Sunday, September 30, 2012

MASTERING THE FIVE "S's' - Sooth a crying baby -

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MASTERING THE FIVE "S's'
According to Karp, all babies are born with a calming reflex. Turning it on is the tricky part. But it can be done. He suggests before your baby is born (or quickly after), you become a pro of the "5 S's" -- swaddling, side or stomach position, shushing, swinging and sucking.
Try these one at a time, in order. In difficult cases, all five steps done at the same time are necessary. This is called the "cuddle cure."
Using these techniques will even help your baby sleep longer, Karp said, up to five hours straight.
- Swaddling. If a baby is wrapped tightly with his arms at his sides in a warm blanket, it creates the womb feeling, and it keeps his hands from flailing. In most cases, all it takes to stop a baby from crying is to swaddle him. But you have to have a larger blanket to do this. (See the information box for instructions on how to swaddle a baby.)
Babies will sometimes cry harder at first when you swaddle them, then they'll calm down, Karp said.
Swaddling your babies and placing them on their backs for bedtime greatly reduces the risk for Sudden Infant Death Syndrome. They're not able to turn over if they're lying on their back with their arms tucked inside the blanket, explained Jennice Razza, a child birth educator who is certified to teach Karp's calming reflex to expecting parents at Pomona Valley Hospital Medical Center. That hospital is the first in the nation to offer a class section on Karp's methods.
- Side or stomach position. The back is the last place a baby wants to be when he's crying. If you cradle him in your arm with his stomach down and his head on its side in your hand, he feels like he's safe once again -- nice and tucked away like he was in his previous "home."
- Shushing. The womb is as noisy as a vacuum cleaner because of blood flowing to the placenta. You don't have to tip-toe around your newborn.
"Silence is deafening to a newborn," Razza told her class recently at the PVHMC session.
Once you've swaddled your baby and you have him positioned on his stomach or side, bend in close to his ear and make a "Shhhhhhh" sound -- as loud as he is crying. This will trigger the calming reflex. It might feel awkward and wrong to shush in a baby's ear. You might think you're hurting your baby's eardrums, but you're not, Razza said.
Babies are accustomed to the noise level of a vacuum cleaner. Remember? As the baby quiets down, bring the volume of your shushing down. Razza suggested parents run a white noise machine, a static radio station, the dishwasher, a fan or the clothes dryer while your baby is sleeping. These are soothing sounds to an infant.
- Swinging. If you've tried everything else and your baby is still crying with no signs of letting up, with the baby lying in the side/stomach position, attempt to shimmy or shiver the baby's head in very short, quick repetitions. Some of Karp's patients call this the "Jell-O head" jiggle. This is totally different from shaking a baby so vigorously that the baby suffers injury.
You could try swinging a fussy baby in a mechanical swing at a fast speed. Swings work best when the baby has already been calmed, Karp said. Car rides and rocking chairs help, too.
- Sucking. Some babies suck on their thumbs in the womb. So, when you give them something to suck on -- a finger, breast or pacifier, it turns on the calming reflex.




Sunday, March 06, 2005 - EVERYTHING stops the instant a newborn starts crying. Parents rush to figure out what's wrong. They change the diaper, feed and burp her. But the infant's cries crescendo -- inevitably grating on mom and dad's nerves. Frustration sets in. Parents begin to think if they can't even calm their baby's cries, what good are they?
What if there were a way to hush a crying infant in seconds? What if parents could turn their baby's nerve-wracking wailing into happy and relaxed gurgling and elevate themselves to confident, successful parents?
Dr. Harvey Karp, a long-time pediatritian and an assistant professor at the UCLA School of Medicine, says he has the answers. There's no magic or miracle involved. According to Karp, babies have a built-in calming reflex and parents just need to learn how to turn it on.
"It's not so obvious. If it were, we'd all be doing it," Karp said. "It just takes a little guidance to learn how to do it."
Prompted by a desire to stop abuse and shaken baby syndrome (a term used to describe the violent shaking of a baby -- usually because the infant won't stop crying -- to the point of injury, brain damage, hearing loss, paralysis or even death), Karp began researching how other cultures handle newborns. He found that babies in African and some Asian cultures don't cry much at all.
"I read about this culture in Africa where 90 percent of babies could be calmed in less than 30 seconds," Karp explained. "So, it was instantly clear that either these babies were mutant little babies, or else their parents knew something that we'd forgotten in our culture."
HOME SWEET HOME
Karp says parents first have to understand life from a crying newborn's perspective. The baby has been evicted from a snug, comfortably noisy and soothing home (mom's womb) to a harsh environment of cribs, silence and diminished human contact.
"Even if you hold your baby 18 hours a day, which seems like A LOT from our point of view -- from their point of view, it's a rip-off because they're used to 24 hours a day (in the womb)," said Karp, who's been featured on a number of talk shows including "The Dr. Phil Show" and "The View."
According to this author of "The Happiest Baby on the Block" (Bantam $13.95), the first three months of a newborn's life are the "missing fourth trimester." Babies need to be held often during that time. Studies show that this will help babies develop independence and strong self-esteem because their needs were met by their parents.
"You can't spoil newborns by holding them too much," Karp said.
During the "fourth trimester," some babies have extreme difficulty adjusting to their new environment, and they cry often. Karp says some babies cry at least three hours a day. Colicky babies cry for hours and hours on end, wailing like they are in pain.
What is colic? Ask health professionals and parents and they can't really explain it. The dictionary describes it as abdominal pain. Gas? Maybe. Tummy discomfort? Possibly.
Karp says in most cases, colic is simply homesickness -- a longing to be back in the womb. If a baby were truly colic, then why would he immediately fall to sleep when you take him for a ride in the car? If a baby were indeed colicky, then why would holding and rocking her, calm her? Abdominal discomfort, gas or otherwise, doesn't go away because babies are in a car or being rocked in mom's or dad's arms.
MASTERING THE FIVE "S's'
According to Karp, all babies are born with a calming reflex. Turning it on is the tricky part. But it can be done. He suggests before your baby is born (or quickly after), you become a pro of the "5 S's" -- swaddling, side or stomach position, shushing, swinging and sucking.
Try these one at a time, in order. In difficult cases, all five steps done at the same time are necessary. This is called the "cuddle cure."
Using these techniques will even help your baby sleep longer, Karp said, up to five hours straight.
- Swaddling. If a baby is wrapped tightly with his arms at his sides in a warm blanket, it creates the womb feeling, and it keeps his hands from flailing. In most cases, all it takes to stop a baby from crying is to swaddle him. But you have to have a larger blanket to do this. (See the information box for instructions on how to swaddle a baby.)
Babies will sometimes cry harder at first when you swaddle them, then they'll calm down, Karp said.
Swaddling your babies and placing them on their backs for bedtime greatly reduces the risk for Sudden Infant Death Syndrome. They're not able to turn over if they're lying on their back with their arms tucked inside the blanket, explained Jennice Razza, a child birth educator who is certified to teach Karp's calming reflex to expecting parents at Pomona Valley Hospital Medical Center. That hospital is the first in the nation to offer a class section on Karp's methods.
- Side or stomach position. The back is the last place a baby wants to be when he's crying. If you cradle him in your arm with his stomach down and his head on its side in your hand, he feels like he's safe once again -- nice and tucked away like he was in his previous "home."
- Shushing. The womb is as noisy as a vacuum cleaner because of blood flowing to the placenta. You don't have to tip-toe around your newborn.
"Silence is deafening to a newborn," Razza told her class recently at the PVHMC session.
Once you've swaddled your baby and you have him positioned on his stomach or side, bend in close to his ear and make a "Shhhhhhh" sound -- as loud as he is crying. This will trigger the calming reflex. It might feel awkward and wrong to shush in a baby's ear. You might think you're hurting your baby's eardrums, but you're not, Razza said.
Babies are accustomed to the noise level of a vacuum cleaner. Remember? As the baby quiets down, bring the volume of your shushing down. Razza suggested parents run a white noise machine, a static radio station, the dishwasher, a fan or the clothes dryer while your baby is sleeping. These are soothing sounds to an infant.
- Swinging. If you've tried everything else and your baby is still crying with no signs of letting up, with the baby lying in the side/stomach position, attempt to shimmy or shiver the baby's head in very short, quick repetitions. Some of Karp's patients call this the "Jell-O head" jiggle. This is totally different from shaking a baby so vigorously that the baby suffers injury.
You could try swinging a fussy baby in a mechanical swing at a fast speed. Swings work best when the baby has already been calmed, Karp said. Car rides and rocking chairs help, too.
- Sucking. Some babies suck on their thumbs in the womb. So, when you give them something to suck on -- a finger, breast or pacifier, it turns on the calming reflex.
PRACTICE MAKES PERFECT
These methods take practice and they each have to be done correctly, or else a baby's calming reflex won't be turned on and he will keep crying, Karp said.
"With refelexes, you've got to do it exactly right, otherwise it doesn't work," Karp said. "If I hit your knee, but I'm off by an inch, nothing happens. If I hit it in the right place, I can get your knee reflex a thousand times in a row. Same thing with the calming reflex."
But, in some cases, a baby will continue to cry even if you've done everything right. In this situation, you should rule out illness or other medical conditions. Consult your physician for help.
Once you've mastered the quintet of S's, you might look forward to your baby crying because you'll be able to calm him so easily.
"It's kinda like riding a bike. It's going to be weird in the beginning, but once you get the hang of it, you feel like you've been doing it your whole life," Karp said.
FIND OUT MORE
Dr. Harvey Karp, a Los Angeles-based pediatrician, explains in detail his methodology for calming a crying baby in his book, "The Happiest Baby on the Block," (Bantam $13). Visit www.thehappiestbaby.com to purchase the book, DVD or VHS.
To get the word out faster, Karp began certifying individuals to teach new parents -- or anyone who wants to learn -- how to effectively execute his methodology. His goal is to help improve infant/parent bonding and reduce the occurrence of shaken baby syndrome, which often happens when parents don't know how to stop their babies from crying and instead get so frustrated and angry that they violently shake their babies to the point of causing physical harm.
In January, Pomona Valley Hospital Medical Center became the first hospital in the nation to offer a hospital-based class with Karp's Happiest Baby program included. The "Baby Express" parenting classes covers four areas where parents often need information: car seat safety, breast-feeding basics, baby basics and the Happiest Baby method.
"Because of changes in our society and family life over the past couple of generations, parents are not often taught valuable baby skills that have proven effective in many other societies found around the world," said Sherry Turney-Mayeaux, education coordinator at PVHMC and director of education for The Happiest Baby, Inc. "Babies don't go home with manuals. Our class is designed to help parents learn the skills they need to be successful parents."
PVHMC's Baby Express class, including The Happiest Baby portion, is offered as either a Saturday class or two weeknight classes. The class is open to everyone in the community and is $40 per couple, which includes the VHS or DVD version of "The Happiest Baby on the Block" video and a "Soothing Sounds" CD.
For more information or a class schedule, call the hospital's Family Resource and Education Center at (909) 620-6663.
* Wendy Rizzo, a certified childbirth educator in Upland, teaches a private class for anyone who's willing to learn how to calm and soothe a crying baby. It's a hands-on, three-hour class so parents can learn all about Karp's methods.
The class is $40 per couple, which includes the parent kit and the white noise CD. Class times depend on demand. Call (909) 981-8837 for more information.
* Julianne Langlois, a mom with a background in teaching who used Karp's program with great success when she had her first babies (twins) 17 months ago, is also certified to teach Karp's methods. Her class is about three hours long and will be taught at different locations in the Inland Empire. She charges $30 per couple, which includes the "Happiest Baby On the Block" DVD (or VHS) and white noise CD. Please contact her at (951) 817-2533.
-- La Rue Novick
HOW TO SWADDLE YOUR BABY
Dr. Harvey Karp teaches what he dubbed the DUDU (down, up, down, up) method of swaddling. It's better to watch his DVD or take a certified class, but to describe it simply, you have to first place a large, square blanket on your bed and position it like a diamond. Next, fold down the top corner a third of the way down to meet the center of the blanket. Lay your baby down so his head is just above the folded blanket line. Keep his arms at his sides.
Bring the right side of the blanket (D)own across the baby's body and tuck snugly under the baby's lower back. This part must be done well, or the wrap will unravel. Your baby's arm should be held so securely against his side that he can't bend his arm up, even if you let go of the blanket.
Straighten your baby's left arm against his body. Bring the bottom corner (or tail) (U)p across his body to cover that arm and then tuck the fabric tightly under his left arm and shoulder.
Then hold the remaining material in your right hand and bring the fold (D)own to the baby's midchest. Then hold it with your left hand.
Grab the remaining tail and wrap it tightly across the baby's waist and around him like a belt. Bring the rest (U)p to tuck it in at the top, near the baby's chest or shoulder.
If you can slip your hand inside the bound blanket and your hand fits snugly between the blanket and your baby's chest, then it's OK. You don't want it make it too tight, or too loose or else it won't work.
La Rue Novick may be reached by phone at (909) 483-9328.





If your Venus is in Aquarius

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If your Venus is in Aquarius:

When your Venus is in Aquarius, you don't want to follow all the "rules" in love, preferring to love in your own way, unfettered by convention or what is "supposed" to  be, or usually, done. You are future-minded, a tad unconventional (in love, anyhow) and there's an unmistakable "free spirit" in you that shows up most obviously in matters of the heart. This is not to say you cannot—or will not—fall in love. Infatuations happen easily, but true love can be a little elusive for you. When you do make a commitment, you are generally able to stick to it. The commitment you make generally has to be a little different in order to be tolerable to you, and you are proud of that difference. Following the beaten track simply doesn't sit well with you. You have an aloof air about you that others find attractive. If they are looking for a commitment from you at a later date, however, what was once considered charismatic might become annoying! It is easy for you to feel claustrophobic in relationships that are too close, too needy, or too demanding of your time. If you have the space to breathe a little, all the better. This is when you are at your best.You are a curious person and enjoy intellectual stimulation in your relationships. Although you are not someone who would be considered flighty, you do not tolerate stagnation very well. You need to feel like your relationship is heading somewhere. Your ability to detach yourself from a situation, take a step back, and look at it from a unique perspective is a tremendous strength. As willing as you are to stir things up if you are in the mood to enforce change, there is a wonderful calm surrounding you that can be most appealing to others. You are ahead of your time in matters of the heart, and you will be best off finding a partner who values your insight.(See Venus in Aquarius for more details on the Venus in Aquarius temperament). How You Relate to a Partner with Venus in Aries: In most cases, this combination inspires mutual respect and appreciation. Both of you are generally positive in matters of the heart, so optimism is likely the general theme when you are together. You are somewhat unpredictable when it comes to expressions of love, and your partner is more likely to appreciate this "quirkiness" than most Venusian signs, simply because he or she enjoys challenges and the feeling that a relationship is "alive". Furthermore, your unconventionality can be quite attractive to your Venus in Aries partner. While others might complain that you are a little too aloof, your lover is more apt to see that trait as a challenge—and rise to it! The only difficulty with all of this is that your partner's desires in love are quite variable, and when they're turned on, he or she wants love and wants it right now. If you happen to be off on a tangent, seemingly in another world, your partner can quickly become impatient. However, both of you will give the other enough space to breathe, probably because you each need some independence. With your Venus signs in a sextile with one another, you are likely to appreciate and respect each other, off-moods aside. How You Relate to a Partner with Venus in Taurus:  Both of you are strong individuals with rather fervent ideas of what you want in a partnership, and those ideas clash in many ways! Your partner is more traditional than you are in his or her view of partnerships. Your lover values constancy and dependability in his or her relationships. On the other hand, you resist doing things that are tried and true, preferring to forge out a new path rather than traveling along the " beaten track". Your partner wants his or her love life to be uncomplicated, sensual, and comfortable. You know how to stick with things, as does your partner, and you aren't especially attracted to complications as well. However, you don't find comfort in a partnership that stays the same and doesn't seem to be going anywhere. Your partner, on the other hand, seems to be quite content as long as his or her basic needs are met, and sometimes can even seem complacent. Ideally, the two of you will find a common ground, although it is difficult to predict who is going to budge, as you both can be somewhat stubborn! The only option is to try to learn from each other. Your quirkiness can be fun and even electric. Your lover can remind you how wonderful simple pleasures can be. With effort, your partnership can certainly work.How You Relate to a Partner with Venus in Gemini: This combination is definitely one of the easier pairings. Certainly, you stimulate each other, enjoy being together, and find plenty of common interests. Both of you love to talk, finding a partnership that is growth-oriented and mentally stimulating a plus. You, more than most people, understand your lover's tendency to be a bit inconstant. Others might call it flightiness, but you appreciate his or her changeability, seeing it as really quite natural. However, you are more stubborn than your partner. Your partner's moods change quickly, and while you can hardly be labeled predictable, you are not as flexible as your partner is. This can cause a few problems, although if love is strong between you, your partner is most inclined to be the one to make adjustments when needed. Each of you understands that partners need a little space to grow on their own, and the minimal amount of possessiveness and jealousy in your partnership will be appreciated on both sides. Liveliness, cheerfulness, and plenty of activity characterize your partnership. This is a creative combination, and while your lover works on keeping things fresh, you will help steady your partner. Mutual admiration is a rare quality, and it is more than likely that you have it.How You Relate to a Partner with Venus in Cancer: This combination can be a challenging one, simply because your styles and needs in love tend to be at odds with one another. Your partner craves a relationship that is very personal and committed, while you are more inclined to look for a classic friendship in any love relationship! The powerful initial attraction you may feel to each other is likely due to the fascination with the differences between you. There's a bit of quirkiness in you both, although yours is a direct and offbeat sort of charm, while your partner's charm is softer and more intimate. Your partner might find your behavior unsettling at times, simply because he or she is looking for a certain measure of security in partnership. You are a freedom-lover, and your love may seem universal and impersonal—the style doesn't hold the kind of intimacy and attachment that your partner craves. Your partner's tendency to wrap himself or herself around a partner is soothing and nurturing for some, and is probably attractive and fascinating to you, but can cause a problem if you begin to interpret it as stifling or restricting. Each of you can learn a lot from each other, as long as you are tolerant of each other's needs. Love can make it work, although plenty of adjustments are necessary to keep this union moving in healthy directions. How You Relate to a Partner with Venus in Leo: This is the case of "opposites attract". Because Leo and Aquarius are opposite signs of the zodiac, you can be intrigued with one another, and really quite frustrated as well! In astrology, opposite signs can actually be easier to deal with than side-by-side signs because they work under a similar overall vibration. You, with your Venus in Aquarius, are most concerned with the greater group process, while Leo places great emphasis on personal and creative expression of the self. You express your feelings of love in a detached manner, and this can certainly frustrate your partner. Your partner has a fight or flight reaction—either he or she sees this as a challenge or runs in the opposite direction! You are largely objective, while your partner is subjective. Both of you like to be special and "different", but your partner wants to be special, where "special" means "the best" in a lover's eyes. You want to be valued for your uniqueness in terms of the group. Your partner is personal, involved, and intense in his or her romantic dealings; you are more impersonal and rather detached, able to see the bigger picture. So why, pray tell, do people say opposites attract? Because opposite signs fascinate each other. Each of you expresses a different loving style that holds some answers to what you may be overdoing in your own life. The promise of balance is there, somewhere, and both you and your partner may sense this "shadow" personality in the other.  How You Relate to a Partner with Venus in Virgo: You get off on visions, possibilities, and opportunities. Your partner, on the other hand, is most concerned with making a relationship work. Mentally, you and your partner might have much to share. Both of you enjoy having meaningful conversations with the people you love. What you prefer to talk about may not be compatible, however! Your partner believes his or her needs are simple, and in many ways they are, although you might consider these needs unnecessarily complicated. Your lover responds best to practical displays of affection, and because his or her Venus is in an Earth sign, your partner most values your physical presence and attention. A partner who is always running off to see friends, for example, could make your lover feel somewhat insecure and decidedly unloved. You value exactly that freedom, so this is an area in your relationship that you both will need to work on. Your partner's need for appreciation is paramount. Otherwise, your lover is prone to feeling like he or she has done something wrong. You reveal your love in different ways, and the independence you need, if misunderstood, can lead to a fair share of worrying on your lover's part. Make sure your partner knows that if he or she feels comfortable enough to loosen up and be himself or herself, you will appreciate him or her all the more. Misunderstanding of each other's unique and different love natures is what is most likely to divide you. This relationship can be a little more challenging than some, but compassion and understanding can most certainly make it work.How You Relate to a Partner with Venus in Libra: Each of you places a high value on sharing ideas with your partner, which can be a major source of common ground in your relationship. Communication will be flowing between the two of you! There may be some issues surrounding the definition of your relationship. Whereas your partner values partnerships more than anything, you are more inclined to place the highest value on the friendship first, before the partnership. Both of you are cooperative souls in relationships, and this fact adds tremendous strength to the opportunity for a flowing and respectful relationship. You can sometimes frustrate love interests with an air of indifference, but your partner is more apt to understand this quality and appreciate it than others. You value peace and not only believe in equality, you treat people with equality in practice. This is something that is especially appealing to your partner. Both of you are reasonable people, and this can be a very reasonable union as a result. Conflicts, of course, will occur, but your ability to reason things through (and your partner's responsiveness in this department) can help smooth over rough edges. 
How You Relate to a Partner with Venus in Scorpio: This is one of the more challenging combinations! With love, of course, it can work, but acceptance and understanding are especially vital. You are likely to be intrigued with your partner's love nature. It's intense and personal, and very passionate. While you are able to take a step back from many emotional issues in your partnership, if only to gain perspective and understanding, your partner has the hardest time doing just that. This can be complementary at times, but can also be intensely frustrating. It may not be very easy for your partner to "get" why you are capable of detaching yourself, and he or she may find it threatening to the basic love bond between you. You may be quite baffled by your partner's passionate reactions to you, as you tend to feel that getting too emotionally tangled up in problems is counterproductive. You value objectivity and pride yourself on your ability to reason things through. You may be inclined to react to your partner's more emotionally intense moments by giving him or her space. This is likely to frustrate your partner more, as he or she interprets your "stepping aside" as walking away—or, even worse, lack of concern for your relationship. This relationship can be rather tempestuous at times, but exciting nevertheless. At the very least, you will admire each other's strength of character.
How You Relate to a Partner with Venus in Sagittarius: Both of you value freedom, growth, and independence in love relationships. As a result, you are unlikely to be a "joined-at-the-hip" type of couple. Each of you appreciates the need for individuality, and neither of you believes that a partnership should act to stifle this basic need. Your partner's approach to love, however, may be a little more impulsive and emotional than yours, as you tend to be much more calm and less excitable. When your partner gets excited about something, forging ahead with gusto, your collected demeanor may feel a bit like rain on his or her parade. If your partner remembers and accepts that he or she tends to be more expressive than you, and that his or her reactions to most things are immediate and emotionally-charged, things will run more smoothly between the two of you. You are more apt to analyze a situation before letting yourself feel the energy of the moment. If you can get beyond this minor incompatibility, and treat it as an opportunity to grow, your partnership has much potential to work well. Both of you are moving forward, disinclined to stifle one another or fall into the ruts that many couples do, and this basic compatibility will most likely lay the ground for a solid yet exciting relationship foundation.
How You Relate to a Partner with Venus in Capricorn: This is a somewhat odd combination, as your Venus sign position is in a next-door-neighbor sign to your partner's Venus. In astrology, next-door-neighbor signs generally have a difficult time finding common ground. However, there can be quite a bit of intrigue between the two of you. Each of you has a certain aloof quality about you when it comes to romance and love. However, your partner's manner hides an earthy sensuality and attachment to the person he or she loves. Your aloofness, on the other hand, isn't hiding much of anything! You are genuinely somewhat detached when it comes to relationships, and commitment is not your primary goal. You enjoy making friends and sharing social activities with your mate, while your partner is usually content to spend more private time with you than spreading themselves around in a social sense. Your partner tends to be more possessive of his or her partner as well. Certainly, you will give your partner plenty of space to be him- or herself, and that is a true gift. However, your partner might be looking for something more substantial. You have a gift of being able to step back from a problem in order to find ways to solve it. Your ability to reason is something most people appreciate, as long as they aren't threatened by that ability to detach yourself. With love and understanding, this partnership can work. It simply might require more adjustments than either of you may desire.
How You Relate to a Partner who also has Venus in Aquarius: No matter how different your personalities are, you share similar ideas and styles when it comes to relationships. Both of you value a partnership in which there is mental and social interaction. You are not impressed with relationships that are overly traditional or restrictive. As such, you are likely to give each other quite a bit of freedom. Whenever two people with the same Venus signs come together, the strengths lie in seeing eye to eye, and weaknesses stem from a lack of balance. In the case of Aquarius, intimacy may be wanting, as both of you are naturally inclined to live partnerships in the world of intellect. In the absence of a partner who works on creating emotional bonding and intimacy, you two may re-define partnership altogether. This could suit both of you just fine. Your union could be markedly free and different, perhaps considered unusual by some from the outside looking in. As both of you can be rather stubborn in love, there can be an imbalance. Even though you are both inclined to give the other freedom of movement and expression, neither of you is especially adaptable in terms of habits and mindsets. Although you are creative individuals, your interactions may eventually lack spunk or seem a little dry. As long as you both work on the intimate side of partnership, you will find that your relationship is progressive and exciting—and decidedly unique!
How You Relate to a Partner with Venus in Pisces: This is an unusual combination. You might find that you both share a universal love of mankind, and that you are both very idealistic people. You love to brainstorm with your partner, and in Venus in Pisces, you have found a completely fascinating brain to "pick". At times, however, your partner might try to back off from the microscope, as he or she is certainly more sensitive and moody than you are when it comes to relationships. He or she will gladly go along with your wonderful visions and ideals, but your partner looks for a connection that runs very deep. Although he or she will happily engage in conversation, and thoroughly enjoys your enthusiasm and your visions, your partner values tender intimacy more than intellectual debate. You might find your partner a tad too sensitive. If you are receptive, your partner is more likely than most to be able to infuse your creative, inventive mind with just enough emotion, inspiration, and imagination to really take you places. You can help your partner tap into his or her own creative wells and do something real with what is pulled out. The two of you can make a very productive pair as long as you can effectively combine the worlds of thought and feelings. Neither of you wants to waste time arguing about petty things, and both of you want to see the best in each other. These attitudes will help smooth your relationship.

Headache? Why not getting enough sleep may be to blame!

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Headache? Why eating too many sandwiches, not getting enough sleep and having a hot shower each day may be to blame!

By CHARLOTTE DOVEY
  • Comments (18)

When you suffer a headache, the temptation is to reach immediately for the painkillers. But trying to pinpoint the cause might help reduce the pain — and even prevent the problem occurring again.Headaches are one of the most frequent reasons for going to the GP or neurological clinics, says Giles Elrington, a neurologist at the Barts and London NHS Trust and trustee of the London Migraine Clinic.‘In all headaches, and that includes migraines, the physiological explanation is the same,’ he says.An anxious personality, ponytails, sex, jogging on a treadmill... All these have been cited as causing headachesAn anxious personality, ponytails, sex, jogging on a treadmill... All these have been cited as causing headaches‘An electrical circuit at the back of the brain — known as the trigemino-cervical neurovascular pathway — fires off incorrectly, generating pain in the head. Think of a fire alarm ringing without the fire.’The good news is that despite the universal fear, a headache is rarely the sign of a brain tumour. ‘Fewer than 1 per cent of people who consult their GP about a headache actually have something seriously wrong with them,’ says Mr Elrington.  

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‘Nevertheless, in all cases, it’s important to see your GP immediately if your headache occurs suddenly and severely, if it is accompanied by a fever, feelings of drowsiness or any neurological deficiency such as memory loss or a weakness on one side. 'You should also see a doctor if you notice a dramatic change from your normal headache pattern.’We all know that too many glasses of wine and stress can lead to headaches. But here, our experts detail the more surprising causes of that thumping pain.

GOING TO THE HAIRDRESSERS

You can get a headache when your head is held over the basinYou can get a headache when your head is held over the basinA surprisingly common cause of head pain is an appointment with the hairdresser or barber. It’s caused by having to hold your head back over the basin when having your hair washed.This extends the neck awkwardly, stimulating one of the nerves that activates the trigemino-cervical neurovascular pathway. Pain can come a day or two afterwards, so the cause is often missed. ‘Other causes of these types of headache include cradling a phone between your shoulder and ear — and sitting on a chair without any lower back support,’ says Michael Gross, a neurologist and clinical director at Clementine Churchill Hospital, Middlesex. 

COUGHING

While a coughing fit is likely to make any head pain worse, there’s actually a recognised headache known as ‘cough headache’. This is triggered by coughing and other types of straining — such as sneezing, blowing your nose or bending over. Around 1 per cent of headaches are caused by coughing, with men more prone. They occur because of the pressure build-up in the brain. The pain is sharp, stabbing or splitting, and typically lasts a few seconds to a few minutes, usually most pronounced at the back of the head. ‘While in most cases the cause is unknown, some clinical research shows that about 10 per cent of cough headaches indicate another disorder, such as Arnold-Chiari malformation,’ says Mr Elrington. ‘Here when you cough, the pressure pushes the brain downwards into the upper spinal canal, causing the headache.’ The headache is usually accompanied by other symptoms such as neck pain, balance problems, vision problems, hearing loss, insomnia and a ringing or buzzing in the ears. 

JOGGING ON THE TREADMILL

The severe pain starts within seconds of exercisingThe severe pain starts within seconds of exercisingIf you ever need an excuse not to go to the gym, it’s this — ‘exertion headache’.‘Any type of physical exertion, such as jogging or pounding a treadmill, causes blood vessels in the head, neck and scalp to swell, producing a build-up in pressure,’ says Mr Gross. The severe pain starts within seconds of exercising and can occur anywhere in the head. These headaches are most common in people susceptible to migraines. Obviously, changing the type of exercise can help — perhaps swimming instead of running — but taking anti-inflammatories half an hour before exercising may be another option, as this can reduce swelling.Although rare, if you do develop a sudden pain in the head when exercising, it’s important to go to the doctor to rule out other conditions, such as a brain tumour or a ruptured aneurysm — a swelling in one of the blood vessels in the brain.

AN ANXIOUS PERSONALITY

People with low self-esteem or anxious types are more likely to suffer from migraine-style headaches, according to a study at the Headache Centre of Turin University in Italy. ‘It’s thought this temperament makes people more vulnerable to stress, which lowers levels of the brain chemical serotonin. Low levels of this are thought to trigger the pain pathway,’ says Mr Elrington.

HAM SANDWICHES

There’s a whole host of food triggers for migraines — but ham is a double-whammy.It contains tyramine as well as preservatives (nitrates or nitrites) which both appear to increase blood flow to the brain — triggering that headache pathway. Ham contains tyramine as well as preservatives (nitrates or nitrites) which both appear to increase blood flow to the brain - triggering that headache pathwayHam contains tyramine as well as preservatives (nitrates or nitrites) which both appear to increase blood flow to the brain - triggering that headache pathwayInterestingly, headaches caused by food additives are usually felt on both sides of the head (in contrast to a classic migraine, which strikes one side at a time.) Tyramine forms from the breakdown of protein as foods age — meaning it’s mostly found in foods that have been preserved (so pickled or smoked, marinated or fermented). Other foods high in tyramine or food additives include cheese, chocolate, processed meats such as salami and certain fruits such as pineapple and bananas.

PONYTAILS

The ‘Croydon facelift’, favoured by Victoria Beckham, among others, can also bring on a banging headache —  usually after a couple of hours.
When the hair is pulled back tight and tied in a ponytail it strains the connective tissue in the scalp, leading to pain. Plaits, tight-fitting hats and Alice bands can have the same effect.
‘Unsurprisingly this is also a common complaint among Sikhs, who often complain of what’s known as a “turban headache”,’ says Mr Gross. 

SEX

It’s a common excuse to avoid making love — but the climax of the act itself can also lead to a headache. ‘What’s known as a coital headache builds just before or during an orgasm,’ says Mr Elrington. Studies at the Clinic of Neurology in Riiskov, Denmark, estimate it could affect 1.3 per cent of the population. These migraines, which affect men more than women, manifest as a tight, cramping dull pain at the back  of the head. It may be related  to a build-up of blood pressure in the brain. ‘Ironically they are more common in those having sex with a casual partner,’ says Mr Gross. ‘Probably because the excitement is greater.’  Rarely, coital headaches can result from bleeding in the brain, known as haemorrhagic stroke. However, along with a headache, you may also experience a change in alertness, sleepiness, a difficulty speaking or swallowing, a loss of balance, numbness on one side of the body and nausea.This is more common in those with high blood pressure or a family history of this kind of stroke. A headache accompanied by the above symptoms requires urgent medical attention.

HOT SHOWERS

That comforting warm shower in the morning may actually bring on a headache for some. It’s thought the change in temperature alters the body’s blood pressure — including that in the head, leading to a sharp, stabbing pain in the forehead that peaks about 30-60 seconds after it has begun.It's thought the change in temperature alters the body's blood pressure - including that in the head, leading to a sharp, stabbing pain in the foreheadIt's thought the change in temperature alters the body's blood pressure - including that in the head, leading to a sharp, stabbing pain in the foreheadThe pain rarely lasts longer than five minutes. ‘Cold extremes — such as swimming in cold water or eating ice-cream — may also trigger the pain,’ says Mr Gross.

THAT SNEAKY CIGARETTE

It may help calm the nerves, but smoking can bring on a headache, say researchers at the University of Salamanca in Spain. In a study, 59 per cent of people felt that smoking precipitated a migraine attack and 71 per cent thought that smoking during an attack made it worse. The nicotine in the cigarette causes blood vessels in the brain to narrow, triggering the pathway and, hence, an attack.

LACK OF SLEEP

Variable amounts of sleep loss has been blamed for causing headachesVariable amounts of sleep loss has been blamed for causing headachesGrumpiness, an inability to function properly and a poor memory are most obviously associated with sleep deprivation. But in a study at the National Hospital for Nervous Diseases in London, variable amounts of sleep loss (one to three hours over one to three nights) was also to blame for causing headaches, lasting from an hour to all day. ‘Lack of sleep causes levels of the brain chemical serotonin — which plays an important role in the body’s sleep cycle — to lower, which brings on the pain,’ says Mr Elrington. A second study at the Headache Centre of Atlanta on more than 1,200 migraine sufferers suggests that those who sleep around six hours a night are also more likely to suffer more severe and more frequent headaches than those who sleep for longer.

WARM WEATHER

It’s something we’ve not had a lot of recently — and for some, that’s a good thing. Studying more than 7,000 patients diagnosed with headaches, researchers at Beth Israel Deaconess Medical Centre in Boston found headache complaints increased along with rises in temperature — be it in the winter or summer months. According to the study, the risk of getting a stabbing headache jumped by an average of 7.5 per cent with every increase of 9 Fahrenheit. It’s thought upswings in temperature may cause blood pressure to dip (impairing the brain’s ability to regulate blood flow), says lead researcher Kenneth Mukumal.  
migraineclinic.org.uk, neurologyclinic.co.uk

How to prevent a Headache

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How to prevent a Headache


5. Get in a Groove, and Stay There

Boring though it may sound, sticking to a routine helps prevent a migraine. That's because changes in your daily schedule, sleeping in late on the weekends, blowing off breakfast, or skipping your daily bike ride, can trigger a migraine, says Dr. Biondi."The brain of a person with a migraine likes to have consistency. When you get off schedule, the brain may respond by triggering a headache. So a person with a migraine should stay on as regimented a program as possible," advises Dr. Biondi.Keep to a regular bedtime schedule, don't skip meals, and try to eat at the same time of day every day. If your blood sugar falls too quickly, it can trigger a migraine.

6. Learn to Take It Easy

Stress is one of the most common migraine triggers, so learning to cope with stress may help reduce the severity and frequency of attacks, says Dr. Mauskop.What seems to work well for many migraine sufferers is biofeedback. Using special equipment that measures muscle tension or body temperature, biofeedback teaches you how to control both muscle contraction and the swelling of blood vessels, two physical reactions that seem to play a major role in headaches of all kinds. Once you've become adept at biofeedback, you can use what you've learned to alleviate or even stop a mild attack.You can go low-tech too. Progressive muscle relaxation can reduce or even stop migraine pain. It's easy to learn and requires practice but no training. Find a quiet room where you can lie down on a flat, comfortable surface. Take a few deep breaths. Now, slowly tighten, then relax, the different muscle groups of the body in succession from head to toe. As you tighten each muscle, inhale deeply, and hold the tension for several seconds. Relax, and exhale slowly.Other stress relievers include yoga, meditation, and guided imagery. Basically, "anything you can do daily that takes your mind off your worries will go a long way in helping to prevent migraines," says Dr. Mauskop.

7. Know Your Food Triggers

The old expression "you are what you eat" can mean something very painful to a migraineur: It's long been thought that certain foods and food additives may trigger a headache. (Though recently it's been theorized that cravings for these foods may actually signal the onset of a migraine.)Chocolate, for example, contains vasoactive amines, which can provoke a headache by dilating blood vessels. You may also have a headache associated with foods such as processed meats that contain additives called nitrites. Like amines, they cause blood vessels to swell, provoking headaches in migraine-susceptible people.Other common food triggers include aged cheese; alcohol; pickled and marinated foods; citrus fruits; bananas; onions; monosodium glutamate (MSG), a food preservative; and aspartame/ phenylalanine-containing foods and beverages.Uncovering your food triggers may take time, says Dr. Biondi. "One of the most difficult things about food triggers is that a food may only be a trigger once or twice out of 10 times you eat it." You may be more susceptible to food triggers when other triggers are present, such as stress, bright lights, or loud noises. And foods that trigger migraines in one person may have little effect on someone else.Chocolate, for example, contains vasoactive amines, which can provoke a headache by dilating blood vessels. You may also have a headache associated with foods such as processed meats that contain additives called nitrites. Like amines, they cause blood vessels to swell, provoking headaches in migraine-susceptible people.Other common food triggers include aged cheese; alcohol; pickled and marinated foods; citrus fruits; bananas; onions; monosodium glutamate (MSG), a food preservative; and aspartame/ phenylalanine-containing foods and beverages.Uncovering your food triggers may take time, says Dr. Biondi. "One of the most difficult things about food triggers is that a food may only be a trigger once or twice out of 10 times you eat it." You may be more susceptible to food triggers when other triggers are present, such as stress, bright lights, or loud noises. And foods that trigger migraines in one person may have little effect on someone else.

8 Ways To Clobber the Big Headache


http://health.yahoo.net/articles/healthcare/8-ways-clobber-big-headacheTeacher Mary Riley awoke one morning with searing pain on one side of her head. It started on top, then worked its way down and around the back of her neck.She thought it would go away with time and a little help from an over-the-counter (OTC) pain reliever. It didn't. It was the first of many headaches she would endure that day and every day that followed. At age 48, Riley had become a migraineur, a term used to describe migraine sufferers.She's in good company. An estimated 28 million Americans, nearly 10 percent of the population, and most of them women, suffer from migraines. Not "just a headache," migraine is a complex disease that causes severe and often disabling head pain, usually located on one side of the head, often accompanied by nausea, light and noise sensitivity, and other symptoms. Less than a third of migraineurs have a pre-headache phenomenon called an aura, during which they may have tingling and numbness of the face or arm, and may see flashing lights, blind spots, or zigzag lines.Migraine symptoms can be so debilitating, and the pain so explosive, that a 1999 survey found that one-quarter of those who experience it go to the emergency room for help. Yet more than half of migraineurs never see a doctor for a diagnosis, depriving themselves of new and effective treatments that can stop the symptoms dead and may actually short-circuit the entire headache process.There may not be a cure for migraine, but you certainly don't have to live with the pain. Here are eight medically proven ways to clobber the big headache.Discover Natural Remedies For Migraine Headaches

1. Get a Diagnosis

Why don't more migraine sufferers see a doctor? Because some get adequate , if not entirely reliable, relief from OTC pain relievers, says Richard B. Lipton, MD, professor of neurology, epidemiology, and behavioral sciences at Albert Einstein College of Medicine in New York City.But many others "don't know that headache is a treatable medical disorder," says Dr. Lipton, who was the lead author on the study that found so many migraineurs keeping mum around their doctors. Since migraine runs in families, it may seem normal to get these headaches, as if the pain is something they just have to live with, he says. And, "just as migraine runs in families, so too does not seeking care for migraine."But it's only in a doctor's office that you'll find the latest treatments that could help you to control your migraines, or even prevent them, reliably and for good."Our goals in therapy today aren't just to stop the pain," says Merle Diamond, MD, associate director of the Diamond Headache Clinic in Chicago. "With some of the newer medications, such as the triptans, we can actually turn off the headache process. That means we can stop the pain and get rid of the nausea and other symptoms without causing drowsiness. That's something we didn't have 10 years ago."The triptans, available as regular and dissolvable tablets, an injectable, and a nasal spray, may work in part by correcting a "glitch" in brain chemistry that causes a drop in the neurotransmitter serotonin. The triptans mimic serotonin, attaching to specific serotonin receptor sites in the brain, which not only relieves pain but also other migraine symptoms. They also stop the release of certain neuropeptides, the vasoactive and inflammatory chemicals that cause blood vessels to dilate and activate pain-sensitive nerve endings.When To See A Doctor For Your Headache

2. See a Specialist

Still in pain after consulting your doctor? It may be time to call in the big guns.Most family doctors can treat headaches quite well, says neurologist David M. Biondi, DO. But the same survey found that 48 percent of people who do see a doctor report that they're still often in severe pain.If your headaches aren't being controlled after several months, or your doctor is unsure about your diagnosis, ask for a referral to a neurologist or headache specialist.Neurologists have a special interest in headaches, says Dr. Lipton. And headache specialists are usually neurologists who spend even more time on headaches, offering greater expertise in diagnosis and treatment, he says.Most important for you, a headache specialist will also be up to date on the latest migraine medications, such as the triptans and preventives that are taken daily to reduce the frequency, intensity, and duration of migraine attacks.Some specialists are also using Botox, a natural substance that can be injected into the forehead, temples, or back of the head, temporarily paralyzing the muscles and causing them to relax. Some patients have reported complete or nearly complete relief from their headaches for up to 4 months, says Alexander Mauskop, MD, director of the New York Headache Center in New York City, who uses Botox in his practice. However, Botox, like other migraine treatments, doesn't work for everyone.A specialist can also help you manage your medications and help avoid what's known as the rebound headache, which occurs when the medications you're taking on a regular basis (more than two or three times a week) to alleviate pain actually cause a headache.

3. Catch It Early

Never ignore the early signs that a migraine is coming on. Most pain relievers become less effective as the headache progresses, says Dr. Biondi.Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium may bring pain under control when used at the first glimmer of a headache. "But once the migraine headache reaches a more intense phase, where there's more pain, nausea, light and sound sensitivity, and other associated symptoms, the nonsteroidals and other simple pain relievers are usually less effective," he says."Simple pain relievers" include aspirin, acetaminophen, or aspirin/acetaminophen/caffeine combinations.

4. Hop On the Treadmill

Walking, jogging, swimming, or any form of aerobic exercise may help prevent migraine headaches. Exercise stimulates the body to release endorphins, which are brain chemicals that improve mood, explains Dr. Mauskop. Exercise also helps relieve stress, one of the known headache triggers.Any form of aerobic exercise will do, but find something you like so that you're more likely to stick with it. Aim for 40 minutes a day, 5 days a week.One thing exercise will not do is stop a migraine in progress. In fact, exercise makes a migraine feel worse.Heal A Headache With Yoga

5. Get in a Groove, and Stay There

Boring though it may sound, sticking to a routine helps prevent a migraine. That's because changes in your daily schedule, sleeping in late on the weekends, blowing off breakfast, or skipping your daily bike ride, can trigger a migraine, says Dr. Biondi."The brain of a person with a migraine likes to have consistency. When you get off schedule, the brain may respond by triggering a headache. So a person with a migraine should stay on as regimented a program as possible," advises Dr. Biondi.Keep to a regular bedtime schedule, don't skip meals, and try to eat at the same time of day every day. If your blood sugar falls too quickly, it can trigger a migraine.

6. Learn to Take It Easy

Stress is one of the most common migraine triggers, so learning to cope with stress may help reduce the severity and frequency of attacks, says Dr. Mauskop.What seems to work well for many migraine sufferers is biofeedback. Using special equipment that measures muscle tension or body temperature, biofeedback teaches you how to control both muscle contraction and the swelling of blood vessels, two physical reactions that seem to play a major role in headaches of all kinds. Once you've become adept at biofeedback, you can use what you've learned to alleviate or even stop a mild attack.You can go low-tech too. Progressive muscle relaxation can reduce or even stop migraine pain. It's easy to learn and requires practice but no training. Find a quiet room where you can lie down on a flat, comfortable surface. Take a few deep breaths. Now, slowly tighten, then relax, the different muscle groups of the body in succession from head to toe. As you tighten each muscle, inhale deeply, and hold the tension for several seconds. Relax, and exhale slowly.Other stress relievers include yoga, meditation, and guided imagery. Basically, "anything you can do daily that takes your mind off your worries will go a long way in helping to prevent migraines," says Dr. Mauskop.

7. Know Your Food Triggers

The old expression "you are what you eat" can mean something very painful to a migraineur: It's long been thought that certain foods and food additives may trigger a headache. (Though recently it's been theorized that cravings for these foods may actually signal the onset of a migraine.)Chocolate, for example, contains vasoactive amines, which can provoke a headache by dilating blood vessels. You may also have a headache associated with foods such as processed meats that contain additives called nitrites. Like amines, they cause blood vessels to swell, provoking headaches in migraine-susceptible people.Other common food triggers include aged cheese; alcohol; pickled and marinated foods; citrus fruits; bananas; onions; monosodium glutamate (MSG), a food preservative; and aspartame/ phenylalanine-containing foods and beverages.Uncovering your food triggers may take time, says Dr. Biondi. "One of the most difficult things about food triggers is that a food may only be a trigger once or twice out of 10 times you eat it." You may be more susceptible to food triggers when other triggers are present, such as stress, bright lights, or loud noises. And foods that trigger migraines in one person may have little effect on someone else.Chocolate, for example, contains vasoactive amines, which can provoke a headache by dilating blood vessels. You may also have a headache associated with foods such as processed meats that contain additives called nitrites. Like amines, they cause blood vessels to swell, provoking headaches in migraine-susceptible people.Other common food triggers include aged cheese; alcohol; pickled and marinated foods; citrus fruits; bananas; onions; monosodium glutamate (MSG), a food preservative; and aspartame/ phenylalanine-containing foods and beverages.Uncovering your food triggers may take time, says Dr. Biondi. "One of the most difficult things about food triggers is that a food may only be a trigger once or twice out of 10 times you eat it." You may be more susceptible to food triggers when other triggers are present, such as stress, bright lights, or loud noises. And foods that trigger migraines in one person may have little effect on someone else.

8. Keep Track of Your Headaches

Keeping a headache diary is one of the best ways to identify your triggers and prevent future attacks. It also helps your doctor to find a prevention and treatment plan that works for you.Write in your diary every day, even if you don't have a headache, and include the following information and note any factors that may have contributed to your headache, including known food triggers, emotional stress, alcohol, and not getting enough sleep.
  • Did you have a headache?
  • What time did it start?
  • Were there any warning signs?
  • How did it feel (mild, moderate, severe, etc.)?
  • What medications did you use, including dosage?
  • How long did the headache last?


Please help me, I'm so scared!!?

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Please help me, I'm so scared!!?
Best answer:
could be a hernia. don't say it's a cystocoele when you go to a doctor. at your age, hernia is more common. Don't be too scared. But a doctor's appointment would really help relieving your worries. I can't recommend any non- medical treatment, though.I think this is what you have, and you need to go to another nurse, or your own doctor, right away. If they won't examine you, you need to be sure you can explain all the symptoms, and you should also let them know that you think it is the cystoceles. If one nurse turns you down, go to another. You need this looked at!!!dont worry go to a doctor and try to see what is wrong. it is important to go so please do. look, dont worry so much and it might turn out regular or somethingSweetie its ok to be scared,AND the nurse was/is a nut.You are never to young to "have"anything.Just go to the ER of see an OBGYN asap.Like Monday.IF your uterous perforates(sp)you could start heavy life threatening bleedingAlso your bladder could be damaged by simple neglect-not your neglect!.Everything inside is held together by muscle and tendon,they dont need to be overstreched.take care of YOU I'd like to have a wee chat with that "nurse".I'm actually angry.Just have a friend take you to ER okay. Write us back and lets us know your ok,please.Love and Prayers ,J





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Saturday, September 29, 2012

Pathophysiology of Paget's disease (Osteitis deformans)

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BASIC PHYSIOLOGY OF NORMAL BONE RESORPTION AND FORMATION :


*Osteoclast maturation is regulated by various factors, such as Receptor Activator of Nuclear Factor-kappaB (NF-kappaB) Ligand (RANKL). RANKL can exist as a soluble form and binds to the osteoclast receptor RANK.
*This binding activates osteoclast differentiation via the translocation of NF-kappaB into the nucleus by intermediates such as Tumor Necrosis Factor (TNF) Receptor-Associated Factor 6 (TRAF6).
*RANKL signals can be blocked by a soluble RANKL-binding decoy receptor, osteoprotegerin (OPG), produced by osteoblasts.
*Vacuolar H+-ATPase pump (H+), matrix metalloproteinase (MMP), Cathepsin K and Tartrate-Resistant Acid Phosphatase (TRAcP) are involved in osteoclast activity.

*This picture above helps us in understanding the pathophysiology behind PAGET'S disease :

*PATHOPHYSIOLOGY OF PAGET'S DISEASE:
- The principal abnormality in Paget disease is the increased number and activity of osteoclasts. - Pagetic osteoclasts are large, increased 10- to 100-fold in number, and have a greater number of nuclei (as many as 100 compared to 3–5 nuclei in the normal osteoclast). - The overactive osteoclasts may create a sevenfold increase in resorptive surfaces and an erosion rate of 9 microg/d (normal is 1 microg/d).
- Several causes for the increased number and activity of pagetic osteoclasts have been identified: (1) Osteoclastic precursors are hypersensitive to 1,25(OH)2D3(2) Osteoclasts are hyperresponsive to RANK ligand (RANKL), the osteoclast stimulatory factor that mediates the effects of most osteotropic factors on osteoclast formation; (3) Marrow stromal cells from pagetic lesions have increased RANKL expression; (4) Osteoclast precursor recruitment is increased by interleukin (IL) 6, which is increased in the blood of patients with active Paget disease and is overexpressed in pagetic osteoclasts; (5) Expression of the proto-oncogene c-fos, which increases osteoclastic activity, is increased; and (6) The antiapoptotic oncogene Bcl-2 in pagetic bone is overexpressed. Numerous osteoblasts are recruited to active resorption sites and produce large amounts of new bone matrix. As a result, bone turnover is high and bone mass is normal or increased, not reduced.
- The characteristic feature of Paget disease is increased bone resorption accompanied by accelerated bone formation. - An initial osteolytic phase involves prominent bone resorption and marked hypervascularization. - Radiographically, this manifests as an advancing lytic wedge, or "blade of grass" lesion. - The second phase is a period of very active bone formation and resorption that replaces normal lamellar bone with haphazard (woven) bone. - The mosaic pattern of woven bone is structurally inferior and can bow and fracture more readily. - At the same time, fibrous connective tissue may replace normal bone marrow. - In the final sclerotic phase, bone resorption declines progressively and leads to a hard, dense, less vascular pagetic or mosaic bone, which represents the so-called burned-out phase of Paget disease. - All three phases may be present at the same time at different skeletal sites.

*Acutely marginated bone demineralization during lytic phase in skull - OSTEOPOROSIS CIRCUMSCRIPTA.
*Acutely marginated demineralization of long bones - BLADE OF GRASS SIGN and FLAME SHAPED MARGIN.
*Mixed lytic and sclerotic phase in spine - PICTURE FRAME VERTEBRAE
*Mixed lytic and sclerotic phase in skull - COTTON WOOL SKULL.

Haglund's deformity (Pump Bump)

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*A Haglund deformity, or pump bump, is caused by chronic inflammation of the adventitious superficial pretendinous Achilles bursa that separates the Achilles tendon from the overlying skin.

*According to Jones, this bursa is present in about 50% of patients. This pretendinous bursitis usually is caused by chronic irritation from a shoe heel counter, and modification of shoe wear usually relieves symptoms. This deformity usually occurs in young women in their 20s or 30s. Surgery is infrequently required.

*The following technique is recommended if conservative measures fail :

1. Place the patient prone. After administration of general or local anesthesia, make a longitudinal lateral incision 1 cm lateral to the Achilles tendon, extending distally from 3 to 4 cm proximal to the superior tuberosity of the calcaneus to 2 to 3 cm distal to the superior tuberosity of the calcaneus.

2. Plantar flex the ankle joint and by sharp and blunt dissection, identify the Achilles tendon.

3. Place a right-angle retractor between the Achilles tendon and posterior and superior borders of the calcaneal tuberosity. With the foot plantar flexed, this usually affords enough exposure to remove the superior border of the calcaneal tuberosity without raising any of the Achilles tendon off the calcaneus. However, the Achilles tendon has such an extensive insertion into the posterior and plantar aspect of the calcaneal tuberosity that raising a 1- to 2-cm-long portion of the tendon may be necessary to resect the bone adequately.

4. Remove the superior aspect of the tuberosity with a microsagittal saw or an osteotome. Placement of several drill holes along the proposed osteotomy site makes this resection easier.

5. If an area of ossification remains, split the Achilles tendon in a coronal plane distally with the anterior third or half to free up enough to excise the calcified tendon.

6. Lavage the wound and close in layers.

7. Apply a well-padded, short leg, non–weight bearing cast with the ankle in approximately 20 degrees of plantar flexion.

AFTER TREATMENT:
*The cast and sutures are removed at 3 weeks. The sutures may be removed earlier if indicated, but the non–weight bearing cast remains on for 3 weeks. Then a removable weight bearing cast boot is applied, and active plantar flexion and dorsiflexion exercises are begun. It is important in the preoperative counseling to explain to a young woman with a pump bump that it might be 3 to 6 months before she can wear a stylish shoe and that there is no guarantee that she will ever be able to do so comfortably.