാണ് പലരും മാനസിക സംഘര്‍ഷത്തിന്റെ ആഴങ്ങളില്‍ പതിക്കുന്നത്.

ആരോഗ്യകരമായ ജീവിതത്തിന് ലൈംഗിക സംതൃപ്തി അനിവാര്യഘടകമാണ്. എന്നാല്‍ നമ്മുടെ സാമൂഹിക സാഹചര്യങ്ങള്‍ പൊതുവെ സ്ത്രീകള്‍ക്ക് പ്രതികൂലവുമാണ്. സ്വയം ലൈംഗികാനന്ദം കണ്ടെത്താനും സ്വന്തം ശരീരം ആസ്വദിക്കാനും കഴിയുന്ന സ്ത്രീകള്‍ വിരളമാണെന്നു തന്നെ പറയാം. ജോലിയുടെയും കുടുംബപ്രാരാബ്ധങ്ങളുടെയും തിരക്കില്‍ ആനന്ദിക്കാന്‍ മറന്നു പോകുന്ന സ്ത്രീകള്‍ക്കു വേണ്ടിയാണ് ഈ കുറിപ്പ്.

പൊതുവെ സ്വയംഭോഗം ചെയ്യുന്ന സ്ത്രീകള്‍ കുറവാണ്. ആസ്വദിച്ചു ചെയ്യുന്നവരാകട്ടെ വളരെ കുറവും. മനസു വച്ചാല്‍ ആര്‍ക്കും ആസ്വദിക്കാവുന്നതേയുളളൂ സ്വയംരതി.

സ്ത്രീകള്‍ രതിമൂര്‍ച്ഛയിലെത്തുന്നത് പ്രധാനമായും മൂന്നു തരം വിധങ്ങളാലാണ്. ക്ലിറ്റോറിസ് ഉത്തേജനം, യോനീഭോഗം, ജി സ്പോട്ട് ഉത്തേജനം. സ്വയം രതിയ്ക്ക് മുതിരുമ്പോഴും ഇത് മനസിലുണ്ടാവണം.
ഏതു സന്ദര്‍ഭത്തിലെയുമെന്ന പോലെ ഇവിടെയും അന്തരീക്ഷമൊരുക്കുക എന്നതാണ് പ്രധാനം. ആവശ്യത്തിന് സമയം കണ്ടെത്തുക എന്നതാണ് പ്രധാന വഴി. അടുപ്പില്‍ അരി തിളയ്ക്കുന്നതിനിടയ്ക്ക് അല്‍പം സ്വയം രതി നടത്തിക്കളയാം എന്ന ചിന്തയല്ല വേണ്ടത്.

ഏറ്റവും കുറഞ്ഞത് ഒരു അരമണിക്കൂര്‍ കണ്ടെത്തണം. മനസിന്റെ പിരിമുറുക്കങ്ങളെല്ലാം പോകട്ടെ. ആദ്യം ഒന്നു കുളിക്കാം. കിട്ടുമെങ്കില്‍ ഒരുഗ്ലാസ് വൈനുമാകാം. ഇല്ലെങ്കിലും കുഴപ്പമില്ല.

സ്ത്രീകളുടെ ലൈംഗികാസ്വാദനം അവരുടെ മാനസിക സുരക്ഷിതത്വവുമായി ഏറെ ബന്ധപ്പെട്ടിരിക്കുന്നതാണെന്ന് ഇടയ്ക്ക് ഓര്‍മ്മിപ്പിക്കട്ടെ. ശല്യപ്പെടുത്താന്‍ ആരും വരില്ലെന്ന ഉറപ്പാണ് സ്ത്രീയ്ക്ക് ഏറെ പ്രധാനം. അതുകൊണ്ടാണ് അന്തരീക്ഷമൊരുക്കുന്നത് വളരെ പ്രധാനകാര്യമായി മാറുന്നത്.

മൊബൈല്‍ അല്‍പ നേരെ ഓഫാകട്ടെ. ഫോണിന്റെ റിസീവര്‍ മാറ്റിവയ്ക്കുകയോ, കണക്ഷന്‍ ഊരിയിടുകയോ ആകാം. വാതില്‍ നന്നായി അടച്ചു കുറ്റിയിട്ടില്ലേ. ശല്യപ്പെടുത്താന്‍ ഇനിയാരുമെത്തില്ല. ഉറപ്പ്.

സൗകര്യപ്രദമായ തരത്തില്‍ ഇരിക്കുകയോ നില്‍ക്കുകയോ ആകാം. സ്ത്രീകള്‍ സാധാരണ സ്വയം ഉണര്‍ത്തുന്നത് നിതംബത്തില്‍ തഴുകിയാണ്. കൈകള്‍ തുടകളിലും അണിവയറിലും തഴുകലിന്റെ തരംഗങ്ങളുമായി വിലസുമ്പോള്‍ രതിവികാരം പതിയെ ഉണര്‍ന്നു തുടങ്ങും.
ഭാവന വിടരട്ടെ.. ശരീരമുണരട്ടെ.
വികാരപരവശയാകാന്‍ ഇനിയല്‍പം ഭാവനയുപയോഗിക്കാം. വിവാഹിതരാണെങ്കില്‍ മുറുകി നടന്ന വേഴ്ചയുടെ നിമിഷങ്ങള്‍ മനസിലേയ്ക്ക് കടന്നു വരട്ടെ. ശരീരമാകെ തീപടര്‍ത്തി അരക്കെട്ടില്‍ നടന്ന താണ്ഡവം. അന്നുവരെ കാണാത്ത ആവേശങ്ങളിലേയ്ക്ക് കുതിച്ചു പാഞ്ഞ സുന്ദര നിമിഷങ്ങള്‍ മനസിലെത്തട്ടെ.

ഇനി വിവാഹിതയല്ലെങ്കിലും നിരാശ വേണ്ട. രതിവികാരം ഉണര്‍ത്തുന്ന കഥകള്‍ വായിച്ചിട്ടില്ലേ. കൂട്ടുകാരികളാരെങ്കിലും പറഞ്ഞു തന്ന ലൈംഗികാനുഭവങ്ങളും ഓര്‍ക്കാം. ചില സിനിമാ രംഗങ്ങള്‍ മനസിലേയ്ക്ക് കൊണ്ടുവരാം. നായികയുടെ സ്ഥാനത്ത് സ്വയം സങ്കല്‍പിക്കാം.

ഒറ്റയ്ക്കല്ലേ ഉളളൂ. ഭാവന വിവസ്ത്രമായി പറക്കട്ടേ. ചോരയോട്ടം കൂടട്ടേ
അവയവങ്ങളൊന്നാസ്വദിക്കൂ...സ്വയം.
പലര്‍ക്കും അറിയില്ല സ്വന്തം ശരീരം എത്ര മനോഹരമാണെന്ന്. പൂര്‍ണനഗ്നയായി കണ്ണാടിയുടെ മുന്നില്‍ നിന്ന് ശരീരമാസകലം ഒന്നു നോക്കിയിട്ടുളള സ്ത്രീകള്‍ വളരെ കുറവായിരിക്കും. സ്വന്തം അഴകളവുകളുടെ ഭംഗിയും അവയവങ്ങളുടെ മുഴുപ്പും കൊഴുപ്പുമൊക്കെ സ്വയം ഒന്നാസ്വദിച്ചു നോക്കുന്നത് നന്നായിരിക്കും.

സ്വന്തം കൈകള്‍ അവിടവിടെ ഒന്നു ചലിപ്പിച്ചു നോക്കൂ. ഭര്‍ത്താവോ കാമുകനോ അങ്ങനെ ചെയ്യുന്നതായി സങ്കല്‍പിച്ചു കൊണ്ട്. അനുഭൂതിയുടെ ഇതുവരെ അറിഞ്ഞിട്ടില്ലാത്ത മേഖലകള്‍ ശരീരമറിഞ്ഞു തുടങ്ങും, സംശയമില്ല.

ലൈംഗികാവയവങ്ങള്‍ നല്ല വെളിച്ചത്തില്‍ നന്നായൊന്നാസ്വദിക്കാം. അതൊക്കെ ഒന്നു തടവിത്തലോടി നോക്കാം. സുഖകരമായ ഒരു തളര്‍ച്ച പടരാന്‍ തുടങ്ങും, മനസിലും ശരീരത്തിലും.

യോനിയുടെ ചുണ്ടുകളില്‍, ക്ലിറ്റോറിസില്‍, അടിവയറില്‍ ഒക്കെ വിരലും കൈയും വേണ്ടുന്ന ഇടപെടല്‍ നടത്തണം.
വിരലുകള്‍ റെഡിയല്ലേ....
വിരലുകള്‍ യഥാവിധി പ്രയോഗിക്കേണ്ട സമയമായി. ഒന്നോ രണ്ടോ വിരലുകള്‍ ഉപയോഗിച്ച് യോനിയുടെ മേല്‍ഭാഗത്ത് അമര്‍ത്തി ഉരയ്ക്കുകയാണ് ചെയ്യേണ്ടത്.

ലൈംഗികവികാരം പടര്‍ന്നു കയറുമ്പോള്‍ ക്ലീറ്റോറിസിലും യോനീദളങ്ങളിലും ഇത് ചെയ്യാം. സുഖം പകരുന്ന ഒരു താളം കണ്ടെത്തുക എന്നത് പ്രധാനമാണ്.

വേഗതയും ചലനവും സമ്മര്‍ദ്ദവും സ്വയം പരീക്ഷിച്ചാണ് ഈ താളം കരസ്ഥമാക്കേണ്ടത്.

ചൂണ്ടുവിരലും നടുവിരലും ക്ലിറ്റോറിസിന്റെ ഇരുവശങ്ങളിലും വച്ച് മുന്നോട്ടും പിന്നോട്ടും അമര്‍ത്തി ചലിപ്പിക്കുക എന്നതാണ് ഒരു രീതി. അല്ലെങ്കില്‍ ക്ലിറ്റോറിസിന്റെ മേല്‍ത്തടത്തില്‍ ഇരുവിരലുകളും അമര്‍ത്തി വൃത്താകൃതിയിലും ചലിപ്പിക്കാം.

ആസ്വാദ്യകരമായ താളം കണ്ടെത്തുക എന്നതാണ് പ്രധാനം.
ഒറ്റയ്ക്കല്ലേ...എന്തും ചെയ്യാം..
ഇത്രയുമേ ചെയ്യാവൂ എന്ന് ഒരു ഭരണഘടനയിലും പറയുന്നില്ല. ഇന്നതേ ചെയ്യാവൂ എന്ന് നിയമവുമില്ല. ശരീര കലകളില്‍ ആനന്ദം വന്നു നിറയുന്ന ഏതു പ്രവര്‍ത്തിയും ലൈംഗിക കാര്യത്തില്‍ അനുവദനീയമത്രേ.

പരീക്ഷണങ്ങള്‍ സദാ സജ്ജമായ മനസുണ്ടാവുക എന്നതാണ് പ്രധാനം.

വ്യത്യസ്ത രീതികളില്‍ പലേടത്തും തൊട്ടു നോക്കാം.സ്വയം ഇക്കിളിപ്പെടുത്താം. അമര്‍ത്തി തടവാം. തൂവലൊഴുകും പോലെ തഴുകാം. യോനിയുടെ ചുണ്ടുകളും മുലക്കണ്ണുകളും വലിച്ചു നീട്ടി നോക്കാം. ആരുമില്ലല്ലോ കാണാന്‍. ഇതൊക്കെ ആരെങ്കിലും അറിയുമെന്ന പേടിയും വേണ്ട.
ഒന്നു തളര്‍ന്നാല്‍ രണ്ട്... പിന്നെ....
ഒരു വിരലിന്റെ ആസ്വാദ്യത തീരുമ്പോള്‍ ഇരുവിരലുപയോഗിക്കാം. പിന്നെ എല്ലാ വിരലുമുപയോഗിക്കാം. കൈപ്പടം വച്ച് തഴുകാം. വിരലിന്റെ പ്രവൃത്തി തീര്‍ന്നെങ്കില്‍ ഇനിയതെല്ലാം വിരലിന്റെ മുട്ടുപയോഗിച്ച് ഒന്നുകൂടി ആവര്‍ത്തിച്ചു നോക്കാം. അനുഭൂതിയുടെ ഒരു വഴിയും നാം അടയ്ക്കേണ്ടതില്ല.

ക്ലൈമാക്സിനെക്കുറിച്ചുളള പ്രതീക്ഷകളും ആസ്വാദ്യകരമാണ്. ഒരു വലിയ തിരമാലയുടെ ചിറകിലേറിയാണ് അവിടെയെത്താന്‍ നാം ആഗ്രഹിക്കുന്നത്. ക്ലൈമാക്സിന്റെ അനുഭൂതിയെക്കുറിച്ചുളള എല്ലാ സങ്കല്‍പങ്ങളും വിരലിന്റെ ചലനവേഗതയും ശക്തിയും കൂട്ടും. എന്നാല്‍ ശരിയായ താളത്തില്‍ നിന്ന് വ്യതിചലിക്കാതിരിക്കുക എന്നത് പ്രധാനമാണ്.

ക്ലൈമാക്സിനോട് അടുക്കാറാവുമ്പോള്‍ ഉത്തേജനം മെല്ലെയാക്കി ശരീരം എന്തു പറയുന്നു എന്ന് ശ്രദ്ധിക്കുക. വേണ്ടതെന്തെന്ന് ശരീരം നിങ്ങളോട് പറയും. ആ സംഗീതത്തിന് ശ്രുതി മീട്ടുക എന്നതാണ് അടുത്ത പടി.
ആസ്വദിക്കുക, ആഴത്തില്‍ ശ്വസിച്ച്....
ക്ലൈമാക്സ് കൈവരിക്കുമ്പോള്‍ പുറത്തു വരുന്ന ലൈംഗികോര്‍ജത്തെ ചെറുക്കാതിരിക്കുക. ആഴത്തില്‍ ശ്വസിച്ച് അതിനെ ഏറ്റുവാങ്ങുക. ശ്വാസം പിടിച്ച് ശരീരത്തോട് ഏറ്റുമുട്ടാതിരിക്കണം.

ആഴത്തില്‍ ശ്വസിച്ച് അടിവയറിലെ പേശികള്‍ ചലിപ്പിക്കുക എന്നതാണ് ചെയ്യേണ്ടത്. ഇത് വേഴ്ച നല്‍കുന്ന സുഖത്തിന് സമാനമായ ആനന്ദം നല്‍കും. മന്മഥ പേശികള്‍ (pelvic muscle‍) സങ്കോചിപ്പിക്കുകയും വികസിപ്പിക്കുകയും ചെയ്യുന്നതും നല്ലതാണ്.

രതിമൂര്‍ച്ഛയിലെത്തിയാലും ഉത്തേജനം തുടരണം. ആദ്യരതിമൂര്‍ച്ഛയോടെ ശരീരം തീക്ഷ്ണമായി സംവേദനക്ഷമമാവും. അടുത്ത രതിമൂര്‍ച്ഛയ്ക്കു വേണ്ടി തീകത്തിക്കേണ്ട വേളയാണിത്. ആദ്യത്തേതു കൊണ്ട് തൃപ്തമായാല്‍ തുടരെ ലഭിക്കുന്ന മറ്റൊരനുഭൂതി ശരീരത്തിന് നിഷേധിക്കപ്പെടുകയാവും ഫലം.
സ്വയം സെക്സ് ആസ്വദിക്കൂ... മെച്ചമുണ്ട്....
ആദ്യരതിമൂര്‍ച്ഛ ഒരു വികാരസ്ഫോടനമാണെങ്കില്‍ തുടര്‍ന്നുവരുന്നത് ആഴമേറിയ ശാരീരികാനുഭൂതിയാണ്. അതിന്റെ അലകളെ ഉള്‍ക്കൊളളാന്‍ പരിശീലനം ആവശ്യവുമാണ്. ശരീരത്തിനുണ്ടാകുന്ന തളര്‍ച്ചയും സങ്കോചവും വികാസവുമൊക്കെ മനസു കൊണ്ടുള്‍ക്കൊളളുമ്പോഴാണ് രതിയുടെ ആസ്വാദനം പൂര്‍ണതോതില്‍ നടക്കുന്നത്.

ഓരോരുത്തര്‍ക്കും ഓരോ അനുഭൂതിയാണ് ആസ്വാദ്യം. ഒരാളിന്റേത് മറ്റൊരാളിന്റേതിന് സമാനമാകണമെന്നില്ല. തനിക്കു വേണ്ടത് സ്വയം കണ്ടെത്തി അതിനെ ആലിംഗനം ചെയ്ത് സ്വന്തമാക്കുകയാണ് വേണ്ടത്. പിന്നെ അതിന്റെ അടുത്ത ഘട്ടമെത്താനുളള പരിശീലനവും.

സ്വയം ശാരീരികാനുഭൂതി ആസ്വദിക്കാന്‍ കഴിയുന്നു എന്നതു മാത്രമല്ല സ്വയം സെക്സിന്റെ പ്രസക്തി. സ്വന്തം ശരീരത്തിന് എന്താണ് വേണ്ടത് എന്ന് ലൈംഗിക വേഴ്ചയില്‍ പങ്കാളിയോട് പറയാനും സ്വയം സെക്സ് സഹായിക്കും. ഒറ്റയ്ക്കും പങ്കാളിക്കൊപ്പവും രതിയാസ്വദിക്കാം, നന്നായി സ്വയം രതി ചെയ്യാനറിയാമെങ്കില്‍.

ലൈംഗികതയുടെ പ്രയോജനങ്ങള്‍

മനുഷ്യന്റെ അടിസ്ഥാനവികാരമാണ് ലൈംഗികത. ലൈംഗികമായി സജീവമായവര്‍ക്ക് അതിനപപവാദമായവരെ അപേക്ഷിച്ച് പല ഗുണങ്ങളുമുണ്ട്. ശരീരത്തിനും മനസിനും ആനന്ദം നല്‍കുന്ന പക്രിയയാണ് ലൈംഗികത.
ആഴ്ചയില്‍ മൂന്ന് തവണ ലൈംഗികബന്ധത്തില്‍ ഏര്‍പ്പെട്ടാല്‍ 7500 കലോറി ഊര്‍ജ്ജമാണ് ശരീരത്തില്‍ നിന്ന് പുറന്തള്ളപ്പെടുക. ഇത് 75 മൈല്‍ ഓടുന്നതിന് തുല്യമായ പ്രയോജനമാണ് നല്‍കുക.
ഒരു രാത്രിയിലെ തീവ്രമായ ലൈംഗിക ബന്ധം കോശങ്ങളിലെ ഓക്‌സിജന്റെ അളവ് വര്‍ദ്ധിപ്പിക്കും. അവയവങ്ങളുടെയും കോശങ്ങളുടെയും മികച്ച പ്രവര്‍ത്തനത്തിന് ഇത് സഹായിക്കും.വന്യമായ ലൈംഗികതയില്‍ ഏര്‍പ്പെടുന്ന പുരുഷനില്‍ പുരുഷഹോര്‍മോണുകള്‍ കൂടുതല്‍ ഉല്‍പാദിപ്പിക്കപ്പെടും. പുരുഷന്മാരുടെ എല്ലുകള്‍ക്കും മാംസപേശികള്‍ക്കും കൂടുതല്‍ ശക്തി ലഭിക്കാന്‍ ഇതുപകരിക്കും.

പതിവായി ലൈംഗിക ബന്ധത്തില്‍ ഏര്‍പ്പെടുന്നവരില്‍ കൊളസ്രേ്ടാള്‍ നില കുറയുന്നു. ചീത്ത കൊളസ്രേ്ടാളിനെ അപേക്ഷിച്ച് നല്ല കൊളസ്രേ്ടാള്‍ ശരീരത്തില്‍ ഏറുകയും ചെയ്യും.ലൈംഗികത ശരീരവേദനയും തലവേദനയുമൊക്കെ അകറ്റാനും പര്യാപ്തമാണ്. ഊഷ്മളമായ ലൈംഗിക ബന്ധം ഇണകളില്‍ അനിര്‍വ്വചനീയമായ ആനന്ദം പ്രദാനം ചെയ്യും.
പതിവായുള്ള ലൈംഗികത പുരുഷഗ്രന്ഥി എന്നറിയപ്പെടുന്ന പ്രോസ്രേ്ടറ്റ് ഗ്‌ളാന്‍ഡിന്റെ പ്രവര്‍ത്തനത്തെയും ഉത്തേജിപ്പിക്കും. പതിവായി സ്ഖലനം സംഭവിക്കുന്ന പുരുഷന്റെ പ്രോസ്രേ്ടറ്റ് ഗ്‌ളാന്‍ഡില്‍ ദ്രാവകം അടിഞ്ഞ് കൂടിയുള്ള അസ്വസ്ഥത ഉണ്ടാകില്ല.തീവ്രമായുള്ള ലൈംഗിക ബന്ധം ഇണകളെ കൂടുതല്‍ അടുപ്പിക്കുന്നു. ഇണചേരുമ്പൊള്‍ ഇണകളുടെ ശരീരത്തില്‍ ഇരുവരെയും തമ്മില്‍ അടുപ്പിക്കുന്ന ഹോര്‍മോണായ ഓസിടോസിന്‍ കൂടുതല്‍ ഉല്‍പാദിപ്പിക്കപ്പെടുന്നതാണ് കാരണം.
പതിവായി ലൈംഗിക ബന്ധത്തില്‍ ഏര്‍പ്പെടുന്നത് വഴി സ്ര്തീ ഹോര്‍മോണായ ഈസ്ര്ടജന്‍ നില വര്‍ദ്ധിക്കുന്നു. ഇത് സ്ര്തീകളുടെ ഹൃദയത്തെ സംരക്ഷിക്കുന്നു. യോനീകോശങ്ങള്‍ കൂടുതല്‍ മസൃണമാകാനും നന്ന്.

Hot actress honey rose

Hot actress honey rose

Procedures for treating vertebral fractures

Two minimally invasive procedures — vertebroplasty and kyphoplasty — involve the injection of a medical cement to stabilize compressed vertebrae. Introduced in the United States in the 1990s, they've become increasingly available for the treatment of fracture pain that doesn't respond to more conservative therapy. According to Dr. John Pan, a radiologist at Boston's Brigham and Women's Hospital, bracing and analgesics are usually tried first "to see if the fracture heals on its own. If it doesn't and the person continues to have pain — usually after four to six weeks — that's when the procedure is considered."

There are very few controlled studies comparing the long-term effectiveness and safety of vertebroplasty and kyphoplasty — with each other or with conservative treatment. It's not clear whether either procedure improves spine stability or prevents fractures in the long run. But the main reason for these procedures is pain, and as many as 85% to 90% of people who undergo them experience immediate relief. A review of 21 studies involving 1,309 patients, published in 2007 in the journal Pain Physician, found that both techniques reduced pain by more than 50%.

No one knows exactly how these procedures do that. One theory is that the pain is largely an inflammatory response to the uneven distribution of mechanical forces caused by bone fragmentation. The cement is thought to help by restabilizing the vertebra, which reduces inflammation and thus pain. It's also possible that the cement destroys pain-conducting nerve endings in the vertebra.

Before either procedure, MRI is usually performed to determine if the patient is likely to benefit. A good candidate is one whose MRI shows the presence of bone edema, or fluid, which is associated with recent fracture. If bone edema is absent, that implies the fracture has healed and is not what's causing the pain. An MRI can also help ascertain whether a disk, the spinal cord, or other soft tissue is involved.

Both kyphoplasty and vertebroplasty are performed percutaneously (that is, through the skin), often as day surgery and under conscious sedation. If the fractures are numerous or severe, or the patient is older and in poor health — or cannot tolerate lying on his or her stomach — general anesthesia may be used. Sometimes an overnight hospital stay is necessary. Here's what's involved:

Vertebroplasty. Guided by computed tomography (CT) or fluoroscopy (real-time x-rays), a specially trained radiologist, neurologist, or orthopedic surgeon inserts a hollow needle through a small incision in the skin into the compressed portion of the vertebra. When the needle is in place, she or he injects a surgical cement (methyl methacrylate), which has the consistency of toothpaste. It's mixed with an agent that allows the physician to see its flow into the vertebra. The cement hardens within about 15 minutes. The patient is monitored for two to three hours in the recovery room before going home.

Kyphoplasty. In this procedure, which is also image-guided and performed through tiny incisions in the back, inflatable balloons are inserted through tubes in both sides of the fractured vertebra (see illustration). The balloons are inflated, creating a cavity and restoring vertebral height. They are then deflated and withdrawn and the cavity is filled with cement. The procedure takes 30 to 60 minutes for each fracture and sometimes involves an overnight hospital stay.

What is kyphoplasty? Kyphoplasty is a two-step process. First, a tubelike device with a balloon at the end is inserted into each side of the collapsed vertebra (A). The balloons are then inflated, creating a cavity and restoring vertebral height. The balloon is withdrawn and cement is injected, filling the cavity (B).

How Can Osteoporosis Affect My Spine?

Given the prevalence of osteoporosis, it is not surprising that fractures resulting from the disease are quite common. In addition to other fractures such as the wrist, forearm, or hip, osteoporosis causes approximately 700,000 to 750,000 vertebral compression fractures (VCFs) annually. For people suffering from osteoporosis, VCFs can result from many different regular, everyday activities. Unlike other types of fracture associated with osteoporosis (for example, fractures of the hip), VCFs are less associated with falls. Bending forward, lifting objects, climbing stairs, and even seemingly minor movements like coughing or sneezing can lead to a vertebral compression fracture.

These fractures can happen to vertebrae in any part of the spine, and can vary in type. A wedge fracture occurs when the front or back of a vertebra collapses, while a biconcave fracture is the result of the central portion of both vertebral body endplates collapsing. A crush fracture means the entire vertebra has collapsed. VCFs can cause back pain, spinal deformity, impaired physical function, decreased pulmonary function, decreased lung capacity, loss of appetite, and sleep issues. As with many types of chronic pain and spine injuries, they can also decrease quality of life in many other ways, leading to anxiety, depression, and feelings of frustration and defeat.

Treatment Options for Vertebral Compression Fractures

What are the Symptoms of Vertebral Compression Fractures?
Pain varies from person to person, depending on the location and severity of the fracture, as well as the individual’s overall health. For some people, the pain is minimal and subsides as the bone heals (usually over a period of two to three months). For others, the pain may continue even after the fracture has healed.

Unlike with a broken wrist or hip, you may not know that you have suffered a VCF. Symptoms that may indicate a VCF include sudden, severe back pain; worsening pain when walking or standing, difficulty and increased pain when bending and twisting; a curved or stooped posture; and experiencing some relief from pain when lying down. For an accurate diagnosis, an x-ray or another form of imaging is needed.

Having one VCF is a major risk factor for incurring another one. Multiple vertebral compression fractures can lead to spinal deformity and can make normal activities painful and difficult.

What are the Treatment Options for Vertebral Compression Fractures?
Conservative treatments for VCFs include bed rest, oral pain medications, steroid or pain relieving injections, back braces, physical therapy, and anti-inflammatory drugs. For many, this is not enough to alleviate the pain from a VCF. In the past, any additional treatment required open back spinal surgery. Today however, those who do not respond to non-operative treatments and are faced with severe pain and/or disability can also consider two types of minimally invasive spine surgery to treat vertebral compression fractures. These are vertebroplasty and kyphoplasty.

Percutaneous vertebroplasty was developed in France in the 1980s, and has been performed in the United States for nearly twenty years. This minimally invasive procedure is designed to relieve the pain caused by vertebral compression fractures, and to strengthen weakened vertebral bodies in the hopes of preventing future fractures. In this procedure, a small amount of medical grade acrylic cement called polymethylmethacrylate (PMMA) is injected into the collapsed vertebra to stabilize and strengthen the fracture and vertebral body. Using a flexible needle, the surgeon is able to directly access the entire vertebra through one small incision and precisely deliver the bone cement. When the cement is injected it is a viscous paste, but it hardens rapidly. Most percutaneous vertebroplasty patients are ambulatory within a few hours after the procedure. Patients often experience significant improvement from their fracture symptoms within six to twelve weeks, and can return to their normal activities once the fracture has fully healed.

Percutaneous Vertebral Augmentation, or kyhphoplasty, is a newer treatment option which is also a percutaneous and minimally invasive procedure. In kyphoplasty, a device is used to create a space within the vertebral body which is then filled with bone cement to strengthen the vertebra. Kyphoplasty is performed under local or general anesthesia. Using image guidance x-rays, a small incision is made, and a device is inserted into the center of the vertebral body to the site of the fractured bone. The space created by the device is then filled with PMMA, the same orthopedic cement used in vertebroplasty, to seal up the fracture. As in vertebroplasty, the cement hardens quickly, providing strength and stability to the vertebra.

Procedures such as vertebroplasty and kyphoplasty can provide substantial benefits, including pain relief, stabilization of bone fractures, and a reduction of the debilitating effects of progressive osteoporosis. Compared to traditional surgical procedures, these minimally invasive procedures generally require a much smaller incision, can be performed on an outpatient basis, and allow patients to enjoy a quicker return to normal activity. Though no surgery can have a guaranteed outcome, these new treatments provide more options for people who have suffered a vertebral compression fracture. 

Snoring - Treatments

The treatment will depend on whether the board certified sleep physician finds that you have sleep apnea. If you do not have sleep apnea, the sleep physician and his or her team may offer the following treatments:

Behavioral Changes

Weight loss
Weight loss can help reduce or eliminate your snoring for some people. If you are overweight or obese losing weight should be a priority. Weight gain can make snoring worse, and may even lead to sleep apnea.

Positional therapy
For some people, snoring mostly occurs while they sleep on their back. If you are one of these types of snorers, you may be able to improve your snoring by changing your sleep position. There are a variety of products that you can wear when you go to sleep that prevent you from sleeping on your back. You can also attach a tennis ball to the back of your shirt or pajamas. This does not work for everyone.

Avoiding alcohol, muscle relaxants and certain medications
These can relax your throat or tongue muscles causing you to snore. By avoiding use of these substances, you may be able to reduce or eliminate your snoring. Speak to your primary care physician about alternative medications if your medication is causing you to snore.

Treatment

Oral appliances
An oral appliance is a small plastic device that fits in your mouth over your teeth while you sleep that stops you from snoring. It may resemble a sports mouth guard or an orthodontic retainer. The device prevents the airway from collapsing by holding the tongue in position or by sliding your jaw forward so that you can breathe when you are asleep. A dentist trained in dental sleep medicine can fit you with an oral appliance. Read more...

Surgery
There are a variety of elective surgeries you can have to reduce your snoring. The most common surgeries reduce or eliminate the bulky tissue in your throat. Other more complicated procedures can adjust your bone structure. Read more...

If your snoring is a symptom of obstructive sleep apnea, these treatments may not be effective. A board certified sleep medicine physician may recommend other treatments, including CPAP, the front-line treatment for obstructive sleep apnea. Find a sleep medicine physician at an AASM-Accredited Sleep Center near you. 

Snoring - Self-Tests and Diagnosis

Does your partner complain that you snore regularly?

Have you recently gained weight or stopped exercising?

Do you have family members that snore?

If you answered yes to any of these questions you either snore or are at risk for snoring. You may want to see a sleep medicine physician if you snore regularly or loudly. If you also make choking or gasping sounds as you snore, you will need to be tested for obstructive sleep apnea.

In addition to a complete medical history, the physician will need to know how long you have been snoring. You will also need to tell the physician whether you recently gained weight or stopped exercising. Be sure to tell your physician of any past or present drug and medication use. If you can, ask your partner, roommate or family member if they have ever heard you snore.

A sleep medicine physician will recommend a home sleep test, or in some cases an in-lab sleep study. A board-certified sleep physician is specially trained to diagnose sleep apnea.

Snoring - Causes and Symptoms

Causes

Obesity, Pregnancy and Genetic Factors

Extra tissue in the throat can vibrate as you breathe in air in your sleep, causing you to snore. People who are overweight, obese or pregnant often have extra bulky throat tissue. Genetic factors that can cause snoring include extra throat tissue as well as enlarged tonsils, large adenoids, long soft palate or long uvula. 

Allergies, Congestion and Certain Nasal Structures

Anything that prevents you from breathing through your nose can cause you to snore. This can include congestion from a cold or flu, allergies or deformities of the nose such as a deviated septum.

Alcohol, smoking, aging and certain drugs and medications, including muscle relaxants

You may snore when your throat or tongue muscles are relaxed. Substances that can relax these muscles may cause you to snore. This includes alcohol, muscle relaxants and other medications. Normal aging and the prolonged effects of smoking can also relax your throat and tongue muscles. 

Symptoms

The primary symptom of snoring is unmistakable - the often loud, harsh or hoarse noises that you make while you are asleep. Other symptoms may include waking up with a sore throat or dry mouth. 

If you have any of the following symptoms you may have sleep apnea:

• Excessive daytime sleepiness
• Choking or gasping while you sleep
• Pauses in breathing
• Morning headaches
• Difficulty concentrating
• Moodiness, irritability or depression
• Frequent need to urinate during the night

WHAT IS A TRACHEOSTOMY? WHEN IS IT PERFORMED FOR THE TREATMENT OF SLEEP APNEA?

As noted earlier, OSA can have significant impact on patients’ health and – in some cases – life-expectancy. In severe cases of OSA, extreme interventions may be required. In a tracheotomy, a surgical opening is made through the skin of the lower neck and directly into the trachea. A hole is cut into the trachea thereby bypassing the sites of obstruction higher up. While a tracheotomy is typically considered “curative” of OSA, it is an extreme measure with potentially severe complications, and is performed only in special circumstances.

DOES THE TONGUE CONTRIBUTE TO SNORING AND SLEEP APNEA? IF SO, HOW CAN THIS BE TREATED?

In some patients, an enlarged tongue base which relaxes during sleep may fall back in the oral airway (“hypopharynx”) and contribute to obstruction, turbulence and – ultimately – snoring and OSA. Surgeries to treat this area include a Midline glossectomy and – more recently – Radiofrequency ablation (RFA) of the tongue base. Midline glossectomy is less commonly performed given the significant post-operative complications of bleeding, difficulty swallowing, and airway edema necessitating possible tracheostomy98. RFA of the tongue base appears to be reasonably affective for snoring in appropriate patients. It does; however, often require multiple treatments over a period of weeks to months before noticeable improvement is appreciated. Data does not seem to support the same efficacy of RFA for treatment of OSA with success rates reported under 40%99.

WHAT IS THE UVULA? DOES IT CONTRIBUTE TO SNORING/SLEEP APNEA? IF SO, HOW IS IT TREATED?

The uvula, the “punching bag” in the back of your throat, is comprised of a series of intertwined muscles with a mucosal lining. On occasion, an enlarged uvula may contribute to snoring and /or OSA. In these instances the uvula may be surgically resected or removed. Usually, the uvula alone is not a significant enough source of snoring/obstruction that removal of just the uvula will solve the patients’ problem. It is for this reason that uvulectomy is usually performed as an adjunct to other procedures (i.e., Pillar Procedure, tonsillectomy, etc). Patients have noted significant pain after this procedure89.

WHAT ARE THE ADENOIDS, AND CAN THEY CONTRIBUTE TO SNORING/SLEEP APNEA?

The adenoids are typically normal lymphoid tissue that rest in the nasopharynx (where the nasal cavity turns into the “throat” in the back). In children it is not uncommon for the adenoids to be large enough (“hypertrophied”) to obstruct nasal airflow and lead to snoring and, in some cases, OSA. While the adenoids typically shrink and regress with age, there are several adults in whom the adenoids are persistent and large. In these cases, the adenoids may lead to nasal airway blockage, turbulent airflow, snoring, and/or OSA.

CAN RADIOFREQUENCY ABLATION BE USED ON THE PALATE FOR SNORING AND SLEEP APNEA?

While the bulk of data seems to support the safety and efficacy of the Pillar Implants for snoring and sleep apnea, the past few decades have also seen the rise of radiofrequency treatments for OSA and snoring. Many surgeons around the world have suggested the use of radiofrequency ablation (RFA) on the palate as a minimally-invasive treatment option. A recent review of 30 articles published between 1998 and 2008 found that while RFA treatments for snoring appeared relatively safe, there was insufficient evidence to support the claim that this treatment method is effective over the long-term86.

WHAT IS THE PILLAR PROCEDURE FOR SNORING AND SLEEP APNEA? DOES IT REALLY WORK?

In the Pillar Procedure, small implants are inserted into the soft palate to help stiffen the soft palate and diminish the collapse that contributes to snoring and sleep apnea. The Pillar Procedure is performed under local anesthesia and takes around 20 minutes to perform in the clinic setting with most patients. Several studies have shown a significant decrease in patient snoring intensity with associated decreases in daytime sleepiness and significant improvements in lifestyle after patients underwent the Pillar Procedure. Other studies have demonstrated patient and bed partner satisfaction with the reduction in snoring after the Pillar Procedure at 80% or higher77 78. Studies of patients with OSA demonstrate approximately 80% of patients with a reduction in their AHI (sleep index), and results were sustained at one year after palatal implants/Pillar Procedure79 80 81 82 83 84. Another study has documented significant improvement in snoring and sleep apnea with insertion of palatal implants in patients who had failed surgical intervention with prior uvulapalatopharyngoplasty85. The data in support of the Pillar Implant as an effective, minimally invasive treatment for patients with snoring and/or OSA continues to grow.

CAN WEIGHT LOSS IMPROVE MY SNORING AND/OR SLEEP APNEA?

There exist a large number of studies which support the notion that signs and symptoms of OSA and snoring can be improved with weight loss57 58 59. In some patients with significant obesity, surgical intervention (ie-bariatric surgery) may be utilized to help patients with OSA lose weight60. Studies seem to support the efficacy of these interventions, although long-term follow-up data is incomplete61 62. It is apparent that a patient’s overweight status can play a significant role in his/her snoring and OSA. In addition to the other health benefits of good nutrition and fitness, working towards a healthy weight may have significant benefits for patients with OSA and snoring. It is, therefore, imperative that patients with OSA and snoring examine the status of their nutrition and fitness with an eye towards healthy, balanced interventions.

DOES DRINKING ALCOHOL CONTRIBUTE TO MY SNORING AND/OR SLEEP APNEA?

Drinking alcohol may cause the soft tissues of the airway to relax and increase the likelihood of soft tissue collapse associated with snoring and sleep apnea. In fact, it the increased rate of sleep apnea in patients who drink has been well documented63 64. Changing drinking habits and patterns, including decreased nocturnal alcohol consumption may have a positive impact on patients’ sleep and snoring signs and symptoms.

WHAT ARE ORAL APPLIANCES? HOW DO THEY HELP WITH SNORING AND SLEEP APNEA?

In some cases of snoring and OSA an oral appliance may be used for treatment. An oral appliance is an artificial (often plastic or acrylic) device similar in appearance to a mouth-guard [FIGURE 2]. The device is intended to be worn at night during sleep. By moving the lower jaw (mandible) forward, the appliance decreases the likelihood of the oral soft tissues collapsing and obstructing the airway. It is this obstruction that may contribute to snoring and OSA. A second type of oral appliance – a Tongue Retaining Device – applies suction to the tongue at night in order to keep it from falling back in the throat [FIGURE 3].

A 2006 review of 41 studies found mixed results with oral appliances. Only 52% of patients were able to control their OSA with an oral appliance, and oral appliances were found to be less effective than CPAP49. As with CPAP, it appears that many patients find it difficult to tolerate oral appliances. Patient compliance rates seem to vary in studies, and have been reported to be as low as 25%.50

The use of oral appliances may have associated complications. Commonly reported minor (often temporary) side effects have been noted to occur in up to 86% of patients. More severe and persistent complications have been noted to occur in up to 75% of patients. Complications/ adverse events include TMJ (temporomandibular joint) pain, myofascial pain, dental/tooth pain, tongue pain, dry mouth, gum irritation, severe gagging, excessive salivation, occlusal/bite changes, and TM joint sounds.51

Treatments for Snoring and Sleep Apnea

Effective treatment of snoring and OSA depends on proper diagnosis and location of the anatomic source of the problem. Treatments can be medical or surgical and vary in efficacy. Medical treatments include lifestyle changes (weight loss and dietary changes), sleep positioning pillows, nasal sprays, dental/oral appliances, nasal strips, and positive pressure mask devices. Inhalant allergies may also contribute to snoring and OSA, and should be treated when present. Medical interventions are preferable to surgery; however, some of the interventions (ie-use of the continuous positive airway pressure device) are uncomfortable and have poor patient compliance.

Surgical treatments include nasal surgery, adenoid and tonsil surgery, palate surgery, and jaw surgery (mandibular advancement). Some of these surgeries may be performed with the laser (laser-assisted uvulopalatoplasty, or LAUP) Unfortunately most of the surgeries involving the oral cavity (tonsils, palate, jaw) and pharynx (uvulopalatopharyngoplasty, or UPPP) have significant pain and morbidity as well as lengthy patient recovery times with only modest success rates.

Fortunately, the past few years have seen the rise of a variety of effective, minimally-invasive treatments for snoring and sleep apnea. These treatments, along with others, will be discussed in detail in this and the following chapters.

DOES SLEEP APNEA AFFECT MY HEART?

OSA appears to be related to the development of heart and vascular disease, as noted by a 2008 publication of the American Heart Association and the American College of Cardiology.27 Almost 40% of patients with OSA have elevated blood pressure. Moreover, it appears that patients with OSA may have a 2 to 3 times increased risk of heart attack and stroke.28, 29, 30 Americans who have OSA are more likely to die suddenly of cardiac causes between 10 p.m. and 6 a.m. than during the other 16 hours of the day combined, according to findings of a Mayo Clinic study.

WHAT ABOUT SNORING AND DIABETES?

In women aged 25-79 years old, one recent study found snoring with or without sleep apnea to be related to the presence of diabetes mellitus7. This is of particular concern, as diabetes is strongly related to cardiovascular disease and early death. An earlier study supports these results, having found a two-fold higher risk of developing diabetes in women who snore compared to women who do not snore8. Fortunately, there is some evidence that in diabetic patients with sleep apnea, diabetic parameters improve when patients’ sleep apnea is brought under control.

HOW COMMON IS SNORING?

Snoring is widespread, and is believed to affect as many as 50% of adults including both men and women; over 45 million Americans. In one 2006 survey of over 2,000 British couples, 56% of respondents admitted that they snored (70% of men admitted to snoring; 40% of women admitted to snoring). 30% of the respondents stated that their bed partner snores1. 48% of the respondents stated that snoring affected their personal relationships, with 46% of respondents admitting that they sleep in separate bedrooms as a result of snoring. Respondents noted that they felt snoring had caused them to be irritable (47%), had led to arguments (36%), and had impacted their sexual relationships (17%). Some respondents stated that snoring had led to their divorce. Others noted that snoring had led to poor sleep (72%), and had impacted their ability to work effectively (38%).

ANATOMIC CAUSES OF SNORING

Snoring is commonly associated with abnormalities of the soft palate or uvula. An overly long or floppy soft palate may vibrate irregularly with airflow. This abnormal vibration makes a sound – snoring. Other sources may also contribute to snoring and, for this reason, careful and complete evaluation is imperative in order to direct effective treatment. Nasal sources (deviated septum, inferior turbinate hypertrophy, polyps, chronic and allergic nasal congestion), nasopharyngeal sources (enlarged adenoids and nasopharyngeal growths) oral sources (enlarged tongue base, small jaw, enlarged uvula or tonsils), and throat and neck sources (floppy neck soft tissues) may all contribute to snoring and to sleep apnea. In some cases, snoring may be increased by alcohol consumption late at night (which causes your throat to relax and become more floppy).

What happens if you break a fixed deposit?

Breaking a fixed deposit means withdrawing the money before the maturity expires. This may be necessary if you urgently require the funds or if there are better investment opportunities elsewhere. You will have to pay a cost; for instance you may receive an interest rate 1 per cent lower than the stated interest rate on the FD.


For example if you invested in a 3 year FD with 9 per cent and you break it after two years you may receive only 8 per cent interest for those two year instead of 9 per cent.


An alternative to breaking a fixed deposit is taking a loan against the FD. Such loans are quite easy to obtain with amounts ranging up to 90 per cent of the principal and accumulated interest.

Yoga as an effective treatment for back pain

New researchs from the U.S. suggests that the millennia-old therapy of yoga could benefit millions of people who suffer from back pain problems. In an article published in the Annals of Internal Medicine on December 20, researchers concluded that yoga act as a more effective treatment for back pain than conventional therapy.
A study conducted at the Group Health Cooperative in Washington State required 101 adults to follow a choice of remedial treatments – a 12-week course in yoga, 12 weeks of standard therapeutic exercise or the same period following instructions in a self-help book. The results showed yoga both expedited relief from pain and had longer lasting benefits. Lead researcher Dr. Karen Sherman said this was because “mind and body effects” were in collusion.

The article states that: “Most treatments for chronic low back pain have modest efficacy at best. Exercise is one of the few proven treatments…however, its effects are often small, and no form has been shown to be clearly better than another. Yoga, which often couples physical exercise with breathing, is a popular alternative form of ‘mind–body’ therapy…[It] may benefit patients with back pain simply because it involves exercise or because of its effects on mental focus. We found no published studies in western biomedical literature that evaluated yoga for chronic low back pain; therefore, we designed a clinical trial to evaluate its effectiveness.” Millions of people worldwide swear by yoga to improve their mental and physical health.

Diagnosis & Treatment of Facet Joint Pain

Facet joint problems are usually treated with a combination of conservative methods, including pain medication, exercise and physical therapy, posture correction, activity modification, and steroid injections. If your pain doesn’t improve, you may be helped by an outpatient procedure called Radiofrequency Neurotomy, also called Radiofrequency Ablation or lesioning. This approach completes the continuum of care for back pain sufferers who want a minimally invasive alternative to surgery.[1]
How is facet pain diagnosed?
The most definitive diagnosis for determining your pain can be made by a medial branch block.[2] This involves injecting a numbing medicine into or very near the nerves that supply the facet joint. If there is a significant decrease in pain (80% or more), it confirms that the joint is causing the pain.

Things To Do In Fiji

Things to do in Fiji are as vast as your imagination will allow and your body will be able to endure. According to your own personality and the things you enjoy doing, Fiji tourism offers a multi-cultural tropical setting for your playground.

Fiji Beaches

For those that wish to take it easy, things to do in Fiji can be just as simple as sunbathing on one of the many beaches or taking a tour of the Sleeping Giant Gardens.

Diving in Fiji

However, if you are more of an adventurous type then you are sure to want to see what goes on under the blue waters at the vast soft coral reefs and take in a couple of hours of diving. Diving and snorkeling is one of the most sought after things to do in Fiji that have scuba divers from all over the world visiting to enjoy the soft corral reefs that Fiji Tourism is proud to call a part of their natural habitat. The magnificent Bega Lagoon and the Great White Wall are both tourist attractions in Fiji that leave divers wanting more. Water sports of all kinds are a huge part of Fiji tourism, which includes swimming, kayaking, and surfing. Anyone that loves water is sure to find many ways to pass the time away.

Fiji Cruises

Visitors can view attractions in Fiji in many different ways such as a cruise by schooner or yacht to the various islands encompassing Fiji, or a coach tour on the main islands.

Fiji Tours

Taking advantage of the tours will allow you to choose the things to do in Fiji that catch your eye and your desire your adventure such as horse back riding, a quiet picnic on the beach, or browsing through the Fiji museum in Suva.

Koroyanitu National Park

Fiji tourism includes six National Parks that draw campers and hikers to enjoy the natural beauty of Fiji while allowing visitors to get up and close personal to the tropical flora and fauna of the islands. Koroyanitu National Park, Nadi Area, Viti Levu offers camping and hiking through local villages which is one of the attractions in Fiji that everyone loves due to the fact of meeting locals and even possible a chief.

Golfing in Fiji

Golfers love the tropical setting found at the various breath taking clubs and resorts that dot the islands. There are over twelve golf courses scattered throughout the islands that offer challenging and lush green landscape.

Fiji Events

Fiji has many wonderful and unique events throughout the year, which are considered tourist attractions in Fiji. One very popular participating event is the meke, which is Fijian dancing whereas locals dress in national costumes of grass skirts, tapa cloths, and flower leis while males perform warrior dances and the women sing.

Fiji Weddings

Many couples choose Fiji for their destination wedding and stay for their honeymoon at one of the luxurious resorts. Wadigi Island Resort is one such escape that offers the majestic beauty that can only be seen on the edge of Wadigi cliff with amenities such as gourmet chefs. Along with being treated like royalty, you will be able to find an entire of world of things to in Fiji on Wadigi Island including trips to villages, water skiing, fishing, and of course lying on the beach with the love of your life.