ADHD in Adults

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ADHD Symptom Snapshot

There are 3 core symptoms of ADHD: inattention, impulsivity, and hyperactivity. The following are examples of how ADHD symptoms may appear in adults.

Only a doctor or other health care professional can diagnose ADHD.

ONLY A DOCTOR OR OTHER HEALTH CARE PROFESSIONAL CAN DIAGNOSE ADHD

Symptoms of Inattention

  • Often makes careless mistakes and lacks attention to details
    (Examples: overlooking or missing details or handing in work that is inaccurate)
  • Often has difficulty paying attention to tasks
    (Example: difficulty remaining focused during lectures, conversations, or lengthy readings)
  • Often seems to not listen when spoken to directly
    (Example: mind seems elsewhere, even in the absence of obvious distraction)
  • Often fails to follow through on instructions, chores, or duties in the workplace
    (Example: starts tasks but quickly loses focus and is easily sidetracked)
  • Often has difficulty organizing tasks and activities
    (Examples: messy, disorganized work; poor time management; fails to meet deadlines)
  • Often avoids, dislikes, or is reluctant to participate in tasks requiring sustained mental effort, like preparing reports, completing forms, or reviewing lengthy papers 
  • Often loses things like tools, wallets, keys, paperwork, eyeglasses, and mobile phones
  • Often easily distracted by other things, including unrelated thoughts
  • Often forgetful in daily activities, such as running errands, returning calls, paying bills, and keeping appointments

Symptoms of Hyperactivity and Impulsivity

  • Often fidgets with or taps hands and feet or squirms in seat
  • Often leaves seat when remaining seated is expected
    (Example: leaves their place in the office or other workplace setting or in other situations that require remaining seated)
  • Often runs or climbs where it is inappropriate or feels restless (in adults, may be limited to feeling restless)
  • Often unable to participate in leisure activities quietly
  • Often acts as if “on the go” or “driven by a motor”
    (Example: is unable to be or uncomfortable being still for an extended time, as in meetings or restaurants)
  • Often talks excessively
  • Often blurts out an answer before a question has been fully asked
    (Examples: completes people’s sentences; cannot wait for next turn in conversation)
  • Often has difficulty waiting his or her turn, for example, while waiting in line
  • Often interrupts or intrudes on others
    (Examples: butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; may intrude into or take over what others are doing)

Europe’s most dangerous pathogens: Climate change increasing risks

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Europe’s most dangerous pathogens: Climate change increasing risks

Date:
August 2, 2017
Source:
University of Liverpool
Summary:
The impact of climate change on the emergence and spread of infectious diseases could be greater than previously thought, according to new research.

The impact of climate change on the emergence and spread of infectious diseases could be greater than previously thought, according to new research by the University of Liverpool.

The study, published in Scientific Reports, is the first large-scale assessment of how climate affects bacterium, viruses or other microorganisms and parasites (pathogens) that can cause disease in humans or animals in Europe.

The results will help policy makers prioritise the surveillance for pathogens that may respond to climate change and, in turn, contribute to strengthening climate change resilience for infectious diseases.

Epidemics

There is growing evidence that climate change is altering the distribution of some diseases, in some cases causing epidemics or making diseases spread within their natural range, for example, Zika virus in South America, or bluetongue and Schmallenberg disease in livestock in Europe.

Dr Marie McIntyre, who led the project at the University’s Institute of Infection and Global Health, explained: “Although there is a well-established link between climate change and infectious disease, we did not previously understand how big the effects will be and which diseases will be most affected.

“Climate sensitivity of pathogens is a key indicator that diseases might respond to climate change, so assessing which pathogens are most climate-sensitive, and their characteristics, is vital information if we are to prepare for the future.”

Largest effects

The researchers carried out a systematic review of published literature on one hundred human and one hundred domestic animal pathogens present in Europe that have the largest impact on health.

Nearly two-thirds of the pathogens examined were found to be sensitive to climate; and two-thirds of these have more than one climate driver, meaning that the impact of climate change upon them will likely be multifaceted and complex.

Diseases spread by insects and ticks (vector-borne diseases) were found to be the most climate sensitive, followed by those transmitted in soil, water and food. The diseases with the largest number of different climate drivers were Vibrio cholerae (cause of cholera), Fasciola hepatica (cause of liver fluke), Bacillus anthracis (cause of anthrax) and Borrelia burgdorferi (cause of tickborne Lyme disease).

Future effects

Dr Marie McIntyre, commented: “Currently, most models examining climate effects only consider a single or at most two climate drivers, so our results suggest that this should change if we really want to understand future impacts of climate change on health.”

Zoonotic pathogens — those that spread from animals to humans — were also found to be more climate sensitive than those that affect only humans or only animals. As 75% of emerging diseases are zoonotic, emerging diseases may be particularly likely to be impacted by climate change.

However, the researchers stress that their response to climate change will also be dependent on the impacts of other drivers, such as changes to travel and trade, land-use, deforestation, new control measures and the development of antimicrobial resistance.

Big Data

The top 100 human and animals list was compiled using the Enhanced Infectious Disease Database (EID2), — a comprehensive and open-access ‘Big Data’ record of over 60 million scientific papers, electronic sources and textbooks associated with infectious diseases that was developed in Liverpool.


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New light shed on Lyme disease-causing bacteria

Image result for lyme disease infections 2017Prompt removal of ticks can help prevent transmission of Borrelia mayonii

Date:
august 13, 2017
Source:
Entomological Society of America
Summary:
A new species of bacteria that causes Lyme disease needs the same amount of time for transmission after a tick bite compared to previously implicated bacteria, according to new research. Existing guidelines for frequent tick checks and prompt removal of attached ticks remain the same.

A new species of bacteria that causes Lyme disease needs the same amount of time for transmission after a tick bite compared to previously implicated bacteria, according to new research by the Centers for Disease Control and Prevention (CDC). Existing guidelines for frequent tick checks and prompt removal of attached ticks remain the same.

The duration of attachment of a single nymphal blacklegged tick (Ixodes scapularis) needed for the tick to be likely to transmit the bacterial species Borrelia mayonii, identified in 2016, is 48 hours or more, according to the study. By 72 hours, however, likelihood of transmission has risen significantly. This timeframe aligns with existing research on Borrelia burgdorferi, previously the sole bacteria species known to cause Lyme disease in the United States. The research is published in the Entomological Society of America’s Journal of Medical Entomology.

“Our findings show that recommendations for regular tick checks and prompt tick removal as a way to prevent transmission of Lyme disease spirochetes to humans via the bites of infected ticks applies to the newly recognized B. mayonii as well as B. burgdorferi, for which these recommendations originally were developed,” says Lars Eisen, Ph.D., CDC research entomologist and senior author of the study.

The study authors tested transmission rates of B. mayonii from ticks to mice at four time intervals: 24, 48, and 72 hours after attachment and after the tick’s full feed. Their experiment focused on nymphal-stage ticks (the more common source of pathogen transmission, compared to larval or adult ticks) and exposed the mice to a single infected tick each. They found no evidence of transmission by single nymphs infected with B. mayonii in the first 24 or 48 hours, but 31 percent of mice examined after 72 hours were found to be infected. In mice examined after a tick’s complete feed (4-5 days), the infection rate was 57 percent.

“Our findings underscore the importance of finding and removing ticks as soon as possible after they bite,” says Eisen.

Lyme disease is the most commonly reported vector-borne illness in the United States, with around 300,000 people estimated to be diagnosed each year, mostly in the Northeast and upper Midwest regions. The blacklegged tick is the primary vector of Lyme disease as well as at least a dozen other illnesses.

To reduce the risk of tick bites and tickborne diseases, CDC recommendations include:

  • Avoid wooded and brushy areas with high grass and leaf litter.
  • Use insect repellent when outdoors.
  • Use products that contain permethrin on clothing.
  • Bathe or shower as soon as possible after coming indoors to wash off and more easily find ticks.
  • Conduct a full-body tick check after spending time outdoors.
  • Examine gear and pets, as ticks can come into the home on these and later attach to people.

The bacterial species B. mayonii was discovered when six patients exhibiting symptoms of Lyme disease at the Mayo Clinic in Rochester, Minnesota, in 2013 showed unusual blood-test results. The discovery of the new species was confirmed in 2016.

“There is much still to discover about B. mayonii, including to clarify the geographic range of this emerging human pathogen in the U.S., to determine how commonly different life stages of the blacklegged tick are infected with B. mayonii, and to find out whether the same vertebrate animals that serve as natural reservoirs for B. burgdorferi play the same role also for B. mayonii,” says Eisen.


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Typhoid fever

Typhoid fever is caused by Salmonella typhi bacteria. Typhoid fever is rare in industrialized countries. However, it remains a serious health threat in the developing world, especially for children.

Typhoid fever spreads through contaminated food and water or through close contact with someone who’s infected. Signs and symptoms usually include high fever, headache, abdominal pain, and either constipation or diarrhea.

Most people with typhoid fever feel better within a few days of starting antibiotic treatment, although a small number of them may die of complications. Vaccines against typhoid fever are available, but they’re only partially effective. Vaccines usually are reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.

Symptoms

Signs and symptoms are likely to develop gradually — often appearing one to three weeks after exposure to the disease.

Early illness

Once signs and symptoms do appear, you’re likely to experience:

  • Fever that starts low and increases daily, possibly reaching as high as 104.9 F (40.5 C)
  • Headache
  • Weakness and fatigue
  • Muscle aches
  • Sweating
  • Dry cough
  • Loss of appetite and weight loss
  • Abdominal pain
  • Diarrhea or constipation
  • Rash
  • Extremely swollen abdomen

Later illness

If you don’t receive treatment, you may:

  • Become delirious
  • Lie motionless and exhausted with your eyes half-closed in what’s known as the typhoid state

In addition, life-threatening complications often develop at this time.

In some people, signs and symptoms may return up to two weeks after the fever has subsided.

When to see a doctor

See a doctor immediately if you suspect you have typhoid fever. If you become ill while traveling in a foreign country, call the U.S. Consulate for a list of doctors. Better yet, find out in advance about medical care in the areas you’ll visit, and carry a list of the names, addresses and phone numbers of recommended doctors.

If you develop signs and symptoms after you return home, consider consulting a doctor who focuses on international travel medicine or infectious diseases. A specialist may be able to recognize and treat your illness more quickly than can a doctor who isn’t familiar with these areas.

Causes

Typhoid fever is caused by virulent bacteria called Salmonella typhi (S. typhi). Although they’re related, S. typhi and the bacteria responsible for salmonellosis, another serious intestinal infection, aren’t the same.

Fecal-oral transmission route

The bacteria that cause typhoid fever spread through contaminated food or water and occasionally through direct contact with someone who is infected. In developing nations, where typhoid fever is endemic, most cases result from contaminated drinking water and poor sanitation. The majority of people in industrialized countries pick up typhoid bacteria while traveling and spread it to others through the fecal-oral route.

This means that S. typhi is passed in the feces and sometimes in the urine of infected people. You can contract the infection if you eat food handled by someone with typhoid fever who hasn’t washed carefully after using the toilet. You can also become infected by drinking water contaminated with the bacteria.

Typhoid carriers

Even after treatment with antibiotics, a small number of people who recover from typhoid fever continue to harbor the bacteria in their intestinal tracts or gallbladders, often for years. These people, called chronic carriers, shed the bacteria in their feces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves.

Risk factors

Typhoid fever remains a serious worldwide threat — especially in the developing world — affecting an estimated 26 million or more people each year. The disease is endemic in India, Southeast Asia, Africa, South America and many other areas.

Worldwide, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.

If you live in a country where typhoid fever is rare, you’re at increased risk if you:

  • Work in or travel to areas where typhoid fever is endemic
  • Work as a clinical microbiologist handling Salmonella typhi bacteria
  • Have close contact with someone who is infected or has recently been infected with typhoid fever
  • Drink water contaminated by sewage that contains S.
  • Complications

    Intestinal bleeding or holes

    The most serious complications of typhoid fever — intestinal bleeding or holes (perforations) in the intestine — may develop in the third week of illness. A perforated intestine occurs when your small intestine or large bowel develops a hole, causing intestinal contents to leak into your abdominal cavity and triggering signs and symptoms, such as severe abdominal pain, nausea, vomiting and bloodstream infection (sepsis). This life-threatening complication requires immediate medical care.

    Other, less common complications

    Other possible complications include:

    • Inflammation of the heart muscle (myocarditis)
    • Inflammation of the lining of the heart and valves (endocarditis)
    • Pneumonia
    • Inflammation of the pancreas (pancreatitis)
    • Kidney or bladder infections
    • Infection and inflammation of the membranes and fluid surrounding your brain and spinal cord (meningitis)
    • Psychiatric problems, such as delirium, hallucinations and paranoid psychosis

    With prompt treatment, nearly all people in industrialized nations recover from typhoid fever. Without treatment, some people may not survive complications of the disease.

  • Preparing for your appointment

    Call your doctor if you’ve recently returned from travel abroad and develop mild symptoms similar to those that occur with typhoid fever. If your symptoms are severe, go to an emergency room or call 911 or your local emergency number.

    Here’s some information to help you get ready and know what to expect from your doctor.

    Information to gather in advance

    • Pre-appointment restrictions. At the time you make your appointment, ask if there are restrictions you need to follow in the time leading up to your visit. Your doctor will not be able to confirm typhoid fever without a blood test, and may recommend taking steps to reduce the risk of passing a possible contagious illness to others.
    • Symptom history. Write down any symptoms you’re experiencing and for how long.
    • Recent exposure to possible sources of infection. Be prepared to describe international trips in detail, including the countries you visited and the dates you traveled.
    • Medical history. Make a list of your key medical information, including other conditions for which you’re being treated and any medications, vitamins or supplements you’re taking. Your doctor will also need to know your vaccination history.
    • Questions to ask your doctor. Write down your questions in advance so that you can make the most of your time with your doctor.

    For typhoid fever, possible questions to ask your doctor include:

    • What are the possible causes for my symptoms?
    • What kinds of tests do I need?
    • Are treatments available to help me recover?
    • I have other health problems. How can I best manage these conditions together?
    • How long do you expect a full recovery will take?
    • When can I return to work or school?
    • Am I at risk of any long-term complications from typhoid fever?

    Don’t hesitate to ask any other related questions you have.

    What to expect from your doctor

    Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

    • What are your symptoms and when did they begin?
    • Have your symptoms gotten better or worse?
    • Did your symptoms briefly get better and then come back?
    • Have you recently traveled abroad? Where?
    • Did you update your vaccinations before traveling?
    • Are you being treated for any other medical conditions?
    • Are you currently taking any medications?
    • Tests and diagnosis

      Medical and travel history

      Your doctor is likely to suspect typhoid fever based on your symptoms and your medical and travel history. But the diagnosis is usually confirmed by identifying S. typhi in a culture of your blood or other body fluid or tissue.

      Body fluid or tissue culture

      For the culture, a small sample of your blood, stool, urine or bone marrow is placed on a special medium that encourages the growth of bacteria. The culture is checked under a microscope for the presence of typhoid bacteria. A bone marrow culture often is the most sensitive test for S. typhi.

      Although performing a culture test is the mainstay for diagnosis, in some instances other testing may be used to confirm a suspected typhoid fever infection, such as a test to detect antibodies to typhoid bacteria in your blood or a test that checks for typhoid DNA in your blood.

    • Treatments and drugs

      Antibiotic therapy is the only effective treatment for typhoid fever.

      Commonly prescribed antibiotics

      • Ciprofloxacin (Cipro). In the United States, doctors often prescribe this for nonpregnant adults.
      • Ceftriaxone (Rocephin). This injectable antibiotic is an alternative for people who may not be candidates for ciprofloxacin, such as children.

      These drugs can cause side effects, and long-term use can lead to the development of antibiotic-resistant strains of bacteria.

      Problems with antibiotic resistance

      In the past, the drug of choice was chloramphenicol. Doctors no longer commonly use it, however, because of side effects, a high rate of health deterioration after a period of improvement (relapse) and widespread bacterial resistance.

      In fact, the existence of antibiotic-resistant bacteria is a growing problem in the treatment of typhoid fever, especially in the developing world. In recent years, S. typhi also has proved resistant to trimethoprim-sulfamethoxazole and ampicillin.

      Other treatments

      Other treatments include:

      • Drinking fluids. This helps prevent the dehydration that results from a prolonged fever and diarrhea. If you’re severely dehydrated, you may need to receive fluids through a vein (intravenously).
      • Surgery. If your intestines become perforated, you’ll need surgery to repair the hole.
      • Prevention

        In many developing nations, the public health goals that can help prevent and control typhoid fever — safe drinking water, improved sanitation and adequate medical care — may be difficult to achieve. For that reason, some experts believe that vaccinating high-risk populations is the best way to control typhoid fever.

        A vaccine is recommended if you’re traveling to areas where the risk of getting typhoid fever is high.

        Vaccines

        Two vaccines are available.

        • One is injected in a single dose at least one week before travel.
        • One is given orally in four capsules, with one capsule to be taken every other day.

        Neither vaccine is 100 percent effective, and both require repeat immunizations, as vaccine effectiveness diminishes over time.

        Because the vaccine won’t provide complete protection, follow these guidelines when traveling to high-risk areas:

        • Wash your hands. Frequent hand-washing in hot, soapy water is the best way to control infection. Wash before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer for times when water isn’t available.
        • Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid fever is endemic. For that reason, drink only bottled water or canned or bottled carbonated beverages, wine and beer. Carbonated bottled water is safer than uncarbonated bottled water is.

          Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow water in the shower.

        • Avoid raw fruits and vegetables. Because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can’t peel, especially lettuce. To be absolutely safe, you may want to avoid raw foods entirely.
        • Choose hot foods. Avoid food that’s stored or served at room temperature. Steaming hot foods are best. And although there’s no guarantee that meals served at the finest restaurants are safe, it’s best to avoid food from street vendors — it’s more likely to be contaminated.

        Prevent infecting others

        If you’re recovering from typhoid fever, these measures can help keep others safe:

        • Take your antibiotics. Follow your doctor’s instructions for taking your antibiotics, and be sure to finish the entire prescription.
        • Wash your hands often. This is the single most important thing you can do to keep from spreading the infection to others. Use hot, soapy water and scrub thoroughly for at least 30 seconds, especially before eating and after using the toilet.
        • Avoid handling food. Avoid preparing food for others until your doctor says you’re no longer contagious. If you work in the food service industry or a health care facility, you won’t be allowed to return to work until tests show that you’re no longer shedding typhoid bacteria.

Aging doesn’t mean the end of sex

Sex may not be the same as it was in your 20s, but it can still be fulfilling. Communication is essential for maintaining a satisfying sex life. Talk with your partner about what you want from him or her. Be honest about what you’re experiencing physically and emotionally. If you take medications or have health problems that affect your sex life, don’t be afraid to talk with your doctor.

Vaccines for adults: Which do you need?

Vaccines offer protection from infectious diseases. Find out how to stay on top of the vaccines recommended for adults.

You’re not a kid anymore, so you don’t have to worry about shots, right? Wrong. Find out how to stay on top of your vaccines.

What vaccines do adults need?

Vaccines for adults are recommended based on your age, prior vaccinations, health, lifestyle, occupation and travel destinations.

The schedule is updated every year, and changes range from the addition of a new vaccine to tweaks of current recommendations. To determine exactly which vaccines you need now and which vaccines are coming up, check the Centers for Disease Control and Prevention’s website.

What factors might affect my vaccine recommendations?

Several factors can affect whether you need certain vaccines. Be sure to tell your doctor if you:

  • Are planning to travel abroad
  • Have had your spleen removed
  • Work in certain occupations where exposures could occur
  • Are or might be pregnant
  • Are breast-feeding
  • Are moderately or severely ill or have a chronic illness
  • Have any severe allergies, including a serious allergic reaction to a previous dose of a vaccine
  • Have had a disorder in which your body’s immune system attacks your nerves, such as Guillain-Barre syndrome
  • Have a weakened immune system or are being treated with an immunosuppressant
  • Have recently had another vaccine
  • Have recently had a transfusion or received other blood products
  • Have a personal or family history of seizures

Your doctor might also recommend certain vaccines based on your sexual activity. Vaccinations can protect you from hepatitis A and hepatitis B, serious liver infections that can spread through sexual contact. The HPV vaccine is recommended for men up to age 21 and women up to age 26.

Why are some vaccines particularly important for adults?

Adults of any age can benefit from vaccines. However, certain diseases, such as the flu, can be particularly serious for older adults or those living with certain chronic illnesses.

How can I keep track of my vaccines?

To gather information about your vaccination status, talk to your parents or other caregivers. Check with your doctor’s office, as well as any previous doctors’ offices, schools and employers. Some states also have registries that include adult immunizations. To check, contact your state health department.

If you can’t find your records, talk to your doctor. He or she might be able to do blood tests to see if you are immune to certain diseases that can be prevented by vaccines. You might need to get some vaccines again.

To stay on top of your vaccines, ask your doctor for an immunization record form. Bring the form with you to all of your doctor visits and ask your provider to sign and date the form for each vaccine you receive.

Breast Cancer Stages

Once a person is determined to have a malignant tumor or the diagnosis of breast cancer, the healthcare team will determine staging to communicate how far the disease has progressed.

Why is the breast cancer stage important?

Determining the stage helps determine the best way to contain and eli

minate the breast cancer.

How is the stage determined?

The stage is based on the following factors:

breast cancer stage1 tumor

  • The size of the tumor within the breast
  • The number of lymph nodes affected
  • The nearest lymph nodes are found under the arm, known as the axillary area
  • Signs indicating whether or not the breast cancer cancer has invaded other organs within the body

If breast cancer has spread, or metastasized, evidence be may found in the bones, liver, lungs, or brain.

What Types Of Cancer Are Diagnosed As Stage 0 And 1 Breast Cancer?

 

breast cancer stages thumb stage1 stage0

The stage of cancer indicates the size of the tumor of abnormal cells and whether or not those cells are contained to the place of origin. The most common type of breast cancer is ductal carcinoma in situ (DCIS), indicating the cancer cell growth starts in the milk ducts.

What does the term, “in situ” mean?

Stage 0 cancers are called “carcinoma in situ.” Carcinoma means cancer and “in situ” means “in the original place.” Three possible types of “in situ carcinoma” of the breast tissue are:

  • DCIS – Ductal carcinoma in situ
  • LCIS – Lobular carcinoma in situ
  • Paget disease of the nipple

    What Does It Mean To Have Stage 2 Breast Cancer?

 

  • breast cancer stages thumb stage2Stage 2 means the breast cancer is growing, but it is still contained in the breast or growth has only extended to the nearby lymph nodes.

    This stage is divided into groups: Stage 2A and Stage 2B. The difference is determined by the size of the tumor and whether the breast cancer has spread to the lymph nodes.

 

Stage 3 (III) A, B, And C

breast cancer stages thumb stage3

Stage 3 breast cancer is considered advanced cancer with evidence of cancer invading surrounding tissues near the breast.

Stage 4 (IV)

breast cancer stages thumb stage4

Stage 4 breast cancer indicates that cancer has spread beyond the breast to other areas of the body.

Current Standards Of Care

Should patients insist on comprehensive scans, regardless of the stage?
It may not be necessary, but always seek the advice of your physician. There was a time when everyone diagnosed with breast cancer would routinely have a series of scans and tests to rule out the presence of cancer in other organs.However, this standard was discontinued in 1998 by the National Comprehensive Cancer Network.

The NCCN put forth new national standards for diagnosis and treatment of each type of breast cancer. Instead of undergoing complete “staging work-ups” as they are called, such extensive testing is now often unnecessary, in part due to earlier detection.

The most extensive testing is now commonly reserved for patients with locally advanced disease  (very large tumors with cancer affecting several lymph nodes, for example) or for patients whose long-term physical symptoms may imply that breast cancer has spread elsewhere.

Choosing Your Doctor

Working with a doctor to guide your breast cancer treatment decisions is key.  Determine what you need to do to cultivate a positive partnership with your doctor and when it might be prudent to seek a second opinion

Standard Treatment Vs. Clinical Trials

Before selecting your breast cancer treatment plan, it’s a good idea to understand the difference between standard treatment and clinical trials so you can make an informed decision about what is right for you.

Surger

The most common form of treatment for breast cancer is surgery. This involves removing the tumor and nearby margins. Surgical options may include a lumpectomy, partial mastectomy, radical mastectomy, and reconstruction

 

Chemotherapy

Chemotherapy is a breast cancer treatment method that uses a combination of drugs to either destroy cancer cells or slow down the growth of cancer cells.

Radiation Therapy

breast cancer treatment radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects the nearby skin or cells only in the part of the body that is treated with the radiation.

Hormone Therapy

If the cancer cells have hormone receptors, you may be prescribed hormone therapy drugs, such as blockers or inhibitors. Both types of drugs help to destroy cancer cells by cutting off their supply of hormones.

Targeted Therapy

Targeted therapy uses drugs that block the growth of breast cancer cells in specific ways, often reducing side effects.

Nutrition And Physical Activity

It’s important for you to take very good care of yourself before, during, and after breast cancer treatment.

Follow-Up Care

You’ll need regular check-ups after treatment for breast cancer. This helps ensure that any changes in your health are noted and treated if needed.

Dyslexia-Symptoms and treatment

Symptoms

Signs of dyslexia can be difficult to recognize before your child enters school, but some early clues may indicate a problem. Once your child reaches school age, your child’s teacher may be the first to notice a problem. Severity varies, but the condition often becomes apparent as a child starts learning to read.

Before school

Signs that a young child may be at risk of dyslexia include:

  • Late talking
  • Learning new words slowly
  • Problems forming words correctly, such as reversing sounds in words or confusing words that sound alike
  • Problems remembering or naming letters, numbers and colors
  • Difficulty learning nursery rhymes or playing rhyming games

School age

Once your child is in school, dyslexia signs and symptoms may become more apparent, including:

  • Reading well below the expected level for age
  • Problems processing and understanding what he or she hears
  • Difficulty finding the right word or forming answers to questions
  • Problems remembering the sequence of things
  • Difficulty seeing (and occasionally hearing) similarities and differences in letters and words
  • Inability to sound out the pronunciation of an unfamiliar word
  • Difficulty spelling
  • Spending an unusually long time completing tasks that involve reading or writing
  • Avoiding activities that involve reading

Teens and adults

Dyslexia signs in teens and adults are similar to those in children. Some common dyslexia signs and symptoms in teens and adults include:

  • Difficulty reading, including reading aloud
  • Slow and labor-intensive reading and writing
  • Problems spelling
  • Avoiding activities that involve reading
  • Mispronouncing names or words, or problems retrieving words
  • Trouble understanding jokes or expressions that have a meaning not easily understood from the specific words (idioms), such as “piece of cake” meaning “easy”
  • Spending an unusually long time completing tasks that involve reading or writing
  • Difficulty summarizing a story
  • Trouble learning a foreign language
  • Difficulty memorizing
  • Difficulty doing math problems

When to see a doctor

Though most children are ready to learn reading by kindergarten or first grade, children with dyslexia often can’t grasp the basics of reading by that time. Talk with your doctor if your child’s reading level is below what’s expected for his or her age or if you notice other signs of dyslexia.

When dyslexia goes undiagnosed and untreated, childhood reading difficulties continue into adulthood.

Causes

Dyslexia tends to run in families. It appears to be linked to certain genes that affect how the brain processes reading and language, as well as risk factors in the environment.

Risk factors

Dyslexia risk factors include:

  • A family history of dyslexia or other learning disabilities
  • Premature birth or low birth weight
  • Exposure during pregnancy to nicotine, drugs, alcohol or infection that may alter brain development in the fetus
  • Individual differences in the parts of the brain that enable reading

Complications

Dyslexia can lead to a number of problems, including:

  • Trouble learning. Because reading is a skill basic to most other school subjects, a child with dyslexia is at a disadvantage in most classes and may have trouble keeping up with peers.
  • Social problems. Left untreated, dyslexia may lead to low self-esteem, behavior problems, anxiety, aggression, and withdrawal from friends, parents and teachers.
  • Problems as adults. The inability to read and comprehend can prevent a child from reaching his or her potential as the child grows up. This can have long-term educational, social and economic consequences.

Children who have dyslexia are at increased risk of having attention-deficit/hyperactivity disorder (ADHD), and vice versa. ADHD can cause difficulty sustaining attention as well as hyperactivity and impulsive behavior, which can make dyslexia harder to treat.

Treatment

There’s no known way to correct the underlying brain abnormality that causes dyslexia — dyslexia is a lifelong problem. However, early detection and evaluation to determine specific needs and appropriate treatment can improve success.

Educational techniques

Dyslexia is treated using specific educational approaches and techniques, and the sooner the intervention begins, the better. Psychological testing will help your child’s teachers develop a suitable teaching program.

Teachers may use techniques involving hearing, vision and touch to improve reading skills. Helping a child use several senses to learn — for example, listening to a taped lesson and tracing with a finger the shape of the letters used and the words spoken — can help in processing the information.

Treatment focuses on helping your child:

  • Learn to recognize and use the smallest sounds that make up words (phonemes)
  • Understand that letters and strings of letters represent these sounds and words (phonics)
  • Comprehend what he or she is reading
  • Read aloud to build reading accuracy, speed and expression (fluency)
  • Build a vocabulary of recognized and understood words

If available, tutoring sessions with a reading specialist can be helpful for many children with dyslexia. If your child has a severe reading disability, tutoring may need to occur more frequently, and progress may be slower.

Individual education plan

In the United States, schools have a legal obligation to take steps to help children diagnosed with dyslexia with their learning problems. Talk to your child’s teacher about setting up a meeting to create a structured, written plan that outlines your child’s needs and how the school will help him or her succeed. This is called an Individualized Education Plan (IEP).

Early treatment

Children with dyslexia who get extra help in kindergarten or first grade often improve their reading skills enough to succeed in grade school and high school.

Children who don’t get help until later grades may have more difficulty learning the skills needed to read well. They’re likely to lag behind academically and may never be able to catch up. A child with severe dyslexia may never have an easy time reading, but he or she can learn skills that improve reading and develop strategies to improve school performance and quality of life.

What parents can do

You play a key role in helping your child succeed. Take these steps:

  • Address the problem early. If you suspect your child has dyslexia, talk to your child’s doctor. Early intervention can improve success.
  • Read aloud to your child. It’s best if you start when your child is 6 months old or even younger. Try listening to recorded books with your child. When your child is old enough, read the stories together after your child hears them.
  • Work with your child’s school. Talk to your child’s teacher about how the school will help him or her succeed. You are your child’s best advocate.
  • Encourage reading time. To improve reading skills, a child must practice reading. Encourage your child to read.
  • Set an example for reading. Designate a time each day to read something of your own while your child reads — this sets an example and supports your child. Show your child that reading can be enjoyable.

What adults with dyslexia can do

Success in employment can be difficult for adults struggling with dyslexia. To help achieve your goals:

  • Seek evaluation and instructional help with reading and writing, regardless of your age
  • Ask about additional training and reasonable accommodations from your employer or academic institution under the Americans with Disabilities Act

پانچ جنسی راز

عورتیں چاہتی ہیں کہ ان کے مرد یہ راز جان جائیں
’’ ہم میاں بیوی ایک دوسرے کو بے پناہ چاہتے ہیں ، پھر بھی ہماری جنسی زندگی کچھ ٹھیک نہیں جارہی ۔‘‘
یہ شکایت ایک پڑھی لکھی خاتون نے کی ہے ۔ وہ ہائی سکول میں ٹیچر ہے اور خاصی ذہین اور سمجھدار ہے ۔
اچھا تو کیا تم نے اپنے شوہر سے اس مسئلہ پر گفتگو کی ہے ؟ میں نے زرینہ سے اس کی شکایت سن کر کہا ۔ اس کا شوہر لاہور کے ایک ہسپتال میں معروف ڈاکٹر ہے ۔ دونوں کی شادی کو بارہ برس بیت چکے ہیں۔ میں جب کبھی ان کے گھر جاتا ہوں تو ایک خوش باش اور معقول حد تک کامیاب گھرانے کا احساس ہوتا ہے ۔ زرینہ اپنی شکایت نوک زبان پر نہ لاتی تو مجھے ان کی ازدواجی زندگی میں اس خامی کا کبھی احساس نہیں ہوسکتا تھا۔
میں اس سے ہربات کرسکتی ہوں۔لیکن بابا، میں سیکس پر بات نہیں کرسکتی ۔ ہمت ہی نہیں پڑتی ۔ زرینہ کہنے لگی ۔ آخر میں اسے کیسے بتاؤں کہ میں کیا چاہتی ہوں ۔
آپ جانتے ہیں کہ یہ صرف زرینہ کا مسئلہ نہیں ۔ مختلف تعلیمی اور سماجی حیثیت رکھنے والی عورتوں کو اکثر اوقات اسی قسم کے احساسات ہوا کرتے ہیں ۔ اس کے علاوہ یہ صرف ہمارے ملک کا معاملہ نہیں ہے۔ امریکا جیسے ترقی یافتہ اور جنسی طورپرآزاد روئیے رکھنے والے ملک میں بھی صورت حال اسی قسم کی ہے ۔
اکثر شادہ شدہ افراد اپنے ساتھیوں کی جنسی ترجیحات سے بے خبر ہوتے ہیں ۔یہ الفاظ پامیلا شروک کے ہیں ۔ شروک صاحبہ امریکا کی نارتھ ویسٹرن یونیورسٹی کے جنسی تعلیم کے پروگرام میں ذہنی معالجہ ہیں۔ ایک اور ممتاز امریکی ماہر کیتھلسن میکائے نے چند سال پہلے بہت سی شادی شدہ خواتین کا ایک غیر رسمی سروے کیا تو معلوم ہوا کہ ان کی کئی ایسی جنسی ضرورتیں ہیں جن سے ان کے شوہر بالکل بے خبر رہتے ہیں ۔ عورتیں چاہتی ہیں کہ کسی نہ کسی طور ان کے شوہروں کو ان ضروریات کی اطلاع ہوجائے ۔ مگر مسئلہ وہی ہے ’’ سمجھ میں نہیں آتا بات کہاں سے شروع کی جائے‘‘ ۔
سروے مکمل کرنے کے بعد کیتھلسن میکائے نے امریکا کے چھ بہترین جنسی معالجین سے اس موضوع پر گفتگو کی ۔ تعجب کی بات ہے کہ وہ بھی ان عورتوں کی رائے سے متفق تھے کہ ان کے شوہروں کو ان جنسی ضرورتوں کو علم ہونا چاہئے ۔ آپ ان کو ایسے جنسی راز قرار دے سکتے ہیں جن سے عورتیں اپنے شوہروں کو باخبر دیکھنا چاہتی ہیں۔
عورت کے لیے سیکس زندگی کا جزو ہوتی ہے 

مردوں کو یہ بات اچھی طرح ذہن نشین کر لینی چاہئے کہ اکثر عورتیں اس وقت تک جنسی طور پر مطمئن نہیں ہوتیں جب تک ان کی مجموعی ازدواجی زندگی خوش گوار نہ ہو۔ گویا یہ نہیں ہوتا کہ ان کے دن اچھے نہ ہوں مگر راتیں اچھی ہوجائیں ۔
سات برسوں سے حمید کے ساتھ بیاہی ہوئی انتیس سالہ بانو کا کہنا ہے کہ ’’ حمید کو اس بات کی سمجھ نہیں آتی ۔ اس پردفتری کام کا بہت بوجھ ہے ۔ وہ بجھا بجھا سا گھر آتا ہے ۔میرے ساتھ کوئی بات نہیں کرتا ،کسی چاہت کا اظہار نہیں کرتا ۔ آدھی رات تک ٹیلی ویژن دیکھتا رہتا ہے ۔پھر بیڈروم میں آتے ہی مجھے دبوچ لیتا ہے۔میں فورا ہی گرم جوشی نہ دکھاؤں تو اس کا موڈ بگڑ جاتا ہے‘‘ ۔
بیڈ پر بیوی کے روئیے کا تعین اس امر پر ہوتا ہے کہ گھر میں شوہر کا رویہ اس کے ساتھ کیسا ہے اور گھر کے مجموعی ماحول کی کیفیت کیا ہے ۔ اگر دونوں کی شام لڑنے جھگڑنے یا ایک دوسرے سے بے نیازی میں گزری ہو تو پھر بیڈ پر عورت سردمہر اور لاتعلق ہوتی ہے ۔
اکثر شوہر عورت کی اس فطرت سے لاعلم ہیں ۔ لہذا وہ بہت حیران ہوتے ہیں ۔ چنانچہ تینتالیس سالہ جمیل پوچھتا ہے ’’ عورت جنسی لمحات کو بذات خود اہم کیوں نہیں سمجھتی ؟ وہ ان کی قدر کیوں نہیں کرتی ؟ ان لمحوں سے لطف اٹھانے کے بجائے وہ پرانے لڑائی جھگڑے لے کر کیوں بیٹھ جاتی ہے ‘‘؟
جمیل کے سوال کا جواب سٹین ہال ہونیورسٹی کی ماہر سماجیات لائن ایٹواٹر نے دیاہے ۔ وہ لکھتی ہیں ’’ عورتیں زندگی کے تمام معاملات کو ایک دوسرے سے جڑا ہوا سمجھتی ہیں جبکہ مرد مختلف معاملات کو الگ تھلگ رکھتے ہیں ۔ ان کا خیال ہے کہ زندگی کی الجھنوں کو وقتی طورپر نظر انداز کرکے جنس کے مزے لیے جاسکتے ہیں‘‘ ۔
جنسی امور کی شہرہ آفاق ماہر ورجینا جانسن اپنے علم اور مہارت کی بنا پر دعوی کرتی ہیں ’’ جنسیت اور چاہت کو خانوں میں تقسیم نہیں کیاجاسکتا ۔بھرپور سیکس قربت اور چاہت کا تسلسل ہوتی ہے‘‘ ۔
یہ حقیقت بہت اہم ہے ۔ چنانچہ ماہرین اچھی ازدواجی زندگی کے لیے یہ مشورہ دیا کرتے ہیں کہ میاں بیوی جب سیکس پر آمادہ نہ ہوں تو بھی ان کو ایک دوسرے کے لیے چاہت کا اظہار کرتے رہنا چاہئے ۔ شوہر شام کو گھر لوٹتے ہوئے ، کسی وجہ کے بغیر ہی ، بیوی کے لیے گلدستہ یا کوئی اور تحفہ لے آئے،بچوں کو سیروتفریح کے لیے لے جائے تو اس قسم کی باتوں سے ان کی جنسی مسرتیں بڑھ جاتی ہیں۔ ان کی ازدواجی زندگی بہتر ہوجاتی ہے ۔
ناگوار امور کے بارے میں نرمی سے مگر صاف صاف بات کرنے سے بھی مدد مل سکتی ہے ۔ وکی نے ایسا ہی کیا تھا ۔ اس نے شوہر کو صاف صاف کہہ دیا تھا کہ بیڈ پر جانے سے پہلے وہ اس کی توجہ اور گفتگو کی آرزو کرتی ہے ۔
وکی نے ہمیں بتایا ’’ میری اس بات کا اچھا اثر ہوا ۔ اب ہم دونوں میں ایک نئی مفاہمت پیدا ہوچکی ہے ۔ بیڈ ٹائم سے پہلے ہم ایک گھنٹہ مل کر بیٹھتے ہیں ۔باتیں کرتے ہیں یا موسیقی سنتے ہیں ۔ اب ہم دونوں جنسی طورپر زیادہ مطمئن ہیں ۔
گفتگو اکثر عورتوں کے لیے محرک ہوتی ہے 
رات کے کھانے کے دوران یا کسی اور فرصت کے وقت اچھی گفتگو سیکس کے لیے موثر محرک ثابت ہوتی ہے ۔ ایک دوسرے سے کہے جانے والے چاہت بھرے الفاظ رفاقت کی خواہش کو بڑھاتے ہیں ۔
لائن ایٹواٹر کا ذکر پہلے کر چکے ہیں ۔ انہوں نے ایک اہم بات دریافت کی ۔
ایٹواٹر صاحبہ نے کئی عورتوں کے انٹرویو لئے جنہوں نے اپنے شوہروں کے علاوہ غیر مردوں سے جنسی تعلقات استوار کر رکھے تھے۔ ان عورتوں کے مفصل مطالعے سے ایٹواٹر نے یہ نتیجہ اخذ کیا کہ غیر مردوں سے جنسی تعلق رکھنے والی پچھتر فیصد عورتوں کو محض جنسی تسکین کے لیے غیروں کی ضرورت نہیں پڑتی ۔ وہ آزادانہ مکالمے کی طلب گار ہوتی ہیں ۔ وہ بھرپور رفاقت چاہتی ہیں ۔
لائن ایٹواٹر نے لکھا ہے ’’ میں نے جن عورتوں کا مطالعہ کیا ،ان میں سے ایک کو بخوبی علم تھا کہ اس کا آشنا نامرد ہے ۔ لیکن وہ لچھے دار باتیں کرنے کا فن جانتا تھا ۔ یوں اس کی صحبت میں اس عورت کو وہ کچھ مل جاتا تھا جو اس کا شوہر اس کو نہ دے سکتا تھا م یا دینے پرآمادہ نہ تھا‘‘۔
کیلی فورنیا یونیورسٹی کے سکول آف میڈیسن کی نفسیات دان لونی بارباخ نے اس بات کو آگے بڑھایا ہے ۔ وہ کہتی ہیں ’’ بہت سی عورتوں کے لیے سیکس سے زیادہ اہم بات یہ ہوتی ہے کہ ان کو چاہے جانے کا احساس دلایا جائے ۔ ان کے ساتھ باتیں کی جائیں ۔ خاص طور پر وہ عورتیں جو سارا دن گھریلو کام کاج اور بچوں کی دیکھ بھال میں مصروف رہتی ہیں ،وہ گفتگو کے لیے ترستی ہیں ۔ ان سے باتیں کی جائیں ، ان کی بات سنی جائے اور ان سے میٹھے بول کہے جائیں تو وہ خوشی سے پھولی نہیں سما تیں‘‘۔
میرے ایک بیالیس سالہ دوست امجد کو اس کا ذاتی تجربہ ہے ۔ دس سال پہلے اس کی شادی شبنم سے ہوئی تھی ۔ وہ کہتا ہے کہ شروع شروع میں محبت کا اظہار میرے بس کا روگ نہ تھا۔میں اس معاملے میں بہت شرمیلا اور نکما تھا ۔ لیکن ایک رات میں گہرا سانس لیا اور دل کی بات شبنم سے کہہ ڈالی ۔ میں نے اسے بتایا کہ مجھے اس سے گہری محبت ہے ۔ میرے لیے وہ دنیا کی حسین ترین عورت ہے ۔ میرے الفاظ سے وہ بہت متاثر ہوئی ۔اب میں گاہے بگاہے اپنے جذبوں کو الفاظ کا روپ دیتا رہتا ہوں ۔ اس طرح ہماری زندگی ہی بدل گئی ہے ۔ہم بہت خوش اور ایک دوسرے سے مطمئن ہیں‘‘۔
عورتوں کو بھی جنسی کارکردگی کی تشویش لاحق ہوتی ہے 
عورتوں کے جنسی رویوں کے بہت سے سائنسی مطالعے کیے گئے ہیں ۔ان کے نتیجے میں سامنے آنے والے حقائق میں سے ایک یہ ہے کہ صرف ساٹھ فیصد عورتیں ایسی ہیں کہ جتنی بار وہ جنسی فعل کرتی ہیں وہ انزال تک پہنچتی ہیں ۔اکثر عورتوں کو اپنے ساتھی یا خود اپنی طرف سے انزال کے لیے دباؤ ہوتا ہے ۔
اس موضوع کو اٹھاتے ہوئے ایک ماہر نفسیات نے لکھا ہے ’’ لوگ بھول جاتے ہیں کہ بسا اوقات محبوب کی رفاقت بذات خود لطف انگیز ہوتی ہے ۔اکثر مردوں کے نزدیک اچھا جنسی ساتھی وہ ہوتا ہے جو اپنی بیوی کو ڈرامائی جنسی تسکین سے ہمکنار کرتا ہے ۔بلاشبہ اس قسم کے لمحات زبردست ہوتے ہیں لیکن ہر بار ضروری نہیں ہوتے ‘‘۔
انزال کو مقصد بنا کر سیکس کرنے کا معاملہ ایسے ہی ہے جیسے ہم گردوپیش کے مناظر سے لطف اندوز ہونے کے بجائے منزل مقصود تک پہنچنے کے لیے اندھا دھند بھاگتے چلے جائیں ۔ سیکس کا مقصد باہمی رفاقت سے مسرت حاصل کرنا ہے ۔ اس کے سوا اور کچھ نہیں ۔ چنانچہ جو عورتیں یا مرد انزال کو ٹارگٹ بنا کر سیکس کرتے ہیں ، ان پرمنزل تک پہنچنے کی تشویش رہتی ہے ۔وہ سارا مزہ کرکرا کردیتی ہے۔
بہت سی عورتیں اپنی جسمانی کشش کے بارے میں تشویش میں مبتلا رہتی ہیں ۔ دو بچوں کی ماں انتالیس سالہ فریحہ کہتی ہیں ’’ شادی کے دس برسوں میں میرا وزن چھبیس پونڈ بڑھ گیا ہے ۔ میں پریشان رہتی ہوں کہ شاہد کہیں بددل نہ ہوجائیں‘‘ ۔
شوہر بیوی کو دلکشی اور چاہت کا احساس کس طرح دلا سکتا ہے ؟
اس کا سیدھا سا طریقہ یہ ہے کہ بناوٹ سے کام نہ لیا جائے ۔بیوی موٹی ہے تو اس کو پھول کی پنکھڑی سے تشبیہ دینے کی ضرورت نہیں ۔
ہاں اس میں جو بات اچھی لگتی ہے ،اس کی تعریف ضرور کریں ۔ بیوی کے ہاتھ خوبصورت لگتے ہیں تو یہ بات اس کو جتلاتے رہا کریں ۔آنکھیں پسند ہیں ،تو شرم کی کون سی بات ہے ۔ ان کی تعریف کردیں ۔
اس سلسلے میں ایک اور بات یہ ہے کہ بیڈ پر بہت سنجیدہ رویہ کوئی قابل تعریف معاملہ نہیں ۔ یہ ہنسنے کھیلنے کے لمحات ہیں ۔ان کو بوجھ نہ بنایا کریں ۔
سیکس کے بعد توجہ عورت کو تسکین دیتی ہے 
اکیس سال سے شادی شدہ چوالیس سالہ زبیدہ کو اب بھی گلہ ہے کہ جنسی فعل کے بعد وہ تنہائی محسوس کرتی ہے ’’ میرا میاں شب بخیر بھی کہے بغیر منہ موڑ کر خراٹے لینے لگتا ہے‘‘ ۔
اس قسم کی شکایتیں بہت سی عورتیں کرتی ہیں ۔ ان کو شوہروں کا یہ رویہ پسند نہیں ہوتا ۔ وہ چاہتی ہیں کہ سیکس کے بعد منہ پھیرنے کی بجائے شوہر ان پر توجہ مرکوز رکھے ۔ یہ ان کے لیے خوشی کا باعث ہوتا ہے ۔وہ چاہتی ہیں کہ شوہروں کو اس ضرورت کا علم ہو جائے ۔
جن عورتوں کے شوہر سیکس کے بعد بھی متوجہ رہتے ہیں ، وہ خاص قسم کی مسرت محسوس کرتی ہیں ۔ وہ توجہ طلب لمحات کو جنسی فعل کے بعد بھی جاری رکھنا چاہتی ہیں ۔لہذا بعد میں ان سے دو میٹھی باتیں ضرور کریں ۔ اور ہاں ان لمحوں میں کوئی غلط بات کہنے سے گریز کریں ۔ بارباخ کی تلقین یہ ہے ’’ شوہر کو اس وقت کوئی نکتہ چینی نہیں کرنی چاہئے‘‘ ۔


ایک تجربہ کار خاتون کا عورتوں کو مشورہ یہ ہے کہ ان کو بھی جنسی فعل کے بعد کے لمحات میں احتیاط سے گفتگو کرنی چاہئے ۔ اس خاتون نے اپنی ایک سہیلی کی حماقت کی مثال دیتے ہوئے کہا ’’ ایک بار بھرپور سیکس کے بعد اس نے اپنے شوہر سے کہا آج آخری تاریخ تھی تم نے سوئی گیس کا بل جمع کرا دیا تھا ۔‘‘ یہ برسوں پرانی بات ہے مگر ہم آج بھی اس پرہنسا کرتے ہیں ۔ اس قسم کی حماقتوں سے بہتر یہ ہے کہ میاں بیوی چند لمحوں کے لیے باقی دنیا کو فراموش کردیں ۔
عورتوں کو غیر جنسی چھیڑ چھاڑ بھی چاہئے 
بتیس سالہ شیلا  اپنے شوہر کی ایک  ہی شکایت کرتی ہے کہ وہ صرف اس وقت اس کو چھوتا ہے جب وہ سیکس پر آمادہ ہوتا ہے ’’ کبھی میرا دل چاہتا ہے کہ وہ محض چھیڑ چھاڑ میں مجھے چوم لے یا چھو ہی لے ۔ پتہ نہیں اس کے لیے یہ کام مشکل کیوں ہے ‘‘؟
شیلا کے شوہر کا کہنا ہے کہ چھونے سے جنسی جذبے بھڑک اٹھتے ہیں ۔لہذا وہ غیر ضروری لمحات میں اس سے گریز ہی کرتا ہے ۔
آئیے اس بارے میں ایٹواٹر صاحبہ سے پوچھتے ہیں ۔وہ کہتی ہیں کہ یہ رومانس غیر معمولی نہیں ۔ عورتیں رومانس چاہتی ہیں ۔یہ ان کی ذہنی ضرورت ہے۔ اس کو پورا کرنا چاہئے ‘‘۔
’’ میاں بیوی کا رشتہ زندگی کا اہم ترین تعلق ہے ۔ان کو باہمی رفاقت کے لمحوں کو باقی چیزوں پر ترجیح حاصل ہونی چاہئے ۔ قربت کا مطلب لازمی طورپر سیکس نہیں ہے ۔ اس کا مطلب ایک دوسرے کے جذبوں میں شراکت ہے ۔ دونوں کو اکٹھا گزارنے کے لیے وقت نکالنا چاہئے ۔ بھرپور زندگی کے لیے یہ معاملہ بہت ضروری ہے‘‘

11 ways to last longer in bed and extend your sex time naturally

How to increase sexual time?’,’How to last longer in bed naturally?’, ‘How to increase sex time?’ and  ‘How to increase sex period?’ are some of the most common questions people have. No we aren’t imagining these questions, people actually ask us these questions quite often on our forum.  While we are not entirely sure if people know how long is actually good enough for good sex, it is quite possible that porn has influenced the preponderance of this worry. But just to lay this fear to rest, not being able to last long enough in bed is not always premature ejaculation orerectile dysfunction. The demarcation is fairly simple — if you last for anything less than three minutes you should probably investigate the cause further. Here is a step-by-step guide to get your woman in mood for sex. 

That being said there are a few ways to help you last longer in bed naturally.

Eat more veggies and fruits: Studies have actually shown that men who are mostly vegetarian last much longer in bed than non-vegetarians. They have more stamina due to the nutrients they get from these fruits and veggies, especially potassium.Here are 11 things you should beware off, as they can kill your sex drive. 

a. Eating a banana just before sex could help improve your performance as it contains potassium. It also has a large amount of glucose that can help you last longer. Read more about health benefits of bananas.

b. Drinking amla or gooseberry juice everyday could help you last longer in bed and also improve sperm quality as it contains iron and zinc.

c. Eat a handful of strawberries before intercourse. Its high zinc content and glucose concentration can help you last longer.

Avoid processed sugar: The ‘sugar slump’ that comes after a ‘sugar rush’ could reduce your stamina.

Cut down on smoking: It hardens your arteries and lessens blood flow to the penis.  According to men’s health Physician and Medical Sex Therapist Dr Vijayasarathi Ramanathan, Smoking affects every system/organ of the body including sexual functioning. People need to understand that erection in men has a lot to do with a healthy heart, blood vessels. Smokers are twice as likely to get erectile dysfunction as non-smokers.’

Reduce alcohol intake: Alcohol has a bad effect on your senses and you are not ‘fully’ in the moment. So, exerting control is out of question, isn’t it?

Work on your arms and abdominal muscles: Most of the sexual positions require the man to be on his hands and feet. This means his core has to be very strong in order to last longer. So, working on biceps, triceps and abs at the gym or body-weight exercises at home can help. Exercise also improves blood flow in general including to the penis and this could also help. You may also like to read Revealed — men with bigger bellies last 5 minutes longer in bed than slim men.

Try Kegels or pelvic floor exercises:These exercises are mostly used for gaining better bladder control, but also help in maintaining erections for longer. Imagine you are urinating and then try to stop the flow. Repeat this – squeeze, hold, release cycle 10 times, trying to hold for 10 seconds per squeeze.

Try ‘edging’: When you are almost there (during intercourse or masturbation), stop all sexual activity. Distract yourself for a bit. This way you can gain better control and extend sex time.

Try the squeeze technique: When you are almost about to orgasm, squeeze just below the head of the penis. This pushes the blood back from the penis giving you more time.

Focus more on foreplay and your woman: Sometimes, trying to get her to orgasm first with either your fingers or your mouth could help relieve your stress and help maintain your erection longer. You may also like to read a man’s step-by-step guide to pleasuring his woman.

Get enough sleep: According to a research conducted by researchers from University of Chicago, men who got less than five hours of sleep at night had lower levels of testosterone. It is important that you get 7-8 hours of sleep to boost your sexual performance.

Try yoga: Certain yoga asanas like thecobra pose (bhujangasana),paschimotasana can increase blood flow to the genital area and increase the time you last in bed. You may also like to read about these yoga poses that can help you last longer in bed.

Have any doubts about how to last longer in bed and extend your sex time. Continue reading 11 ways to last longer in bed and extend your sex time naturally