Saturday, September 24, 2011

[sehat] Digest Number 16109

Messages In This Digest (25 Messages)

1a.
Re: [Tanya] Terapi bicara untuk anak penderita cerebral palsy From: Endah
1b.
Re: [Tanya] Terapi bicara untuk anak penderita cerebral palsy From: Cherry Anzella
2a.
Salep Elidel utk Dermatitis atopi pd bayi From: dinovianthi@gmail.com
2b.
Re: Salep Elidel utk Dermatitis atopi pd bayi From: Ira Indrawati
2c.
Re: Salep Elidel utk Dermatitis atopi pd bayi From: dinovianthi@gmail.com
2d.
Re: Salep Elidel utk Dermatitis atopi pd bayi From: ufitriyanni@yahoo.com
3a.
Re: Kumpul Smart Parents Yogyakarta From: re hani
4a.
Re: Epistaksis kok di periksa tympanometri juga ya? From: Ira Indrawati
5a.
Re: bleeding setelah kuret From: Leocadia intas Jati Awandhani
5b.
REPOST Fw: [sehat] bleeding setelah kuret (OOT) kebobolan IUD harusk From: Leocadia intas Jati Awandhani
5c.
Re: REPOST Fw: [sehat] bleeding setelah kuret (OOT) kebobolan IUD ha From: purnamawati.spak@cbn.net.id
6a.
Re: (TANYA): BB&PB bayi cenderung menurun?? From: donanoor@gmail.com
7a.
Re: mengalami saraf kejepit,apakah boleh hamil? From: Laksmi Purwitosari
7b.
Re: mengalami saraf kejepit,apakah boleh hamil? From: Laksmi Purwitosari
7c.
Re: mengalami saraf kejepit,apakah boleh hamil? From: yessiman@gmail.com
7d.
Re: mengalami saraf kejepit,apakah boleh hamil? From: soraya sofa
7e.
Re: mengalami saraf kejepit,apakah boleh hamil? From: Laksmi Purwitosari
8.1.
Re: Talkshow Milis Sehat di SocMedFest From: kristierenst@yahoo.com
9a.
KELAS PERSIAPAN KELAHIRAN & MENYUSUI BANDUNG 29-30 Oktober 2011 From: klasibdg@yahoo.com
10.
Rubella? From: Ida Rifai
11a.
Pil Yasmin untuk Ibu Menyusui. From: arumski@yahoo.com
11b.
Re: Pil Yasmin untuk Ibu Menyusui. From: yani.febriyanti@yahoo.com
12.
DSA RUM di RS PGI Cikini From: Galuh Ayu Widasari
13.
KB susuk From: lulu_wewet@yahoo.com
14a.
Re: gatal di ketiak From: septysophia@yahoo.co.id

Messages

1a.

Re: [Tanya] Terapi bicara untuk anak penderita cerebral palsy

Posted by: "Endah" endahgunawan@ymail.com

Fri Sep 23, 2011 10:45 pm (PDT)



Di RSAB Harapan Kita ada Klinik Khusus Tumbuh Kembang, cuma kayaknya krn penuh agak ngantri. Baiknya sih cari yg dekat rumah krn terapi begitu biasanya musti sering dan lama.

Endah

1b.

Re: [Tanya] Terapi bicara untuk anak penderita cerebral palsy

Posted by: "Cherry Anzella" rumainov_love2@yahoo.com   rumainov_love2

Fri Sep 23, 2011 10:55 pm (PDT)



Selain di Harapan Kita, dimana lg ya Dok? Makasih :)

Regards,
Cherry
Parenting is never stop...

2a.

Salep Elidel utk Dermatitis atopi pd bayi

Posted by: "dinovianthi@gmail.com" dinovianthi@gmail.com

Fri Sep 23, 2011 10:46 pm (PDT)



Dear SP dan dokter yth

Mau tanya lagi nih, skarang case bayi saya (Faiza, 2 bulan). Masih ASI ex. Kmarin, pd waktu imunisasi saya tanyakan tentang rash dipipi anak saya, diagnosa dokter dermatitis atopic. Yg sy tanyakan:
1. Diberikan salep Elidel . Komposisinya pimecrolimus. Apakah aman di berikan pd bayi 2 bulan? Saya baca dipetunjuknya utk bayi (3-23 bulan). Penggunaan utk bayi dibawah 3 bulan blum dievaluasi

2. Menurut dokternya penyebab DA itu adalah alergi susu sapi. Jadi saya ibunya diminta pantang susu sapi dan kacang tanah. Apakah mungkin ya deteksi alergi tanpa tes darah dll? Mengingat saya dan suami tdk punya riwayat alergi.
Trus apabila sya tdk pantang, apakah rash anak sy akan tmbah parah?

Terima kasih,
-dian-
Sent from my HP Jadull

2b.

Re: Salep Elidel utk Dermatitis atopi pd bayi

Posted by: "Ira Indrawati" ira.tgh.indrawati@gmail.com   ira_indrawati

Fri Sep 23, 2011 11:25 pm (PDT)



Singkat dulu mbak,
1. Elidel dan Protopic sebenarnya di-save sebagai obat lini kedua untuk DA,
kalau salep kortikosteroid tidak mempan lagi. Sebaiknya kembali ke
kortikosteroid, jenis yg potensial paling rendah dan kadar ringan. Kalau
kurang mempan, kadarnya boleh ditingkatkan (misalnya dari 0,5% ke 1%).

2. Susu sapi memang bisa memperparah DA pada bayi, tapi tidak otomatis
berarti bayi ibu alergi protein susu sapi.
Ceritanya agak panjang nih...tapi yg jelas hubungan DA dgn susu sapi bukan
termasuk "IgE mediated food allergy", kecuali kalo ada tanda2 lain berupa
reaksi alergi yg cepat, berat dan multisistem (anafilaksis).
Kebetulan anak saya punya DA dan alergi kacang tanah (IgE mediated food
allergy, di mana dia pernah mengalami anafilaksis). Berdasarkan pengalaman
ini, saya kok jadi cenderung mendukung kalo mbak untuk sementara pantang
susu sapi dan kacang tanah selama menyusui anak.
Btw, anak saya umurnya udah 9 tahun. Sudah tidak apa-apa kalo mengkonsumsi
protein susu sapi, tapi tetap tidak bisa makan/menyentuh kacang tanah
(bahaya besar).

Kalau ibu dan suami nggak ada riwayat alergi, coba cek di keluarga besar
kedua belah pihak. Apakah nenek/kakek, oom-tante ada yg punya alergi
makanan, dermatitis atopi, asma, atau rinitis alergika? Itu sudah indikasi
ada riwayat alergi di kedua keluarga.

Ira
*kapan jalan-jalannya haha*

2011/9/24 <dinovianthi@gmail.com>

> **
>
>
> Dear SP dan dokter yth
>
> Mau tanya lagi nih, skarang case bayi saya (Faiza, 2 bulan). Masih ASI ex.
> Kmarin, pd waktu imunisasi saya tanyakan tentang rash dipipi anak saya,
> diagnosa dokter dermatitis atopic. Yg sy tanyakan:
> 1. Diberikan salep Elidel . Apakah aman di berikan pd bayi 2 bulan? Saya
> baca dipetunjuknya utk bayi (3-23 bulan).
>
2. Menurut dokternya penyebab DA itu adalah alergi susu sapi. Jadi saya
ibunya diminta pantang susu sapi dan kacang tanah. Apakah mungkin ya deteksi
alergi tanpa tes darah dll? Mengingat saya dan suami tdk punya riwayat
alergi.

[Non-text portions of this message have been removed]

2c.

Re: Salep Elidel utk Dermatitis atopi pd bayi

Posted by: "dinovianthi@gmail.com" dinovianthi@gmail.com

Sat Sep 24, 2011 12:09 am (PDT)



Makasih banyak mbak ira atas penjelasannya yg cepat dan jelas
Berarti sy memang harus pantang ya . Demi anak :)

Salam sehat,
-dian-
Sent from my HP Jadull

2d.

Re: Salep Elidel utk Dermatitis atopi pd bayi

Posted by: "ufitriyanni@yahoo.com" ufitriyanni@yahoo.com   ufitriyanni

Sat Sep 24, 2011 4:00 am (PDT)



Klo anak sy Aisha 5bln,dl wkt 1 bln jg ngalamin hal yg sama,penyebabnya kayaknya bukan krn susu sapi mba..wkt itu sy kompres aja pake air infus,lama kelamaan juga hilang kok..
Mgkn bs dicoba..
Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!

-----Original Message-----
From: dinovianthi@gmail.com
Sender: sehat@yahoogroups.com
Date: Sat, 24 Sep 2011 05:51:44
To: <sehat@yahoogroups.com>
Reply-To: sehat@yahoogroups.com
Subject: [sehat] Salep Elidel utk Dermatitis atopi pd bayi

Dear SP dan dokter yth

Mau tanya lagi nih, skarang case bayi saya (Faiza, 2 bulan). Masih ASI ex. Kmarin, pd waktu imunisasi saya tanyakan tentang rash dipipi anak saya, diagnosa dokter dermatitis atopic. Yg sy tanyakan:
1. Diberikan salep Elidel . Komposisinya pimecrolimus. Apakah aman di berikan pd bayi 2 bulan? Saya baca dipetunjuknya utk bayi (3-23 bulan). Penggunaan utk bayi dibawah 3 bulan blum dievaluasi

2. Menurut dokternya penyebab DA itu adalah alergi susu sapi. Jadi saya ibunya diminta pantang susu sapi dan kacang tanah. Apakah mungkin ya deteksi alergi tanpa tes darah dll? Mengingat saya dan suami tdk punya riwayat alergi.
Trus apabila sya tdk pantang, apakah rash anak sy akan tmbah parah?

Terima kasih,
-dian-
Sent from my HP Jadull


[Non-text portions of this message have been removed]

3a.

Re: Kumpul Smart Parents Yogyakarta

Posted by: "re hani" retno.handayani@gmail.com   re_hani

Fri Sep 23, 2011 10:46 pm (PDT)



wah sayang ga bs dtg krn itu jam tidurnya audy.
smga rame,seru dan sukses ya!

retno

4a.

Re: Epistaksis kok di periksa tympanometri juga ya?

Posted by: "Ira Indrawati" ira.tgh.indrawati@gmail.com   ira_indrawati

Fri Sep 23, 2011 11:01 pm (PDT)



Mbak Putri,
coba baca sharing saya "Indikasi adenotonsillectomy" di arsip milis.

Si bungsu saya juga pernah demikian (didiagnosa adenoid hypertrophy DAN
OME/otitis media with effusion alias serous otitis media).
Diperiksa dgn tympanometry dan audiometry, hasilnya memang ada kekurangan
pendengaran sebesar 25-40 deciBel (termasuk mild hearing loss).
Banyak gejala lain yg menyertai, termasuk hidung tersumbat, pilek terus,
upilan terus, mimisan, ngorok (nah, cuma untuk bagian ini, setelah tanya
jawab yg panjang diambil kesimpulan belum sampai terjadi sleep apnea),
tonsil/amandel membengkak (tonsil hypertrophy), pa lagi ya?

Adenoid/tonsil hypertrophy = adenoid/tonsil membesar/membengkak, tapi sedang
tidak mengalami infeksi atau peradangan akut; sepertinya termasuk
kondisi/kategori kronis.
Adenoiditis/tonsillitis = peradangan (akut) pada adenoid/tonsil.
Perlu ditanyakan lagi sebenarnya, peradangan akut atau bukan ya?
Coba baca2 referensinya di internet, dan cari perbedaan antara hypertrophy
dengan -itis (peradangan).

Memang banyak yang harus dijelaskan oleh dokter kepada orangtua pasien
sehubungan dgn adenoid/tonsil hypertrophy atau adenoiditis/tonsillitis,
apalagi kalau sampai ada komplikasi berupa OME dan kekurangan pendengaran.
Masalah ini cukup kompleks kok. Saya saja sampai 5x bolak-balik ke bagian
THT, belum termasuk tes2 penunjang (tympanometry, audiometry, rontgen cavum
nasi). Setelah pindah tempat tinggal, masih dilanjutkan dengan
observasi/evaluasi lanjutan sebanyak 2x kontrol lagi.

Jadi memang wajar kalau kita bertanya panjang-lebar. Memang hak dan tugas
pasien kok ya..hehehe.
Saya dulu juga selalu menyiapkan daftar pertanyaan sampai sedetil-detilnya
(sebelumnya baca2 referensi, pokoknya kayak mau maju ujian..hehe).
Alhamdulillah dokter-dokternya pada akomodatif.

Oxymetazolin (dekongestan) setahu saya memang obat untuk kondisi akut.
Dipakainya tidak boleh lama-lama.
Tapi tentang antibiotik, sepertinya tergantung diagnosanya. Jadi dipastikan
dulu: adenoiditis/tonsillitis atau adenoid/tonsil hypertrophy? Btw
adenoiditis/tonsillitis pun tidak selalu akibat infeksi bakteri, bisa juga
viral.

Tentang tympanometry, coba baca di wikipedia dan bandingkan bentuk kurva yg
mbak punya dgn contoh di sana. Mudah2an mencerahkan.

Semoga membantu,
Ira
*jalan-jalan dulu ;-)*

2011/9/24 <milis.utifkg@gmail.com>

>
> Tapi ternyata kesimpulan dokter yg ke 3 kurang lebih sama seperti dokter
> pertama. Dan akhirnya saya pun bilang klo pernah ke dokter THT lain kemarin.
>
> Akhirnya tadi pagi saya 3rd opinion di RS. Proklamasi.
> Alhamdulillah dokternya mau diajak diskusi.

Saya bilang diagnosisnya apa dok, kok saya harus tympanometri? Beliau
bilang: adenoid tonsilitis.
Karena anamnesa anak saya: ngorok/sleep apnea. Ketika dilihat amandelnya
membesar.

Dan menganjurkan obat kemarin dari dokter pertama di minumkan saja.
Karena tetep ngeyel dan ragu2 untuk meminumkan, akhirnya beliau minta
tympanometri lagi, saya pun setuju supaya beliau dan saya sama2 tau.

Hasil tympanogramnya:
Kanan:
Ear volume 0,79 ml
Compliance 0,36 ml
Pressure -197 daPa
Gradient 0,13 ml

Kiri:
Ear volume 0,78 ml
Compliance 0,80 ml
Pressure -198 daPa
Gradient 0,44 ml

Dari hasil tympanogram hari ini dokter mendiagnosa: Tubair catarrh

Klo saya tidak mau minum obatnya, bisa jadi: Sero otitis media acuta.
Yang menurut beliau bisa bikin anak saya berkurang fungsi pendengarannya...
:(
Beliau pun menambahkan obat tetes hidung Iliadin 0,025% (oxymetazoline HCL),
beliau bilang untuk membuka katup apa gitu di telinga (maaf saya lupa).

Saya minta obat bukan puyer dan ab-nya boleh tidak diganti amox tapi malah
dimarahin n diceramahin...
Pengen nangis juga rasanya disana tapi ya ditahan2...

Keputusan memberikan obat memang ada di tangan saya. Sudah 3 dokter THT
menyarankan diminum saja obatnya.
Tapi kok ya rasanya berat banget klo mau nurutin...

[Non-text portions of this message have been removed]

5a.

Re: bleeding setelah kuret

Posted by: "Leocadia intas Jati Awandhani" awandhani@yahoo.com   awandhani

Fri Sep 23, 2011 11:46 pm (PDT)



dear bunda,and docs,

sekalian nih mau nanya...apakah kalo pake IUD kemudian kebobolan +hamil, IUD memang benar2 harus dilepas ya??? tidak bisa dibiarkan saja sampai bayi lahir?

Hampir 2 minggu lalu, saya keguguran usia kehamilan 6mgg, seminggu sebelum keguguran itu memang IUD nya dilepas. Kebetulan SPOG nya om sendiri dan ada tante yg juga bidan dan kepala Akper Panti rapih. Dan konsul dg beliau memang katanya hrs dilepas kalo tidak akan mengganggu pertumbuhan janin, memang dijelaskan juga bahwa ada resiko terjadi keguguran.

salam,
Intas

________________________________

Coba kontak dsognya atau langsung besok besok ke prakteknya supaya dicek; untuk memastikan ada tidaknya sisa plasenta

Wati
Patient Safety, first

[Non-text portions of this message have been removed]

5b.

REPOST Fw: [sehat] bleeding setelah kuret (OOT) kebobolan IUD harusk

Posted by: "Leocadia intas Jati Awandhani" awandhani@yahoo.com   awandhani

Sat Sep 24, 2011 12:14 am (PDT)





----- Forwarded Message -----
From: Leocadia intas Jati Awandhani <awandhani@yahoo.com>
To: "sehat@yahoogroups.com" <sehat@yahoogroups.com>
Sent: Saturday, September 24, 2011 1:46 PM
Subject: Re: [sehat] bleeding setelah kuret

 
dear bunda,and docs,

sekalian nih mau nanya...apakah kalo pake IUD kemudian kebobolan +hamil, IUD memang benar2 harus dilepas ya??? tidak bisa dibiarkan saja sampai bayi lahir?

Hampir 2 minggu lalu, saya keguguran usia kehamilan 6mgg, seminggu sebelum keguguran itu memang IUD nya dilepas. Kebetulan SPOG nya om sendiri dan ada tante yg juga bidan dan kepala Akper Panti rapih. Dan konsul dg beliau memang katanya hrs dilepas kalo tidak akan mengganggu pertumbuhan janin, memang dijelaskan juga bahwa ada resiko terjadi keguguran.

salam,
Intas

________________________________

Coba kontak dsognya atau langsung besok besok ke prakteknya supaya dicek; untuk memastikan ada tidaknya sisa plasenta

Wati
Patient Safety, first

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

5c.

Re: REPOST Fw: [sehat] bleeding setelah kuret (OOT) kebobolan IUD ha

Posted by: "purnamawati.spak@cbn.net.id" purnamawati.spak@cbn.net.id

Sat Sep 24, 2011 3:35 am (PDT)



Intas
Dulu rasanya pernah dibahas isu ini
Memang ada dua aliran. Tapi kalau bunda sih milih yg gak dilepas hehehe
Wati
Patient Safety, first

6a.

Re: (TANYA): BB&PB bayi cenderung menurun??

Posted by: "donanoor@gmail.com" donanoor@gmail.com   unong

Sat Sep 24, 2011 12:06 am (PDT)



Dear mbak bulan

Maaf kalau boleh tanya dpt program excel utk masukin BB & PB k plot growth chart dmn?dr kmrn aku lg cari2.
Kasusku mirip2 sm anak mbak, sempet di persentil 50 trus turun k 25 (skr tiap bln dr bln k-3 naiknya skitar 500g), anak saya 5 bln skr mbak.
Saya jg sdkt khawatir sih, cm sejauh ini anaknya aktif dan perkembangan motorik sesuai usianya.
Maaf ya mbak kalau tdk membantu. Tp tep semangat memberi asi utk si kecil ya :)

Regards
Dona
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7a.

Re: mengalami saraf kejepit,apakah boleh hamil?

Posted by: "Laksmi Purwitosari" laksmipurwitosari@yahoo.com   laksmipurwitosari

Sat Sep 24, 2011 12:07 am (PDT)



Dear Mba Aya,

Cervical syndrom adalah diagnosis klinis, istilah yang digunakan untuk beberapa gejala yang terjadi di daerah cervical.

ENMG digunakan untuk melihat gangguan fungsi saraf, jika hasil ENMG menggambarkan adanya kompresi di akar saraf cervical 5,6,7, berarti secara fungsional ada gangguan di akar saraf tersebut.

Langkah selanjutnya yang sangat perlu dilakukan adalah mencari penyebab jepitan (kompresi).

Tidak semua jepitan di akar saraf disebabkan oleh hernia nukleus pulposus, masih banyak kemungkinan penyebab lain, betul perlu dilakukan pemeriksaan MRI, untuk mengetahui apa yang sebenarnya menjepit akar saraf cervical 5,6,7.

Untuk manajemennya, tergantung pada kondisi sekarang, klinis sekarang apa? adakah perubahan dari klinis 2009, apa yang dirasakan sekarang

Apa saja gejala cervical syndromnya?
Nyeri leher?
Nyeri leher menjalar ke lengan?
Baal, kesemutan, panas terbakar di bahu sampai lengan?
Kelemahan otot otot bahu, lengan atau telapak tangan?
Atropi otot?
Vertigo?

Penanganan kelainan daerah cervical dan daerah lumbal agak sedikit berbeda, karena secara anatomi juga berbeda, jadi apa yang baik untuk daerah lumbal belum berarti baik untuk cervical.

Saran saya, jika klinis memang dirasakan memberat, segera lacak penyebab cervical syndrom, datang ke dokter spesialis saraf terdekat, untuk konfirmasi klinis terkini, dan pengantar pemeriksaan MRI.

Kenapa harus MRI, jika rontgen polos vertebra hanya dapat memvisualisasikan tulang, tidak dapat memvisualisasikan soft tissue termasuk saraf dan nukleus pulposus juga tidak terlihat.

Untuk radiofrekuensinya, tegakkan penyebabnya dahulu, jangan buru-buru untuk melakukan suatu tindakan apalagi untuk tujuan penghilangan simtom tanpa mengetahui penyebabnya.

Semoga membantu,

Laksmi Purwitosari

[Non-text portions of this message have been removed]

7b.

Re: mengalami saraf kejepit,apakah boleh hamil?

Posted by: "Laksmi Purwitosari" laksmipurwitosari@yahoo.com   laksmipurwitosari

Sat Sep 24, 2011 12:38 am (PDT)



Dear all,
Buat siapa saja yang tertarik dengan radiofrekuensi silahkan dibaca dulu link dibawah ini, pertimbangkan betul untung ruginya dan tentu saja pertimbangkan keefektifan biaya, kalo bisa yang murah kenapa pake yang mahal.
Pelajari dulu ya, sebelum memutuskan sesuatu.

http://www.ncpainmanagement.com/RadiofrequencyLesioning.htm
RADIOFREQUENCY LESIONING
What is a Radio Frequency Lesioning?
Radio Frequency Lesioning is a procedure using a specialized computer controlled machine to interrupt nerve conduction on a semi-permanent basis. The nerves are usually blocked for 6-9 months (can be as short as 3 months or as long at 18 months). The first practical and commercially available Radio Frequency (RF) lesion generators were built in the early 1950s using continuous wave radio frequencies in the 1-MHZ range. RF lesioning is used when other conservative therapies such as exercise, bed rest, or medications other than narcotics, have failed. RF is only considered after a diagnostic (local anesthetic) block has been shown to be of benefit, but of short duration.

Treatments that are usually undertaken with the use of RF lesioning include, but are not limited to:
· Facet denervation (Headaches, neck pains, and upper or lower back pain)
· Sacroiliac Joint denervation (Hip Pain)
· Sympathetic blocks (upper or lower extremity pains)
· Dorsal Root Ganglion lesions (pain of spinal origin)
· RF disc procedures (Headaches, neck pains, and upper or lower back pain)

Each of these procedures may be done at various levels since there is a great deal of segmental overlap on the nerve conduction to these structures.
Am I a candidate for RadioFrequency Lesioning?
Radio Frequency Lesioning is offered to patients with:
· RSD/CRPS/SMP involving upper or lower extremities
· Mechanical neck or low back pain due to facet joint disease
· Occipital neuralgia (Headaches)
· Abdominal (visceral) pain responsive to splanchnic nerve blocks.
· Discogenic Pain (Low Back Pain)
· Nerve Root Pain (Radiculopathy / Radiculitis) (Arm or Leg Pain)

You must have responded well to local anesthetic blocks, to be a candidate for Radiofrequency Lesioning.
What are the benefits of RadioFrequency Lesioning?
The procedure disrupts nerve conduction (such as conduction of pain signals), and it may in turn reduce pain, and other related symptoms. Approximately70-80% of patients will get good pain relief. Occasionally, after a nerve is blocked, it becomes clear that there is pain also coming from other areas as well.
How long does the procedure take?
Depending upon the areas to be treated, the procedure can take from about twenty minutes to an hour.
Does this require that I be hospitalized?
No. The procedure is performed in our clinic as a same day surgery. Except for a few cases, most patients will be discharged home two (2) hours after the procedure.
Where is the procedure performed?
The procedure is usually performed under fluoroscopy (x-ray) guidance, in our clinic.
How is the procedure actually performed?
You will be scheduled for the procedure with enough time to make arrangements to get a driver, and someone to stay with you at home, the day of the procedure. You will take all of your usual medicines the morning of the procedure, except for any blood thinners, which you should have stopped with enough time for their effects to disappear form your body. (If you have any questions about specific medications, please call us for clarification. Do not wait until the day before the procedure to ask.) The day of your procedure, you will need to come in 30 to 45 minutes prior to your schedule procedure time, at which time an IV will be started and your physician will check on you, to answer any questions and to assess to see if there are any contraindications to proceed. Since nerves cannot be seen on x-ray, the needles are positioned using bony landmarks that indicate where the nerves usually are. Fluoroscopy (x-ray) is used to identify those bony landmarks. A
local anesthetic (Lidocaine) is injected to numb the skin before placing the radiofrequency needles. The needles are then positioned using x-ray guidance. The radiofrequency machine is then used in the diagnostic stimulation mode to provide a small electrical pulse used to identify proper needle placement. At this point you will be asked to let us know, by saying "NOW", when you first feel any sensation different from what you normally feel in the area. This sensation could be a type of pressure, or a tingling sensation. Because we are slowly increasing the electrical output on the machine, it is important that you say "NOW", as soon as you feel this sensation. Otherwise, the magnitude of the sensation will increase to the point where it will become painful. To avoid this, simply pay attention to the change in sensations and report it as soon as you experience it. After confirmation of the needle tip position, a special needle tip is inserted.

When the needle is in good position, as confirmed by x-ray, electrical stimulation is done before any lesioning. This stimulation may produce a buzzing, tingling, pain, or pressure sensation or may be like hitting your "funny bone". Because we also do motor stimulation testing, you may also feel your muscles jump or twitch. You need to be awake during this part of the procedure so you can report what you're feeling. The tissues surrounding the needle tip are then heated when electronic current is passed using the Radio Frequency machine, for a few seconds. This "numbs" the nerves semi-permanently.
Will the procedure hurt?
There will be some discomfort. Layers of muscle and soft tissues protect nerves. The procedure involves inserting a needle through skin and those layers of muscle and soft tissues, so there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the radiofrequency needle. In addition, an IV will be started and you will be given sedatives and pain medication. Local anesthetics will also be injected prior to the "burning" of the nerve; therefore, the actual lesion should be painless. The action of the local anesthetics should last four (4) to six (6) hours, after which, the local anesthetic will were off and the pain will return. You will probably then experience more pain than usual for five (5) to ten (10) days before it gets any better. This pain is from the procedure itself (needle sticks). You may also have pain and discomfort for up to six (6) weeks, until the
lesion itself heals (the "burn"). To help you with this, you will be instructed to apply cold compresses on the day of the procedure (to minimize swelling), followed by heat, from the next day on. You will also be provided with a prescription for pain medication to have available, in case you do experience some increased pain.
Will I be "put to sleep" for this procedure?
No. This procedure is done under local anesthesia and sedation. Most of the patients receive intravenous sedation and analgesia, which makes the procedure easier to tolerate. The amount of sedation given generally depends upon the patient tolerance. It is necessary for you to be awake enough to communicate easily during the procedure.
How is the procedure performed?
It is done either with the patient lying on the stomach when working on the facet joints, low back for lumbar sympathetic nerves, and the back when lesioning the cervical (neck) area (e.g. Stellate Ganglion). The patients are monitored with EKG, blood pressure cuff, and blood oxygen-monitoring device. The skin on the back is cleaned with antiseptic solution and then the procedure is carried out. X-ray (fluoroscopy) is used to guide the needles.
What should I expect after the procedure?
Most people will feel an increase in their pain, which could last up to 5weeks, after which it should go away gradually. Your physician knows this, and will therefore provide you with enough pain medications to last until then. Because of this same reason, you need not be seen in the Pain Clinic until 5-6 weeks after your RF lesioning, unless you need to see you pain specialist because of a possible complication or unexpected side effect.

Most procedures involve the use of local anesthetics (numbing medicine), steroids (anti-inflammatory medicines) and possibly sedation (relaxation or nerve medicine). Sedation may affect your memory, not allowing you to remember the procedure, or the instructions that we give you after it. Because of this, your Doctor may want to avoid providing you with important information after the procedure, since you may not remember. The Doctor will be more than happy to go over the information upon your return.

Local anesthetics, on the other hand, may cause temporary numbness and weakness of the legs or arms, depending on the location of the block. This numbness/weakness may last 4-6 hours (the duration of the local anesthetic). During this period of numbness, you must be more careful than usual, to prevent any injuries to the extremity.

Steroids will begin to work immediately after injected, but on the average, it will take 6-10 days for the swelling to come down to the point where you will be able to tell a difference in terms of the pain.

In summary, you should expect for your pain to get better within 15-20 minutes after the procedure. This relief or numbness should last 4-6 hours, after which, it will wear off. Once it wears off, you may experience more pain than usual until the steroids ìkick inî. This discomfort is due to the procedure itself. To minimize this, we recommend applying ice (fill a plastic sandwich bag with ice and wrap it on a towel to prevent frostbite) to the area, 15 minutes on and 15 minutes off, the day of the procedure. This will minimize any swelling. Starting the next day, you should then start with heat (moist or dry, it does not matter). Heat therapy should continue until the pain improves (4-6 days). Be careful not to burn yourself.

In the case of Radiofrequency procedures, you should expect more pain than usual for 5 to 6 weeks after the procedure. This is how long it takes the burned tissue to heal. We cannot assess any definite results on the success of the procedure until this recovery period has elapsed.
What should I do after the procedure?
You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.
Can I go to work to work the next day?
You should be able to return to your work the next day. Sometimes soreness at the injection site causes you to be off work for a day or two.
How long will the effects of the procedure last?
If successful, the effects of the procedure can last from 3-18 months, usually 6-9 months.
Duration of Results
Unfortunately, nothing available at this time is permanent. The duration of pain relief can be from 0 days to 2.7 years. There is currently no way to predict which patients will obtain long pain relief. However, it is our experience that those patients that obtain longer benefits from the diagnostic injections, tend to also attain longer benefits from the radiofrequency procedures. Keep in mind that every patient is different.
How many procedures do I need to have?
If the first procedure does not relieve your symptoms completely, you maybe recommended having a repeat procedure after re-evaluation. Because these are not permanent procedures, they may need to be repeated when the numbness wears off (often 6-12 months).
Can the procedure be repeated when and if my pain returns?
Yes. The effectiveness of subsequent repeat procedures is also variable. Some patients obtain longer duration of pain relief while others obtain shorter duration.
Will the RadioFrequency Lesioning help me?
It is very difficult to predict if the procedure will indeed help you or not. Generally speaking, the patients who have responded to repeated local anesthetic blocks will have better results.
Will I obtain complete (100%) pain relief?
Although possible, it is our experience that in 85% of the patients suffering from chronic pain, the cause of the pain is usually multifactorial. Therefore, it is highly unlikely that we will be able to completely address the problem with only one type of therapy.
What are the risks, Side Effects, and possible complications?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and the possibility of complications. The risks and complications are dependent upon the sites that are lesioned. The closer the procedure is to the spine, the more serious the risks are. Great care is taken when placing the radiofrequency needles, but sometimes complications can occur.

Everything in medicine is subject to possible side effects and complications. No two patients are alike. Side effects and complications are not the same as malpractice. Malpractice refers to an injury incurred by a patient, which occurs as a consequence of negligence in the practice of medicine. Side effects and complications, on the other hand, are untoward events, which can occur and may injure a patient, in certain percentages of the population. These events can, and do, occur even if everything seems to have taken place as planned, and in the absence of negligence or malpractice. Possible side effects and complications of RF include, but are not limited to:

· Those related to needle insertion:
- Pain or worsening of symptoms: The needles have to go through skin and soft tissues, which will cause soreness.
- Infection: (local = abscess, or generalized = sepsis), including meningitis and death. Any time there is an injection through the skin, there is a risk of infection. This is why sterile conditions are used for these blocks. There are three possible types of infection:
1. Localized skin infection.
2. Central Nervous System infection. This can be in the form of meningitis, which can be deadly.
3. Epidural Infections. This can be in the form of an epidural abscess, which can cause pressure inside of the spine, causing compression of the spinal cord with subsequent paralysis. This would require an emergency surgery to decompress, and there are no guarantees that the patient would recover from the paralysis.
- Bleeding: Bleeding is more common if the patient is taking blood thinners such as aspirin, Coumadin, Ticlid, Plavix, etc., or if he/she have some genetic predisposition such as hemophilia. Bleeding into the spinal canal can cause compression of the spinal cord with subsequent paralysis. This would require an emergency surgery to decompress and there are no guarantees that the patient would recover from the paralysis.
- Nerve damage: By working so close to the spinal cord, there is always a possibility of nerve damage, which could be as serious as a permanent spinal cord injury with paralysis.
· Those related to intentional production of heat:
- Pain or worsening of symptoms
- Permanent motor or sensory deficits (nerve damage)
· Those related to instrument failure:
- Skin burns
- Pain or worsening of symptoms
- Permanent nerve damage
· Death: Although rare, severe deadly allergic reactions known as "Anaphylactic Reaction" can occur to any of the medications used.
· Worsening of the symptoms: We can always make things worse.
· Chances of any of this occurring are extremely low. By statistics, you have more of a chance of getting killed in a motor vehicle accident driving to the Hospital, than any of the above occurring. Nevertheless, you should be aware that they are possibilities.

Incidence of Side Effects and Possible Complications
These occur in approximately 1 (one) in every 5,000 patient that undergo this mode of therapy.
Guarantees that it will help
None. There are no guarantees in medicine.
Results of RF Treatment
· For headaches - approximately 60% of patients obtain more than 50% pain relief.
· For post-traumatic neck pain - approximately 57% of patients obtain more than 50% pain relief
· For back pain due to facet disease
· Without previous surgery - approximately 60% of patients obtain more than 50%pain relief
· With prior surgery - approximately 40% of patients obtain more than 50% pain relief
· For arm pain - approximately 52% of patients obtained more than 50% pain relief.
· For chest and abdominal pain - approximately 52% of patients obtained more than 50% pain relief.
Who should not have this procedure?
If you are on a blood thinning medication (e.g. Coumadin, Plavix), or if you have an active infection going on, you should not have the procedure. If you have not responded to local anesthetic blocks, you may not be a candidate for this procedure. If you are taking any blood thinners, please inform your physician.
How should I prepare for this procedure?
· Do not eat or drink anything, at least six hours prior to the procedure.
· Bring a driver with you. Cannot be a Taxi.
· Take all of your medicines the morning of the procedure, with just enough water to swallow them. If you have diabetes, do not take your Insulin or your sugar pills (oral hypoglycemics) until after the procedure.
· Do not take aspirin or any aspirin-containing medications, at least eleven (11) days prior to the procedure. They may prolong bleeding.
· Do not take any non-steroidal anti-inflammatory drugs, at least one day prior to the procedure. They may prolong bleeding.
· Wear loose fitting clothing that may be easy to take off and that you would not mind if it got stained with Betadine or blood.
· Take a shower the morning of the procedure, using a bactericidal soap to minimize chances of infection.
· Do not wear any jewelry or perfumes.
· During the testing phase of the procedure, you will be asked to let us know as soon as you feel the stimulation. It is imperative that you let us know the instant that you begin to feel it. This stimulation may be initially felt as a pressure or a tingling sensation. Nevertheless, because we will be increasing the intensity of the stimulation, until you tell us that you feel it, if you do not tell us the instant that you begin to feel it, we will continue to increase the intensity and it may become very painful.

Laksmi Purwitosari

[Non-text portions of this message have been removed]

7c.

Re: mengalami saraf kejepit,apakah boleh hamil?

Posted by: "yessiman@gmail.com" yessiman@gmail.com

Sat Sep 24, 2011 12:59 am (PDT)



Dear dr. Laksmi,

Maaf, jadi memperpanjang thread.
Saya jg ada penyempitan di leher di 5,6 dan 7. Mulai sakitnya sudah lama, terdeteksi sejak 1995. Sudah menjalankan fisioterapi tp tidak ada perubahan. Disarankan operasi tapi saya mundur karena kansnya 50-50.

Saat ini bisa dikatakan separuh badan nyeri terutama daerah leher, pundak dan punggung sebelah kiri. Dan sekarang cukup ditahan2 saja sakitnya. Paling minta tolong suami buat pijat pelan di daerah yg nyeri.

Penyempitan ini diakibatkan adanya pengapuran. Selain operasi, adakah jalan lain at least buat meringankan nyerinya? Jika ada latihan/exercise, olahraga apa yg sebaiknya dilakukan?

Terima kasih sebelumnya, dok. Maaf jadi merepotkan.

Regards,
Yessi
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7d.

Re: mengalami saraf kejepit,apakah boleh hamil?

Posted by: "soraya sofa" sorayasofa@gmail.com

Sat Sep 24, 2011 1:27 am (PDT)



Dear dr Laksmi,

sblmnya sy ucapkan terima kasih atas perhatian dan penjelasannya ttg
penyakit ini

scara klinis blm ada perubahan yg berarti ,sy sdh menjalani
fisioterapi ,pnh disuntik tp tidak berpengaruh sm sekali. juga sdh
berobat alternatif. yg sangat terasa saat ini sy tdk bs menarik nafas
panjang krn nyeri sekali di bagian dada sampai punggung.
yg ingin sy tanyakan, apakah sy harus lsg konsultasi ke dr bedah syaraf?
maaf jd panjang pertanyaanya.
terima kasih banyak.

salam,

soraya

On 9/24/11, Laksmi Purwitosari <laksmipurwitosari@yahoo.com> wrote:
> Dear all,
> Buat siapa saja yang tertarik dengan radiofrekuensi silahkan dibaca dulu
> link dibawah ini, pertimbangkan betul untung ruginya dan tentu saja
> pertimbangkan keefektifan biaya, kalo bisa yang murah kenapa pake yang
> mahal.
> Pelajari dulu ya, sebelum memutuskan sesuatu.
>
> http://www.ncpainmanagement.com/RadiofrequencyLesioning.htm
> RADIOFREQUENCY LESIONING
> What is a Radio Frequency Lesioning?
> Radio Frequency Lesioning is a procedure using a specialized computer
> controlled machine to interrupt nerve conduction on a semi-permanent basis.
> The nerves are usually blocked for 6-9 months (can be as short as 3 months
> or as long at 18 months). The first practical and commercially available
> Radio Frequency (RF) lesion generators were built in the early 1950s using
> continuous wave radio frequencies in the 1-MHZ range. RF lesioning is used
> when other conservative therapies such as exercise, bed rest, or medications
> other than narcotics, have failed. RF is only considered after a diagnostic
> (local anesthetic) block has been shown to be of benefit, but of short
> duration.
>
> Treatments that are usually undertaken with the use of RF lesioning include,
> but are not limited to:
> · Facet denervation (Headaches, neck pains, and upper or lower back
> pain)
> · Sacroiliac Joint denervation (Hip Pain)
> · Sympathetic blocks (upper or lower extremity pains)
> · Dorsal Root Ganglion lesions (pain of spinal origin)
> · RF disc procedures (Headaches, neck pains, and upper or lower back
> pain)
>
> Each of these procedures may be done at various levels since there is a
> great deal of segmental overlap on the nerve conduction to these structures.
> Am I a candidate for RadioFrequency Lesioning?
> Radio Frequency Lesioning is offered to patients with:
> · RSD/CRPS/SMP involving upper or lower extremities
> · Mechanical neck or low back pain due to facet joint disease
> · Occipital neuralgia (Headaches)
> · Abdominal (visceral) pain responsive to splanchnic nerve blocks.
> · Discogenic Pain (Low Back Pain)
> · Nerve Root Pain (Radiculopathy / Radiculitis) (Arm or Leg Pain)
>
> You must have responded well to local anesthetic blocks, to be a candidate
> for Radiofrequency Lesioning.
> What are the benefits of RadioFrequency Lesioning?
> The procedure disrupts nerve conduction (such as conduction of pain
> signals), and it may in turn reduce pain, and other related symptoms.
> Approximately70-80% of patients will get good pain relief. Occasionally,
> after a nerve is blocked, it becomes clear that there is pain also coming
> from other areas as well.
> How long does the procedure take?
> Depending upon the areas to be treated, the procedure can take from about
> twenty minutes to an hour.
> Does this require that I be hospitalized?
> No. The procedure is performed in our clinic as a same day surgery. Except
> for a few cases, most patients will be discharged home two (2) hours after
> the procedure.
> Where is the procedure performed?
> The procedure is usually performed under fluoroscopy (x-ray) guidance, in
> our clinic.
> How is the procedure actually performed?
> You will be scheduled for the procedure with enough time to make
> arrangements to get a driver, and someone to stay with you at home, the day
> of the procedure. You will take all of your usual medicines the morning of
> the procedure, except for any blood thinners, which you should have stopped
> with enough time for their effects to disappear form your body. (If you have
> any questions about specific medications, please call us for clarification.
> Do not wait until the day before the procedure to ask.) The day of your
> procedure, you will need to come in 30 to 45 minutes prior to your schedule
> procedure time, at which time an IV will be started and your physician will
> check on you, to answer any questions and to assess to see if there are any
> contraindications to proceed. Since nerves cannot be seen on x-ray, the
> needles are positioned using bony landmarks that indicate where the nerves
> usually are. Fluoroscopy (x-ray) is used to identify those bony landmarks. A
> local anesthetic (Lidocaine) is injected to numb the skin before placing
> the radiofrequency needles. The needles are then positioned using x-ray
> guidance. The radiofrequency machine is then used in the diagnostic
> stimulation mode to provide a small electrical pulse used to identify proper
> needle placement. At this point you will be asked to let us know, by saying
> "NOW", when you first feel any sensation different from what you normally
> feel in the area. This sensation could be a type of pressure, or a tingling
> sensation. Because we are slowly increasing the electrical output on the
> machine, it is important that you say "NOW", as soon as you feel this
> sensation. Otherwise, the magnitude of the sensation will increase to the
> point where it will become painful. To avoid this, simply pay attention to
> the change in sensations and report it as soon as you experience it. After
> confirmation of the needle tip position, a special needle tip is inserted.
>
> When the needle is in good position, as confirmed by x-ray, electrical
> stimulation is done before any lesioning. This stimulation may produce a
> buzzing, tingling, pain, or pressure sensation or may be like hitting your
> "funny bone". Because we also do motor stimulation testing, you may also
> feel your muscles jump or twitch. You need to be awake during this part of
> the procedure so you can report what you're feeling. The tissues surrounding
> the needle tip are then heated when electronic current is passed using the
> Radio Frequency machine, for a few seconds. This "numbs" the nerves
> semi-permanently.
> Will the procedure hurt?
> There will be some discomfort. Layers of muscle and soft tissues protect
> nerves. The procedure involves inserting a needle through skin and those
> layers of muscle and soft tissues, so there is some discomfort involved.
> However, we numb the skin and deeper tissues with a local anesthetic using a
> very thin needle prior to inserting the radiofrequency needle. In addition,
> an IV will be started and you will be given sedatives and pain medication.
> Local anesthetics will also be injected prior to the "burning" of the nerve;
> therefore, the actual lesion should be painless. The action of the local
> anesthetics should last four (4) to six (6) hours, after which, the local
> anesthetic will were off and the pain will return. You will probably then
> experience more pain than usual for five (5) to ten (10) days before it gets
> any better. This pain is from the procedure itself (needle sticks). You may
> also have pain and discomfort for up to six (6) weeks, until the
> lesion itself heals (the "burn"). To help you with this, you will be
> instructed to apply cold compresses on the day of the procedure (to minimize
> swelling), followed by heat, from the next day on. You will also be provided
> with a prescription for pain medication to have available, in case you do
> experience some increased pain.
> Will I be "put to sleep" for this procedure?
> No. This procedure is done under local anesthesia and sedation. Most of the
> patients receive intravenous sedation and analgesia, which makes the
> procedure easier to tolerate. The amount of sedation given generally depends
> upon the patient tolerance. It is necessary for you to be awake enough to
> communicate easily during the procedure.
> How is the procedure performed?
> It is done either with the patient lying on the stomach when working on the
> facet joints, low back for lumbar sympathetic nerves, and the back when
> lesioning the cervical (neck) area (e.g. Stellate Ganglion). The patients
> are monitored with EKG, blood pressure cuff, and blood oxygen-monitoring
> device. The skin on the back is cleaned with antiseptic solution and then
> the procedure is carried out. X-ray (fluoroscopy) is used to guide the
> needles.
> What should I expect after the procedure?
> Most people will feel an increase in their pain, which could last up to
> 5weeks, after which it should go away gradually. Your physician knows this,
> and will therefore provide you with enough pain medications to last until
> then. Because of this same reason, you need not be seen in the Pain Clinic
> until 5-6 weeks after your RF lesioning, unless you need to see you pain
> specialist because of a possible complication or unexpected side effect.
>
> Most procedures involve the use of local anesthetics (numbing medicine),
> steroids (anti-inflammatory medicines) and possibly sedation (relaxation or
> nerve medicine). Sedation may affect your memory, not allowing you to
> remember the procedure, or the instructions that we give you after it.
> Because of this, your Doctor may want to avoid providing you with important
> information after the procedure, since you may not remember. The Doctor
> will be more than happy to go over the information upon your return.
>
> Local anesthetics, on the other hand, may cause temporary numbness and
> weakness of the legs or arms, depending on the location of the block. This
> numbness/weakness may last 4-6 hours (the duration of the local anesthetic).
> During this period of numbness, you must be more careful than usual, to
> prevent any injuries to the extremity.
>
> Steroids will begin to work immediately after injected, but on the average,
> it will take 6-10 days for the swelling to come down to the point where you
> will be able to tell a difference in terms of the pain.
>
> In summary, you should expect for your pain to get better within 15-20
> minutes after the procedure. This relief or numbness should last 4-6 hours,
> after which, it will wear off. Once it wears off, you may experience more
> pain than usual until the steroids ìkick inî. This discomfort is due to the
> procedure itself. To minimize this, we recommend applying ice (fill a
> plastic sandwich bag with ice and wrap it on a towel to prevent frostbite)
> to the area, 15 minutes on and 15 minutes off, the day of the procedure.
> This will minimize any swelling. Starting the next day, you should then
> start with heat (moist or dry, it does not matter). Heat therapy should
> continue until the pain improves (4-6 days). Be careful not to burn
> yourself.
>
> In the case of Radiofrequency procedures, you should expect more pain than
> usual for 5 to 6 weeks after the procedure. This is how long it takes the
> burned tissue to heal. We cannot assess any definite results on the success
> of the procedure until this recovery period has elapsed.
> What should I do after the procedure?
> You should have a ride home. We advise the patients to take it easy for a
> day or so after the procedure. You may want to apply ice to the affected
> area. Perform the activities as tolerated by you.
> Can I go to work to work the next day?
> You should be able to return to your work the next day. Sometimes soreness
> at the injection site causes you to be off work for a day or two.
> How long will the effects of the procedure last?
> If successful, the effects of the procedure can last from 3-18 months,
> usually 6-9 months.
> Duration of Results
> Unfortunately, nothing available at this time is permanent. The duration of
> pain relief can be from 0 days to 2.7 years. There is currently no way to
> predict which patients will obtain long pain relief. However, it is our
> experience that those patients that obtain longer benefits from the
> diagnostic injections, tend to also attain longer benefits from the
> radiofrequency procedures. Keep in mind that every patient is different.
> How many procedures do I need to have?
> If the first procedure does not relieve your symptoms completely, you maybe
> recommended having a repeat procedure after re-evaluation. Because these are
> not permanent procedures, they may need to be repeated when the numbness
> wears off (often 6-12 months).
> Can the procedure be repeated when and if my pain returns?
> Yes. The effectiveness of subsequent repeat procedures is also variable.
> Some patients obtain longer duration of pain relief while others obtain
> shorter duration.
> Will the RadioFrequency Lesioning help me?
> It is very difficult to predict if the procedure will indeed help you or
> not. Generally speaking, the patients who have responded to repeated local
> anesthetic blocks will have better results.
> Will I obtain complete (100%) pain relief?
> Although possible, it is our experience that in 85% of the patients
> suffering from chronic pain, the cause of the pain is usually
> multifactorial. Therefore, it is highly unlikely that we will be able to
> completely address the problem with only one type of therapy.
> What are the risks, Side Effects, and possible complications?
> Generally speaking, this procedure is safe. However, with any procedure
> there are risks, side effects, and the possibility of complications. The
> risks and complications are dependent upon the sites that are lesioned. The
> closer the procedure is to the spine, the more serious the risks are. Great
> care is taken when placing the radiofrequency needles, but sometimes
> complications can occur.
>
> Everything in medicine is subject to possible side effects and
> complications. No two patients are alike. Side effects and complications
> are not the same as malpractice. Malpractice refers to an injury incurred
> by a patient, which occurs as a consequence of negligence in the practice of
> medicine. Side effects and complications, on the other hand, are untoward
> events, which can occur and may injure a patient, in certain percentages of
> the population. These events can, and do, occur even if everything seems to
> have taken place as planned, and in the absence of negligence or
> malpractice. Possible side effects and complications of RF include, but are
> not limited to:
>
> · Those related to needle insertion:
> - Pain or worsening of symptoms: The needles have to go through skin and
> soft tissues, which will cause soreness.
> - Infection: (local = abscess, or generalized = sepsis), including
> meningitis and death. Any time there is an injection through the skin, there
> is a risk of infection. This is why sterile conditions are used for these
> blocks. There are three possible types of infection:
> 1. Localized skin infection.
> 2. Central Nervous System infection. This can be in the form of
> meningitis, which can be deadly.
> 3. Epidural Infections. This can be in the form of an epidural abscess,
> which can cause pressure inside of the spine, causing compression of the
> spinal cord with subsequent paralysis. This would require an emergency
> surgery to decompress, and there are no guarantees that the patient would
> recover from the paralysis.
> - Bleeding: Bleeding is more common if the patient is taking blood
> thinners such as aspirin, Coumadin, Ticlid, Plavix, etc., or if he/she have
> some genetic predisposition such as hemophilia. Bleeding into the spinal
> canal can cause compression of the spinal cord with subsequent paralysis.
> This would require an emergency surgery to decompress and there are no
> guarantees that the patient would recover from the paralysis.
> - Nerve damage: By working so close to the spinal cord, there is always
> a possibility of nerve damage, which could be as serious as a permanent
> spinal cord injury with paralysis.
> · Those related to intentional production of heat:
> - Pain or worsening of symptoms
> - Permanent motor or sensory deficits (nerve damage)
> · Those related to instrument failure:
> - Skin burns
> - Pain or worsening of symptoms
> - Permanent nerve damage
> · Death: Although rare, severe deadly allergic reactions known as
> "Anaphylactic Reaction" can occur to any of the medications used.
> · Worsening of the symptoms: We can always make things worse.
> · Chances of any of this occurring are extremely low. By statistics,
> you have more of a chance of getting killed in a motor vehicle accident
> driving to the Hospital, than any of the above occurring. Nevertheless, you
> should be aware that they are possibilities.
>
> Incidence of Side Effects and Possible Complications
> These occur in approximately 1 (one) in every 5,000 patient that undergo
> this mode of therapy.
> Guarantees that it will help
> None. There are no guarantees in medicine.
> Results of RF Treatment
> · For headaches - approximately 60% of patients obtain more than 50%
> pain relief.
> · For post-traumatic neck pain - approximately 57% of patients obtain
> more than 50% pain relief
> · For back pain due to facet disease
> · Without previous surgery - approximately 60% of patients obtain
> more than 50%pain relief
> · With prior surgery - approximately 40% of patients obtain more than
> 50% pain relief
> · For arm pain - approximately 52% of patients obtained more than 50%
> pain relief.
> · For chest and abdominal pain - approximately 52% of patients
> obtained more than 50% pain relief.
> Who should not have this procedure?
> If you are on a blood thinning medication (e.g. Coumadin, Plavix), or if you
> have an active infection going on, you should not have the procedure. If you
> have not responded to local anesthetic blocks, you may not be a candidate
> for this procedure. If you are taking any blood thinners, please inform your
> physician.
> How should I prepare for this procedure?
> · Do not eat or drink anything, at least six hours prior to the
> procedure.
> · Bring a driver with you. Cannot be a Taxi.
> · Take all of your medicines the morning of the procedure, with just
> enough water to swallow them. If you have diabetes, do not take your Insulin
> or your sugar pills (oral hypoglycemics) until after the procedure.
> · Do not take aspirin or any aspirin-containing medications, at least
> eleven (11) days prior to the procedure. They may prolong bleeding.
> · Do not take any non-steroidal anti-inflammatory drugs, at least one
> day prior to the procedure. They may prolong bleeding.
> · Wear loose fitting clothing that may be easy to take off and that
> you would not mind if it got stained with Betadine or blood.
> · Take a shower the morning of the procedure, using a bactericidal
> soap to minimize chances of infection.
> · Do not wear any jewelry or perfumes.
> · During the testing phase of the procedure, you will be asked to let
> us know as soon as you feel the stimulation. It is imperative that you let
> us know the instant that you begin to feel it. This stimulation may be
> initially felt as a pressure or a tingling sensation. Nevertheless, because
> we will be increasing the intensity of the stimulation, until you tell us
> that you feel it, if you do not tell us the instant that you begin to feel
> it, we will continue to increase the intensity and it may become very
> painful.
>
>
> Laksmi Purwitosari
>
>
>
> [Non-text portions of this message have been removed]
>
>

7e.

Re: mengalami saraf kejepit,apakah boleh hamil?

Posted by: "Laksmi Purwitosari" laksmipurwitosari@yahoo.com   laksmipurwitosari

Sat Sep 24, 2011 2:11 am (PDT)



Dear all,
Maaf gak disebut satu satu, ternyata banyak banget yang ngalamin back pain baik yang upper maupun lower.

Tindakan operatif dan tindakan tindakan lain yang invasif sekali lagi perlu dengan pertimbangan matang, kesembuhan juga bergantung dengN derajat kerusakan sarafnya, jika kerusakannya sudah berat walaupun kompresi (jepitan) sudah dibebaskan, nyeri tetap akan terjadi karena gangguan fungsi sarafnya mungkin sudah bersifat menetap, jika terjadi hal ini ya tinggal memanfaatkan cognitive behavioural therapy.

Jika gangguannya ringan ya tidak perlu juga tindakan operatif, kadang kadang saja nyerinya, nyeri tidak menganggu produktifitas, ya sayang di ongkos untuk operasi. Untuk cervical spine, risikonya secara anatomi lebih besar, walaupun sekarang tindakan sudah canggih, microsurgery, endoscopic dsb.

Untuk tidak memperparah gejala silahkan lakukan dibawah ini,

Poin pentingnya
Such strategies can assist patients to continue their normal activities with simple adaptations. For instance, they should be advised to choose a center seat at theaters or at dinner parties to avoid prolonged sustained rotation positions and taught good lifting and carrying practices, including limiting the weight carried. This applies to the weight of shopping bags, handbags, briefcases, or hand luggage. Household activities such as cleaning tasks or gardening can be spread out over days or tasks rotated frequently between lighter and heavier ones. Patients' individual circumstances need to be understood and identifi ed to assist them to develop strategies that allow them to maintain their functional activities without unnecessarily adversely straining their necks.

Selengkapnya
Prevention of adverse strain to the neck inherent in work or lifestyle practices and optimization of the work or home environment are very vital components of management of neck disorders.

Clinicians are well versed in fundamental ergonomic principles and can advise patients on such aspects as offi ce design, workstation set-ups, optimal chair confi gurations, bench heights, or other factors as relevant to the patient's work or lifestyle practices. It may be appropriate to recommend a formal worksite assessment from those specialized in the fi eld.

There is also the human factor and how the person functions even within the best-designed workplace. Discussion here will focus on rehabilitation and preventive strategies that are focused on the patient's contribution to better work and lifestyle practices.

Education is of paramount importance in changing or modifying work or lifestyle habits and practices. The evidence should be clearly provided and, when possible, a practical demonstration provided of the relationship between a certain activity, strain on cervical structures, and pain. Patients must be encouraged to recognize provocative work or lifestyle practices and, importantly, those that they can perform comfortably without neck pain.

They are helped to recognize the poor and good elements of these practices in relation to strain or symptom provocation in the learning process. The clinician should be alert to discrepancies between what patients believe is supposed to be a good posture, good exercise, good pillow or sleeping position and what in reality might be more benefi cial for their condition. Patients must gain a good understanding of the consequences of repeated adverse and unnecessary strain on neck structures for current and long-term prognoses.

They must understand their role and responsibilities in training new work or lifestyle habits in the management of their condition and prevention of any future recurrence. Several physical features have been associated with the report of neck, neck and arm pain, or cervicogenic headache with computer use both at work and at home, for example, the tendency for those with neck pain to drift into a more forward head posture with computer work.94â€"96 Hence patients should be taught to position themselves well in the chair to limit this occurrence but at regular intervals actively to assume an upright neutral spinal posture which they initiate from the pelvis (Chapter 14).

They should aim to hold this position for at least 10â€"15 seconds either while continuing to work or in a mini-pause break. This change in position not only relieves structures from static strain but will also activate the deep fl exor supporting musculature of the cervical curve.97 The postural correction exercise should be performed approximately every 15 minutes, as it is known that it only takes a few minutes of work for the posture to begin to slump.94

We find repetitive practice throughout the day is better tolerated by patients rather than asking them to try to hold a neutral posture permanently, which results in fatigue and quick abandonment of the exercise. With repetitive practice, patients usually develop a new sense of a better working posture as well as developing postural holding endurance.

Improvement of the control of head postural position also occurs as the activation capacity and tonic endurance capacity of deep neck fl exors are trained with more formal therapeutic exercise.94 Patients need reminders to assume the neutral upright postural position in the initial stages of training. The cue could be in the form of an alarm preset into the computer or watch, or the correction exercise could be performed in conjunction with a repetitive activity in the day, for example, answering the telephone. A fl exed or forward-head working posture is not restricted to computer workers, but occurs with many occupations.

The principles of repeatedly relieving static strain and activating postural supporting muscles are applied in a way relevant to the patient's occupation or activity. This is an important principle as it has been shown that force variations (that is, variability in task performance) result in less muscle fatigue and redistribution of muscle activity compared to a static task/contraction.98

It is also known that computer or desk workers with neck pain exhibit altered activation of the superfi cial neck extensor, fl exor and upper trapezius muscles.99, 100 An altered motor pattern between the deep and superfi cial cervical fl exors has been demonstrated in the craniocervical fl exion test101 and formal training of the deep neck fl exors results in a desired reduction in activity of the superfi cial fl exors.11 However this reduction in activity does not appear to translate automatically to functional tasks in sitting.102

This would reinforce the need for task-specifi c training of the deep cervical muscles. It is possible that this could be achieved with repeated activation of deep neck fl exors in the frequent correction to the upright neutral spinal postural position during the working day. However it is yet to be shown if this postural correction exercise decreases the activity of the superfi cial fl exors during functional tasks such as typing.

Pain in the regions of the upper trapezius and insertion of the levator scapulae is commonly reported in association with offi ce work and other process workers. Szeto et al.96 showed that there was a subtle change in scapular position to a more protracted position during computer work in those with neck pain. There has been extensive study of the myoelectric activity of upper trapezius in association with offi ce work and computer use. For example, it has been shown that the upper trapezius exhibits a decreased ability to relax, reduced muscle rest periods during repetitive tasks, and is susceptible to increased activity during tasks involving mental demand (Chapter 4).

There are several therapeutic strategies that can be employed in an effort to address the problem in scapular control and upper trapezius function. Scapular muscles and postural positioning of the scapulae need to be trained for functional demands. Exercise also includes specifi c task-based training so that patients can maintain postures and function with muscle patterns comparable to their asymptomatic counterparts (Chapter 14). The task-specifi c training is incorporated in the workplace. For example, the patient is taught to activate scapular muscles and correct scapular posture in association with the repeated corrections to the upright neutral spinal postural position during the working day.
This positioning often leads to a palpable reduction in tenderness and relaxation of the levator scapulae and/or upper trapezius. There are many other workplace variables, both physical and psychosocial, which may contribute to the development of neck pain in the workplace.

The clinician must work with patients to identify these and help them to modify how they may perform functional tasks to avoid unnecessary strain or aggravation of their neck or cervicobrachial pain. This also applies to recreational and household activities. Much of the advice is seemingly common sense, but strategies might not have occurred to patients and should be reinforced.

Such strategies can assist patients to continue their normal activities with simple adaptations. For instance, they should be advised to choose a center seat at theaters or at dinner parties to avoid prolonged sustained rotation positions and taught good lifting and carrying practices, including limiting the weight carried. This applies to the weight of shopping bags, handbags, briefcases, or hand luggage. Household activities such as cleaning tasks or gardening can be spread out over days or tasks rotated frequently between lighter and heavier ones. Patients' individual circumstances need to be understood and identifi ed to assist them to develop strategies that allow them to maintain their functional activities without unnecessarily adversely straining their necks.

Whiplash, Headache, and Neck Pain,
Gwendolen Jull, Michele Sterling, Deborah Falla, Julia Treleaven, and Shaun O'L
Elsevier 2008

Laksmi Purwitosari

[Non-text portions of this message have been removed]

8.1.

Re: Talkshow Milis Sehat di SocMedFest

Posted by: "kristierenst@yahoo.com" kristierenst@yahoo.com   kristierenst

Sat Sep 24, 2011 12:55 am (PDT)



Huaaaa....sedih bgt kemarin sore gak bisa dtg lagi ke FX,padahal paginya sempat mampir ke booth YOP n ketemu mba sisil n mba ade yg lagi jaga booth.
*hai mba sisil n mba ade,aku yg dtg pake batik wktu lantai F5 lampunya masih mati hihihi*sorry sorenya gak bisa dtg,soalnya masih diare n kepala pusiiinnggg bgt,janjian sAma mba ela utk ketemuan di FX juga gatot deh.
Padahal maksain ngantor kemarin,karena mau ke FX sore nya.
Mudah2an akan ada acara talk show lagi yaaaaa.....

Regards,
Kristi
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9a.

KELAS PERSIAPAN KELAHIRAN & MENYUSUI BANDUNG 29-30 Oktober 2011

Posted by: "klasibdg@yahoo.com" klasibdg@yahoo.com   klasibdg

Sat Sep 24, 2011 1:25 am (PDT)



Dear Smart Parents,

Sadarkah kita bahwa ASI, TataLaksana Kehamilan & Kelahiran dan juga Penangananan Bayi Baru Lahir ternyata sangat berkaitan? Alangkah baiknya jika kesadaran itu kita munculkan sekarang, sebelum tugas sebagai orangtua kita jalani.

Yuk, maksimalkan setiap usaha dalam memberikan yang terbaik dan juga benar sesuai tata laksana kepada buah hati kita.

Klub Peduli ASI YOP hadir untuk memfasilitasi orangtua menjalani salah satu perannya dengan menyediakan informasi seputar persiapan kelahiran dan menyusui serta media support group orangtua peduli ASI.

KELAS PERSIAPAN KELAHIRAN & MENYUSUI BANDUNG

Pelaksanaan :Hari : Sabtu , 29 Okt  dan Minggu, 30 Okt 2011
Waktu : Pukul 09:00 â€" 14:00 WIB
Tempat : CAFE ASIX.
Jl. Telaga Bodas 25 Bandung. Jawa
Barat.
Tel : (022) 731 2460
Materi di dalam Kelas Persiapan Kelahiran & Menyusui ini adalah semua hal yang penting diketahui setiap orangtua/calon orangtua, atau siapapun yang berhubungan erat dengan pengasuhan anak. 

Kelas ini dibagi menjadi 2 Sesi.
Sesi I: ASI dan Seputar Kehamilan (29 Okt 2011)
- Inisiasi Menyusu Dini (IMD)
- Keuntungan ASI
- Posisi Menyusui (latch-on)
- Prinsip dasar
- Persiapan menjelang kelahiran
- Hamil ≠ sakit, suplemen, makanan, mitos-mitos
- Indikasi caesar
- Perawatanbayi baru lahir
- Kegawatdaruratan pada kehamilan 

Sesi II: Masalah-masalah Menyusui dan Pasca Kehamilan (30 Okt 2011)
- Memerah ASI
- ASI Perah dan Penyimpanannya
- Mastitis, Inverted Nipple , Cracked Nipple
- Nursing Strike
- Self Weaning
- Hal-hal penting dalam check-up bayi sampai dengan 6 bulan.
- Kecukupan ASI dari segi nutrisi, terutama ASI perah
- Mengenali dan mencegah gagal tumbuh pada neonatus
- Jaundice
- Cara memantau pertumbuhan dengan kurva pertumbuhan
- Cara memantau perkembangan dan milestones
- Prinsip Rational Use of Medicines (RUM) 

Materi akan disampaikan oleh dokter dan TIM ASI YOP disertai dengan praktek, pemutaran video dan diskusi grup.

Melalui kelas ASI ini diharapkan peserta akan memperoleh pengetahuan yang komprehensif mengenai persiapan kelahiran dan menyusui sekaligus mendapatkan kelompok support yang bisa saling mendukung dan berbagi.

Biaya Rp 130.000,- per orang, atau Rp. 230.000 untuk pasangan. Biaya ini sudah termasuk handout materi, CDmateri, snack dan makan siang. Bagi yang berminat menjadi peserta, silakan mengisi dan mengirimkan formulir pendaftaran di bawah ini kirim ke
klasibdg@yahoo.com dengan Subject: “Kelas Persiapan Kelahiran & Menyusui”.

Untuk informasi lebih lanjut dapat hubungi : Monika . Tlp : 081320678893

http://klasibandung.com/kelas-persiapan-kelahiran-dan-menyusui-29-30-oktober-2011

Tempat Terbatas!
Salam SEHAT, Tim KLASI YOP (Bandung) Proudly Supports Breastfeeding

FORMULIR PENDAFTARAN KELAS PERSIAPAN KELAHIRAN &MENYUSUI 29-30 Oktober 2011

Nama Lengkap 1 :_____ (diisi oleh peserta perorangan)

Nama Lengkap 2 :_____ (diisi apabila mengajak pasangan)

Alamat :_____

Telepon/HP :_____

Email aktif :_____ (untuk mengingatkan peserta)

Jumlah anak:_____

Usia anak:_____ bulan/tahun

Due Date (tanggal perkiraan kelahiran): ____ (jika sedang hamil)

Ibu bekerja di luar rumah:_____ (ya/tidak)

Apakah sudah pernah mengetahui ilmu tentang laktasi / menyusui?_____ (ya/tidak)

Jika ya, dari mana sumbernya?_____ (buku/milis/tenaga kesehatan/lainnya …)

Apakah sudah pernah menyusui?_____ (ya/tidak)

Jika ya, apakah berhasil melakukan ASI eksklusif?_____

Permasalahan yang sedang atau pernah dihadapi dalam proses menyusui:_____

Apa yang diharapkan dari kelas Persiapan Kelahiran dan Menyusui yang akan

diikuti?_____

Salam SEHAT,

Tim KLASI YOP (Bandung) Proudly Supports Breastfeeding

http://klasibdg.multiply.com/

klasibdg@yahoo.com

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10.

Rubella?

Posted by: "Ida Rifai" riffatriffan@gmail.com   farida_indriyani

Sat Sep 24, 2011 1:43 am (PDT)



Dear Bunda, docs dan sps..

Mohon masukannya atas kondisi saya sekarang.
Udah seminggu ini saya demam on off, hilang nafsu makan, sakit kepala, nyeri sendi (kaki dan pinggang), tdk bisa jalan lama / berdiri lama. Di hari ke 4 saya ternyata keluar ruam ruam di tangan dan kaki, dan hari ini (hari ke 7) menyebar ke perut, yg kalo saya cocokkan ruamnya mirip rubella. Dan dengan gejala2 diatas jg meyakinkan saya kalo kena rubella.

Treatment yg saya lakukan perbanyak minum, minum, minum..
Saat ini sakit kepala sudah berkurang hanya nyeri sendi yang bikin saya suffer banget :(

Oh ya dulu saya pernah tes torch th 2005 dan saya mempunyai kekebalan thdp rubella (igg positif). Nah apakah mungkin saya bisa terinfeksi lagi?

Apa benarr saya kena rubella?
Ada kemungkinan lainkah selain rubella?

Mohon masukannya yah..

Terima kasih
Ida

Ida
Mama 2R

11a.

Pil Yasmin untuk Ibu Menyusui.

Posted by: "arumski@yahoo.com" arumski@yahoo.com   arumski

Sat Sep 24, 2011 2:38 am (PDT)



Dear all...

Maaf kalau sudah pernah di bahas sebelumnya...
Saya ibu dari Abiyy (1th 4bln) alhamdulillah masih asi. Kmrn saya berencana ikut KB dan minta yg melalui oral,obgyn memberikan pil Yasmin drospirenone+ethinylestradiol. Yang ingin saya tanya, apakah pengaruh obat tersebut nantinya ke anak saya? Mengingat abiyy masih asi, walau hanya malam hari.

Terimakasih
Arum
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11b.

Re: Pil Yasmin untuk Ibu Menyusui.

Posted by: "yani.febriyanti@yahoo.com" yani.febriyanti@yahoo.com   yani.febriyanti

Sat Sep 24, 2011 3:02 am (PDT)



Mom,

kalau saya dulu minum yasmin malah memberhetikan produksi asi, kalo ga salah yg buat busui itu pil kb cerazette deh..

Maaf krg membantu

Yani
Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!
12.

DSA RUM di RS PGI Cikini

Posted by: "Galuh Ayu Widasari" galuh_aw@yahoo.com   galuh_aw

Sat Sep 24, 2011 3:12 am (PDT)



Dear SPers & Docs,

Mohon bantuannya info DSA yg RUM di RS PGI Cikini. Makasih sebelumnya..

- ayu widasari -
dikirim pake hape mamanya arek Dhika

[Non-text portions of this message have been removed]

13.

KB susuk

Posted by: "lulu_wewet@yahoo.com" lulu_wewet@yahoo.com   lulu_wewet

Sat Sep 24, 2011 3:32 am (PDT)



Dear sp's and Doc's
Saya mau tanya mengenai alat kontrasepsi susuk. Kira2 apa kekurangan dan kelebihannya. Jujur saya masih takut kalau pakai spiral sedangkan suntik dan p tidak disarankan karena saya pernah ada miom.
Mungkin ada yg pernah pengalaman pakai dan bisa share ke saya

Mohon informasinya ya

Thank u

Lulu
Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!
14a.

Re: gatal di ketiak

Posted by: "septysophia@yahoo.co.id" septysophia@yahoo.co.id   septysophia

Sat Sep 24, 2011 4:00 am (PDT)



Mb ira, mb risma, makasih sekali responnya. Saya akan coba browsing mlm ini. Clekit2nya bnr2 mengganggu.
*huhu mana lg kena macet pol disawangan

Regards
Lia
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