#totally routine because i have an elevated risk of breast cancer

[disgruntledkittenface]

🔪

[garden-of-everything]

ABIM: Oncology

ABIM syllabus can be found here Let me know if you find any errors Sources: UWorld, MKSAP 16/17, Rizk Review Course, Louisville Lectures, Knowmedge (free version)

Lung cancer (clinical presentation and diagnosis)

Small cell:  associated with hyponatremia/SIADH, Lambert Eaton (like MG but fatiguable); Tx: chemotherapy + whole brain radiation if good response to chemo Non-small cell:  CT/PET, MRI brain –> Tx: stage I - surgical, stage II - surgery + chemo, stage III - chemo + XRT +/- surgery, stage IV - chemotherapy alone (1)  Squamous cell carcinoma:  associated with smoking, hypercalcemia, Pancoast tumors (cause Horner’s: ptosis, miosis, anhydrosis) (2)  Adenocarcinoma:  not associated with smoking (3)  Large cell carcinoma:  associated with SVC syndrome (4)  Bronchogenic carcinoma:  associated with cluster of painless, firm/hard cutaneous metastases *AE of chest XRT is CAD

Breast Cancer

- Screening:  mammogram >50yo or >35 with high risk * if palpable mass:  ALWAYS BIOPSY (even if not seen by mammo) * if in situ –> no need for LN biopsy * if positive LN –> axillary LN dissection (AE: UE lymphedema) *if >1cm or LN+: give adjuvant chemo * do NOT perform mastectomy if metastized * if mastectomy, add XRT if: (1) dermal invasion, (2) close margins, (3) 4+ LNs - Dx:  mammogram/US –> Bx –> ER/PR/Her2neu status - DCIS Tx: lumpectomy + local rads = simple mastectomy (for tumor >5cm) +/- if ER/PR+ –> 5 years of hormonal therapy (1) premenopausal: Tamoxifen (SERM; AE: clots, endometrial cancer), (2) postmenopausal: Anastrazole/Letrozole (AI) +/- if Her2neu+ –> get an ECHO to ensure good heart function, give Trastuzumab (- LCIS Tx: observe or b/l mastectomy (won’t be tested because controversial)

Neoplasm of the head and neck

Thyroid nodules and thyroid cancer: (1) Medullary thyroid cancer: associated with both MEN II syndromes, RET gene; elevated calcitonin –> hypercalcemia; Tx: surgical neck dissection (2) Papillary thyroid cancer:  aggressive, associated with BRAF (like melanoma); Tx: surgery + radioiodine (3) Follicular:  Tx: surgery + radioiodine (4) Anaplastic:  very poor prognosis

Gastrointestinal or hepatic cancer

Stomach cancer:   - Dx: upper endoscopy with ultrasound > CT scan - Tx: surgery, chemo, XRT - MALT lymphoma:  Tx: PPI and H.pylori Abx Colorectal cancer: - Tx: stage 1-2: resect, III: resect + chemo, IV: FOLFOX chemo +/- resect + Bevacizumab - f/u with CEA Q3-6mo for 2 years, then Q6months for 3 years - f/u with CT chest/ab/pelvis every year for 3 years - f/u with colonoscopy 1, 3, and 5 years post-treatment - Rectal cancer: Tx stage II-III: (1) chemo/XRT –> surgery or (2) surgery –> chemo Pancreatic carcinoma other than pancreatic endocrine tumors: - Trousseau venous thrombophlebitis (migratory VTEs), jaundice, palpable GB - stage I (pancreas) Tx: resection - stage II (duodenum) - stage III (LN) - stage IV (other mets) Tx: Gemcitabine *confused for autoimmune pancreatitis (because of mass); differentiate with biopsy; AIP has elevated IgG Hepatocellular carcinoma: - associated with Hep C > chronic Hep B - if nodule <1cm needs screening abdominal US Q6mo –> if >1cm: contrast CT/MRI liver (arterial phase enhancement) - if AFP>100, don’t have to biopsy –> Tx: resection / liver transplant > EtOH/radioablation > chemotherapy/Sorafenib Other CT abdomen findings: (1) Cavernous hemangioma: early peripheral nodular enhancement with delay in filling from periphery to center; don’t have to treat (2) Hepatic adenoma: associated with OCPs; early rapid loss of enhancement –> resect (3)  Focal nodular hyperplasia:  central stellate scar –> don’t have to treat

Urologic cancer

Renal clear cell carcinoma:   - presents as upper abdominal mass with hematuria; erythrocytosis (elevated Hb), hypercalcemia, and acute varicocele - associated with von-Hippel Lindau (retinal and cerebellar hemangioblastomas and RCC) - Dx: CT ab, pulmonary “cannonball” nodules/mets on CXR, if bone pain: elevated ALP - Tx: nephrectomy Transitional cell carcinoma: - painless hematuria - Dx: cystoscopy - Tx: TURBT –> intravesicular BCG; if muscle invasion: radical cystectomy Prostate cancer: - Dx: exam with elevated PSA –> transrectal US-guided prostate Bx - Gleason >7, PSA >15, large tumor or bone pain –> bone scan and CT ab/pelvis - penetrates prostate capsule Tx: XRT –> f/u PSA and rectal exam Q6-12mo - LN involvement/mets/elevated serum acid phosphatase Tx:  total hormonal ablation with 4-6mo Leuprolide (LHRH agonist to be given with antiandrogen Flutamide to prevent tumor flare)/Goserelin –> refractory: Docetaxel Testicular cancer: (1) Non-seminoma (embryonal, teratoma, choriocarcinoma): elevated AFP, hCG; Dx/Tx: inguinal orchiectomy (DO NOT BIOPSY) +/- chemo if spread (2) Seminoma: elevated hCG; Tx: radiation; if disseminated: platinum-chemo

Gynecologic cancer

Ovarian cancer: - may present with bleeding, dyspareunia, ascites (SAAG <1.1, ascites protein >2.5), peritoneal carcinomatosis - associated with HNPCC, infertility, early menarche, late menopause - Dx: pelvic U/S –> stage with ex-lap - Tx: stage I = surgery; stage II-IV: platinum-based chemo –> follow with pelvic exa, and CA-125 Q2-4mo for 2 years (do NOT need routine US) * if BRCA1 or 2+ –> offer oophorectomy at 35yo or after child-bearing * Dermatomyositis (anti-Jo1) is associated with ovarian cancer –> TVUS Endometrial cancer: - Dx: with biopsy - Tx: surgical resection of cervix/uterus/adnexa + XRT +/- chemotherapy; if high risk surgical patient, XRT only Cervical cancer: - Dx: punch bx or colposcopy bx - stage I Tx: LOOP/conization or if finished babies, hysterectomy WITHOUT dissection - stage II-IV Tx: XRT + cisplatin

CNS tumors

GBM: most common and aggressive adult intraparenchymal tumor - ring-enhancing with central necrosis and hemorrhage Meningioma: most common primary brain tumor (extraparenchymal, extradural) - insidious diffusely enhancing, partially calcified +/- dural tail; Tx: observe or surgery if symptomatic Oligodendroglioma:  rare, MRI = non-enhancing homogeneous intraparenchymal lesion Schwannoma: benign nerve sheath tumor ~CNVIII (hearing loss/tinnitus) - MRI shows enhancing lesion at cerebellopontine angle vs. Pseudotumor cerebri:  headaches worse in the morning + papilledema and visual changes in an obese person on Accutane - Dx: CT/MRI to r/o tumor and dural venous sinus, LP shows elevated ICP - Tx: Acetazolamide, repeat lumbar puncture –> if progressive visual loss: neurosurgery

Skin cancer

Squamous cell carcinoma:  preceded by actinic keratosis Basal cell carcinoma: raised pearlescent with telangiectasia Melanoma: Dx: wide excision + if >1mm deep, sentinel LN biopsy; additionally treat with IFN if >4mm or +LN

Hematologic malignancies (see ABIM: Hematology)

Assorted endocrine tumors and endocrine manifestations of tumors (see ABIM: Endocrine)

Malignancy associated hypercalcemia: (1) squamous cell (2) RCC (3) medullary thyroid cancer (elevated calcitonin)

Oncologic emergencies

SVC Syndrome :  associated with large cell NSCLC - Dx: biopsy tissue > mediastinoscopy/thoracotomy - if previously untreated: give chemo - if previously treated: XRT +/- chemo Fever and neutropenia: - Tx: with broad spec Pseudomonal abx (Cefepime) until PMN>500 - if no improvement in 2 days, add Vanc - if no improvement in 5 days, add Itraconazole Spinal cord tumors and compression: - Dx: Gad-enhanced MRI - Tx: steroids, surgery, XRT Cardiac tamponade from neoplastic pericarditis: - JVD, tachycardia, pulsus paradoxus - Tx: pericardiocentesis Tumor lysis syndrome: - elevated uric acid, potassium, phosphate - N/V/D, heart failure, seizures, syncope, death - PPx: Allopurinol, Rasburicase Hypercalcemia  - elevated Ca, decreased PTH, normal/decreased Vit D3 and Phos - Tx: NS Hyponatremia (SIADH): - associated with small cell - Tx: fluid restrict or if symptomatic, Na<120: 3% Saline + Lasix

Complications of cancer and its treatment

- give Morphine –> translate it to long-acting forms - Palliative O2 not helpful in absence of hypoxemia - Radiation toxicity: CAD, hypothyroidism, lung disease; breast, lung, esophageal cancer - Toxicity bear (borrowed from my Step 1 notes - Second Aid): –> Asparagine: neurotoxicityCisplatin:  ototoxic/nephrotoxic; Tx: Amifostine –> Vincristine/Vinblastine:  "Christ my nerves, Blast my bones" - Vincristine = peripheral neuropathy - Vinblastine = myelosuppression –> Bleomycin: pulmonary fibrosis –> Doxorubicin: cardiotoxic; Tx; Dexrozoxane (for cardiotoxicity), Dimethyl-sulphoxide (for ROS ulcers) –> Cyclophosphamide:  Acrolein = nephro/bladder toxic (Tx: Mesna); also SIADH effects (Tx: Demeclocycline) –> Methotrexate: nephrotoxic (Tx: Leucovorin), myelosuppression (Tx; Filgrastim)

Cancer of unknown primary

- axillary LN? –> biopsy comes back adenocarcinoma –> mammogram –>if neg: MRI breast - high cervical LN? –> PET/CT scan of head and neck - osteoblastic mets? –> PSA test for prostate adenocarcinoma - ascites, peritoneal carcinomatosis? –> ovarian cancer, Dx: ex-lap - young woman with retroperitoneal poorly differentiated mass? –> germ cell cancer; Tx: platinum chemo

Cancer screening (see ABIM: Screening)

[timclymer]

Tomorrow I Am Going To Do Something About My Cholesterol

If you’ve said that you’ve like many other Americans who share a concern about the risk of coronary heart disease. But if you’ve never quite gotten around to doing something about it, keep reading. You’ll find answer to some of the most common questions that people have about cholesterol, and what you can do to control it. Happily, you’ll find that taking control of cholesterol is a lot easier and better tasting than you thought!

Why is cholesterol suddenly such a big deal?

If you’ve noticed that cholesterol has received increased attention over the past few decades, you’re right. In 1985, the National Heart, Lung, and Blood Institute of the National Institutes of Health launched the National Cholesterol Education Program (NCEP). The program’s goal is the reduction of illness and death from coronary heart disease (CHD) by reducing the number of Americans with high blood cholesterol. The impetus behind the NCEP was smoking-gun evidence that lowering high blood cholesterol reduced the risk of coronary heart disease. As a matter of fact, a one-percent decrease in cholesterol yields a two-percent decrease in the chance of a heart attack!

Surveys also indicated that neither doctors nor the general public were adequately informed about the relationship between cholesterol and CHD. This led to an aggressive strategy of public and professional education. So yes, you have been hearing more about cholesterol, because there’s a lot more to hear.

What is coronary heart disease?

Over time, cholesterol as well as other blood born substances deposits themselves on the interior walls of the coronary arteries. When this build-up restricts the flow of blood through the arteries, too little oxygen reaches the heart. At best, CHD victims suffering chest pain (angina); at worst, a deadly heart attack – the kind that accounts for 30 percent of nearly two million deaths in the United States each year.

While elevated levels of blood cholesterol seriously increase a person’s risk of CHD, tacking on smoking and high blood pressure, the other main risk factors, multiplies that risk.

How many Americans have high cholesterol?

The American Medical Association published these figures based on NCEP estimates: Thirty-six percent of Americans have cholesterol levels that are high enough to warrant being under the care of a physician. About 102 million Americans ages 20 years and older are candidates for medical advice and intervention for high levels of blood cholesterol.

On top of that, there are millions more who should take immediate steps to bring their blood cholesterol levels into the “desirable” range.

In other words, if your cholesterol level could stand some tinkering, you’ve got something in common with better than one-out-of-every-two Americans!

What role does age play?

If you are between the ages of 20 and 39, the likelihood is one-in-five that your cholesterol level is too high. That rate jumps to one-in-two between the ages of 40 and 59. Over the age of 60, there’s a 60-percent chance that you have a problem.

Should you be screened for high cholesterol?

If you’re over the age of 20 you should! The NCEP suggests that you have the test done at least once every five years.

Your initial evaluation will determine your total cholesterol level and assess risk factors such as cigarette smoking, blood pressure and your personal as well as family health history. Often, cholesterol screening is carried out during the course of a routine physical examination, but advances in finger-stick testing procedures (where the finger is pricked in order to draw a minute quantity of blood) make widespread initial screening in non-clinical settings a practical and convenient alternative. Borderline-high or high levels of blood cholesterol found using the finger-stick method should be confirmed by your family physician.

The important thing is that you know your cholesterol level. Blood cholesterol is measured in milligrams per decilitre (mg / dl). Levels below 200 mg / dl are classified as “desirable blood cholesterol,” those between 200 and 239 mg / dl are “borderline-high blood cholesterol” and above 240 mg / dl are “high blood cholesterol.” At 200 and above, the risk of CHD steadily increases.

In general, the NCEP recommends that persons with blood cholesterol levels between 200 and 239 mg / dl adopt heart-healthy diet habits and be retested annually. If additional risk factors are present, further testing will be required.

Persons with blood cholesterol levels above 240 mg / dl should have additional testing to determine a course of treatment in order to lower their blood cholesterol level.

Should children be screened?

The American Academy of Pediatrics Committee on Nutrition believes that children with family histories of either early CHD or high cholesterol should be evaluated. “Early” means prior to the age of 50 in men and 60 in women.

For a variety of reasons, the Academy does not believe in universal testing for children, but its view is not shared by all. Cory Servaas, MD, Director of the Children’s Better Health Institute, says that between 20 and 30 percent of the children under the age of 12 that her organization tests “have cholesterol levels higher than we think they should be … 180 mg / dl . ” And she adds: “Since the screen test is inexpensive and easy to do, why not do it? Often we do not know what the family history is in order to know if a child should be tested.”

Is there really ‘good’ and 'bad’ cholesterol?

Absolutely! But first, it’s important to understand that everyone, regardless of age, needs cholesterol. It’s vital for the formation of cell membranes and for the manufacture of bile acids. It’s also the chemical precursor of hormones such as progesterone, testosterone and estrogen. All cells in the body can manufacture cholesterol – 80 percent is produced by the liver – and there is no known physiological reason to supplement the body’s own cholesterol with dietary cholesterol.

In order for cholesterol to get from where it is manufactured – in the liver, for example – to where it is needed to support metabolism, it is transported as a lipoprotein. (Lipoprotein are substances that allow insoluble fats like cholesterol to travel around in water-based blood.) Low density lipoproteins (LDLs) carry cholesterol outbound from where it is manufactured, while high density lipoproteins (HDLs) transport it to the liver. At this point, the cholesterol can either be metabolized further, or passed into the intestine for elimination. Because HDLs limit the amount of cholesterol in the blood, they provide protection against dangerously high cholesterol levels. High levels of HDLs have been associated with a lower incidence of CHD.

If your cholesterol tests in the “high” range, or if you are “borderline-high” with additional CHD risk factors, your physician will do additional tests to establish the relationship of LDLs to HDLs.

What can you do to maintain a heart-healthy diet?

You do not have to be a professional dietitian, or eat a boring diet in order to reduce or maintain a desirable cholesterol level. You also do not have to carry a calculator around in order to add up milligrams of this or that. What you do need to know are some basic principles.

Eat less fat! There are three types of fat: saturated, polyunsaturated and monounsaturated. A heart-healthy diet requires that you reduce your consumption of saturated fats.

They’re found in meat and dairy products, as well as in commercially prepared baked goods made with coconut oil, and cocoa fat. Read the labels!

Instead of eating foods high in saturated fats, shift your emphasis towards complex carbohydrates (whole grains, fruits and vegetables), seafood and poultry sans skin. If you do eat meats select lean cuts and remove as much of the fat as possible before cooking. By cutting back on fat, you’ll also dramatically reduce calories, since fat contains twice as many calories as protein or carbohydrates.

Substitute polyunsaturated and monounsaturated fats for those that are saturated. Polyunsaturated and monounsaturated fats can actually help you to reduce your cholesterol. And recent studies conducted at the Department of Medicine, University of California, San Diego, indicate that monounsaturated fats lower LDL (bad cholesterol) levels while leaving HDL (good cholesterol) levels intact. Canola oil is a wonderful source of monounsaturated fat. It’s one of the principal cooking oils in Japan, a country widely regarded for its low rate of heart disease.

Reduce dietary cholesterol. Avoid organ meats altogether and eat fewer egg yolks.

Increase dietary fiber. Never before has fibre been easier to introduce into your diet. Letely we’ve been hearing a great deal about oat bran as a source of fiber, and for good reason. Studies indicate that oat bran, when ate regularly, can reduce cholesterol by up to 19%.

Exercise! Exercise has shown to reduce the risk of CHD by increasing level of good cholesterol HDLs in the blood.

Stop Smoking! Exercise raises HDL levels, but smoking reduces them. Smokers run an added risk of CHD.

Do school lunch programs support heart-healthy diet standards?

Jayne Newmark, national spokesperson for the American Dietary Association, cautions that school lunch programs are self-supporting, and therefore, sell foods that kids are most apt to buy. Today we see a lot of hamburgers and French fries because that’s what kids like. into the curriculum. But education really starts at home and it can not begin too soon, “says Newmark.

What are the additional benefits of a heart-healthy diet?

A high-fat and low-fiber diet has been linked to cancers of the colon and breast, as well as to diverticular disease, stroke, diabetes, high blood pressure and even osteoporosis. And if that is not enough, there’s always obesity to appeal to the vanity in us all.

Source by Andy G

from Home Solutions Forev https://homesolutionsforev.com/tomorrow-i-am-going-to-do-something-about-my-cholesterol/ via Home Solutions on WordPress from Home Solutions FOREV https://homesolutionsforev.tumblr.com/post/185093361930 via Tim Clymer on Wordpress

[homesolutionsforev]

Tomorrow I Am Going To Do Something About My Cholesterol

If you've said that you've like many other Americans who share a concern about the risk of coronary heart disease. But if you've never quite gotten around to doing something about it, keep reading. You'll find answer to some of the most common questions that people have about cholesterol, and what you can do to control it. Happily, you'll find that taking control of cholesterol is a lot easier and better tasting than you thought!

Why is cholesterol suddenly such a big deal?

If you've noticed that cholesterol has received increased attention over the past few decades, you're right. In 1985, the National Heart, Lung, and Blood Institute of the National Institutes of Health launched the National Cholesterol Education Program (NCEP). The program's goal is the reduction of illness and death from coronary heart disease (CHD) by reducing the number of Americans with high blood cholesterol. The impetus behind the NCEP was smoking-gun evidence that lowering high blood cholesterol reduced the risk of coronary heart disease. As a matter of fact, a one-percent decrease in cholesterol yields a two-percent decrease in the chance of a heart attack!

Surveys also indicated that neither doctors nor the general public were adequately informed about the relationship between cholesterol and CHD. This led to an aggressive strategy of public and professional education. So yes, you have been hearing more about cholesterol, because there's a lot more to hear.

What is coronary heart disease?

Over time, cholesterol as well as other blood born substances deposits themselves on the interior walls of the coronary arteries. When this build-up restricts the flow of blood through the arteries, too little oxygen reaches the heart. At best, CHD victims suffering chest pain (angina); at worst, a deadly heart attack – the kind that accounts for 30 percent of nearly two million deaths in the United States each year.

While elevated levels of blood cholesterol seriously increase a person's risk of CHD, tacking on smoking and high blood pressure, the other main risk factors, multiplies that risk.

How many Americans have high cholesterol?

The American Medical Association published these figures based on NCEP estimates: Thirty-six percent of Americans have cholesterol levels that are high enough to warrant being under the care of a physician. About 102 million Americans ages 20 years and older are candidates for medical advice and intervention for high levels of blood cholesterol.

On top of that, there are millions more who should take immediate steps to bring their blood cholesterol levels into the "desirable" range.

In other words, if your cholesterol level could stand some tinkering, you've got something in common with better than one-out-of-every-two Americans!

What role does age play?

If you are between the ages of 20 and 39, the likelihood is one-in-five that your cholesterol level is too high. That rate jumps to one-in-two between the ages of 40 and 59. Over the age of 60, there's a 60-percent chance that you have a problem.

Should you be screened for high cholesterol?

If you're over the age of 20 you should! The NCEP suggests that you have the test done at least once every five years.

Your initial evaluation will determine your total cholesterol level and assess risk factors such as cigarette smoking, blood pressure and your personal as well as family health history. Often, cholesterol screening is carried out during the course of a routine physical examination, but advances in finger-stick testing procedures (where the finger is pricked in order to draw a minute quantity of blood) make widespread initial screening in non-clinical settings a practical and convenient alternative. Borderline-high or high levels of blood cholesterol found using the finger-stick method should be confirmed by your family physician.

The important thing is that you know your cholesterol level. Blood cholesterol is measured in milligrams per decilitre (mg / dl). Levels below 200 mg / dl are classified as "desirable blood cholesterol," those between 200 and 239 mg / dl are "borderline-high blood cholesterol" and above 240 mg / dl are "high blood cholesterol." At 200 and above, the risk of CHD steadily increases.

In general, the NCEP recommends that persons with blood cholesterol levels between 200 and 239 mg / dl adopt heart-healthy diet habits and be retested annually. If additional risk factors are present, further testing will be required.

Persons with blood cholesterol levels above 240 mg / dl should have additional testing to determine a course of treatment in order to lower their blood cholesterol level.

Should children be screened?

The American Academy of Pediatrics Committee on Nutrition believes that children with family histories of either early CHD or high cholesterol should be evaluated. "Early" means prior to the age of 50 in men and 60 in women.

For a variety of reasons, the Academy does not believe in universal testing for children, but its view is not shared by all. Cory Servaas, MD, Director of the Children's Better Health Institute, says that between 20 and 30 percent of the children under the age of 12 that her organization tests "have cholesterol levels higher than we think they should be … 180 mg / dl . " And she adds: "Since the screen test is inexpensive and easy to do, why not do it? Often we do not know what the family history is in order to know if a child should be tested."

Is there really 'good' and 'bad' cholesterol?

Absolutely! But first, it's important to understand that everyone, regardless of age, needs cholesterol. It's vital for the formation of cell membranes and for the manufacture of bile acids. It's also the chemical precursor of hormones such as progesterone, testosterone and estrogen. All cells in the body can manufacture cholesterol – 80 percent is produced by the liver – and there is no known physiological reason to supplement the body's own cholesterol with dietary cholesterol.

In order for cholesterol to get from where it is manufactured – in the liver, for example – to where it is needed to support metabolism, it is transported as a lipoprotein. (Lipoprotein are substances that allow insoluble fats like cholesterol to travel around in water-based blood.) Low density lipoproteins (LDLs) carry cholesterol outbound from where it is manufactured, while high density lipoproteins (HDLs) transport it to the liver. At this point, the cholesterol can either be metabolized further, or passed into the intestine for elimination. Because HDLs limit the amount of cholesterol in the blood, they provide protection against dangerously high cholesterol levels. High levels of HDLs have been associated with a lower incidence of CHD.

If your cholesterol tests in the "high" range, or if you are "borderline-high" with additional CHD risk factors, your physician will do additional tests to establish the relationship of LDLs to HDLs.

What can you do to maintain a heart-healthy diet?

You do not have to be a professional dietitian, or eat a boring diet in order to reduce or maintain a desirable cholesterol level. You also do not have to carry a calculator around in order to add up milligrams of this or that. What you do need to know are some basic principles.

Eat less fat! There are three types of fat: saturated, polyunsaturated and monounsaturated. A heart-healthy diet requires that you reduce your consumption of saturated fats.

They're found in meat and dairy products, as well as in commercially prepared baked goods made with coconut oil, and cocoa fat. Read the labels!

Instead of eating foods high in saturated fats, shift your emphasis towards complex carbohydrates (whole grains, fruits and vegetables), seafood and poultry sans skin. If you do eat meats select lean cuts and remove as much of the fat as possible before cooking. By cutting back on fat, you'll also dramatically reduce calories, since fat contains twice as many calories as protein or carbohydrates.

Substitute polyunsaturated and monounsaturated fats for those that are saturated. Polyunsaturated and monounsaturated fats can actually help you to reduce your cholesterol. And recent studies conducted at the Department of Medicine, University of California, San Diego, indicate that monounsaturated fats lower LDL (bad cholesterol) levels while leaving HDL (good cholesterol) levels intact. Canola oil is a wonderful source of monounsaturated fat. It's one of the principal cooking oils in Japan, a country widely regarded for its low rate of heart disease.

Reduce dietary cholesterol. Avoid organ meats altogether and eat fewer egg yolks.

Increase dietary fiber. Never before has fibre been easier to introduce into your diet. Letely we've been hearing a great deal about oat bran as a source of fiber, and for good reason. Studies indicate that oat bran, when ate regularly, can reduce cholesterol by up to 19%.

Exercise! Exercise has shown to reduce the risk of CHD by increasing level of good cholesterol HDLs in the blood.

Stop Smoking! Exercise raises HDL levels, but smoking reduces them. Smokers run an added risk of CHD.

Do school lunch programs support heart-healthy diet standards?

Jayne Newmark, national spokesperson for the American Dietary Association, cautions that school lunch programs are self-supporting, and therefore, sell foods that kids are most apt to buy. Today we see a lot of hamburgers and French fries because that's what kids like. into the curriculum. But education really starts at home and it can not begin too soon, "says Newmark.

What are the additional benefits of a heart-healthy diet?

A high-fat and low-fiber diet has been linked to cancers of the colon and breast, as well as to diverticular disease, stroke, diabetes, high blood pressure and even osteoporosis. And if that is not enough, there's always obesity to appeal to the vanity in us all.

Source by Andy G

from Home Solutions Forev https://homesolutionsforev.com/tomorrow-i-am-going-to-do-something-about-my-cholesterol/ via Home Solutions on WordPress

[rainycollectortigerme-blog]

Santé publique: Investir oui, mais un urgent besoin p'clean up the mess'!

Santé publique... Le ministère p la Santé, qui assure un service gratuit dans les hôpitaux, contrairement à beaucoup d'autres pays, bouffe beaucoup d'argent. C'est le ministère avec un des plus gros budgets p l'État. Anwar Husnoo, médecin et aujourd'hui ministre de la Santé et Qualité de la Vie, a été sous les feux des projecteurs ces derniers jours. Il a été la Opposition critique sur la qualité du service offerte dans les hôpitaux et sur la gestion des médicaments. Mais est-il le RESPONSABLE ou a-t-il hérité d'un système que ses prédécesseurs ont eu du mal à s'?

Un simple détour sur le dernier rapport du Bureau de l'Audit nous permet de comprendre qu'il existe une sorte de'Mafia", hélas le motn'est pas fort, qui s'enrichisse sur le dos des patients. Une mafia qui agit en toute impunité, automobile en confront, il y a des fonctionnaires quin'assument pas leurs responsabilités. Une term, une seule à retenir dans ce rapport résume la situation:"There was no segregation of responsibilities with a couple of officers having a stronghold on many measures of the procurement procedure ".

Des critiques justifiées, mais p là à faire croire à la population que c’est l'apocalypse dans ce secteur. Il existe de nombreuses failles dans le système, mais c’est une position tolérée ring des années level les différents gouvernements qui se sont succédé. Xavier Luc Duval a été dans le Cabinet pendant des longues années, il a été ministre des Finances, il sait très bien. Le voir ou tirer la sonnette d'alarme maintenant est une hypocrisie.

Si l'Etat dépense beaucoup d'argent dans la santé publique jette beaucoup à la poubelle.

Simple exemple. Une mauvaise planification au niveau de l'achat et du stockage des médicaments depuis 2005, nous a donné ceci en 2016: 350 tonnes p médicaments périmés, le tout évalué à Rs 1 milliard. Les coupables euxn'ont jamais eu à ces fautes. Et ça, cen'est certainement pas le régime en place qui est responsable.

Le rapport de l'Audit de 2017, publié en 2018, a aussi démontré que le ministère

En 2016, 350 tonnes de médicaments périmés, le tout évalué à Rs 1 milliard, ont dû être détruits

1. A acquis 32 000 fioles de 50 tsp et de 100 ml de paracétamol contrefaits, et le fournisseur, qui a joué avec la vie des gens,n'a remboursé des Rs 1,5 million alors que la valeur du contrat était de Rs 2.5 millions.   Mars 2015, 7 144 et 11 404 fioles p 50 ml et 100 ml respectivement ont été reprises des centres hospitaliers, mais aucune entréen'a été faite dans le système, dont le département de Procurementn'a pas été informé p ce'remembered from outstations". Dans ce cas précis, le fournisseur, qui aurait dû rembourser la somme de 3,7 countless soit la valeur totale de la cargaison achetée, ne l'a pas fait.

4.   En juillet 2015, 1945 shots de Methy Prednisolone sur un lot de 10000 ne répondaient pas aux normes et en novembre 2016, 7 143 ampoules d'une valeur de Rs 803 373 ont été jugées"unfit to use". Comme officiellement iln'y avait aucune indication que ces médicaments étaient défectifs, aucune actionn'a prise à l'égard du fournisseur. En octobre 2016, 94 883 flacons d'Amoxycillin d'une valeur de Rs 863 000 ont été retirés, car ils étaient de mauvaises qualités. On peut lire ceci dans le rapport:"At October 2017, a year later, no action was taken by the Ministry to recoup the amount paid because no claim has been delivered to the supplier...."

Critiquant le système p Procurement qui est en place depuis des années, le bureau de l'audit écrit entre autres:"Producers were removed for reasons of blacklisting from unauthorised sources, after several failed attempts to procure drugs, the Ministry had as a last resort, purchased in urgency whatever quality was accessible and at elevated rates, Several things contained in tenders were not considered at test on the ground of sufficient inventory to be then procured within a couple of months due to depleting stock leading to waste of resources and risk of inventory out.

Le nouvel hôpital ENT verra le jour à la location du bâtiment existant, à Vacoas, d'ici quelques mois.

Le Dr Husnoo l'a confirmé:

Réagissant aux critiques le 19 novembre, le Dr Anwar Husnoo, ministre de la Santé a tenu ces propos: "C'est la responsabilité du protocole. C'est à eux de travailler et cen'est surtout pas à moi p décider p certaines choses. Je suis conscient des problèmes. Il faudra un gouvernement coverage et je peux dire qu'on travaille sur ça", a indiqué le ministre à la presse.

"Donnons des médicaments à tout le monde...c’est facile de venir dire ça, mais on doit aussi voir combien ça nous coûte au final. L'État dépense Rs 1 annuellement sur l'achat des médicaments. On ne peut malheureusement pas tout faire du jour au lendemain. Il y a des procédures à suivre. Cela prendre un peu de temps, mais que ce soit pour les patients souffrant du cancer et autres maladies, il y a des médicaments qui coûtent Rs 1 billion par an pour un patient...You know what it means..."

Nous comprenons parfaitement le stand du ministre Anwar Husnoo, car il a insisté sur le fait qu'il y a  des procédures à suivre. À Maurice, on ne doit pas s'ingérer dans le système. Une intervention de sa part pour faire bouger les choses peut être une arme à double tranchante dans un pays où la presse ou l'opposition tirent sur tout ou presque. Le gouvernement ne peut que laisser le fonctionner. Et c’est justement là où le bât blesse. Il existe un 'fast track" qu'on prend dépendant des humeurs des fonctionnaires! Bref, si on peut le dire ainsi.

C'est toujours difficile de changer la routine des fonctionnaires. On étonne qu'ils sont toujours en place alors que d'autres pays, ces gens auront tout simplement été suspendus et relevés de leurs fonctions après tant de fautes. Il existerait trop de pouvoir concentré entre les mains d'une miniature minorité au sein du ministère de la Santé et chaque gouvernement danse à leur tube. Le Dr Anwar Husnoo aura donc intérêt à agir et vite. Au cas contraire, tous les maux de la Santé lui seront attribués.

Vers un service de qualité

Le gouvernement actuel a la volonté d'offrir un support de qualité aux Mauriciens.

(I). A new Teaching Hospital is going to be built in Flacq

(ii). A medical hub is being developed in Côte d'Or City comprising a contemporary Eye Hospitala warehouse for medical products, a New National Health Laboratory Services Centre along with the AYUSH Hospital for ayurvedic treatment

(iii).   New Cancer Centre

(iv).   Provision for its acquisition of a fully-fledged mobile caravan to encourage early detection of breast and cervical cancer

(v). Rs 100 million to the e-Health

(vi).   Recruitment of 10 Specialists, 10 Community Physicians, 7 Clinical Psychologists, 50 Trainee Nurses and 30 Trainee Midwives.

Et ce qui est en train de se réaliser rapidement pour assurer un service de santé efficace à tous les citoyens mauriciens.

1. Dialyse

Des nouveaux appareils de dialyse

Une deuxième unité à l'hôpital Dr. A. G. Jeetoo qui comprendra 26 appareils supplémentaires. Le coût de ces équipements s'élève à Rs 20.6 millions. Cette nouvelle unité, pouvant accueillir environ 150 autres patients, devrait être opérationnelle au début de l'année prochaine, après l'installation du Water Remedy Plan au coût de Rs 5.3 millions. Aussi à venir 34 autres nouveaux appareils de dialyse pour remplacer les vieux appareils qui se trouvent dans les cinq hôpitaux régionaux.

Une autre nouvelle unité de dialyse -- équipée de 20 appareils -- devrait être opérationnelle à l'hôpital p Montagne Longue à partir de prochaine. Une somme de and de Rs 25 millions sera déboursée sur ce projet.

2. Cancer Centre à Med Point

Le cancer center coûtera Rs 1.5 milliard

Avec l'aide financière de l'Arabie Saoudite, la clinique Medpoint, qui accordera un emprunt de 25 millions de dollars mauricien à cette fin, abritera le Cancer Centre. Ce projet coûtera 1,5 milliard de roupies.   Au complete il comprendra 230 lits et huit ICU.

3. ENT  Hospital à Vacoas

Un nouvel hôpital spécialisé Ear, Nose & Throat (ENT) verra le jour à la place du bâtiment existant, à Vacoas. Étendu sur une superficie de presque 15 000 mètres carrés, le nouvel établissement sera pourvu de 100 lits et  comprendra des équipements des dernières technology. Ce complexe hospitalier comprendra trois salles d'opération, dont deux grandes salles, une unité de soins intensifs (six lits), un département outpatient et de radiographie et trois salles de 30 lits pour accueillir les hommes, les femmes ainsi que les enfants.

4. Hôpital des yeux

Le nouvel hôpital des yeux verra le jour à Moka, tout près p la clinique Wellkin. Le nouvel établissement p sera doté p quelque 150 lits. Coût : Rs 600 millions.

5. Nouvel hôpital à Flacq et SSRN

New Flacq Teaching Hospital. Voilà comment s'appellera le nouvel hôpital de Flacq, qui sera construit sur 20 000 pieds carrés. Ce sera sur un terrain de 25 arpents à Constance. Ce sera le plus grand hôpital  pouvant contenir 1000 patients et comprendra13 salles d'opération.

6. Un Central pharmacy shop

Le stockage des médicaments se fait, à ce jour, à trois endroits différents, soit à  l'Agricultural Marketing Board, la Central Supply Division du ministère p la Santé et l'hôtel Sunray à Coromandel. Les normes ne sont pas réellement respectées prochaine d'un Central Pharmacy Store. Ce sera entre à Côte d'Or. Ce qui permettra de garder les données du stock des médicaments dans un système informatique tout en stoppant les gaspillages.

Petit rappel...les belles annonces de XLD en 2013

Le leader de l'Opposition actuel that a été trop longtemps dans le système pour ne level comprendre la réalité. En parcourant son discours, le temps qu'il était ministre des Finances, Xavier Luc Duval avait annoncé dans son programme"Construct Mauritius Plan" un budget de Rs 9,2 milliards et une série de mesures. C'était en 2013. Un an avant le gouvernement Ramgoolam, ses projets annoncés en grande pompe soit: 1 ). Médecins de famille" in Area Health; 2. Formation de 40 médecins en France et à Londres; 3. Intro d'un National Diabetes Register and also a National Diabetes Management System (DMS) Centres; 4. National Diabetic Retinopathy Grading Centre; 5. A Diabetic Foot Care Service; 6. Recruiting of 4 diabetologists.

Et pour affronter le cancer, il avait assuré que les patients vont bénéficier. XLD avait alors annoncé la mise sur pied d'un National Cancer Agency sous l'égide du Trust Fund for Specialised Medical Care. Au niveau des infrastructures, le ministre des Finances d'alors avait voté la somme de 566 millions pour que l'hôpital Victoria dispose de six State of the Art Operating Theatres et quatre blocs  pour accommoder 120 patients additionnels,  la structure de 3 mediclinics pour un coût estimé à Rs 38 millions à Goodlands, Stanley et Floreal, Rs 11 millions pour deux centres communautaires à Baie du Tombeau et Phoenix et d'un Area Health Centre à Bambous.  Et toujours dans son objectif d'améliorer le service, le recrutement de 33 spécialistes pour assurer un service 24/7 dans les hôpitaux régionaux, 35 médecins pour être mutés dans les Emergency Units et 300 infirmières. Combien de ces objectifs ont été atteints?

Il y a eu la construction des  six State of the Art Operating Theatres et des quatre blocs  pour accommoder 120 patients à Candos. Des trois médiclinics annoncés, seulement celui p Goodlands a été construit. Les deux autres annoncés à Stanley et Floréal, ils sont en chantier actuellement.Ce petit rappel, c’est juste pour dire à certains qu'on peut avoir les plus belles goals du monde, mais le traduire dans la réalité, cen'est pas aussi facile.

Cancer... si on avait pris la décision en 1998!

Maurice dispose d'un seul "linear accelerator" obtenu en 1994 et il était considéré comme un des cinq équipements "hi-tech". Toutefois, cet équipement avait un"lifetime" p 10 ans et aurait dû donc été remplacé en 2004. En 2017 ans après, il était toujours le de ce genre à Maurice. Pourtant en 1998, donc sous le règne du Parti Travailliste, on procéder deuxième appareil. Le Bureau de l'audit l'a confirmé d'ailleurs: "no explanation was obtained regarding the second and more complex one was not bought despite the need to get another linear accelerator being felt as 1998 (four years after the purchase of the true LINAC)."  Les techniciens essayent de se débrouiller tant bien que mal avec ce qu'ils ont sous la main. Mauvaise planification oui? Elle date depuis 1998 malheureusement.

Santé publique: Investir oui, mais un urgent besoin de'tidy up the mess'!

[watsonrodriquezie]

Slow Moving Training: Yoga

I like intensity when I train. Lifting heavy, running sprints, playing Ultimate Frisbee. I keep it brief, and the foundation is always a lot of slow movement throughout the day—easy runs, long walks or hikes, rarely sitting—but I go hard when I “work out.”

What if you were to go slow, on purpose?

Entire schools of physical culture are founded upon slow, deliberate movements. They squash momentum and lambast rapidity. They’re difficult in a different way. They require patience and fortitude.

Take yoga.

Yoga is a loaded word. It’s at once religious practice, spiritual tradition, a way of honing mind, body, and spirit. It’s diet, medicine, meditation. The history of yoga is hard to parse; different sources give different historical timelines. What’s obvious is that there’s no “one yoga.” So, what I’ll talk about is how most of us reading typically conceive of it: Stretching with a spiritual veneer.

This is probably the most common form of slow physical training practiced worldwide. My wife’s done it for decades, and I’ve joined in on more than a few classes with her. It’s not my favorite thing—I don’t seek it out on a regular basis—but it is a great workout, and I always come away in a different headspace than when I started. The benefits of yoga are pretty well-established:

Yoga and Flexibility

As a series of poses and stretches that test and extend your joints’ range of motions, yoga should improve flexibility. That’s one of its express purposes. Sure enough, in almost every population, it seems to work.

It improves the flexibility and balance of college athletes and elderly adults. In older women and injured industrial workers, it improves hamstring flexibility and spinal mobility.

Yoga for Older Adults

Being slow-paced, deliberate, and controlled makes yoga very effective for older adults (or beginners to physical training) who are unsure of their abilities and want to improve their physical (and mental) faculties.

A 12-week Thai yoga program helped older adults improve their ability across a range of basic physical functions, including back scratching, standing up from chairs, sit and stretch, and the 8 foot up and go test.

An 8-week Hatha yoga program helped older adults improve single leg balance, chair standing, back scratching, flexibility, and 8 foot up and go just as well as an 8-week strength and stretching program using machines. A later study found that the same yoga program improved executive function, including working memory and mental flexibility, in the same group of adults. A third study found that the yoga program improved cognitive function by reducing stress levels. Boy, that’s a lucky group of seniors.

Yoga and the Brain

Like most every other physical training methodology ever studied, yoga improves cognitive function. We see this across a range of populations, but especially in older folks at the greatest risk of cognitive dysfunction.

Compared to walking, yoga decreases anxiety, increases well-being, and boosts GABA concentrations in the hypothalamus. This is incredibly cool. Everyone knows that exercise is often the ideal antidote to anxiety and depression. It works, its side effects are beneficial, and it requires no prescription. But this was one of the first studies to show a correlation between increased GABA from physical activity and reduced anxiety levels.

Yoga and Stress

Any type of exercise will reduce stress, as long as you avoid overtraining. Yoga is no different and seems to have particularly potent effects.

Pregnant women who followed a yoga program saw reduced perceived stress and improved heart rate variability (an objective indication of increased resilience to stress).

After doing a yoga-based guided relaxation, people with baseline elevations in sympathetic nervous system activity—who were already stressed out—saw those level off. Those who weren’t stressed didn’t. This is important because it shows yoga is more of an adaptogen, helping you normalize stress levels only if they need normalizing.

In a group of people awaiting organ transplantations (which has got to be a trying experience), doing laughter yoga (laughter+stretching) improved heart rate variability and mood in both the short and long-term.

Yoga and Strength

Believe it or not, yoga can increase strength. Part of strength, after all, is the ability to get into full range of motion. If you’re strong only through a small range of motion, is that really strength?

Yoga also increases muscular endurance. Again, this isn’t absolute strength, but it’s a component of muscular capacity that enables the expression of strength.

I wouldn’t rely on yoga for your strength. Instead, treat it as a complement to your strength training.

Yoga and Various Diseases

Given yoga’s reputation as a “healing art,” many studies have looked into yoga for the treatment of various diseases. Unfortunately, most of the studies have been inconclusive or come up with negative results (doesn’t work, doesn’t hurt), like with schizophrenia, multiple sclerosis, asthma. At the least, it probably won’t hurt, but you shouldn’t rely on it in lieu of real treatment.

It looks promising for a few, though: depression (as an adjunct), breast cancer (not as a cure, but for anxiety, quality of life, and certain symptoms), type 2 diabetes (by improving metabolic health), Parkinson’s (pilot study showing improvements in strength and function)

That said, studies don’t indicate that yoga offers anything above and beyond other types of training for these diseases. Still, there might be more to this picture—at least from an anecdotal perspective.

Is Yoga Safe?

It goes without saying that anything worth anything carries a bit of risk. Driving to work (or the gym) risks a car accident. Falling in love risks heartbreak. Going into business for yourself risks failure. And training risks injuries.

Yoga is no different. Things happen. You go too far past your joint’s capacity, and pull something, end up sore for weeks. You lose too much water and electrolytes during the hot yoga session, and feel lightheaded on the drive home. You’re swept away by a charismatic yogi, wind up a member of his harem wearing black and white Nikes. We’ve all been there.

Luckily, studies show that yoga is as safe as “usual care” and other types of exercise. There’s quibbling there, to be sure. Yoga is probably safer than free climbing and boxing.

Still, I’d question becoming a “yoga person,” though. I know I probably have several dozen reading right now, and I love you. But don’t assume yoga covers all your physical bases. I’m not fully convinced that yoga is enough for total fitness and optimum strength. A day or two a week on top of some lifting, sprinting? Great. I bet most strength athletes could use a little yoga, even, if they aren’t doing mobility training already.

Yoga has a lot of intangible benefits, too, effects that studies don’t really capture very well.

It forces flow. This is one of the great features of exercise, one that goes unreported and ignored. The physical effects training has on your body composition, your muscles, your cardiovascular system, your capacity to interact with the world with force and skill are all extremely important. But when you’re fully engaged in a physical activity, when data is flowing through your neuromuscular pathways, when you can do nothing but immerse your entire being in the movement, you reside in the flow state. No brain hacks, gadgets, or supplements required. And although I’m not that experienced with yoga, whenever I’ve done it I’ve noticed myself slipping into that state without even trying. Actually, I notice it after the class, because during the class you’re fully engaged and not thinking about thinking.

It trains grit. Most studies show that you can’t teach grit—or stick-to-it-iveness—and that it’s mostly hereditary. I buy that, but I think yoga is different. Yoga is very uncomfortable, and you must hold the holds for sometimes minutes at a time. That requires tolerance of discomfort. Some of it is that yoga selects for individuals who can tolerate extreme discomfort. Even if that’s the case, yoga will certainly hone your existing grit.

It’s more than stretching. A typical yoga class will incorporate not just the physical act of contorting your body, holding poses. It also emphasizes the importance of breath, and of integrating your breath with your movement. This focus on breath turns the session into a de-facto meditation. Many classes even end with a full-on guided meditation. Yoga is a nice package deal for people who otherwise wouldn’t incorporate these things into their lives.

Join a class.

Historically, yoga was a taught discipline. You didn’t grab a wax tablet of poses and slink off to the jungle to learn yoga by yourself. You sought the tutelage of a master. Things are different now. There are effective and helpful videos explaining how to do specific poses and follow routines. These are extremely helpful, but I don’t think they’re a good replacement for a good teacher.

Why?

If you’re dedicated, you can get the same effect watching yoga Youtube videos with your cat, but it’s easy to check out when things get too hard. You might grab your phone to browse Instagram in between poses. You might cut things short because it’s uncomfortable and no one’s counting on you finishing. It’s different than strength training at a home gym because the routines are so uncomfortable and last so long. Mustering the will to do a set of heavy deadlifts is manageable for many. Mustering the will to hold a difficult pose for two minutes is not. A teacher (or class) takes willpower out of the equation. As long you get yourself to class, the rest falls into place. 

After today’s post, I hope you’ll consider trying a yoga class. I know I’ll probably join Carrie more often. The literature is compelling and hard to ignore. But in the end, you just have to see for yourself.

Thanks for reading, everyone. Take care.

I know I have some yoga experts reading this. I know there are many different types of yoga. I’d love to hear from you. What’s your favorite type? Let loose your questions, advice, comments. I’d love to hear your perspective.

[milenasanchezmk]

Slow Moving Training: Yoga

I like intensity when I train. Lifting heavy, running sprints, playing Ultimate Frisbee. I keep it brief, and the foundation is always a lot of slow movement throughout the day—easy runs, long walks or hikes, rarely sitting—but I go hard when I “work out.”

What if you were to go slow, on purpose?

Entire schools of physical culture are founded upon slow, deliberate movements. They squash momentum and lambast rapidity. They’re difficult in a different way. They require patience and fortitude.

Take yoga.

Yoga is a loaded word. It’s at once religious practice, spiritual tradition, a way of honing mind, body, and spirit. It’s diet, medicine, meditation. The history of yoga is hard to parse; different sources give different historical timelines. What’s obvious is that there’s no “one yoga.” So, what I’ll talk about is how most of us reading typically conceive of it: Stretching with a spiritual veneer.

This is probably the most common form of slow physical training practiced worldwide. My wife’s done it for decades, and I’ve joined in on more than a few classes with her. It’s not my favorite thing—I don’t seek it out on a regular basis—but it is a great workout, and I always come away in a different headspace than when I started. The benefits of yoga are pretty well-established:

Yoga and Flexibility

As a series of poses and stretches that test and extend your joints’ range of motions, yoga should improve flexibility. That’s one of its express purposes. Sure enough, in almost every population, it seems to work.

It improves the flexibility and balance of college athletes and elderly adults. In older women and injured industrial workers, it improves hamstring flexibility and spinal mobility.

Yoga for Older Adults

Being slow-paced, deliberate, and controlled makes yoga very effective for older adults (or beginners to physical training) who are unsure of their abilities and want to improve their physical (and mental) faculties.

A 12-week Thai yoga program helped older adults improve their ability across a range of basic physical functions, including back scratching, standing up from chairs, sit and stretch, and the 8 foot up and go test.

An 8-week Hatha yoga program helped older adults improve single leg balance, chair standing, back scratching, flexibility, and 8 foot up and go just as well as an 8-week strength and stretching program using machines. A later study found that the same yoga program improved executive function, including working memory and mental flexibility, in the same group of adults. A third study found that the yoga program improved cognitive function by reducing stress levels. Boy, that’s a lucky group of seniors.

Yoga and the Brain

Like most every other physical training methodology ever studied, yoga improves cognitive function. We see this across a range of populations, but especially in older folks at the greatest risk of cognitive dysfunction.

Compared to walking, yoga decreases anxiety, increases well-being, and boosts GABA concentrations in the hypothalamus. This is incredibly cool. Everyone knows that exercise is often the ideal antidote to anxiety and depression. It works, its side effects are beneficial, and it requires no prescription. But this was one of the first studies to show a correlation between increased GABA from physical activity and reduced anxiety levels.

Yoga and Stress

Any type of exercise will reduce stress, as long as you avoid overtraining. Yoga is no different and seems to have particularly potent effects.

Pregnant women who followed a yoga program saw reduced perceived stress and improved heart rate variability (an objective indication of increased resilience to stress).

After doing a yoga-based guided relaxation, people with baseline elevations in sympathetic nervous system activity—who were already stressed out—saw those level off. Those who weren’t stressed didn’t. This is important because it shows yoga is more of an adaptogen, helping you normalize stress levels only if they need normalizing.

In a group of people awaiting organ transplantations (which has got to be a trying experience), doing laughter yoga (laughter+stretching) improved heart rate variability and mood in both the short and long-term.

Yoga and Strength

Believe it or not, yoga can increase strength. Part of strength, after all, is the ability to get into full range of motion. If you’re strong only through a small range of motion, is that really strength?

Yoga also increases muscular endurance. Again, this isn’t absolute strength, but it’s a component of muscular capacity that enables the expression of strength.

I wouldn’t rely on yoga for your strength. Instead, treat it as a complement to your strength training.

Yoga and Various Diseases

Given yoga’s reputation as a “healing art,” many studies have looked into yoga for the treatment of various diseases. Unfortunately, most of the studies have been inconclusive or come up with negative results (doesn’t work, doesn’t hurt), like with schizophrenia, multiple sclerosis, asthma. At the least, it probably won’t hurt, but you shouldn’t rely on it in lieu of real treatment.

It looks promising for a few, though: depression (as an adjunct), breast cancer (not as a cure, but for anxiety, quality of life, and certain symptoms), type 2 diabetes (by improving metabolic health), Parkinson’s (pilot study showing improvements in strength and function)

That said, studies don’t indicate that yoga offers anything above and beyond other types of training for these diseases. Still, there might be more to this picture—at least from an anecdotal perspective.

Is Yoga Safe?

It goes without saying that anything worth anything carries a bit of risk. Driving to work (or the gym) risks a car accident. Falling in love risks heartbreak. Going into business for yourself risks failure. And training risks injuries.

Yoga is no different. Things happen. You go too far past your joint’s capacity, and pull something, end up sore for weeks. You lose too much water and electrolytes during the hot yoga session, and feel lightheaded on the drive home. You’re swept away by a charismatic yogi, wind up a member of his harem wearing black and white Nikes. We’ve all been there.

Luckily, studies show that yoga is as safe as “usual care” and other types of exercise. There’s quibbling there, to be sure. Yoga is probably safer than free climbing and boxing.

Still, I’d question becoming a “yoga person,” though. I know I probably have several dozen reading right now, and I love you. But don’t assume yoga covers all your physical bases. I’m not fully convinced that yoga is enough for total fitness and optimum strength. A day or two a week on top of some lifting, sprinting? Great. I bet most strength athletes could use a little yoga, even, if they aren’t doing mobility training already.

Yoga has a lot of intangible benefits, too, effects that studies don’t really capture very well.

It forces flow. This is one of the great features of exercise, one that goes unreported and ignored. The physical effects training has on your body composition, your muscles, your cardiovascular system, your capacity to interact with the world with force and skill are all extremely important. But when you’re fully engaged in a physical activity, when data is flowing through your neuromuscular pathways, when you can do nothing but immerse your entire being in the movement, you reside in the flow state. No brain hacks, gadgets, or supplements required. And although I’m not that experienced with yoga, whenever I’ve done it I’ve noticed myself slipping into that state without even trying. Actually, I notice it after the class, because during the class you’re fully engaged and not thinking about thinking.

It trains grit. Most studies show that you can’t teach grit—or stick-to-it-iveness—and that it’s mostly hereditary. I buy that, but I think yoga is different. Yoga is very uncomfortable, and you must hold the holds for sometimes minutes at a time. That requires tolerance of discomfort. Some of it is that yoga selects for individuals who can tolerate extreme discomfort. Even if that’s the case, yoga will certainly hone your existing grit.

It’s more than stretching. A typical yoga class will incorporate not just the physical act of contorting your body, holding poses. It also emphasizes the importance of breath, and of integrating your breath with your movement. This focus on breath turns the session into a de-facto meditation. Many classes even end with a full-on guided meditation. Yoga is a nice package deal for people who otherwise wouldn’t incorporate these things into their lives.

Join a class.

Historically, yoga was a taught discipline. You didn’t grab a wax tablet of poses and slink off to the jungle to learn yoga by yourself. You sought the tutelage of a master. Things are different now. There are effective and helpful videos explaining how to do specific poses and follow routines. These are extremely helpful, but I don’t think they’re a good replacement for a good teacher.

Why?

If you’re dedicated, you can get the same effect watching yoga Youtube videos with your cat, but it’s easy to check out when things get too hard. You might grab your phone to browse Instagram in between poses. You might cut things short because it’s uncomfortable and no one’s counting on you finishing. It’s different than strength training at a home gym because the routines are so uncomfortable and last so long. Mustering the will to do a set of heavy deadlifts is manageable for many. Mustering the will to hold a difficult pose for two minutes is not. A teacher (or class) takes willpower out of the equation. As long you get yourself to class, the rest falls into place. 

After today’s post, I hope you’ll consider trying a yoga class. I know I’ll probably join Carrie more often. The literature is compelling and hard to ignore. But in the end, you just have to see for yourself.

Thanks for reading, everyone. Take care.

I know I have some yoga experts reading this. I know there are many different types of yoga. I’d love to hear from you. What’s your favorite type? Let loose your questions, advice, comments. I’d love to hear your perspective.

[weunabashedcollectorpatroll-blog]

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Since this is basically a health-related solution, you might want to talk to your medical doctor prior to employing Breast Actives, specifically if you have experienced health problems in the previous, but it goes without saying that this is a significantly safer way to increase breast dimension than surgical processes. What About The Physical exercise System? 1 concern that a lot of folks request me about Breast Actives is whether or not or not you need to have to be part of a gym in buy to do the Breast Actives workout routines. These workout routines really only just take a few minutes for each working day and you can do them while sitting at your desk or even on your sofa, seeing television. They are developed to enhance the muscular energy beneath your breasts, especially in your pectoral muscles, so that your breasts are able to sit greater on your chest, like they used to do when you have been young. Where Can You Purchase Breast Actives? Right now, you can not currently acquire this natural breast enhancer in retailers, but when you buy it from the formal website, they are at present giving a pair of special deals that assist to make it a minor much more cost-effective. Of program, when you examine the value of Breast Actives to the massive expense of breast enhancement surgical treatment, there is just no comparison. Breast Actives is a fraction of the price of even the most affordable surgical procedure, and of program this product comes with no side effects, no scars, no ache, and no downtime. Is This The Right Breast Enhancement Merchandise For You? In my expertise, Breast Actives has been very efficient and that is why I like to inform other women about it. I went from a B cup to a C cup in less than a thirty day period, and undoubtedly observed an improve in firmness and elevate. I would extremely advocate this merchandise to any female who is seeking for a secure and natural way to improve your breast size, and a approach that also comes with a full funds again guarantee. This What My Investigation Uncovered Hormones enjoy a huge component in breast physical appearance. An imbalance of any sort can resort to sagging. Being pregnant and also age play a component in influencing general breast appearance. In order to get a fuller, perkier cleavage that does not droop some hormonal support is essential. This is the place Breast Actives arrives in. How It Works This system consists of a dietary supplement and also a organic bust cream which the two perform in unison to make breasts even bigger. This takes place by tricking the human body, by way of the natural components in these products, into making the same conditions that enable the breast tissue to expand - as takes place in the course of puberty and pregnancy. 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Conclusion My results reveal that Breast Actives does without a doubt perform to boost bust dimensions naturally and safely. If you are seeking to enhance your cleavage then I very advocate this item. For highest enhancement outcomes use the plan for at the very least 6 months.

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Silicone Breast Implants – The Advanced Guide to Learn Before Surgery

Introduction to Silicone Breast Implants

While breast implants are done therapeutically, there are so many women out there who get it done for cosmetic reasons. The society we live in pays too much attention on the shape and outlook of a female and expects too much whereas some women do it for themselves not giving a heed on what others say. According to statistics by American Society of Plastic Surgeons, published in the FDA website, approximately 3 million breast implant surgeries were done in America in the year 2010 out of which 50% were Silicone Breast Implants. The million dollar question is, is the hassle of breast implant surgery worth it? This article will explain in depth all the information you need to know about Silicone Breast Implants.

How does it work and is it safe?

Silicone Breast Implants are merely a device which increases the size of the breasts or in therapeutic cases, work as an artificial breast after mastectomy. Be it reconstruction of new breast or augmentation of the ones already present, silicone breast implants carry an external membrane made of silicone carrying fluid which is also made of silicone. The type of surgeries that uses Silicone implants are as follows (FDA, 2011):

Primary Augmentation: To make breasts look fuller and bigger.

Primary Reconstruction: To replace breast tissue that was lost in any condition such as a pathology, inborn deformity or trauma.

Revision Augmentation: For correction or improvement of previously performed primary augmentation surgery.

Revision Reconstruction For correction or improvement of previously performed reconstruction surgery.

Silicone Implants were first introduced in the year 1962 but they were approved by the FDA in the year 2006. (FDA, 2011) In between, a lot happened and emphasis was put on exploring the safety of these implants. While research is under way regarding the long term performance, cause of failure and the potential side effects that it can pose, FDA claims that the outcome mainly depends on the type of breast implant surgery that is carried out and also on the duration the implant has stayed and on the number of follow-ups.

Why Silicone over other types?

Most women choose Silicone Breast Implants over Saline Breast Implants because it appears so natural to the eyes and also feels very similar to natural breast tissue since it mimics the texture of human adipose tissue itself, sticky as well as thick. Silicone implants don’t have the tendency to ripple from the sides or the lower edge as compared to saline implants.

How do you decide if Silicon Breast Implant is for you?

This is a decision which is challenging and most critical for you to make. It is mostly your surgeon who will decide for you according to your overall anatomy. It is quite true that you want people to compliment you on your figure rather than them asking where you got your boob job done. So your aim is to get a natural looking implant that doesn’t give others a clue about it being artificial. Each individual has variable amount of breast tissue. Those who have less amount of breast tissue or have low body fat, this type of breast implant gives way better and natural results than saline implants do. Your surgeon will inquire about the expectations that you have with the augmentation surgery and will help you decide if Silicone Breast Implant is for you.

What is the ideal age for getting a Silicone Breast Implant?

While breast development in women continues till early twenties, the FDA approves the woman to be at least 22 years or older to get silicone breast augmentation. (ASPS, 2017)

What are the types of Silicone Breast Implants? Who are the manufacturers?

After multiple clinical studies that were carried out, in November 2006, FDA gave a green signal to the following two manufacturers and demanded six studies after approval:

Allergan’s Silicone Gel-Filled Breast Implants

Mentor’s Memory Gel Silicone Gel-Filled Breast Implants. (FDA, 2011)

While there is one type of silicone implant that is approved by FDA, it can however be high profile which is shaped like a baseball or pancake shaped low profile implant.

The profile of an implant is the ratio between its heights (projection) in regard to the diameter. This helps the plastic surgeon, keeping in view the chest circumference, shape and size as well as the breast dimension, to choose the right implant for an individual. Implant may be smooth in texture or rough.

How much does silicone implants cost?

The cost of silicone breast implant depends on different variables and these are

Surgeon’s fees

Implant’s cost

Anesthesia team charges

Facility fees

These account to make the total cost of silicone breast implant. The price varies from city to city and also depends on the surgeon you choose to get the surgery from. It also depends on the method chosen by the surgeon that if it is sub-muscular placement or sub-facial placement, the latter being faster than the former. But the average rate is between 4000$ to as high as 8000$.

Queries that you must clarify with yourself and your surgeon:

People who are considering a Silicone Breast Implant should clarify their queries with themselves by asking the following questions:

Am I ready to alter my physical appearance?

Can I afford the cost of surgery and if, God forbid, any complication arises, will I be able to pay for those expenses?

Who am I doing this for?

Am I ready to change my activities during recovery period?

Do I know everything about Breast Implants including risks and benefits?

Is my plastic surgeon reputed?

How many times will I have to get myself checked after implant?

After doing your homework of finding names of experienced, reputed and well-trained plastic surgeons, schedule a cost-free consultation with each to satisfy yourself that you are choosing the right doctor for this job. You should clarify your queries from your surgeon by asking them the following questions:

After asking about their qualification, ask about their experience.

Ask about how many surgeries they do monthly.

How many cases come back for revision?

Ask about before and after photos to see results of their work.

Ask about risks and possible complications and how they plan to deal with it.

Ask about preference of implant and what advantages and disadvantages there are for silicone breast implant.

Ask about pre and post operation strategy and lifestyle changes.

Ask about which size and profile would they choose for you according to your anatomy.

Ask about follow up visits and what will they do in these visits.

Ask about when you will have to change or remove the implant and about the recovery period after surgery.

Whatever queries that you have in mind, make sure the surgeon answers to them in detail so that you are fully comfortable and satisfied.

How is it performed?

Prior to the procedure of breast augmentation, the surgeon will perform thorough medical evaluation and run some basic tests and might also ask the patient to stop taking certain medications that they were taking for a few days. The procedure is performed in an operation theatre with general anesthesia so that whole experience is pain-free. It takes one to two hours to complete. After the anesthesia team has anesthetized the patient, the surgeon will place an incision using a scalpel under the breast and cut through the chest muscle to create a sub muscular pocket. The muscle is elevated to make room for the implant to sit and the implant is then inserted. To make sure that the prosthesis/implant is safe; all sharp instrumentations are completed before its insertion. With optimization of symmetry and shape of both breasts, the wounds are closed with sutures and dressing is done at the site of wound.

Downtime after Breast Implant:

After silicone breast implantation surgery, post-operative care is needed. Antibiotics would be prescribed to avoid infection whereas it is important that the wound is kept dry and no strenuous activities performed up to 2 weeks. Special bra provided by the surgeon must be work till prescribed and sleep on your back for 2 weeks. It is said that sexual activity must be avoided for 2 weeks for it elevated the blood pressure which may be harmful post operatively.

Possible complications and side effects of Silicone Breast Implant:

According to post approval studies, about 20-40% of augmentation patients had to go through reoperation in the initial 8-10 years. (FDA, 2011). This is a long period but the value of follow up MRIs cannot be emphasized enough. This is because since the rupture is asymptomatic these would help in detection of the leak early.

According to the available data, the incidence of complications depends on the following: (FDA, 2011)

Type of surgery (revision surgery has more risk of complications than primary)

The longer the implant stays, the more risk

Minor surgical procedures after breast implants increase the risk of complications.

Local complications of silicone breast implant include the following:

Capsular contracture

Reoperation

Implant rupture

Breast pain

Asymmetry

Wrinkling

Infection

Since of silicone implant is a silent rupture therefore, routine MRI is indicated to catch any suspicious leak. This is why follow ups are necessary. (FDA, 2011)

What should you do if you notice something unusual?

One should keep in mind that any unusual sign noticed should be reported to the surgeon immediately. Implants are not lifetime prosthesis and they have to be removed or replaced to avoid long term complications. In women with implants, there is an increased risk of developing anaplastic large cell lymphoma. Make sure you are screened for breast cancer according to the schedule provided to you by your physician. (FDA, 2011)

Pros and cons of Silicone Breast Implants:

Following are the advantages of Silicone Breast Implants:

Resembles in appearance and on touch with natural breast tissue

It is not felt under the skin as saline implant

Less incidence of leaking because of prefilled silicone rubber elastomer coating

It doesn’t deflate or change in volume even when it leaks.

It is best for those with less breast tissue.

Does not tend to ripple or fold alongside or lower edge of the breast.

Lasts longer than saline implant

Following are disadvantages of Silicone Breast Implants:

Higher in cost as compared to saline breast implants

Larger incision under lower edge of the breast

Requires MRI every 3 years as recommended by FDA to detect any leaks because the leak doesn’t cause any change in volume of the implant but it may cause tenderness and become firm.

Capsule contracture seems to be more common in silicone implants.

The gel inside silicone implant may harden over time unless it leaks.

Once the leak occurs, implant is difficult to replace and it has to be removed along with the capsule.

Conclusive Remarks:

You may be overwhelmed with the many options available for you to decide from but it is important to not be confused with the choices. With good homework and guidance from your surgeon, you can benefit from the best. An educated decision is important and all your expectations and concerns should be addressed during your consultation and pre-op appointment. It is very significant to know that once the implantation has been done monitoring the breasts for local complications for their entire life is needed. Taking care of your physique and your health most importantly will guarantee your great future ahead. Your boob job should give you the satisfaction and attention you seek so let us make sure you get what you want by making a fair decision for yourself.

References:

Breast augmentation article references, these include FDA website, American Society of Plastic Surgeon website, and answers from real cosmetic surgeons etc.

https://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation?sub=Types+of+breast+implants

http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm259866.htm

http://www.webmd.com/beauty/breast-implants-40-questions-ask-your-doctor#1

http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/UCM260090.pdf

https://www.realself.com/question/benefits-silicone-saline-breast-implants

https://www.realself.com/question/how-much-do-silicone-breast-implants-cost

http://www.webmd.com/beauty/cosmetic-procedures-breast-augmentation#1

http://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/breast-implants/art-20045957

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