Refractive Lensectomy – Discover Life Without Glasses Or Contact Lenses

If you’re as nearsighted as I am, you’ve probably fantasized about getting rid of your glasses or contacts forever. Many people choose Lasik (laser surgery to reshape the cornea), which takes care of their nearsightedness. Lasik is great if you’re in your 20s or 30s, but it does nothing to address age-related presbyopia-the condition that forces most of us to wear bifocals or trifocals in middle age and beyond.

When I was in my late 30s an ophthalmologist recommended Lasik but added, “Of course, you’ll still need to wear glasses to read or work on the computer.” I guess he wasn’t paying attention when I told him that I make my living as a writer and editor. I spend most of my waking hours reading and working on the computer. Why would I pay thousands of dollars for Lasik surgery if it meant I would still have to wear glasses most of the time?

I have never felt attractive in glasses. When you’re very nearsighted, the lenses make your eyes look smaller. I wore contact lenses from age 18 to 40, but around my late 30s I began to notice that my eyes would turn red every time I put in my contacts. My eye doctor explained that I had “thin tears” that didn’t form a good buffer between the contact lens and the surface of the eye. I decide that bloodshot eyes were even less attractive than Coke-bottle lenses, so I gave up on wearing contacts.

Then a few months before my 49th birthday I interviewed an eye surgeon for an article in a local magazine, and he told me about another option for nearsighted people in middle age and beyond: refractive lensectomy. Simply put, this procedure is cataract surgery before the insurance company will pay for it. Instead of replacing the natural crystalline lens of the eye with a monofocal lens (to correct nearsightedness or farsightedness but not both), the surgeon inserts a multifocal lens. Multifocal lenses (with trade names like ReZOOM, ReSTOR, and Crystalens), provide good vision at a variety of focusing distances.

Of course, there’s a downside. The biggest drawback of refractive lensectomy is the cost: about $4500 per eye, which is 2 to 3 times the cost of Lasik. But after 40 years of wearing corrective lenses (I got my first pair of glasses at age 9), I was eager to get rid of glasses and contact lenses forever. I wanted to rediscover the freedom of life without glasses. I divided the total cost by the number of days in 41 years (because I fully intend to live until I’m 90) and decided 60 cents a day was bargain for a spectacle-free lifestyle. As an added bonus, I would never have to deal with cataracts in old age.

One week before my 49th birthday I had surgery on my left eye, and two weeks later my right eye received its new ReZOOM lens. I was nervous before the first procedure but calmer the second time around because I knew what to expect. I kept a blog to preserve a detailed account of my surgery, recovery, and adjustment (see the first URL in the resource box).

Almost two years have passed since I got rid of my glasses and contacts forever, and I believe the results are well worth the expense and anxiety involved. I can drive my car and see my computer screen well enough to distinguish between a comma and a period in 9-point type, and I can read small print easily with the aid of a Verilux desk lamp or strong sunlight. Trying to read low-contrast print (yellow on a white background, for example) is hopeless, and so is reading in dim light. Threading a needle is a little tricky, but I can do it by the third try. I’m aware of a few more vitreous floaters than I noticed before the surgery, but they’re not bad enough to interfere with my quality of life. Overall, I’m completely satisfied with my new “bionic eyes” and would recommend the procedure to any nearsighted middle-aged person who wants to experience the freedom of life without glasses.

Primary Peritoneal Cancer Prognosis -What Now?

A cancer diagnosis is devastating. A stage IV cancer diagnosis is even worse. Primary Peritoneal Cancer Prognosis is not great but it is manageable. This cancer mimics ovarian cancer in that few symptoms show up until it is quite advanced. Standard treatments include surgery and chemotherapy.

There are other forms cancer that seem to hide or be misdiagnosed until they are very advanced. One is GIST-Gastro Intestinal Stroma tumor. Just a few years ago, a diagnosis of this stomach lining tumor was enough to start making funeral arrangements. But that is not the case now. Thanks to advances in research and actually separating this type of tumor from other cancers that were all lumped into the stomach cancer category, a diagnosis of GIST is no more an immediate death sentence.

A couple of drugs on the market have made a big difference. One is called Gleevec and the other is called Sutent. Gleevec is usually the first line of defense. This drug is a protein inhibitor that attacks the tumor and shrinks it. It has a 70% success rate which is unheard of for most kinds of cancer.

Interestingly, it was initially used in the treatment of leukemia and was used by a doctor as a last ditch effort for a patient who was dying of GIST. It is now standard protocol for GIST treatment.

Gleevec is not without its side effects but most are manageable. One of them is short term memory loss. That’s not a big deal to you are in line at the post office and can’t remember where the package your are mailing is supposed to go.

Primary peritoneal cancer prognosis will also be more favorable as other drugs are developed for treatment of this specific type of Cancer. Research is ongoing and breakthroughs are being made all the time.

How Fast Does A Cataract Grow?

A cataract as some people think is not a tissue growth or a tumor that grows over the eye lens. It is actually the clouding of the eye lens and generally develops in front of the pupil and the iris. It causes fogging and loss of lens clarity and can lead to partial or total cloudy vision. In worse condition, it can cause temporary blindness which can only be remedied through surgery.

There are many causes why cataracts develop. The pace of cataract progression may also vary from every individual. There are people who develop their cataracts in their younger years while some may have it during their old ages. The most possible causes of cataracts are prolong exposure to UV light, diabetes, use of medications that can alter the body’s immune system, vitamin deficiencies and eye illnesses like iritis, glaucoma or eye trauma. If the person already has cataract and regularly exposed to such conditions, progression may be quicker. Basically, people who are over 65 years old are most prone to develop cataracts so presumably cataracts are part of our aging process. Fortunately, only 10 percent of those who have it do require eye surgery to correct their vision.

Cause of Progression of Cataracts

Previously, doctors advised their patients to wait for their cataracts to reach full stage before eye surgery is advised. But with today’s technology, doctors can now treat cataracts even it is in its early development stage. Talking about the pace of the development of cataracts, many people are asking how fast a cataract can grow. According to some eye experts, there are certain types of cataracts that can grow rapidly and cause blurry vision to the sufferer in such a short time while there are also cataracts that do not progress at all or if ever it progresses, the person is truly in his later stage of life. Incidentally, the case of cataract progression can be influenced by the person’s health condition. Like if the person has a weak immune system or has a history of eye illnesses that makes his eye vulnerable to eye disorder, the development of eye cataract can be faster.

Especially people who have diabetes or suffering from autoimmune diseases like AIDS or Lupus, the rate of cataract development is more accelerated. Cataracts, like other diseases can also be inherited though it may come at a later stage. On the other hand, not all cataracts will require surgery. Most of the times, cataracts only require maintenance so that it would not advance that it may require surgery while some doctors advise their patients not to mind their cataracts as long as it is not causing discomfort, problems with vision and risk to their everyday lives.

What Must Be Done?

People who have cataracts must visit their eye doctors on regular basis because their doctors must know the progression of their cataract growth. If the cataract grows rapidly, the doctors can advise their patients to undergo intensive medical check-up because as we have said the growth and development of cataracts can be influenced by many health issues. Wearing glasses cannot actually help in preventing the development of cataracts but only medical procedures and the doctors’ intervention. The patient may be advised to change his or her lifestyle or get away from sources that contribute to the rapid development of the cataract.

Pepper Spray Vs Stun Gun Vs Mace – Which Is The Best Choice For Women’s Personal Defense?

Whenever I question a woman and ask her what piece of personal defense equipment she would carry if she had a choice, the answer is always different. Some choose pepper spray…Some choose Mace…And some choose a stun gun. Others tell me they “really don’t need to carry anything like that”…They have no idea how mistaken they are in today’s environment. Every woman needs to carry some form of protection with her at all times…period!

The best way to analyze which choice is the “most correct” for each case is to first explain the pros and the cons of each weapon; and then go from there to match them up to the specific individual. Let’s begin…

Pepper spray is a common defensive spray that is inexpensive and easy to use…It is made from hot peppers. The active ingredient is oleoresin capsicum or OC. It causes tearing, intense eye pain and even temporary blindness. It comes in varying strengths and is delivered in a pressurized spray form (usually from a small canister held in the hand). There are stream versions and fog versions; each having a devastating effect on an attacker. It hides easily in a purse or on a keychain and has a simple “point and shoot” delivery. Depending on the size, the number of bursts and the distance it will shoot varies…The pros: Inexpensive, easy to use, easy to conceal and it will bring most attackers to their knees rendering them helpless for an extended period of time…The cons: Limited amount of uses, requires a steady hand and good aim, and you better be upwind!

Stun Guns are the most effective method of defending ones self as far as incapacitating an attacker without a doubt. Just touching the prongs of one of these beauties to an attackers body will deliver anywhere between 350,00 to 1.2 million volts of electricity and knock him or her down for the count. Stun guns are available in a variety of sizes and also a variety of disguises; such as cell phones, pens and even a lipstick! They are simple to use and more suited for hands on combat. The pros: relatively inexpensive, easy to use, comes in a variety of disguised versions and will knock even the biggest and strongest attacker down for at least 10-20 minutes. The cons: Illegal in several states, needs time to recharge after extended use, and you have to be close enough to your attacker to use it on him.

Mace is the final weapon of choice we will explore. Mace is actually the trademark name of a defensive spray made by Mace Security International in Mount Laurel, New Jersey. Mace Inc. manufacturers 3 types of defensive sprays…They are Triple Action, PepperGard and Pepper Foam.

Mace Triple Action is a combination of tear gas, UV dye and oleoresin capsicum (OC). This is the strongest formula they make. The UV dye is purple in color. The tear gas and OC combination causes coughing, tearing, temporary blindness and skin irritation. The affects will last up to 90 minutes. The dye aids law enforcement in later identification.

PepperGard (Also known as Pepper Mace) is 10% OC and contains UV dye; but contains no tear gas.

Pepper Foam is the exact same as PepperGard; except it sprays a thick foam instead of spraying in a liquid state. It also contains the UV dye for identification purposes. The pros and cons of Mace are the same as Pepper Spray; except for the fact that the Triple Action Formula will disable an attacker for a much longer time…3 times as long… minimum. And its effects are much more devastating and painful to the attacker.

In conclusion, my opinion as an expert in the personal defense industry is as follows: Every woman should carry a small can of pepper spray with them at all times…no exceptions! If they have a large purse they should carry a 4 oz. can as well…It holds 8 times the amount and shoots almost twice as far. And if it is legal in your state you should without a doubt carry a stun gun as well…You can never be over prepared in today’s environment.

States Where Stun Guns Are Restricted:

Indiana (No Tasers), Hawaii, Massachusetts, Michigan, New Jersey, New York, Rhode Island, Wisconsin, Illinois

Cities Where Stun Guns Are Restricted:

Annapolis, Md Baltimore, Md Baltimore County, Md Chicago, Il Dension / Crawford County, Ia District Of Columbia Philadelphia

Any of the other 50 states are legal to possess a stun gun. So if you are a woman in today’s world you should be well aware of your surroundings and learn to “people watch”…Carry pepper spray, Mace and / or Stun Guns for your protection whenever possible…Bottom line is it is better to be prepared and never have to use these items than to be in a life or death situation and not have any of them…Think about it…

How Coconut Oil Can Help Take Care Of Pneumonia In Children

There are numerous individuals who feel that is is best to cure distinct health developments with all natural products rather then with over the counter and prescription medicines. They think that most of the things we cook with or the plants that we see every day have healing qualities that function quicker and are much better for us.

One such ingredient is coconut oil. Recent reports show a strong link that this is able to be used to address kids who are suffering from pneumonia. They believe that it holds specific antibiotic attributes that aid to assuage the symptoms quicker then typical medicinal methods. Pneumonia is a problem that will infect the lungs. For youngsters and some adults it is a crucial infection that may be fatal if it is not addressed the right way.

In the study they separated the children in to two distinct groups; the one that used coconut oil and the kids that did not. The children who had the oil along with a few other antibiotic drugs were able to recover faster. Their respiratory rate and fever had reinforced and they had improved oxygen saturation in the blood.

A part of the group was given the oil orally every day depending on what they weighed. They did this for three continual days and discovered that their respiratory rate had become average after merely 32 hours. The different group took 48 hours to get better.

Health researchers believe that the coconut oil was able to work with the ampicillin – the familiar medication used to treat pneumonia. It carries lauric acid – which has particular antimicrobial attributes that function well with the ampicillin.

This is only one way that you have the ability to improve your children’s health with coconut oil. It’s healing attributes will serve to help them recover from health other problems.

Macular Degeneration – 6 Tips on How to Prevent & Reverse Age-Related Macular Degeneration

All of us have one thing in common. As time passes, we age. Aging does have some benefits. For example, as the years march on we gain more experience and become a little more savvy and wise.

But aging also comes with a laundry list of effects that range from being merely inconvenient to being life-altering. Maybe your memory is not as sharp as it used to be, so you are experiencing those dreaded “senior moments.” Maybe you can’t hear as well as you used to, or have aches and pains.

One of the areas that begins to deteriorate as we grow older is our eyes. If you are over the age of 40, you’ve probably experienced some vision problem or another, whether it’s near-sightedness, far-sightedness, “tired” eyes, watery eyes, or dry eyes. Many of these problems can be controlled with lenses or medication.

While the kinds of eye issues above are annoying and sometimes inconvenient, what concerns us more are those vision problems that are linked to blindness. For many of us, the idea of going blind is one of the most fearful things about aging. Not only does blindness mean we can’t see our loved ones, read a book, or watch television, it also diminishes our independence. People who are blind can’t drive, do everyday chores around the home, and have difficulty doing self-care tasks such as getting dressed, grooming themselves, or making a meal. No wonder why the thought of going blind is so terrifying.

One leading cause of vision loss and blindness is Age-Related Macular Degeneration (ARMD). In this condition, the retina becomes blocked by debris, which affects your central vision. Central vision is your “straight ahead” vision, the kind of vision you need to read, drive, or do any kind of activity in which you need to focus in front of you. Macular degeneration does not affect your peripheral vision. People who suffer from macular degeneration see black spots and wavy lines that obliterate or distort the objects in front of them. Age-related macular degeneration can deplete vision up to 60 percent, and is one of the more prevalent causes of age-related blindness. While we don’t know exactly what causes macular degeneration, we do know that poor blood supply to the eye, oxidization of the retina, and leaky capillaries can all contribute to this condition.

Unfortunately, age-related macular degeneration can’t be simply treated with eye drops or lenses. Because doctors aren’t sure what causes macular degeneration, there is no medically accepted cure. As a matter of fact, if you’ve already been diagnosed with macular degeneration, chances are your doctor has told you there’s nothing you can do, aside from learn to accept the idea that blindness is in your future.

However, you don’t have to accept the fact that you are going to go slowly but surely blind as a result of age-related macular degeneration. While there are no pills that you can take to slow or stop macular degeneration, while eye drops and special lenses won’t save your vision, there are things you can do to stop, slow down, and even reverse age-related macular degeneration. What’s more, as additional research is being done, more and more progressive eye specialists agree that there are steps you can take to maintain or restore your vision in a safe, natural way.

Do you want to halt, delay, or even reverse macular degeneration? The answer lies making new lifestyle choices. Stopping, slowing, and reversing your macular degeneration is as easy if you follow the 12 easy steps below. These steps are safe and natural, and you have absolutely nothing to lose by trying them. Best of all, these healthy lifestyle choices will not only have a positive impact on your eyes, they will have a positive impact on your overall health in general.

Step #1: See Your Eye Doctor

Macular degeneration isn’t commonly talked about, and many people don’t know what it is until they’ve been diagnosed with it. Be sure to have your eyes checked annually, and ask your doctor to test you for macular degeneration. In order to determine whether you have macular degeneration, your doctor will ask you to look at a tool called an “Amsler chart.” This chart is essentially a grid with a black dot in the middle. If, after focusing on the dot in the middle of the graph, you see shaky, uneven, or undulating lines, you are most likely experiencing the early stages of macular degeneration. A dark spot or blob in the center of the graph may also indicate macular degeneration. Your ophthalmologist will characterize your macular degeneration as either “wet” or “dry.” “Dry” macular degeneration is the less serious of the two types, and accounts for about 90 percent of all cases of macular degeneration. Unfortunately, there is no surgery, drug, drop, or lens that can treat “dry” macular degeneration. Severe “wet” macular degeneration can be treated with last-ditch efforts designed to preserve sight for an additional amount of time, but these treatments carry significant risk and offer no long-term solution.

Step #2: Take Stock of Prescription Drugs

Some experts believe that aspirin, Ibuprofen, and other NSAIDs can cause retinal hemorrhages in the blood vessels, which can then develop into macular Degeneration. People with high blood pressure are particularly at risk for developing retinal blood vessel issues as a result of taking NSAIDs. Other drugs that have a negative effect on the retina and may contribute to macular degeneration include Plaquenil and Cortisone. Talk to your doctor about replacement drugs if you take any of the above drugs.

Step #3: Protect Your Eyes from the Sun

UV-A and UV-B rays, as well as Blue Light, cause oxidization in the retina, which contributes to macular degeneration. Investing in a high-quality pair of sunglasses that filters out these dangerous rays, and wearing a hat with a brim, will protect your eyes.

Step #4: Add Vitamins, Minerals, and Supplements to Your Daily Diet.

There are a wide variety of vitamins, minerals, and supplements known to contribute to eye health, including vitamins A, C, D, and E, omega 3 fatty acids, beta-carotene, magnesium, garlic, zeaxanthin and lutein, selenium, taurine, N-acetyl cysteine, zinc, hydrochloric acid, coenzyme Q-10, boron, chromium, copper, and manganese. The best place to find eye-healthy vitamins and minerals? In your food. But to be sure you’re getting enough of what you need, take a multi-vitamin that includes the majority of the above vitamins and minerals, and supplement with anything it doesn’t include.

Step #5: Up Your Antioxidants and Amino Acids

Because one of the causes of macular degeneration is oxidization of the retina, it makes sense that adding anti-oxidants to your diet can help fight off macular degeneration. Lack of antioxidants in the diet can allow free radicals to multiply, causing more blocked capillaries in the retina. Be sure your diet contains plenty of vitamins C and E, quercetin, bilberry, selenium, bioflavonoids, beta-carotene, and ginko biloba. Plenty of amino acids in the form of N-Acetyl cysteine, L-glutathione, L-glutamine, and L-cysteine are also integral for eye health.

Step #6: Watch Your Fat and Cholesterol Intake

According to a study done by the University of Wisconsin Medical School, diets rich in saturated fat and cholesterol increase macular degeneration by 80 percent. Stick to mono-unsaturated fats like olive oil, and eat healthfully by incorporating natural carbohydrates such as beans, grains, fruits, and vegetables. Eating plenty of soy protein and fish, as well as having one alcoholic drink per day if it fits into your lifestyle, can boost your good cholesterol levels.

To get 6 additional tips and a free subscription to the “Healthy Vision” Newsletter, visit www.MacularDegenerationAuthority.com

Eye Floaters Treatment – Eliminate Eye Floaters With a Simple and Easy Solution

Learn eye floaters treatment in simple and natural ways. End your frustration of spider webs, clouds or fogs, moving dots or squiggly lines that move around and float around in the field of your vision. Follow these amazing tips to help eliminate those annoying eye floaters.

Eye floaters can be very irritating and annoying, but there are no safe and proven methods to get rid of the symptoms caused by vitreous syneresis or posterior vitreous detachment. Not to worry because there are simple and natural ways to clear your vision effectively.

What is eye floater?

Eye floaters are deposits or condensation in the vitreous jelly of the eye. An eye floater can appear as floating spots, or black dot that will move around when you move your eyes.

As you get older, a substance known as vitreous, that is similar to jelly in texture, starts to become more like a liquid. In this case, fibers within the vitreous glue together then float continuously around in the vitreous cavity. Your will see these as floaters, shadowing the retina. Diabetic retinopathy, eye trauma, complications from cataract surgery and nearsightedness may further increase risk.

Below are eye floaters treatment that will help to clear your vision

Step 1

Warm your hands by rubbing them together, then lightly press your palms against your eyes for about 10 seconds. Repeat this process about 5 times. Do this everyday to gradually eliminate floaters in the eye.

Step 2

Tilt your head so you face the ceiling. Look ahead and roll your eyes around in a circular clockwise motion, then change to counter clockwise motion. Repeat this exercise ten times in each direction.

Step 3

Hold a pencil in front of your face at arm length. Look at the pencil, and then slowly move it towards you until it is about 6 inches away from your eyes. Continue to focus at the object. Do this relaxing massage 10 times daily to reduce floaters in the eye.

Step 4

Slowly massage your temples with your thumbs knuckles with circular motion, forward and backward. Do this 20 times in each direction. Very gently do the same thing on your forehead between the eyebrows and on each side of the bridge of your nose.

3 Major Reasons Why Marketing is Important

Kotler and Armstrong define marketing as “the process by which companies create value for customers and build strong customer relationships in order to capture value from customer in return.” This definition alone can explain why marketing is important, but let’s outline several reasons why marketing should be one of the small business owner’s main priorities.

1. Marketing builds value in your products and services for your customers.

Most salespeople want to know as little as possible to make the sale. Some sales staff needs technical specifications and things of that nature, but ultimately, the less they have to learn the better. This makes sense, because their goal is to make sales. Therefore, marketing has to step in and create value for your customer. If you can not create value for your customers, why will they buy from you? Sometimes they will buy from you once, but will they come back if there is no value?

Many times, business owners don’t capitalize on all the ways they can give value to their customers. They get lost in the production or product concept of marketing and end up with marketing myopia. Marketing myopia happens when a company pays more attention to the product/service than the value or benefits it offers to the customer. You can not let this happen to you. Pay attention to your customers and why they buy your products. People buy a Toyota Prius not only because it saves on gas, but because it makes them fell more eco-friendly.

2. Marketing helps build customer relationships.

Everyone put emphasis on the sales staff when it comes to sales. “If the sales team doesn’t work harder, we won’t increase sales,” but this is not necessarily true. It costs three times as much to obtain a new customer as it does to keep an existing one. This means you need to maintain the relationship with your current customers in order to lower marketing and sales costs and increase sales.

Properly planned and implemented marketing activities are the only real way to build customer relationships. These activities can include a lot of things: loyalty programs, thank-you cards, customer appreciation events, free gifts, and so on. Each company must find a unique way to set themselves apart from the competition while building a loyal and long-lasting relationship.

3. Marketing establishes a brand image.

When you use FedEx for shipping, you know what you are getting: fast delivery, flexible shipping options, and better service than other shippers. Are all of these things true? They may be, but their marketing activities established all of these. FedEx will have to live up to these expectations of their brand, but their marketing department set the customer up with this image.

You must use marketing to establish your brand. Customers need to know what to expect from your company based on your brand image. What kind of products and what types of service will you provide the customer? Let your marketing tell the story and establish your brand.

USMLE Step 2 CK Exam – FOUR Mistakes That Can Hurt Your USMLE Score

The USMLE Step 2 CK exam is thought to be the easiest of the USMLE exams, and for this reason, many of us fail to prepare adequately, and as a result our scores are not as strong as they should be. There are many things you can do to ensure you get a strong score, but there are also many things that many medical students fail to realize, which can dramatically impact the strength of your score.

Here are four of the top reasons why many medical students do poorly on the Step 2 CK exam:

1. Failing to adequately study both mechanisms of disease and pathophysiology

When we study for the Step 1 exam, these two categories are at the top of our priority list because they are the most high-yield. Unfortunately, many of us don’t realize that mechanisms of disease and pathophysiology are still extremely high-yield for the Step 2 CK exam. The difference between this category from Step 1 to Step 2 is that it is more “clinical” on the CK exam, meaning the test-writers will link pathophysiological processes to different clinical scenarios.

Therefore, to ensure you don’t fail the CK due to lack of preparation, be sure to include the basics of pathophysiology and mechanism of disease in your Step 2 CK preparation.

2. Forgetting the details

The problem here comes from the fact that all of the study guides on the market are “review”, and are not meant to go into detail. When you fail to use a study source that is anything beyond a topical review, you are seriously risking not only a low score on the CK exam, but you are risking a failure. Many questions on the CK exam will be secondary, tertiary, and even quaternary questions, and if you do not have a detailed knowledge of the high-yield concepts, you may be putting yourself at risk.

Avoid this problem by attacking the “high-yield” concepts, and then learning everything you can about them. For example, if a review book tells you that Parkinson’s disease is a high-yield subject, then only gives you 4-5 facts about it, go that extra step and dig deeper and learn as much as you can about this certain subject. Doing this will allow you to know the “high-yield” information, but on a much deeper level, which I ensure you will help you on your exam.

3. Not fully understanding how to answer the “next-best-step” type of questions

These types of questions are GOLD on the Step 2 CK exam. You will encounter “what is the next best step”, “what is the most appropriate next step”, “what is the best step to reduce mortality”, and many more. It is crucial that you pay very special attention to exactly what the question is asking, because the patient may be bleeding to death and you may be thinking the patient needs emergent surgery, but the question may be asking you “what is the most important immediate step?”, which is going to likely be airway security, not an emergent laparotomy.

So you see how understanding exactly what to do in each situation is highly important for the CK exam. The best approach in preparing for this type of question is to develop your own algorithm charts for each medical scenario. Not only will this enable you to visualize each step, but it will help you become better at problem solving and situational management.

4. Realizing that there are different types of presentations for disease entities

This one is kind of tricky, but it is important that you realize, as a test-taker, that there will be both typical and atypical presentations of common and uncommon diseases. Therefore, you will get many “common presentations” of many common diseases, such as a patient with ataxia who has a cerebellar lesion. You will also get scenarios where the presentation is completely atypical, and you will have to use things such as patient history and patient risk factors in order to figure out exactly what is being asked of you.

For example, cystic fibrosis is most commonly thought of as a disease of males, however the exam might throw you a trick and give you a female patient. Keeping in mind that not every case will be ideal in presentation can help you think in a more abstract manner, which will help you go a long way in attacking difficult exam questions.

You have now been educated about the FOUR most common mistakes that medical students are making that is hurting their Step 2 CK exam scores. Do yourself a favor and make yourself fully aware of these errors, be sure to avoid making them yourself, and you will be well on your way to scoring very well on the USMLE Step 2 CK exam.

Do You Need a License to Sell Organic Skincare Products?

In 2004, American cosmetic buyers indicated that 66% of them use organic make up products. The market for these products has also risen from $190 million to $318 over a five year period. Because of these numbers, organic cosmetics are becoming more mainstream and can be found in well known stores all over the country. This promising trend underlines current attitudes regarding green causes and a desire to lead healthier lifestyles.

As manufacturer grows to meet the demand, they look fro more outlets to sell their products.

This opens the door for individuals who wish to start a small home business pedaling organic merchandise. For these entrepreneurs, the prospect of providing customers with products that are moving like hotcakes is alluring but how does one get started and is a license necessary to market these items?

Legal Licensing

The answer to this can be a bit tricky. Although the organic cosmetic industry is a bit unregulated, selling any item, no matter what it is made of, is not. If you wish to start a business you will need to obtain a license – the kind of license may depend on the way you structure your business.

Brick and Mortar businesses

Dermatologists, cosmetologists, aestheticians, makeup artists and health care professionals will most often already have a license. In many cases these licenses will allow them to sell beauty products from their offices. If your expertise falls within these parameters, you should check and see if you need a specialty license to advertise and traffic organic beauty products. Laws may differ from state to state but chances are you will be okay if you already have a license in the beauty trades.

Online and Home based

For individuals with no formal health and beauty certification, a license to hawk organic products may be necessary. This is because anyone who starts a business has to be licensed. Once again, laws may differ from state to state, so check with their local governmental agency about what may be required regarding the purchase of a business license.

You may find that some laws are written to where you may not need a business license if you only sale a certain amount of product a month or annually. In some instances, an individual can own a sole proprietorship but may not necessarily have to have a license.

When you call the commerce related government agency in your city, be sure to ask in depth questions that cover all of these bases.

There’s money to be made

The organic cosmetic industry is not only an exciting one to enter into, it can be quite lucrative, in fact; experts postulate that natural and organic cosmetics sales will reach $6.6 billion by 2010. This figure can be very enticing, just be sure that you have what it takes to make your cosmetic business work. Although the company will more than likely provide you with the merchandise you will need to get started, you will have to work to build your clientele and partake in the billions that can be made in the coming years.

Venture capital

The main thing that keeps people from starting their own business is the assumption that they do not have the money to begin. The wonderful thing about a cosmetic business however, is that it often doesn’t take a lot of money to start, in fact, in some instances, it may only require a initial willingness to receive the product.

Once again, if you are interested in investing in an organic skincare products business, contact the company you are interested in working with and have them send you information about their set up.

With the right mindset, you should be able to excel at an organic cosmetic business and make a significant amount of money to boot!

Physical Benefits of Massage Therapy

After a long day, a massage can help you relax and unwind. Your body will appreciate this effective form of stress management. Learn about the physical benefits of this alternative therapy.

Muscle Pain Reduction

Muscle pain can be debilitating for many people. Massage can be an effective tool for relieving muscle pain and tension. After a session, most people emerge feeling calmer and more relaxed. The kneading and circular movements target deep layers of muscle. This can be particularly beneficial for people recovering from an injury.

Improved Immunity

Regular stress can wreak havoc on the body’s immune system. A weakened immune system often leads to more illnesses and infections. Regular sessions can help improve immunity naturally. A number of reasons exist for this improvement. First, the kneading movements help activate cytotoxic capacity within the body, which involves killer cells that will fight infection. This process also helps eliminate T-cells in the body, which helps the immune system function more efficiently. Serotonin naturally elevates after a session, which also boosts immunity naturally.

Fighting Depression

When depression hits, a massage might be an effective way to fight it. Stress and unhappiness usually result in elevated cortisol levels in the body. Elevated cortisol levels are associated with depression. However, this type of physical therapy can decrease cortisol levels by as much as 50 percent. An increase in serotonin and dopamine also helps improve and stabilize moods.

Flexibility and Range of Motion

Aging and activity can result in tightened joints. Restricted joints result in a decrease in flexibility and range of motion. This therapy is effective for improving range of motion and comfort with flexibility. The therapist will focus on kneading muscles, tendons, ligaments, connective tissue, and joints. After a session, most people will experience greater fluidity in joints, which can improve comfort and reduce injuries.

Blood Flow and Circulation

Poor circulation results in numerous maladies, including achiness, pain, fatigue, and tense muscles. These kneading motions apply pressure to move blood through various regions of the body. After releasing the pressure, new blood moves in quickly. The pressure also serves to flush out lactic acid from tired muscles. This flushing helps lymph nodes work more effectively to eliminate metabolic waste.

Skin

Enhanced circulation is also beneficial for the skin. After a massage, skin typically glows from the extra blood flow. If the masseuse uses oil, skin will also receive nourishment and hydration. Vitamin E, jojoba, primrose, or almond oil are examples of beneficial oils that will improve skin texture.

Working tight and weak muscles can make them feel vibrant once again. Athletes could engage in this treatment either in preparation for an event or to recover from one. This could be a viable option to help you recover from surgery to fight against postsurgical swelling. Whether you’ve had an injury or you are experiencing stress, a massage can be an effective way to help you feel better.

Polynesian Diet Strategies – 7 Tips to Help You Lose Weight Permanently

I am constantly amazed when I hear stories of Polynesians who suddenly passed away from heart attack, diabetes, and even colon cancer, at such a young age. My grandfather was very young when he died from colon cancer. My mother who is now 62 has suffered from a long history of chronic illnesses, arthritis, stroke, and now has diabetes. Outside of my immediate family, I see other Polynesians suffering from diet induced diseases, and I fear they will not live to see their grandchildren. So what is happening to our people, and what can we do to stop it?

I am going to give you seven of the best tips you can implement to lose weight, and get back your health starting right now, but first I want to tell you a little about myself.

I am a Polynesian male in my late thirties. I was born and raised in New Zealand to loving parents of six children. I came to the United States in the late nineties to attend school. After the first year of College, I had gained some extra weight, about 15lbs. No big deal right, wrong. As each year passed I was gaining more and more unsightly body fat.

This was extremely abnormal for me, since I was fairly active and played a great deal of competitive sports, such as rugby, basketball, tennis and volleyball. I have always had a good sense about being in shape and was growing frustrated at the elusive body fat accumulating day to day. I ignored it for a long time until one day I was flipping through some photos I just developed. I saw a shot of myself where my back was facing the camera. For a brief moment I was confused as to who that was. I didn’t even recognize myself. I was embarrassed and ashamed to realize that the way I thought I looked, and how I actually looked were completely different. Is this what people were seeing?

At this point I bought a pair of scales to assess the damage. After three years of denial I weighed a hefty 246lbs. I was stunned. This wasn’t the worst part. I was beginning to have bad chest pains, and experienced dizziness and shortness of breath. I felt tired all the time. I was also becoming more and more depressed. So what was going on? Well, in a nutshell, I was eating the wrong foods, at the wrong times, and way too much of it.

I decided I was going to embark on a mission, to lose 30lbs, after all how hard can that be right. I mean I am a hard worker, should be a snap. So I did what most people do, head out to the local gym, sign up for a membership and personal trainer, bought all the protein bars, shakes and supplements they recommended. I even subscribed to a fitness magazine and purchased products they recommended. All in all I had spent a small fortune in order to get started, but this was fine because I was really committing myself.

I spent the next 3 months working out with my trainer twice a week, and on my own four times a week, with only Sunday off. My workouts consisted of 35-45mins of cardio six days a week and weight training for 60 Min’s 5 days a week. At first I started to lose weight by 4-5lbs a week. I was really excited, then slowly but surely, it started to drop to 2lbs a week, then not even one. My trainer told me ‘we need to tweak your diet a little, and work a little harder’. Believe me when I tell you I was busting my butt to get in shape. There were days when I was the only one in the gym at 1.30am doing cardio. The cleaners would joke around saying I needed to pay rent I was there so much.

And then it happened, at my next weigh in day I had actually gained 2lbs. My trainer assured me this was muscle gain, and not to worry as the scales don’t distinguish between muscle gain, and fat gain, or muscle loss and fat loss for that matter. I was skeptical because I felt so much weaker. I couldn’t bench or leg press what I could 3 months earlier, and if I was really gaining muscle, shouldn’t I be stronger. It didn’t make sense to me. Nevertheless I continued on to the end of our scheduled training program. When all was said and done I weighed 227lbs. I had lost 19lbs, not bad, but a far cry from my goal of 30lbs.

The worst thing about it, was that I didn’t look much different, just smaller. It was discouraging to me to think I had worked so hard for 3 months and was still not happy with the way I looked. I was still flabby, still undefined, and still felt tired all the time, some days even more tired than when I was heavier. Then it dawned on me, the trainers at the gym had taken specific courses and certifications to help their clients get into better shape. Perhaps they were not specific enough for me. I started to pay a lot more attention to the things I ate, the types of foods, as well as how they affected me, even the foods recommended by my trainer which I had taken as gospel. Here is what I found.

1. Many of the carbohydrates I was eating, even the healthy fibrous carbs, had an adverse affect on me.

2. I could stuff myself with veges and fruits all day long and still be hungry.

3. I would eat less then 36g of fat a day for weeks and still be flabby

4. Eating the forbidden red meat made me feel strong and induced powerful workouts

5. Eating coconut, a food rich in saturated fats curbed my hunger, and accelerated my fat loss

6. Eating larger meals less often, gave me unbelievable energy, despite the accepted idea of eating smaller frequent meals.

7. Healthy grains, such as oatmeal, and wheat bread slowed my weight loss.

8. Cardio sessions left me feeling weak and depleted, and you guessed it, still smooth, not cut

9. Weight training energized me

10. All the protein shakes I was using were making me fat

11. White rice surprisingly did not

12. Although yams were sweeter than potatoes, they helped my progress, where potatoes hindered

13. I could eat a lot, and I mean a lot of fish, and still get lean

I realize now that there is a uniqueness to the Polynesian body and how many of the accepted laws and practices of the fitness industry do not apply to us.

Last year I travelled to Cambodia. While I was there I couldn’t help but notice how slender and healthy the people of that culture were, despite being a third world country, or perhaps due to it. Obesity was practically non existent, and I thought to myself there must be something to the way they eat. I really doubt the average Cambodian has a membership to Golds Gym, and I didn’t see them out running all the time. Many of them where just sitting around on the streets.

When I flew back to the US my first stop was San Fransisco Airport, and there was no mistaking being back in America. Eight out of ten people I saw were either overweight or obese. I thought more about the Cambodian culture. What did they eat so ordinarily that kept them in shape? Then it came to me. They eat the foods their bodies have evolved to assimilate. It was an epiphany of mass proportion. Once I realised this I could apply it to myself right. Well, I couldn’t have been more right.

I began to research more and more about my heritage. Where did I come from? Who are my parents? Where are they from? What did the people from that region of the world eat before the introduction of commercially processed foods? Now I was getting somewhere. It all led to genetics.

I researched several case studies from the early sixties concerning cultures from the isles of the sea. It was amazing to see the differences in what they ate and how they obtained their food. It was also sad to see how their health has plummeted as they have strayed from that food. It has long been understood that in order to discover truth, you must go to the source. Unchanged and untainted, it is the wellspring from which all knowledge will flow. Cheap imitations may mimic the truth, but from their fruits, they will be revealed.

What I am speaking of are fake foods, fake fats, fake sugars, engineered additives, harmful chemicals, and unnatural preservatives, powders, shakes, and meal replacements to name a few. All in all they eventually reveal themselves through unsightly bodies, crippling health issues, and the loss of quality of life. As soon as I started eliminating all processed foods, refined sugars, and all so called health foods, my fat loss skyrocketed. In just a few weeks, I had lost 14lbs, and the weight continued to come off. My energy levels were very high, and this made me more excited and motivated to exercise. Over the next 3 months I had lost a significant amount of body fat and a total of 38lbs not including the 19lbs I had lost working my butt off. Funny thing was that I was working out half as much as I was to lose those 19lbs, as I did to lose the 38lbs. I was really onto something. All in all I had lost a total of 57lbs.

One day at the gym, a trainer was blown away by how I looked. He had the audacity to ask me ‘what happened?’, as if I had survived a life threatening disease. He then asked ‘what’s your secret’, and I found myself caught in the irony of telling a trainer that my secret was diet and exercise. This was the same advice I had paid over $900 for three months earlier. If only that advice were the right diet, and the right exercise for a Polynesian. Well, back to genetics.

I discovered something very interesting about my heritage. My parents are from the Polynesian islands. My father was born in Lotopa Upolu, and my mother in Suva Fiji. Genetic mapping shows that these cultures have strong links to the indigenous people of Taiwan, and that they are more closely linked to this culture than any other. I thought, hm, seems plausible; Polynesians love chop suey, eat a lot of rice, love their fish, even eat it raw like the Asian cultures. All I did was eat more of the foods they would have eaten on those islands fifty years ago, and why, because these are the foods my body has evolved to assimilate, despite the fact that my diet can contain as much as 60% saturated fats. Yep, you read it right. I can eat a lot more fat and be lean and healthy if they are natural fats, but I cannot eat a small amount of sugar and get away with it.

I went on to discover many important aspects of health that are specific to Polynesians, which cannot be addressed in the scope of this article, but here are some guide lines to help you lose weight safely and permanently.

Tip #1 You must lower your carbohydrates and eliminate processed foods

Before the white man showed up on the islands, organic foods were called ordinary foods. Nothing was processed, and the work effort alone to provide food for your family would be enough to keep anyone lean.

Tip #2 Increase your fiber intake

Tip #3 Drink more water

Get rid of sodas, sports drinks, alcohol, diet beverages, and caffeinated drinks, with the exception of green tea. Polynesians can benefit a great deal from green tea as it has been used by their ancestors (Asians) for medicinal purposes for more than 2000 years. Can’t be wrong.

Tip #4 Eat more protein

Eat whole foods in the form of organic pork, organic beef, and fish. Hey this is the best part. It’s what we love and our bodies are designed for it.

Tip #5 Replace your olive, vegetable and corn oils with coconut oil

Although olive oil is highly recommended and a mainstay of most diets, last time I checked no islanders descended from Italians. Again believe me when I say, our bodies have evolved to assimilate coconut oil better than any other. Various studies show that although there is little nutritional value in coconut oil, many people lose weight by eating it.

In the islands coconut and coconut cream is used in everything. Sixty percent of the normal diet is comprised of saturated fat compared to the typical western diet of thirty five to forty five percent fat, yet the islanders had less heart disease and less blood cholesterol. Diabetes, and colon cancer were completely absent before the introduction of processed foods. Problems arise when you combine these high natural oil diets with refined sugars, and processed foods containing chemicals, additives and preservatives that wreak havoc on the typical Polynesian body type. Things like spam, and canned corned beef that use fake fats are dangerous, and should not be eaten.

Tip #6 Avoid these foods at all cost

High Fructose Corn Syrup

Refined sugar

Fake fats such as trans fats and partially hydrogenated oil

Artificial sweeteners and diet foods

Dairy

Soy products

If you are eliminating all processed foods you will not have a difficulty with most of these. Also avoid processed meats, such as bacon and deli meats as they can contain modified salts, sugars and dangerous nitrates.

Tip #7 Keep a food journal

You may be surprised at how much you eat, or how little. If you keep a journal, you will have an accurate record of how your body is affected by different foods. This is a very useful tool.

Obviously there are so many things you can learn that break down the very specifics of dieting techniques, but trust me, these simple techniques will work for you as they have for me. I have kept the weight off for six years now, and feel terrific. I do recommend that you do more research as I did, to learn everything you can about successful weight loss, and how it relates to you specifically. Don’t be disheartened by all the information that is available out there. A lot of the diet strategies and work out programs won’t work for us, but some of them will. Educate yourself, for knowledge is power. Nothing is more important than investing in your own health, and that of your family.

Rapid or Slow Weight Loss – Which Method Brings Enduring Results?

Everyone wants to be slim in order to look handsome or beautiful depending upon whether the person is a male or female. To say straightforwardly people want to lose weight and want to do it fast. But which one is a better way, lose weight rapidly or to focus on slow weight reduction? This is a question that has puzzled researchers in light of the fact that the studies have indicated mixed results. Still, the findings do offer some great bits of knowledge.

Research About Rapid Weight Reduction

In a study done at the University of Florida scientists concluded that quick weight reduction is a better approach to attain enduring results. The faster group lost over 1.5 pounds for every week. The slower group lost just half pound every week. This study reported that females who shed pounds quicker were 5 times more likely than the other group to lose 10% of their body weight after eighteen months.

In this study, the people who shed pounds quicker kept food diaries and did not eat the same number of calories as the group that lost weight more gradually. These are remarkable observations since they are a hint into what will help you to attain durable results.

Further inferences were that the fast weight loss group was seeing noticeable changes in physical appearance and vitality levels. This encouraged them to go on with their plans relentlessly.

Defining Rapid Weight Reduction

The key to replying this question rests in defining “brisk weight reduction.” According to a few studies people who lose outrageous quantities of pounds in a brief period without first modifying their habits end up putting on the weight back. This bodes well since losing 5 to 10 pounds or more a week is taxing, and possibly unhealthy. It is something that is hard to keep up long-term since it often requires cutting an extreme number of calories or working-out for an amount of time and intensity level that is not achievable in the long run.

For example, if your target is losing 5 pounds per week, that means burning off 17,500 calories in one week. To get to this goal, you would need to cut your caloric intake by 1,500 calories for every day and burn 1,000 every day through intense work-out. This is extremely hard to sustain long-term for a great many people and doesn’t let you form new, healthy habits.

Setting Doable Weight Loss Targets

As showed by the above study, setting your weight loss goal at 1 to 2 pounds for each week is sensible and achievable. You can attain this by eliminating high fat foods and sugary snacks and beverages. Keeping a record of your food intake in a nourishment diary will help you to form healthy eating habits.

To wind up, you need to keep away from weight loss plans that urge you to lose a lot of or too little weight at once. You need to lose enough weight to see a difference and remain inspired to continue with your healthy habits. It is best to keep away from extreme eating plans that make you feel deprived and leave you longing for your old eating habits.

The Importance of Ambulance Services in Society

Certain situations in life require immediate medical care and a fraction of a second delay can drastically change somebody’s life. The ambulance service and paramedics are very important in society as they save hundreds of lives daily by responding to emergency calls. They operate from ambulance stations located in various areas with control centres that respond to emergency calls and dispatch them when needed. Whether the patient is in rural retreats, busy seaside resorts or large urban conurbations, they reach the emergency scene within minutes of the call.

The emergency ambulance service crew includes a technician and a paramedic. Once the paramedics arrive at the emergency scene they evaluate the situation and the condition of the casualty and decide whether to take them to the hospital or just treat them there. One of the important roles of the ambulance crew is to stabilize and treat patients quickly to prevent any mishap before the patient reaches the hospital.

They provide immediate and effective life-saving care in a safe and clinical working environment with maximum mobility. They are well trained in first aid skills to be able to deal with profuse bleeding, crush and fall injuries, cardiac arrests, road accidents, and much more.

During earlier times they were used to transport patients after the doctor or fire department rescue squad applied simple first aid. Mostly the patient would ride alone however, in some cases the doctor rode along in the ambulance. Today, ambulances come in a wide variety of shapes and sizes equipped with a huge range of essential pre-hospital emergency machines including heart defibrillators, intravenous drips, splints, oxygen, drugs and much more. All ambulances have radios installed in them. Many times ambulances also transport non-emergency patients that might be transferring to another hospital or treatment centre.

In some cases patients may be transported in an air ambulance which is basically an aircraft specially designed for providing emergency medical assistance in critical medical situations. An air ambulance is used when the patient has to be transported over a long distance or terrain or if the patient has to be quickly transported to a treatment centre. Air ambulances are equipped with basic equipment like ECG monitors, ventilators, medication and stretchers.

For more information regarding ambulance services in the UK refer to SearchMe4 online business directory.

Fast Bowling Injuries in Cricket

Introduction

Cricket is one of the oldest sports known to mankind. In the 19th and the early 20th century, cricket was meant to be played and enjoyed at a leisurely pace. However, with the advent of one day cricket in the mid 1970s and twenty20 cricket in the early 2000s, its popularity has soared immensely. The frenetic pace at which matches are being organised and played means players are at an increased risk of getting injured.

Epidemiology of back injury

A longitudinal study done in South Africa found that bowling (41%), fielding and wicket keeping (30%) and batting (16%) accounted for most of the injuries in cricket. The primary mechanism by which most of these occurred was found to be the delivery and follow through of the fast bowler (26%), fielding (23%), overuse (17%), ball impacts (17%), training (4%) and participation in other sports accounting for 3%. Whereas, an Australian study reported the injury prevalence as 14% for pace bowlers, 4% for spin bowlers and batsmen and 2% for wicketkeepers. Furthermore, the study goes on to state that pace bowlers who had bowled more than 20 match overs in the week leading up to the current match were more likely to sustain a injury in that match and the risk was even greater if the player was bowling second in the match- that is, having already batted in the first innings.

Lower back injury in fast bowlers

Of greatest concern are those conditions that occur due to overuse or repetitive stress like lumbar stress fractures. Bowling involves concomitant hyperextension of lumbar spine and rotation of the thoracic spine. In addition,, there is an added impact loading at back foot contact. This can cause injuries to the bones, joints, ligaments and muscles in and around the lumbar spine. The main lesions are spondylosis and spondylolisthesis.

Spondylosis

Is a stress fracture occurring at the pars interarticularis (a joint in the vertebral column). It is more likely to occur in a fast bowler having a mixed action rather than a side-on or front-on one.

Spondylolisthesis

Here the vertebral body has bilateral ununited fractures; the upper vertebral body tends to slide forwards on the vertebra situated below causing tensile stresses on the adjoining connective tissue. This condition is associated with severe back pain.

Clinical presentation

The usual presentation is of a dull lower back ache or pain. It is usually unilateral, occurring on the non bowling arm, i.e. a right handed bowler develops spondylosis on the left pars and vice versa. It is gradual in onset and is characteristically described as the ‘crescendo-type’ of pain, i.e. occurring at the end of day’s play initially, then earlier the next time around and so on, until the bowler is unable to bowl in the middle of a spell.

Clinically, spondylosis can be picked by the one-legged hyperextension test, i.e., occurrence of pain when the player bends backwards especially if standing on one leg. Clinical suspicion should be backed up by investigations. Use of plain radiographs, with oblique views, 99 Tc bone scans and CT is warranted. Bone response to spondylosis is in the form of pedicle sclerosis and hypertrophy. Absence of fracture with increased bone density in and around the pars, the pedicle and the posterolateral margin of the vertebral body is usually diagnostic.

Risk Factors

Traditionally, fast bowling lower back injuries have been thought to occur due to hereditary factors, lack of proper technique, poor physical conditioning, lack of pre-season preparation and overuse or increased workload in terms of the amount of deliveries bowled per spell or week or a season without allowing for recovery to occur. Various phases of delivery of a cricket ball by a fast bowler have been defined: pre-delivery stride (gather), mid-bound (delivery jump), back foot impact, stride length, front foot impact, release / delivery and follow through. A number of technical and biomechanical parameters are considered crucial to predict injury potential, namely the speed of and the angle of the run-up, positioning of feet at the bowling as well as the popping crease, shoulder alignment, attitude of the upper torso, non bowling arm position, release height, front knee angle during front foot impact and last but not the least, the follow through.

Also, there are two distinct ways in which pace bowlers deliver a cricket ball, side-on action and the front on action. These are defined in terms of the attitude of the feet, the non bowling arm, the shoulders, upper torso and the follow through. A third kind of action involves some features of either of these actions; characterised by the lower half of the body being front-on while the upper half is side-on. The biggest disadvantage of mixed action is that it involves greater rotation of the shoulders to realign with the rest of the body. This is then responsible for greater amounts of lumbar hyperextension and rotation than the other two actions and thus more injury prone. A recent study of fast bowling biomechanics done in 2008 has revealed a greater risk associated with a mixed action rather than with purely side-on or front on actions.

Treatment

Persistent back pain indicates underlying vertebral injury. In most cases, complete rest from the sport is the treatment of choice. It should ideally take 6 weeks for the bone to heal. During this time a progressive rehabilitation program can be initiated. This involves strengthening of the structures supporting the lumbar spine like the transverses abdominis, multifidus, spinal erectors and abductors of hip. Improving trunk core stability and flexibility of the trunk and lower extremity is also undertaken. Subtle modifications are made to the action to reduce the stresses on the vertebrae. Use of a brace while bowling to support the back is also advocated. Surgical intervention is rarely required.

Segmental wire fixation is probably the treatment of choice if surgery is indicated. Injury prevention Improved biomechanics (beyond the scope of this article)

Individualised fitness programs

· for strengthening the musculature of the mid section and the lower extremities and improving flexibility

Player management at professional level · 1. Pre-season sport specificity training, concentrating on rhythm to start off with and gradual building up of pace. · 2. Record of the bowling work load and rest periods should be maintained so that the fast bowlers in the squad can rested on a rotation policy, picking and choosing the players according to the work load and the importance of the match.

Player management at junior level

· 1. Work load is of more important in young fast bowlers since the vertebral growth cartilage is less resistant to repetitive stresses than the adult cartilage. Thus, young fast bowlers, especially, in their teens, should be discouraged form bowling long spells.

· 2. Mixed actions are best altered at an early age. Attempt to alter the action at a professional level are usually fraught with risks of the bowler losing quite a lot of pace and consequently confidence in his ability.

· 3. Early diagnosis of stress in the lumbar vertebrae thus preventing progression to spondylosis and spondylolisthesis. Regular investigations in this direction should be undertaken at a very early age so that corrective interventions can be implemented.

Application of these recommendations may not necessarily produce genuinely quick bowlers but may help them pursue prolonged ‘pain free’ careers and realise their full potential.