Let's Talk About Stress

a. What is the meaning of stress?
Stress is a normal physical response to events that make you feel threatened or upset your balance in some way.But beyond a certain point, stress stops being helpful and starts causing major damage to your health, your mood, your productivity, your relationships, and your quality of life.

b. Why we can get Stress?
The stress response is the body’s way of protecting you. When working properly, it helps you stay focused, energetic, and alert. In emergency situations, stress can save your life – giving you extra strength to defend yourself, for example, or spurring you to slam on the brakes to avoid an accident. When you sense danger – whether it’s real or imagined – the body's defenses kick into high gear in a rapid, automatic process known as the “fight-or-flight” reaction, or the stress response

c. Cause Of Stress?
External Factor :

• Major life changes
• Work
• Relationship difficulties
• Financial problems
• Being too busy
• Children and family

Internal Factor :

• Inability to accept uncertainty
• Pessimism
• Negative self-talk
• Unrealistic expectations, perfectionism

d. Stress Symptom :

Cognitive Symptoms	Emotional Symptoms
Memory problems Inability to concentrate Poor judgment Seeing only the negative Anxious or racing thoughts Constant worrying	Moodiness Irritability or short temper Agitation, inability to relax Feeling overwhelmed Sense of loneliness and isolation Depression or general unhappiness
Physical Symptoms	Behavioral Symptoms
Aches and pains Diarrhea or constipation Nausea, dizziness Chest pain, rapid heartbeat Loss of sex drive Frequent colds	Eating more or less Sleeping too much or too little Isolating yourself from others Procrastinating or neglecting responsibilities Using alcohol, cigarettes, or drugs to relax Nervous habits (e.g. nail biting, pacing)

e. What is effect cronic of stress?
The body doesn’t distinguish between physical and psychological threats. When you’re stressed over a busy schedule, an argument with a friend, a traffic jam, or a mountain of bills, your body reacts just as strongly as if you were facing a life-or-death situation. If you have a lot of responsibilities and worries, your emergency stress response may be “on” most of the time. The more your body’s stress system is activated, the easier it is to trip and the harder it is to shut off.

Long-term exposure to stress can lead to serious health problems. Chronic stress disrupts nearly every system in your body. It can raise blood pressure, suppress the immune system, increase the risk of heart attack and stroke, contribute to infertility, and speed up the aging process. Long-term stress can even rewire the brain, leaving you more vulnerable to anxiety and depression.

Many health problems are caused or exacerbated by stress, including:

Pain of any kind Heart disease Digestive problems Sleep problems

Depression Obesity Autoimmune diseases Skin conditions, such as eczem

d. How to manage the stress??

• 
• Alter the situation : manage your time better, be willing to compromise etc.

• Adapt to the stressor : reframe problem, focus on the positive etc.
  

• Accept the things you can’t change : share your feelings, learn to forgive etc.
  

• Make time for fun and relaxation : do something you enjoy every day, humorAdopt etc.
  

• A healthy lifestyle : Exercise regularly, reduce caffein & sugar etc.
  

Author : Melinda Smith, M.A., Ellen Jaffe-Gill, M.A., and Robert Segal, M.A

About Osteoporosis.......

Osteoporosis is a disease characterized by low bone mass and loss of bone tissue that may lead to weak and fragile bones. In the United States, nearly 10 million people already have osteoporosis. Another 18 million people have low bone mass that places them at an increased risk for developing osteoporosis. As our population ages, these numbers will increase. About 80% of those with osteoporosis are women. Of people older than 50 years of age, one in two women and one in eight men are predicted to have an osteoporosis-related fracture in their lifetime.

Cause Of Osteoporosis :
Osteoporosis occurs when there is an imbalance between new bone formation and old bone resorption. Two essential minerals for normal bone formation are calcium and phosphate. Throughout youth, the body uses these minerals to produce bones. Usually, the loss of bone occurs over an extended period of years. Often, a person will sustain a fracture before becoming aware that the disease is present. he leading cause of osteoporosis is a lack of certain hormones, particularly estrogen in women and androgen in men. Women, especially those older than 60 years of age, are frequently diagnosed with the disease. Menopause is accompanied by lower estrogen levels and increases a woman's risk for osteoporosis.

Osteoporosis Symptom
Early in the course of the disease, osteoporosis may cause no symptoms. Later, it may cause dull pain in the bones or muscles, particularly low back pain or neck pain. Later in the course of the disease, sharp pains may come on suddenly. The pain may not radiate (spread to other areas); it may be made worse by activity that puts weight on the area, may be accompanied by tenderness, and generally begins to subside in one week. Pain may linger more than three months.

Prevention

Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later. The average woman has acquired 98% of her skeletal mass by 30 years of age.

There are four steps to prevent osteoporosis. No one step alone is enough to prevent osteoporosis.

• Eat a balanced diet rich in calcium and vitamin D.
• Engage in weight-bearing exercise.
• Adopt a healthy lifestyle with no smoking or excessive alcohol intake.
• Take medication to improve bone density when appropriate.
• Participate in osteoporosis exercise with
  

STROKE

Previously only the stroke of the information age (elderly). Along with the time, there is a tendency that is now threatening stroke age even under the age of 45 years. The disease also appeared to stroke can strike anyone regardless of their position or socio-economic levels.
Here are some facts and reviews you need to know in order to increase vigilance against the threat of stroke at age:

1. Stroke, No.3 murderer in Indonesia
2. Recognize the type - Type of Stroke
3. Know Stroke Risk Factors
4. Reading Stroke Symptoms
5. Diagnose Stroke
6. Handling of Stroke
7. There is still hope better
8. Lifestyle, the spark of stroke
9. Expert Review of stroke
Stroke, No.3 murderer in Indonesia

Stroke case increased in developed countries like United States where obesity and junk food has been infecting. Based on statistical data in the United States, occur each year 750,000 new cases of stroke in the United States. The data shows that every 45 minutes, there is one person in the United States affected by the attack of stroke.

According to the Stroke Foundation of Indonesia (Yastroki), there is a tendency of increasing the number of stroke in Indonesia in the last decade. Kecenderungannya attack the young generation that is still productive. This will affect the level of productivity and the decrease can lead to social and economic terganggunya family.

Could not be denied that the increase in the number of stroke patients in Indonesia associated with outbreaks of obesity due to fat-rich meal pattern or the cholesterol in the whole world, not the exception of Indonesia.

In Indonesia, the disease is stroke number three after the death of heart and cancer. In fact, according to a survey in 2004, stroke is the No.1 killer in hospitals all over the government in Indonesia.

Estimated to have 500,000 people affected by stroke. Of these, third could recover, another third of the functional disturbances are light up and the remaining third of the weight of the functional disturbance that requires a patient continuously in the mattress.

Serebrovaskuler diseases including stroke (brain blood vessel), which marked the death of the brain network (infark serebral) happens because the reduced flow of blood and oxygen to the brain. WHO defines stroke is that the symptoms of nervous system function deficits caused by brain blood vessel disease and not by the other than that.
Recognizing Types of Stroke

Type of Stroke divided into two types, namely iskemik stroke and stroke hemorragik. On iskemik stroke, blood flow to the brain has stopped because aterosklerosis (cumulation cholesterol in the blood vessel wall), or blood clot that has a clog blood vessel to the brain. Most patients or 83% of the stroke type.

Stroke hemorragik, broken blood vessel so that obstruct the normal flow of blood and blood leak into an area in the brain and damaged. Almost 70 percent of stroke cases hemorrhagik occur in people with hypertension.

At the stroke iskemik, stoppage could occur in the blood vessel along the arterial routes leading to the brain. Blood to the brain supplied by the two karotis Interna arteria and two arterial vertebralis. Arterial-arterial is a branch of the aorta arch heart.

A ateroma (deposition of fat) can form in the arterial blood vessel karotis causing reduced blood flow. The situation is very serious because every blood vessel arterial karotis in normal circumstances to give blood to most of the brain. Deposition of fat can also be detached from the wall and the arterial flow in the blood, and arterial clog smaller.

Arterial blood vessel arterial karotis and vertebralis with percabangannya can also stopped because of a blood clot originating from elsewhere, for example, from the heart or one valve. This kind of stroke called serebral embolism (embolism sumbatan =, = serebral brain blood vessel), which most often occur in patients who undergo new heart surgery and heart valve patients aberration or heart rhythm disturbances (especially atrium fibrillation).

Fat embolism rarely cause stroke. If the form of fat embolism of fat from the bone marrow that is released into the broken blood flow and eventually join in an arterial.

Stroke can also occur when an infection causing inflammation or constriction of the blood vessel to the brain. Drugs (eg cocaine and amfetamin) also can narrow the blood vessel in the brain and cause a stroke.

Decrease in blood pressure that suddenly can cause reduced blood flow to the brain, which usually cause a person unconscious. Stroke can occur if blood pressure is very low weight and chronic. This occurs when someone has lost a lot of blood due to injury or surgery, heart attack or heart rhythm is abnormal.

Know Stroke Risk Factors

Stroke or circumstances which caused the stroke or called Stroke Risk Factors. Diseases mentioned above, among others, Hypertension, Heart Diseases, Diabetes Mellitus, Hiperlipidemia (elevation in blood lipid content). The condition can cause a stroke that is old age, Obesity, smoking, ethnic group (MaRia vega / Spain), gender (male), lack of exercise.
Reading Stroke Symptoms

Most cases of stroke occur suddenly, very quickly and cause brain damage in a few minutes (completed stroke). Then a stroke wither in a few hours to 1-2 days due to increased extent of the network of brain death (stroke in evolution).

Development of the disease usually (but not always) diselingi with a stable period, where the expansion of the network or dead stop while some improvements occurred. Stroke symptoms that appear depend on any part of the brain affected.

Reading cue stroke can be done with some of the symptoms of stroke following:

* Weakness or paralysis arm or leg or one of the body.
* The loss of some vision or hearing.
* Vision ganda.
* Pusing.
* Talk is not clear (rero).
* It's hard to think or say the words right.
* Not able to identify the part of the body.
* Unusual movements.
* Loss of bladder control.
* Imparity and drop.
* Fainting.

Neurologis aberration that resulted from the attack of stroke can be more serious or more extensive, dealing with coma or stupor and are settled. In addition, the stroke can cause depression, or the inability to control emotions.

Stroke can also cause brain swelling or edema. This is dangerous because the space in the skull is limited. Pressure that can arise further brain damage and aggravate network neurologis aberration, although strokenya itself does not grow large.
Diagnose Stroke

Diagnosis stroke was builded usually based on the results of the disease and physical examination. Physical examination can help determine the location of damage to the brain. There are two types of imaging examination techniques (pencitraan) to evaluate the cases of stroke or brain blood vessel disease (Cerebrovascular Disease / CVD), the Computed Tomography (CT scan) and Magnetic resonance Imaging (MRI).

CT scan imaging known as the most simple, fast and relatively inexpensive for the case of stroke. However, in some cases, CT scan is less sensitive than MRI, for example, in the case of stroke hiperakut.

To strengthen the diagnosis is usually made examination MRI or CT scan. Both the examination can also help determine the cause of stroke, bleeding, or whether the brain tumor. Sometimes made, namely the determination of the order angiografi blood vessel / lymph through kapilaroskopi or fluoroskopi.
Handling of Stroke respiratory a stroke attack, immediately do the examination to determine whether the causes of blood clot or bleeding that can not be corrected with drugs not clot.

Recent research shows that paralysis and other symptoms can be prevented or restored if recombinant tissue plasminogen activator (RTPA) or streptokinase that function given the clot within 3 hours after the occurrence of stroke.

Antikoagulan also does not usually given to people with high blood pressure and is never given to patients with brain haemorrhage because akan add to the risk of the occurrence of bleeding in the brain.

Stroke patients are usually given oxygen and installed infus to enter the liquid and food substances. At the stroke in evolution given antikoagulan (eg, heparin), but the medicine is not given if there has been completed stroke.

Completed on the stroke, some brain dead network. Improve blood flow to the area will not be able to restore its function. Because it usually does not do surgery.

Appointment sumbatan vein after minor stroke or transient ischemic attack, in fact can reduce the risk of a stroke in the future. Around 24.5% patients experienced recurrent stroke.

To reduce the swelling and pressure in the brain in acute stroke patients, usually given manitol or kortikosteroid. Stroke patients who may require a very heavy respirator (breathing equipment bantu) to maintain the respiratory adekuat. In addition, special attention needs to function to the bladder, alimentary tract and skin (to prevent the occurrence of injury in the skin because of the emphasis).

Stroke usually does not stand on its own, so that when a physiological difference that must be treated for example, accompany the heart failure, heart rhythm is not regular, high blood pressure and infection of the lungs. After the attack of stroke, usually occur mood changes (especially depression), which can be corrected with medication or psychological therapy.
There is still hope for better

Rehabilitation of stroke about 30% -40% of stroke patients who can still heal perfectly provided with in a period of 6 hours or less. This is important so that patients do not experience disability. Even if there are symptoms such as the way the rest of the game or berbicaranya Pelo, but the rest of the symptoms of this can still be cured.

Unfortunately, most of the new stroke patients came to hospital 48-72 hours after the attack. If so, action needs to be done is the restoration. Recovery action is necessary to reduce complications due to stroke and attempt to restore the patient back to normal as before the attack of stroke.

Efforts to restore the health of stroke patients should be done as soon as possible, ideally starting 4-5 days after the patient's condition is stable. Each patient requires handling different, depending on the needs of the patient. This process takes about 6-12 days.

Life style, fuse Stroke Productive Age. Age is a risk factor of stroke, the risk of old age then was exposed to the higher strokenya. However, now the age need to be wary of the threat of stroke. At the age, stroke can strike, especially on those who like fatty foods and drugs (even if it does not yet have an exact number).

Junk foodLife style lifestyle is always the black sheep disease that attacks various age. Young people often apply the pattern of eating that is not often consumed with a healthy dishes are loaded with fat and cholesterol but low fiber.

Young people who travel the length of his life is still able to compete with berkiprah and human resources from abroad. Disability due to the clothing of their stroke, a burden not only families, but also burden the public in general.

Always better to prevent than treat. While stroke can still be prevented, why not try?

First, with the behavior of healthy living since early. Second, the control of risk factors must be optimal. Third, conduct medical check-up regularly and periodically, and the patient must recognize the early signs of stroke.

To prevent "the silent killer" and someone recommended this to reduce smoking, doing regular exercise, limiting alcoholic beverages, and avoid excessive stress.

Meditation For Balancing Body & Soul

With the hectic pace and demands of modern life, many people feel stressed and over-worked. It often feels like there is just not enough time in the day to get everything done. Our stress and tiredness make us unhappy, impatient and frustrated. It can even affect our health. We are often so busy we feel there is no time to stop and meditate! But meditation actually gives you more time by making your mind calmer and more focused. A simple ten or fifteen minute breathing meditation as explained below can help you to overcome your stress and find some inner peace and balance.

Meditation can also help us to understand our own mind. We can learn how to transform our mind from negative to positive, from disturbed to peaceful, from unhappy to happy. Overcoming negative minds and cultivating constructive thoughts is the purpose of the transforming meditations found in the Buddhist tradition. This is a profound spiritual practice you can enjoy throughout the day, not just while seated in meditation.

Benefit of meditation

The purpose of meditation is to make our mind calm and peaceful. If our mind is peaceful, we will be free from worries and mental discomfort, and so we will experience true happiness; but if our mind is not peaceful, we will find it very difficult to be happy, even if we are living in the very best conditions. If we train in meditation, our mind will gradually become more and more peaceful, and we will experience a purer and purer form of happiness. Eventually, we will be able to stay happy all the time, even in the most difficult circumstances.

Usually we find it difficult to control our mind. It seems as if our mind is like a balloon in the wind – blown here and there by external circumstances. If things go well, our mind is happy, but if they go badly, it immediately becomes unhappy. For example, if we get what we want, such as a new possession or a new partner, we become excited and cling to them tightly. However, since we cannot have everything we want, and since we will inevitably be separated from the friends and possessions we currently enjoy, this mental stickiness, or attachment, serves only to cause us pain. On the other hand, if we do not get what we want, or if we lose something that we like, we become despondent or irritated. For example, if we are forced to work with a colleague whom we dislike, we will probably become irritated and feel aggrieved, with the result that we will be unable to work with him or her efficiently and our time at work will become stressful and unrewarding.

Meditation Posture

When practise meditation we need to have a comfortable seat and a good posture. The most important feature of the posture is to keep our back straight. To help us do this, if we are sitting on a cushion we make sure that the back of the cushion is slightly higher than the front, inclining our pelvis slightly forward. It is not necessary at first to sit cross-legged, but it is a good idea to become accustomed to sitting in the posture of Buddha Vairochana. If we cannot hold this posture we should sit in one which is as close to this as possible while remaining comfortable.

The seven features of Vairochana’s posture are:

• The legs are crossed in the vajra posture. This helps to reduce thoughts and feelings of desirous attachment.
• The right hand is placed in the left hand, palms upwards, with the tips of the thumbs slightly raised and gently touching. The hands are held about four fingers’ width below the navel. This helps us to develop good concentration. The right hand symbolizes method and the left hand symbolizes wisdom – the two together symbolize the union of method and wisdom. The two thumbs at the level of the navel symbolize the blazing of inner fire.
• The back is straight but not tense. This helps us to develop and maintain a clear mind, and it allows the subtle energy winds to flow freely.
• The lips and teeth are held as usual, but the tongue touches against the back of the upper teeth. This prevents excessive salivation while also preventing our mouth from becoming too dry.
• The head is tipped a little forward with the chin slightly tucked in so that the eyes are cast down. This helps prevent mental excitement.
• The eyes are neither wide open nor completely closed, but remain half open and gaze down along the line of the nose. If the eyes are wide open we are likely to develop mental excitement and if they are closed we are likely to develop mental sinking.
• The shoulders are level and the elbows are held slightly away from the sides to let air circulate. (author by www.how-to-meditate.org)
  

Aromatherapy To The Healing Art

While the pleasant, uplifting effects of some odors have been known for centuries, modern, condition-specific aromatherapy based on essential oils is usually traced back to the work of French chemist Rene-Maurice Gattefosse in the late 1920s. Essential oils are volatile, aromatic products extracted from flowers, fruits, leaves, barks, and roots by various methods, such as steam distillation. The quality of essential oils varies tremendously, with the best and purest being very concentrated and very expensive. Aromatherapists may dilute essential oils with carrier oils and apply them to the skin, put them in diffusers so that people can inhale the vapors, or prepare them for ingestion.

In France and Japan, medical aromatherapy is an established field that treats medical conditions such as diabetes and seizure disorders. In the United States, aromatherapy is much less evolved and is mainly associated with the spa and beauty industries.

An increasing amount of research is delving into the questions of whether aromatherapy can improve sleep, ease pain and anxiety, reduce the respiratory congestion of colds and flu, relieve constipation, reduce post-operative nausea and even help grow hair. In most cases, further investigation will be needed before doctors here are convinced that aromatherapy works, but there is already good evidence that certain scents can help induce relaxation and improve sleep.

For example, a 1994 study at New York's Memorial Sloan-Kettering Cancer Center found that the vanilla-like aroma of heliotropin significantly reduced anxiety in patients undergoing MRI scans. In England in 2002, researchers found that applying lemon balm oil to the faces and arms of patients with severe dementia reduced their agitation by 35 percent. The study was published in the Journal of Clinical Psychiatry. At Wesleyan University in Connecticut, researchers found that the scent of lavender increased deep, restful sleep for both men and women; a Korean study published this year (2006) came to the same conclusion (but included only women). Another intriguing study, in Scotland, showed that a combination of cedarwood, lavender, rosemary, and thyme oils promoted hair growth among patients with alopecia areata, an autoimmune disorder that causes hair to fall out. The study was published in the November, 1998, issue of the Archives of Dermatology.

We may get a better fix on aromatherapy benefits after completion of a study sponsored by the National Center for Complementary and Alternative Medicine examining the effect of specific odors on immune, endocrine and autonomic system responses. Janice Kiecolt-Glaser, Ph.D., a widely-respected researcher at the Ohio State University Institute for Biobehavioral Medicine Research, is testing three odors, one selected for its reported sedating or relaxing effects, one for its activating or stimulant effects and one neutral control odor. This study is enrolling 60 volunteers and is expected to end in August of 2007.

If aromatherapy makes you feel better, by all means indulge. I would only caution against buying into dubious claims that it can treat everything from acne to yeast infections. And do make sure that your aromatherapist is qualified; in the United States, anyone can get a piece of paper attesting to "certification."

Aromatherapy is generally safe but improperly used oils can cause burns, allergic reactions, headaches and nausea, and some are toxic if ingested. Check with local certified massage therapists (their certification does mean something) who may be able to recommend a good aromatherapist.

Some of the materials employed include:

• Essential oils: Fragrant oils extracted from plants chiefly through steam distillation (e.g. eucalyptus oil) or expression (grapefruit oil). However, the term is also occasionally used to describe fragrant oils extracted from plant material by any solvent extraction.
• Absolutes: Fragrant oils extracted primarily from flowers or delicate plant tissues through solvent or supercritical fluid extraction (e.g. rose absolute). The term is also used to describe oils extracted from fragrant butters, concretes, and enfleurage pommades using ethanol.
• Phytoncides: Various volatile organic compounds from plants that kill microbes. Many terpene-based fragrant oils and sulfuric compounds from plants in the genus "Allium" are phytoncides, though the latter are likely less commonly used in aromatherapy due to their disagreeable odors.
• Herbal distillates or hydrosols: The aqueous by-products of the distillation process (e.g. rosewater). There are many herbs that make herbal distillates and they have culinary uses, medicinal uses and skin care uses. Common herbal distillates are rose, lemon balm and chamomile.
• Infusions: Aqueous extracts of various plant material (e.g. infusion of chamomile)
• Carrier oils: Typically (wikipedia)
  

Author : Andrew Weil, M.D.

Has you to protect your health with health insurance?

Health insurance is insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a government-sponsored social insurance

program, or from private insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. In each case, the covered groups or individuals pay premiums or taxes to help protect themselves from high or unexpected healthcare expenses. Similar benefits paying for medical expenses may also be provided through social welfare programs funded by the government.

By estimating the overall risk of healthcare expenses, a routine finance structure (such as a monthly premium or annual tax) can be developed, ensuring that money is available to pay for the healthcare benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.

How it works

A health insurance policy is a contract between an insurance company and an individual or his sponsor (e.g. an employer). The contract can be renewable annually or monthly. The type and amount of health care costs that will be covered by the health insurance company are specified in advance, in the member contract or "Evidence of Coverage" booklet. The individual insurered person's obligations may take several forms^[7]:

• Premium: The amount the policy-holder or his sponsor (e.g. an employer) pays to the health plan each month to purchase health coverage.
• Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor's visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care.
• Copayment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 copayment for a doctor's visit, or to obtain a prescription. A copayment must be paid each time a particular service is obtained.
• Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a copayment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.
• Exclusions: Not all services are covered. The insured person is generally expected to pay the full cost of non-covered services out of their own pocket.
• Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
• Out-of-pocket maximums: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and the health company pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
• Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.
• In-Network Provider: (U.S. term) A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or copayments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers.
• Prior Authorization: A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an authorization means that the insurer is obligated to pay for the service, assume it matches what was authorized. Many smaller, routine services do not require authorization^[8]
• Explanation of Benefits: A document sent by an insurer to a patient explaining what was covered for a medical service, and how they arrived at the payment amount and patient responsibility amount^[9]

Prescription drug plans are a form of insurance offered through some employer benefit plans in the US, where the patient pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan.

Some, if not most, health care providers in the United States will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay. The insurance company pays out of network providers according to "reasonable and customary" charges, which may be less than the provider's usual fee. The provider may also have a separate contract with the insurer to accept what amounts to a discounted rate or capitation to the provider's standard charges. It generally costs the patient less to use an in-network provider.

Health plan vs. health insurance

Historically, HMOs tended to use the term "health plan", while commercial insurance companies used the term "health insurance". A health plan can also refer to a subscription-based medical care arrangement offered through HMOs, preferred provider organizations, or point of service plans. These plans are similar to pre-paid dental, pre-paid legal, and pre-paid vision plans. Pre-paid health plans typically pay for a fixed number of services (for instance, $300 in preventive care, a certain number of days of hospice care or care in a skilled nursing facility, a fixed number of home health visits, a fixed number of spinal manipulation charges, etc.) The services offered are usually at the discretion of a utilization review nurse who is often contracted through the managed care entity providing the subscription health plan. This determination may be made either prior to or after hospital admission (concurrent utilization review).

author : wiki pedia

Know About Osteoathritis

Osteoarthritis Fact Sheet

Osteoarthritis is characterized by mild to debilitating pain in the hands and joints such as knees, hips, feet and back. The disease is most prevalent among individuals 45 years of age and older. Women are more prone to the disease.

What is osteoarthritis?

A degenerative joint disease, osteoarthritis is one of the oldest and most common forms of arthritis. The disease causes cartilage breakdown found in joints. This breakdown removes the buffer between bones and the resulting bone against bone friction causes pain and eventual loss of movement. Symptoms include joint pain or aching (often after exercise or extended periods of pressure on weight-bearing joints) and limited or eventual loss of range of motion.

As the opposing cartilage surfaces wear away, the knee collapses causing deformities such as bowleggedness (varus) or knock knees (valgus). These deformities can contribute to pain and functional losses of the knee.

How do you get osteoarthritis?

There are a wide array of factors that cause the development and progression of the disease.

Risk factors include:

• Aging
• Obesity
• Joint injuries (sports, work or accidents)
• Genetics

How do patients find out if they have osteoarthritis?

An individual must seek the diagnosis of a doctor. After a physical examination and full detailing of symptoms have been discussed, the doctor may also recommend X-rays to confirm presence of the disease.

What are treatment options?

The treatment options for osteoarthritis, include:

• Joint and muscle exercises to improve strength and flexibility
• Weight management to relieve stress on weight-bearing joints
• Anti-inflammatory drugs for degenerative joint disorders
• Heat/Cold therapies
• Synovectomy (surgical removal of inflamed synovial tissue)
• Osteotomy (restructuring of the bones to shift stresses from diseased to more healthy tissue)
• Partial knee replacements (unicompartmental knee - replaces only diseased portion of the joint)
• Total knee replacement (used when severe osteoarthritis is present)

Exercise For Osteoathritis

Of course we should all eat right, control our weight and get exercise. But joint problems can make these goals even more difficult. The following frequently asked questions help highlight the special benefits to your health and the special challenges you may face..

Can exercise really affect my lifestyle?

Americans could significantly improve their health and quality of life by practicing some form of physical activity on a regular basis. According to the Surgeon General's Report on Physical Activity and Health, regular, moderate physical activity is beneficial in decreasing fatigue, strengthening muscles and bones, increasing flexibility and stamina, and improving an overall sense of well-being.

Remember, you don't need to lift weights or train for the marathon. Just do something active on a regular basis.

Is there a specific benefit of exercise for an arthritis sufferer?

Yes. Exercise helps to:

• Keep joints moving
• Strengthen muscles around the joints
• Strengthen and maintain bone and cartilage tissue
• Improve overall ability to do everyday activities
• Improve health and fitness by:
  • increasing energy level
  • improving sleep
  • assisting weight control
  • improving overall cardiovascular condition
  • decreasing depression
  • improving self-esteem and emotional health

What happens if I don't exercise?

Lack of exercise contributes to:

• Smaller and weaker muscles
• Brittle bones
• Pain
• Disfigured joints that stay in one position for so long that the ability to straighten them may be lost
• Loss of mobility in joints that may become locked in a position if they are not routinely worked

What type of exercise programs should an arthritis sufferer use?

For most people, a balanced exercise program is best. However, before you begin an exercise program, you should consult a physician on a program that is tailored to your needs and that considers your joint health. It should include a combination of the three main types of exercise:

• Range-of-Motion Exercises: These are basic stretching exercises to keep joints supple and mobile by moving them through their full "range-of-motion". Make sure that you get the advice of a medical professional about which kinds of this exercise you should do and which joints to focus on.
• Strengthening Exercises: These are beneficial because they help maintain or increase muscle strength. Some special exercises have been developed that allow you to strengthen muscles without putting stress on joints. They may involve pulling or pushing against an object that does not move (such as the floor or wall). These "isometric exercises" can be as simple as just flexing and relaxing certain muscles.
• Endurance Exercises: These are beneficial because they strengthen the heart, while making the lungs more efficient and improving stamina. They also help improve your sleep, aid weight loss and lift your mood. Examples are walking, cycling and swimming.

Before you begin an exercise program, you should consult a physician or a physical therapist, especially if you have not exercised in a while, have had any surgical procedures, or are over age 40.

author : www.zimmer.co

Guide To Healthy Sleep

The following ten tips can help you achieve sleep and the benefits it provides. These tips are intended for "typical" adults, but not necessarily for children or persons experiencing medical problems.

You can find information on this site about children and sleep and NSF recommends that persons treated for medical conditions consult their doctor – check our resource, "Sleep Talk with Your Doctor."

Finally, if you have trouble falling asleep, maintaining sleep, awaken earlier than you wish, feel unrefreshed after sleep or suffer from excessive sleepiness during the day or when you wish to be alert, you should also consult your physician. Be sure to tell him/her if you have already tried these tips and for how long. To check for possible sleep problems, go to our checklist, "How's Your Sleep?"

1. Maintain a regular bed and wake time schedule including weekends

Our sleep-wake cycle is regulated by a "circadian clock" in our brain and the body's need to balance both sleep time and wake time. A regular waking time in the morning strengthens the circadian function and can help with sleep onset at night. That is also why it is important to keep a regular bedtime and wake-time, even on the weekends when there is the temptation to sleep-in.

2. Establish a regular, relaxing bedtime routine such as soaking in a hot bath or hot tub and then reading a book or listening to soothing music.

A relaxing, routine activity right before bedtime conducted away from bright lights helps separate your sleep time from activities that can cause excitement, stress or anxiety which can make it more difficult to fall asleep, get sound and deep sleep or remain asleep. Avoid arousing activities before bedtime like working, paying bills, engaging in competitive games or family problem-solving. Some studies suggest that soaking in hot water (such as a hot tub or bath) before retiring to bed can ease the transition into deeper sleep, but it should be done early enough that you are no longer sweating or over-heated. If you are unable to avoid tension and stress, it may be helpful to learn relaxation therapy from a trained professional. Finally, avoid exposure to bright before bedtime because it signals the neurons that help control the sleep-wake cycle that it is time to awaken, not to sleep.

3. Create a sleep-conducive environment that is dark, quiet, comfortable and cool.

Design your sleep environment to establish the conditions you need for sleep – cool, quiet, dark, comfortable and free of interruptions. Also make your bedroom reflective of the value you place on sleep. Check your room for noise or other distractions, including a bed partner's sleep disruptions such as snoring, light, and a dry or hot environment. Consider using blackout curtains, eye shades, ear plugs, "white noise," humidifiers, fans and other devices.

4. Sleep on a comfortable mattress and pillows.

Make sure your mattress is comfortable and supportive. The one you have been using for years may have exceeded its life expectancy – about 9 or 10 years for most good quality mattresses. Have comfortable pillows and make the room attractive and inviting for sleep but also free of allergens that might affect you and objects that might cause you to slip or fall if you have to get up during the night.

5. Use your bedroom only for sleep and sex.

It is best to take work materials, computers and televisions out of the sleeping environment. Use your bed only for sleep and sex to strengthen the association between bed and sleep. If you associate a particular activity or item with anxiety about sleeping, omit it from your bedtime routine. For example, if looking at a bedroom clock makes you anxious about how much time you have before you must get up, move the clock out of sight. Do not engage in activities that cause you anxiety and prevent you from sleeping.

6. Finish eating at least 2-3 hours before your regular bedtime.

Eating or drinking too much may make you less comfortable when settling down for bed. It is best to avoid a heavy meal too close to bedtime. Also, spicy foods may cause heartburn, which leads to difficulty falling asleep and discomfort during the night. Try to restrict fluids close to bedtime to prevent nighttime awakenings to go to the bathroom, though some people find milk or herbal, non-caffeinated teas to be soothing and a helpful part of a bedtime routine.

7. Exercise regularly. It is best to complete your workout at least a few hours before bedtime.

In general, exercising regularly makes it easier to fall asleep and contributes to sounder sleep. However, exercising sporadically or right before going to bed will make falling asleep more difficult. In addition to making us more alert, our body temperature rises during exercise, and takes as much as 6 hours to begin to drop. A cooler body temperature is associated with sleep onset... Finish your exercise at least 3 hours before bedtime. Late afternoon exercise is the perfect way to help you fall asleep at night.

8. Avoid caffeine (e.g. coffee, tea, soft drinks, chocolate) close to bedtime. It can keep you awake.

Caffeine is a stimulant, which means it can produce an alerting effect. Caffeine products, such as coffee, tea, colas and chocolate, remain in the body on average from 3 to 5 hours, but they can affect some people up to 12 hours later. Even if you do not think caffeine affects you, it may be disrupting and changing the quality of your sleep. Avoiding caffeine within 6-8 hours of going to bed can help improve sleep quality.

9. Avoid nicotine (e.g. cigarettes, tobacco products). Used close to bedtime, it can lead to poor sleep.

Nicotine is also a stimulant. Smoking before bed makes it more difficult to fall asleep. When smokers go to sleep, they experience withdrawal symptoms from nicotine, which also cause sleep problems. Nicotine can cause difficulty falling asleep, problems waking in the morning, and may also cause nightmares. Difficulty sleeping is just one more reason to quit smoking. And never smoke in bed or when sleepy!

10. Avoid alcohol close to bedtime.

Although many people think of alcohol as a sedative, it actually disrupts sleep, causing nighttime awakenings. Consuming alcohol leads to a night of less restful sleep.

If you have sleep problems...

Use a sleep diary and talk to your doctor. Note what type of sleep problem is affecting your sleep or if you are sleepy when you wish to be awake and alert. Try these tips and record your sleep and sleep-related activities in a sleep diary. If problems continue, discuss the sleep diary with your doctor. There may be an underlying cause and you will want to be properly diagnosed. Your doctor will help treat the problem or may refer you to a sleep specialist.

author : http://www.sleepfoundation.org

Low Back Pain

Most people will experience back pain during their lifetime. Some patients fear the worst, especially when pain is severe. Although back pain can be caused by fracture, disc disorder, or tumor, the most common cause is sprain or strain.

Sprains and strains often result from excessive physical demands on the back. Lifting something too heavy, a sudden fall, car crash, or sports injury can cause soft tissues (ligaments, muscles, tendons) to stretch too much.

Sprains · Strains
The spine includes vertebrae (bones), discs (cartilaginous pads or shock absorbers), the spinal cord and nerve roots (neurological wiring system), and blood vessels (nourishment). Ligaments link bones together, and tendons connect muscles to bones and discs. The ligaments, muscles, and tendons work together to handle the external forces the spine encounters during movement, such as bending forward and lifting.

Sprains and strains are similar disorders affecting different soft tissues in the spine. Sprains are limited to ligaments whereas strains affect muscles, tendons, or muscle-tendon combinations.

Ligaments are strong flexible bands of fibrous tissue. Although ligaments are resistant to being stretched, they do allow some freedom of movement. Muscle is made up of individual and segmental strands of tissue. When back muscles encounter excessive external force, individual strands can stretch or tear while the rest of the muscle is spared injury.

To illustrate a sprain or strain, consider what happens when lifting something heavy. Initially muscles are recruited to manage the load. When the load or force exceeds the muscles' ability to cope, the force is shared with the ligaments. When a ligament is stressed beyond its strength, it can tear.

Local tissues swell when ligaments, muscles, tendons, or combinations become overstretched, overused, or torn. Swelling causes pain, tenderness, and stiffness; swelling serves to protect the injured back by restricting movement - similar to a splint on a broken leg.

author : Jean-Jacques Abitbol, MD, FRCSC, Edgar G. Dawson, M.D., Regis W. Haid, Jr., MD

a. Symptom and Diagnosis Back Pain

What is acute low/mechanical back pain?
Acute low/mechanical back pain is a common medical problem. Acute pain is pain that has been present less than 4 to 6 weeks. Mechanical means the source of the pain may be in the spinal joints, discs, vertebrae or soft tissues. Acute mechanical back pain may also be called acute low back pain, lumbago, idiopathic low back pain, lumbosacral strain or sprain, or lumbar syndrome.

What causes low/mechanical back pain?
A precise cause of low/mechanical back pain can be identified 20 percent of the time. Sometimes, a specific trauma or strenuous activity may cause the pain. However, 80 percent of the time, the specific source of pain is not found.

It implies the source of pain is in the spine and/or its supporting structure. The surrounding muscles and ligaments may become inflamed and irritated.

Less than one percent of people who develop acute low back pain have a serious cause, such as cancer or infection, to explain their pain.

What are the symptoms of low/mechanical back pain?
Most people experience pain primarily in the lower back. The pain may spread (radiate) to the buttocks, thighs or knees. Many people may also experience spasms with mechanical back pain. The symptoms of low/mechanical back pain are generally more noticeable with flexion of the back and when lifting heavy objects.

Back pain is usually more severe than leg pain (sciatica). Sciatica is usually the result of a pinched nerve, when a protruding disc is putting pressure on a spinal nerve. With sciatica, the pain frequently extends below the level of the knee.

How is back pain diagnosed?
A careful evaluation of your medical history and a physical examination will help your health care providers determine if you have mechanical back pain. Then, they will work with you to create an appropriate treatment plan.

If your health care provider has determined your back pain is mechanical, additional testing is not usually necessary. If your symptoms or examination suggest the possibility of infection, malignancy or a pinched nerve, additional tests may be necessary. Additional testing may include blood tests, X-rays, computed tomography (CT) scan, magnetic resonance imaging (MRI), and/or nerve conduction studies.

b. Exercise For Back Pain

1. What is Physical Therapy?

Physical Therapy (PT) is considered a conservative treatment method addressing the treatment, healing and prevention of injuries and disabilities. PT focuses primarily, but not solely, on pain relief, promoting healing, and restoring function and movement associated with injury. Other areas within physical therapy are ergonomic (body mechanic) training, fitness/ wellness, and especially education and prevention.

2. What can a Physical Therapy program do for me that I cannot do on my own?

Many patients may think that they know how to properly exercise, manage their pain and rehabilitate themselves. I have commonly been given explanations from patients for why they do not need therapy - for example, "I have had this before and I know what works for me" or "I know what is causing this, because my neighbor had the same thing so I will just do what she did" and attempt to manage themselves. A Physical Therapist is a specialist skilled and educated specifically in proper rehabilitation. We are continually educated as to management for different dysfunctions, differentiation of one dysfunction/injury from another and work closely with the referring physician in the development of a rehabilitation program specifically designed for each individual. The other important aspect to remember with physical therapy is that each individual is different. We all have different types of bodies, different patterns of movement, alignments and habits. A physical therapist, along with their trained staff, monitors each individual and attempts to correct improper movements, alignments and habits.

Most importantly with therapy comes education. Because of healthcare guidelines and reimbursement changes, your physician may not have the time needed to explain exactly what your injury/dysfunction/disability is and why/how it occurred. Your therapist is specialized in this and many times is the person who will educate you about the specifics of your problem and what the course of action will be to correct it and hopefully prevent it from reoccurring. PT focuses on education, correction and prevention.

3. How long is it going to take?

This is such a popular question. It seems that everyone has to have timelines, which is understandable because we all have lives to lead. Your physical therapist is aware that rehabilitation can be an imposition. I explain that because each person is different, rates of healing are different. I can usually get an idea of your progress within two weeks. I explain to my patients that even though they have other things to do, rehab is important. Although rehab takes time, it also took time for the injury to progress to the point of causing pain or contirbuting to injury.

Physical therapists want their patients to understand that although we are here to teach and rehabilitation them, their Home Program it is their responsibility. The Home Program is a major contributing factor to how quickly the patient recovers.

4. Who benefits from physical therapy?

Many and all can benefit from physical therapy. As an active therapist, I work out and always observe others. I very rarely come across individuals with perfect body mechanics, training techniques or movement patterns. This is where wellness comes into play. Typically, the most appropriate patients are those who have been in accidents (work, auto, or falls), athletes with overstress injuries, patients with arthritis, pre- and post-operative patients, and people with general deconditioning or strains.

5. What will I have to do in physical therapy?

PT generally encompasses pain relief, strength and flexibility training, proper postural alignment, regaining movement or range of motion, improving and correcting posture, endurance training, relaxation and stress relieving techniques, balance and coordination training, proper walking, education, safety awareness and development/implementation of a home exercise program.

Remember that each individual is different, so each rehab/physical therapy experience and program is different. Be patient with yourself, your physician and your physical therapy staff. Healing takes time, diligence and compliance. If you think you may be a candidate for physical therapy, speak to your physician or to a therapist. We never will say "no" to questions.

author : Dana L Davis MPT