Dr.Rufus' Medical Website - Recently Updated Pages

Tuberculosis

dr.rufusrajadurai — Sat, 21 Jun 2008 15:32:36 CDT

TuberculosisTuberculosis (abbreviated as TB for tubercle bacillus or Tuberculosis) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. This bacteria is transmitted through the respiratory route and is very slow-growing. It is engulfted by phagocytes in the lungs but lives and multiplies within these cells. Eventaully the body tries to contain the infection by building up a tough "tubercle" around the bacteria-infected white blood cells. Tuberculosis most commonly attacks the lungs (as pulmonary TB) but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, bones, joints and even the skin. Other mycobacteria species can also cause tuberculosis, but these species do not usually infect healthy adults.
Over one-third of the world's population (over 2,000,000,000 people!) has been infected by the TB bacterium, and new infections occur at a rate of one per second. Most of these people never develop the full-blown disease. However, one in ten latent infections will progress to active TB disease, which, if left untreated, kills more than half of its victims.
In 2004, mortality and morbidity statistics included 14.6 million chronic active TB cases, 8.9 million new cases, and 1.6 million deaths, mostly in developing countries. In addition, a rising number of people in the developed world are contracting tuberculosis because their immune systems are compromised by immunosuppressive drugs, substance abuse, or HIV/AIDS.
The rise in HIV infections and the neglect of TB control programs have enabled a resurgence of tuberculosis. The emergence of drug-resistant strains has also contributed to this new epidemic with, from 2000 to 2004, 20% of TB cases being resistant to standard treatments and 2% resistant to second-line drugs. TB incidence varies widely, even in neighboring countries, apparently because of differences in health care systems. The World Health Organization declared TB a global health emergency in 1993, and the Stop TB Partnership developed a Global Plan to Stop Tuberculosis that aims to save 14 million lives between 2006 and 2015.

--A chest x-ray can tell a Doctor whether a patient has TB
-- This chest x-ray is positive for TB.

-- This is a TB test to see if you have been exposed to Tuberculosis
-- 1 cc of TB reagent is place subcutaneously in an arm.
-- Patients return to have their test read in between 48-72 hours giving the reagent time to react.

-- This is a Positive skin test meaning this person has been exposed to TB.
-- The red swollen area is measured with a ruler and is measured in duration of millimeters. Any red swollen are reading over 5 mm is consider a positive read out.

-- There is a vaccination that is used in some countries that will react with the TB reagent
used in the skin test. If a person has had this vaccination their test could come
back as looking positive.

The Centre of Attraction

dr.rufusrajadurai — Fri, 13 Jun 2008 14:57:56 CDT

This is a MEDICAL EDUCATIONAL WEBSITE dedicated to all Health Care Professionals and Medical Students with the additional 3D Animation Videos.It also contains a lot of Health & Herbal Beauty Tips.Now it has been updated with the FREE DOWNLOAD section.You can get many Study materials and Educational 3D Animation videos for 100% FREE......
CLICK HERE FOR DOWNLOAD LINK

Hope you will enjoy the stay...........

Get Inside From Here

Chronic Limb Ischemia

dr.rufusrajadurai — Wed, 02 Apr 2008 16:03:19 CDT

Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent. Objective hemodynamic parameters that support the diagnosis of critical limb ischemia include an ankle-brachial index of 0.4 or less, an ankle systolic pressure of 50 mm Hg or less, or a toe systolic pressure of 30 mm Hg or less. Intervention may include conservative therapy, revascularization or amputation. Progressive gangrene, rapidly enlarging wounds or continuous ischemic rest pain can signify a threat to the limb and suggest the need for revascularization in patients without prohibitive operative risks. Bypass grafts are usually required because of the multilevel and distal nature of the arterial narrowing in critical limb ischemia. Patients with diabetes are more likely than other patients to have distal disease that is less amenable to bypass grafting. Compared with amputation, revascularization is more cost-effective and is associated with better perioperative morbidity and mortality. Limb preservation should be the goal in most patients with critical limb ischemia.

Atherosclerosis underlies most peripheral arterial disease. Narrowed vessels that cannot supply sufficient blood flow to exercising leg muscles may cause claudication, which is brought on by exercise and relieved by rest. (For a review of the diagnosis and management of claudication, see the article by Santilli, et al., in the March 1996 issue of American Family Physician.1) As vessel narrowing increases, critical limb ischemia can develop when the blood flow does not meet the metabolic demands of tissue at rest. While critical limb ischemia may be due to an acute condition such as an embolus or thrombosis, most cases are the progressive result of a chronic condition, most commonly atherosclerosis.


An ankle systolic pressure of 50 mm Hg or less or a toe systolic pressure of 30 mm Hg or less suggests the presence of critical limb ischemia.

Chronic critical limb ischemia is defined not only by the clinical presentation but also by an objective measurement of impaired blood flow. Criteria for diagnosis include either one of the following (1) more than two weeks of recurrent foot pain at rest that requires regular use of analgesics and is associated with an ankle systolic pressure of 50 mm Hg or less, or a toe systolic pressure of 30 mm Hg or less, or (2) a nonhealing wound or gangrene of the foot or toes, with similar hemodynamic measurements.2 The hemodynamic parameters may be less reliable in patients with diabetes because arterial wall calcification can impair compression by a blood pressure cuff and produce systolic pressure measurements that are greater than the actual levels.
Risk Factors
Chronic critical limb ischemia is the end result of arterial occlusive disease, most commonly atherosclerosis. In addition to atherosclerosis in association with hypertension, hypercholesterolemia, cigarette smoking and diabetes,3,4 less frequent causes of chronic critical limb ischemia include Buerger's disease, or thromboangiitis obliterans, and some forms of arteritis.5

FIGURE 1A. Right heel ulcer in a 56-year-old patient with diabetes. The ulcer failed to heal after three months of conservative treatment.

Diabetes is a particularly important risk factor because it is frequently associated with severe peripheral arterial disease. Atherosclerosis develops at a younger age in patients with diabetes and progresses rapidly. Moreover, atherosclerosis affects more distal vessels in patients with diabetes; the profunda femoris, popliteal and tibial arteries are frequently affected, while the aorta and iliac arteries are minimally narrowed. These distal lesions are less amenable to revascularization. Atherosclerosis in distal arteries in combination with diabetic neuropathy contributes to the higher rates of limb loss in diabetic patients compared with nondiabetic patients.6,7
Clinical Presentation
The development of chronic critical limb ischemia usually requires multiple sites of arterial obstruction that severely reduce blood flow to the tissues.7,8 Critical tissue ischemia is manifested clinically as rest pain, nonhealing wounds (because of the increased metabolic requirements of wound healing) or tissue necrosis (gangrene).
Ischemic rest pain is classically described as a burning pain in the ball of the foot and toes that is worse at night when the patient is in bed. The pain is exacerbated by the recumbent position because of the loss of gravity-assisted flow to the foot. Ischemic rest pain is located in the foot, where tissue is farthest from the heart and distal to the arterial occlusions.1 Patients with ischemic rest pain often need to dangle their legs over the side of the bed or sleep in a recliner to regain gravity-augmented blood flow and relieve the pain. Patients who keep their legs in a dependent position for comfort often present with considerable edema of the feet and ankles.
Nonhealing wounds are usually found in areas of foot trauma caused by improperly fitting shoes or an injury. A wound is generally considered to be nonhealing if it fails to respond to a four- to 12-week trial of conservative therapy such as regular dressing changes, avoidance of trauma, treatment of infection and debridement of necrotic tissue.
Gangrene is usually found on the toes. It develops when the blood supply is so low that spontaneous necrosis occurs in the most poorly perfused tissues.


Ankle-Brachial Index


FIGURE 1B. Segmental pressures and ankle-brachial index (ABI) in the same patient as in Figure 1a. The ABI of 0.58 on the right and the pulsatile monophasic waveform in the posterior tibial artery suggested that the ulcer could heal with conservative therapy.

Diagnosis


Patients with diabetes develop atherosclerotic lesions in the more distal leg vessels, which are less amenable to revascularization.

The presence of rest pain can sometimes be difficult to discern in patients with other chronic leg pain, such as that caused by peripheral neuropathy. Labeling a wound as nonhealing can also be a subjective assessment. However, a number of physical findings and objective hemodynamic parameters can be used to substantiate a diagnosis of chronic critical limb ischemia. Typical physical findings include absent or diminished pedal pulses, shiny smooth skin of the feet and legs, and muscle wasting of the calves.
An objective measurement of blood flow is easily accomplished with the use of a hand-held Doppler probe and a blood pressure cuff.1 The cuff is inflated until the pulse distal to the cuff is no longer heard by Doppler. The cuff is then slowly deflated until the pulse is again detected. This measurement is recorded as the systolic pressure. As previously mentioned, an ankle systolic pressure of 50 mm Hg or less or a toe systolic pressure of 30 mm Hg or less suggests the presence of critical limb ischemia.

FIGURE 1C. The patient underwent operative debridement and began a regimen of dressing changes (gauze dampened with normal saline) three times a day. He also began wearing a shoe that allowed ambulation without direct pressure on the ulcer. He was followed weekly in the outpatient clinic.

FIGURE 1D. The ulcer shows good progress in healing after three weeks of conservative therapy.

FIGURE 1E. After six weeks of outpatient treatment, the ulcer is well healed.

Another widely used parameter is the ankle-brachial index, which is a ratio of the systolic pressure at the dorsalis pedis or posterior tibial artery divided by the systolic pressure at the brachial artery. Patients with claudication typically have an ankle-brachial index of 0.5 to 0.8, while patients with critical limb ischemia usually have an ankle-brachial index of 0.4 or less.9,10

FIGURE 2A. Left foot of a 77-year-old patient with diabetes who presented with a two-year history of progressively worsening claudication. The foot shows dependent rubor and several areas of gangrene, characteristic of severe ischemia. The patient's rest pain had worsened during the past month.

Vascular laboratories also use Doppler probes to measure the pulse volume waveform at segmental locations in the leg arteries. A change in the Doppler waveform from triphasic to biphasic to monophasic and then stenotic waveforms can identify sites of arterial blockage.
Differential Diagnosis
Ischemic rest pain may be confused with night cramps, arthritis or diabetic neuropathy. Night cramps occur in the calf muscles; they usually awaken the patient from sleep and are relieved by massaging the muscle, by walking or by using antispasmodic agents. Patients with arthritis of the metatarsal bones may have pain in the foot. This pain is often experienced at night and may be relieved by standing. The distinguishing characteristic of arthritic pain is that it usually occurs intermittently and at sporadic intervals, whereas ischemic rest pain consistently occurs after a specific interval of recumbency.
Diabetic neuropathy may also present with pain in the foot and is occasionally associated with diminished pulses and trophic skin changes. This pain, however, is not steadfastly associated with recumbency. The other features of diabetic neuropathy, such as loss of light touch (i.e., the monofilament test) and decreased vibratory sense, can also serve as distinguishing characteristics.
Conservative Treatment
Risk factor modification, including smoking cessation, blood pressure control, good glycemic control and reduction of lipid levels, should be instituted. Antiplatelet therapy with aspirin has been shown to substantially decrease the risk of myocardial infarction, stroke and death in patients with peripheral vascular disease and also reduces the rate of arterial reocclusion after angioplasty or bypass grafting.11
Ischemic Rest Pain
Patients with ischemic rest pain should be given pain medication as necessary, and any underlying systemic cause of inadequate blood flow, such as cardiac failure, should be corrected. If pain persists after four to eight weeks of conservative therapy with pain medication and interventions to optimize the patient's overall condition, the possibility of operative intervention should be explained to the patient, including the risks and benefits of the procedure.


Patients with claudication typically have an ankle-brachial ratio of 0.5 to 0.8, while patients with critical limb ischemia usually have a ratio of 0.4 or less.

Surgical intervention includes revascularization and amputation. If the patient wants to undergo revascularization and is an acceptable operative candidate, arteriography is often performed for further evaluation and planning of revascularization. Some centers are utilizing magnetic resonance angiography as an alternative or supplement to arteriography to minimize the risk of dye exposure.12
Nonhealing Wounds
Patients with nonhealing wounds or gangrene should be evaluated for the presence of infection. Infected wounds require antibiotic therapy, surgical debridement, or both. Conservative therapy includes teaching the patient ways to avoid trauma to the wound site, including the wearing of properly fitting shoes. Dressings should be changed frequently; the patient should be seen weekly until the wound heals (Figures 1a through 1e).
Further intervention may be required if conservative therapy does not lead to improvement, as indicated by increasing wound size, persistent or spreading infection or no evidence of healing after four to eight weeks. Progressive gangrene, rapidly enlarging wounds and continuous ischemic rest pain unrelieved by dependency are each unstable conditions that can rapidly lead to limb loss and require urgent intervention. However, many patients with critical limb ischemia have a stable or slowly progressive presentation. Review of the data reveals that patients with chronic critical limb ischemia have a three-year limb loss rate of about 40 percent.13-16 This suggests that a substantial proportion of patients with critical ischemia are not at risk of imminent limb loss.


Ankle-Brachial Index


FIGURE 2B. Segmental pressures and ankle-brachial index (ABI) in the same patient as in Figure 2a. The brachial pressure on the right side was 86 mm Hg because of subclavian artery stenosis. (The ABI is calculated using the highest normal brachial pressure, which in this patient was 150 mm Hg.) The ABI of 0.30 on the left side, the stenotic nonpulsatile waveform in the posterior tibial and dorsalis pedal arteries, and the rapid progression of ischemic symptoms suggested that this patient was in imminent danger of limb loss and was not a candidate for conservative therapy.

FIGURE 2C. Arteriography in the same patient as in Figures 2a and 2b, showing diffuse but nonsignificant occlusive disease in the aorta, iliac and common femoral arteries.

FIGURE 2D. Runoff of the left leg shows no superficial femoral or popliteal artery. There was only collateral flow (arrow) from the thigh to the calf.

FIGURE 2E. A reconstituted posterior tibial artery (arrow) in the calf continued into the foot. This artery was considered an acceptable vessel for bypass.

FIGURE 2F. Intraoperative arteriography shows the distal end of a common femoral to posterior tibial artery saphenous vein bypass (arrows).


Ankle-Brachial Index


FIGURE 2G. Postoperative ankle-brachial index (ABI) of this patient revealed a significant improvement in values, from 0.30 preoperatively to 0.75 postoperatively. As noted in the legend for Figure 2b, the brachial pressure on the right side was 86 mm Hg because of subclavian artery stenosis. The patient's highest normal brachial pressure (114 mm Hg) was used to calculate the ABI.

FIGURE 2H. Even after revascularization, however, necrotic tissue persisted in the foot. Despite wound debridement, transmetatarsal amputation was required. This photograph was taken at the follow-up visit three weeks after amputation. The surgical wound healed satisfactorily. The patient was fitted with a special shoe and has maintained an active and independent lifestyle.

Operative Intervention
Revascularization
While carefully designed conservative therapy can benefit many patients with critical limb ischemia, the severe nature of their disease may lead to consideration of operative intervention. Surgical interventions include revascularization or amputation. If the patient wants to undergo revascularization and is an acceptable operative candidate, arteriography is often performed for further evaluation and planning of revascularization. At some centers, magnetic resonance angiography is used as an alternative or supplement to arteriography to minimize the risk of dye exposure.12 Limb preservation by means of revascularization is cost-effective, leads to a better quality of life for most patients and is associated with lower perioperative morbidity and mortality than amputation. Limb preservation should be the goal in most patients with chronic critical limb ischemia.13,14
The feasibility of revascularization is determined by the arteriographic findings as well as the availability of a bypass conduit (Figures 2a through 2h). Angioplasty or stent placement, or both, is most successful with short, proximal lesions, such as those in patients with claudication, but is unlikely to be the only treatment necessary in the setting of critical limb ischemia because of the multilevel nature of the arterial occlusive disease. The ideal bypass conduit is the greater saphenous vein, but other conduits include the lesser saphenous veins, the arm veins or a prosthetic conduit. In most surgical series, three-year bypass patency rates of calf arteries range from 40 percent for prosthetic bypasses to 85 percent for saphenous vein bypasses.17-21 In comparison, studies of conservative therapy have demonstrated a 25 to 49 percent success rate with nonhealing wounds and a 50 to 80 percent rate of improvement in ischemic rest pain.13-16
Primary Amputation
Primary amputation may be indicated in certain patients, such as those with extensive tissue necrosis, life-threatening infection or lesions not amenable to revascularization. The decision to monitor the patient's condition with watchful waiting and conservative management or to perform revascularization or amputation depends on careful assessment of the attendant risks and benefits of surgery versus conservative management.
More importantly, it depends on the patient's interpretation of the invasiveness or appropriateness of the available options. Even patients unable to walk because of their condition may consider amputation inappropriate, and not all patients are motivated to do the work necessary for rehabilitation after amputation. If the decision is made to amputate, the level of amputation should be one that has the greatest likelihood of healing while giving the patient the maximal chance for functional rehabilitation.


Revascularization is cost-effective and results in less perioperative morbidity and mortality than amputation. Limb preservation should be the goal in most patients with critical limb ischemia.

Follow-up
Patients with chronic critical limb ischemia require lifelong follow-up for a number of reasons. After amputation or revascularization, patients require rehabilitation to hasten their return to maximal independence. Careful attention to nutritional status will assist in wound healing and recovery. In addition, bypass graft patency should be assessed frequently after revascularization. Some authorities recommend periodic surveillance with duplex ultrasonography every three months to maximize the chance that re-stenosis is identified early, when it is more amenable to repair.
Four-year survival rates as low as 40 percent are reported in patients with critical limb ischemia, with the vast majority of deaths caused by coronary artery disease and cerebrovascular disease.17 Close follow-up of coronary artery disease and cerebrovascular disease may help extend life expectancy in these high-risk patients.

Aneurysm

dr.rufusrajadurai — Wed, 02 Apr 2008 15:53:20 CDT

An abnormal bulge or ballooning in the wall of an artery. Arteries are blood vessels that carry oxygen-rich blood from the heart to other parts of the body. An aneurysm that grows and becomes large enough can burst, causing dangerous, often fatal, bleeding inside the body.

Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The aorta comes out from the left ventricle of the heart and travels through the chest and abdomen. An aneurysm that occurs in the aorta in the chest is called a thoracic aortic aneurysm. An aneurysm that occurs in the aorta in the abdomen is called an abdominal aortic aneurysm.

Aneurysms also can occur in arteries in the brain, heart, intestine, neck, spleen, back of the knees and thighs, and in other parts of the body. If an aneurysm in the brain bursts, it causes a stroke.

Aneurysms come in two general shapes. The first is called a saccular aneurysm and is a formation of a sac or pouch on one side of the blood vessel wall. The second type is called a fusiform" aneurysm and is an outward bulging of the blood vessel wall in all directions. A ruptured aneurysm is one that has burst and caused bleeding into the surrounding tissues.

About 15,000 Americans die each year from ruptured aortic aneurysms. Ruptured aortic aneurysm is the tenth leading cause of death in men over age 50 in the United States.

Many cases of ruptured aneurysm can be prevented with early diagnosis and medical treatment. Because aneurysms can develop and become large before causing any symptoms, it is important to look for them in people who are at the highest risk. Experts recommend that men who are 65 to 75 years old and have ever smoked (at least 100 cigarettes in their lifetime) should be checked for abdominal aortic aneurysms.

When found in time, aneurysms can usually be treated successfully with medicines or surgery. If an aortic aneurysm is found, the doctor may prescribe medicine to reduce the heart rate and blood pressure. This can reduce the risk of rupture.

Large aortic aneurysms, if found in time, can often be repaired with surgery to replace the diseased portion of the aorta. The outlook is usually excellent.

Types of aneurysm

Types of aneurysm include aortic aneurysms, cerebral aneurysms, and peripheral aneurysms.

Aortic aneurysm

Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The aorta comes out from the left ventricle of the heart and travels through the chest and abdomen. The two types of aortic aneurysm are thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA).

Thoracic aortic aneurysm

An aortic aneurysm that occurs in the part of the aorta running through the thorax (chest) is a thoracic aortic aneurysm. One in four aortic aneurysms is a TAA.

Most TAAs do not produce symptoms, even when they are large. Only half of all people with TAAs notice any symptoms. TAAs are identified more often now than in the past because of chest computed tomography (CT) scans performed for other medical problems.

In a common type of TAA, the walls of the aorta become weak and a section nearest to the heart enlarges. Then the valve between the heart and the aorta cannot close properly and blood leaks backward into the heart. Less commonly, a TAA can develop in the upper back away from the heart. A TAA in this location can result from and injury to the chest such as from an auto crash.

Abdominal aortic aneurysm

An aortic aneurysm that occurs in the part of the aorta running through the abdomen is an abdominal aortic aneurysm. Three in four aortic aneurysms are AAAs.

An AAA can grow very large without producing symptoms. About 1 in 5 AAAs rupture.

Figure A shows a normal aorta. Figure B shows a thoracic aortic aneurysm located behind the heart. Figure C shows an abdominal aortic aneurysm located below the arteries that supply the kidneys.

Cerebral aneurysm

Aneurysms that occur in an artery in the brain are called cerebral aneurysms. They are sometimes called berry aneurysms because they are often the size of a small berry. Most cerebral aneurysms produce no symptoms until they become large, begin to leak blood, or rupture.

Typical location of a cerebral (berry) aneurysm in the arteries supplying blood to the brain. The inset image shows a close-up of the sac-like aneurysm.

A ruptured cerebral aneurysm causes a stroke. Signs and symptoms can include a sudden, extremely severe headache, nausea, vomiting, stiff neck, sudden weakness in an area of the body, sudden difficulty speaking, and even loss of consciousness, coma, or death. The danger of a cerebral aneurysm depends on its size and location in the brain, whether it leaks or ruptures, and the person’s age and overall health.

Peripheral aneurysm

Aneurysms that occur in arteries other than the aorta (and not in the brain) are called peripheral aneurysms. Common locations for peripheral aneurysms include the artery that runs down the back of the thigh behind the knee (popliteal artery), the main artery in the groin (femoral artery), and the main artery in the neck (carotid artery).

Peripheral aneurysms are not as likely to rupture as aortic aneurysms, but blood clots can form in peripheral aneurysms. If a blood clot breaks away from the aneurysm, it can block blood flow through the artery. If a peripheral aneurysm is large, it can press on a nearby nerve or vein and cause pain, numbness, or swelling.

Who is at risk for an aneurysm?

Populations affected

Men are 5 to 10 times more likely than women to have an abdominal aortic aneurysm (AAA) – the most common type of aneurysm.

The risk of AAA increases as you get older, and it is more likely to occur in people between the ages of 60 to 80. A peripheral aneurysm also is more likely to affect people ages 60 to 80. Cerebral (brain) aneurysms, though rare, are more likely to occur in people ages 35 to 60.

Risk factors

Factors that increase your risk for aneurysm include:

Atherosclerosis, a buildup of fatty deposits in the arteries.

Smoking. You are eight times more likely to develop an aneurysm if you smoke.

Overweight or Obesity.

A family history of aortic aneurysm, heart disease, or other diseases of the arteries.

Certain diseases that can weaken the wall of the aorta, such as:

Marfan syndrome (an inherited disease in which tissues don’t develop normally)

Untreated syphilis (a very rare cause today)

Tuberculosis (also a very rare cause today)

Trauma such as a blow to the chest in a car accident.

Severe and persistent high blood pressure between the ages of 35 and 60. This increases the risk for a cerebral aneurysm.

Use of stimulant drugs such as cocaine.

Signs and symptoms of an aneurysm

The signs and symptoms of an aneurysm depend on its type, location, and whether it has ruptured or is interfering with other structures in the body. Aneurysms can develop and grow for years without causing any signs or symptoms. It is often not until an aneurysm ruptures or grows large enough to press on nearby parts of the body or block blood flow that it produces any signs or symptoms.

Abdominal aortic aneurysm

Most abdominal aortic aneurysms (AAAs) develop slowly over years and have no signs or symptoms until (or if) they rupture. Sometimes, a doctor can feel a pulsating mass while examining a patient's abdomen. When symptoms are present, they can include:

Deep penetrating pain in your back or the side of your abdomen

Steady gnawing pain in your abdomen that lasts for hours or days at a time

Coldness, numbness, or tingling in your feet due to blocked blood flow in your legs

If an AAA ruptures, symptoms can include sudden, severe pain in your lower abdomen and back; nausea and vomiting; clammy, sweaty skin; lightheadedness; and a rapid heart rate when standing up. Internal bleeding from a ruptured AAA can send you into shock. Shock is a life-threatening condition in which the organs of the body do not get enough blood flow.

Thoracic aortic aneurysm

A thoracic (chest) aortic aneurysm may have no symptoms until the aneurysm begins to leak or grow. Signs or symptoms may include:

Pain in your jaw, neck, upper back (or other part of your back), or chest

Coughing, hoarseness, or trouble breathing

Cerebral aneurysm

If a cerebral (brain) aneurysm presses on nerves in your brain, it can cause signs and symptoms. These can include:

A droopy eyelid

Double vision or other changes in vision

Pain above or behind the eye

A dilated pupil

Numbness or weakness on one side of the face or body

If a cerebral aneurysm ruptures, symptoms can include a sudden, severe headache, nausea and vomiting, stiff neck, loss of consciousness, and signs of a stroke. Signs of a stroke are similar to those listed above for cerebral aneurysm, but they usually come on suddenly and are more severe. Any of these symptoms require immediate medical attention.

Peripheral aneurysm

Signs and symptoms of peripheral aneurysm may include:

A pulsating lump that can be felt in your neck, arm, or leg

Leg or arm pain, or cramping with exercise

Painful sores on toes or fingers

Gangrene (tissue death) from severely blocked blood flow in your limbs

An aneurysm in the popliteal artery (behind the knee) can compress nerves and cause pain, weakness, and numbness in your knee and leg.

Blood clots can form in peripheral aneurysms. If a clot breaks loose and travels through the bloodstream, it can lodge in your arm, leg, or brain and block the artery. An aneurysm in your neck can block the artery to the brain and cause a stroke.

Diagnosis

An aneurysm may be found by chance during a routine physical exam. More often, an aneurysm is found by chance during an X-ray, ultrasound, or computed tomography (CT) scan performed for another reason, such as chest or abdominal pain.

If you have an abdominal aortic aneurysm (AAA), the doctor may feel a pulsating mass in your abdomen. A rapidly growing aneurysm about to rupture can be tender and very painful when pressed. If you are overweight or obese, it may be difficult for your doctor to feel even a large abdominal aneurysm.

If you have an AAA, your doctor may hear rushing blood flow instead of the normal whooshing sound when listening to your abdomen with a stethoscope.

Specialists involved

You may be referred to a cardiothoracic surgeon, vascular surgeon, or neurosurgeon for diagnosis and treatment of an aneurysm. A cardiothoracic surgeon performs surgery on the heart, lungs, and other organs and structures in the chest, including the aorta. A vascular surgeon performs surgery on the abdominal aorta and on the peripheral arteries. A neurosurgeon performs surgery on the brain, including the arteries in the head, and on the spine and nerves.

Diagnostic tests and procedures

To diagnose and evaluate an aneurysm, one or more of the following tests or procedures may be performed:

Chest X-Ray. A chest X-ray provides a picture of the organs and structures inside the chest, including the heart, lungs, and blood vessels.

Ultrasound. This simple and painless test uses sound waves to create a picture of the inside of the body. It shows the size of an aneurysm, if one is detected. The ultrasound scan may be repeated every few months to see how quickly an aneurysm is growing.

CT Scan. A CT scan provides computer-generated, X-ray images of the internal organs. A CT scan may be performed if the doctor suspects a TAA or AAA. A liquid dye that can be seen on an X-ray is injected into an arm vein to outline the aorta or artery on the CT scan. The CT scan images can be used to determine the size and shape of an abdominal aneurysm more accurately than an ultrasound.

MRI. MRI uses magnets and radio waves to create images of the inside of the body. It is very accurate in detecting aneurysms and determining their size and exact location.

Angiography. Angiography also uses a special dye injected into the blood stream to make the insides of arteries show up on X-ray pictures. An angiogram shows the amount of damage and blockage in blood vessels.

Aortogram. An aortogram is an angiogram of the aorta. It may show the location and size of an aortic aneurysm, and the arteries of the aorta that are involved.

Treatment

Some aneurysms, mainly small ones that are not causing pain, can be treated with "watchful waiting." Others need to be treated to prevent growth and complications. The goals of treatment are to prevent the aneurysm from growing, prevent or reverse damage to other body structures, prevent or treat a rupture, and to allow you to continue to participate in normal daily activities.

Treatment options

Medicine and surgery are the two types of treatment for an aneurysm. Medicines may be prescribed before surgery or instead of surgery. Medicines are used to reduce pressure, relax blood vessels, and reduce the risk of rupture. Beta blockers and calcium channel blockers are the medicines most commonly used.

Surgery may be recommended if an aneurysm is large and likely to rupture.

Treatment by type of aneurysm

Aortic aneurysm

Experts recommend that men who have ever smoked (at least 100 cigarettes in their lifetime) and are between the ages of 65 and 75 should have an ultrasound screening to check for abdominal aortic aneurysms.

Treatment recommendations for aortic aneurysms are based on the size of the aneurysm. Small aneurysms found early can be treated with “watchful waiting.”

If the diameter of the aorta is small – less than 3 centimeters (cm) – and there are no symptoms, “watchful waiting” and a followup screening in 5 to 10 years may be all that is needed, as determined by the doctor.

If the aorta is between 3 and 4 cm in diameter, the patient should return to the doctor every year for an ultrasound to see if the aneurysm has grown.

If the aorta is between 4 and 4.5 cm, testing should be repeated every 6 months.

If the aorta is larger than 5 cm (2 inches around or about the size of a lemon) or growing more than 1 cm per year, surgery should be considered as soon as possible.

Two main types of surgery to repair aortic aneurysms are open abdominal or open chest repair and endovascular repair.

The traditional and most common type of surgery for aortic aneurysms is open abdominal or open chest repair. It involves a major incision in the abdomen or chest. General anesthesia is needed with this procedure.

The aneurysm is removed and the section of aorta is replaced with an artificial graft made of material such as Dacron® or Teflon®. The surgery takes 3 to 6 hours, and the patient remains in the hospital for 5 to 8 days. It often takes a month to recover from open abdominal or open chest surgery and return to full activity. Open abdominal and chest surgeries have been performed for 50 years. More than 90 percent of patients make a full recovery.

In endovascular repair, the aneurysm is not removed, but a graft is inserted into the aorta to strengthen it. This type of surgery is performed through catheters (tubes) inserted into the arteries; it does not require surgically opening the chest or abdomen.

To perform endovascular repair, the doctor first inserts a catheter into an artery in the groin (upper thigh) and threads it up to the area of the aneurysm. Then, watching on X-ray, the surgeon threads the graft (also called a stent graft) into the aorta to the aneurysm. The graft is then expanded inside the aorta and fastened in place to form a stable channel for blood flow. The graft reinforces the weakened section of the aorta to prevent the aneurysm from rupturing.

Placement of an endovascular stent graft in an aortic aneurysm. In figure A, a catheter is inserted into an artery in the groin (upper thigh). It is then threaded up to the abdominal aorta, and the stent graft is released from the catheter. In figure B, the stent graft allows blood to flow through the aneurysm.

Endovascular repair surgery reduces recovery time to a few days and greatly reduces time in the hospital. The procedure has been used since 1999. Not all aortic aneurysms can be repaired with this procedure. The exact location or size of the aneurysm may prevent the stent graft from being safely or reliably positioned inside the aneurysm.

Cerebral aneurysm

Treatment for cerebral (brain) aneurysms depends on the size and location of the aneurysm, whether it is infected, and whether it has ruptured. A small cerebral aneurysm that hasn’t burst may not need treatment. A large cerebral aneurysm may press against brain tissue, causing a severe headache or impaired vision, and is likely to burst. If the aneurysm ruptures, there will be bleeding into the brain which will cause a stroke. If a cerebral aneurysm becomes infected, it requires immediate medical treatment. Treatment of many cerebral aneurysms, especially large or growing ones, involves surgery, which can be risky depending on the location of the aneurysm.

Peripheral aneurysm

Most peripheral aneurysms have no symptoms, especially if they are small. They seldom rupture.

Treatment of peripheral aneurysms depends on the presence of symptoms, the location of the aneurysm, and whether the blood flow through the artery is blocked. Blood clots can form in a peripheral aneurysm, break loose, and block the artery.

An aneurysm in the back of the knee that is larger than 1 inch in diameter usually requires surgery. An aneurysm in the thigh also is usually repaired with surgery.

How can an aneurysm be prevented?

The best way to prevent an aneurysm is to avoid the risk factors that increase the changes of developing one. To do this, you can:

Quit smoking.

Eat a low-fat, low-cholesterol diet to reduce the buildup of plaque in the arteries. Plaque is a fatty buildup that narrows the arteries.

Control HIGH BLOOD PRESSURE (eating a low-salt diet helps).

Control HIGH CHOLESTEROL.

Get regular physical activity.

Special Cardiac Care with 3D Animation Videos

dr.rufusrajadurai — Tue, 01 Apr 2008 15:09:50 CDT

This page has been made specially for the increasing incidence of Cardio-Vascular Diseases.
The 3D Animation Videos provided here will be very informative in understanding the reason of coronary artery stenosis and the surgical way i.e., the coronary artery stenting of treatment in a very simple way.
FOR DOWNLOADING THE FILES ATTACHED TO THIS PAGE PLEASE SCROLL DOWN TO ATTACHMENTS SECTION.
FOR ANIMATION VIDEO DOWNLOAD PLEASE VISIT THE DOWNLOAD PAGE....

Fever

dr.rufusrajadurai — Tue, 01 Apr 2008 15:08:23 CDT

Fevers are typically indicators of infection or illness. Fevers occur because the body’s immune system is working harder than normal to fight off an illness or an infection. Low grade fevers are considered between 99 and 101 degrees Fahrenheit. High fevers are considered any temperature over 102.5 degrees Fahrenheit. Young children and infants can run a fever if they are simply overdressed as they have not yet been able to regulate their body temperature.

Fevers are the name we give to the body’s internal temperature running higher than normal. Fevers are a symptom and by themselves do not represent a disease. Normal body temperature tends to run around 98.6 degrees Fahrenheit and 37 degrees Celsius. Fevers are often accompanied by sweating, discomfort, flushing of the skin, and warm skin to the touch. Fevers over 104 degrees Fahrenheit, 40 degrees Celsius, require attention which is typically a fever reducing medication such as acetaminophen or ibuprophen to encourage a fever to reduce. Fevers that reach 107 degrees Fahrenheit, 42 degree Celsius, require immediate emergency medical attention. It is rare for humans to survive internal body temperatures much higher than that.

While illness or infections are the primary cause of fevers, other medical factors may cause the body to run a fever. Surgery or physical trauma, infectious diseases like HIV, influenza, Malaria, the common cold, mononucleosis, or gastroenteritis can cause fevers. Immunological diseases like inflammatory bowel disease, lupus, or sarcoidosis are likely to cause random fevers. Tissue destruction has also been known to cause fevers. Tissue destruction includes things such as surgery, injury, crush syndrome, infarction, and cerebral hemorrhage. There is something known as drug fever, wherein the cause of the fever is directly related to medication, a reaction to the medication, or withdrawal from a drug or medication. Diet pills and energy supplements have been shown to cause short term fevers in people after use.

Fevers are usually indicators of some form of infection or other illness. The elderly have a difficult time retaining body heat, thus a low grade fever can be caused by almost any abnormality or change but require medical attention. Children can run fevers if overdressed or even if they have been engaged in vigorous activity, which has nothing to do with illness. Women can run low grade fevers associated with menstruation or even with ovulation. The body temperature fluctuates throughout the day and may fall under the range of a low grade fever even when there is nothing wrong. The body’s temperature runs at the lowest point around 4:00 am. The body tends to run at its highest temperature around 6 pm.

With the exception of high fevers which are 104 degrees Fahrenheit or higher, fevers themselves usually do not need to be treated. Fevers do need to be reduced for patients who already have complications from other illnesses, as fevers tend to put stress on the heart. Elderly patients, patients with metabolic issues, and patients with heart disease should routinely reduce fevers. The causes of fevers typically require treatment. However, fevers can be uncomfortable, especially for young children, and can contribute to dehydration. Fevers which are high enough to be uncomfortable can be treated with a fever reducing medication. A physician should be consulted prior to administering a fever reducing medication if the cause of the fever is being medicated with a different medication to avoid potential drug interactions or over medicating. Most cold and flu medications have fever reducers in their ingredients.

Self care is important when a fever is present. It is important to understand the cause of the fever in order to provide adequate self care. Following physician instructions and drinking ample electrolyte filled fluids to prevent dehydration are the two most important steps in providing self care for a fever.

Since fevers tend to cause discomfort, including a feeling of fatigue, resting the body as it is needed is important when coping with a fever. Applying room temperature damp cloths to the skin can provide relief from the feeling of overheating associated with running a significant fever. The body will tell a patient with a fever what they should be doing. They will be thirsty, thus they should drink. They will be tired and thus they should sleep. Listening to the body is a good way to cope with a fever.

Download

dr.rufusrajadurai — Mon, 31 Mar 2008 13:39:27 CDT

Friends you can download some of the valuable information provided in this page for FREE OF COST.It is strictly for educational purpose only.Please do not misuse the copies.
Kindly scroll down to the attachments below to download the files

Some of our videos in this download section need the codecs of K-Lite Mega Codecs pack of version 3.6.0 or above.so please download the codecs in case if you have problem in playing those videos.

OR
DOWNLOAD FROM HERE
1)click here
2)click here

MANY VIDEO PROVIDED IN OUR WEBSITE CAN BE AVAILABLE ON REQUEST.PLEASE POST A COMMENT FOR THE VIDEO THAT YOU NEED.THE DOWNLOAD LINK WILL BE POSTED SHORTLY...

MORE FREE DOWNLOAD UPDATES ARE COMING SOON.KEEP UPDATED

More Download Links ADDED NEW Scroll down........

DOWNLOAD HIV REPLICATION 3D MEDICAL ANIMATION HERE

some Screen shots

Click Below for Download
http://www.mediafire.com/?6uoixmb2dg1

Download RNA Interference 3D Animation video Here

Some Screen Shots

Click Below For Download
http://www.mediafire.com/?6kme7nuhqtg

Download Pseudomonas Infection Animation Video Here

Some Screen Shots

Click Below For Download
http://www.mediafire.com/?ctzdwxtzugz

DOWNLOAD INTUBATION DURING GENERAL ANESTHESIA ANIMATION VIDEO HERE

Some Screen Shots

Click Below For Download
http://www.mediafire.com/?8ccnojxkz3i

DOWNLOAD HUMAN FERTILISATION VIDEO HERE

Some Screen Shots

Click Below For Download
http://www.mediafire.com/?8jmtyzmxcxs

DOWNLOAD PERCUTANEOUS CORONARY STENTING 3D ANIMATION HERE

Some Screen Shots

Click Below For Download
http://www.mediafire.com/?fxgmg0exmgt

DOWNLOAD ASTHMA 3D ANIMATION HERE

Some Screen Shots

Click Below For Download
http://www.mediafire.com/?dotjhejzjnj

FREE DOWNLOAD-OCCULAR TRAUMA-PRINCIPLES AND PRACTICE-Ferenc Kuhn & Dante J. Pieramici

Screen Shot

Click Below for Download
http://www.mediafire.com/?4mldlsz3ojt

Free Download-ATLAS OF SKELETAL MUSCLES-Robert J. Stone(THIRD EDITION)

Screen shot

Click Below for Download
http://www.mediafire.com/?bzpzxznmz21

FREE DOWNLOAD-Essentials of Anatomy and Physiology-Valerie C. Scanlon & Tina Scanders(FIFTH EDITION)

Screen Shot

Click Below for Download
http://www.mediafire.com/?f7dd2jnyjyh

Free Download-Clinical Neurology-LANGE-David,Michael&Roger(FIFTH Edition)

Screen Shot

Click Below for Download
http://www.mediafire.com/?z2xyvdvm1vg

MEMBERS AREA-Special Offer for free
Download Netter Atlas of Physiology for FREE(BOOK IS IN PDF FILE FORMAT)

Procerdure to Download
1)Register in this Website for FREE
2)Send a mail to the Chief Administrator of this site(Dr.Rufus Rajadurai.M.D.,D.N.S., at :dr.rufusrajadurai@yahoo.com)

3)Receive password by e-mail
4)Click the Download link Below
5)Enter password Provided by e-mail
6)Click Download

DOWNLOAD

Download HARRISONS MANUAL OF MEDICINE-16TH EDITION

Some Screen Shots

Procerdure to Download
1)Register in this Website for FREE
2)Send a mail to the Chief Administrator of this site(Dr.Rufus Rajadurai.M.D.,D.N.S., at :dr.rufusrajadurai@yahoo.com)

3)Receive password by e-mail
4)Click the Download link Below
5)Enter password Provided by e-mail
6)Click Download

DOWNLOAD

Download 12 in 1 ABC collection of Medical e-books for FREE..

Some Screen Shots

BOOKS INCLUDED IN THIS SERIES
1)ABC of AIDS
2)ABC of ANTENATAL CARE
3)ABC of ANTITHROMBOTIC THERAPY
4)ABC of COLORECTAL CANCER
5)ABC of DERMATOLOGY
6)ABC of DIABETES
7)ABC of LEARNING AND TEACHING IN MEDICINE
8)ABC of LIVER,PANCREAS AND GALL BLADDER
9)ABC of NUTRITION
10)ABC of OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
11)ABC of PSYCHOLOGICAL MEDICINE
12)ABC of THE FIRST YEAR

Procerdure to Download
1)Register in this Website for FREE
2)Send a mail to the Chief Administrator of this site(Dr.Rufus Rajadurai.M.D.,D.N.S., at :dr.rufusrajadurai@yahoo.com)

3)Receive password by e-mail
4)Click the Download link Below
5)Enter password Provided by e-mail
6)Click Download
DOWNLOAD

Download ABC OF DERMATOLOGY BOOK Here

Some screen shots

Click Here For FREE Download
http://www.mediafire.com/?90ig5dnxe70

Download Urolithiasis.ppt here
DOWNLOAD

Download Urinary Tract Infections.ppt Here
DOWNLOAD

Download Back Pain.pps for free Here
DOWNLOAD

Download How to perform Injection.doc Here
DOWNLOAD

Download improper computer usage and it's effects and the method to overcome the effects Here
DOWNLOAD

Copyright Disclaimer:
Contents of this page are from the Internet, the copyright belongs to the original page. Check the original page for copyright statement. All actions are under your responsability, please delete them after 24 hours or purchase it. Email us to report illegal contents.

Weight Loss

dr.rufusrajadurai — Mon, 31 Mar 2008 12:48:14 CDT

Weight loss is invariably American’s number one personal goal. As an overweight society, weight loss has become one of the biggest industries in the United States. Other countries, while they do have a small percentage of overweight people, do not have even 50% of the United States struggle with weight loss. Weight loss can, however, be an unintentional and unexplained phenomenon. Unintentional weight loss should be reviewed by a physician as it can be a sign of serious illness.

Weight loss is typically recommended for people who are 20 or more pounds overweight. Being overweight can lead to diabetes, heart attack, stroke, early death, and complicate pregnancy. Those who are significantly overweight complain of joint and foot pain, foot disfigurement from an inability to find proper shoes, and chronic fatigue.

Weight problems can have various contributing factors, most of which has to do with lifestyle and the ability to make healthy choices. Snack foods, preprocessed foods, and candy are all contributors of weight problems. While it is true that thyroid problems can contribute to obesity, thyroid problems can be medicated. Some prescription medications cause significant weight gain such as prednisone, and other medications such as antidepressants.

The majority of obese people are victims of diet. Eating too much, having little to no education on what the food groups are and how they impact weight, and making chronically poor choices are often issues that are handed down from one generation to another. Children who come from obese households run a very high risk of becoming obese themselves.

Often doctors will encourage overweight patients to lose weight. Weight indicator charts allow both physicians and patients see exactly where a patient’s body weight should be by figuring in their age and height.

Overweight people are at risk for complications regarding their overall health. Heart attacks and strokes lead the list, but other complications exist such as kidney problems, joint problems, breathing problems, and breast problems in women. Underweight people are at risk for serious health issues as well, including osteoporosis, the inability to fight infection, the inability to regulate body temperature, and even death.

Obese treatments vary, and most doctors still insist that the absolute best way to fight obesity is to reduce caloric intake and increase caloric output. Burning more calories than a person puts in invariably leads to weight loss. While the media has barraged television and magazine viewers with magic diet pills that will peel the pounds off for you, the Mayo Clinic studies have found no conclusive evidence that these pills do anything. Weight loss supplements, drinks, prepackaged foods, workout DVDs, surgically reducing the size of the stomach, and weight loss programs are all weight loss ideas that have become part of Americana. Some work reasonably well while others have not been proven to enhance permanent weight loss. Anything that promotes the burning of energy such as exercise DVDs has potential. Prepackaged weight loss meals teach people how to make better choices, and group programs help people stay in the program.

Unintentional weight loss may be the result of an illness or depression. Diagnosing the problem is the key to stopping the weight loss and encouraging healthy body weight. Unintentional weight loss that can be attributed to lack of appetite may be caused by medication. Many people who have lost weight unintentionally do not wish to gain the weight back.

Losing weight is a struggle, and patients need to be motivated in order to be successful. They need to stop believing the media hype that promises weight loss of unreasonable weight in very short amounts of time. Dropping too much weight in a short time is not healthy. Real weight loss comes from a dedicated effort to chronically make healthy food choices and exercising regularly. Patients need to set reasonable goals for themselves and ask for their physician’s assistance in the best weight loss program for them.

Underweight individuals need to recognize that they are unhealthy and learn to manage their weight issues with more care, without just eating high calorie, high fat foods.

Coping with weight issues can be a chronic lifetime struggle. Every time the patient exercises and makes good choices, they are winning the battle. Every time they can see the results on a scale or when they put their clothes on, they receive positive feedback. Positive feedback reinforces the positive behavior.

Our Daily Habits and it's Influence on Health

dr.rufusrajadurai — Sun, 30 Mar 2008 15:17:54 CDT

BRAIN DAMAGING HABITS

1. No Breakfast
People who do not take breakfast are going to have a lower blood sugar level. This leads to an insufficient supply of nutrients to the brain causing brain degeneration.

2. Overeating
It causes hardening of the brain arteries, leading to a decrease in mental power.

3. Smoking
It causes multiple brain shrinkage and may lead to Alzheimer disease.

4. High Sugar consumption
Too much sugar will interrupt the absorption of proteins and nutrients causing malnutrition and may interfere with brain development.

5. Air Pollution
The brain is the largest oxygen consumer in our body. Inhaling polluted air decreases the supply of oxygen to the brain, bringing about a decrease in brain efficiency.

6. Sleep Deprivation
Sleep allows our brain to rest. Long term deprivation from sleep will accelerate the death of brain cells.

7. Head covered while sleeping
Sleeping with the head covered, increases the concentration of carbon dioxide and decrease concentration of oxygen that may lead to brain damaging effects.

8. Working your brain during illness
Working hard or studying with sickness may lead to a decrease in effectiveness of the brain as well as damage the brain.

9. Lacking in stimulating thoughts
Thinking is the best way to train our brain, lacking in brain stimulation thoughts may cause brain shrinkage.

10. Talking Rarely
Intellectual conversations will promote the efficiency of the brain

LIVER DAMAGING HABITS

1. Sleeping too late and waking up too late are main cause.
2. Not urinating in the morning.
3. Too much eating.
4. Skipping breakfast.
5. Consuming too much medication.
6. Consuming too much preservatives, additives, food coloring, and artificial sweetener.
7. Consuming unhealthy cooking oil. As much as possible reduce cooking oil use when frying, which includes even the best cooking oils like olive oil. Do not consume fried foods when you are tired, except if the body is very fit.
8. Consuming raw (overly done) foods also add to the burden of liver. Veggies should be eaten raw or cooked 3-5 parts. Fried veggies should be finished in one sitting, do not store.

We should prevent this without necessarily spending more. We just have to adopt a good daily lifestyle and eating habits. Maintaining good eating habits and time condition are very important for our bodies to absorb and get rid of unnecessary chemicals according to "schedule."

Because

Evening at 9 – 11am: is the time for eliminating unnecessary/ toxic chemicals (detoxification) from the antibody system (lymph nodes). This time duration should be spent by relaxing or listening to music. If during this time a housewife is still in an unrelaxed state such as washing the dishes or monitoring children doing their homework, this will have a negative impact on health.

Evening at 11pm - 1 am: is the detoxification process in the liver, and ideally should be done in a deep sleep state.

Early morning 1 - 3 am: detoxification process in the gall, also ideally done in a deep sleep state.

Early morning 3 - 5 am: detoxification in the lungs. Therefore there will sometimes be a severe cough for cough sufferers during this time. Since the detoxification process had reached the respiratory tract, there is no need to take cough medicine so as not to interfere with toxin removal process.

Morning 5 - 7am: detoxification in the colon, you should empty your bowel.

Morning 7 - 9 am: absorption of nutrients in the small intestine, you should be having breakfast at this time. Breakfast should be earlier, before 6:30 am, for those who are sick. Breakfast before 7:30 am is very beneficial to those wanting to stay fit. Those who always skip breakfast, they should change their habits, and it is still better to eat breakfast late until 9 - 10 am rather than no meal at all.

Sleeping so late and waking up too late will disrupt the process of removing unnecessary chemicals. Aside from that, midnight to 4:00 am is the time when the bone marrow produces blood. Therefore, have a good sleep and don't sleep late.

DO TAKE CARE ABOUT YOUR HEALTH...... ......... ..