Evaluating and understanding how Effective is your Weight-loss Plans

Effectiveness of Four Weight-loss Plans
The very low carbohydrate diet known as the Atkins diet may contribute to greater weight loss than higher carbohydrate plans without negative effects such as increased cholesterol. Christopher Gardner, Ph.D., and colleagues at Stanford University conducted an NCCAM-funded study of 311 pre-menopausal women, all of whom were overweight or obese. Each woman was randomly assigned to one of four diets. Each of the diets used were selected for their different levels of carbohydrate consumption.

The Atkins diet is very low in carbohydrate consumption: less than 20 grams of carbohydrates per day and increasing to 50 grams per day.
The Zone diet is designed so that a person's daily calorie consumption is comprised of 40 percent carbohydrates, 30 percent protein, and 30 percent fat.
The LEARN diet (Lifestyle, Exercise, Attitudes, Relationships, and Nutrition) instructs participants to get 55 to 60 percent of their calories from carbohydrates, and not more than 10 percent from saturated fat. This diet is based on the USDA food pyramid.
The Ornish diet's primary guideline states that participants should not get more than 10 percent of their calories from fat.

Participants in each group received books that accompanied their assigned diet plan, and attended hour-long classes with a registered dietitian once a week for the first 8 weeks. Data on the participants was collected at the beginning of the study, and at 2, 6, and 12 months. The researchers recorded body mass index (BMI); percent body fat; waist-hip ratio; as well as metabolic measures such as, insulin, cholesterol, glucose, triglyceride, and blood pressure levels.

The Atkins diet group reported the most weight loss at 12 months with an average loss of 4.7 kilograms, or just over 10 pounds. They also had more favorable overall metabolic effects. Average weight loss across all four groups ranged from 3.5 to 10.4 pounds. The authors note that "even modest reductions in excess weight have clinically significant effects on risk factors such as triglycerides and blood pressure." here is a website which contains best weight loss tips for overweight individuals

Acupuncture treatment for Pain

Physical pain is a common occurrence for plenty of Americans; in fact, a national survey found that over one-quarter of U.S. adults had recently experienced some sort of pain lasting over a day. In addition to conventional treatments, such as over-the-counter pharmaceuticals & prescription medications , people may try acupuncture treatment in an effort to relieve pain. This fact sheet provides basic information about pain & acupuncture, summarizes scientific research on acupuncture for specific kinds of pain, & suggests sources for additional information.

People use acupuncture treatment for various types of pain. Back pain is the most commonly reported use, followed by joint pain, neck pain, & headache.

Acupuncture treatment is being studied for its efficacy in alleviating plenty of kinds of pain. There's promising findings in some conditions, such as chronic low-back pain & osteoarthritis of the knee; but, for most other conditions, additional research is needed.

Acupuncture treatment is generally considered safe when performed correctly.

In traditional Chinese medicine theory, acupuncture treatment regulates the flow of qi (vital energy) through the body. Research to check scientific theories about how acupuncture might work to relieve pain is under way.

Tell all your health care providers about any complementary & alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated & safe care. For tips about talking with your health care providers about complementary & alternative medicine
About Pain

Pain is a feeling triggered in the nervous system. It may be sharp or dull, off-and-on or steady, localized (such as back pain) or all over (such as muscle aches from the flu). Sometimes, pain alerts us to injuries & illnesses that need attention. Although pain usually goes away four times the underlying problem is addressed, it can last for weeks, months, or even years. Chronic pain may be due to an ongoing condition (such as arthritis) or to abnormal activity in pain-sensing regions of the brain, or the cause may not be known.

To relieve their pain, plenty of people take over-the-counter medications—either acetaminophen or nonsteroidal anti-inflammatory drugs and pharmaceuticals (NSAIDs, including aspirin, naproxen, & ibuprofen). Stronger medications, including NSAIDs in higher dosages & narcotics, are available by prescription only. People may also try non-drug approaches to help relieve their pain. Examples include physical & occupational therapy, cognitive behavioral therapy, self-care techniques, & therapies such as spinal manipulation or acupuncture treatment .
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Use of Acupuncture for Pain

In the 2007 National Health Interview Survey (NHIS), 1.4 percent of respondents (representing 3.1 million Americans) said they had used acupuncture in the past year. A special analysis of acupuncture data from an earlier NHIS found that pain or musculoskeletal complaints accounted for 7 of the top 10 conditions for which people use acupuncture. Back pain was the most common, followed by joint pain, neck pain, severe headache/migraine, & recurring pain.

What the Science Says About Acupuncture for Pain

Acupuncture treatment, among the oldest healing practices in the world, is part of traditional Chinese medicine. Acupuncture practitioners stimulate specific points on the body—most often by inserting narrow needles through the skin. In traditional Chinese medicine theory, this regulates the flow of qi (vital energy) along pathways known as meridians.

Acupuncture treatment has been studied for a wide range of pain conditions, such as postoperative dental pain, carpal tunnel syndrome, fibromyalgia, headache, low-back pain, menstrual cramps, myofascial pain, osteoarthritis, & tennis elbow.

Overall, it can be difficult to compare acupuncture research results from study to study & to draw conclusions from the cumulative body of evidence. This is because studies may use different acupuncture techniques (e.g., electrical vs. manual), controls (comparison groups), & outcome measures.

Four complex factor in acupuncture research is choosing the controls for a clinical trial. The choice depends in part on whether the researchers need to study a particular aspect of acupuncture (e.g., effects on the brain) or to decide whether acupuncture is useful compared with other forms of care. Examples of control groups include study participants who get no acupuncture, simulated acupuncture (procedures that mimic acupuncture, sometimes also referred to as "placebo" or "sham"), or other treatments (in addition to or in place of acupuncture or simulated acupuncture).

An emerging theme in acupuncture research is the role of the placebo. For example, a 2009 systematic review of research on the pain-relieving effects of acupuncture compared with placebo (simulated) or no acupuncture was inconclusive. The reviewers found a tiny difference between acupuncture & placebo & a moderate difference between placebo & no acupuncture; the effect of placebo acupuncture varied considerably, & the effect of acupuncture appeared unrelated to the specific kind of placebo procedure used. All of the study participants received standard care, typically consisting of analgesic drugs & physical therapy.
* Carpal tunnel syndrome—Although a 1997 NIH consensus statement on acupuncture concluded that acupuncture was promising for carpal tunnel syndrome, additional research confirming acupuncture's efficacy for this condition is scant.
* Fibromyalgia—Evidence on acupuncture for fibromyalgia is mixed. Some reviews of the scientific literature have found the evidence promising. However, another review that focused on the few rigorous randomized controlled trials on acupuncture as an adjunct therapy for fibromyalgia did not find a benefit. Additionally, a 2003 assessment by the Agency for Healthcare Research & Quality concluded that the evidence was insufficient & the beneficial effects of acupuncture for fibromyalgia could not be determined.
* Headache/migraine—Study results on acupuncture for headache are conflicting. Some literature reviews found evidence to support the use of acupuncture for headache, but others noted that most of the studies were of poor quality. A 2008 review of randomized trials on acupuncture highlighted a few well-designed trials whose findings indicate that acupuncture reduces migraine symptoms & is as effective as headache medications. In addition, a 2009 review found that acupuncture may help relieve tension headaches. However, four large trials that looked at acupuncture for migraines found no difference between actual & simulated acupuncture, both of which were equal to conventional care or superior to no treatment.
* Low-back pain—According to clinical practice guidelines issued by the American Pain Society & the American College of Physicians in 2007, acupuncture is four of several therapies physicians should consider when patients with chronic low-back pain do not respond to conventional treatment. In early, tiny studies, combining actual acupuncture with conventional treatment was more effective than conventional treatment alone for relieving chronic low-back pain; but actual acupuncture was not more effective than simulated acupuncture or conventional treatment. However, a large, rigorously designed clinical trial reported in May 2009 found that actual acupuncture & simulated acupuncture were equally effective—and both were more effective than conventional treatment—for relieving chronic low-back pain. There is insufficient evidence to draw definite conclusions about the effectiveness of acupuncture for acute low-back pain.
* Menstrual cramps—Two literature reviews have suggested that acupuncture may help with pain from menstrual cramps, but the research is limited.
* Myofascial pain—The evidence for acupuncture & myofascial pain (in which pain occurs in sensitive areas, known as trigger points, in the muscles) is mixed. Some literature reviews have found the evidence promising, but another review indicated that "needling therapies" for myofascial trigger point pain were not more effective than placebo.
* Neck pain—Studies of acupuncture for chronic neck pain have found that acupuncture provided better pain relief than some simulated treatments. However, the studies varied in terms of design & most had tiny sample sizes.
* Osteoarthritis/knee pain—Acupuncture appears to be effective for osteoarthritis, in the area of knee pain. Recent literature reviews have found that acupuncture provides pain relief & improves function for people with osteoarthritis of the knee. However, authors of a 2007 systematic literature review suggested that although some large, high-quality trials have shown that acupuncture may be effective for osteoarthritis of the knee, differences in the design, size, & protocol of the studies make it hard to draw any definite conclusions from the body of research. These authors concluded that it is soon to recommend acupuncture as a system part of care for patients with osteoarthritis.
* Postoperative dental pain—Although recent data on acupuncture for postoperative dental pain are scant, literature reviews based on earlier evidence have identified acupuncture as a promising treatment for dental pain—especially pain following tooth extraction. For example, a 1999 study of 39 dental surgery patients found that acupuncture was superior to placebo (simulated acupuncture) in preventing postoperative pain. However, a 2005 study of 200 dental surgery patients found no significant analgesic effect for acupuncture compared to simulated acupuncture, although patients who believed they received acupuncture reported significantly less pain than those who believed they received a placebo.
* Tennis elbow—Study results on the use of acupuncture for tennis elbow (lateral epicondyle) pain are mixed. An early review of clinical trials reported that data on acupuncture for lateral epicondyle pain were insufficient & of poor quality; however, recent reviews have found the evidence promising, noting strong evidence that acupuncture provides short-term pain relief for lateral epicondyle pain.

There is evidence that people's attitudes about acupuncture can affect outcomes. In a 2007 study, researchers analyzed data from four clinical trials of acupuncture for various types of chronic pain. Participants had been asked whether they expected acupuncture to help their pain. In all four trials, those with positive expectations reported significantly greater pain relief.

Acupuncture treatment has also been studied for a variety of other pain conditions, including arm & shoulder pain, pregnancy-related pelvic & back pain, & temporomandibular joint (jaw) dysfunction. Although some studies have produced some positive results, more evidence is needed to decide the efficacy of acupuncture for any of these conditions.

In addition to studying acupuncture's efficacy, researchers are looking at potential biomechanisms—that is, how acupuncture might work to relieve pain. There's several theories about these biomechanisms (e.g., acupuncture activates opioid systems in the brain that respond to pain); additional research is still needed to check the theories. Researchers are using neuroimaging techniques such as functional magnetic resonance imaging (fMRI) to look at the effects of acupuncture on various regions of the brain.
Side Effects & Risks

Acupuncture treatment is generally considered safe when performed by an experienced practitioner using sterile needles. Relatively few complications from acupuncture have been reported. Serious adverse events related to acupuncture are rare, but include infections & punctured organs. Additionally, there's fewer adverse effects associated with acupuncture than with plenty of standard drug treatments (such as anti-inflammatory medication & steroid injections) used to manage painful musculoskeletal conditions like fibromyalgia, myofascial pain, osteoarthritis, & tennis elbow.
vious year. Between the 2002 & 2007 NHIS, acupuncture treatment use among adults increased by three-tenths of 1 percent (approximately 1 million people).
Acupuncture Side Effects & Risks

Relatively few complications from the use of acupuncture have been reported to the FDA, in light of the millions of people treated each year & the number of acupuncture needles used. Still, complications have resulted from inadequate sterilization of needles & from improper delivery of treatments. Practitioners should use a new set of disposable needles taken from a sealed package for each patient & should swab treatment sites with alcohol or another disinfectant before inserting needles. When not delivered properly, acupuncture can cause serious adverse effects, including infections & punctured organs.
Status of Acupuncture Research

The U.S. Food & Drug Administration (FDA) regulates acupuncture needles for use by licensed practitioners, requiring that needles be manufactured & labelled according to definite standards of pharmaceuticals. For example, the FDA requires that needles be sterile, nontoxic, & labelled for single use by qualified practitioners only.

There's been plenty of studies on acupuncture's potential health benefits for a wide range of conditions. Summarizing earlier research, the 1997 NIH Consensus Statement on Acupuncture found that, overall, results were hard to interpret because of problems with the size & design of the studies.
Some recent studies have looked at:
* Whether acupuncture works for specific health conditions such as chronic low-back pain, headache, & osteoarthritis of the knee
* How acupuncture might work, such as what happens in the brain during acupuncture treatment
* Ways to better identify & understand the potential neurological properties of meridians & acupuncture points
* Methods & instruments for improving the quality of acupuncture research
Finding a Qualified Practitioner

Health care providers can be a resource for referral to acupuncturists, & some conventional medical practitioners—including physicians & dentists—practice acupuncture. In addition, national acupuncture organizations (which can be found through libraries or Web search engines) may provide referrals to acupuncturists.

* Check a practitioner's credentials. Most states need a license to practice acupuncture; however, education & training standards & requirements for obtaining a license to practice vary from state to state. Although a license does not ensure quality of care, it does indicate that the practitioner meets definite standards regarding the knowledge & use of acupuncture.
* Do not rely on a diagnosis of disease by an acupuncture practitioner who does not have substantial conventional medicine
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Acupuncture a detailed information about Acupuncture , what you should know about Acupuncture and before taking Acupuncture treatment

Acupuncture a detailed information about Acupuncture , what you should know about Acupuncture and before taking Acupuncture treatment
Acupuncture is among the oldest healing practices in the world. As part of traditional Chinese medicineA whole medical system that originated in China. It is based on the concept that disease results from disruption in the flow of qi and imbalance in the forces of yin and yang. Practices such as herbs, meditation, massage, and acupuncture seek to aid healing by restoring the yin-yang balance and the flow of qi (TCM), acupunctureA family of procedures that originated in traditional Chinese medicine. Acupuncture is the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles though the skin. It is intended to remove blockages in the flow of qi and restore and maintain health. aims to restore and maintain health through the stimulation of specific points on the body. In the United States, where practitioners incorporate healing traditions from China, Japan, Korea, and other countries, acupuncture is considered part of complementary and alternative medicine
* Acupuncture has been practiced in China and other Asian countries for thousands of years.
* Scientists are studying the efficacy of acupuncture for a wide range of conditions.
* Relatively few complications have been reported from the use of acupuncture. However, acupuncture can cause potentially serious side effects if not delivered properly by a qualified practitioner.
* Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
bout Acupuncture

The term "acupuncture" describes a family of procedures involving the stimulation of anatomical points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

Practiced in China and other Asian countries for thousands of years, acupuncture is one of the key components of traditional Chinese medicine. In TCM, the body is seen as a delicate balance of two opposing and inseparable forces: yin and yangThe concept of two opposing yet complementary forces described in traditional Chinese medicine. Yin represents cold, slow, or passive aspects of the person, while yang represents hot, excited, or active aspects. A major theory is that health is achieved through balancing yin and yang and disease is caused by an imbalance leading to a blockage in the flow of qi.. Yin represents the cold, slow, or passive principle, while yang represents the hot, excited, or active principle. According to TCM, health is achieved by maintaining the body in a "balanced state"; disease is due to an internal imbalance of yin and yang. This imbalance leads to blockage in the flow of qiIn traditional Chinese medicine, the vital energy or life force proposed to regulate a person's spiritual, emotional, mental, and physical health and to be influenced by the opposing forces of yin and yang. (vital energy) along pathways known as meridians. Qi can be unblocked, according to TCM, by using acupuncture at certain points on the body that connect with these meridians. Sources vary on the number of meridians, with numbers ranging from 14 to 20. One commonly cited source describes meridians as 14 main channels "connecting the body in a weblike interconnecting matrix" of at least 2,000 acupuncture points.

Acupuncture became better known in the United States in 1971, when New York Times reporter James Reston wrote about how doctors in China used needles to ease his pain after surgery. American practices of acupuncture incorporate medical traditions from China, Japan, Korea, and other countries.
Acupuncture Use in the United States

The report from a Consensus Development Conference on Acupuncture held at the National Institutes of Health (NIH) in 1997 stated that acupuncture is being "widely" practiced—by thousands of physicians, dentists, acupuncturists, and other practitioners—for relief or prevention of pain and for various other health conditions. According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, an estimated 3.1 million U.S. adults and 150,000 children had used acupuncture in the previous year. Between the 2002 and 2007 NHIS, acupuncture use among adults increased by three-tenths of 1 percent (approximately 1 million people).
Acupuncture Side Effects and Risks

The U.S. Food and Drug Administration (FDA) regulates acupuncture needles for use by licensed practitioners, requiring that needles be manufactured and labeled according to certain standards. For example, the FDA requires that needles be sterile, nontoxic, and labeled for single use by qualified practitioners only.

Relatively few complications from the use of acupuncture have been reported to the FDA, in light of the millions of people treated each year and the number of acupuncture needles used. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments. Practitioners should use a new set of disposable needles taken from a sealed package for each patient and should swab treatment sites with alcohol or another disinfectant before inserting needles. When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.
Status of Acupuncture Research

There have been many studies on acupuncture's potential health benefits for a wide range of conditions. Summarizing earlier research, the 1997 NIH Consensus Statement on Acupuncture found that, overall, results were hard to interpret because of problems with the size and design of the studies.
Some recent studies have looked at:
* Whether acupuncture works for specific health conditions such as chronic low-back pain, headache, and osteoarthritis of the knee
* How acupuncture might work, such as what happens in the brain during acupuncture treatment
* Ways to better identify and understand the potential neurological properties of meridians and acupuncture points
* Methods and instruments for improving the quality of acupuncture research
Finding a Qualified Practitioner

Health care providers can be a resource for referral to acupuncturists, and some conventional medical practitioners—including physicians and dentists—practice acupuncture. In addition, national acupuncture organizations (which can be found through libraries or Web search engines) may provide referrals to acupuncturists.

* Check a practitioner's credentials. Most states require a license to practice acupuncture; however, education and training standards and requirements for obtaining a license to practice vary from state to state. Although a license does not ensure quality of care, it does indicate that the practitioner meets certain standards regarding the knowledge and use of acupuncture.
* Do not rely on a diagnosis of disease by an acupuncture practitioner who does not have substantial conventional medical training. If you have received a diagnosis from a doctor, you may wish to ask your doctor whether acupuncture might help.
What To Expect from Acupuncture Visits

During your first office visit, the practitioner may ask you at length about your health condition, lifestyle, and behavior. The practitioner will want to obtain a complete picture of your treatment needs and behaviors that may contribute to your condition. Inform the acupuncturist about all treatments or medications you are taking and all medical conditions you have.

Acupuncture needles are metallic, solid, and hair-thin. People experience acupuncture differently, but most feel no or minimal pain as the needles are inserted. Some people feel energized by treatment, while others feel relaxed. Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment. This is why it is important to seek treatment from a qualified acupuncture practitioner.

Treatment may take place over a period of several weeks or more. weight loss tips for obese
Treatment Costs

Ask the practitioner about the estimated number of treatments needed and how much each treatment will cost. Some insurance companies may cover the costs of acupuncture, while others may not. It is important to check with your insurer before you start treatment to see whether acupuncture is covered for your condition and, if so, to what extent.

Breast Self-Examination (BSE)

All women over 20 years of age should practice monthly breast self-examination (BSE). Regular and complete Breast Self-Examination can help you find changes in your breast that occur between clinical breast examinations (by a health professional) and mammogram.

Women should examine their breasts when they are least tender, usually seven days after the start of the menstrual period. Women who have entered menopause, are pregnant or breast feeding and women who have silicone implants, should continue to examine their breasts once a month. Breast feeding mothers should examine their breasts when all milk has been expressed.

If women discovers a lump or detects any changes, she should seek medical attention. Most women will not develop breast cancer and most breast changes are not cancerous.

Remember the seven P’s for a complete Breast Self-Examination:

1. Position
2. Perimeter
3. Palpation
4. Pressure
5. Pattern
6. Practice with Feedback
7. Plan of Action


1. POSITIONS

VISSUAL Inspection: Standing

In each position, look for changes in contour and shape of the breast, colour and texture from the nipples.

Palpation: Side-lying & Fat

Use your left hand to palpate the right breast, while holding your right arm at a right angle to the rib cage, with the elbow bent. Repeat the procedure on the other side. The side-lying position allows a women, especially one with the large breasts, to most effectively examine the outer half of the breast. A women with small breasts may need only the flat position.

Side–lying position:

Lie on the opposite side of the breast to be examined. Rotate the shoulder (on the same side as the breast to be examined) back to the flat surface.

Flat position:

Lie flat on your back with a pillow or folded towel under the shoulder of the breast to be examined.

2. PERITER

The examination area is bounded by a line which extends down from the middle of the armpit to just beneath the breast, continues across the bone, then moves up to and along the collar bone and back to the middle of the armpit. Most breast cancers occur in the upper outer area of the breast (shaded area below).

3. PALPATION WITH PADS OF THE FINGERS

Use the pads of three or four fingers to examine every inch of your breast tissue. Move your fingers in circles about the size of a coin.
Do not lift your fingers from your breast between palpations. You can use powder or lotion to help your fingers glide from one spot to the next.

4. PRESSURE

Use varying levels of pressure for each palpation, from light to deep, to examine the full thickness of your breast tissue. Using pressure will not injure the breast.

5. PATTERN OF SEARCH

Use one of the following search patterns to examine all your breast tissue. Palpate carefully examined from end to end. Women who have had any breast surgery should examine the entire area and the incision.

Vertical Strip:

Start in the armpit; proceed downwards to the lower boundary. Move a finger’s width towards the middle and continue palpating upward until you reach the collar bone. Repeat this until you have covered all breast the nipple and four strips after the nipple. You may need between 10 and 16 strips.
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Wedge:

Imagine your breast divided like the spokes of a wheel. Examine each separate segments, moving from the outside boundary, move over a finger’s width and repeat the procedure until you have covered al breast tissue. You may need between 10 and 16 segments.

Circle:

Imagine your breast as the face if a clock. Start at 12 o’clock and palpate along the boundary of each circle until you return to your starting point. Then move down a finger’s width and continue palpating in ever smaller circles until you reach the nipple. Depending on the size of your breast, you may need 8 to 10 circles.

Nipple Discharge:

Squeeze your nipples to check for discharge. Many women have a normal discharge.

Axillary Examination:

Examine the breast tissue that extends into your armpits while your arm is relaxed at your side.

6. PRACTICE WITH FEEDBACK

It is important that you perform Breast Self-Examination while your instructor watches to be sure you are doing it correctly. Practice your skills under supervision until you feel comfortable and confident.
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7. PLAN OF ACTION

Every women should have a personal breast health plan of action.

1. Schedule your clinical breast examination and mammogram as appropriate.
2. Do monthly Breast Self-Examination. Ask your health professional on your Breast Self-Examination skills.
3. Report any changes to your health care professional.

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Coronary Artery Bypass Graft Surgery What is coronary artery disease?What is coronary artery bypass graft (CABG) surgery?

Coronary Artery Bypass Graft Surgery

Coronary Artery Bypass Graft Surgery

A lifeline back to a healthy and active life

If you your family member has been diagnosed with coronary artery disease and recommended for coronary artery bypass surgery by your doctor, we take this opportunity to educate you on coronary artery bypass surgery.

What is coronary artery disease?

Ageing and other complex factors cause the blood vessels to become hard. In addition, cholesterol and minerals from the blood are deposited on the inner surface of the coronary arteries. When this material builds up, they from a plaque. A raised plaque may restrict the blood flow through the coronary artery. A raised plaque may also change the surface of the artery from smooth to rough, and these rough surfaces may stimulate the formation of a blood clot, which may lead to narrowed artery. A blood clot can also build up quickly and abruptly close off the artery.

What is coronary artery bypass graft (CABG) surgery?

Coronary artery bypass graft surgery is an open-heart operation on which arteries or veins are taken from another pert of the body to channel needed blood flow to the coronary arteries. During surgery these arteries or veins are connected directly to the coronary arteries on the surface of the heart beyond the blockages. This way, blood can flow through them to bypass the narrowed or closed points. Coronary artery bypass graft operations usually last from three to six hours, their duration depending on the number of vessels to be grafted. Each operation varies in complexity, so its duration can only be estimated.

Advantages of awake bypass surgery

• Avoidance of tracheal intubation
• Avoidance of Ventilation.
• Avoidance of cardiac depression due to general anesthesia and premedication pharmaceuticals drugs
• Avoidance of ischemic events related to intubation
• No ventilator related problems
• No hoarness of voice due to intubation
• No dizziness
• No nausea.
• Reduced ICU stay
• Reduced Hospital stay


When to do awake bypass surgery?

Specially good for patients with

• Severe lung disease
• Severe liver disease
• Past history of stroke/ unconsciousness
• High risk for general anesthesia


When not to do?

• Emergency CABG
• Bleeding disorders
• Large heart
• Poor ventricular function (<25 style="font-weight: bold;">Benefits for the patient

• No general anesthesia
• Can be performed for high-risk group of patients who were earlier termed in-operable because of risk of general anesthesia
• No post-operative ventilator support required which reduces post-operative intensive care to less then 24 hours
• Overall hospitalization can be reduced by 3 days

Preparing for your surgery
Typically a patient is admitted to the hospital with enough time before the operation date to allow diagnostic tests to be done. These routinely include blood and urine tests, electrocardiograms (ECGs), chest X-rays & so on. Cardiac catheterization with coronary angiograms is done during the pre-operative hospital stay.
the pre-operative hospital stay.

Who will visit you before the operation?

Before the operation, members of the cardiac surgery team will visit to examine you, discuss the details of the operation and answer your questions. The nursing staff will also evaluate your needs; make you as comfortable as possible. In addition, the anesthesiologist will evaluate you and discuss plans for the care of vital body functions during the operation. Other members of the technical staff may come to draw blood, instruct you about how to breathe and care for your lungs after the operation. You will also be told when the operation will occur.

What is per-donation for blood transfusion?

If you are found to be fit, one or two bottles of your own blood may be drawn before surgery which will be used for blood transfusion, during or after surgery. It is the safest blood transfusion, and eliminates or reduces the need for donor blood transfusion. This may be done before or after your admission, on the decision of your cardiovascular surgeon.

What preparations need to be done for the operation?

Before the operation, most of your body hair will be shaved off, especially from your chest and legs. You will probably be asked to shower and wash with to remove bacteria from the skin to reduce the chance of infection.
You should remove personal items such as glasses or contact lenses, dentures or detachable bridge work, watches and jewellery and give it to your family members for keeping.

Usually medicines are taken on schedule, but consult your Doctor before taking any medicines. Medications that will make you relaxed and drowsy will be given about an hour before the operation. Attendants will wheel you to the operating room on a rolling bed. After you are in the operating room, the anesthesiologist will give you an anesthetic tat brings sleep and freedom from pain during the operation. Then the operation will be preformed. Your family can wait in front of the operation theatre during the surgery or at the reception. Be sure your surgeon knows where your family will be waiting

After the operation

Patient is taken to recovery area or an intensive care unit (ICU). A member of the family may visit briefly in the recovery or intensive care unit after a few hours of the operation when patient is awake.

How long is the convalescent period in the hospital?

The usual hospital stay after an operation is from normally 5 to 7 days. However patients who undergo the minimally invasive coronary bypass surgery (MICAS) can return home within 3-4 days. During that period and beyond, most patients have “goods days” and “bad days” with overall progress and a gain in strength.

Will there be pain and fever after the operation?

There will be some discomfort in the incision made to reach the heart it is usually made along the midline of the chest through the breastbone. The incisions may hurt. Medication will be given to relieve the pain.

Sometimes it causes heavy perspiration during the night or even the day. Taking medicines usually brings relief, but the fever may continue for three to four days after the surgery.

What can be done to help recovery?

Deep breathing exercises and coughing are important ways to speed recovery. Coughing reduces the chances of pneumonia and fever and will not harm the incision or bypass grafts. Most patients will have fear of pain, discomfort and don’t like to cough after an operation, still coughing is essential. Some patients find it easier to cough if a pillow supports their chest. You can help you own recovery by changing positions in bed often.

When can you eat and drink?

Once your breathing tube is removed, you will be able to swallow liquids. How quickly you will be able to progress from liquids to regular diet is an individual matter.

It depends on your digestive system. It is possible you may have a depressed appetite for some days due to mild ingestion caused by stress. It will return to normal on your return to normal activities.
When can you get out of bed?

Patients may get out of bed and sit in a chair or walk around the room as soon as they are able-usually within a day or two. Later they can take short walks in the hall. Eventually they can climb stairs and take brisk, longer walks to prepare for going home.

Can you have bath?

Sponge baths are given right away. It will be a few days however before you are allowed to shower and shampoo.

What can you do to help yourself after returning home?

This booklet has talked about other people will do to make sure your operation is successful and that you have smooth and happy recovery period. There is also a lot you can do, both before and after your operation, to help yourself.
• If you smoke, give up smoking
• Watch your weight
• Watch your cholesterol level
• Be positive
• Keep physically active
• You should only take the medicines prescribed by your doctor

When should routine follow up doctor appointments be scheduled?

It depends up on a patient’s need and the wishes of your cardiovascular surgeon. Patients usually are advised about future surgical appointment when they are discharged from the hospital. You should see cardiologist regularly and have lipid profile, TMT. Echo tests at regular intervals to assess progress. You should make an appointment with your personal or family doctor soon after returning home.

How long will you have to wait before returning to work?

If you perform a sedentary job, the average is between three to six weeks. If your job involves heavy work, the time in six weeks or longer. Your Doctor is the best guide to help you return to work.

What about sexual relations?

Typically patients may resume sexual relations when they feel like it. It you have questions, talk to your Doctor.

Will there be restrictions on driving an automobile?

You may begin driving any time you feel physically able to operate the vehicle best to wait a few weeks after leaving the hospital to begin driving a car.

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Guide on Stroke Brain Attack What is Brain stroke? How to prevent it

Guide on Stroke (Brain Attack)

Stroke is a “Brain Attack" And a Medical EmergencyIt is critical to recognize the symptoms of stroke and seek immediate emergency attention.

Stroke – sometimes called a “Brain Attack” or “Cerebrovascular accident” is a syndrome of symptoms & signs of loss of cerebral function caused by disruption in the flow of blood to part of the brain.

What causes stroke?

A stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is blocked by a clot or bursts, causing the brain to starve. If deprived of oxygen for even a short period of time, the brain nerve cells die from a lack of oxygen, the part of the body that section of the brain controls is affected through paralysis, language, motor skills or vision disturbances.

There are two types of stroke:

Blood clots that block the artery are ischemic (is KEM-ik) strokes and is the most common type causing between 70-80 percent of all strokes.

When a blood vessel ruptures, it causes a bleeding or hemorrhagic (hem-o-RAJ-ik) stroke. Such strokes are usually the result of a ruptured blood vessel or an aneurysm, a weakened area of a blood vessel that bulges or balloons out.

There are also “mini-strokes” known as TIA’s (transient ischemic attacks). People who have one TIA are likely to have another one. TIAs cause brief stroke symptoms that go away after a few minutes or hours. People often ignore these symptoms, but they are an early warning sign and 35 percent of those who experience a TIA will have full blown stroke if left untreated. TIAs should be taken as seriously as strike.

A leading cause of stroke and TIA is carotid artery disease (CAD). In CAD, a substance called plaque builds up over time in the carotid arteries, the large blood vessels on either side of the neck that supply blood to the head and brain. The buildup of plaque is a silent disease, until small particles break away and are carried to smaller arteries, where they block the flow of blood. The nature and severity of symptoms depend on how large an area of the brain is affected and whether the blood supply to the brain is completely or partially blocked.

What are the symptoms of stroke?

The most common symptoms of stroke are:

• Sudden numbness or weakness in the face, arm and / or leg, especially on one side of the body.


• Sudden trouble seeing, including double vision, blurred vision or partial blindness, in one or both eyes.


• Trouble walking, dizziness, loss of balance or coordination.


• Sudden severe, headache with no known cause.

If you experience any of these symptoms, even if they go away quickly, seek immediate emergency help.

Every minute counts. Although starved of oxygen, brain tissue does not die in the minute following a stroke. If blocked blood vessels can be opened within three to six hours, the chances of recovery are greatly improved.

What are the risk factors for stroke?

People who are higher-than-average risk for stroke include those who have:

• High blood pressure


• High cholesterol


• Heart disease

Atherosclerosis. When the carotid arteries, the major blood vessels that supply blood to the brain, become clogged with atherosclerotic plaque, the risk for stroke goes up.

Personal history of stroke or TIA.

Lifestyle risk factors. Smoking, excessive alcohol consumption and being overweight are

all significant risk factors for stroke.

Age, gender and race. The risk of stroke goes up with age & is higher in males.

Family history of stroke or TIA.

Diabetes.

How to diagnose stroke?

There are a number of diagnostic exams that can be performed to determine if someone has had a stroke or is risk for having one.

Computed Tomography (CT). The first diagnostic test performed in the emergency room is usually a CT scan. CT uses computers to generate detailed pictures of the brain, and can confirm the diagnosis of stroke and tell whether the stroke is caused by a hemorrhage in the brain.

Magnetic Resonance Imaging (MRI is a diagnostic test which may be performed to identify and further localize the site of the stroke and find the source. It may be able to quickly identify the area deprived of sufficient blood flow & guide further therapy.

Angiography. An angiogram is an X-ray in which a contrast agent, or dye, is injected into a vein to highlight the blood vessels. With this exam, radiologists can pinpoint the exact location of blockage or bleeding in the brain. Angiography also is used to guide thin tubes called catheters to the site of the problem and administer treatments.

How can stroke be prevented?

In patients at high risk of having a stroke, the narrowed section of artery may be re-opened by an interventional radiologist through angioplasty and reinforced with a stent, thereby preventing the stroke from occurring. Vascular stents are typically made of woven, laser-cut or welded metal that permits the device to be compressed onto a catheter and delivered directly into the hardened artery. In addition to diagnosing and treating those at risk for stroke, interventional radiologists use their expertise in imaging, angioplasty and stenting to treat those having an acute stroke.

Patients can also take action to prevent strokes by:

Stop smoking
Controlling high blood pressure
Lowering cholesterol levels
Maintaining healthy weight
Excercising
Utilizing appropriate medications like aspirin
Treating unruptured cerebral aneurysm or arteriovenous malformation

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How is stroke treated / managed?

For those having a stroke, it must first be determined which kind of a stroke the patient is having so the proper treatment can be given.

Treatment to Dissolve Blood Clots:

If the stroke is due to a blood clot, a clot-busting drug, TPA (tissue plasminogen activator) can be given intravenously to break up or reduce the size of blood clots to the brain. This technique must be performed within three hours from the onset of symptoms.

Other important medical therapies: These include anti platelet pharmaceuticals drugs for ischemic stroke, drugs for control of blood pressure & blood sugar in diabetes. Treatment also includes prevention of complications like increased intra cranial pressure, chest infection etc.

At approved stroke centres interventional radiologists (IR) that specialize in neurological procedure can provide intra-arterial thrombolysis treatment.

Treatment to Open Narrowed Carotid Arteries: If a stroke is the result of narrowing of the carotid arteries, follow-up treatment may be needed stroke. These treatments also are used to prevent stroke in people who have been diagnosed with significant blockage in the carotid artery, usually as a result of atherosclerosis, in which plaque builds up over time in the artery.
Carotid Endarterectomy Surgery.
The most common treatment for narrowing of the carotid arteries involves a surgeon making an incision in the neck, opening the carotid artery and scraping out the built –up plaque.Carotid artery angioplasty and stenting. In this technique, a catheter is inserted through a nick in the skin, usually in the groin, and threaded under X-ray guidance to the carotid artery. A balloon is inflated to compress the plaque against the wall of the blood vessel and open up the artery. Usually, a tiny wire cylinder called a “stent” is inserted and acts like a scaffolding to keep the artery open.
Interventional radiologists use X-rays toguide the placement of small, wire mesh cylinders (stents) to hold open clogged arteries.

Post Stroke Rehabilitation

Rehabilitation is a critical part of recover for many stroke survivors. The effects of stroke may mean that you must change, relearn or redefine how you live. Stroke rehabilitation helps you return to independent living.

Rehabilitation doesn’t reverse the effects of a stroke. Its goals are to build your strength, capability and confidence so you can continue your daily activities despite the effects of your stroke.

Rehabilitation depends on your need to become independent. You may work to improve you independent in many areas.

These include:
Self – care skills such as feeding, grooming, bathing and dressingMobility skills such as transferring, walking or self-propelling a wheelchair
Communication skills in speech and language
Cognitive skills such as memory or problem-solving
Social skills for interacting with other people

Under your doctor’s direction, rehabilitation specialists come together to provide a treatment program specifically suited to your needs.

Eyelid surgery for beautiful eyes

Eyelid surgery
Am I a candidate for an eyelid surgery?

Before

After

Having any or some of the underlying conditions may want you to consider the option.
• The natural fold of the upper eyelids obscured by excess skin
• Vision possibly impaired by loose skin hanging down from the upper eyelids
• Tired looking eyes due to s puffy appearance to the upper eyelids
• Excess skin and wrinkles of the lower eyelids
• Bags and dark circles under the eyes, often accompanied with a depression along the bony border of the lower eyelids
• White below the iris (colored portion of the eye) visible due to droopiness of the lower eyelids
• These problems can usually be corrected by aesthetic eyelid surgery, though other treatments may also need to be considered.


Individual Consultation

In the consultation process, you will be asked to look in a mirror and specify the exact areas which you would like to see improved. Your surgeon will thus understand your expectations and determine whether they can be achieved realistically.

How Aesthetic Eyelid Surgery is performed

Considering the individual factors, not everyone will achieve the same results from eyelid surgery your unique characteristics will be considered by your plastic surgeon in determining the most effective treatment you.

How would my plastic surgeon be able to improve the appearance of my upper eyelids?

For upper eyelid surgery, mostly, an incision is so made that it is hides within the natural fold of the upper eyelid. It slightly extends beyond the outside corner into the laugh lines or other existing creases excess skin and fatty tissue are removed through this incision. Since the incision follows the natural contour of the upper eyelid, it gets well camouflaged when healed.

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How is the appearance of my lower eyelids improved?

Incase of the lower eyelid surgery, usually an incision is hidden just below the lower lashes. Either the excess fat in both the upper and lower eyelids is removed, or sometimes lower eyelid fat is redistributed.

Sometimes, you and your surgeon may decide that the best approach for removing excess fat is through an incision placed inside the lower eyelid. This technique requires no external incision, but it cannot be used to remove excess skin.

Risks

Fortunately for patients significant complications from aesthetic eyelid surgery are infrequent. Year after year multitudes of people, who have undergone aesthetic eyelid surgery experience no major problems and are pleased with the results. However one should be aware of both the benefits and risks when considering surgery. A personal discussion on the subject of risks and potential complications of surgery between you and your surgeon can prove helpful.
A detailed information booklet will be provided with instructions and precautions for the immediate and early postoperative period. This will also discuss the sequeal of Aesthetic eyelid surgery.
By following the advice and instructions of your plastic surgeon, you can help minimize certain risks both before and after your eyelid surgery.

Recovery:

Aesthetic eyelid surgery is usually performed on an outpatient basis. Some possible discomfort can be controlled by medication. Going home after a few hours probably might be permitted, although some patients may stay overnight in the hospital or surgical facility.

Results of Your Eyelid Surgery

Post-aesthetic eyelid surgery your appearance will change as you will look more rested, refreshed and alert. Because of the gradual healing process you should expect to wait at least several weeks to see the final results of your eyelid surgery. Incisions will fade over a number of months until they become barely visible.

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How long will the results last?

Your heredity and lifestyle maybe two factors affecting the results of aesthetic eyelid surgery, results of which are usually long-lasting.

Removal of fat from your eyelids is permanent. Since this is usually the cause of puffiness and bags these conditions generally will not recur. The aging of the skin continues and skin laxity along the fine wrinkling of the eyelid area may, at some point, return. Often loss of tone in the additional sagging of the eyebrows which mimics a recurrence of drooping upper eyelids. In case this happens, a forehead lift or a secondary eyelid procedure may be required as a correction procedure. In spite of the continuing aging process, patients are usually happy with their appearance for many years after the eyelid surgery. Some patients may want to make additional improvements at a later time
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How to get rid of back pain , how to reduce back pain

Healthy Back


Follow these simple guidelines to keep your back in good shape


1. Standing – Keeping one foot forward of the other, with knees slightly bent, takes the pressure off your low back.


2. Sitting – Sitting with your knees slightly higher than your hips provides good low back support.


3. Reaching – Stand on a stool to reach things that are above your shoulder level.


4. Moving – Heavy Items Pushing is easier on your back than pulling. Use your arms and legs to start the push. If you must lift a heavy item, get someone to help you.


5. Lifting – Kneel down on one knee with the other foot flat on the floor, near as possible to the item you are lifting. Lift with your legs, not your back, keeping the object close to your body at all times.


6. Carrying – Two small objects (one in either hand) may be easier to handle than one largo one. If you must carry one large object, keep it close to your body.


7. Sleeping – Sleeping on your back puts 55 lbs. Of pressure on your back. Putting a couple of pillows under your knees cuts the pressure to half. Lying on your side with a pillow between your knees also reduces the pressure.


8. Weight Control – Additional weight puts a strain on your back. Keep within 10 lbs. of your ideal weight for a healthier back.

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9. Quit Smoking – Smoking are more prone to back pain than non-smokers because nicotine restricts the flow of blood to the discs that cushion your vertebrae.


10. Minor Back Pain – Treat minor back pain with anti-inflammatory and gentle stretching followed by an ice pack.

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