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Fibromyalgia

Sunday, 31 October 2010

Fibromyalgia is defined as pain for more than three months both above and below the waist. The more accurate name for this condition is Chronic widespread pain. It is a diagnosis of exclusion when the doctor does not identify an obvious cause for the pain.
An important feature of diagnosis is tender trigger points. Besides, usually the patient is a female. It can occur at any age but is increasingly recognized in teenagers.
The tender points are illustrated in the following diagram:
 
 For the diagnosis to be made, 11 of the 18 points must be tender on digital palpation.
Skin rolling tenderness (A) and reactive hyperemia (B) in fibromyalgia
(From Hochberg MC, Silman AJ, Smolen JS, et al [eds]: Rheumatology, 3rd ed. St Louis, Mosby, 2003.)
Symptoms: 
1. The number one symptoms is Pain that has no boundaries. Pain can have variable character from one individual to another. Pain can be deep aching, throbbing, shooting, stabbing or intense burning.

2. Fatique: patients can feel that their arms and legs are weighted down by heavy blocks. Besides they feel that their bodies are out of energy.

3. Sleeping disturbances: as insomnia . This can cause difficult concentration and memory problems.

4. Other associated problems as irritable bowel syndrome, depression, pre-menstrual syndrome, tension headache,
Restless leg syndrome

What can aggravate fibromyalgia ?
Flare-ups can be caused by a change in the weather, cold environment, stress, depression, over-exertion, pre-menopausal and menopausal states. 

Now an important question arises, What is the treatment of such condition ?




Unfortunately there is no definitive treatment for it but the current practice is to use analgesics to reduce pain. Besides, patients who suffer from depression should have an anti-depressant (and avoiding the potentially addictive anxiolytic agents).
Trigger points can be injected with a local anaesthetic or corticosteroids. Acupuncture can be helpful in some cases.

Other options include:
- Physiotherapy
- Diet: adding some components can be of great help in fibromyalgia as Omega-3 fatty acids, vitamin C, B complex vitamins, vitamin D, magnesium.

- Exercise: can help a lot with the reduction of pain and giving the sensation of being active.
- Mind-awareness practices: as yoga and breathing exercises. These can help in decreasing the intensity of pain. 

A new study showed that yoga is now being evaluated as a suitable treatment for fibromyalgia as it proved that it can improve the symptoms in many patients. For more details about the study: Click Here  

I would like to thank you for reading it and i hope you benefited from this article. Please share this article as we need to raise the awareness for this condition and maybe help the patients with new treatment options. 
 

Breast reconstructive surgery

Saturday, 30 October 2010

Breast cancer is a common cancer nowadays. Some of the patients will have to undergo a surgical operation as a part of the management plan. Mastectomy is a surgery that involves the removal of one or both breasts. This surgery can cause an emotional and a cosmetic problem in those women due to the loss of her breast.

However the solution is Breast reconstruction. As the name suggests, it is a surgery that rebuilds the breast after mastectomy so that the normal shape and size will be attained. There are many factors involved and will be explained in details in this article.

Timing of reconstruction:
Reconstruction can be done either immediately after mastectomy (in the same surgical setting) or delayed after months and years from the mastectomy surgery. 
Studies have showed a psychological effect, cost-effectiveness and better cosmetic appearance with the immediate reconstruction.

Surgical options:
Reconstructions can be done by the use of either autogenous (originating the patient's own body) or alloplastic (implantation of an inorganic material) or both

i. The most common method used is Tissue expander - Breast implant.

Indications of implants reconstruction:
1. Bilateral reconstruction
2. Patient requesting augmentation + reconstruction
3. Patient not fit for long surgery
4.  Patient not willing to have more scars on the back or abdomen

Contraindications:
1. The need for adjuvant radiotherapy
2. Previously failed implants
3. Implant fear

ii. A common autogenous method is also used: 
Flap reconstruction. This method uses tissues from other parts of the patient's body such as the back (latissimus dorsi muscle flap) or the abdomen (TRAM flap).


Latissimus dorsi reconstruction:

Indications:
1. Small breast
2. Mild breast ptosis
3. Abdominal donor site unavailable


Contarindications:
1. Very large breast in a patient who does not desire reduction
2. Previous lateral thoracotomy

TRAM flap:

Indications:
1. Breasts of all sizes 
2. Breast ptosis
Contraindications:
1. Previous abdominoplasty
2. Patient unfit for long surgery
3. Patient unable to tolerate long recovery period
There are more surgical options in breast reconstruction but we mentioned the most common ones done. 
Besides surgical details were not explained for the sake of making the topic much easier and clearer. 
 

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