TENIS ELBOW (Lateral Epicondylitis)

Tennis elbow (lateral epicondylitis) is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities can also put you at risk.

Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.

There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists, and, in some cases, surgeons work together to provide the most effective care.

Anatomy

Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.

The ECRB muscle and tendon is usually involved in tennis elbow.

Muscles, ligaments, and tendons hold the elbow joint together.

Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone. They attach on the lateral epicondyle. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).

Cause

Overuse

Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.

The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.

Activities or jobs involving repetitive arm motion also cause tennis elbow. They include:

·         Painting

·         Tree-cutting

·         Carpentry

·         Playing some musical

·         Repetitive computer mouse use

Also, cooks, butchers, and assembly-line workers are among those who often suffer tennis elbow.

Note: Tennis elbow is different from Golfer’s elbow even though tendon tears are caused by repetitive movements of the hands. Because, the pain in Golfer’s elbow is focused on the inside of the elbow.

Symptoms

The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with

the start of symptoms.Common signs and symptoms of tennis elbow include:

·         Pain or burning on the outer part of your elbow

·         Weak grip strength

The ache on the outside of the elbow is the major symptom of tennis elbow, which may affect both the arms.

The ache may turn into a chronic pain over time.Eventually, it may become difficult even to lift things.Pain and weakness may make it difficult even to shake hands, turn a door knob, or even hold a coffee cup.The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however both arms can be affected.

Doctor Examination

consider many factors in making a diagnosis. These include how your symptoms developed, any occupational risk factors, and recreational sports participation.

what activities cause symptoms and where on your arm the symptoms occur. History of rheumatoid arthritis, injured your elbow or nerve disease.use of variety of tests to pinpoint the diagnosis. For example, try to straighten your wrist and fingers against resistance with your arm fully straight to see if this causes pain. If the tests are positive, those muscles may not be healthy.

Tests

recommend additional tests to rule out other causes of your problem.

·         X-rays. These tests provide clear images of dense structures like bone. They may be taken to rule out arthritis of the elbow.

·         Magnetic resonance imaging (MRI) scan. If symptoms are related to a neck problem, an MRI scan may be ordered. MRIs scans show details of soft tissues, and possible herniated disk or arthritis in your neck. Both of these conditions often produce arm pain.

·         Electromyography (EMG).  rule out nerve compression. Many nerves travel around the elbow, and the symptoms of nerve compression are similar to those of tennis elbow.

Treatment 

Nonsurgical Treatment

        Approximately 80% to 95% of patients have success with nonsurgical treatment.

    Rest: The first step toward recovery is to give your arm proper rest. This means that you   will have to stop participation in sports or heavy work activities for several weeks.

·  Physical therapy: The therapist helps gradually stretch and strengthen muscles, especially of the forearm. Eccentric exercises help big time, as they involve lowering and raising the wrist very slowly. The doctor may suggest the brace or the forearm strap to reduce stress on the injured tissue. 

     Medications as prescribed by the doctor including aspirin, ibuprofen, Motrin, Advil. Over the counter pills may also offer reduce pain and swelling.

  Surgical or other procedures:

 (i) Injections: To control the pain, the doctor might suggest injecting platelet-rich plasma, Botox or some irritant (prolotherapy) into the painful tendon. Dry needling can also help, which is nothing but piercing needles at the damaged tendon in many places. 

(ii) Ultrasonic tenotomy (TENEX procedure): It is a medical procedure that involves inserting a special needle through the skin under ultrasound guidance into the damaged portion of the tendon. The needle is vibrated swiftly by the ultrasonic energy for the damaged tissue to get liquefied and can be suctioned out. 

(iii) Surgery: Even after the 6 to 12 months treatment if the pain does not subside, a surgery may become the option for the removal of the damaged tissue. Such procedures can be performed through several small incisions or a large incision. Rehabilitation exercises play a prominent role in recovery.

· Lifestyle and home remedies: Rest so that the elbow pain doesn’t exaggerate. Expert-evaluation to analyze the tennis techniques and movements to correct and take right measures to reduce the stress on the injured tissues. Self-care measures like applying ice bags or a cold pack for 15 minutes at least thrice a day will be helpful.

·         Exercising as per the expert guidance.

What Are The Strengthening Exercises For Tennis Elbow:Strengthening exercises for Tennis elbow are listed below.

Ball or sock squeeze:

1.      Hold tennis ball in your hand.

2.      Make a fist and squeeze.

3.      Hold for 6 seconds and release.

4.      Repeat 10 times a day. Repeat in both the hands.

Wrist deviation

1.      Sit by resting your arm on a flat surface and leaving your hand hanging off the edge.

2.      Move your hand up and down. Keep repeating the motion for 8 to 12 times.

3.      Repeat by switching arms.

Wrist Curl exercises

1.      Sit placing your forearm on a table, palm up, and hand hanging over the edge.

2.      Place an object that weighs around 1 to 2 pounds in your hand.

3.      Slowing keep raising and rest forearm on the table.

4.      Keep repeating the motion for 8 to 12 times. Switch arms.

Bicep curls

1.      Lean forward and sit with legs spread little.

2.      Place your left hand on your left thigh. Right hand on the right thigh.

3.      Hold weight with your forearm. Curl the weight slowly toward the chest.

4.      Keep repeating the motion for 8 to 12 times. Switch arms.

Overview

Tennis elbow or lateral epicondylitis is a painful condition that occurs due to overuse and muscle strain injury.

Occurs when elbow tendons are overloaded due to repetitive motions of arm and the wrist.

Over-the-counter pain relievers and enough rest help relieve tennis elbow. Surgery may be a last option if all the conservative treatments fail or if the symptoms are disabling.

10 Symptoms of Tennis Elbow

Despite the name, you don’t have to be a tennis player to suffer from this painful arm injury. Tennis players are certainly some of the most likely people to get injured in this way, with as many as one out of two getting tennis elbow, but it also affects plumbers, butchers, typists and anyone else who commonly make certain repeated motions with their arms and wrists. Believe it or not, even video game players sometimes get tennis elbow from game controller manipulations. It happens in every age group, but statistics show that those in their 30s and 40s face higher risks than other age groups.

1. Pain on the upper forearm

A persistent pain in the upper forearm is one of the classic tennis elbow symptoms. This pain usually occurs on the outer arm just beneath the elbow. Sufferers commonly describe this sensation as a burning pain. However, similar symptoms happen with certain other illness, so everyone is recommended to consult their doctor. They will be pleased to get a tennis elbow diagnosis since although it can be quite painful, it still represents a mild injury that often requires no medical intervention.

2. Pains increase with activities

Someone with tennis elbow immediately notices that certain activities become very painful to them. Commonly they experience this pain if they raise or bend their arms and even while performing simple tasks like holding a pen and writing a note. They also often get these pains when they need to turn the forearm to open a door; it hurts when they need to move their wrist forcefully. There is no need to lift a heavy item to feel this pain but even lifting up something as light as fork becomes very painful.

3. Normally rest brings a measure of relief

In the majority of cases those with less severe cases of tennis elbow notice that their pain lessens significantly when they rest. Someone in this situation has no need to seek any medical advice, but if rest brings no real relief, or if they find themselves unable to move the elbow or lose feeling in it, they need to contact a doctor urgently.

4. Pains often vary according to the time of day

Sufferers from tennis elbow often notice that the elbow of their injured arm feels very stiff and aches when they wake up in the morning. As the day proceeds, this stiffness and aching lessen somewhat, but it still continues at some level.

5. The nature of the pain changes

The tennis elbow pain often starts off like a burning ache located on the outer forearm and elbow, but it starts to grow more intense. If the arm gets no rest the pain sometimes goes down all the way to the wrist. In the opposite direction, these pains might also ascend the upper section of the arm towards the shoulder. Everything depends on the source of the original injury and subsequent activities using this hand, so it is impossible to describe how the pains will develop in every instance.

6. Handshakes are no fun

The handshake is one of our most common and accepted social interactions. This sign of respect or good will is expected when meeting customers or public figures, but for anyone with tennis elbow, this simple act becomes a very painful procedure. It is not only shaking hands that hurt them, but they experience a similar kind of pain squeezing an orange or some other object. The best way to avoid the pain and social embarrassment are to let the other person know about the hand injury in advance, so they will not get offended.

7. Increased sensitivity to pressure

You might think that handshakes are so painful to someone with tennis elbow because it pains them to move their hand in this way but this is only half of the picture. In addition to the pain, this particular wrist movement causes the pressure of the other person’s hand further exacerbates the pain. Any pressure on the affected area serves to increase their pain. The source of this pain is an inflamed tendon where the muscle is attached to the bone on the outer side of the elbow.

8. These pains start all of a sudden

With sport and most other injuries, the party involved easily makes the connection between an injury they suffer and the pain that comes on but in many instances of tennis elbow, there is no such link. This happens because the person affected might not have noticed whatever action or event led to this injury. Furthermore, symptoms often appear three or four days down the line, so this makes it that much harder to work out the source of the problem. The fact that pains usually develop gradually is another factor that distances the complaint from its cause to impede easy identification.

9. Pains go away without treatment

Although nobody disputes that tennis elbow pains are very painful and interfere with people’s working and sporting lives they still deserve to be classed as a mild injury. In the vast majority of cases, these pains decline and eventually cease altogether without the need for any medical intervention. If you rest the injured arm sufficiently expect a complete healing within a couple of months although there are extreme cases where tennis elbow continues over a couple of years. The more the injured person tries to use this arm the longer the healing takes.

10. It becomes harder to grip everyday objects

The way tennis elbow weakens a person’s grip is one of the most significant ways to which it interferes with their normal life. If it was simply a matter of difficulties holding a racquet, it is easy to put up with, but it makes it harder to hold all kinds of objects people regularly use. Any actions that require some strength of the hand are no longer moves performed with little forethought but challenges. The actions in question include such simple tasks as gripping light objects such as a cup or screwdriver.

Amputed Rt Thumb with # proximal phalynx of Rt 5th digit

WHAT CAN BE THE FURTHER POSSIBILITIES OF MGMT ? 

EXPERT OPINION

E

Percutaneous Nephrolithotomy (PCNL)

What is it?

Percutaneous Nephrolithotomy (PCNL) is the preferred technique for treating large stones (over 2cm in diameter) within the kidney. It involves keyhole surgery performed through a 1cm incision in the skin overlying the kidney.     

What are the advantages?

Allows large or complicated stones to be treated in a minimally invasive fashion, where in the past this would have necessitated a large skin incision.

Hospital stay is 3-4 days, and out of hospital recovery time is significantly shorter than traditional open surgery.

What are the disadvantages?

Compared to traditional treatments of large complex stones, there are no disadvantages. Improved techniques and equipment have allowed this type of surgery to be safer than ever before.

What preparation is required?

You will be required to have detailed imaging to allow the surgeon to assess the stone in fine detail regarding its relationship to the kidney and nearby structures. This will enable the surgeon to plan the best access point(s) to the kidney to allow effective clearance of stones.

As the procedure is performed under general anaesthesia, you should have nothing to eat or drink for 6 hours prior to treatment. Regular medications can be taken with a sip of water with the exception of blood thinning agents (eg. warfarin, aspirin, clopidogrel) or non-steroidal anti-inflammatories which need to be stopped for 7-10 days. A mid stream urine (MSU) test is required to ensure the urine is sterile before treatment is undertaken. Other tests required include urine culture, kidney function studies, and complete blood counts. These tests will all be organized from the rooms after your consultation.

What are the risks?

This form of surgery is low risk if performed by an urologist who is specifically trained in this technique, and aided by meticulous pre-operative planning. The specific risks are uncommon but include infection, excessive bleeding (necessitating blood transfusion 2%, embolisation 1%, renal exploration 0.5%), and adjacent organ injury (spleen, liver, bowel, and lung).

What do I need to bring to surgery?

All related available imaging such as KUB (kidneys, ureter, and bladder) x-ray, CT scan abdomen, or kidney ultrasound

Your usual medications

What happens in the operating room?

The operation is performed under a general anaesthetic and lasts approximately 2 to 3 hours. It is a team effort requiring coordination between surgeon, anaesthetist, radiology and nursing staff. You will be positioned on the operating room table lying on your front “stomach” for the duration of the surgery. The procedure is accomplished with the assistance of x-ray imaging to guide entry of a 1cm tube into the kidney. This provides access into the kidney drainage system allowing telescopes and instruments to visualize, fragment and remove stones. A drainage catheter (nephrostomy tube) which exits through the skin is left in the kidney at the end of the procedure.

What to expect afterwards?

You will have a temporary catheter called a nephrostomy tube draining the kidney, as well as a urinary catheter in-situ. They will be removed prior to discharge from hospital. The urine will be bloodstained for up to a week after discharge from hospital. Imaging is performed immediately after surgery to assess stone clearance. Occasionally, further minor surgery is required to clear any remaining stones to achieve complete stone clearance. Your hospital stay will be 3-4 days on average.

Follow-up

You will be required to take it easy during the recovery phase for several weeks. There should only be minimal discomfort from the wound. Oral antibiotics will be given for a further five days to prevent infection. It is important to inform us if you feel unwell with fevers, chills, or develop heavy bleeding in the urine. Your initial follow-up will be in 6 weeks after discharge. Occasionally, a urinary stent is left to ensure the urine drains correctly into the bladder. This will require removal at a later time

तामाको भाँडामा राखेको पानी किन पिउने

प्रदुषित पानीको समस्यालाई ध्यानमा राख्दै आजभोलि मानिसहरुले आफ्नो घरमा वाटर प्यूरीफायरहरु लगाएका हुन्छन्। वाटर प्यूरीफायरले पानीमा भएका दूषित किटाणु मार्न मद्दत गर्छ। तर पुरानो जमानामा यस्तो सुविधा थिएन। यसको समाधानका लागि मानिसहरु तामाको भाँडामा पानी जम्मा गर्थे।

१. तामाको भाँडामा पानी राख्नाले विभिन्न प्रकारका फङ्गल, एलगी र पानीमा पाइने अन्य ब्याक्टेरियालाई सजिलै मार्छ। तामाले हाम्रो शरीरलाई धेरै किसिमले फाईदा गर्छ।

२. तामाले पानीमा हुने सम्पूर्ण प्रकारको ब्याक्टेरियाहरुलाई मार्छ जसले पखाला, आउँ र जन्डिस जस्ता रोगको खतराबाट बचाउँछ।

३ .   तामाको भाँडामा राखेको पानी पिउनाले एसिडिटी, ग्यास र कब्जियत जस्ता समस्यालाई टाढा राख्छ।

४ .   पाचन सही राख्नुका साथै तामाले फ्याट्टि कोषहरुलाई बढ्नबाट पनि रोक्छ। यसले मोटोपन नियन्त्रण गर्छ।

५ .   तामामा पाइने खनिजले मुटुसँग जोडिएका समस्यालाई टाढा राख्छ। रक्तचाप नियन्त्रण गर्नुका साथै नराम्रो कोलस्ट्रोललाई पनि कम गर्छ। यसका साथै उक्त खनिजले थायोराइडको समस्यामा राहत दिन्छ। त्यस्तै यसले मुटु, दिमाग, कलेजो र मृगौलाको कार्य सही राख्न पनि मद्दत गर्छ। 

६ .    छालासँगै आँखा र कपालको रङ्ग बढाउने मेलालिन बनाउन तामाले मद्दत गर्छ। मेलालिनले छालालाई अल्ट्रोभायालेट किरणहरुबाट बचाउँछ र मुहारका दाग धब्बालाई पनि टाढा राख्छ।

७.      रक्त अल्पताको समस्याबाट बच्न पनि तामा राखेको पानी पिउने गरिन्छ।

८ .  तामा निकै राम्रो एन्टिअक्सिडेन्ट हुन्छ जसले समय अगावै हुने चाउरीपनाको समस्या टाढा राख्छ।

९ .    तामामा एन्टि इन्फ्ल्यामेटरी गुण हुन्छ जसले शरीर दुख्ने समस्या कम गर्नुका साथै आर्थराइटिसको समस्या पनि कम गर्छ।

http://kinmel.setopati.com/ausadhi-upachar/28475/

Autoimmune Diseases Could be Treated With Medical Marijuana

Researchers at the University of South Carolina conducted a study that analyzed the effects of THC in marijuana on patients with autoimmune diseases because the drug has previously shown to have an immunomodulatory activity.

Immunomodulatory means something is capable of modifying or regulating one or more immune functions, or can provide an immunologic adjustment, regulation, or potentiation. In this study's case, the researchers found that the application of marijuana has the ability to suppress an immune response to treat autoimmune diseases, such as arthritis, lupus, colitis, multiple sclerosis, and others.
Tetrehydrocannabinol (THC) is the chemical in marijuana that is responsible for the drug's psychological effects. It binds to cannabinoid receptors on nerve cells. These cannabinoid receptors are located in certain areas of that brain that are associated with thinking, memory, pleasure, coordination, and time perception. Through conducting tests on mice, the researchers found that THC gene regulation could result in epigenetic changes.
This finding means that marijuana could cause alterations to the function of genes controlled by DNA. When an individual suffers from an autoimmune disease, the immune system cannot tell the difference between healthy body tissue and antigens, so normal body tissues are destroyed as a result. Administering marijuana in the experimental mice revealed that the drug has the capacity to affect DNA expression through epigenetic pathways outside of the DNA.
"Our results showed that THC treatment leads to the association of active histone modification signals to Th2 cytokine genes and suppressive modification signals to Th1 cytokine genes, indicating that such a mechanism may play a critical role in THC-mediated switch from Th1 to Th2," reads the study's abstract. "At the global level, a significant portion of histone methylation and acetylation regions were altered by THC."
The epigenomes, "histones," lead to the suppression of inflammation. The THC in marijuana can help manipulate these epigenomes to suppress inflammation in the body, being that inflammation worsens one's autoimmune condition.
The study, "Histone modifications are associated with Delta(9)-tetrahydrocannabinol-mediated alterations in antigen-specific T cell responses," was published in the Journal of Biological Chemistry.
http://www.scienceworldreport.com/articles/15145/20140603/autoimmune-diseases-treated-medical-marijuana.htm

किन बढ्दैछ नेपालमा मधुमेह ?

किन बढ्दैछ नेपालमा मधुमेह ?

प्रकाशित मिति:२०७२ साउन १९ गते १५:४१

-डा प्रदीपकुमार श्रेष्ठ

विश्वमा महामारीका रुपमा फैलिरहेको मधुमेहसम्बन्धी प्रशस्त जानकारी दिइँदै आइएको छ । यसबारे जति धेरै सूचना र सचेतना प्रवाह भइरहेको छ, त्यही अनुसार भ्रम पनि बढ्दै गएका छन् । रोगबारे भ्रम फैलिँदा सर्वसाधारणको स्वास्थ्य संकटमा पर्छ ।
बिहान खाली पेटमा रगत जाँच्दा चिनीको मात्रा १२६ मिलिग्रामभन्दा बढी देखियो भने ब्लड सुगर बढेको मानिन्छ । यदि १०० देखि १२६ मिलिग्रामको बीचमा देखियो भने मधुमेह रोग लाग्ने सम्भावना भएकोे मानिन्छ । त्यस्तै खाना खाएपछि सुगर २०० मिलिग्रामभन्दा बढी देखिएमा पनि ब्लड सुगर बढेको मानिन्छ भने १४० देखि १९९ सम्म भएमा मधुमेहको जोखिम मानिन्छ । रगतमा ग्लुकोजको मात्रा १८० मिलिग्रामभन्दा बढी पुगेको अवस्थामा मात्र पिसाब जाँचेर मधुमेह पत्ता लगाउन सकिन्छ ।
एउटा स्वस्थ व्यक्तिको रगतमा ग्लुकोजको मात्रा नियन्त्रित हुन्छ । आठ घण्टा मानिस भोकै रहँदा पनि रगतमा ग्लुकोजको मात्रा ७०–१०० मिलिग्रामको बीचमा रहन्छ भने खाना खाएको दुई घण्टामा जाँच्दा यो मात्रा करिब १४० मिलिग्रामसम्म पुग्न सक्छ ।

हामी मधुमेह जाति

विश्वमै मधुमेहको उच्च जोखिममा दक्षिण एसिया छ । चीन र भारतलाई मधुमेहको खतरा धेरै भएका मात्रै होइन, रोगीको संख्या पनि उच्च भएका देश भनिरहँदा बीचको नेपाल अछुतो रहँदैन । दक्षिण एसियामा महामारीका रुपमा रहेको टाइप २ मधुमेह हो । यो क्षेत्रमा मधुमेह उच्च देखिनुको कारण वंशाणुगत हो । कतिपय कुरा प्राकृतिक हुन्छन् । जब प्रकृतिका विरुद्ध मानवीय व्यवहार जान थाल्छ, त्यसपछि रोगको विकास हुने हो । यसै पनि रगतमा चिनी वा चिल्लो मात्रा हुनु अस्वाभाविक होइन तर त्यसको प्रयोग भएन भने रोगको रुप लिन्छ । यो क्षेत्रमा मधुमेह हुनुको कारण जातीय हो । यो जातिमा वंशाणुगत रुपमै चिनीको मात्रा उच्च देखिन्छ । किनभने यो क्षेत्रका बासिन्दाको खानपानमा पहिले ग्लुकोजको मात्रा कम हुन्थ्यो । हाम्रो पुर्खाहरुले खानामा भातभन्दा बढी तरकारी र फलफूल खान्थे । त्यसैगरी चिल्लो पदार्थ उच्च भएका खाना पनि नियमित हुन्थेनन् ।
यस क्षेत्रका बासिन्दाको जीवनशैली कडा शारीरिक श्रम हो । कृषि कार्य गर्ने भएकाले कडा शारीरिक श्रम गर्नुपथ्र्याे । बाह्य स्रोतबाट चिनीको आपूर्ति कम तर खपत धेरै हुने भएपछि यो क्षेत्रका जातिको रगतमा प्राकृतिक रुपमै चिनीको मात्रा उच्च रहन्थ्यो । त्यो प्रक्रिया वंशाणुगत रुपमा सर्दै गयो तर अहिले आएर जीवनशैलीमा एकाएक परिवर्तन आयो । भौतिक सुख सुविधाका कारण शारीरिक परिश्रम घट्यो र पश्चिमा देशको खानपान अपनाइयो । जुन प्रकृतिअनुसार ठीक उल्टो भयो । शरीरमा ग्लुकोजको बाह्य आपूर्ति उच्च भयो भने शाररिक परिश्रम कम भयो । यसले यो क्षेत्रमा मधुमेहको समस्या निकै बढाएको छ ।

जीवनशैली बदल्नु जरुरी
नेपालीमा देखिएको मधुमेहको मूल कारण बदलिँदो जीवनशैली नै हो । अब हामीले यो रोगबाट जोगिन फेरि पुर्खाकै जस्तो जीवनशैली अपनाउन सक्छौँ । खानामा भात कम तरकारी र दाल बढी खान सकिन्छ । चिल्लो खानेकुरा कम खाने गर्नुपर्छ । विशेषगरी शारीरिक व्यायाम बढाउनु पर्छ । शारीरिक व्यायाम गर्ने नाममा एकाबिहानै कुद्ने धेरै हुन्छन् । मधुमेहको समस्या दूर गर्न भने खाना खाएको एक घन्टापछि हिँडेको राम्रो हुन्छ । नेपालमा साइकल लेन नै छैन । यो रोगको महामारी नियन्त्रण गर्न सरकारी तवरबाटै साइकल प्रयोगलाई उच्च प्राथमिकता दिनुपर्छ ।

आवासै नपाएपछि के को आवासीय चिकित्सक !

-डा. एसपी रिमाल

 ‘खुइयययय…….’
बाले फेरि कुनै कामको असफलताको संकेत गर्दै बोल्नुभयो, ‘आज पनि कुरो मिलेन ! बिना धितो बैंकले ऋण दिंदैन।’

‘धितोको लागि सबै सर्टिफिकेटको फोटोकपी पठाएको छु त ,’ करौंडौको सम्पत्ति धितोका लागि पठा’कोझैं मेरो उत्तर ।

‘यो संसारमा ऋण खोज्नु सार्है गार्हो काम हो । एकाध मेरा जस्ता सहृदयी साथी नहुनेहरुले त त्यसकै लागि कैयौं कुकर्म गरेको दुई चक्षुले प्रत्यक्ष दृष्टिबोध गरेका छन्,’ बाले जफाव फर्काउनुभयो ।

ऋणको कुरामा मेरो र ‘बा’ को कैयौं पटक वाक संघर्ष परेको छ ।
छोरो डाक्टर नहुँदासम्म ‘बा’ ले खूब ऋण खोज्नुभो रे । सोच्नुभएको थियो रे डाक्टर भएपछि त छोरोले जादुयी चमत्कार गर्नेछ । पैसा आएको आयै हुनेछ  ।  तर, मेरा सोझा ‘बा’ले मेडिकल माफियागिरी, पिजी  अध्ययन, पिजी शुल्क लगायतका हाउगुजीले डाक्टर भएपछि पनि कसरी सताउँछन् भन्ने कुरा थाहै पाउनुभएन । जब म पिजी पढ्न थालेपछि पनि ऋण खोज्नुपर्यो त्यसपछि दिनको घाम झैं छर्लङ्ग भो होला उहाँलाई । डाक्टर फलाउनु रुपैयाँको बोट उमार्नु होइन भन्ने  ।

डाक्टर भएपछि छोराले कमाएर लिएको ऋण फिर्ता गरौंला भन्ने उहाँको अपेक्षा स्वभाविक हो । मेरो यथार्थ र उहाँको अपेक्षा बाझिदा बा र म बिच सवालजफाव भइरहन्छन् । यसक्रममा उहाँले गर्ने कतिपय तर्क र दिने कतिपय जफावले मेरो मानसपटलमा जरा गाडेर बसीरहेका छन् । बेला–बेला मेरै मानसपलटमा संघर्ष गरिरहन्छन् ।

‘कहिलेसम्म तँलाई ऋण खोजेर पढाउने मैले ?,’ उहाँले दोहो¥याउने प्रश्न हो । उहाँको यो सदाबहार प्रश्नले मलाई अहिलेसम्म छाडेको छैन । यसको उत्तर मसँग कहिल्यै हुँदैन । एमबिबिएस सकेर पनि मेरै पढाइका लागि ऋण खोज्नु परेपछि बा कहिलेकाहिँ हतास मनस्थितिबाट गुज्रिनुहुन्छ ।

यो प्रश्नको जफाव रफावसहित हुन्थ्यो मेरो, ‘म छात्रवृत्तिमा पढ्दै छु । तर ‘बा’ ले ऋण नखोजी कहिल्यै मलाई पढ्ने पैसा पुगेन । हरेक तहसँगै दुई गुणा यो क्रम वृद्धी हुँदै गयो । प्लस टूमा ‘बा’ ले थोरै ऋण बोक्नुभो, एमबिबिएसमा अलि धेरै र अहिले त मलाई भन्न पनि लाज लाग्छ । मेरा कलेजका महामहिमहरु हामीजस्ता चिकित्सकलाई ‘आवासीय चिकित्सक’ भन्दछन् । ‘बा’ ले यो कुरा मान्नुहुन्न । भन्नुहुन्छ, ‘आवास नै नदिई कसरी आवासीय चिकित्सक ?

जीवन निर्वाह हुने तलब पनि नपाउने र ७२ घण्टासम्म लगातार काम गर्नुपरेपछि बाले प्रश्न स्वभाविक रुपमा उठाउनुहुने भो– के को चिकित्सक ?
भन्छु, ‘२७ हजार रुपैयाँ दिन्छन् त ।’
बाका ६ वटा उत्तर एकसाथ आउँछन् ।
१. २७ हजारमा मा १८ त कलेजले थुतेर लग्छ फी भनेर ।
२. बाँकी रहेको ६ हजार मध्ये इन्टरनेट, विद्युतलगायत भनेर बाँडीचुँडी लग्छन् त ।
३. तिमीहरु त चिकित्सक होइन, बिना ज्याल काम गर्ने मजदुर हौ । तिमीहरुजस्तलाई भारतमा ५० हजार भारु      दिन्छ ।
४. लौ भारत त टाढा भो त्यै टिचिङमा (आइओएम) मा पनि ३७ हजार दिन्छ ।
५. १० वर्षअघि विद्यार्थीले तिर्ने १५ लाख बढेर ४५ लाख भो तर तलब २० हजारबाट २७ हजार मात्र ।
६. २४ हजार त एक सामान्य साक्षर मजदुरको तलब पनि होला ।

त्यो कलेजमा अब त्यति त गर्नै पर्यो नि ‘बा’ । हाम्रा कलेजका ‘महामहिम’हरुले भने अनुसार त ४ सय ७५ छात्रविृत्ति दे’को छ रे त कलेजले ।
बाले ठाडै नकार्दै भन्नुभो, ‘तेरो कलेज मा छात्रवृत्ति शुन्य प्रतिशत छ ।’
(म छक्क परे र अक्क न बक्क भएँ)

बा निरन्तर बोल्नुभयो, ‘छात्रवृत्तिको अर्थ त हुन्छ, निःशुल्क अध्ययन ।  त्यसमा आवास र भोजको समेत व्यवस्था हुन्छ । त्यही कलेजकैलाई पढ्छु भन्नेलाई त डेढ लाख रुपैयाँको बज्र प्रहार छ । खुला भनेर आउने तँ जस्ताले ७ लाख तिर्नुपर्छ । ७ लाख तिरेपछि के को छात्रवृत्ति ? मैले आजसम्म यतिका ऋण लिएको थिइन, जुन तेरो छात्रवत्तिका लागि लिएँ ।ऋण खोजी खोजी छात्रवृत्ति ? वाह ! यो छात्रवृत्ति कुनचाहिँ परिभाषामा पर्दछ ? यो छात्रवत्ति होइन,  छात्रवृद्धि हो !

‘बा’का यी शब्द मेरा मानसपटलमा दौडेका दौड्यै छन् । अनुत्तरित छु । सरकारले दिने तलबसुबिधामा काम गर्ने भए के के गर्छु, भन्ने महामहिम हरुको भनाई पनि वहाँलाई थाहा रहेछ । यसबाट प्रष्ट हुन्छ कि सरकारी तलब चिकित्सकको लागि कति हद्सम्म अनुचित र अव्यवहारिक छ । कुनै चिकित्सकलाई  तलब सुबिधामा सजाय दिनुपर्यो भने ‘सरकारी सुबिधा सरह भनेर राखे भो’ भन्नुहुन्छ । यसो गम्छु म प्लस टूसम्मको त्यत्रो मेहनत, एमबिबिएस दिनरात एक गर्दै पढेको, डाक्टर भ’को गर्दा त मेरो १८ बर्षको अध्ययन सकिएछ ।

 तर मेरो तथा मजस्ता मेडिकल अधिकृतको तलब सामान्य कर्मचारीको भन्दा खासै फरक देखिएन  । अर्काेतर पोष्टग्य्राजुएटको फी, पढ्न पाउन गर्नुपर्ने मेहनत, तिकडमबाजी, पिजीपछि गर्नुपर्ने लगातार ७२ घण्टासम्मको अवैज्ञानीक कार्य, भीड्तन्त्र जसले कुनै पनि बेला कुनै पनि चिकित्सक माथि हातपात गरेमा कानून मौन बस्ने पद्धती, मेडिकल माफियागिरी लगायतका स्वास्थ्य क्षेत्रमा भएका असंख्य समस्याहरु देखेरै हो कि धेरैजसो चिकित्सक अमेरिका जस्ता देशहरुमा पलायन भइरहेका ? यक्ष प्रश्न सिरुपाते खुकुरी जस्तो आँखै अघि तर्सिएको जसतो लाग्छ । 

तसर्थ, राष्ट्रिय रुपमै देशलाई र चिकित्सकीय पेशालाई माया गर्नेहरुले राष्ट्रिय एउटा नियम​ र सहमती नबनाइ हुँदैन । हजारौं एमबिबिएस डाक्टर निकालेर, थोरै त्यो पनि ’आकाशको फल आँखा तरी मर’ जस्तो पिजी सिटको भयावह स्थितीले सम्पूर्ण स्वास्थ्य सेवा, चिकित्सकको दक्षता, डाक्टर–बिरामी बिचको सम्बन्ध तथा समाजप्रति उत्तरदायी चिकित्सकको संख्यामा ह्रास आउँदै गएको छ  । हरेक दिनका घटनाक्रमले यो कुरो को पुष्टी हुँदै आएको छ । मेडिकल माफियातन्त्र झाँगिदै छ । रोगीहरु डाक्टरले प्रयास गर्दागर्दै हस्पिटलमा हैन, हस्पिटलमा मर्यो भने ’लफडा’ हुन्छ भन्ने डरले अन्यत्र रिफर गर्दा बाटोमै मृत्यु भइरहेको छ । कसरी रोकिएला यो परिपाटी ?

रिमाल विपी कोइराला स्वास्थ्य विज्ञान प्रतिष्ठान धरानका आवासीय चिकित्सक हुन् ।

स्वास्थ खबर बाट साबार 

अनुहारका काला थोप्ला हटाउने घरेलु उपाय

अनुहारमा टुप्पो कालो भएका स-साना थोप्लाहरु हुन्छन् । भित्र डल्लो जस्तो देखिने यस्ता थोप्लाहरु निचोर्दा कडा जमेको सेतो खैरो पदार्थ आउँछ अनि छालामा सानो खाडल पर्दछ । यस्ता थोप्लाहरुलाई ब्लाकहेड्स भनिन्छ । अनुहारको सुन्दरताका लागि यस्ता ब्लाकहेड्स वास्तवमै अभिसाप नै हुन्छ, किनकी यसले अनुहारको छालालाई कुरुप बनाइदिनछ ।
जब छालामा हुने स-साना छिद्रहरु सरीरबाट निस्कने चिल्लो पदार्थ, जिवाणुहरु तथा मृत कोशिकाका कारण बन्द हुन्छन् तब ब्लाकहेड्स देखिन थाल्छ । अनुहारमा टाँसिने धुलो, माटो तथा फोहोरका कारण समेत संक्रमण भएर यो सिर्जना हुनसक्छ । यो समस्या सबैभन्दा बढि तैलीय छाला हुनेहरुमा हुन्छ ।

ब्लाकहेड्सको समस्याबाट धेरै मानिस पीडित हुने गरेको र यसबाट छुटकारा पाउनका लागि विभिन्न खाले उपाय तथा उपचार समेत अपनाउने गरेको पाइन्छ । तर केही सजिला घरेलु उपाय अपनाउने हो भनेमात्रै पनि यो समस्या समस्या कम हुन्छ ।

ती घरेलु उपाय यस्ता छन् :

वाफ लिने– दुइ मिनेटसम्म अनुहारमा वाफ लिनुहोस् र त्यसपछि प्राकृतिक स्क्रबरले अनुहार पुछ्नुहोस् । नियमित रुपमा यसो गर्दा अनुहारमा रहेका यस्ता ब्लाकहेड्स हट्दछन् यसले अनुहारका अन्य सेता फुस्रा दागहरु पनि हराउँछन् ।

तुलसी– अनुहार चम्किलो पार्नुका साथै डण्डिफोरको समस्या हटाउन तथा कालोपोतो र कालो टाउके थोप्लाहरु हटाउनका लागि समेत तुलसी उपयोगी हुन्छ । यसका लागि तुलसीको पातलाई पानीमा भिजाउने अनि त्यसलाई माथिपट्टि फर्काएर ब्लाकहेड्स भएको अनुहारको छालामा ५-१० मिनेट  राख्ने । त्यसपछि तुलसीको पातलाई हटाएर मुख धुने । यो प्रक्रिया दैनिक रुपमा दोहोराएमा अनुहारको यस्ता कालो टाउका भएका थोप्लाहरु कम हुन्छ ।

बदाम– बदाम टुक्राटुक्रा पार्नुहोस् अनि त्यसमा बेसन मिलाएर लेदो बनाउनुहोस् । अनि टुक्रा बदाम र बेसनको मिश्रणले अनुहार स्क्रब गर्नुहोस् । नियमित रुपमा यसो गर्दा अनुहारको ब्लाकहेड्स कम हुन्छ ।

कागती र मह– कागतीको रस, नुन तथा मह समान मात्रामा मिलाएर झोल तयार गर्नुहोस् । यसमा दही पनि मिलाउन सक्नुहुन्छ त्यसपछि त्यो लेदोलाई अनुहारमा दलेर केही समयसम्म रगड्नुहोस् र स्क्रब गर्नुहोस् । ५-१० मिनेटपछि अनुहार धुनुहोस् र सफा रुमालले अनुहार पुछ्नुहोस् । नियमित रुपमा यसो गर्दा अनुहारको ब्लाकहेड्स, कालोपोतो, डण्डिफोर तथा अनुहार चिलाउने जस्ता समस्या हट्ने र अनुहार चम्किलो तथा तथा सफा हुन्छ ।