Sunday, August 27, 2006

Health Insurance

Why We Need Health Insurance?

Live is not always healthy, so we have to keep our healthy against many kind of diseases, but some time even we have protection ourself, we still getting sick. The disability or disease are health problem that we meet unexpected, unpredictable, they can come to us any time, how you will prepare anything to counter your health problem, no everybody ready to pay Hospital charge if the health problem taking place, Therefore we need Health Insurance to cover our healthy in order to protected our body from the illness.
How To Choose Health Insurance?
Before we are decided one Health Insurance that will be cover, we have to understanding about which Health Insurance well, reliable and what it covers. You may ask to insurance representative to explain about what benefit insurance for, and how to claim when customer getting problem, how long time must we reported to company, and many inquiry around Health Insurance. You can also ask to any customer that have been joined with Health Insurance so you can share experience which they have, because several Health Insurance some time is not reliable and have not high credibility, therefore looking Understanding about Health Insurance background is better than choose ones in order to avoid problem in the future.

Saturday, August 26, 2006

Prostate Cancer

What is the prostate?

The prostate is a small gland that only men have. It is normally about the size of a walnut. The prostate is located underneath the bladder and in front of the rectum. Because the prostate is close to the rectum, it can be felt by a doctor during a digital rectal exam (the part of a physical where the doctor inserts a gloved, lubricated finger into a man's anus). The prostate makes and stores fluid that is part of semen, and this fluid is released from a man's penis during ejaculation. The prostate is signaled to do its job by the male hormone testosterone, which can influence the behavior of the prostate gland and prostate cancer. Nerves to the penis that are important in producing and maintaining an erection run very close to the prostate. The prostate completely encircles the tube that carriers urine from the bladder to the penis, called the urethra.
If the prostate enlarges, it can block the flow of urine from the bladder making it difficult for a man to urinate.
What is prostate cancer?
Prostate cancer happens when cells in the prostate begin to grow out of control and can then invade nearby tissues or spread throughout the body. Large collections of this out of control tissue are called tumors. However, some tumors are not really cancer because they cannot spread or threaten someone's life. These are called benign tumors. The tumors that can spread throughout the body or invade nearby tissues are considered cancer and are called malignant tumors. Usually, prostate cancer is very slow growing. However, sometimes it will grow quickly and spread to nearby lymph nodes. Lymph nodes are small, pea-sized pieces of tissue that filter and clean lymph, a clear liquid waste product. If prostate cancer has spread to your lymph nodes when it is diagnosed, it means that there is higher chance that it has spread to other areas of the body.

Am I at risk for prostate cancer?
Every man over the age of 45 is at risk for prostate cancer. Although prostate cancer can occasionally strike younger men, the risk of getting prostate cancer increases with age and more than 70% of men diagnosed with prostate cancer are over the age of 65. Prostate cancer is the most common cancer that men get in the United States behind skin cancer. It is estimated that there will be 189,000 new cases of prostate cancer and 30,200 deaths from prostate cancer in the year 2002 in the United States.

Although there are several known risk factors for getting prostate cancer, no one knows exactly why one man gets it and another doesn't. Some of the most important risk factors for prostate cancer include age, ethnicity, genetics and diet. Age is generally considered the most important risk factor for prostate cancer. The incidence of prostate cancer rises quickly after the age of 60, and the majority of men will have some form of prostate cancer after the age of 80. One of the sayings about prostate cancer is that older men (over the age of 80) die with prostate cancer not from prostate cancer. This saying means that many older men have microscopic disease that doesn't shorten their life expectancy because the cancer takes a long time to grow and become clinically important. However, this saying is only a generalization; sometimes prostate cancer can grow quickly even in older patients.

Another important risk factor for prostate cancer is ethnicity. No one knows exactly why, but prostate cancer is more common in African-American and Latino men than Caucasian men. African-American men have a 1.6 fold higher chance of getting and dying from prostate cancer than Caucasian men. Asian and Native American men have the lowest chances of getting prostate cancer. Some doctors believe that genetic differences are important in explaining the different rates of prostate cancer between different ethnic groups; however, there is some evidence that differences in diets may be the cause. When Asian men move to Western countries like the United States, their chances of getting prostate cancer rise. Men who live in the United States and Northern Europe have the highest rates of prostate cancer, while men who live in South America, Central America, Africa, and Asia all have much lower chances of developing prostate cancer.
There is some evidence that a man's diet may affect his risk of developing prostate cancer. The most common dietary culprit implicated in raising prostate cancer risk is a high fat diet, particularly a diet high in animal fats. Also, a few studies have suggested that a diet low in vegetables causes an increased risk of prostate cancer. There are a few foods that have been implicated in decreasing prostate cancer risk: a diet high in tomatoes (lycopene) has been suggested as well as diet high in omega-3-fatty acids (oils found in fish like salmon and mackerel). Doctors and scientists aren't in full agreement as to the usefulness of eating these foods when in comes to decreasing prostate cancer risk. Diets high in selenium, vitamin D, and soy have all been suggested to decrease prostate cancer risk; but a these are currently under study and data from large trials is needed before firm recommendations can be given about their use for this purpose.
A family history of prostate cancer increases a man's chances of developing the disease. This increase shows itself when a man has either a father or brothers (or both) with prostate cancer, and is even greater when his relatives develop prostate cancer at a young age. A variety of different genetic factors are currently being researched. Variations and mutations in certain genes may be responsible for some increases in prostate cancer rates in families. Men who carry mutations in genes known as BRCA1 or BRCA2 (these are genes implicated in breast and ovarian cancer in women) may have a 2 to 5 fold increase in prostate cancer risk. Men with high levels of testosterone or a hormone known as IGF-1 (insulin-like growth factor 1) seem to be at a higher risk for developing prostate cancer as well.
How can I prevent prostate cancer?
Because prostate cancer is a common disease and often has a very slow growing course, there is a lot of interest in trying to prevent prostate cancer with drugs, foods, or nutrients. Even a compound that could slow the progression of the disease could potentially decrease mortality from it. Right now, the best way to try and prevent prostate cancer is to modify the risk factors for prostate cancer that you have control over. You may want to try to eat a low fat diet that is rich in fruits and vegetables. Although certain foods, vitamins and minerals have been suggested to decrease your chances for getting prostate cancer, doctors still need more data before any particular food or supplement can be endorsed for preventing prostate cancer. Currently, there are studies looking at selenium, lycopen, vitamin A and other retinoids, vitamin D, vitamin E, and soy for prostate cancer prevention.

There is also interest in preventing prostate cancer by using drugs. We know that hormones like testosterone can cause prostate cancers to grow and develop, so there are experiments looking at drugs that can decrease the levels of testosterone in the prostate to attempt to stop prostate cancer from forming and growing. Drugs like Flutamide and Finasteride work in this manner, and they are currently under investigation for prostate cancer prevention. Another way to decrease testosterone in the prostate is to decrease the total amount of testosterone in the body. Drugs that decrease total body testosterone have a whole host of undesirable side effects (drugs that do this are currently used to treat men who have already developed prostate cancer and will be discussed later in the treatment section), so they aren't nearly as good choices for prostate cancer prevention.

What screening tests are available?
Whether or not men should be screened for prostate cancer is an intensely debated issue. We know that prostate cancer usually grows very slowly, so intuitively it would make sense that we could reduce mortality from prostate cancer by picking it up early so it could be treated before it spreads. However, in order for a screening test to be fully embraced, we need to prove that picking up a disease early actually does help reduce the number of deaths. Right now, there is no good data showing that screening for prostate cancer reduces deaths from prostate cancer. There are currently very large trials on-going to see which populations of men will benefit most.

Currently, there are two methods that physicians use to screen for prostate cancer. One of them is called a digital rectal exam (DRE). A digital rectal exam is done in your primary care physician's office. Because your prostate is so close to your rectum, your doctor can feel it by inserting a gloved, lubricated finger into your anus. Your doctor can feel if there are lumps, asymmetries, or if your prostate is enlarged. A digital rectal exam is uncomfortable, but not painful. It is a useful test, but it is not perfect because some small cancers can be missed and only the bottom and sides of the prostate can be examined in this manner. Although it isn't a perfect test, it becomes more useful when it is combined with another test called a PSA.

A PSA (prostate specific antigen) test is a blood test that looks for a protein that the prostate makes. Normal prostate tissue makes a little bit of PSA, but prostate cancer usually makes much more. By checking to see if your PSA is elevated, your doctor can screen you for prostate cancer. The PSA test isn't perfect either, because some tumors won't elevate the PSA and some other processes (like benign prostatic hyperplasia and prostatitis) can cause it to be falsely elevated. However, the higher your PSA is, the more likely the elevation is caused by a prostate cancer. The cut-off that your doctor usually uses is 4.0 ng/ml, meaning that anything below 4.0 ng/ml is normal and anything above it is abnormal. If your PSA is elevated, or you have an abnormal digital rectal exam, then you need to get further evaluation; however, this doesn't necessarily mean that you have prostate cancer. The only way to know for sure whether or not you have cancer is to get a sample of your prostate from a biopsy.

Both a digital rectal exam and a PSA are simple, non-invasive tests. Most physicians recommend screening for prostate cancer with these tests in men with a life expectance of 10 years or more. However, some doctors don't think screening for prostate cancer is worth doing. One of the downsides is that you may go through an extensive workup and treatment for a disease that never would have shortened your life. We know that some prostate cancers are very slow growing (often taking more than 10 years to become significant), so if your life expectancy is less than 10 years it may not be worthwhile to go through the process of screening, biopsy and treatment. The treatment options for prostate cancer are not completely benign, and all of them have the potential for side effects. However, it is difficult for physicians to determine which prostate cancers will progress versus those that will remain indolent in any individual patient. Another argument against prostate cancer screening is that it has never been proven to save lives in studies of large populations. However, many doctors think that newer treatments for early stage prostate cancers may make this argument obsolete. Data from large trials currently being carried out should help to settle this argument in the near future.

The American Cancer Society and the American Urological Society recommend regular prostate cancer screening. The American Cancer Society recommends that men start getting annual PSAs and digital rectal exams starting at age 50, unless they are high risk (meaning they have a family history of prostate cancer or are African-American), who should begin screening at age 45. However, they mention that screening should only be carried out if your life expectancy is greater than 10 years, so men in their 80s and 90s (especially if they have other serious medical problems) should probably not be screened. The most important thing is to discuss the issue with your doctor. Decisions about screening should be individualized and reached after hearing about the potential benefits and harms of screening, biopsy and treatment.

What are the signs of prostate cancer?
Most early prostate cancers are detected with PSA tests or digital rectal exams before they cause any symptoms. However, more advanced prostate cancers can cause a variety of symptoms including:

  • trouble starting urination
  • urinating much more frequently than usual
  • the feeling that you can't release all of your urine
  • pain on urination or ejaculation
  • blood in your urine or semen
  • impotence
  • bone pain
All of these symptoms can be caused by a variety of things besides prostate cancer, so experiencing them doesn't necessarily mean you have prostate cancer. When older men have problems urinating, it is usually caused by process called benign prostatic hyperplasia (BPH) which is not prostate cancer. If you experience any of these symptoms, you need to see your doctor for evaluation.

  1. Stage I - tumor cannot be felt during a digital rectal exam; it was detected by an elevated PSA blood test or incidentally found during another prostate procedure for a benign condition.
  2. Stage II - tumor can be felt during a digital rectal exam, but it has not spread beyond the prostate and it hasn't spread to lymph nodes or other organs
  3. Stage III - tumor extends outside the prostate and can be in the seminal vesicles, but not in any other organs or lymph nodes
  4. Stage IV - tumor has spread to other organs or lymph nodes

There are many different ways to treat prostate cancer, and you will most likely be consulting multiple types of doctors before making a final decision. Physicians are not always in agreement as to the way to proceed because there haven't been enough large trials that compare the different treatment modalities. For prostate cancer, it is important that you get a second opinion and you should talk to both urologists and radiation oncologists to hear about the benefits and risks of surgery, hormonal therapy and radiation in your particular case. If your prostate cancer has already spread at the time of diagnosis, you will also need a medical oncologist to talk about chemotherapy. The most important thing is to discuss your options and make a decision that suits your lifestyle, beliefs and values.
Surgery is a common form of treatment for men with prostate cancer. Surgery attempts to cure prostate cancer by removing the entire prostate and getting all of the cancer out of the body. An attempt at a surgical cure for prostate cancer is usually done with early stage prostate cancers, but sometimes surgery will be used to relieve symptoms in advanced stage prostate cancers. Surgery for prostate cancer is generally felt to be equivalent to radiation for prostate cancer in terms of survival, especially in early stage, low to intermediate grade cancers. The decision to have surgery versus radiation is often made on the basis of the patient's age and health status; the two different approaches have different side effect profiles depending on the patient's age.
The most common surgical procedure for prostate cancer is known as a radical prostatectomy. Radical prostatectomy means that the entire prostate gland is removed from around the tube that connects the bladder to the penis (the urethra). This surgery can be done in two different ways, the retropubic approach and the perineal approach. The retropubic approach means that incision in made in the lower abdomen, while the perineal approach means that the incision is made between the scrotum and the anus. Often times during a retropubic approach, the surgeon will remove some lymph nodes in the area and have them quickly examined by a pathologist for signs of cancer. If the nodes have cancer, then the surgeon will not to proceed with the operation. This is the major reason a retropubic approach is used in most surgeries today.
Radical prostatectomies are very safe surgeries with few life threatening complications; however, there is a significant risk for other side effects. Both urinary incontinence (not being able to hold in your urine) and impotence (inability to achieve and maintain an erection) are commonly associated with this procedure. The risk for having either of these side effects increases with age; this is why younger men are often recommended to have surgery while older men are recommended to have radiation. The skill of your particular surgeon influences your chances of having these side effects during a radical prostatectomy. Talk to your surgeon about their complication rates before your operation. Sometimes, particularly with lower grade and smaller cancers, a nerve sparing prostatectomy can be performed. This type of prostatectomy can decrease the chances that you will be impotent after the procedure. However, there is always a risk and not every patient is a candidate for a nerve sparing prostatectomy. With surgery, urinary incontinence and impotence are often most severe right after the operation and get better with time. There are things that your doctors can recommend to help you with either of these problems. Talk to your urologist about your options.

Prostate cancer commonly is treated with radiation therapy. Radiation therapy uses high energy rays (similar to x-rays) to kill cancer cells. Radiation therapy is another option besides surgery for early stage prostate cancer; and when advanced stage prostate cancer needs to be treated, it is usually done with radiation therapy. Radiation helps avoid surgery in patients who are too ill to risk having anaesthesia. Radiation is usually offered to older patients in the case of early stage prostate cancer because of its side effect profile is less than surgery in the elderly. Radiation can have impotence rates similar to surgery, but the risk of urinary incontinence is very low. Impotence develops months to years after the radiation treatment, unlike with surgery, which tends to have the side effects occur immediately. Other side effects from radiation include bladder irritation, which can cause urinary frequency and urgency as well as bladder pain, and diarrhea or rectal bleeding. Your radiation oncologist tries to limit the amount of radiation to other organs, but often the bladder and rectum can get some dosage because they are in such close proximity to the prostate.

Radiation therapy for prostate cancer either comes from an external source (external beam radiation) or an internal source where small radioactive seeds are implanted into the patient's prostate (brachytherapy). External beam radiation therapy requires patients to come in 5 days a week for up 6-8 weeks to a radiation therapy treatment center. The treatment takes just a few minutes, and it is painless. Brachytherapy is done as a one-time insertion, in the operating room. Brachytherapy cannot be done in all patients and is usually reserved for early stage prostate cancers. Your radiation oncologist can answer questions about the utility, process, and side effects of both of these types of radiation therapy in your particular case.
Hormonal Therapy
Both normal prostate tissue and prostate cancers depend on male sex hormones, called androgens, to grow and replicate. Testosterone is an androgen very important to the prostate gland. Men make androgens in their testicles. One of the ways to treat prostate cancer is to remove androgens from the body, thus making the cancer shrink and then grow more slowly. There are a few different ways to remove androgens: you can remove a man's testicles (called an orchiectomy), you can give a man drugs that block the production of androgens (called LHRH agonists), you can give a man drugs that block androgen receptors (called anti-androgens) or you can give a man estrogens. Different methods of deceasing androgens are often used in the same patient: using LHRH agonists with anti-androgens can achieve what is known as a total androgen blockade. Hormone therapy can also be used in conjunction with other treatments, especially in the case of advanced stage prostate cancer being treated with radiation therapy. In that case, hormonal therapy is often given before the radiation and this is known as neoadjuvant hormonal therapy. Another use for hormones is in patients who present with metastatic disease. After a while, all prostate cancers will become resistant to hormonal therapy. However, this often takes many years and hormonal therapy can buy a lot of time in patients with extensive disease or patients who choose not to undergo surgery or radiation.

There are a number of side effects associated with hormonal therapy. Hormonal therapy will almost universally cause impotence and the loss of your sex drive. It can also cause breast enlargement, hot flashes, and muscle and bone loss (osteoporosis). There are some things your doctors can prescribe to help with bone loss and hot flashes, but little can be done about loss of libido and impotence.

Chemotherapy is the use of anti-cancer drugs that go throughout the entire body. Chemotherapy is prescribed by medical oncologists, who are experts at choosing appropriate regimens for particular patients. Chemotherapy for prostate cancer is generally only reserved for very advanced cancers that are no longer responsive to hormonal therapy. There are a number of chemotherapy drugs that can be used for prostate cancer, and they are often used in combinations. A common chemotherapy regimen is Mitoxantrone with Coritcosteroids; and other regimens that are becoming increasingly popular use a drug called Estramustane with drugs called Taxanes. The use of chemotherapy in prostate cancer is currently being studied and men who get chemotherapy are encouraged to talk to their doctors about experimental trials. There are advantages and disadvantages to each of the different regimens that your medical oncologist will discuss with you. Based on your own health, your personal values and wishes, and side effects you may wish to avoid, you can work with your doctors to come up with the best regimen for your lifestyle

Cryosurgery is a somewhat experimental approach to treating prostate cancer whereby probes with liquid nitrogen are implanted into the prostate and then the tissue is frozen. This freezing kills the cancer cells, and it can be repeated multiple times if needed. However, data to date has shown that cryosurgery is not as effective as radiation and surgery for treating prostate cancer. Cryosurgery also has a variety of side effects including urinary incontinence and impotence.

Watchful Waiting
Some patients choose to receive no therapy for their prostate cancer in the hopes that it will grow very slowly. By avoiding any therapy, they avoid the side effects that come along with surgery, radiation, or hormones. Watchful waiting is appropriate for older men with small, low-grade tumors, and slowly rising PSAs, and multiple other medical problems. Watchful waiting can be considered in patients who have a life expectancy less than 10 years as long as the cancer isn't large or of a high grade. Men who choose to undergo watchful waiting should have PSAs and digital rectal exams done every 3-6 months, and need to be re-biopsied at some point to make sure the grade hasn't become less favorable. However, it is never really clear what change in clinical status should institute treatment. Also, if the tumor has progressed, they may no longer be eligible for curative therapy.

Follow-up testing
>Once a patient has been treated for prostate cancer, they need to be closely followed for a recurrence. At first, you will have follow-up visits fairly often. The longer you are free of disease, the less often you will have to go for checkups. Your doctor will tell you when he or she wants follow-up visits, PSAs and x-rays or scans depending on your case. Your doctor will also probably do digital rectal exams regularly during your office visits. It is very important that you let your doctor know about any symptoms you are experiencing and that you keep all of your follow-up appointments.

Clinical trials are extremely important in furthering our knowledge of this disease. It is through clinical trials that we know what we do today, and many exciting new therapies are currently being tested. Talk to your doctor about participating in clinical trials in your area.

This article is meant to give you a better understanding of prostate cancer. Use this knowledge when meeting with your physician, making treatment decisions, and continuing your search for information. You can learn more about prostate cancer on OncoLink through the related links to the left., for complete information visit to Link Here

Monday, August 21, 2006

Detect Your Early Breast Cancer

Breast cancer is the second leading cause at the cancer death in women at the world. The early detection means will be help to save and easily to treatment,because if the problems was knew late cause so many difficulties cure and treatment. The early recognizing better than left it till worse and makes high cost charge for management.The following reason why, women supposed to be early recognize about their breast cancer as are:
  • Why Do The Breast SElf Exam?

  • There are many good reason for doing a breast self exam each month. One reason is that is easy to do and the more you do it, the better you will get at it. When you get to know how your breasts normally fell, you will quickly be able to fell any changed, and early detection is the key to successfull treatmen and cure.
  • When To Do Self Breast Self Exam ?
  • The best time to do breast self-exam is right after your period, when breasts are not tender or swollen, if you do not regular periods or something skip a month, do it on the some day every month.
  • Now, How To Breast Self-Exam.
    1. Lie down and put a pillow under your right shoulder. Place your right arm behind your head
    2. Use the fingers pads of your three middle fingers on your left hand to fell for lumps or thickening. Your finger pads are the top third of each finger
    3. Press firmly enough to know how your breast feels. If you,re not sure how hard to press, ask your health care provider, or try to copy the way your health care provider uses the finger pads during a breasts exam. Learn what your breast fells like most of the time. A firm ridge in the lower curve of each breast is normal
    4. Move around the breast in set a way. You can chose either the circle(on the breast), the up and down line,or the wedge. Do it the some way every time . It will be help you to make sure taht you,ve gone over the entire breast area, and to remember how your breast fells
    5. Now examine your left breast using right hand fingers pads.
    6. If you find any changes, see your doctor right away

    For adding safety:

  • You should also check your breasts while standing in front of a mirror right after you do your breast self-exam each month. See if there are any changes in the way your breasts look; dimpling of the skin, changes in the nipple, or redness or swelling. You might also want to do breast self-exam while you are in the shower . Your soapy hands will glide over the wet skin making it easy to check how your breasts feel

  • REMEMBER: A breast self-exam could save your breast and save your life. Most breast lumps are found by women themselves, but in fact, most lumps in the breast are not cancer, Be save and be sure. If you need more information abaout breast cancer visit toenter here and also come to Demo Breas self-exam

    Tuesday, August 15, 2006


    Baru-baru ini ada berita yang menarik dari Media Indonesia mengenai Vaksin PENTAYELEN, memang asing kedengaranya,tapi itu adalah vaksin tunggal yang disinyalir mampu mengantikan beberapa fungsi vaksin seperti Dipteri,Pertusis(batuk Rejan/batuk 100 hari),Hepatitis B dan Influensa tipe B. Dimana jika saat ini Vaksin yang digunakan adalah per jenis penyakit maka jika vaksin PENTAYELEN telah diluncurkan maka akan lebih efektif karena hanya sekali immunisasi saja, kelima jenis penyakit tersebut sudah dapat dicegah.

    Kita tentunya berharap semoga dengan diketemukanya vaksin gabungan tersebut bermanfaat buat kita semua terutama bagi yang mempunyai anak-anak balita,karena jika dulu vaksinasi dilakukan sampai lima kali disamping balita merasa kesakitan,trauma dengan suntikan,maka PENTAYELEN mampu menjadi sahabat sekali saja buat para balita serta ibu-ibupun akan merasa senang karena balitanya hanya disuntik sekali saja.
    Vaksin tersebut akan diluncurkan pada tahun 2007 mendatang, kata Bpk. Marzuki Abdullah, Direktur Utama ,PT Bio Farma. Rencanaya Pembuatan vaksin tersebut akan dikerjakan di Indonesia oleh PT Bio Farma bekerja sama dengan Perusahan dari Belanda . Dari pihak Indonesia, yang dalam hal ini PT Bio Farma hanya menyediakan fasilitas dan sumber daya manusia (SDM), sedangkan tenaga ahlinya akan didatangkan dari Belanda.

    Untuk launching perdana kapasitas produksinya tergantung dari kebutuhan pemerintah,serta rencananya akan juga di ekspor ke negara-negara Asia dan Afrika, yang memang negara-negara tersebut masih membutuhkan vaksinasi, untuk dalam negeri vaksin tersebut akan didistribusikan ke 10 propinsi yang memerlukan vaksinasi.

    Marilah kita tunggu hadirnya si "VAKSIN MULTIFUNGSI INI", sahabat anak Balita Anda.
    (berita disadur dari Media Indonesia On-line "13/8/06",dengan gaya penyampaian bahasa yang berbeda,tanpa menguransi maksud dan tujuan dari penulis media indonesia :Eriez)

    Sunday, August 13, 2006


    Inner health is a very important subject because 95% of life threatening diseases starts inside our bodies where we can't see what is happening. By ignoring symptoms we often allow the problem to increase until treatment become difficult or, in the worst cases, impossible. It is also true that one hour of prevention is far better than one year of treatment, therefore recognize your self when getting any abnormal condition especially to the Diabetes Mellitus.

    What is Diabetes?

    In the rural people called Diabetes is more over blood sugar is the blood flow, but in medical term Diabetes is condition associated with abnormality high level of glucose (sugar) in the blood (hyperglycemia).
    Normally blood glucose level stay within narrow limit throughout the day was 4 to 7mmol/l before meal and will be increase till to less than 10mmol/l 90 minute after a meal, and around 8mmol/l at the bedtime.

    Diabetes mellitus is a chronic hereditary disorder of carbohydrate ,protein, and fat metabolism . It is characterized by lack of insulin activity and the ability to regulate blood glucose level, resulting hyperglycemia and glucosuria. There are two types of Diabetes mellitus:
    1. In type 1 diabetes, which usually starts in childhood or adolescence, the pancreas stop making insulin altogether. It is also called Insulin Dependent Diabetes Mellitus(IDDM).
    2. In type 2 diabetes, which starts in adulthood (and in some teenagers, mainly after 40 years of age), the body still makes some insulin , but it doesn't make enough insulin,or the body can't use it properly. It also called Non-Insulin Dependent Diabetes Mellitus (NIDDM).
    Insulin deficiency may be due to abnormality of beta cell function in the manufacture or release of insulin ,autoimmunity factors ,insensitivity of body cell to insulin or the excessive demands for insulin in obesity ,pregnancy, periods of extreme stressor infection.

    Glucose increases in the blood (hyperglycemia) ,because without insulin it can't be converted to glycogen or cross cell membranes. The conversion of fat and protein to glucose energy will occur.
    This fault fat metabolism produces ketone bodies ,acetone, and low blood pH (metabolic acidosis). Hyperglycemia in a severe state causes ketoacidosis and diabetic coma.

    Symptom and Causes
    • Glycosuria (sugar in urine) : Excess glucose in the blood ultimately results in high levels of glucose being present of the urine
    • Polyuria (excessive urinary output and dehydration) : This increase of urine output ,which leads to dehydration and increase thirst.
    • Polydipsia (excessive thirst ) : to counter of dehydration makes the body need lot of water
    • Polyphagia ( excessive hunger) : Loss of calorie (glucose excreted) and cell starvation makes the body need much of energy that supplied by ate over
    • Weight loss : Causes by calorie loss via urine (urine glucose),cell starvation, catabolism of stored fat and protein
    • Drowsiness,fatigue : Lack of energy from absence of glucose in cell, CNS (Central Nervous System),depression of ketone bodies, metabolism acidosis
    • Electrolyte losses : Loss of electrolyte such as NA+,K+,Ca++,CL-,depletion with polyuria and increasing of acidosis
    • Acidosis(metabolic) : Causes ketone bodies are acidic. Excessive H+ ions (Low pH) overwhelm and lower HCO3
    • Kussmaul breathing (air hunger rapid,deep breathing) : Causes respiratory compensation which lowers carbonic acid "blow off" CO2 in acidosis state ,Acetone odor on breath may be present.
    Diagnosis test
    The blood studies measure the body's ability to clear excessive glucose from the blood in the fasting state or after an increased load. Usually test to FBS (Fasting Blood Sugar),2 hour Post Prandial Blood Sugar (PPBS),and also GTT ( Glucose Tolerance Test) should be done.

    Diabetes Complication
    A key of diabetes treatment is to prevent complications because, over time, diabetes can damage the heart, blood vessels ,eyes, kidneys, and nerves, although the person may not know damage is taking place. Complications are most likely to occur in someone who has had diabetes for many years.
    If uncontrolled for many years ,diabetes mellitus can lead to more serious health problems as a below:
    1. Heart Disease
    2. Heart disease is the most common life-threatening disease linked to diabetes, and experts say diabetes doubles a person's risk of developing heart disease .In heart disease ,deposit of fat and cholesterol build-up in the arteries that supply the heart with blood. If this build-up blocks blood from getting to the heart a potentially fatal heart attack can occur.

    3. Kidney Disease
    4. People with diabetes are also more likely to develop kidney disease (nephropathy) or kidney failure than the other people.

    5. Eye Problems
    6. Diabetes can effect the eyes in several ways. Frequently, the effect are temporary and can be corrected with better diabetes control. However, long-term diabetes can cause changes in the eyes that threaten vision as cause by the blood vessel damage whitin the eyes (retinopathy).
      Diabetes also may affect the function of the nerves that control eyesight causing blurred vision. Cataract and glaucoma are eye disease that occur more frequently in the people with diabetes.

    7. Diabetic retinopathy
    8. Retinopathy a disease of retina, the light sensing tissue at the back of the eye, is a common concern among people with diabetes. Diabetes retinopathy damages the tiny vessels that supply the retina with blood.

    9. Legs and Feet
    10. Leg and foot problems can arise in the people with diabetes due to changes in blood vessel and nerves in these areas. Peripheral vascular disease is condition in the which blood vessel become narrowed by fatty deposits ,reducing blood supply to the legs and feet. Diabetes also can dull the sensitivity of nerves . Someone with this condition, called peripheral neuropathy ,might not notice a sore spot caused by tight shoes or pressure from walking. If ignored, the sore can become infected, and because circulation blood is poor, may be affect to slow healing ability even can makes gangrene if there is no good treatment will be go to amputation.

    11. Other effects of Diabetic Neuropathy
    12. Someone who has had diabetes for some years and has other complications, may find that spells of indigestion or diarrhea are common. Diabetes also can affect the nerves that control penile erection in the men ,which can cause impotence that show up gradually ,without any loss of desire for sex.

    13. Skin and Oral Infections
    14. People with diabetes are more likely to develop infections, like boils and ulcers, than the average person. Women with diabetes may develop vaginal infection more often then the other women.

    15. Emergencies
    Someone whose blood glucose has become too low may feel nervous, shaky, and weak. The person may sweat, feel hungry, and have a headache. Severe hypoglycemia can cause loss of consciousness .A person with hypoglycemia who begins too feel weak and shaky should eat or drink something with sugar in immediately, like orange juice . If the person is unconscious, he or she should be taken to a hospital emergency room right way.

    Very high glucose levels cause symptom that are hard to ignore . Frequent urination and excessive thirst .However, in someone who is elderly or in poor health these symptoms may go unnoticed. Without treatment a person with high blood glucose level or hyperglycemia can lose fluids ,become weak, confuse and even unconscious . Breathing will be shallow and the pulse rapid. The person's lips and tongue will be dry, and his or her hands and feet will be cool. If the condition is taking place, a doctor should be called immediately.

    The opposite of high blood glucose ,very low blood glucose or hypoglycemia ,is also dangerous. Hypoglycemia can occur when someone hasn't eaten enough to balance the effects of insulin or medicine. Prolonged, strenuous exercise in someone taking oral diabetes drugs or insulin also can cause hypoglycemia ,as can alcohol.

    Saturday, August 12, 2006


    Infection is an invasion of the body by pathogenic organisms that multiply and produce injurious effect. Communicable disease is an infectious disease that was be transmitted from one person to another.
    Chain of transmitted event as a following:

    1. Causative agent: invading organism (e.q,bacteria,virus)
    2. Reservoir:environment in which the invading organism lives and multiplies
    3. Portal of exit: mode of escape from reservoir (e.q, respiratory tract, gastro interitis tract)
    4. Mode of transmission: methode by which invading organism is transported to new host (e.q, direct contact,air,food)
    5. Portal of entry: means by which organism enter new host (e.q,respiratory tract,broken skin)
    6. Susseptible host: sussebtibility determined by factors such as number of invading organisms,duration of exposure,age,state of health,nutrition status.


    Nursing responsibilities to minimize any infection that will be spread to other patients, therefore nursing should be take action as soon as possible before infection spreading.The nursing action as a below:
    1. Maintain environment that is clean,dry and well ventilation
    2. Use proper hand washing before and after client contact and after contact with contaminated material
    3. Disinfected and handle wastes and contaminated material properly
    4. Prevent transmission of infectious droplets,
    5. Institute proper isolation techniques as required by specific disease
    6. Use surgical technique when appropriate,caring for open wound,irrigating,or entering sterile cavites
    7. Practice universal precaution when caring for all clients regadless of their diagnosis in order to minimize contact whit the blood and body fluids and prevent the transmission of specific infections susch as Hepatitis and Human Immunodeficiency Virus (HIV).

    Safety is one of way to protect nurses who working in Hospital,sometime that nurses work very busy or there is no any safety supervisor they do careless to themselves, so, tink safety first and protect to your self before do any help or assist to the patients. The following safety way nurses must be comply, as a below:
    1. Hands must always be washed before and after contac with clients even when gloves have been used.
    2. If hand come in contact with blood,body fluids,or tumor tissue they should be immediately washed with soap and water.
    3. Gloves should be worn before touching blood or body fluids,mucous membranes,or nonintact skin

    Thursday, August 10, 2006


    Perawat sebagai pemberi pelayanan keperawatan sebagai bagian integral dari pelayanan kesehatan yang diberikan kepada masyarakat,keluarga,kelompok maupun individu . Hal ini menyebabkan perawat selalu menjadi pusat perhatian dari masyarakat maupun pasien yang dirawatnya. Mengikuti perkembangan perawatan dunia, para perawat menginginkan perubahan yang mendasar dalam kegiatan profesinya.Kalau tadinya hanya membantu tugas pelaksanaan tugas dokter ,yang menjadi bagian dari upaya pencapaian tujuan asuhan medis,kini mereka menginginkan pelayanan keperawatan mandiri sebagai upaya mencapai tujuan asuhan keperawatan.

    Pola pendidikanpun mulai berkembang pesat,bilamana dulu perawat sebgaian besar adalah lulusan SPK(Sekolah Perawat Kesehatan) yang setara dengan tingkat pendidikan SMA, kini telah sejajar dengan pendidikan tinggi setara D III (Akademi Keperawatan), Sarjara(S1 Keperawatan) dan bahkan sampai pada tingkat Magister (S2,S3, Keperawatan).

    Tuntutan tanggungjawab dan tugaspun mulai bergeser yang dulu perawat hanya sebagai perpanjangan tangan dari dokter untuk merawat pasien selama 24 jam , kini tuntutan itu sudah menjadi tanggungjawab profesi perawatan secara mandiri yang tentunya mempunyai konsekuensi terhadap perawat tentang tanggungjawab dan tanggung gugat, baik dari pasien,dokter,maupun profesi kesehatan lainya, dan bahkan kadang harus mempertanggungjawabkan dirinya baik secara perdata maupun pidana di pengadilan akibat kesalahan tindakan terhadap pasien maupun malpraktik yang terjadi atas diri perawat itu maupun bersama-sama dengan profesi kesehatan lainya,seperti dokter,X-ray technician,Laboratorium Technician.

    Walaupun Perawat mempunyai Induk organisasi Keperawatan PPNI, namun jika terjadi kasus-kasus yang berhubungan dengan perawat ternyata masih belum mampu membantu banyak penyelesaian yang dihadapi perawat,hal ini memyebabkan perlindungan terhadap perawat masih sangat rendah, dikarenakan masih belum adanya Undang-undang yang mengatur perlindungan terhadap perawat.Ternyata resiko-resiko yang dihadapi oleh perawat tidak hanya berhenti sampai disitu saja tentunya karena perawat sebagai tenaga pelayanan keperawatan yang berada 24 jam disamping pasien juga menghadapi berbagai resiko kesehatan akan terjadinya infeksi silang berbagai macam penyakit dari pasien maupun kejadian kecelakaan kerja akibat pekerjaanya seperti tertusuk jarum,nyeri pungung sehubungan dengan pekerjaan mengangkat dan memindahkan pasien,bed making dan bahkan sampai HNP (Hernia Nucleous Pulposus) yang berakibat kelumpuhan.

    Ternyata tanggungjawab dan resiko yang diemban perawat masih belum sebanding dengan upah yang yang mereka terima rata-rata berkisar antara 400rb-1jt rupiah,yang mana masih jauh dibawah UMP(Upah Minimum Propinsi) yang salah satu contoh untuk DKI Jakarta berkisar 711.843 rupiah(sumber Direktorat Pengupahan,jamsos&Kesejahteraan,2005),yang mana upah ini diberikan terhadap para pekerja yang bekerja dipabrik-pabrik. Sungguh ironis memang,sebuah profesi yang dituntuk memberikan pelayanan kesehatan yang maksimal ternyata mendapatkan penghargaan yang masih jauh dari harapan. Keadaan ini terjadi karena DEPKES sebagai Depatemen yang membawahi berbagai profesi kesehatan tidak memiliki standar upah yang diberikan terhadap tenaga kesehatan,akhirnya yang menjadi standar adalah rumah sakit maupun layanan kesehatan dimana perawat bekerja yang hal ini sangat bervariasi tergantung kemampuan keuangan rumah sakit maupun layanan kesehatan,yang berakibat semaunya saja mengaji para karyawan dan bahkan memberikan standar gaji yang sangat rendah ,lebih rendah dari standar UMP.

    Ketidakcukupan upah inilah yang walaupun bukan faktor utama akhirnya para perawat terjebak dalam kegiatan "klinical practice",yang ilegal, yang mau tidak mau mereka harus melakukannya karenan tuntutan ekonomi dan kebutuhan sehari-hari yang memang harus dipenuhi yang tidak dapat dicukupi dari upah yang diterimanya.Lalu yang menjadi pertanyaan, sampai kapankah keadaan ini harus terjadi,padahal keperawatan diindonesia bahkan lebih dulu dari negara tetangga semisal malaysia yang sudah mampu memberikan upah yang memadai bagi tenaga profesional kesehatan. Haruskan perawat akan terjebak terus dengan"clinikal practice" yang ilegal, atau haruskah semua perawat Indonesia EXSODUS ke Luar Negeri seperti yang dilakukan oleh sebagaian perawat Philipine,yang menyebabkan kekurangan Perawat di Philipine

    Tentunya tidak berharap demikian jika Departemen Kesehatan mampu memberikan standar upah yang lebih layak, sehingga mereka akan tetap bekerja di Indonesia dengan anak dan keluarganya yang akan mampu memenuhi program pemerintah dalam misinya SEHAT DI TAHUN 2010,namun seandainya pemerintah tidak mampu lagi,bekerja di LN tampaknya akan menjadi pilihan maupun trend Perawat Masa Depan Indonesia

    Tuesday, August 01, 2006

    Modern Nursing Activity

    Nursing development starting Florence Nightingale, OM (12 May 1820 – 13 August 1910), who came to be known as The Lady with the Lamp, was a pioneer of modern nursing. She was also a noted statistician

    Modern Nursing, Traditional Belief

    Minority nurses can play a crucial role in helping Asian patients bridge the gap between East and West, old and new

    By Jean Ann Cantore

    In a world where the latest is often considered to be the greatest, many health care professionals are returning to ancient healing practices. Asian remedies such as acupuncture, acupressure, herbs and meditation are being used alongside more modern health care practices. As this holistic approach to health care continues to grow in the U.S., career opportunities will increase for nurses of Asian and Pacific Islander descent because of their unique understanding of Asian cultural beliefs and their familiarity with Eastern medicine.

    “Asian beliefs about health are very popular today,” says Kem Louie, R.N., Ph.D., CS, FAAN, associate professor at the William Paterson University Department of Nursing in Wayne, N.J., and president of the Asian American Pacific Islander Nurses Association, Inc. “Eastern practices are popular because health consumers are more informed and are taking more responsibility for and control of their health. In addition, these practices and remedies assist the body in maintaining health and aid the body in natural healing.”
    Combining Eastern and Western remedies has become quite common in America, especially in areas of the country where there are large populations of people of Asian and Pacific Islander descent. For years, patients interested in traditional Asian remedies had to seek out these treatments on their own, visiting independent acupuncturists or purchasing herbs from Asian markets. Although those choices are still available for patients, an increasing number of modern health care clinics have begun to offer traditional treatments or refer patients to practitioners who use them. Some major insurance carriers even cover treatments such as acupuncture.
    Ancient Remedies

    In clinics and hospitals that serve diverse Asian populations, there is a critical need for Asian-American nurses who can combine their nursing school training with the additional ability to understand the value of traditional remedies. Not only are these nurses caregivers of modern medicine, but they also know how to integrate Eastern and Western beliefs.

    The roots of holistic nursing are found in ancient practices first used in Asia thousands of years ago. But today, many schools and certification programs in the United States prepare nurses to practice holistic nursing, including opportunities in clinics that integrate holism with modern health care procedures.

    Many health care professionals who are not of Asian descent practice this approach to integrated medicine, Louie points out. For example, the well-known medical advisor Andrew Weil, M.D., discusses herbal remedies in his books. In addition, physicians may prescribe acupuncture to treat pain or injuries. The technique involves inserting flexible needles into pressure points on the body to release energy. Acupressure, which is non-invasive, involves massaging certain pressure points in the body to release energy and relax the patient. It can be used to stimulate sleep or digestion or to increase mental stability. In addition, many doctors recommend meditation and yoga to relax patients undergoing modern procedures such as chemotherapy or surgery.

    Most acupuncturists in the United States have been trained in Asia, but there are schools in this country that teach the technique as well. Learning to apply acupuncture is quite involved and requires extensive knowledge of human physiology. Clinics that offer this service are commonly found in communities with large populations of Asian Americans. Although insurance companies are beginning to cover acupuncture when a physician prescribes it, the treatment is not commonly found in hospitals. Most practitioners of this technique work in independent health care centers or clinics.
    Belief Systems

    “The Asian American/Pacific Islander population in the U.S. is mostly foreign-born. Therefore, these families continue to hold on to traditional views of health and illness,” Louie comments. As a result, modern health care clinics that treat people of Asian descent have become more sensitive to cultural differences and beliefs, and recognize the key role Asian nurses can play in bridging cultural gaps.

    Some nurses who work with Asian populations find that their patients want the best of both worlds. Nurses of Asian or Pacific Islander descent can appreciate their patients’ desire to hold on to traditional treatments and beliefs and understand why their patients prefer Eastern treatments or a combination of Eastern and Western remedies. To be able to combine these treatments effectively, though, health care providers must know what treatments patients are receiving elsewhere. For example, patients often come to a modern health care clinic while they are taking herbs they bought at a market or from an herbalist.

    “We try to get patients to tell us what they’re taking on the outside,” says Dominic Koh, R.N., PNP, ANP, a nurse practitioner with Asian Pacific Health Care Venture, Inc., in Los Angeles. “I usually have them bring their medication with them so we can look at it together. Some of it I’m familiar with. We want to be sure the herbs don’t contain lead or mercury; very few do, but we have found a couple. Certain herbs can cause hypoglycemia. Also, we tell them it is best not to mix traditional medications with Western medications. If, however, the products pose no harm, they are free to use them.”

    Often, people of Asian descent view Western medicine as “too strong” and not something to be taken for very long. Koh notes that some patients believe that taking too much Western medicine can cause irreparable damage to the liver or kidneys. In Asian culture, the liver and kidneys are considered dominant organs in the body, controlling all bodily functions.

    “Yesterday, a patient came in and said, ‘I became very dizzy and went to an Eastern medicine herbalist to get medicine. He said I had a weak pulse and was having problems with weakness in the liver and kidney. I have a gall bladder removal scheduled, but I’m not going to go,’” says Jean Song, R.N., a clinic nurse at International Community Health Services in Seattle, who is also studying to be a family nurse practitioner. “I have to find a way to convince her that she needs to have the surgery.”

    Beliefs about food may also affect a patient’s health care. Koh says that many older patients who are told to reduce their food intake for health reasons may not cooperate because food, and especially meat, is a sign of prosperity in many Eastern cultures. Being able to eat meat or meat products is a sign of wealth because meat is often expensive. People who cannot afford to eat meat eat vegetables more often and generally eat less, and therefore are thinner. Although there is an increased awareness that being overweight is unhealthy, Koh also notes that food is not to be wasted in Asian countries. When a patient on a restricted diet lives with a family, he or she may have trouble refusing portions that are served.

    “Diet and the effects of diet [foods] play a major role in maintaining health,” Louie explains. “Specifically, it is believed that certain foods are either ‘cold’ or ‘hot,’ and when the body is out of balance or during certain conditions such as childbirth, specific foods are prescribed, and others are avoided.”
    Hand in Hand

    Nurses in the U.S. who are of Asian descent may not be trained in traditional treatments, but many of them know or have grown up around caregivers who use them. In addition, many of these nurses and their family members have received traditional treatments themselves. Such immersion into the world of Eastern medicine gives these nurses a better understanding of these remedies.

    International Community Health Services in Seattle is affiliated with an acupuncture clinic. While a large number of patients of the acupuncture clinic are American-born, the majority are Asian immigrants and often have not lived in the United States for very long. In their native countries, they may have visited acupuncturists for treatments without seeing a physician first.

    “Mostly it is patients with chronic pain or injuries that receive acupuncture treatments,” Song says. “Their common belief is that if the problem is acute, or one that takes time to cure, they need to have Western medicine; if the problem is chronic, they need Eastern medicine. The patients come here and ask for acupuncture first, and we say, ‘No, you have to see a primary care physician first.’”

    Susan Park, R.N., clinical services manager for Asian Health Services, located in Chinatown in Oakland, Calif., says the clinic where she works has a unique niche. They serve the Asian/ Pacific Islander population, regardless of a patient’s income, insurance or immigration status. Park comments that many of their patients prefer traditional medicine to modern medicine.

    “We see a lot of patients who are recent immigrants and who don’t speak English,” Park notes. “It’s difficult to refer these patients to outside sources because they are not able to communicate with providers outside of Asian Health Services. There’s a lack of linguistically and culturally appropriate health care services for the Asian/Pacific Islander community.”

    Park emphasizes the importance of establishing relationships with patients so that they will feel comfortable at the clinic. She says that nine different languages are spoken by patients who visit the clinic, so having trained medical interpreters who can communicate in these languages is crucial in establishing a therapeutic relationship. Park explains that for patients to begin to trust modern health care procedures, which can be quite different from the health care system of their country of origin, they must first trust their care providers.

    To educate patients about the Western health care system, many larger clinics employ health educators who are familiar with, and well known in, the Asian community. These people play a key role in allaying patients’ fears about modern health care and in getting patients to comply with prescribed care.

    “At the clinic where I work, probably 75% to 80% of our patients are of Thai descent,” Koh explains. “Other groups we treat include people from Cambodia, the Philippines and Vietnam. It helps if you have someone who is in touch with the community. We have really good outreach workers who have been in touch with the Vietnamese community, so we’re starting to get more Vietnamese patients.”
    Overcoming Fears

    In many communities where Eastern medicine is practiced, traditional medicine and modern medicine coexist harmoniously. Health care providers, however, still face challenges in helping Asian patients overcome fears about Western medicine. Nurses of Asian or Pacific Islander descent share their patients’ appreciation for Eastern medicine, which gives them an advantage in caring for patients who hold on to traditional beliefs about healing.

    “For many old folks here, Eastern medicine is No. 1,” Song says. “But they know they have to go to Western medicine for certain treatments. Still, a lot of them are afraid of it. For example, many people with kidney failure will not go for dialysis until the last minute.”

    Even when common languages are spoken, getting a point across to a patient may be difficult. Koh says that when nurses at his clinic discuss medication with their patients, the patients will often nod their heads in agreement and say “yes” when they really don’t understand or intend to follow the instructions. They are simply being polite and showing respect for the nurses by agreeing.

    “Another problem is that in Asia, people may be used to being able to access health care whenever they want,” Koh adds. “We use an appointment system, and they don’t understand that they can’t just walk in. They also may not understand how insurance works.”

    Interestingly, although many people of Asian descent seek Eastern treatments for themselves, they will allow their children to be treated with Western techniques. Song comments that among the patients at the clinic where she works, there is a very high immunization rate for children—as high as 90%.

    Yet non-compliance with prescribed health care still presents a problem. “One difficulty we encounter a lot is that parents carry on the belief that what worked in China will work here,” Song says. “It depends on how much influence a person has in a family. Recently, I had a patient who was two or three years old and had chronic diarrhea. The grandmother in the family had the say as to what the kids in the family were fed. She was giving him herbs. An herb used to treat a virus in China may not work on a virus here because the viruses are different.”

    Song explains that many of the herbs Asian immigrants take on their own are imported from China or Japan and that the contents are written on the label in those languages. Nurses who received their health care training in the United States may not be familiar with the Chinese or Japanese medical terms or know the ingredients that are listed on the labels.

    “We try to keep up to date as much as possible,” Park says. “Sometimes it’s difficult because patients insist on taking traditional medicine only, or they mix traditional and Western medications, which can be quite hazardous. We have to keep educating our patients.”

    She notes that the Asian Health Services clinic is hoping to establish a link with a traditional medicine school in the area. The partnership would enable the providers in her clinic to have a better understanding of the various traditional treatments patients are receiving.

    Although combining traditional and modern health care is a relatively new practice, it seems to be working. Education—for both patients and caregivers—is key to effective treatment. Because nurses of Asian or Pacific Islander descent are ahead of others when it comes to understanding patients’ preferences for treatments such as acupuncture, demand for their services will continue to increase. The ability to see the value in both modern and traditional medicine is an example of how everyone benefits when East meets West.

    Jean Ann Cantore is a free-lance writer in Lubbock, Texas.
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