22 THINGS TO AVOID IF YOU HAVE CHIARI MALFORMATION

1. Wear highly cushioned, support shoes to reduce neck, cerebellum pounding. Commercial cross-trainer sneakers are recommended – New Balance, Nike, Reebok etc.- test before buying.

2. Avoid neck-stressing activities (football, soccer, basketball, wave pools, diving, tennis, roller coasters, other amusement park rides of high G forces, lifting in excess of 15 lb, backpacking, falling asleep in chairs, extended reading with head bent etc.)

3. Get plenty of rest and sleep (eight hr minimum). Pillows and sleep position are very important. Soft, small pillows with fiberfill are very good for this i.e. little or no”push” back. (see expanded list below for other comments about pillows). Most Chiarians are side-sensitive. Use a large pillow(s) etc. to prevent rollover onto affected side. Elevate your bed at the head 4-6 inches by inserting old telephone books, bricks, boards or blocks under the front frame legs.  Have a strong relative or friend assist you.  If possible, do the same when staying at a hotel/motel or at the home of relatives.”  Stop eating and drinking three to four hours before bedtime to reduce the need to get up at night.

4. Avoid caffeine, alcohol, aspirin and/or high salt diet if tinnitus is a major symptom or any of these dietary items increase other symptoms.

5. Stay in excellent physical condition via walking, exercise bikes and other non-neck stressing activities – STAY LEAN

6. Sit in soft recliners with high backs and foot rests.

7. Support reading material with elbows on your knees/thighs or chair arms. Read “straight” ahead. Use book holders or music stands. Look at computer monitors straight ahead.

8. Drive if you have to but use wide vision mirrors and get seats with high backs. -Take your time and limit your driving to short distances at slow speed preferably during the day. Some Chiarians find orthopedic collars help reduce neck stress when riding in a car etc. Some do not.

9. Relax and avoid stress and noise. Don’t tighten the neck muscles. Stay “cool”.

10. Put soft cold compresses on the neck/ brain joint area or on the top of your head for about an hour while lying down (these are soft compresses). Some Chiarians prefer warm compresses.

11. Straining during bowel movements should be avoided. Eat plenty of roughage and eat at regular times. Drinking herbal tea containing senna may help give pain-free relief from constipation.

12. Heavy jewelry, scarves, ties, tight collars, bras, rings, bracelets and watches might feel uncomfortable. Adopt a casual life style and don’t wear them.

13. Try to avoid waiting in lines where stutter stepping is involved. Uneven surfaces or checkered designs in floors maybe difficult to walk on. Focusing on an object in front of your or closing one eye may help when dizziness hits.

14. Do crossword puzzles to assist short- term memory retention. Ditto for playing cards.

15. Take calcium supplements to assist in bone enhancement especially after surgery. Be very cautious using vitamins and supplements- most have not been thoroughly tested for primary and side effects. As always, check with your doctor first.

16. TENS machines may help ACM/SM patients, especially those with spasticity (cervical, thoracic, lumbar muscles) and spinal pain. TENS units also can help with headaches. You can buy one for use at home. As always, check with your doctor first.

17. Avoid cervical traction.

18. Lumbar punctures, spinal taps or epidurals can be dangerous for Chiarians. Always ask your doctor and insist they review the literature on these procedures with respect to increasing herniation.

19. Brushing teeth or gargling can result in sneezing. Minimize head motion during brushing and not bending the neck when gargling.

20. Avoid chiropractor adjustment. Most chiropractors have no experience in treating ACM’s. One member’s herniation significantly increased after cervical adjustment. “That is because the herniated went from 3-4 mm to 15-20 mm in 8 months with this treatment (documented on MRIs)”.

21. Review daily movements to include cooking and cleaning. Eliminate as much neck stress as possible.

22. Use the special tray that most beauty shops have for washing hair for people who cannot lean back on blunt sink rims. Chiarians should never lean back on the edges of sinks.

What Living With Idiopathic Hypersomnia Is Really Like

Sleep is my drug; I can’t live without it, I can’t get enough of it, and I crave it every second of every day. To the average person, I might just sound like your typical sleep-deprived college student surviving off of very little shut-eye and numerous shots of espresso. How can sleeping too much be a medical issue? Many times I have been reminded how “blessed” I am that I have no problems falling asleep or staying asleep. Sure, I’m not saying I don’t enjoy dozing off moments after my head hits the pillow, but sometimes I want to be able to fully experience the world beyond the dreams that conspire in my mind. How can I live when all my brain and my body want is to sleep?

It’s called Idiopathic Hypersomnia. I’m guessing you haven’t heard of it, and I don’t blame you for not knowing about such a rare disorder. Everyone seems to know what insomnia is, so when asked what my disorder means, I usually refer to it as the opposite of insomnia; instead of sleeping too little, I sleep too much. Idiopathic Hypersomnia (IH) is commonly defined as excessive daytime sleepiness. My brain is constantly telling me to sleep, but even after hours and hours of resting, I often feel more tired than I did before. On rare occasions, I will feel completely awake, and it is the most amazing feeling ever, something that the average person might take for granted.

Even though my symptoms were not fully apparent until my teenage years, I have always been a tired person. When I was a baby, my mom couldn’t even breastfeed me because I would fall asleep before she got the chance. Once I got older, my tiredness was easily mistaken for laziness, which is ironic because people with IH are the least lazy people that I know. We want so desperately to be able to do what everyone else does, but often times, we just physically and mentally are not capable of keeping up with the busy day-to-day life. I did not find out that I had IH until I had a sleep study done the middle of my senior year of high school. Before that time, my family, friends, and teachers didn’t understand why I would cancel plans, turn in homework late, or sleep all afternoon and still all through the night. Receiving a diagnosis was one of the best moments of my life. Some people might not understand why that is, but for me it was an answer to my problems, and in some ways, it was a solution as well.

Now that I have been diagnosed, I have been on a stimulant called Modafinil. Although it often takes away my appetite, for the most part, it does a decent job of keeping me awake. However, mornings are still the absolute worst. I love mornings, but I often miss them because I can’t will myself out of my bed. Because of this, I requested that my school let me sign up for classes early in order to ensure that I didn’t have any early morning classes. I don’t know if my school didn’t understand the depths of my disorder because they had never heard of it, but I was not welcomed with understanding. In fact, I was told that there was only so much that could be done for me without risking me jeopardizing the system. Well, if you have ever been in college, I’m sure you know that the system is already pretty messed up, but this was just another situation where I felt misunderstood and hopeless.

Sleepy is not a synonym for lazy. I often imagine my life without idiopathic hypersomnia. I think of all the things that I could accomplish, all the challenges that I wouldn’t have to face, and all the mornings that I would be awake for. After I am done feeling sorry for myself, I move on to think about all the things I have accomplished, all the lessons I have learned, and all the relationships I have built not only despite of IH, but also because of IH. All I ask for is understanding. I’m not making excuses, and I’m not being lazy, but I am still trying to just figure this all out. It might take a few (or a lot) of naps along the way, but someday, I hope to get my mornings back.

Source

Good Step by Punjab Govt

 

 

 

Punjab Food Authority (PFA) is fairly active these days. Other than banning certain food items in school canteens, the authority is also campaigning actively against food items which either cause harm or do not contain any nutritional value, especially for children.

In its most recent public awareness message, PFA informs that a recent government survey shows that 44 percent children in Pakistan suffer from lack of proper nutrition. In its campaign to inform parents about adequate diet and healthy food items for kids, PFA said that instant drinks are bad for growing children.

Instant drinks are those which come in powdered form and are mixed with water. According to PFA, Tang, Mixer Star, Sunsip Limupani, Fruitly and any other similar drinks are completely artificial.

Such drinks make use of artificial flavors and colors. One can only obtain calories from such food items as they lack “Original Fruit Content” and any other nutritional content.
The authority recommends that parents should avoid such drinks which have no nutritional value and instead choose fruit juices, flavored milk, milk shakes, etc. for better physical and mental health of their children
Continue reading Good Step by Punjab Govt

Foods to eat while in diabetes

When you think of managing blood sugar, odds are you obsess over everything you can’t have.While it’s certainly important to limit no-no ingredients (like white, refined breads and pastas and fried, fatty, processed foods), it’s just as crucial to pay attention to what you should eat. We suggest you start here. Numerous nutrition and diabetes experts singled out these power foods because 1) they’re packed with the four healthy nutrients (fiber, omega-3s, calcium, and vitamin D) that make up our Diabetes DTOUR Diet, and 2) they’re exceptionally versatile, so you can use them in recipes, as add-ons to meals, or stand-alone snacks.

Continue reading Foods to eat while in diabetes

Anal Canal Anatomy

The anal canal is the most terminal part of the lower GI tract/large intestine, which lies between the anal verge (anal orifice, anus) in the perineum below and the rectum above. The description in this topic is from below upwards, as that is how this region is usually examined in clinical practice. Images depicting the anal canal can be seen below. [1, 2]

Coronal section of rectum and anal canal. Coronal section of rectum and anal canal.
Coronal section through the anal canal. Coronal section through the anal canal.

The pigmented, keratinized perianal skin of the buttocks (around the anal verge) has skin appendages (eg, hair, sweat glands, sebaceous glands); compare this with the anal canal skin above the anal verge, which is also pigmented and keratinized but does not have skin appendages. [3, 4]

The demarcation between the rectum above and the anal canal below is the anorectal ring or anorectal flexure, where the puborectalis muscle forms a sling around the posterior aspect of the anorectal junction, kinking it anteriorly.

The anal canal is completely extraperitoneal. The length of the anal canal is about 4 cm (range, 3-5 cm), with two thirds of this being above the pectinate line (also known as the dentate line) and one third below the pectinate line.

The epithelium of the anal canal between the anal verge below and the pectinate line above is variously described as anal mucosa or anal skin. The author believes that it should be called anal skin (anoderm), as it looks like (pigmented) skin, is sensitive like skin (why a fissure-in-ano is very painful), and is keratinized (but does not have skin appendages).

The pectinate line is the site of transition of the proctodeum below and the postallantoic gut above. It is a scalloped demarcation formed by the anal valves (transverse folds of mucosa) at the inferior-most ends of the anal columns. Anal glands open above the anal valves into the anal sinuses. The pectinate line is not seen on inspection in clinical practice, but under anesthesia the anal canal descends down, and the pectinate line can be seen on slight retraction of the anal canal skin.

The anal canal just above the pectinate line for about 1-2 cm is called the anal pecten or transitional zone. Above this transitional zone, the anal canal is lined with columnar epithelium (which is insensitive to cutting). Anal columns (of Morgagni) are 6-10 longitudinal (vertical) mucosal folds in the upper part of the anal canal.

At the bottom of these columns are anal sinuses or crypts, into which open the anal glands and anal papillae. Infection of the anal glands is likely the initial event in causation of perianal abscess and fistula-in-ano. Three of these columns (left lateral, right posterior, and right anterior, at 3-, 7-, and 11-o’clock positions in supine position) are prominent; they are called anal cushions and contain branches and tributaries of superior rectal (hemorrhoidal) artery and vein. When prominent, veins in these cushions form the internal hemorrhoids.

The anorectal junction or anorectal ring is situated about 5 cm from the anus. At the anorectal flexure or angle, the anorectal junction is pulled anterosuperiorly by the puborectal sling to continue below as the anal canal.

Levator ani and coccygeus muscles form the pelvic diaphragm. Lateral to the anal canal are the pyramidal ischioanal (ischiorectal) fossae (1 on either side), below the pelvic diaphragm and above the perianal skin. The paired ischioanal fossae communicate with each other behind the anal canal. The anterior relations of the anal canal are, in males, the seminal vesicles, prostate, and urethra, and, in females, the cervix and vagina with perineal body in between. In front of (anterior to) the anal canal is the rectovesical fascia (of Denonvilliers), and behind (posterior) is the presacral endopelvic fascia (of Waldeyer), under which lie a rich presacral plexus of veins. Posterior to the anal canal lie the tip of the coccyx (joined to it by the anococcygeal ligament) and lower sacrum.

The anal canal is surrounded by several perianal spaces: subcutaneous, submucosal, intersphincteric, ischioanal (rectal) and pelvirectal.

Blood supply and lymphatics

The anal canal above the pectinate line is supplied by the terminal branches of the superior rectal (hemorrhoidal) artery, which is the terminal branch of the inferior mesenteric artery. The middle rectal artery (a branch of the internal iliac artery) and the inferior rectal artery (a branch of the internal pudendal artery) supply the lower anal canal.

Beneath the anal canal skin (below the pectinate line) lies the external hemorrhoidal plexus of veins, which drains into systemic veins. Beneath the anal canal mucosa (above the pectinate line) lies the internal hemorrhoidal plexus of veins, which drains into the portal system of veins. The anal canal is, therefore, an important area of portosystemic venous connection (the other being the esophagogastric junction). Lymphatics from the anal canal drain into the superficial inguinal group of lymph nodes.

Physiology

Anorectal sphincter tone can be assessed during digital rectal examination (DRE) when the patient is asked to squeeze the examining finger. Anorectal manometry measures the pressures: resting and squeezing.

Embryology

The anal canal below the pectinate line develops from the proctodeum (ectoderm), while that above the pectinate line develops from the endoderm of the hindgut.

10 Images That Prove Lahore Lahore Ae!

Lahore is Pakistan’s second largest city, the capital of Punjab and probably one with the most history. There are also tons of cultural landmarks and other historical places that the city has to offer.

If you are traveling to Lahore and want to get to know which are the must-visit tourist attractions in the city, then you’ve come to the right place.

Let’s take a look at some of the photos that makes you go “Lahore Lahore ae!”

1. Fountains of Grand Bahria Mosque

2. Badshahi Mosque

3. Eiffel Tower, Bahria Town

4. Lahore Food Street

5. Lahore Fort

6. Minar-e-Pakistan

7. Liberty Roundabout

8. Masjid Wazir Khan

9. Jail Road

10. Canal Road

Did we miss out on some of the most picturesque Lahori attractions? Let us know in the comments below!

What Is Cystic Fibrosis?

Cystic fibrosis is a serious genetic condition that causes severe damage to the respiratory and digestive systems. This damage often results from a buildup of thick, sticky mucus in the organs. The most commonly affected organs include the:

Image result for cystic fibrosis control

  • lungs
  • pancreas
  • liver
  • intestines

Cystic fibrosis affects the cells that produce sweat, mucus, and digestive enzymes. Normally, these secreted fluids are thin and smooth like olive oil. They lubricate various organs and tissues, preventing them from getting too dry or infected. In people with cystic fibrosis, however, a faulty gene causes the fluids to become thick and sticky. Instead of acting as a lubricant, the fluids clog the ducts, tubes, and passageways in the body. This can lead to life-threatening problems, including infections, respiratory failure, and malnutrition. It’s critical to get treatment for cystic fibrosis right away. Early diagnosis and treatment are critical for improving quality of life and lengthening the expected lifespan.

Approximately 1,000 people are diagnosed with cystic fibrosis every year in the United States. Although people with the condition require daily care, they can still lead a relatively normal life and work or attend school. Screening tests and treatment methods have improved in recent years, so many people with cystic fibrosis can now live into their 40s and 50s.

What Are the Symptoms of Cystic Fibrosis?

The symptoms of cystic fibrosis can vary depending on the person and the severity of the condition. The age at which symptoms develop can also differ. Symptoms may appear at infancy, but for other children, symptoms may not begin until after puberty or even later in life. As time passes, the symptoms associated with the disease may get better or worse.

One of the first signs of cystic fibrosis is a strong salty taste to the skin. Parents of children with cystic fibrosis have mentioned tasting this saltiness when kissing their children.

Other symptoms of cystic fibrosis result from complications that affect:

  • the lungs
  • the pancreas
    • the liver
    • other glandular organs

    Respiratory Problems

    The thick, sticky mucus associated with cystic fibrosis often blocks the passageways that carry air into and out of the lungs. This can cause the following symptoms:

    • wheezing
    • a persistent cough that produces thick mucus or phlegm
    • shortness of breath, especially when exercising
    • recurrent lung infections
    • a stuffy nose
    • stuffy sinuses

    Digestive Problems

    The abnormal mucus can also plug up the channels that carry the enzymes produced by the pancreas to the small intestine. Without these digestive enzymes, the intestine can’t absorb the necessary nutrients from food. This can result in:

    • greasy, foul-smelling stools
    • constipation
    • nausea
    • a swollen abdomen
    • loss of appetite
    • poor weight gain in children
    • delayed growth in children

    Part 3 of 8

    What Causes Cystic Fibrosis?

    Cystic fibrosis occurs as a result of a defect in what’s called the “cystic fibrosis transmembrane conductance regulator” gene, or CFTR gene. This gene controls the movement of water and salt in and out of your body’s cells. A sudden mutation, or change, in the CFTR gene causes your mucus to become thicker and stickier than it’s supposed to be. This abnormal mucus builds up in various organs throughout the body, including the:

    • intestines
    • pancreas
    • liver
    • lungs

    It also increases the amount of salt in your sweat.

    Many different defects can affect the CFTR gene. The type of defect is associated with the severity of cystic fibrosis. The damaged gene is passed

Claire King reveals her daily battle with arthritis

Claire King doesn’t look like your typical arthritis sufferer but the former Emmerdale star faces a daily battle to cope with the painful condition.

And as she gets older she admits she’s becoming more worried about the future and the possibility she may face major surgery one day.

But she’s determined it won’t stop her living life to the full at the moment.

“I worry about my health deteriorating. It scares me,” Claire says.

“It feels like my whole body is falling apart. I have elderly parents and they’ve got problems too, so I want to be around to help them.

“I don’t want to be a helpless old woman who can’t do anything for anyone because all my joints are falling apart.

“That’s what motivates me to look after my health.”

She first realised something was wrong when she woke up up to a throbbing pain in her fingers, three days in a row.

Her GP diagnosed rheumatoid arthritis – an auto-immune disease that causes inflammation in the joints.

Claire, 46, best known for playing superbitch Kim Tate in Emmerdale and Karen Betts in Bad Girls, says the constant pain affected her entire life.

She said: “I was diagnosed about 13 years ago, not long after I joined Emmerdale.

“I had started getting really bad aches in my hands, feet and knees – it felt like I had been hit with a hammer.

“My doctor put me on a course of medication and gave me some advice about helpful things to try to ease the pain.

“But for a while it just carried on getting worse.

“I would get up in the morning and be hobbling like an old woman because my joints hurt so much.

“I struggled to go to work and to do the things I love, like horse-riding, because of the pressure it put on my knees.”

Rheumatoid arthritis affects one in a hundred adults in the UK and progresses differently, depending on how aggressive the condition is. In the worst cases, it seriously damages your ability to carry out everyday tasks and leaves you dependent on others.

There is cure for the condition at present but it can be managed with drugs and some simple lifestyle changes.

Claire says finding the right treatment has allowed her to live a normal life – even competing with Brendan Cole in Strictly Come Dancing three years ago.

“The medication I was prescribed after my diagnosis wasn’t very effective and after a few months I was still in a very bad way.

“My doctor suggested I try some natural products: Hellenia’s MSM tablets, Celadrin tablets and joint relief cream. They were fantastic – particularly the cream, which relieves the pain in about half an hour.

“It was great, because I could use them when I was really struggling and everything became much more manageable.

“Strictly Come Dancing was at times quite a painful experience but I really wanted to do it, and I did, with painkillers and bandages on my feet.”

Partnered with ballroom bad-boy Brendan, Claire became the ninth celebrity to leave – the longest an over 40 female contestant has ever lasted.

“I wanted to do Strictly to prove to myself and other people I could do it.

“My doctor warned me to pull out if I had any problems, but luckily it never got to that stage.

“My feet did get quite bad, but I looked after myself with lots of hot baths and foot spa treatments, so I could keep going –

though those stilettos were absolute killers.

“The thing that really annoyed me was after I mentioned my arthritis on screen, lots of people wrote online that I only said it for the sympathy vote. That made me really angry – how would they know what it’s like?”

After her stint on Strictly, Claire took her new, toned curves a step further, producing a fitness DVD aimed at older women – the Ultimate Body Workout.

The exercise has helped her arthritis.

She says: “I did the DVD because all of the ones already out seemed to be from 20-year-olds doing disco moves to lose weight.

“I wanted to bring one out for women aged 30 and over who wanted to tone up rather than drop a dress size.

“And I still do it all the time, despite my arthritis, because it helps to exercise, as long as you don’t overdo it.”

While there are several ways for people with rheumatoid arthritis to limit the damage it causes, sufferers need to look after themselves well to make sure their condition does not deteriorate.

Claire says: “I can still go horse-riding and exercise – if I can do Strictly I can probably do most things.

“And even though my feet are sometimes painful, I can still wear stilettos.

“I just buy a bigger size and put in padding.”

What is it?

Rheumatoid arthritis is an auto-immune disease that causes inflammation of the joints – leading to painful aches and stiffness.

While the causes are not known, possible culprits include infections or viruses, diet or injury.

Symptoms can occur at any age, though they are most common in adults between 40 and 60.

Women are three times more likely to be affected than men.

While there is no cure for the disease, it can be treated effectively, allowing sufferers to live normal lives. But for this to happen, the condition must be diagnosed early.

Director of Operations at the National Rheumatoid Arthritis Society, Lynn Love said: “People often mistake their symptoms for general tiredness, or aches and pains.

“They will feel very tired and experience stiffness in their joints in the morning, but think it is normal.

“I would encourage anyone with these symptoms to go to their GP – the sooner the condition is diagnosed the better.”

What you can do

MEDICINE

When you are diagnosed, your doctor should refer you to a rheumatologist, who will prescribe a course of drugs. You can also try natural remedies such as Hellenia Joint Synergy tablets and cream.

DIET

Try to stick to a heathy diet with plenty of vegetables.

Steer clear of caffeine and alcohol and reduce your salt intake. Also avoid as much processed food as possible.

EXERCISE

A little exercise is healthy as long as you don’t overdo it. Try to do some light activities to keep you moving. If you’re not sure about fast-paced exercise try something more relaxing, like yoga.