Each year 185,000 women in this country learn that they have breast cancer. Because less than a quarter of them have genetic or other known risk factors, the diagnosis often comes as a devastating surprise. The emotional turmoil that results can affect women's physical health as well as their psychological well-being. This question-and-answer fact sheet explains how psychological treatment can help these women harness the healing powers of their own minds.
What impact does a breast cancer diagnosis have on psychological well-being?
Receiving a diagnosis of breast cancer can be one of the most distressing events women ever experience. And women may not know where to turn for help.
Distress typically continues even after the initial shock of diagnosis has passed. As women begin what is often a lengthy treatment process, they may find themselves faced with new problems. They may find their personal relationships in turmoil, for instance. They may feel tired all the time. They may be very worried about their symptoms, treatment and mortality. They may face discrimination from employers or insurance companies. Factors like these can contribute to chronic stress, anxiety and depression.
Why is it important to seek psychological help?
Feeling overwhelmed is a perfectly normal response to a breast cancer diagnosis. But negative emotions can cause women to stop doing things that are good for them and start doing things that are bad for anyone but especially worrisome for those with a serious disease. Women with breast cancer may start eating poorly, for instance, eating fewer meals and choosing foods of lower nutritional value. They may cut back on their exercise. They may have trouble getting a good night's sleep. And they may withdraw from family and friends. At the same time, these women may use alcohol, cigarettes, caffeine or other drugs in an attempt to soothe themselves.
A breast cancer diagnosis can also lead to more severe problems. Researchers estimate that anywhere from 20 to 60 percent of cancer patients experience depressive symptoms, which can make it more difficult for women to adjust, participate optimally in treatment activities and take advantage of whatever sources of social support are available. Some women become so disheartened by the ordeal of having cancer that they refuse to undergo surgery or simply stop going to radiation or chemotherapy appointments. As a result, they may get even sicker. In fact, studies show that missing as few as 15 percent of chemotherapy appointments results in significantly poorer outcomes.
How can psychological treatment help women adjust?
Licensed psychologists and other mental health professionals with experience in breast cancer treatment can help a great deal. Their primary goal is to help women learn how to cope with the physical, emotional and lifestyle changes associated with cancer as well as with medical treatments that can be painful and traumatic.
For some women, the focus may be on how to explain their illness to their children or how to deal with a partner's response. For others, it may be on how to choose the right hospital or medical treatment. For still others, it may be on how to control stress, anxiety or depression. By teaching patients problem-solving strategies in a supportive environment, psychologists help women work through their grief, fear, and other emotions. For many women, this life-threatening crisis eventually proves to be an opportunity for life-enhancing personal growth.
Breast cancer patients themselves aren't the only ones who can benefit from psychological treatment. Psychologists often help spouses who must offer both emotional and practical support while dealing with their own feelings, for instance. Children, parents and friends involved in caretaking can also benefit from psychological interventions.
The need for psychological treatment may not end when medical treatment does. In fact, emotional recovery may take longer than physical recovery and is sometimes less predictable. Although societal pressure to get everything back to normal is intense, breast cancer survivors need time to create a new self-image that incorporates both the experience and their changed bodies. Psychologists can help women achieve that goal and learn to cope with such issues as fears about recurrence and impatience with life's more mundane problems.
Can psychological treatment help the body, too?
Absolutely. Take the nausea and vomiting that often accompany chemotherapy, for example. For some women, these side effects can be severe enough to make them reject further treatment efforts. Psychologists can teach women relaxation exercises, meditation, self-hypnosis, imagery or other skills that can effectively relieve nausea without the side effects of pharmaceutical approaches.
Psychological treatment has indirect effects on physical health as well. Researchers already know that stress suppresses the body's ability to protect itself. What they now suspect is that the coping skills that psychologists teach may actually boost the immune system's strength. In one well-known study, for example, patients with advanced breast cancer who underwent group therapy lived longer than those who did not.
Research also suggests that patients who ask questions and are assertive with their physicians have better health outcomes than patients who passively accept proposed treatment regimens. Psychologists can empower women to make more informed choices in the face of often-conflicting advice and can help them communicate more effectively with their health care providers. In short, psychologists can help women become more fully engaged in their own treatment. The result is an enhanced understanding of the disease and its treatment and a greater willingness to do what needs to be done to get well again.
What type of psychological treatment is helpful?
A combination of individual and group treatment some-times works best. Individual sessions with a licensed psychologist typically emphasize the understanding and modification of patterns of thinking and behavior. Group psychological treatment with others who have breast cancer gives women a chance to give and receive emotional support and learn from the experiences of others. To be most effective, groups should be made up of women at similar stages of the disease and led by psychologists or other mental health professionals with experience in breast cancer treatment.
Whether aimed at individuals or groups, psychological interventions strive to help women adjust to their diagnoses, cope with treatment and come to terms with the disease's impact on their lives. These interventions offer psychologists an opportunity to help women better understand breast cancer and its treatment. Psychologists typically ask women open-ended questions about their assumptions, ideas for living life more fully and other matters. Although negative thoughts and feelings are addressed, most psychological interventions focus on problem-solving as women meet each new challenge.
A breast cancer diagnosis can severely impair a woman's psychological functioning, which in turn can jeopardize her physical health. But it doesn't have to be that way. Women who seek help from licensed psychologists with experience in breast cancer treatment can actually use the mind-body connection to their advantage to enhance both mental and physical health.
Rabu, 19 Maret 2008
Colds and the Flu: (What to Do If You Get Sick)
Be Aware of Common Flu Symptoms
The flu usually comes on suddenly and may include these symptoms:
• High fever
• Headache
• Tiredness/weakness (can be extreme)
• Dry cough
• Sore throat
• Runny nose
• Body or muscle aches
• Diarrhea and vomiting also can occur, but are more common in children.
These symptoms are usually referred to as "flu-like symptoms." A lot of different illnesses, including the common cold, can have similar symptoms.
Cold Versus the Flu
The flu and the common cold are both respiratory illnesses caused by different viruses. Because these two types of illnesses have similar symptoms, it can be difficult to tell the difference between them. In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness, and dry cough are more common and intense. Colds are usually milder than the flu. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations.
General Steps to Take If You Get Sick
If you develop flu-like symptoms, and you are not at high risk for complications from the flu:
• Get plenty of rest
• Drink a lot of liquids
• Avoid using alcohol and tobacco
• Consider taking over-the-counter medications to relieve the symptoms of flu (but never give aspirin to children or teenagers who have flu-like symptoms)
• Stay home and avoid contact with other people to protect them from catching your illness
• Cover your nose and mouth with a tissue when you cough or sneeze to protect others from your germs.
Most healthy people recover from the flu without complications.
Look Out for Emergency Warning Signs
There are some “emergency warning signs” that require urgent medical attention.
In children, some emergency warning signs that need urgent medical attention include:
• High or prolonged fever
• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Changes in mental status, such as not waking up or not interacting; being so irritable that the child does not want to be held; or seizures
• Flu-like symptoms improve but then return with fever and worse cough
• Worsening of underlying chronic medical conditions (for example, heart or lung disease, diabetes)
In adults, some emergency warning signs that need urgent medical attention include:
• High or prolonged fever
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest
• Near-fainting or fainting
• Confusion
• Severe or persistent vomiting
Seek medical care immediately, either by calling your doctor or going to an emergency room, if you or someone you know is experiencing any of the signs described above or other unusually severe symptoms. When you arrive, tell the receptionist or nurse about your symptoms. You may be asked to wear a mask and/or sit in a separate area to protect others from getting sick.
Special Concerns for People at High Risk for Complications from the Flu
Some people are at increased risk to develop complications of flu. This group includes:
• People 65 years of age and older
• Children 6-23 months of age*
• People of any age with chronic medical conditions (for example, heart or lung disease, asthma, diabetes, or HIV infection)
• Pregnant women
If you are in a group that is considered to be at high risk for complications from the flu and you get flu-like symptoms, you should consult your health-care provider when your symptoms begin.
Some of the complications caused by flu include bacterial pneumonia, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes. Children also may get sinus and ear infections.
*Children 6-23 months of age are at increased risk for influenza-related hospitalization.
Coping with HIV and AIDS
Acquired Immune Deficiency Syndrome (AIDS) is caused by the Human Immunodeficiency Virus (HIV). The virus attacks and eventually destroys certain white blood cells, which are a part of the body’s immune system that we need to fight off infections. The immune system makes antibodies to combat the HIV virus. Their presence in the blood can be measured. If a person has antibodies, they are called “HIV positive” because they have been infected with the HIV virus. However, the person may remain healthy for a long time, even many years. AIDS is the late stage of the illness known as HIV disease, and occurs when so many white blood cells have been destroyed that the immune system cannot do its job well. The person with AIDS develops infections, even from unusual organisms (opportunistic infections) and various malignancies. HIV virus also can affect the brain and nerves.
There are medications to control the infections and malignancies. There are also medications to slow the growth of HIV. However, right now there is no cure and no vaccination to prevent infection. The disease is fatal. However, many new treatments are being developed and there is hope that medical research will rapidly find better forms of treatment and prevention. HIV is spread through the transmission of contaminated body fluids—such as semen, vaginal secretions and blood—into the body of another person. The entry occurs through broken skin and mucous membranes (tissues that line the mouth, vagina, rectum, and urethra). Any activity where one partner—either heterosexual or homosexual—penetrates another sexually can spread the illness. Any cutting into the body with contaminated
instruments can cause infection; this includes needles used by IV drug abusers, unsterilized medical and dental equipment, as well as ear piercing, tattooing, and manicure equipment. Take precautions. Always ask if equipment used in medical, dental or cosmetic procedures is sterilized, new, or disposable. Always practice safe sex. Mothers infected with HIV should also know that they can pass the infection to their children during pregnancy and breast feeding. However, the virus is not spread by casual contact, such as hugging, holding hands, close conversation, sharing a meal, etc. Don’t assume AIDS can’t happen to you or your loved ones. It can. The only absolute treatment is prevention. We must try hard not to stigmatize and isolate those who are infected with HIV or have developed AIDS. If you have questions about what is safe, consult your physician.
Should I be tested for HIV antibodies?
It is important that you know your HIV antibody status. There are many places where you can take a test anonymously and where no record is kept of your results. Taking the test is also important because early diagnosis and treatment of HIV disease may prolong life and reduce disability. Those who engage in high-risk behavior—i.e., those who may become infected or infect others through IV drug use or unprotected (without a condom) hetero or homosexual intercourse—should consider taking the test immediately. In addition, anyone who received blood or blood products prior to screening of the blood supply in 1985 may have been exposed to the HIV virus.
You should never take the test without careful preparation and counseling, however. You should consider the emotional, social, legal, financial, and insurance consequences. It often helps to bring along a knowledgeable person whom you trust to help you ask questions that will get you the information you need to make an informed decision in the event you test positive. It is a good idea as well to have an expert with whom you can discuss your results.
What should I do with my test results?
If you are HIV positive, find a physician who knows about HIV disease and with whom you feel comfortable. You will need to work together very closely and will want someone who cares what happens to you.
If you are HIV negative, consult your physician about the need for future testing and about lifestyle changes you may need to make in order to stay HIV negative.
If I’m HIV positive, should I tell other people?
It is important to tell those whom you may have exposed through sexual contact, needle sharing or other risky behavior. They need to be tested and have the knowledge that allows them to seek medical are. This can be very difficult to do and counseling can help. You will profit from a network of helpful and supportive people. However, you do need to be careful about whom you tell. Some people have very strong reactions. Telling your boss and coworkers can have financial and legal ramifications. It is best to start with a few friends or family with whom you feel close and whom you can trust not to tell others. Developing a community of support is a process and takes time. There may be HIV-positive support groups in your area or HIV hotlines that provide education and helpful support.
How does it feel to be HIV positive?
It is normal to have strong reactions such as fear, anger, and a sense of being overwhelmed. Some people even have suicidal thoughts. It is understandable that you might feel helpless and fear illness, disability and death. Other reactions might include:
Denial
Often, people who find out they are HIV positive will handle the news by denying that it is true. This denial may come up soon after the diagnosis is made. Denial can be helpful: it can give you time to get used to the idea of infection. It can, however, cause problems for oneself and others if one engages in risky behavior. And if it goes on too long it can get in the way of your getting the assistance and medical attention you need.
Guilt
It is not unusual for people to blame themselves for illness and to feel it is punishment. This guilt can be worsened by society’s prejudice and ignorance about HIV and AIDS. It is important, if you are HIV positive, to seek out those who are accepting and supportive.
Sadness
HIV disease means life changes and losses of one kind or another. Sadness is an understandable reaction. Sadness lifts for most people as they adjust. On the other hand, it can turn —sometimes slowly and subtly, sometimes quickly—into a more serious problem, called Depression.
If you are feeling depressed, it is important that you talk your feelings out. Your physician— as well as knowledgeable and supportive friends and loved ones—can help. Remember that there is always help through counseling, and any strong and lasting reaction calls for some kind of assistance.
What other psychiatric reactions are possible with HIV disease?
Many people with HIV disease do not develop serious emotional illness. However, if you develop any if the following reactions, it is important that you seek treatment. Depression—Characterized by prolonged periods of sadness and crying, feeling low or despairing, feelings of guilt and lowered self-esteem, a tendency to see only the negative side of things; also, fatigue, decreased ability to concentrate, loss of pleasure in activities, changes in appetite and weight, trouble sleeping, and, sometimes, thoughts of suicide.
Anxiety disorders—Characterized by excessive worry, feelings of being always on edge, muscle tension, restlessness; and other physical symptoms such as shortness of breath, sweating, rapid heart rate, nausea and diarrhea. They may also appear as sudden attacks of intense anxiety.
Mania—Characterized by an abnormally and persistently elevated mood or great shifts of mood, often with marked irritability. There is decreased desire for sleep, overactivity, rapid talking, poor concentration, and racing thoughts. People with this disorder may also have grand and sometimes bizarre ideas about themselves and impossible schemes for making money and becoming famous. They
may engage in spending sprees and other impulsive behavior. They may become very disorganized in their thinking and behavior and be unable to take care of themselves.
Psychotic symptoms—People may develop hallucinations, seeing things or hearing things that other people do not. They also may become “delusional,” developing strange, unrealistic, and very unlikely ideas. For example, they may think that even their closest friends are plotting to harm them or that secret organizations are spying on them, bugging their telephone or sending messages by television or radio. These are just a few examples of the many forms psychosis can take.
Alcohol and drug abuse—Some people may try to numb their feelings by abusing drugs and alcohol. At times, the person has a history of such problems. At other times, they begin to abuse drugs and alcohol after they learn they are HIV positive or develop symptoms of AIDS.
Difficulties with memory and thinking
Infections, malignancies, and nutritional deficiencies that are the results of AIDS can affect brain functioning. Some medications used to treat HIV infection or its complications can also have these effects. HIV itself can infect the brain, causing a condition doctors call AIDS Dementia Complex. Symptoms that might be a signal of trouble include:
-Forgetfulness
-Confusion
-Difficulty paying attention
-Slurred or changed speech
-Sudden changes in mood or behavior
-Clumsiness or difficulty walking
-Muscle weakness or strange sensations, like numbness or tingling
-Slowed thinking and difficulty finding words
If you have any of these problems you should discuss your concerns with your physician. He or she may suggest the help of a psychiatrist or other mental health specialist.
How can a psychiatrist help me?
A psychiatrist will talk with you and take a history in which he or she will ask about your current problems and how you managed in the past. He or she will need to know about any past or present alcohol or drug abuse and whether there is any family history of emotional problems or substance abuse. The psychiatrist, who is a medical doctor, will need to speak with your other physicians and review your medical history. The psychiatrist will ask specific questions to test memory, attention, and other aspects of thinking and problem solving. Your psychiatrist will tell you and your physician what he or she thinks is the nature of your problem, and will make recommendations for treatment. With your agreement, he or she may provide the recommended treatment if the expertise of a psychiatrist is required.
What treatments are available?
Various forms of psychotherapy may be useful, alone or in combination with medications which can help people with HIV disease express and understand their emotional reactions and find better ways to cope. Some problems can be treated with medications. There are anti-anxiety medications and antidepressants, including psycho-stimulants, that are safe and effective for use in people with HIV disease. People with Mania may need a mood stabilizing medication and those with psychotic symptoms may need an antipsychotic medication. There is substance abuse counseling for those with alcohol or drug abuse problems. In some areas of the country, there may be support groups or AA groups for people who have both HIV and substance abuse problems.
Are there other forms of help?
Many areas have community groups that provide services such as food preparation, housing, buddy networks, hotlines, and information on how to access medical care. There are also self-help support groups where people with HIV or AIDS can meet with others coping with the same or similar problems. Groups are also available to provide support and services for friends and family members.
If you are HIV positive, are there things you can do to help yourself?
It is important that you see your doctor regularly, and that you follow his or her recommendations. You can help by making some lifestyle adjustments. It is important to maintain good nutrition and to get enough rest. If you smoke, try to stop. It is helpful to stop or reduce alcohol use. It is very important to develop social contacts and to enlist the support and help of friends and family. If you feel that you are alone, it is important to recognize that help and companionship are available. A local community group or hotline that specializes in helping those with HIV disease and AIDS can be a good place to start.
What sort of reaction should I expect from family and
friends when I tell them I’m HIV positive?
Your family and friends will be affected by the consequences of your HIV infection, too. They may also experience feelings of denial, anger, fear, and grief. Some, unfortunately, will suffer from the same misunderstandings and prejudices that exist in society at large concerning people with HIV disease. They may also have questions about how they can prevent the spread of the infection, as well as questions about what is to be expected as the consequence of infections. Discussion with your physician can be helpful. It is important to remember that counseling— including couples and family counseling—is available and can be useful. There are also support groups for spouses, partners, and close friends of those with HIV disease.
There are medications to control the infections and malignancies. There are also medications to slow the growth of HIV. However, right now there is no cure and no vaccination to prevent infection. The disease is fatal. However, many new treatments are being developed and there is hope that medical research will rapidly find better forms of treatment and prevention. HIV is spread through the transmission of contaminated body fluids—such as semen, vaginal secretions and blood—into the body of another person. The entry occurs through broken skin and mucous membranes (tissues that line the mouth, vagina, rectum, and urethra). Any activity where one partner—either heterosexual or homosexual—penetrates another sexually can spread the illness. Any cutting into the body with contaminated
instruments can cause infection; this includes needles used by IV drug abusers, unsterilized medical and dental equipment, as well as ear piercing, tattooing, and manicure equipment. Take precautions. Always ask if equipment used in medical, dental or cosmetic procedures is sterilized, new, or disposable. Always practice safe sex. Mothers infected with HIV should also know that they can pass the infection to their children during pregnancy and breast feeding. However, the virus is not spread by casual contact, such as hugging, holding hands, close conversation, sharing a meal, etc. Don’t assume AIDS can’t happen to you or your loved ones. It can. The only absolute treatment is prevention. We must try hard not to stigmatize and isolate those who are infected with HIV or have developed AIDS. If you have questions about what is safe, consult your physician.
Should I be tested for HIV antibodies?
It is important that you know your HIV antibody status. There are many places where you can take a test anonymously and where no record is kept of your results. Taking the test is also important because early diagnosis and treatment of HIV disease may prolong life and reduce disability. Those who engage in high-risk behavior—i.e., those who may become infected or infect others through IV drug use or unprotected (without a condom) hetero or homosexual intercourse—should consider taking the test immediately. In addition, anyone who received blood or blood products prior to screening of the blood supply in 1985 may have been exposed to the HIV virus.
You should never take the test without careful preparation and counseling, however. You should consider the emotional, social, legal, financial, and insurance consequences. It often helps to bring along a knowledgeable person whom you trust to help you ask questions that will get you the information you need to make an informed decision in the event you test positive. It is a good idea as well to have an expert with whom you can discuss your results.
What should I do with my test results?
If you are HIV positive, find a physician who knows about HIV disease and with whom you feel comfortable. You will need to work together very closely and will want someone who cares what happens to you.
If you are HIV negative, consult your physician about the need for future testing and about lifestyle changes you may need to make in order to stay HIV negative.
If I’m HIV positive, should I tell other people?
It is important to tell those whom you may have exposed through sexual contact, needle sharing or other risky behavior. They need to be tested and have the knowledge that allows them to seek medical are. This can be very difficult to do and counseling can help. You will profit from a network of helpful and supportive people. However, you do need to be careful about whom you tell. Some people have very strong reactions. Telling your boss and coworkers can have financial and legal ramifications. It is best to start with a few friends or family with whom you feel close and whom you can trust not to tell others. Developing a community of support is a process and takes time. There may be HIV-positive support groups in your area or HIV hotlines that provide education and helpful support.
How does it feel to be HIV positive?
It is normal to have strong reactions such as fear, anger, and a sense of being overwhelmed. Some people even have suicidal thoughts. It is understandable that you might feel helpless and fear illness, disability and death. Other reactions might include:
Denial
Often, people who find out they are HIV positive will handle the news by denying that it is true. This denial may come up soon after the diagnosis is made. Denial can be helpful: it can give you time to get used to the idea of infection. It can, however, cause problems for oneself and others if one engages in risky behavior. And if it goes on too long it can get in the way of your getting the assistance and medical attention you need.
Guilt
It is not unusual for people to blame themselves for illness and to feel it is punishment. This guilt can be worsened by society’s prejudice and ignorance about HIV and AIDS. It is important, if you are HIV positive, to seek out those who are accepting and supportive.
Sadness
HIV disease means life changes and losses of one kind or another. Sadness is an understandable reaction. Sadness lifts for most people as they adjust. On the other hand, it can turn —sometimes slowly and subtly, sometimes quickly—into a more serious problem, called Depression.
If you are feeling depressed, it is important that you talk your feelings out. Your physician— as well as knowledgeable and supportive friends and loved ones—can help. Remember that there is always help through counseling, and any strong and lasting reaction calls for some kind of assistance.
What other psychiatric reactions are possible with HIV disease?
Many people with HIV disease do not develop serious emotional illness. However, if you develop any if the following reactions, it is important that you seek treatment. Depression—Characterized by prolonged periods of sadness and crying, feeling low or despairing, feelings of guilt and lowered self-esteem, a tendency to see only the negative side of things; also, fatigue, decreased ability to concentrate, loss of pleasure in activities, changes in appetite and weight, trouble sleeping, and, sometimes, thoughts of suicide.
Anxiety disorders—Characterized by excessive worry, feelings of being always on edge, muscle tension, restlessness; and other physical symptoms such as shortness of breath, sweating, rapid heart rate, nausea and diarrhea. They may also appear as sudden attacks of intense anxiety.
Mania—Characterized by an abnormally and persistently elevated mood or great shifts of mood, often with marked irritability. There is decreased desire for sleep, overactivity, rapid talking, poor concentration, and racing thoughts. People with this disorder may also have grand and sometimes bizarre ideas about themselves and impossible schemes for making money and becoming famous. They
may engage in spending sprees and other impulsive behavior. They may become very disorganized in their thinking and behavior and be unable to take care of themselves.
Psychotic symptoms—People may develop hallucinations, seeing things or hearing things that other people do not. They also may become “delusional,” developing strange, unrealistic, and very unlikely ideas. For example, they may think that even their closest friends are plotting to harm them or that secret organizations are spying on them, bugging their telephone or sending messages by television or radio. These are just a few examples of the many forms psychosis can take.
Alcohol and drug abuse—Some people may try to numb their feelings by abusing drugs and alcohol. At times, the person has a history of such problems. At other times, they begin to abuse drugs and alcohol after they learn they are HIV positive or develop symptoms of AIDS.
Difficulties with memory and thinking
Infections, malignancies, and nutritional deficiencies that are the results of AIDS can affect brain functioning. Some medications used to treat HIV infection or its complications can also have these effects. HIV itself can infect the brain, causing a condition doctors call AIDS Dementia Complex. Symptoms that might be a signal of trouble include:
-Forgetfulness
-Confusion
-Difficulty paying attention
-Slurred or changed speech
-Sudden changes in mood or behavior
-Clumsiness or difficulty walking
-Muscle weakness or strange sensations, like numbness or tingling
-Slowed thinking and difficulty finding words
If you have any of these problems you should discuss your concerns with your physician. He or she may suggest the help of a psychiatrist or other mental health specialist.
How can a psychiatrist help me?
A psychiatrist will talk with you and take a history in which he or she will ask about your current problems and how you managed in the past. He or she will need to know about any past or present alcohol or drug abuse and whether there is any family history of emotional problems or substance abuse. The psychiatrist, who is a medical doctor, will need to speak with your other physicians and review your medical history. The psychiatrist will ask specific questions to test memory, attention, and other aspects of thinking and problem solving. Your psychiatrist will tell you and your physician what he or she thinks is the nature of your problem, and will make recommendations for treatment. With your agreement, he or she may provide the recommended treatment if the expertise of a psychiatrist is required.
What treatments are available?
Various forms of psychotherapy may be useful, alone or in combination with medications which can help people with HIV disease express and understand their emotional reactions and find better ways to cope. Some problems can be treated with medications. There are anti-anxiety medications and antidepressants, including psycho-stimulants, that are safe and effective for use in people with HIV disease. People with Mania may need a mood stabilizing medication and those with psychotic symptoms may need an antipsychotic medication. There is substance abuse counseling for those with alcohol or drug abuse problems. In some areas of the country, there may be support groups or AA groups for people who have both HIV and substance abuse problems.
Are there other forms of help?
Many areas have community groups that provide services such as food preparation, housing, buddy networks, hotlines, and information on how to access medical care. There are also self-help support groups where people with HIV or AIDS can meet with others coping with the same or similar problems. Groups are also available to provide support and services for friends and family members.
If you are HIV positive, are there things you can do to help yourself?
It is important that you see your doctor regularly, and that you follow his or her recommendations. You can help by making some lifestyle adjustments. It is important to maintain good nutrition and to get enough rest. If you smoke, try to stop. It is helpful to stop or reduce alcohol use. It is very important to develop social contacts and to enlist the support and help of friends and family. If you feel that you are alone, it is important to recognize that help and companionship are available. A local community group or hotline that specializes in helping those with HIV disease and AIDS can be a good place to start.
What sort of reaction should I expect from family and
friends when I tell them I’m HIV positive?
Your family and friends will be affected by the consequences of your HIV infection, too. They may also experience feelings of denial, anger, fear, and grief. Some, unfortunately, will suffer from the same misunderstandings and prejudices that exist in society at large concerning people with HIV disease. They may also have questions about how they can prevent the spread of the infection, as well as questions about what is to be expected as the consequence of infections. Discussion with your physician can be helpful. It is important to remember that counseling— including couples and family counseling—is available and can be useful. There are also support groups for spouses, partners, and close friends of those with HIV disease.
Women and Diabetes
• In the U.S., 9.1 million women have
diabetes and 3 million of them don't
even know it.
• Women who have diabetes are more
likely to have a miscarriage or a baby
with birth defects.
• Women with diabetes are more likely
to be poor which makes it harder to
manage the disease.
Heart Disease
and Stroke
• Women with diabetes are more likely
to have a heart attack and have it at a
younger age.
• Most people with diabetes die from
heart attack or stroke.
Are You at Risk for Diabetes?
Are you overweight?
Do you get little or no exercise?
Do you have high blood pressure
(130/80 or higher)?
Do you have a brother or sister with
diabetes?
Do you have a parent with diabetes?
Are you a woman who had diabetes
when you were pregnant OR have you
had a baby who weighed more than 9
pounds at birth?
Warning Signs
Going to the bathroom a lot
Feeling hungry or thirsty all the time
Blurred vision
Lose weight without trying
Cuts/bruises that are slow to heal
Feeling tired all the time
Tingling/numbness in the hands or feet
Most people with diabetes do not notice any
signs.
thke Time To Care…
What is
Diabetes?
• Diabetes changes the way your body
uses food. In your body, the food you
eat turns to sugar.
• Your blood takes this sugar all over the
body. Insulin helps get sugar from the
blood into the body for energy.
• Your body does not get the fuel it
needs, and your blood sugar stays high.
• High blood sugar can cause heart and
kidney problems, blindness, stroke, the
loss of a foot or leg, or even kill you.
Fats
Protein
Cholesterol
Fiber (fruits, vegetables, beans, breads,
and cereals)
• Be active at least 30 minutes a day
most days of the week.
• Exercise helps your body's insulin work
better. It also lowers your blood sugar,
blood pressure and cholesterol.
Use Medicines
Wisely
• Sometimes people with diabetes need to
take pills or take a shot (insulin). Be sure
to follow the directions.
• Ask your doctor, nurse or pharmacist
what your medicines do, when to take
them, and if they have any side effects.
Check Your Blood
Sugar and Know Your
ABCs
• Help prevent heart disease and stroke
by controlling your blood sugar, blood
pressure, and cholesterol.
• Make a plan with your doctor, nurse or
pharmacist.
• Check your blood sugar using a meter
(home testing kit). This tells what your
blood sugar is so you can make wise
choices.
• Ask your doctor for an A-1-C (A-onesee)
blood test. It measures blood
sugar levels over 2-3 months.
• Talk to your health team about your
ABC's:
A - 1 - C
Blood pressure
Cholesterol
Types of Diabetes
• Type 1 - The body does not produce any
insulin. People with type 1 diabetes must
take insulin every day to stay alive.
• Type 2 - The body does not make
enough, or use insulin well. Most people
with diabetes have type 2.
• Some women get diabetes when they
are pregnant.
Watch What You Eat
and Get Exercise
• There is no one diet for people with
diabetes. Work with your team to come
up with a plan for you.
• You can eat the foods you love by
watching serving sizes. Carbohydrates
raise your blood sugar the most.
• The “Nutrition Facts” label on foods can
help. Many packaged foods contain
more than 1 serving.
• The foods we eat are made up of:
Carbohydrates (fruits, vegetables, breads,
juices, milk, cereals and desserts)
The Good
News…You Can
Manage Diabetes
Watch what you eat and get
exercise, use medicines wisely
and check your blood sugar.
diabetes and 3 million of them don't
even know it.
• Women who have diabetes are more
likely to have a miscarriage or a baby
with birth defects.
• Women with diabetes are more likely
to be poor which makes it harder to
manage the disease.
Heart Disease
and Stroke
• Women with diabetes are more likely
to have a heart attack and have it at a
younger age.
• Most people with diabetes die from
heart attack or stroke.
Are You at Risk for Diabetes?
Are you overweight?
Do you get little or no exercise?
Do you have high blood pressure
(130/80 or higher)?
Do you have a brother or sister with
diabetes?
Do you have a parent with diabetes?
Are you a woman who had diabetes
when you were pregnant OR have you
had a baby who weighed more than 9
pounds at birth?
Warning Signs
Going to the bathroom a lot
Feeling hungry or thirsty all the time
Blurred vision
Lose weight without trying
Cuts/bruises that are slow to heal
Feeling tired all the time
Tingling/numbness in the hands or feet
Most people with diabetes do not notice any
signs.
thke Time To Care…
What is
Diabetes?
• Diabetes changes the way your body
uses food. In your body, the food you
eat turns to sugar.
• Your blood takes this sugar all over the
body. Insulin helps get sugar from the
blood into the body for energy.
• Your body does not get the fuel it
needs, and your blood sugar stays high.
• High blood sugar can cause heart and
kidney problems, blindness, stroke, the
loss of a foot or leg, or even kill you.
Fats
Protein
Cholesterol
Fiber (fruits, vegetables, beans, breads,
and cereals)
• Be active at least 30 minutes a day
most days of the week.
• Exercise helps your body's insulin work
better. It also lowers your blood sugar,
blood pressure and cholesterol.
Use Medicines
Wisely
• Sometimes people with diabetes need to
take pills or take a shot (insulin). Be sure
to follow the directions.
• Ask your doctor, nurse or pharmacist
what your medicines do, when to take
them, and if they have any side effects.
Check Your Blood
Sugar and Know Your
ABCs
• Help prevent heart disease and stroke
by controlling your blood sugar, blood
pressure, and cholesterol.
• Make a plan with your doctor, nurse or
pharmacist.
• Check your blood sugar using a meter
(home testing kit). This tells what your
blood sugar is so you can make wise
choices.
• Ask your doctor for an A-1-C (A-onesee)
blood test. It measures blood
sugar levels over 2-3 months.
• Talk to your health team about your
ABC's:
A - 1 - C
Blood pressure
Cholesterol
Types of Diabetes
• Type 1 - The body does not produce any
insulin. People with type 1 diabetes must
take insulin every day to stay alive.
• Type 2 - The body does not make
enough, or use insulin well. Most people
with diabetes have type 2.
• Some women get diabetes when they
are pregnant.
Watch What You Eat
and Get Exercise
• There is no one diet for people with
diabetes. Work with your team to come
up with a plan for you.
• You can eat the foods you love by
watching serving sizes. Carbohydrates
raise your blood sugar the most.
• The “Nutrition Facts” label on foods can
help. Many packaged foods contain
more than 1 serving.
• The foods we eat are made up of:
Carbohydrates (fruits, vegetables, breads,
juices, milk, cereals and desserts)
The Good
News…You Can
Manage Diabetes
Watch what you eat and get
exercise, use medicines wisely
and check your blood sugar.
If You’re Overweight, Slim Down for Better Health
Overweight people have an increased risk of high blood pressure, heart disease, and other illnesses. Losing weight reduces the risk.
Ask Your Doctor About Sensible Goals
Your doctor or other health worker can help you set sensible goals based on a proper weight for your height, build and age.
Men and very active women may need up to 2,500 calories daily. Other women and inactive men need only about 2,000 calories daily. A safe plan is to eat 300 to 500 fewer calories a day to lose 1 to 2 pounds a week.
Exercise 30 Minutes
Do at least 30 minutes of exercise, like brisk walking, most days of the week.The idea is to use up more calories than you eat. You need to use up the day’s calories and some of the calories stored in your body fat.
Eat Less Fat and Sugar
This will help you cut Calories. Fried foods and fatty desserts can quickly use up a day’s calories. And these foods may not provide the other nutrients you need.
Eat a Favorite Rich Food, Sometimes
That may keep you from craving it. But eat only a small amount. Make sure your other foods that day are low in fat and calories.
Eat a Wide Variety Of Foods
Variety in the diet helps you get all the vitamins and other nutrients you need.
Watch Out for Promises of Quick And Easy Weight Loss
Fad diets aren’t good because they often call for too much or too little of one type of food. As a result, you may not get important nutrients you need daily.
Remember, if it sounds too good to be true, it probably isn’t true.
What About Diet Pills?
Diet pills you buy without a Prescription won’t make a big difference in how much you lose each week or how long you keep the weight off. If you do use them, read the label carefully. Because of possible side effects, like high blood pressure, never take more than the listed dose. Also, be careful about taking cough or cold medicines with diet pills you buy without a prescription. These medicines may contain the same drug used in diet pills, or a similar drug with the same effects. If you take both products together, you may get too much of the same type drug. This can hurt you. Skim
Milk Prescription diet pills may help some people. If you use them, follow the doctor’s directions carefully.
Ask Your Doctor About Sensible Goals
Your doctor or other health worker can help you set sensible goals based on a proper weight for your height, build and age.
Men and very active women may need up to 2,500 calories daily. Other women and inactive men need only about 2,000 calories daily. A safe plan is to eat 300 to 500 fewer calories a day to lose 1 to 2 pounds a week.
Exercise 30 Minutes
Do at least 30 minutes of exercise, like brisk walking, most days of the week.The idea is to use up more calories than you eat. You need to use up the day’s calories and some of the calories stored in your body fat.
Eat Less Fat and Sugar
This will help you cut Calories. Fried foods and fatty desserts can quickly use up a day’s calories. And these foods may not provide the other nutrients you need.
Eat a Favorite Rich Food, Sometimes
That may keep you from craving it. But eat only a small amount. Make sure your other foods that day are low in fat and calories.
Eat a Wide Variety Of Foods
Variety in the diet helps you get all the vitamins and other nutrients you need.
Watch Out for Promises of Quick And Easy Weight Loss
Fad diets aren’t good because they often call for too much or too little of one type of food. As a result, you may not get important nutrients you need daily.
Remember, if it sounds too good to be true, it probably isn’t true.
What About Diet Pills?
Diet pills you buy without a Prescription won’t make a big difference in how much you lose each week or how long you keep the weight off. If you do use them, read the label carefully. Because of possible side effects, like high blood pressure, never take more than the listed dose. Also, be careful about taking cough or cold medicines with diet pills you buy without a prescription. These medicines may contain the same drug used in diet pills, or a similar drug with the same effects. If you take both products together, you may get too much of the same type drug. This can hurt you. Skim
Milk Prescription diet pills may help some people. If you use them, follow the doctor’s directions carefully.
SMOG AND YOUR HEALTH
The Issue
Smog can cause damage to your heart and lungs – even when you can’t see or smell it
in the air around you.
Background
When we hear the word smog, many of us picture the chemical “soup” that often appears as a brownish-yellow haze over cities. But smog isn’t always visible. It’s a mixture of air pollutants, including gases and particles that are too small to see. Smog often begins in big cities, but smog levels can be just as high or higher in rural and suburban areas. We all need to protect our health against potential damage from smog.
Types and Sources of Air Pollution
The scientists who study smog are most concerned about the following types of air
pollution:
Type: Particulate Matter – or PM.
This is the name given to microscopic particles that pollute the air. They vary in size and chemical make-up.
Sources: Industrial and vehicle emissions, road dust, agriculture, construction and wood burning.
Type: Ground-level Ozone.
This gas is the result of a chemical reaction when certain pollutants are combined in the presence of sunlight. Ground-level ozone shouldn’t be confused with the ozone layer in the sky, which protects us from ultraviolet radiation.
Sources: Ground-level ozone comes mostly from burning fossil fuels for transportation and industry. Ozone levels peak between noon and 6 p.m. during the summer months.
There is also concern about:
Type: Sulphur dioxide
Sources: Coal-fired power plants and noniron ore smelters
Type: Carbon monoxide
Sources: Mostly from burning carbon fuels (e.g. motor vehicle exhaust)
Potential Health Effects
Since smog is a mixture of air pollutants, its impact on your health will depend on a number of things, including:
• The levels and types of pollutants in
the air
• Your age and general state of health
• The influence of weather
• How long you are exposed
• Where you live
Smog can irritate your eyes, nose and throat. Or it can worsen existing heart and lung problems. In exceptional cases it may result in an early death. The people most at risk are those who suffer from heart and lung problems. Many of these problems are more common in seniors, making them more likely to experience the negative effects of air pollution. Children can be more sensitive to the effects of air pollution because their respiratory systems are still developing and they tend to have an active lifestyle. Even healthy young adults breathe less well on days when the air is heavily polluted. The health effects of ground-level ozone and particulate matter (PM) is also cause for concern. Some studies suggest that long-term regular exposure to PM can increase your risk of early death and perhaps lung cancer. Studies on ozone show that once it gets into
your lungs, it can continue to cause damage even when you feel fine. This is why the federal government, is working to reduce the risks to your health.
Minimize Your Risk
To reduce your exposure to smog and its potential health effects:
• Check the Air Quality index in your community, especially during “smog season” from April to September. Tailor your activities accordingly.
• Avoid or reduce strenuous outdoor activities when smog levels are high, especially during the afternoon when groundlevel ozone reaches its peak. Choose indoor activities instead.
• Avoid or reduce exercising near areas of heavy traffic, especially during rush hour.
• If you have a heart or lung condition, talk to your health care professional about additional ways to protect your health when smog levels are high.
To help reduce the overall levels of smog in the air:
• When possible, use public transportation instead of your car. You could also walk or ride your bicycle, as long as smog levels are not too high.
• Look for alternatives to gaspowered machines and vehicles. Try a rowboat or sailboat instead of a motorboat or a push-type lawnmower instead of one that runs on gasoline.
• Consider fuel efficiency when you buy a vehicle. Keep all vehicles well maintained.
• Reduce energy use in your home. Learn more about alternative energy resources.
• Do not burn leaves, branches or other yard wastes.
• Consider joining a citizens’ committee to advocate for cleaner air in your community.
• Spend time talking with your children about the importance of a sustainable lifestyle.
Smog can cause damage to your heart and lungs – even when you can’t see or smell it
in the air around you.
Background
When we hear the word smog, many of us picture the chemical “soup” that often appears as a brownish-yellow haze over cities. But smog isn’t always visible. It’s a mixture of air pollutants, including gases and particles that are too small to see. Smog often begins in big cities, but smog levels can be just as high or higher in rural and suburban areas. We all need to protect our health against potential damage from smog.
Types and Sources of Air Pollution
The scientists who study smog are most concerned about the following types of air
pollution:
Type: Particulate Matter – or PM.
This is the name given to microscopic particles that pollute the air. They vary in size and chemical make-up.
Sources: Industrial and vehicle emissions, road dust, agriculture, construction and wood burning.
Type: Ground-level Ozone.
This gas is the result of a chemical reaction when certain pollutants are combined in the presence of sunlight. Ground-level ozone shouldn’t be confused with the ozone layer in the sky, which protects us from ultraviolet radiation.
Sources: Ground-level ozone comes mostly from burning fossil fuels for transportation and industry. Ozone levels peak between noon and 6 p.m. during the summer months.
There is also concern about:
Type: Sulphur dioxide
Sources: Coal-fired power plants and noniron ore smelters
Type: Carbon monoxide
Sources: Mostly from burning carbon fuels (e.g. motor vehicle exhaust)
Potential Health Effects
Since smog is a mixture of air pollutants, its impact on your health will depend on a number of things, including:
• The levels and types of pollutants in
the air
• Your age and general state of health
• The influence of weather
• How long you are exposed
• Where you live
Smog can irritate your eyes, nose and throat. Or it can worsen existing heart and lung problems. In exceptional cases it may result in an early death. The people most at risk are those who suffer from heart and lung problems. Many of these problems are more common in seniors, making them more likely to experience the negative effects of air pollution. Children can be more sensitive to the effects of air pollution because their respiratory systems are still developing and they tend to have an active lifestyle. Even healthy young adults breathe less well on days when the air is heavily polluted. The health effects of ground-level ozone and particulate matter (PM) is also cause for concern. Some studies suggest that long-term regular exposure to PM can increase your risk of early death and perhaps lung cancer. Studies on ozone show that once it gets into
your lungs, it can continue to cause damage even when you feel fine. This is why the federal government, is working to reduce the risks to your health.
Minimize Your Risk
To reduce your exposure to smog and its potential health effects:
• Check the Air Quality index in your community, especially during “smog season” from April to September. Tailor your activities accordingly.
• Avoid or reduce strenuous outdoor activities when smog levels are high, especially during the afternoon when groundlevel ozone reaches its peak. Choose indoor activities instead.
• Avoid or reduce exercising near areas of heavy traffic, especially during rush hour.
• If you have a heart or lung condition, talk to your health care professional about additional ways to protect your health when smog levels are high.
To help reduce the overall levels of smog in the air:
• When possible, use public transportation instead of your car. You could also walk or ride your bicycle, as long as smog levels are not too high.
• Look for alternatives to gaspowered machines and vehicles. Try a rowboat or sailboat instead of a motorboat or a push-type lawnmower instead of one that runs on gasoline.
• Consider fuel efficiency when you buy a vehicle. Keep all vehicles well maintained.
• Reduce energy use in your home. Learn more about alternative energy resources.
• Do not burn leaves, branches or other yard wastes.
• Consider joining a citizens’ committee to advocate for cleaner air in your community.
• Spend time talking with your children about the importance of a sustainable lifestyle.
Stroke
About four million Americans have had a stroke -- the interruption of
oxygen flowing to the brain -- and are living with the effects, which can
range from mild to severe. Many people die of strokes, the third leading
cause of death in the United States after heart disease and cancer. But
more than a third of the people who have strokes recover with few or
minor impairments and lead normal lives for years afterward. In addition,
some people may be able to reduce their risk of a stroke by making
changes in their lifestyle.
What is a stroke?
A stroke occurs when something interrupts the normal flow of blood that carries
oxygen to the brain. This interruption usually causes some brain cells to die or
become permanently damaged, which can affect the abilities controlled by the
brain, such as speech and movement. Doctors call a stroke a cerebrovascular
accident (CVA) because it involves a part of the brain called the cerebrum and the
blood vessels or vascular system that supply it with oxygen.
A stroke may seem to occur as suddenly as any other “accident.” But it often
results from changes that have been taking place in the body for years. Strokes
can occur at any age, but are most common in people over 65.
What causes a stroke?
Many things can cause the flow of blood to the brain to become interrupted,
leading to a stroke. Some of them are:
•Thrombosis. A thrombosis is the most common cause of a stroke. It occurs when a
blood clot called a thrombus blocks the flow of blood in an artery bringing
blood to the brain. The clot typically begins in an artery with a build-up of
cholesterol and fats, a condition known as atherosclerosis or “hardening of the
arteries.”
•Embolism. An embolism resembles a thrombosis in that it involves a clot, in this
case called an embolus. But the clot does not begin in the wall of a brain artery.
The embolus begins in another part of the body, such as the heart, and travels
through the blood stream until it blocks a narrow artery in the brain.
•Hemorrhage. A hemorrhage occurs when a blood vessel bursts and bleeds into
aneurysm, a bulge at a weak spot in an artery that is often caused by high blood
pressure or atherosclerosis.
•Other factors. Strokes can also result from other things that affect the arteries of
the brain, including inflammation, an infection, and drugs such as cocaine and
amphetamines.
Sometimes the brain gets too little blood for a short time, and this affects its
ability to function during that time. This condition is known as a transient
ischemic attack (TIA) and can result from a temporary spasm in an artery that
restricts the flow of blood to the brain. Some people refer to TIAs as “small
strokes.” But if the spasm is short enough to cause no permanent damage, it
technically isn’t a stroke. TIAs can be warning signs of a stroke or isolated events
that never lead to a stroke.
Stroke risk factors
Some people have a higher risk of strokes than others. African-Americans face a
greater risk of strokes than whites, and men generally have a slightly higher risk
than women. Other people with a higher risk of strokes are those who:
- are over age 65
- are overweight
- have a family history of stroke
- have high blood pressure, especially if it is untreated or uncontrolled
- have had earlier strokes or TIAs
- have diabetes
- have heart disease, especially atrial fibrillation (AF)
- smoke cigarettes
- drink too much alcohol (more than two glasses a day for men or one glass a
day for women)
Warning signs of a stroke
Sometimes people have strokes so small they don’t know they’ve had them until
they have medical tests for another condition. In other cases the signs of a stroke
are easy to recognize. They may come on very suddenly and include:
- numbness or weakness, especially on one side of the body
- trouble speaking or understanding speech
- double vision, or trouble seeing with one or both eyes
- trouble walking, a loss of balance, or unexplained falls
- confusion, dizziness, or unsteadiness
- changes in personality or mental ability
- very severe and unexplainable headache (sometimes described as “the worst
headache ever”)
It’s essential to get medical help immediately if you have any of these signs. Go
to an emergency room, call 911, or have someone call for you. These signs can
be symptoms of a stroke, a transient ischemic attack, or another problem. But
only a doctor can determine the cause of the problem. Getting help within the
first minutes after a stroke can often mean the difference between life and death
or reduce the permanent damage that may result.
If you have any of the warning signs, your doctor may be able to diagnose a
stroke based on a brief physical or neurological exam or it may be necessary to
do other tests like blood tests, arteriography or angiography, computed
tomagraphy (CT) scans, Doppler ultrasound, or magnetic resonance imaging
(MRI).
Stroke treatment
The treatment for a stroke depends on the cause and the resulting effects. One of
the most common effects is a weakness or paralysis on one side of the body. A
stroke that occurs on the right side of the brain typically leads to left-sided
weakness and may result in personality changes. A stroke on the left side of the
brain leads to right-sided weakness and may cause problems with speaking or
understanding speech. In both cases people may have personality changes or act
differently and may lose memory, vision, or hearing.
In the first few months after a stroke, many people spontaneously get back some
of the abilities they lost. But there are no guarantees, so doctors will begin
treatment right away to reduce the risk of long-term problems. The three
general categories of treatment for a stroke are prevention, treatment
immediately after a stroke, and rehabilitation in the months or weeks after a
stroke.
Prevention
You can’t control some of the things that increase your risk of a stroke, such as
your age. The best way to lower the odds of having a stroke is to follow your
doctor’s advice about reducing the risk factors that you can control.
One of the most important things you can do to reduce your risk of having a
stroke is maintaining a healthy blood pressure. Have regular medical checkups
that include a blood pressure test, and if you have high blood pressure, follow
your doctor’s advice very carefully. Your doctor may advise you to eat a low-fat
diet, get more exercise, quit smoking, take medication, or check your blood
pressure at home. Remember that if you have high blood pressure, you’ll need to
watch this carefully throughout your lifetime, so be sure to ask your doctor
about any special precautions you may need to take if, for example, you go on
vacation or experience a major change in your lifestyle.
If you drink or use drugs, your doctor may recommend that you lower your
alcohol consumption or join a substance-abuse program. People who’ve had one
stroke or TIA are 10 times more like than other people to have another stroke or
TIA, so you may need to take extra steps if you’ve had one of these.
Treatment immediately after a stroke
It’s vital to get medical help immediately if you may be having a stroke, because
doctors can sometimes prevent further damage to the body by acting quickly.
For example, if a blood clot has caused the stroke, doctors may be able to prevent
or reverse paralysis by administering drugs to break up the clot.
Doctors don’t usually treat strokes with surgery. But if a brain artery is severely
blocked, they may recommend removing the blockage to prevent future strokes.
In some cases, they may prescribe medication to reduce pressure on the brain or
to relieve other problems that can accompany a stroke.
Sometimes feelings of depression follow a stroke, especially if it involved a loss of
important abilities. If you have mood changes, it’s important to let your doctor
know. Your doctor may recommend that you take antidepressant medications or
look into counseling or another form of therapy.
Rehabilitation
A well-planned rehabilitation program helps many people overcome some of the
effects of a stroke. Although a stroke damages part of the brain, other parts of the
brain may be able to take over some of the functions of the damaged part.
Rehabilitation usually begins as soon as vital signs, such as pulse and blood
pressure, have stabilized. After leaving the hospital, many people benefit from a
stay in a nursing home or rehabilitation hospital with special facilities to aid
recovery.
Getting the most from a rehabilitation program requires a strong commitment
to working closely with doctors, nurses, and other health workers, such as
physical or occupational therapists. This process takes time and patience, and
you may find it easier to stick to a program if you join a support group for
people who have had strokes and understand the challenges you face. Support
groups can provide both emotional support and practical tips on coping with the
day-to-day realities of life after a stroke. You may be able to find a support group
through the neurology or social work department of a hospital or mental health
center. If you can’t attend meetings, you may want to join an online support
group run by a national organization for people who have had strokes.
oxygen flowing to the brain -- and are living with the effects, which can
range from mild to severe. Many people die of strokes, the third leading
cause of death in the United States after heart disease and cancer. But
more than a third of the people who have strokes recover with few or
minor impairments and lead normal lives for years afterward. In addition,
some people may be able to reduce their risk of a stroke by making
changes in their lifestyle.
What is a stroke?
A stroke occurs when something interrupts the normal flow of blood that carries
oxygen to the brain. This interruption usually causes some brain cells to die or
become permanently damaged, which can affect the abilities controlled by the
brain, such as speech and movement. Doctors call a stroke a cerebrovascular
accident (CVA) because it involves a part of the brain called the cerebrum and the
blood vessels or vascular system that supply it with oxygen.
A stroke may seem to occur as suddenly as any other “accident.” But it often
results from changes that have been taking place in the body for years. Strokes
can occur at any age, but are most common in people over 65.
What causes a stroke?
Many things can cause the flow of blood to the brain to become interrupted,
leading to a stroke. Some of them are:
•Thrombosis. A thrombosis is the most common cause of a stroke. It occurs when a
blood clot called a thrombus blocks the flow of blood in an artery bringing
blood to the brain. The clot typically begins in an artery with a build-up of
cholesterol and fats, a condition known as atherosclerosis or “hardening of the
arteries.”
•Embolism. An embolism resembles a thrombosis in that it involves a clot, in this
case called an embolus. But the clot does not begin in the wall of a brain artery.
The embolus begins in another part of the body, such as the heart, and travels
through the blood stream until it blocks a narrow artery in the brain.
•Hemorrhage. A hemorrhage occurs when a blood vessel bursts and bleeds into
aneurysm, a bulge at a weak spot in an artery that is often caused by high blood
pressure or atherosclerosis.
•Other factors. Strokes can also result from other things that affect the arteries of
the brain, including inflammation, an infection, and drugs such as cocaine and
amphetamines.
Sometimes the brain gets too little blood for a short time, and this affects its
ability to function during that time. This condition is known as a transient
ischemic attack (TIA) and can result from a temporary spasm in an artery that
restricts the flow of blood to the brain. Some people refer to TIAs as “small
strokes.” But if the spasm is short enough to cause no permanent damage, it
technically isn’t a stroke. TIAs can be warning signs of a stroke or isolated events
that never lead to a stroke.
Stroke risk factors
Some people have a higher risk of strokes than others. African-Americans face a
greater risk of strokes than whites, and men generally have a slightly higher risk
than women. Other people with a higher risk of strokes are those who:
- are over age 65
- are overweight
- have a family history of stroke
- have high blood pressure, especially if it is untreated or uncontrolled
- have had earlier strokes or TIAs
- have diabetes
- have heart disease, especially atrial fibrillation (AF)
- smoke cigarettes
- drink too much alcohol (more than two glasses a day for men or one glass a
day for women)
Warning signs of a stroke
Sometimes people have strokes so small they don’t know they’ve had them until
they have medical tests for another condition. In other cases the signs of a stroke
are easy to recognize. They may come on very suddenly and include:
- numbness or weakness, especially on one side of the body
- trouble speaking or understanding speech
- double vision, or trouble seeing with one or both eyes
- trouble walking, a loss of balance, or unexplained falls
- confusion, dizziness, or unsteadiness
- changes in personality or mental ability
- very severe and unexplainable headache (sometimes described as “the worst
headache ever”)
It’s essential to get medical help immediately if you have any of these signs. Go
to an emergency room, call 911, or have someone call for you. These signs can
be symptoms of a stroke, a transient ischemic attack, or another problem. But
only a doctor can determine the cause of the problem. Getting help within the
first minutes after a stroke can often mean the difference between life and death
or reduce the permanent damage that may result.
If you have any of the warning signs, your doctor may be able to diagnose a
stroke based on a brief physical or neurological exam or it may be necessary to
do other tests like blood tests, arteriography or angiography, computed
tomagraphy (CT) scans, Doppler ultrasound, or magnetic resonance imaging
(MRI).
Stroke treatment
The treatment for a stroke depends on the cause and the resulting effects. One of
the most common effects is a weakness or paralysis on one side of the body. A
stroke that occurs on the right side of the brain typically leads to left-sided
weakness and may result in personality changes. A stroke on the left side of the
brain leads to right-sided weakness and may cause problems with speaking or
understanding speech. In both cases people may have personality changes or act
differently and may lose memory, vision, or hearing.
In the first few months after a stroke, many people spontaneously get back some
of the abilities they lost. But there are no guarantees, so doctors will begin
treatment right away to reduce the risk of long-term problems. The three
general categories of treatment for a stroke are prevention, treatment
immediately after a stroke, and rehabilitation in the months or weeks after a
stroke.
Prevention
You can’t control some of the things that increase your risk of a stroke, such as
your age. The best way to lower the odds of having a stroke is to follow your
doctor’s advice about reducing the risk factors that you can control.
One of the most important things you can do to reduce your risk of having a
stroke is maintaining a healthy blood pressure. Have regular medical checkups
that include a blood pressure test, and if you have high blood pressure, follow
your doctor’s advice very carefully. Your doctor may advise you to eat a low-fat
diet, get more exercise, quit smoking, take medication, or check your blood
pressure at home. Remember that if you have high blood pressure, you’ll need to
watch this carefully throughout your lifetime, so be sure to ask your doctor
about any special precautions you may need to take if, for example, you go on
vacation or experience a major change in your lifestyle.
If you drink or use drugs, your doctor may recommend that you lower your
alcohol consumption or join a substance-abuse program. People who’ve had one
stroke or TIA are 10 times more like than other people to have another stroke or
TIA, so you may need to take extra steps if you’ve had one of these.
Treatment immediately after a stroke
It’s vital to get medical help immediately if you may be having a stroke, because
doctors can sometimes prevent further damage to the body by acting quickly.
For example, if a blood clot has caused the stroke, doctors may be able to prevent
or reverse paralysis by administering drugs to break up the clot.
Doctors don’t usually treat strokes with surgery. But if a brain artery is severely
blocked, they may recommend removing the blockage to prevent future strokes.
In some cases, they may prescribe medication to reduce pressure on the brain or
to relieve other problems that can accompany a stroke.
Sometimes feelings of depression follow a stroke, especially if it involved a loss of
important abilities. If you have mood changes, it’s important to let your doctor
know. Your doctor may recommend that you take antidepressant medications or
look into counseling or another form of therapy.
Rehabilitation
A well-planned rehabilitation program helps many people overcome some of the
effects of a stroke. Although a stroke damages part of the brain, other parts of the
brain may be able to take over some of the functions of the damaged part.
Rehabilitation usually begins as soon as vital signs, such as pulse and blood
pressure, have stabilized. After leaving the hospital, many people benefit from a
stay in a nursing home or rehabilitation hospital with special facilities to aid
recovery.
Getting the most from a rehabilitation program requires a strong commitment
to working closely with doctors, nurses, and other health workers, such as
physical or occupational therapists. This process takes time and patience, and
you may find it easier to stick to a program if you join a support group for
people who have had strokes and understand the challenges you face. Support
groups can provide both emotional support and practical tips on coping with the
day-to-day realities of life after a stroke. You may be able to find a support group
through the neurology or social work department of a hospital or mental health
center. If you can’t attend meetings, you may want to join an online support
group run by a national organization for people who have had strokes.
Tips for Cutting Calories and Fat
Eat plenty of vegetables, fruits, and
grain products like bread and rice.
❍ Eat only small, single servings of
foods high in fat or calories.
❍ Eat less sugar and fewer sweets.
❍ Drink less alcohol or no alcohol.
❍ Choose foods whose labels say
low, light or reduced to describe
calories or fat.
❍ Choose 1 percent or skim milk
products and reduced fat cheeses.
❍ Replace ice cream with fat-free
frozen yogurt.
❍ Replace sour cream with fat-free or
low-fat plain yogurt.
❍ Make sure fish, poultry and meat
are lean. Trim skin and fat.
❍ Broil, roast or steam foods.
grain products like bread and rice.
❍ Eat only small, single servings of
foods high in fat or calories.
❍ Eat less sugar and fewer sweets.
❍ Drink less alcohol or no alcohol.
❍ Choose foods whose labels say
low, light or reduced to describe
calories or fat.
❍ Choose 1 percent or skim milk
products and reduced fat cheeses.
❍ Replace ice cream with fat-free
frozen yogurt.
❍ Replace sour cream with fat-free or
low-fat plain yogurt.
❍ Make sure fish, poultry and meat
are lean. Trim skin and fat.
❍ Broil, roast or steam foods.
You Can Quit Smoking
NICOTINE: A POWERFUL ADDICTION
If you have tried to quit smoking, you know how hard it can be. It
is hard because nicotine is a very addictive drug. For some people,
it can be as addictive as heroin or cocaine.
Quitting is hard. Usually people make 2 or 3 tries, or more, before
finally being able to quit. Each time you try to quit, you can learn
about what helps and what hurts.
QUITTING TAKES HARD WORK AND A
LOT OF EFFORT, BUT—YOU CAN QUIT
SMOKING.
GOOD REASONS FOR QUITTING
Quitting smoking is one of the most important things you will ever
do:
• You will live longer and live better.
• Quitting will lower your chance of having a heart attack,
stroke, or cancer.
• If you are pregnant, quitting smoking will improve your
chances of having a healthy baby.
• The people you live with, especially your children, will
be healthier.
• You will have extra money to spend on things other than
cigarettes.
FIVE KEYS FOR QUITTING
Studies have shown that these five steps will help you quit and quit
for good. You have the best chances of quitting if you use them
together:
1. Get ready.
2. Get support.
3. Learn new skills and behaviors.
4. Get medication and use it correctly.
5. Be prepared for relapse or difficult situations.
1. GET READY
• Set a quit date.
• Change your environment.
-Get rid of ALL cigarettes and ashtrays in your home, car,
and place of work.
-Don’t let people smoke in your home.
• Review your past attempts to quit. Think about what worked
and what did not.
• Once you quit, don’t smoke—NOT EVEN A PUFF!
S M T W TH F S
2. GET SUPPORT AND
ENCOURAGEMENT
Studies have shown that you have a better chance of being
successful if you have help. You can get support in many ways:
• Tell your family, friends, and coworkers that you are going to
quit and want their support. Ask them not to smoke around
you or leave cigarettes out.
• Talk to your health care provider (for example, doctor, dentist,
nurse, pharmacist, psychologist, or smoking counselor).
• Get individual, group, or telephone counseling. The more
counseling you have, the better your chances are of quitting.
Programs are given at local hospitals and health centers. Call
your local health department for information about programs
in your area.
3. LEARN NEW SKILLS
AND BEHAVIORS
• Try to distract yourself from urges to smoke. Talk to someone,
go for a walk, or get busy with a task.
• When you first try to quit, change your routine. Use a
different route to work. Drink tea instead of coffee. Eat
breakfast in a different place.
• Do something to reduce your stress. Take a hot bath, exercise,
or read a book.
• Plan something enjoyable to do every day.
• Drink a lot of water and other fluids.
4. GET MEDICATION AND
USE IT CORRECTLY
Medications can help you stop smoking and lessen the urge to
smoke.
• The U.S. Food and Drug Administration (FDA) has approved
five medications to help you quit smoking:
— Bupropion SR - available by prescription
— Nicotine gum - available over-the-counter
— Nicotine inhaler - available by prescription
— Nicotine nasal spray - available by prescription
— Nicotine patch - available by prescription and over-thecounter
• Ask your health care provider for advice and carefully read the
information on the package.
• All of these medications will more or less double your chances
of quitting and quitting for good.
• Everyone who is trying to quit may benefit from using a
medication. If you are pregnant or trying to become pregnant,
nursing, under age 18, smoking fewer than 10 cigarettes per
day, or have a medical condition, talk to your doctor or other
health care provider before taking medications.
5. BE PREPARED FOR
RELAPSE OR DIFFICULT
SITUATIONS
Most relapses occur within the first 3 months after quitting.
Don’t be discouraged if you start smoking again. Remember,
most people try several times before they finally quit. Here are
some difficult situations to watch for.
• Alcohol. Avoid drinking alcohol. Drinking lowers your
chances of success.
• Other smokers. Being around smoking can make you want
to smoke.
• Weight gain. Many smokers will gain weight when they
quit, usually less than 10 pounds. Eat a healthy diet and stay
active. Don’t let weight gain distract you from your main
goal—quitting smoking. Some quit-smoking medications
may help delay weight gain.
• Bad mood or depression. There are a lot of ways to improve
your mood other than smoking.
If you are having problems with any of these situations, talk to
your doctor or other health care provider
SPECIAL SITUATIONS OR CONDITIONS
Studies suggest that everyone can quit smoking. Your situation or
condition can give you a special reason to quit.
Pregnant women/new mothers: By quitting, you protect your
baby’s health and your own.
Hospitalized patients: By quitting, you reduce health
problems and help healing.
Heart attack patients: By quitting, you reduce your risk of a
second heart attack.
Lung, head, and neck cancer patients: By quitting, you
reduce your chance of a second cancer.
Parents of children and adolescents: By quitting, you protect
your children and adolescents from illnesses caused by
second-hand smoke.
If you have tried to quit smoking, you know how hard it can be. It
is hard because nicotine is a very addictive drug. For some people,
it can be as addictive as heroin or cocaine.
Quitting is hard. Usually people make 2 or 3 tries, or more, before
finally being able to quit. Each time you try to quit, you can learn
about what helps and what hurts.
QUITTING TAKES HARD WORK AND A
LOT OF EFFORT, BUT—YOU CAN QUIT
SMOKING.
GOOD REASONS FOR QUITTING
Quitting smoking is one of the most important things you will ever
do:
• You will live longer and live better.
• Quitting will lower your chance of having a heart attack,
stroke, or cancer.
• If you are pregnant, quitting smoking will improve your
chances of having a healthy baby.
• The people you live with, especially your children, will
be healthier.
• You will have extra money to spend on things other than
cigarettes.
FIVE KEYS FOR QUITTING
Studies have shown that these five steps will help you quit and quit
for good. You have the best chances of quitting if you use them
together:
1. Get ready.
2. Get support.
3. Learn new skills and behaviors.
4. Get medication and use it correctly.
5. Be prepared for relapse or difficult situations.
1. GET READY
• Set a quit date.
• Change your environment.
-Get rid of ALL cigarettes and ashtrays in your home, car,
and place of work.
-Don’t let people smoke in your home.
• Review your past attempts to quit. Think about what worked
and what did not.
• Once you quit, don’t smoke—NOT EVEN A PUFF!
S M T W TH F S
2. GET SUPPORT AND
ENCOURAGEMENT
Studies have shown that you have a better chance of being
successful if you have help. You can get support in many ways:
• Tell your family, friends, and coworkers that you are going to
quit and want their support. Ask them not to smoke around
you or leave cigarettes out.
• Talk to your health care provider (for example, doctor, dentist,
nurse, pharmacist, psychologist, or smoking counselor).
• Get individual, group, or telephone counseling. The more
counseling you have, the better your chances are of quitting.
Programs are given at local hospitals and health centers. Call
your local health department for information about programs
in your area.
3. LEARN NEW SKILLS
AND BEHAVIORS
• Try to distract yourself from urges to smoke. Talk to someone,
go for a walk, or get busy with a task.
• When you first try to quit, change your routine. Use a
different route to work. Drink tea instead of coffee. Eat
breakfast in a different place.
• Do something to reduce your stress. Take a hot bath, exercise,
or read a book.
• Plan something enjoyable to do every day.
• Drink a lot of water and other fluids.
4. GET MEDICATION AND
USE IT CORRECTLY
Medications can help you stop smoking and lessen the urge to
smoke.
• The U.S. Food and Drug Administration (FDA) has approved
five medications to help you quit smoking:
— Bupropion SR - available by prescription
— Nicotine gum - available over-the-counter
— Nicotine inhaler - available by prescription
— Nicotine nasal spray - available by prescription
— Nicotine patch - available by prescription and over-thecounter
• Ask your health care provider for advice and carefully read the
information on the package.
• All of these medications will more or less double your chances
of quitting and quitting for good.
• Everyone who is trying to quit may benefit from using a
medication. If you are pregnant or trying to become pregnant,
nursing, under age 18, smoking fewer than 10 cigarettes per
day, or have a medical condition, talk to your doctor or other
health care provider before taking medications.
5. BE PREPARED FOR
RELAPSE OR DIFFICULT
SITUATIONS
Most relapses occur within the first 3 months after quitting.
Don’t be discouraged if you start smoking again. Remember,
most people try several times before they finally quit. Here are
some difficult situations to watch for.
• Alcohol. Avoid drinking alcohol. Drinking lowers your
chances of success.
• Other smokers. Being around smoking can make you want
to smoke.
• Weight gain. Many smokers will gain weight when they
quit, usually less than 10 pounds. Eat a healthy diet and stay
active. Don’t let weight gain distract you from your main
goal—quitting smoking. Some quit-smoking medications
may help delay weight gain.
• Bad mood or depression. There are a lot of ways to improve
your mood other than smoking.
If you are having problems with any of these situations, talk to
your doctor or other health care provider
SPECIAL SITUATIONS OR CONDITIONS
Studies suggest that everyone can quit smoking. Your situation or
condition can give you a special reason to quit.
Pregnant women/new mothers: By quitting, you protect your
baby’s health and your own.
Hospitalized patients: By quitting, you reduce health
problems and help healing.
Heart attack patients: By quitting, you reduce your risk of a
second heart attack.
Lung, head, and neck cancer patients: By quitting, you
reduce your chance of a second cancer.
Parents of children and adolescents: By quitting, you protect
your children and adolescents from illnesses caused by
second-hand smoke.
Sabtu, 15 Maret 2008
obat kanker sudah ditemukan
JIKA ANDA MAU BERBAIK HATI TERHADAP SESAMA....TOLONG SEBARKAN
INFORMASI INI...
Penyakit Kanker Sudah Tidak Berbahaya Lagi
Kanker tidak lagi mematikan. Para penderita kanker di Indonesia dapat memiliki harapan hidup yang lebih lama dengan ditemukannya tanaman "KELADI TIKUS" (Typhonium Flagelliforme/ Rodent Tuber) sebagai tanaman obat yang dapat menghentikan dan mengobati berbagai penyakit kanker dan berbagai penyakit berat lain.
Tanaman sejenis talas dengan tinggi maksimal 25 sampai 30 cm ini hanya tumbuh di semak yang tidak terkena sinar matahari langsung. "Tanaman ini sangat banyak ditemukan di Pulau Jawa," kata Drs.Patoppoi Pasau, orang pertama yang menemukan tanaman itu di Indonesia .
Tanaman obat ini telah diteliti sejak tahun 1995 oleh Prof Dr Chris
K.H.Teo,Dip Agric (M), BSc Agric (Hons)(M), MS, PhD dari Universiti
Sains Malaysia dan juga pendiri Cancer Care Penang, Malaysia. Lembaga
perawatan kanker yang didirikan tahun 1995 itu telah membantu ribuan
pasien dari Malaysia , Amerika, Inggris , Australia , Selandia Baru,
Singapura, dan berbagai negara di dunia.
Di Indonesia, tanaman ini pertama ditemukan oleh Patoppoi di
Pekalongan, Jawa Tengah. Ketika itu, istri Patoppoi mengidap kanker
payudara stadium III dan harus dioperasi 14 Januari 1998. Setelah
kanker ganas tersebut diangkat melalui operasi, istri Patoppoi harus
menjalani kemoterapi (suntikan kimia untuk membunuh sel, Red) untuk
menghentikan penyebaran sel-sel kanker tersebut.
"Sebelum menjalani kemoterapi,dokter mengatakan agar kami
menyiapkan wig (rambut palsu) karena kemoterapi akan mengakibatkan
kerontokan rambut, selain kerusakan kulit dan hilangnya nafsu makan,"
jelas Patoppoi.
Selama mendampingi istrinya menjalani kemoterapi, Patoppoi terus
berusaha mencari pengobatan alternatif sampai akhirnya dia mendapatkan informasi mengenai penggunaan teh Lin Qi di Malaysia untuk mengobati kanker. "Saat itu juga saya langsung terbang ke Malaysiauntuk membeli teh tersebut,"
ujar Patoppoi yang juga ahli biologi. Ketika sedang berada di sebuah
toko
obat di Malaysia , secara tidak sengaja dia melihat dan membaca buku
mengenai pengobatan kanker yang berjudul Cancer, Yet They Live karangan Dr Chris K.H. Teo terbitan 1996.
"Setelah saya baca sekilas, langsung saja saya beli buku tersebut.
Begitu menemukan buku itu, saya malah tidak jadi membeli teh Lin Qi,
tapi langsung pulang ke Indonesia ," kenang Patoppoi sambil tersenyum.
Di buku itulah Patoppoi membaca khasiat typhonium flagelliforme itu.
Berdasarkan pengetahuannya di bidang biologi, pensiunan pejabat
Departemen Pertanian ini langsung menyelidiki dan mencari tanaman
tersebut. Setelah menghubungi beberapa koleganya di berbagai tempat,
familinya di Pekalongan Jawa Tengah, balas menghubunginya. Ternyata,
mereka menemukan tanaman itu di sana . Setelah mendapatkan tanaman tersebut dan mempelajarinya lagi, Patoppoi menghubungi Dr. Teo di Malaysia untuk menanyakan kebenaran tanaman yang ditemukannya itu.
Selang beberapa hari, Dr Teo menghubungi Patoppoi dan menjelaskan bahwa
tanaman tersebut memang benar Rodent Tuber. "Dr Teo mengatakan agar tidak ragu lagi untuk menggunakannya sebagai obat,"
lanjut Patoppoi.
Akhirnya, dengan tekad bulat dan do'a untuk kesembuhan, Patoppoi mulai memproses tanaman tersebut sesuai dengan langkah-langkah pada buku tersebut
untuk diminum sebagai obat. Kemudian Patoppoi menghubungi putranya,
Boni Patoppoi di Buduran, Sidoarjo untuk ikut mencarikan tanaman
tersebut.
"Setelah melihat ciri-ciri tanaman tersebut, saya mulai mencari di
pinggir sungai depan rumah dan langsung saya dapatkan tanaman tersebut tumbuh liar di
pinggir sungai," kata Boni yang mendampingi ayahnya saat itu.
Selama mengkonsumsi sari tanaman tersebut, isteri Patoppoi mengalami penurunan efek samping kemoterapi yang dijalaninya. Rambutnya berhenti rontok, kulitnya tidak rusak dan mual-mual hilang. "Bahkan nafsu makan ibu saya pun kembali normal," lanjut Boni.
Setelah tiga bulan meminum obat tersebut, isteri Patoppoi menjalani
pemeriksaan kankernya. "Hasil pemeriksaan negatif, dan itu sungguh
mengejutkan kami dan dokter-dokter di Jakarta ," kata Patoppoi. Para
dokter itu kemudian menanyakan kepada Patoppoi, apa yang diberikan pada isterinya. "Malah mereka ragu, apakah mereka telah salah memberikan dosis kemoterapi kepada kami," lanjut Patoppoi.
Setelah diterangkan mengenai kisah tanaman Rodent Tuber, para dokter pun mendukung Pengobatan tersebut dan menyarankan agar
mengembangkannya. Apalagi melihat keadaan isterinya yang tidak
mengalami efek samping kemoterapi yang sangat keras tersebut. Dan
pemeriksaan yang seharusnya tiga bulan sekali
diundur menjadi enam bulan sekali."Tetapi karena sesuatu hal, para
dokter tersebut tidak mau mendukung secara terang-terangan penggunaan tanaman sebagai
pengobatan alternatif," sambung Boni sambil tertawa.
Setelah beberapa lama tidak berhubungan, berdasarkan peningkatan
keadaan isterinya, pada bulan April 1998, Patoppoi kemudian menghubungi Dr.Teo
melalui fax untukmenginformasik an bahwa tanaman tersebut banyak terdapat di Jawa dan
mengajak Dr. Teo untuk menyebarkan penggunaan tanaman ini di Indonesia. Kemudian Dr . Teo langsung membalas fax kami, tetapi mereka tidak tahu apa yang harus mereka perbuat, karena jarak yang jauh," sambung Patoppoi.
Meskipun Patoppoi mengusulkan agar buku mereka diterjemahkan dalam
bahasa Indonesiadan disebar-luaskan di Indonesia, Dr. Teo enganjurkan
agar kedua belah pihak bekerja sama dan berkonsentrasi dalam usaha nyata membantu penderita kanker di Indonesia.
Kemudian, pada akhir Januari 2000 saat Jawa Pos mengulas habis mengenai meninggalnya Wing Wiryanto, salah satu wartawan handal Jawa pos,Patoppoi sempat tercengang. Data-data rinci mengenai gejala, penderitaan, pengobatan yang diulas di Jawa Pos, ternyata sama dengan salah satu pengalaman pengobatan penderita kanker usus yang dijelaskan di buku tersebut. Dan eksperimen pengobatan
tersebut berhasil menyembuhkan pasien tersebut.
"Lalu saya langsung menulis di kolom Pembaca Menulis di Jawa Pos,"
ujar Boni.
Dan tanggapan yang diterimanya benar-benar diluar dugaan. Dalam sehari, bisa sekitar 30 telepon yang masuk. "Sampai saat ini, sudah ada sekitar 300 orang
yang datang ke sini," lanjut Boni yang beralamat di Jl. KH. Khamdani,
Buduran Sidoarjo.
Pasien pertama yang berhasil adalah penderita Kanker Mulut Rahim
stadium dini. Setelah diperiksa, dokter mengatakan harus dioperasi.
Tetapi karena belum memiliki biaya dan sambil menunggu rumahnya laku dijual
untuk biaya operasi, mereka datang setelah membaca Jawa Pos.
Setelah diberi tanaman dan cara meminumnya, tidak lama kemudian pasien tersebut datang lagi dan melaporkan bahwa dia tidak perlu dioperasi, karena hasil pemeriksaan mengatakan negatif.
Berdasarkan animo masyarakat sekitar yang sangat tinggi, Patoppoi
berusaha untuk menemui Dr. Teo secara langsung. Atas bantuan Direktur Jenderal Pengawasan Obat dan Makanan Departemen Kesehatan, Sampurno, Patoppoi dapat menemui Dr. Teo di Penang , Malaysia . Di kantor Pusat Cancer Care Penang, Malaysia , Patoppoi mendapat penerangan lebih lanjut
mengenai riset tanaman yang saat ditemukan memiliki nama Indonesia .
Ternyata saat Patoppoi mendapat buku "Cancer, Yet They Live" edisi
revisi tahun 1999, fax yang dikirimnya di masukkan dalam buku tersebut,
serta pengalaman
isterinya dalam usahanya berperang melawan kanker. Dari pembicaraan mereka, Dr. Teo merekomendasi agar Patoppoi mendirikan
perwakilan Cancer Care di Jakarta dan Surabaya . Maka secara resmi,
Patoppoi dan putranya diangkat sebagai perwakilan lembaga sosial Cancer Care Indonesia , yang juga disebutkan dalam buletin bulanan Cancer Care, yaitu di
Jl. Kayu Putih 4 No. 5, Jakarta , telp. 021-4894745,
dan di Buduran, Sidoarjo.
Cancer Care Malaysiatelah mengembangkan bentuk
pengobatan tersebut secara lebih canggih. Mereka telah memproduksi ekstrak Keladi Tikus
dalam bentuk pil dan teh bubuk yang dikombinasikan dengan berbagai
tananaman lainnya dengan dosis tertentu. "Dosis yang diperlukan
tergantung penyakit yang diderita," kata Boni.
Untuk mendapatkan obat tersebut, penderita harus mengisi formulir yang menanyakan keadaan dan gejala penderita dan akan dikirimkan melalui fax
ke Dr. Teo. "Formulir tersebut dapat diisi disini, dan akan kami fax-kan.
Kemudian Dr. Teo sendiri yang akan mengirimkan resep sekaligus
obatnya, dengan harga langsung dari Malaysia , sekitar 40-60 Ringgit
Malaysia ," lanjut Boni.
"Jadi pasien hanya membayar biaya fax dan obat, kami tidak menarik
keuntungan,
malahan untuk yang kurang mampu, Dr.Teo bisa memberikan perpanjangan waktu pembayaran. " tambahnya.
Sebenarnya pengobatan ini juga didukung dan sedang dicoba oleh salah satu dokter senior di Surabaya, pada pasiennya yang mengidap kanker ginjal. Adadua pasien yang sedang dirawat dokter yang pernah menjabat sebagai direktur salah satu rumah sakit terbesar di Surabayaini. Pasien pertama yang
mengidap kanker rahim tidak sempat diberi pengobatan dengan keladi tikus, karena telah
ditangani oleh rekan-rekan dokter yang telah memiliki reputasi. Setelah
menjalani kemoterapi dan radiologi, pasien tersebut mengalami kerontokan rambut, kulit rusak dan gatal, dan selalu muntah.
Tetapi pada pasien kedua yang mengidap kanker ginjal, dokter ini
menanganinya sendiri dan juga memberikan pil keladi tikus untuk membantu proses penyembuhan kemoterapi.
Pada pasien kedua ini, tidak ditemui berbagai efek yang dialami
penderita pertama, bahkan pasien tersebut kelihatan normal. Tetapi
dokter ini menolak untuk diekspos karena
menurutnya, pengobatan ini belum resmi diteliti di Indonesia .
Menurutnya, jika rekan-rekannya mengetahui bahwa dia memakai pengobatan alternatif, mereka akan memberikan predikat sebagai "ter-kun" atau dokter-dukun.
"Disinilah gap yang terbuka antara pengobatan konvensional dan modern," kata dokter tersebut.
Banyak hal menarik yang dialami Boni selama menerima dan memberikan bantuan kepada berbagai pasien. Bahkan ada pecandu berat putaw dan sabu-sabu di Surabaya , yang pada akhirnya pecandu tersebut mendapat kanker paru-paru. Setelah mendapat vonis kanker paru-paru stadium III, pasien tersebut mengkonsumsi pil
dan teh dari Cancer Care. Hasilnya cukup mengejutkan, karena ternyata
obat tersebut dapat mengeluarkan racun narkoba dari peredaran darah penderita dan
mengatasi ketergantungan pada narkoba tersebut.
"Tapi, jika pecandu sudah bisa menetralisir racun dengan keladi tikus,
dia tidak boleh memakai narkoba lagi, karena pasti akan timbul
resistensi. Jadi jangan
seperti kebo, habis mandi berkubang lagi," sambung Boni sambil tertawa.
Juga ada pengalaman pasien yang meraung-raung kesakitan akibat serangan
kanker yang menggerogotinya, karena obat penawar rasa sakit sudah tidak
mempan lagi. Setelah diberi minum sari keladi tikus, beberapa saat
kemudian pasien tersebut tenang dan tidak lagi merasa kesakitan.
Menurut data Cancer Care Malaysia, berbagai penyakit yang telah
disembuhkan adalah berbagai kanker dan penyakit berat seperti kanker payudara, paru-paru, usus besar-rectum,
liver, prostat, ginjal, leher rahim, tenggorokan, tulang, otak, limpa,
leukemia, empedu, pankreas,
dan hepatitis.
Jadi diharapkan agar hasil penelitian yang menghabiskan milyaran
Ringgit
Malaysiaselama 5 tahun
dapat benar-benar berguna bagi dunia kesehatan.
Bagi teman-teman yang memerlukan informasi lebih lanjut sehubungan dengan artikel "Obat Kanker" bisa menghubungi perwakilan lembaga sosial
"Cancer Care Indonesia " beralamat di Jl. Kayu Putih 4 no.5 Jakarta ,
telp : 021-4894745,
INFORMASI INI...
Penyakit Kanker Sudah Tidak Berbahaya Lagi
Kanker tidak lagi mematikan. Para penderita kanker di Indonesia dapat memiliki harapan hidup yang lebih lama dengan ditemukannya tanaman "KELADI TIKUS" (Typhonium Flagelliforme/ Rodent Tuber) sebagai tanaman obat yang dapat menghentikan dan mengobati berbagai penyakit kanker dan berbagai penyakit berat lain.
Tanaman sejenis talas dengan tinggi maksimal 25 sampai 30 cm ini hanya tumbuh di semak yang tidak terkena sinar matahari langsung. "Tanaman ini sangat banyak ditemukan di Pulau Jawa," kata Drs.Patoppoi Pasau, orang pertama yang menemukan tanaman itu di Indonesia .
Tanaman obat ini telah diteliti sejak tahun 1995 oleh Prof Dr Chris
K.H.Teo,Dip Agric (M), BSc Agric (Hons)(M), MS, PhD dari Universiti
Sains Malaysia dan juga pendiri Cancer Care Penang, Malaysia. Lembaga
perawatan kanker yang didirikan tahun 1995 itu telah membantu ribuan
pasien dari Malaysia , Amerika, Inggris , Australia , Selandia Baru,
Singapura, dan berbagai negara di dunia.
Di Indonesia, tanaman ini pertama ditemukan oleh Patoppoi di
Pekalongan, Jawa Tengah. Ketika itu, istri Patoppoi mengidap kanker
payudara stadium III dan harus dioperasi 14 Januari 1998. Setelah
kanker ganas tersebut diangkat melalui operasi, istri Patoppoi harus
menjalani kemoterapi (suntikan kimia untuk membunuh sel, Red) untuk
menghentikan penyebaran sel-sel kanker tersebut.
"Sebelum menjalani kemoterapi,dokter mengatakan agar kami
menyiapkan wig (rambut palsu) karena kemoterapi akan mengakibatkan
kerontokan rambut, selain kerusakan kulit dan hilangnya nafsu makan,"
jelas Patoppoi.
Selama mendampingi istrinya menjalani kemoterapi, Patoppoi terus
berusaha mencari pengobatan alternatif sampai akhirnya dia mendapatkan informasi mengenai penggunaan teh Lin Qi di Malaysia untuk mengobati kanker. "Saat itu juga saya langsung terbang ke Malaysiauntuk membeli teh tersebut,"
ujar Patoppoi yang juga ahli biologi. Ketika sedang berada di sebuah
toko
obat di Malaysia , secara tidak sengaja dia melihat dan membaca buku
mengenai pengobatan kanker yang berjudul Cancer, Yet They Live karangan Dr Chris K.H. Teo terbitan 1996.
"Setelah saya baca sekilas, langsung saja saya beli buku tersebut.
Begitu menemukan buku itu, saya malah tidak jadi membeli teh Lin Qi,
tapi langsung pulang ke Indonesia ," kenang Patoppoi sambil tersenyum.
Di buku itulah Patoppoi membaca khasiat typhonium flagelliforme itu.
Berdasarkan pengetahuannya di bidang biologi, pensiunan pejabat
Departemen Pertanian ini langsung menyelidiki dan mencari tanaman
tersebut. Setelah menghubungi beberapa koleganya di berbagai tempat,
familinya di Pekalongan Jawa Tengah, balas menghubunginya. Ternyata,
mereka menemukan tanaman itu di sana . Setelah mendapatkan tanaman tersebut dan mempelajarinya lagi, Patoppoi menghubungi Dr. Teo di Malaysia untuk menanyakan kebenaran tanaman yang ditemukannya itu.
Selang beberapa hari, Dr Teo menghubungi Patoppoi dan menjelaskan bahwa
tanaman tersebut memang benar Rodent Tuber. "Dr Teo mengatakan agar tidak ragu lagi untuk menggunakannya sebagai obat,"
lanjut Patoppoi.
Akhirnya, dengan tekad bulat dan do'a untuk kesembuhan, Patoppoi mulai memproses tanaman tersebut sesuai dengan langkah-langkah pada buku tersebut
untuk diminum sebagai obat. Kemudian Patoppoi menghubungi putranya,
Boni Patoppoi di Buduran, Sidoarjo untuk ikut mencarikan tanaman
tersebut.
"Setelah melihat ciri-ciri tanaman tersebut, saya mulai mencari di
pinggir sungai depan rumah dan langsung saya dapatkan tanaman tersebut tumbuh liar di
pinggir sungai," kata Boni yang mendampingi ayahnya saat itu.
Selama mengkonsumsi sari tanaman tersebut, isteri Patoppoi mengalami penurunan efek samping kemoterapi yang dijalaninya. Rambutnya berhenti rontok, kulitnya tidak rusak dan mual-mual hilang. "Bahkan nafsu makan ibu saya pun kembali normal," lanjut Boni.
Setelah tiga bulan meminum obat tersebut, isteri Patoppoi menjalani
pemeriksaan kankernya. "Hasil pemeriksaan negatif, dan itu sungguh
mengejutkan kami dan dokter-dokter di Jakarta ," kata Patoppoi. Para
dokter itu kemudian menanyakan kepada Patoppoi, apa yang diberikan pada isterinya. "Malah mereka ragu, apakah mereka telah salah memberikan dosis kemoterapi kepada kami," lanjut Patoppoi.
Setelah diterangkan mengenai kisah tanaman Rodent Tuber, para dokter pun mendukung Pengobatan tersebut dan menyarankan agar
mengembangkannya. Apalagi melihat keadaan isterinya yang tidak
mengalami efek samping kemoterapi yang sangat keras tersebut. Dan
pemeriksaan yang seharusnya tiga bulan sekali
diundur menjadi enam bulan sekali."Tetapi karena sesuatu hal, para
dokter tersebut tidak mau mendukung secara terang-terangan penggunaan tanaman sebagai
pengobatan alternatif," sambung Boni sambil tertawa.
Setelah beberapa lama tidak berhubungan, berdasarkan peningkatan
keadaan isterinya, pada bulan April 1998, Patoppoi kemudian menghubungi Dr.Teo
melalui fax untukmenginformasik an bahwa tanaman tersebut banyak terdapat di Jawa dan
mengajak Dr. Teo untuk menyebarkan penggunaan tanaman ini di Indonesia. Kemudian Dr . Teo langsung membalas fax kami, tetapi mereka tidak tahu apa yang harus mereka perbuat, karena jarak yang jauh," sambung Patoppoi.
Meskipun Patoppoi mengusulkan agar buku mereka diterjemahkan dalam
bahasa Indonesiadan disebar-luaskan di Indonesia, Dr. Teo enganjurkan
agar kedua belah pihak bekerja sama dan berkonsentrasi dalam usaha nyata membantu penderita kanker di Indonesia.
Kemudian, pada akhir Januari 2000 saat Jawa Pos mengulas habis mengenai meninggalnya Wing Wiryanto, salah satu wartawan handal Jawa pos,Patoppoi sempat tercengang. Data-data rinci mengenai gejala, penderitaan, pengobatan yang diulas di Jawa Pos, ternyata sama dengan salah satu pengalaman pengobatan penderita kanker usus yang dijelaskan di buku tersebut. Dan eksperimen pengobatan
tersebut berhasil menyembuhkan pasien tersebut.
"Lalu saya langsung menulis di kolom Pembaca Menulis di Jawa Pos,"
ujar Boni.
Dan tanggapan yang diterimanya benar-benar diluar dugaan. Dalam sehari, bisa sekitar 30 telepon yang masuk. "Sampai saat ini, sudah ada sekitar 300 orang
yang datang ke sini," lanjut Boni yang beralamat di Jl. KH. Khamdani,
Buduran Sidoarjo.
Pasien pertama yang berhasil adalah penderita Kanker Mulut Rahim
stadium dini. Setelah diperiksa, dokter mengatakan harus dioperasi.
Tetapi karena belum memiliki biaya dan sambil menunggu rumahnya laku dijual
untuk biaya operasi, mereka datang setelah membaca Jawa Pos.
Setelah diberi tanaman dan cara meminumnya, tidak lama kemudian pasien tersebut datang lagi dan melaporkan bahwa dia tidak perlu dioperasi, karena hasil pemeriksaan mengatakan negatif.
Berdasarkan animo masyarakat sekitar yang sangat tinggi, Patoppoi
berusaha untuk menemui Dr. Teo secara langsung. Atas bantuan Direktur Jenderal Pengawasan Obat dan Makanan Departemen Kesehatan, Sampurno, Patoppoi dapat menemui Dr. Teo di Penang , Malaysia . Di kantor Pusat Cancer Care Penang, Malaysia , Patoppoi mendapat penerangan lebih lanjut
mengenai riset tanaman yang saat ditemukan memiliki nama Indonesia .
Ternyata saat Patoppoi mendapat buku "Cancer, Yet They Live" edisi
revisi tahun 1999, fax yang dikirimnya di masukkan dalam buku tersebut,
serta pengalaman
isterinya dalam usahanya berperang melawan kanker. Dari pembicaraan mereka, Dr. Teo merekomendasi agar Patoppoi mendirikan
perwakilan Cancer Care di Jakarta dan Surabaya . Maka secara resmi,
Patoppoi dan putranya diangkat sebagai perwakilan lembaga sosial Cancer Care Indonesia , yang juga disebutkan dalam buletin bulanan Cancer Care, yaitu di
Jl. Kayu Putih 4 No. 5, Jakarta , telp. 021-4894745,
dan di Buduran, Sidoarjo.
Cancer Care Malaysiatelah mengembangkan bentuk
pengobatan tersebut secara lebih canggih. Mereka telah memproduksi ekstrak Keladi Tikus
dalam bentuk pil dan teh bubuk yang dikombinasikan dengan berbagai
tananaman lainnya dengan dosis tertentu. "Dosis yang diperlukan
tergantung penyakit yang diderita," kata Boni.
Untuk mendapatkan obat tersebut, penderita harus mengisi formulir yang menanyakan keadaan dan gejala penderita dan akan dikirimkan melalui fax
ke Dr. Teo. "Formulir tersebut dapat diisi disini, dan akan kami fax-kan.
Kemudian Dr. Teo sendiri yang akan mengirimkan resep sekaligus
obatnya, dengan harga langsung dari Malaysia , sekitar 40-60 Ringgit
Malaysia ," lanjut Boni.
"Jadi pasien hanya membayar biaya fax dan obat, kami tidak menarik
keuntungan,
malahan untuk yang kurang mampu, Dr.Teo bisa memberikan perpanjangan waktu pembayaran. " tambahnya.
Sebenarnya pengobatan ini juga didukung dan sedang dicoba oleh salah satu dokter senior di Surabaya, pada pasiennya yang mengidap kanker ginjal. Adadua pasien yang sedang dirawat dokter yang pernah menjabat sebagai direktur salah satu rumah sakit terbesar di Surabayaini. Pasien pertama yang
mengidap kanker rahim tidak sempat diberi pengobatan dengan keladi tikus, karena telah
ditangani oleh rekan-rekan dokter yang telah memiliki reputasi. Setelah
menjalani kemoterapi dan radiologi, pasien tersebut mengalami kerontokan rambut, kulit rusak dan gatal, dan selalu muntah.
Tetapi pada pasien kedua yang mengidap kanker ginjal, dokter ini
menanganinya sendiri dan juga memberikan pil keladi tikus untuk membantu proses penyembuhan kemoterapi.
Pada pasien kedua ini, tidak ditemui berbagai efek yang dialami
penderita pertama, bahkan pasien tersebut kelihatan normal. Tetapi
dokter ini menolak untuk diekspos karena
menurutnya, pengobatan ini belum resmi diteliti di Indonesia .
Menurutnya, jika rekan-rekannya mengetahui bahwa dia memakai pengobatan alternatif, mereka akan memberikan predikat sebagai "ter-kun" atau dokter-dukun.
"Disinilah gap yang terbuka antara pengobatan konvensional dan modern," kata dokter tersebut.
Banyak hal menarik yang dialami Boni selama menerima dan memberikan bantuan kepada berbagai pasien. Bahkan ada pecandu berat putaw dan sabu-sabu di Surabaya , yang pada akhirnya pecandu tersebut mendapat kanker paru-paru. Setelah mendapat vonis kanker paru-paru stadium III, pasien tersebut mengkonsumsi pil
dan teh dari Cancer Care. Hasilnya cukup mengejutkan, karena ternyata
obat tersebut dapat mengeluarkan racun narkoba dari peredaran darah penderita dan
mengatasi ketergantungan pada narkoba tersebut.
"Tapi, jika pecandu sudah bisa menetralisir racun dengan keladi tikus,
dia tidak boleh memakai narkoba lagi, karena pasti akan timbul
resistensi. Jadi jangan
seperti kebo, habis mandi berkubang lagi," sambung Boni sambil tertawa.
Juga ada pengalaman pasien yang meraung-raung kesakitan akibat serangan
kanker yang menggerogotinya, karena obat penawar rasa sakit sudah tidak
mempan lagi. Setelah diberi minum sari keladi tikus, beberapa saat
kemudian pasien tersebut tenang dan tidak lagi merasa kesakitan.
Menurut data Cancer Care Malaysia, berbagai penyakit yang telah
disembuhkan adalah berbagai kanker dan penyakit berat seperti kanker payudara, paru-paru, usus besar-rectum,
liver, prostat, ginjal, leher rahim, tenggorokan, tulang, otak, limpa,
leukemia, empedu, pankreas,
dan hepatitis.
Jadi diharapkan agar hasil penelitian yang menghabiskan milyaran
Ringgit
Malaysiaselama 5 tahun
dapat benar-benar berguna bagi dunia kesehatan.
Bagi teman-teman yang memerlukan informasi lebih lanjut sehubungan dengan artikel "Obat Kanker" bisa menghubungi perwakilan lembaga sosial
"Cancer Care Indonesia " beralamat di Jl. Kayu Putih 4 no.5 Jakarta ,
telp : 021-4894745,
Rabu, 12 Maret 2008
chondrosarcoma
Chondrosarcoma, which constitutes ~20 to 25% of all bone sarcomas, is a tumor of adulthood and old age with a peak incidence in the fourth to sixth decades of life. It has a predilection for the flat bones, especially the shoulder and pelvic girdles, but can also affect the diaphyseal portions of long bones. Chondrosarcomas can arise de novo or as a malignant transformation of an enchondroma or, rarely, of the cartilaginous cap of an osteochondroma. Chondrosarcomas have an indolent natural history and typically present as pain and swelling. Radiographically, the lesion may have a lobular appearance with mottled or punctate or annular calcification of the cartilaginous matrix. It is difficult to distinguish low-grade chondrosarcoma from benign lesions by x-ray or histologic examination. The diagnosis is therefore influenced by clinical history and physical examination. A new onset of pain, signs of inflammation, and progressive increase in the size of the mass suggest malignancy. The histologic classification is complex, but most tumors fall within the classic category. Like other bone sarcomas, high-grade chondrosarcomas spread to the lungs. Most chondrosarcomas are resistant to chemotherapy, and surgical resection of primary or recurrent tumors, including pulmonary metastases, is the mainstay of therapy. There are two histologic variants for which this rule does not hold, however. Dedifferentiated chondrosarcoma has a high-grade osteosarcoma or a malignant fibrous histiocytoma component that responds to chemotherapy. Mesenchymal chondrosarcoma, a rare variant composed of a small cell element, also is responsive to systemic chemotherapy and is treated like Ewing's sarcoma.
osteosarcoma
Osteosarcoma, accounting for almost 45% of all bone sarcomas, is a spindle cell neoplasm that produces osteoid (unmineralized bone) or bone. About 60% of all osteosarcomas occur in children and adolescents in the second decade of life, and about 10% occur in the third decade of life. Osteosarcomas in the fifth and sixth decades of life are frequently secondary to either radiation therapy or transformation in a preexisting benign condition, such as Paget's disease. Males are affected 1.5 to 2 times as often as females. Osteosarcoma has a predilection for metaphyses of long bones; the most common sites of involvement are the distal femur, proximal tibia, and proximal humerus. The classification of osteosarcoma is complex, but 75% of osteosarcomas fall in the "classic" category, which include osteoblastic, chondroblastic, and fibroblastic osteosarcomas.
The remaining 25% are classified as "variants" on the basis of
(1) clinical characteristics, as in the case of osteosarcoma of the jaw, postradiation osteosarcoma, or Paget's osteosarcoma
(2) morphologic characteristics, as in the case of telangiectatic osteosarcoma, small-cell osteosarcoma, or epithelioid osteosarcoma
(3) location, as in parosteal or periosteal osteosarcoma.
Diagnosis usually requires a synthesis of clinical, radiologic, and pathologic features. Patients typically present with pain and swelling of the affected area. A plain radiograph reveals a destructive lesion with a moth-eaten appearance, a spiculated periosteal reaction (sunburst appearance), and a cuff of periosteal new bone formation at the margin of the soft tissue mass (Codman's triangle). A CT3 scan of the primary tumor is best for defining bone destruction and the pattern of calcification, whereas MRI4 is better for defining intramedullary and soft tissue extension. A chest radiograph and CT scan are used to detect lung metastases. Metastases to the bony skeleton should be imaged by a bone scan. Almost all osteosarcomas are hypervascular. Angiography is not helpful for diagnosis, but it is the most sensitive test for assessing the response to preoperative chemotherapy. Pathologic diagnosis is established either with a core-needle biopsy, where feasible, or with an open biopsy with an appropriately placed incision that does not compromise future limb-sparing resection. Most osteosarcomas are high-grade. The most important prognostic factor for long-term survival is response to chemotherapy. Preoperative chemotherapy followed by limb-sparing surgery (which can be accomplished in >80% of patients) followed by postoperative chemotherapy is standard management. The effective drugs are doxorubicin, ifosfamide, cisplatin, and high-dose methotrexate with leucovorin rescue. The various combinations of these agents that have been used have all been about equally successful. Long-term survival rates in extremity osteosarcoma range from 60 to 80%. Osteosarcoma is radioresistant; radiation therapy has no role in the routine management. Malignant fibrous histiocytoma is considered a part of the spectrum of osteosarcoma and is managed similarly.
The remaining 25% are classified as "variants" on the basis of
(1) clinical characteristics, as in the case of osteosarcoma of the jaw, postradiation osteosarcoma, or Paget's osteosarcoma
(2) morphologic characteristics, as in the case of telangiectatic osteosarcoma, small-cell osteosarcoma, or epithelioid osteosarcoma
(3) location, as in parosteal or periosteal osteosarcoma.
Diagnosis usually requires a synthesis of clinical, radiologic, and pathologic features. Patients typically present with pain and swelling of the affected area. A plain radiograph reveals a destructive lesion with a moth-eaten appearance, a spiculated periosteal reaction (sunburst appearance), and a cuff of periosteal new bone formation at the margin of the soft tissue mass (Codman's triangle). A CT3 scan of the primary tumor is best for defining bone destruction and the pattern of calcification, whereas MRI4 is better for defining intramedullary and soft tissue extension. A chest radiograph and CT scan are used to detect lung metastases. Metastases to the bony skeleton should be imaged by a bone scan. Almost all osteosarcomas are hypervascular. Angiography is not helpful for diagnosis, but it is the most sensitive test for assessing the response to preoperative chemotherapy. Pathologic diagnosis is established either with a core-needle biopsy, where feasible, or with an open biopsy with an appropriately placed incision that does not compromise future limb-sparing resection. Most osteosarcomas are high-grade. The most important prognostic factor for long-term survival is response to chemotherapy. Preoperative chemotherapy followed by limb-sparing surgery (which can be accomplished in >80% of patients) followed by postoperative chemotherapy is standard management. The effective drugs are doxorubicin, ifosfamide, cisplatin, and high-dose methotrexate with leucovorin rescue. The various combinations of these agents that have been used have all been about equally successful. Long-term survival rates in extremity osteosarcoma range from 60 to 80%. Osteosarcoma is radioresistant; radiation therapy has no role in the routine management. Malignant fibrous histiocytoma is considered a part of the spectrum of osteosarcoma and is managed similarly.
bone sarcoma
INCIDENCE AND EPIDEMIOLOGY
Bone sarcomas are rarer than soft tissue sarcomas; they accounted for only 0.2% of all new malignancies and ~2400 new cases in the United States in 2004. Several benign bone lesions have the potential for malignant transformation. Enchondromas and osteochondromas can transform into chondrosarcoma; fibrous dysplasia, bone infarcts, and Paget's disease of bone can transform into either malignant fibrous histiocytoma or osteosarcoma.
CLASSIFICATION
Benign Tumors The common benign bone tumors include enchondroma, osteochondroma, chondroblastoma, and chondromyxoid fibroma, of cartilage origin; osteoid osteoma and osteoblastoma, of bone origin; fibroma and desmoplastic fibroma, of fibrous tissue origin; hemangioma, of vascular origin; and giant cell tumor, of unknown origin.
Malignant Tumors The most common malignant tumors of bone are plasma cell tumors. The four most common malignant nonhematopoietic bone tumors are osteosarcoma, chondrosarcoma, Ewing's sarcoma, and malignant fibrous histiocytoma. Rare malignant tumors include chordoma (of notochordal origin), malignant giant cell tumor and adamantinoma (of unknown origin), and hemangioendothelioma (of vascular origin).
Musculoskeletal Tumor Society Staging System Sarcomas of bone are staged according to the Musculoskeletal Tumor Society staging system based on grade and compartmental localization. A Roman numeral reflects the tumor grade: stage I is low-grade, stage II is high-grade, and stage III includes tumors of any grade that have lymph node or distant metastases. In addition, the tumor is given a letter reflecting its compartmental localization. Tumors designated A are intracompartmental (i.e., confined to the same soft tissue compartment as the initial tumor), and tumors designated B are extracompartmental (i.e., extending into the adjacent soft tissue compartment or into bone)
Bone sarcomas are rarer than soft tissue sarcomas; they accounted for only 0.2% of all new malignancies and ~2400 new cases in the United States in 2004. Several benign bone lesions have the potential for malignant transformation. Enchondromas and osteochondromas can transform into chondrosarcoma; fibrous dysplasia, bone infarcts, and Paget's disease of bone can transform into either malignant fibrous histiocytoma or osteosarcoma.
CLASSIFICATION
Benign Tumors The common benign bone tumors include enchondroma, osteochondroma, chondroblastoma, and chondromyxoid fibroma, of cartilage origin; osteoid osteoma and osteoblastoma, of bone origin; fibroma and desmoplastic fibroma, of fibrous tissue origin; hemangioma, of vascular origin; and giant cell tumor, of unknown origin.
Malignant Tumors The most common malignant tumors of bone are plasma cell tumors. The four most common malignant nonhematopoietic bone tumors are osteosarcoma, chondrosarcoma, Ewing's sarcoma, and malignant fibrous histiocytoma. Rare malignant tumors include chordoma (of notochordal origin), malignant giant cell tumor and adamantinoma (of unknown origin), and hemangioendothelioma (of vascular origin).
Musculoskeletal Tumor Society Staging System Sarcomas of bone are staged according to the Musculoskeletal Tumor Society staging system based on grade and compartmental localization. A Roman numeral reflects the tumor grade: stage I is low-grade, stage II is high-grade, and stage III includes tumors of any grade that have lymph node or distant metastases. In addition, the tumor is given a letter reflecting its compartmental localization. Tumors designated A are intracompartmental (i.e., confined to the same soft tissue compartment as the initial tumor), and tumors designated B are extracompartmental (i.e., extending into the adjacent soft tissue compartment or into bone)
staging bone tumor
MUSCULOSKELETAL TUMOR SOCIETY CLASSIFICATION
In 1980, the Musculoskeletal Tumor Society (MSTS) adopted a surgical staging system for bone sarcomas. The system is based on the fact that mesenchymal sarcomas of bone behave similarly, regardless of histiogenic type. The surgical staging system, as described by Enneking and colleagues, is based on the GTM classification: grade (G), location (T), and lymph node involvement and metastases (M).
G represents the histologic grade of a lesion and other clinical data. Grade is further divided into two categories: G1 is low grade, and G2 is high grade.
T represents the site of the lesion, which may be intracompartmental (T1) or extracompartmental (T2). Compartment is defined as “an anatomic structure or space bounded by natural barriers or tumor extension.” The significance of T1 lesions is easier to define clinically, surgically, and radiographically than that of T2 lesions, and the chance is better for adequate removal of the former without amputation. In general, low-grade bone sarcomas are intracompartmental (T1), whereas high-grade ones are extracompartmental (T2).
Lymphatic spread is a sign of widespread dissemination. Regional lymphatic involvement is equated with distal metastases (M1). Absence of any metastasis is designated as M0.
The surgical staging system developed by Enneking and colleagues for surgical planning and assessment of bone sarcomas is summarized thus:
Stage IA (G1,T1,M0): low-grade intracompartmental lesion, without metastasis
Stage IB (G1,T2,M0): low-grade extracompartmental lesion, without metastasis
Stage IIA (G2,T1,M0): high-grade intracompartmental lesion, without metastasis
Stage IIB (G2,T2,M0): high-grade extracompartmental lesion, without metastasis
Stage IIIA (G1 or G2,T1,M1): intracompartmental lesion, any grade, with metastasis
Stage IIIB (G1 or G2,T2,M1): extracompartmental lesion, any grade, with metastasis
AMERICAN JOINT COMMITTEE ON CANCER BONE TUMOR CLASSIFICATION
In 1983, the American Joint Committee on Cancer Bone Tumor Classification (AJCC) recommended a staging system for the malignant tumors of bone. This system has undergone minimal changes and remains unchanged in the fifth edition of the AJCC Cancer Staging Manual. This system is based on two indications: TNM designation [extent of the tumor (T), nodal status (N), and distant metastases (M)] and grade (G). This system is similar to the MSTS classification; however, the AJCC uses four stages instead of three. The four stages are designated I to IV and may be further modified with A or B. Stages I and II are defined by the histologic grade (grade I and II) and modified by tumor extent (i.e., cortical involvement; designated E1 to E6) . T(I) indicates that the tumor is confined within the cortex (similar to the MSTS classification A), and T(II) indicates that the tumor extends beyond the cortex (similar to the MSTS classification B). In the AJCC, stage III has remained undefined and stage IV is defined as the presence of metastases. Stage IV tumors are modified by A, which is equivalent to III M1 in the MSTS system (i.e., indicates a nodal metastasis), and B, which is equivalent to III M1 in the MSTS system (i.e., indicates distant metastases).
In 1980, the Musculoskeletal Tumor Society (MSTS) adopted a surgical staging system for bone sarcomas. The system is based on the fact that mesenchymal sarcomas of bone behave similarly, regardless of histiogenic type. The surgical staging system, as described by Enneking and colleagues, is based on the GTM classification: grade (G), location (T), and lymph node involvement and metastases (M).
G represents the histologic grade of a lesion and other clinical data. Grade is further divided into two categories: G1 is low grade, and G2 is high grade.
T represents the site of the lesion, which may be intracompartmental (T1) or extracompartmental (T2). Compartment is defined as “an anatomic structure or space bounded by natural barriers or tumor extension.” The significance of T1 lesions is easier to define clinically, surgically, and radiographically than that of T2 lesions, and the chance is better for adequate removal of the former without amputation. In general, low-grade bone sarcomas are intracompartmental (T1), whereas high-grade ones are extracompartmental (T2).
Lymphatic spread is a sign of widespread dissemination. Regional lymphatic involvement is equated with distal metastases (M1). Absence of any metastasis is designated as M0.
The surgical staging system developed by Enneking and colleagues for surgical planning and assessment of bone sarcomas is summarized thus:
Stage IA (G1,T1,M0): low-grade intracompartmental lesion, without metastasis
Stage IB (G1,T2,M0): low-grade extracompartmental lesion, without metastasis
Stage IIA (G2,T1,M0): high-grade intracompartmental lesion, without metastasis
Stage IIB (G2,T2,M0): high-grade extracompartmental lesion, without metastasis
Stage IIIA (G1 or G2,T1,M1): intracompartmental lesion, any grade, with metastasis
Stage IIIB (G1 or G2,T2,M1): extracompartmental lesion, any grade, with metastasis
AMERICAN JOINT COMMITTEE ON CANCER BONE TUMOR CLASSIFICATION
In 1983, the American Joint Committee on Cancer Bone Tumor Classification (AJCC) recommended a staging system for the malignant tumors of bone. This system has undergone minimal changes and remains unchanged in the fifth edition of the AJCC Cancer Staging Manual. This system is based on two indications: TNM designation [extent of the tumor (T), nodal status (N), and distant metastases (M)] and grade (G). This system is similar to the MSTS classification; however, the AJCC uses four stages instead of three. The four stages are designated I to IV and may be further modified with A or B. Stages I and II are defined by the histologic grade (grade I and II) and modified by tumor extent (i.e., cortical involvement; designated E1 to E6) . T(I) indicates that the tumor is confined within the cortex (similar to the MSTS classification A), and T(II) indicates that the tumor extends beyond the cortex (similar to the MSTS classification B). In the AJCC, stage III has remained undefined and stage IV is defined as the presence of metastases. Stage IV tumors are modified by A, which is equivalent to III M1 in the MSTS system (i.e., indicates a nodal metastasis), and B, which is equivalent to III M1 in the MSTS system (i.e., indicates distant metastases).
classification bone tumor
Bone consists of cartilaginous, osteoid, and fibrous tissue and bone marrow elements. Each tissue can give rise to benign or malignant spindle cell tumors. Bone tumors are classified on the basis of cell type and recognized products of proliferating cells. Each tumor be considered a separate clinicopathologic entity. Radiographic, histologic, and clinical data are necessary to form an accurate diagnosis and to determine the degree of activity and malignancy of each lesion.
Cartilage tumors are lesions in which cartilage is produced. They are the most common bone tumors. Osteochondroma is the most common benign cartilage tumor; some 1% to 2% of solitary osteochondromas become malignant and Enchondroma is a benign cartilage tumor that occurs centrally; in adults, malignant transformation may occur. Chondrosarcoma, the most common malignant cartilage tumor, is either intramedullary or peripheral. Ten percent are secondary, arising from an underlying benign lesion. Most chondrosarcomas are low grade, although 10% dedifferentiate into high-grade spindle cell sarcomas or, rarely, a mesenchymal chondrosarcoma.
Osteoid tumors are lesions in which the stroma produce osteoid. The benign forms are osteoid osteoma and osteoblastoma. Osteoid osteomas are never malignant. Osteoblastomas rarely metastasize; when they do, it is only after multiple local recurrences.Osteosarcomas are the most common primary malignant tumors of the bone. Histologically, they are composed of malignant spindle cells and osteoblasts that produce osteoid or immature bone. Several variants are now recognized.60 Parosteal, periosteal, and low-grade intraosseous osteosarcoma are histologically and radiographically distinct from the “classic” central medullary osteosarcomas and have a more favorable prognosis.
Fibrous tumors of bone are rare. Desmoplastic fibroma is a locally aggressive, nonmetastasizing tumor, analogous to fibromatosis of soft tissue.Fibrosarcoma of bone appears histologically as its soft tissue counterpart. Multiple sections must be obtained to demonstrate the lack of osteoid production. If osteoid is present, the lesion is classified as an osteosarcoma. MFH, a rare lesion and the counterpart of soft tissue MFH, has been described in bone.The pathophysiologic behavior of bone and soft tissue MFH is similar, consisting of a storiform pattern with a histiocytic component. Giant cell tumors of unknown origin were originally called benign but are now considered low-grade sarcomas. They have high rates of local recurrence and malignant transformation.
Tumors presumably arising from bone marrow elements are the round cell sarcomas. The two most common are Ewing's sarcoma and the rarer non-Hodgkin's lymphoma.
RADIOGRAPHIC EVALUATION AND DIAGNOSIS
Radiographic evaluation combined with the clinical history and histologic examination is necessary for accurate diagnosis. Bone scans, angiography, CT, and MRI are generally not helpful in determining a diagnosis but are important in delineating the extent of local involvement. A systematic approach to the radiographic evaluation of skeletal lesions has been described by Madewell and colleagues, who studied and correlated several hundred radiographic and pathologic specimens. They considered the radiograph as the gross specimen from which a detailed histologic interpretation could be made and biologic activity accurately diagnosed. According to their system, a bone tumor is evaluated by five radiographic parameters:
1. Anatomic site. Specific anatomic sites of the bone give rise to specific groups of lesions. Johnson explained this by a “field” theory, which hypothesizes that the most active cells of a certain area of bone give rise to tumors that are characteristic of that area. In general, spindle cell sarcomas are metaphyseal, whereas round cell sarcomas tend to be diaphyseal.
2. Borders. The border reflects the growth rate and the response of the adjacent normal bone to the tumor. Most tumors have a characteristic border. Benign lesions (e.g., nonossifying fibromas and unicameral bone cysts) have well-defined borders and a narrow transition area that is often associated with a reactive sclerosis. Aggressive or benign tumors [e.g., chondroblastoma and giant cell tumors (GCTs)] tend to have faint borders and wide zones of transition with very little sclerosis, reflecting a faster-growing lesion. Poorly delineated or absent margins indicate an aggressive or malignant lesion.
3. Bone destruction. Bone destruction is the hallmark of a bone tumor. Three patterns of bone destruction are described : geographic, moth-eaten, and permeative. In general, these patterns are found in the tubular bone rather than in the flat bone and represent a combination of cortical and cancellous destruction. These patterns reflect a progressively increasing growth rate of the underlying tumor.
4. Matrix formation. Calcification of the matrix, or new bone formation, may produce an area of increased density within the lesion. Calcification typically appears as flocculent or stippled rings or clusters. The appearance of the new bone varies from dense sclerosis that obliterates all evidence of normal trabeculae, to small, irregular, circumscribed masses described as “wool” or “clouds.” Calcification and ossification may appear in the same lesion. Neither type of matrix formation per se is diagnostic of malignancy.
5. Periosteal reaction. Periosteal reaction is indicative of malignancy but not pathognomonic of a particular tumor. A combination of periosteal changes is often noted. In malignant tumors, periosteal reaction is noncontinuous and thin, with multiple laminations. A parallel or a perpendicular pattern may be present.
The radiographic parameters of benign and malignant tumors are quite different. Benign tumors have round, smooth, well-circumscribed borders. No cortical destruction and, generally, no periosteal reaction are found. Malignant lesions have irregular, poorly defined margins. Evidence of bone destruction and a wide area of transition with periosteal reaction are noted. Soft tissue extension is common.
NATURAL HISTORY
Tumors arising in bone have characteristic patterns of behavior and growth that distinguish them from other malignant lesions. These patterns form the basis of a staging system and current treatment strategies. These principles and their relationship to management, as formulated by Enneking and colleagues, are described here.
BIOLOGY AND GROWTH
Spindle cell sarcomas form a solid lesion that grows centrifugally. The periphery is the least mature part of this lesion. In contradistinction to a true capsule, which surrounds a benign lesion and is composed of compressed normal cells, a malignant tumor is generally enclosed by a pseudocapsule and consists of compressed tumor cells and a fibrovascular zone of reactive tissue with an inflammatory component that interdigitates with the normal tissue adjacent to and beyond the lesion. The thickness of the reactive zone varies with the degree of malignancy and histiogenic type. The histologic hallmark of sarcomas is their potential to break through the pseudocapsule to form satellite lesions of tumor cells. This characteristic distinguishes a nonmalignant mesenchymal tumor from a malignant one.
High-grade sarcomas have a poorly defined reactive zone that may be invaded and destroyed by the tumor. In addition, tumor nodules in tissue may appear to be normal and not continuous with the main tumor. These are termed skip metastases. Although low-grade sarcomas regularly demonstrate tumor interdigitation into the reactive zone, they rarely form tumor nodules beyond this area.
The three mechanisms of growth and extension of bone tumors are:
(1) compression of normal tissue
(2) resorption of bone by reactive osteoclasts
(3) direct destruction of normal tissue.
Benign tumors grow and expand by the first two mechanisms, whereas direct tissue destruction is characteristic of malignant bone tumors. Sarcomas respect anatomic borders and remain within one compartment. Local anatomy influences tumor growth by setting the natural barriers to extension. In general, bone sarcomas take the path of least resistance. Most benign bone tumors are unicompartmental; they remain confined and may expand the bone in which they arose. Malignant bone tumors are bicompartmental; they destroy the overlying cortex and go directly into the adjacent soft tissue. The determination of anatomic compartment involvement has become more important with the advent of limb-preservation surgery.
On the basis of biologic considerations and natural history, Enneking and colleagues classified bone tumors into five categories, each of which shares certain clinical characteristics and radiographic patterns and requires similar surgical procedures.
1. Benign/latent: lesions whose natural history is to grow slowly during normal growth of the individual and then to stop, with a tendency to heal spontaneously. They never become malignant and, if treated by simple curettage, heal rapidly. Surgery is not indicated unless they become symptomatic.
2. Benign/active: lesions whose natural history is one of progressive growth. Simple curettage leaves a reactive rim with some tumor. Curettage is associated with a high recurrence rate. Wide excision through normal bone results in local control in approximately 95% of all cases.
3. Benign/aggressive: lesions that are locally aggressive but do not metastasize. The tumor extends through the capsule into the reactive zone. Local control can be obtained only by removing the lesion with a margin of normal bone beyond the reactive zone.
4. Malignant/low grade: lesions that have a low potential to metastasize. Histologically, a pseudocapsule rather than a true capsule is found. Tumor nodules exist within the reactive zone but rarely beyond. Local control can be accomplished only by removal of all tumor and reactive tissue with a margin of normal bone. These lesions can be treated successfully by surgery alone.
5. Malignant/high grade: lesions whose natural history is to grow rapidly and metastasize early. Tumor nodules are often found within and beyond the reactive zone and at some distance in the normal tissue. Surgery is necessary for local control, and systemic therapy is warranted to prevent metastasis.
METASTASIS
Bone tumors, unlike carcinomas, disseminate almost exclusively through the blood; bones lack a lymphatic system. Early lymphatic spread to regional nodes has only rarely been reported.Lymphatic involvement, which has been noted in 10% of cases at autopsy, is a poor prognostic sign. McKenna and associates noted that patients (3%) with osteosarcoma who underwent amputation demonstrated lymph node involvement. None of these patients survived 5 years. Hematogenous spread is manifested by pulmonary involvement in its early stage and secondarily by bone involvement. Bone metastasis is occasionally the first sign of dissemination. With the use of adjuvant chemotherapy, the skeletal system has become a more common site of initial relapse.
SKIP METASTASIS
A skip metastasis, as previously defined, is a tumor nodule that is located within the same bone as the main tumor but not in continuity with it. Transarticular skip metastases are located in the joint adjacent to the main tumor. Skip metastases are most often seen with high-grade sarcomas. A skip lesion develops by the embolization of tumor cells within the marrow sinusoids; in effect, they are local micrometastases that have not passed through the circulation. Transarticular skips are believed to occur via the periarticular venous anastomosis. The clinical incidence of skip metastases is less than 1%. These lesions are a prognosticator of poor survival.
LOCAL RECURRENCE
Local recurrence of a benign or malignant lesion is due to inadequate removal. The aggressiveness of the tumor determines which surgical procedure is required for local control. Ninety-five percent of all local recurrences, regardless of histology, develop within 24 months of attempted removal. Local recurrence of a high-grade sarcoma decreases overall survival prospects substantially. Local recurrence in patients who have undergone therapy is associated with an even poorer prognosis.
Cartilage tumors are lesions in which cartilage is produced. They are the most common bone tumors. Osteochondroma is the most common benign cartilage tumor; some 1% to 2% of solitary osteochondromas become malignant and Enchondroma is a benign cartilage tumor that occurs centrally; in adults, malignant transformation may occur. Chondrosarcoma, the most common malignant cartilage tumor, is either intramedullary or peripheral. Ten percent are secondary, arising from an underlying benign lesion. Most chondrosarcomas are low grade, although 10% dedifferentiate into high-grade spindle cell sarcomas or, rarely, a mesenchymal chondrosarcoma.
Osteoid tumors are lesions in which the stroma produce osteoid. The benign forms are osteoid osteoma and osteoblastoma. Osteoid osteomas are never malignant. Osteoblastomas rarely metastasize; when they do, it is only after multiple local recurrences.Osteosarcomas are the most common primary malignant tumors of the bone. Histologically, they are composed of malignant spindle cells and osteoblasts that produce osteoid or immature bone. Several variants are now recognized.60 Parosteal, periosteal, and low-grade intraosseous osteosarcoma are histologically and radiographically distinct from the “classic” central medullary osteosarcomas and have a more favorable prognosis.
Fibrous tumors of bone are rare. Desmoplastic fibroma is a locally aggressive, nonmetastasizing tumor, analogous to fibromatosis of soft tissue.Fibrosarcoma of bone appears histologically as its soft tissue counterpart. Multiple sections must be obtained to demonstrate the lack of osteoid production. If osteoid is present, the lesion is classified as an osteosarcoma. MFH, a rare lesion and the counterpart of soft tissue MFH, has been described in bone.The pathophysiologic behavior of bone and soft tissue MFH is similar, consisting of a storiform pattern with a histiocytic component. Giant cell tumors of unknown origin were originally called benign but are now considered low-grade sarcomas. They have high rates of local recurrence and malignant transformation.
Tumors presumably arising from bone marrow elements are the round cell sarcomas. The two most common are Ewing's sarcoma and the rarer non-Hodgkin's lymphoma.
RADIOGRAPHIC EVALUATION AND DIAGNOSIS
Radiographic evaluation combined with the clinical history and histologic examination is necessary for accurate diagnosis. Bone scans, angiography, CT, and MRI are generally not helpful in determining a diagnosis but are important in delineating the extent of local involvement. A systematic approach to the radiographic evaluation of skeletal lesions has been described by Madewell and colleagues, who studied and correlated several hundred radiographic and pathologic specimens. They considered the radiograph as the gross specimen from which a detailed histologic interpretation could be made and biologic activity accurately diagnosed. According to their system, a bone tumor is evaluated by five radiographic parameters:
1. Anatomic site. Specific anatomic sites of the bone give rise to specific groups of lesions. Johnson explained this by a “field” theory, which hypothesizes that the most active cells of a certain area of bone give rise to tumors that are characteristic of that area. In general, spindle cell sarcomas are metaphyseal, whereas round cell sarcomas tend to be diaphyseal.
2. Borders. The border reflects the growth rate and the response of the adjacent normal bone to the tumor. Most tumors have a characteristic border. Benign lesions (e.g., nonossifying fibromas and unicameral bone cysts) have well-defined borders and a narrow transition area that is often associated with a reactive sclerosis. Aggressive or benign tumors [e.g., chondroblastoma and giant cell tumors (GCTs)] tend to have faint borders and wide zones of transition with very little sclerosis, reflecting a faster-growing lesion. Poorly delineated or absent margins indicate an aggressive or malignant lesion.
3. Bone destruction. Bone destruction is the hallmark of a bone tumor. Three patterns of bone destruction are described : geographic, moth-eaten, and permeative. In general, these patterns are found in the tubular bone rather than in the flat bone and represent a combination of cortical and cancellous destruction. These patterns reflect a progressively increasing growth rate of the underlying tumor.
4. Matrix formation. Calcification of the matrix, or new bone formation, may produce an area of increased density within the lesion. Calcification typically appears as flocculent or stippled rings or clusters. The appearance of the new bone varies from dense sclerosis that obliterates all evidence of normal trabeculae, to small, irregular, circumscribed masses described as “wool” or “clouds.” Calcification and ossification may appear in the same lesion. Neither type of matrix formation per se is diagnostic of malignancy.
5. Periosteal reaction. Periosteal reaction is indicative of malignancy but not pathognomonic of a particular tumor. A combination of periosteal changes is often noted. In malignant tumors, periosteal reaction is noncontinuous and thin, with multiple laminations. A parallel or a perpendicular pattern may be present.
The radiographic parameters of benign and malignant tumors are quite different. Benign tumors have round, smooth, well-circumscribed borders. No cortical destruction and, generally, no periosteal reaction are found. Malignant lesions have irregular, poorly defined margins. Evidence of bone destruction and a wide area of transition with periosteal reaction are noted. Soft tissue extension is common.
NATURAL HISTORY
Tumors arising in bone have characteristic patterns of behavior and growth that distinguish them from other malignant lesions. These patterns form the basis of a staging system and current treatment strategies. These principles and their relationship to management, as formulated by Enneking and colleagues, are described here.
BIOLOGY AND GROWTH
Spindle cell sarcomas form a solid lesion that grows centrifugally. The periphery is the least mature part of this lesion. In contradistinction to a true capsule, which surrounds a benign lesion and is composed of compressed normal cells, a malignant tumor is generally enclosed by a pseudocapsule and consists of compressed tumor cells and a fibrovascular zone of reactive tissue with an inflammatory component that interdigitates with the normal tissue adjacent to and beyond the lesion. The thickness of the reactive zone varies with the degree of malignancy and histiogenic type. The histologic hallmark of sarcomas is their potential to break through the pseudocapsule to form satellite lesions of tumor cells. This characteristic distinguishes a nonmalignant mesenchymal tumor from a malignant one.
High-grade sarcomas have a poorly defined reactive zone that may be invaded and destroyed by the tumor. In addition, tumor nodules in tissue may appear to be normal and not continuous with the main tumor. These are termed skip metastases. Although low-grade sarcomas regularly demonstrate tumor interdigitation into the reactive zone, they rarely form tumor nodules beyond this area.
The three mechanisms of growth and extension of bone tumors are:
(1) compression of normal tissue
(2) resorption of bone by reactive osteoclasts
(3) direct destruction of normal tissue.
Benign tumors grow and expand by the first two mechanisms, whereas direct tissue destruction is characteristic of malignant bone tumors. Sarcomas respect anatomic borders and remain within one compartment. Local anatomy influences tumor growth by setting the natural barriers to extension. In general, bone sarcomas take the path of least resistance. Most benign bone tumors are unicompartmental; they remain confined and may expand the bone in which they arose. Malignant bone tumors are bicompartmental; they destroy the overlying cortex and go directly into the adjacent soft tissue. The determination of anatomic compartment involvement has become more important with the advent of limb-preservation surgery.
On the basis of biologic considerations and natural history, Enneking and colleagues classified bone tumors into five categories, each of which shares certain clinical characteristics and radiographic patterns and requires similar surgical procedures.
1. Benign/latent: lesions whose natural history is to grow slowly during normal growth of the individual and then to stop, with a tendency to heal spontaneously. They never become malignant and, if treated by simple curettage, heal rapidly. Surgery is not indicated unless they become symptomatic.
2. Benign/active: lesions whose natural history is one of progressive growth. Simple curettage leaves a reactive rim with some tumor. Curettage is associated with a high recurrence rate. Wide excision through normal bone results in local control in approximately 95% of all cases.
3. Benign/aggressive: lesions that are locally aggressive but do not metastasize. The tumor extends through the capsule into the reactive zone. Local control can be obtained only by removing the lesion with a margin of normal bone beyond the reactive zone.
4. Malignant/low grade: lesions that have a low potential to metastasize. Histologically, a pseudocapsule rather than a true capsule is found. Tumor nodules exist within the reactive zone but rarely beyond. Local control can be accomplished only by removal of all tumor and reactive tissue with a margin of normal bone. These lesions can be treated successfully by surgery alone.
5. Malignant/high grade: lesions whose natural history is to grow rapidly and metastasize early. Tumor nodules are often found within and beyond the reactive zone and at some distance in the normal tissue. Surgery is necessary for local control, and systemic therapy is warranted to prevent metastasis.
METASTASIS
Bone tumors, unlike carcinomas, disseminate almost exclusively through the blood; bones lack a lymphatic system. Early lymphatic spread to regional nodes has only rarely been reported.Lymphatic involvement, which has been noted in 10% of cases at autopsy, is a poor prognostic sign. McKenna and associates noted that patients (3%) with osteosarcoma who underwent amputation demonstrated lymph node involvement. None of these patients survived 5 years. Hematogenous spread is manifested by pulmonary involvement in its early stage and secondarily by bone involvement. Bone metastasis is occasionally the first sign of dissemination. With the use of adjuvant chemotherapy, the skeletal system has become a more common site of initial relapse.
SKIP METASTASIS
A skip metastasis, as previously defined, is a tumor nodule that is located within the same bone as the main tumor but not in continuity with it. Transarticular skip metastases are located in the joint adjacent to the main tumor. Skip metastases are most often seen with high-grade sarcomas. A skip lesion develops by the embolization of tumor cells within the marrow sinusoids; in effect, they are local micrometastases that have not passed through the circulation. Transarticular skips are believed to occur via the periarticular venous anastomosis. The clinical incidence of skip metastases is less than 1%. These lesions are a prognosticator of poor survival.
LOCAL RECURRENCE
Local recurrence of a benign or malignant lesion is due to inadequate removal. The aggressiveness of the tumor determines which surgical procedure is required for local control. Ninety-five percent of all local recurrences, regardless of histology, develop within 24 months of attempted removal. Local recurrence of a high-grade sarcoma decreases overall survival prospects substantially. Local recurrence in patients who have undergone therapy is associated with an even poorer prognosis.
Minggu, 09 Maret 2008
mau sharing aja
akhir-akhir ini aku sering menderita pusing yang teramat sangat di bagian kiri kepala. awalnya aku kira migrain. Tapi kok sampe mau nangis rasanya.Akhirnya aku tidur dengan posisi hadap ke kanan. (kayak posisi nabi tidur)
nah kalo kuhubung-hubung kan dengan aktivitas dan pola makanan ku akhir-akhir ini tampaknya pusing ku ini bisa menjadi sebuah hubungan.
1. aku udah jarang olah raga
2. pola tidur ku gak terartur, subuhan sering telat
3. suka makan gorengan
4. sering main laptop, megang hape, telpon-telponan sampai sejam lebih (kayaknya pengaruh radiasi
5. Kemaren makan daging kambing
berhubung aku habis belajar tentang kanker, jadi ketakutan ku mengarah ke arah sana. Tapi insya Allah nggak..
sekarang udah agak enakan. Lagi pula akhir-akhir ini aku stress banget
intinya aku harus mengubah pola hidup ku
akhir-akhir ini aku sering menderita pusing yang teramat sangat di bagian kiri kepala. awalnya aku kira migrain. Tapi kok sampe mau nangis rasanya.Akhirnya aku tidur dengan posisi hadap ke kanan. (kayak posisi nabi tidur)
nah kalo kuhubung-hubung kan dengan aktivitas dan pola makanan ku akhir-akhir ini tampaknya pusing ku ini bisa menjadi sebuah hubungan.
1. aku udah jarang olah raga
2. pola tidur ku gak terartur, subuhan sering telat
3. suka makan gorengan
4. sering main laptop, megang hape, telpon-telponan sampai sejam lebih (kayaknya pengaruh radiasi
5. Kemaren makan daging kambing
berhubung aku habis belajar tentang kanker, jadi ketakutan ku mengarah ke arah sana. Tapi insya Allah nggak..
sekarang udah agak enakan. Lagi pula akhir-akhir ini aku stress banget
intinya aku harus mengubah pola hidup ku
Senin, 25 Februari 2008
rokok penghancur generasi bangsa
saya merasa aneh menulis artikel ini. Tampaknya apa yang saya tulis bakal menghina-hina rokok dan pemujanya. Saya merasa aneh lagi karena saya sedang berusaha untuk tidak merokok lagi. Alhamdulilah sudah lama saya tidak menyentuh barang itu.
begitu banyak kejelekan yang di bawa oleh rokok. tidak ada satupun komponen dari rokok yang bermanfaat, semuanya adalah bahan kimia yang merusak tubuh dan mental. Mungkin yang bermanfaat dari rokok hanyalah besarnya keuntungan yang di kantongi oleh si empunya pabrik rokok, Cukup itu saja...dan selebihnya adalah kandungan sia-sia yang mematikan.
Mungkin udah banyak yang melihat poster-poster kampannye anti rokok. Semuanya gambarnya menyeramkan dan anehnya hanya sedikit yang sadar tentang bahaya rokok.
ini berarti akal sehat dan mental mereka udah rusak kali ya...
yang lebih aneh lagi, di setiap bungkus rokok selalu di cantumkan warning "merokok dapat menyebabkan...bla..bla..dst" akan tetapi kok masih banyak yang membeli ya? Apa mereka tidak takut kena kanker, impotensi, dsb?
mental sudah hancur...keburukan kok rela di beli.
ada lagi, teman kos saya harus rela gak makan karena duit bulanannya habis...dia makan cuma satu kali dalam sehari..
tapi rokoknya sebungkus sehari....
ketika saya tanya kenapa rokoknya gak di stop dulu, dia menjawab " ah lebih enak nge rokok, mau mati rasanya kalo ga nge rokok"
nah lho...
coba di pikir secara logis....
adakah kejanggalan di sini?
fakta membuktikan.....bahwa anggaran negara untuk mengobati penyakit-penyakit karena rokok jauh lebih besar daripada devisa yang di hasilkan oleh pabrik rokok
kenapa ya gak di stop aja?
anda pernah ke arab saudi?
di sana rokok = haram!!!
merokok = dosa
apakah anda percaya akar dari narkoba adalah rokok?
semua berawal dari rokok. Anak muda di bilang gak gaul karena merokok. lalu dia merokokk, lalu mencoba miras, supaya lebih gaul lagi memakai putaw, inex, dan segala narkotika lainnya.
Polisi berusaha untuk memberantas mereka. Suatu usaha yang pantas untuk di kagumi. Banyak sindikat narkoba tertangkap.
Tapi, tahukah anda jika para polisi tersebut sedang stress, apa yang mereka lakukan?
MEROKOK
lihat saja di kantor polisi dan lakukan survey. Berapa persen polisi yang merokok...
suatu ironi.
Memang susah untuk berhenti. Tapi kita memang harus mencobanya dan membulatkan tekad.
Jangan sampai kita meninggal karena rokok.
Mari kita hidup sehat sejak dini
begitu banyak kejelekan yang di bawa oleh rokok. tidak ada satupun komponen dari rokok yang bermanfaat, semuanya adalah bahan kimia yang merusak tubuh dan mental. Mungkin yang bermanfaat dari rokok hanyalah besarnya keuntungan yang di kantongi oleh si empunya pabrik rokok, Cukup itu saja...dan selebihnya adalah kandungan sia-sia yang mematikan.
Mungkin udah banyak yang melihat poster-poster kampannye anti rokok. Semuanya gambarnya menyeramkan dan anehnya hanya sedikit yang sadar tentang bahaya rokok.
ini berarti akal sehat dan mental mereka udah rusak kali ya...
yang lebih aneh lagi, di setiap bungkus rokok selalu di cantumkan warning "merokok dapat menyebabkan...bla..bla..dst" akan tetapi kok masih banyak yang membeli ya? Apa mereka tidak takut kena kanker, impotensi, dsb?
mental sudah hancur...keburukan kok rela di beli.
ada lagi, teman kos saya harus rela gak makan karena duit bulanannya habis...dia makan cuma satu kali dalam sehari..
tapi rokoknya sebungkus sehari....
ketika saya tanya kenapa rokoknya gak di stop dulu, dia menjawab " ah lebih enak nge rokok, mau mati rasanya kalo ga nge rokok"
nah lho...
coba di pikir secara logis....
adakah kejanggalan di sini?
fakta membuktikan.....bahwa anggaran negara untuk mengobati penyakit-penyakit karena rokok jauh lebih besar daripada devisa yang di hasilkan oleh pabrik rokok
kenapa ya gak di stop aja?
anda pernah ke arab saudi?
di sana rokok = haram!!!
merokok = dosa
apakah anda percaya akar dari narkoba adalah rokok?
semua berawal dari rokok. Anak muda di bilang gak gaul karena merokok. lalu dia merokokk, lalu mencoba miras, supaya lebih gaul lagi memakai putaw, inex, dan segala narkotika lainnya.
Polisi berusaha untuk memberantas mereka. Suatu usaha yang pantas untuk di kagumi. Banyak sindikat narkoba tertangkap.
Tapi, tahukah anda jika para polisi tersebut sedang stress, apa yang mereka lakukan?
MEROKOK
lihat saja di kantor polisi dan lakukan survey. Berapa persen polisi yang merokok...
suatu ironi.
Memang susah untuk berhenti. Tapi kita memang harus mencobanya dan membulatkan tekad.
Jangan sampai kita meninggal karena rokok.
Mari kita hidup sehat sejak dini
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