Ventricular Septal Defect (VSD) – Pathology And Clinical Manifestation

Ventricular Septal Defect (VSD) is the commonest congenital heart conditions which may be an isolated VSD or as part of a complex heart condition which may be a complete endocardial cushion defect, tetralogy of fallot or truncus arteriosus. It is also referred to as ‘hole in the heart’. The defect is seen in the septum that separates the right and left ventricles.

It is a disease complex that affects both boys and girls and because of this defect there is a left to right shunting of blood i.e movement of blood from the left part of the heart to the right part.

PATHOLOGY

This defect can occur any where along the septum and most commonly at the membranous part of the septum. It may also be seen at the muscular part and often not are usually multiple and tiny leading to what is referred as ‘Swiss cheese appearance’. In the normal dynamic of blood flow in the heart, the pressure in the left side of the heart is higher than the right and thus blood initially flows from the left side of the heart to the right side which will lead to flooding of the lungs and a reduction in the cardiac output which is the amount of blood pumped from the heart into the systemic circulation.

CLINICAL MANIFESTATION

Depends on the size of the defect and the level of left to right shunting. In small sized VSD, these children are usually asymptomatic and such defect is detected during routine medical check up Medium and large VSD tend to present early in childhood where the child will get fatigue easily as seen in pausing while breast feeding, excessive sweating, poor weight gain, recurrent chest infection, early onset congestive heart failure. Signs may include tachycardia(fast heart beat), tachypnea(fast breathing), tender hepatomegaly(liver), precordium bulge in long standing heart failure, enlarged heart, a murmur which is an abnormal sound heard with the aid of the stethoscope is heard which is usually a systolic regurgitant murmur of grade ll to V heard best at the lower left sternal border. When pulmonary hypertension sets in, a loud P2 may be heard and a diastolic rumble is also heard at the apex of the heart when there is excessive left to right shunt.

VSD is a treatable condition treated by both medical or surgical modalities. With the availability of sophisticated imaging tools like electrocardiography and MRI the type and location of the defect can be made with ease and treated thereafter. It is worth mentioning that smaller VSD then to close up spontaneously before the age of 4 and even larger ones tend to reduce in size.

Urine Analysis and Laboratory Tests

The data of Urine analysis usually taken are divided into two; qualitative and quantitative data of Urine laboratory tests. As their names imply, qualitative tests is to test for the qualities of the Urine such as colour, transparency, etc, while quantitative test, try to find the amounts of some indexes in the Urine such as volume, specific gravity, amount of pathologic components of Urine (blood, proteins, creatinine, etc).

Qualitative data of Urine laboratory tests

Colour of Urine

• In the first day of child’s Life, Urine is colorless

• On the 2nd-4th days- dark-reddish, because big quantity of Urea is excreted.

• In breast fed infants the urine is almost colorless until they start to drink fruit juices and to eat other foods at the age of 4-6 months

• In formula fed infants, all children and grown-ups, the urine is yellow like straw.

Changes of Urine color can be physiological. For example;

• Colorless urine is excreted when a person drinks a lot of fluids

• Urine acquires Orange color when the food contains a lot of carotene (carrot);

• Urine will be pink after eating red-beet;

• Some medicines influence the Urine colour. SO, rifampicin causes the red color of Urine, analginum and sulfacylamides-pink, mitroxolinum-saffron-yellow.

Some Urine discoloration is of diagnostic value in case of Kidney disorders:

• Dark-brown Urine is a pathognomic symptom of virus hepatitis; the cause of such color is big amount of bile pigments hyperbilirubinuria); characteristic sign is forming of yellowish foam after shaking such Urine.

• Smoky brown Urine, which resembles tea or cola, is formed in case of nephron damage, when RBCs pass through the basal membrane of glomerular capsule and losses the hemoglobin. It is the main sign of acute poststreptococcal glomerulonephritis

• Bright red color can be found when “fresh” RBCs pass into urine in case of trauma, kidney tuberculosis, crystals, cystitis, urethritis, renal tumor.

• Dark-violet discoloration is the sign of considerable RBCs hemolysis in case of poisoning, Rh-conflict, mistakes during blood transfusion etc.

Transparence

The Urine can be cloudy only in newborn child for 2-3 days after birth. After that each healthy person excrete transparent Urine. Cloudy hazy, darkly opalescent Urine can be found in case of Urinary tract infection, enlarged amount of crystals, RBCs or WBCs, pus or fats in Urine.

Quantitative data of Urine Laboratory tests

Diuresis means the process of Urine production. The Urine-volume (UV per 24 hours) is its laboratory reflection. Its meanings depend on age.

Pathological changes of Urine volume

• Poliuria is diagnosed when the urine volume exceeds the normal ranges in 2 times and more. It is the often sign of disorders with other systems decreasing of cardiac edema, diabetes mellitus, diabetes insipiduc). Renal poliutia develops in case of back progress of nephritic edema, chronic renal failure.

• Oliguria means the decreasing of daily urine volume to of age ranges and less. Renal Oliguria is one of the most significant manifestations of renal failure. There also can be extra-renal causes of Oliguria such as massive profuse bleeding, diarrhea, poisoning, cardiax failure, shock. It is very important to identify the reason of Oliguria because the therapeutic plans can be quite different when the Urine volume decrease less than 5% of normal data or there is no Urine per whole day. It is one of the most dangerous conditions for the child’s life and needs the emergency medical help.

• Anuria can be

1. renal-the kidneys don’t form the urine due to considerable damage of their tissues.

2. postrenal (mechanical)-the Urine is produced, but it doesn’t go into the bladder because of upper tract or bladder neck obstruction.

• Nocturia, the normal correlation of daytime and nighttime Urine Volume is 2:1. That means that because of bigger fluid intake and physical activity, Urine excretion is more intensive during daytime. If the night Urine volume is bigger, it is the manifestation of decreased renal function.

Ph of Urine

This sign depends on age, food habits, prescribed medicines and differs in different people as well as in one person in different periods.

Specific gravity

It is the concentration of electrolytes and other substances dissolve in Urine. Decreasing of specific gravity can be seen in case of drinking a lot of fluids, severe renal failure, back progress of edema, diabetes insipidus. Increasing is observed at Oliguria, diabetes mellitus, excretion of marked amount of protein. Excretion of 0.1g of glucose per 11 of Urine causes enlargement of specific gravity on 0.004; 0.4 of protein-on 0.001.

Indexes of Urine analysis which are deviations of the normal ones are indications for metabolic disorders

Advanced Bodybuilding Workout Routine For Monster Mass!

As bodybuilders solidify their adherence to the rules of bodybuilding, something starts to happen. They begin to succeed. They grow like they’ve never grown. Their strength reaches new level, and their bodies reach new sizes. Consistency delivers results. And as results begin to accumulate the body is suddenly able to handle new workloads, and must, in order to continue to grow.

There are two ways a body can be challenged in order to stimulate new growth- Training heavier and training longer. Training heavier is always the goal of beginner and intermediate bodybuilders. But as one reaches advanced levels of bodybuilding, the weights become more and more dangerous, and the body’s joints and tendons become more and more susceptible to injury. The alternative to heavier weights is to train longer – up to two hours per body part.

By definition, this is over training. If you have any element of your bodybuilding regimen unchecked, you will fail. Nutrition, rest, and supplementation need to be covered 100% or you are wasting your time. But if you are able to keep all factors completely in check – and increase them when warranted – you might be ready for 120 minute body part training.

For this example, we’ll examine a chest routine. Suppose you normally complete 4 sets for upper chest (incline bench press), 4 sets for lower/middle chest (flat dumbbell presses) and 4 sets for chest/delt tie-in (cable crossovers). You complete your workout in about 45 to 60 minutes. You will keep this workout, but add new movements to supplement the target areas. Your new workout would look like this:

-3 Sets Flat Bench Press (Warm-Up & Overall Chest)

-4 Sets Incline Bench Press (Upper Chest)

-4 Sets Incline Dumbbell Flies (Upper Chest)

-4 Sets Flat Dumbbell Press (Middle Chest)

-4 Sets Flat Dumbbell Flies (Middle And Outer Chest)

-3 Sets Decline Bench Press (Lower And Middle Chest)

At this point, you would take your ‘recharge’ break. If you’re done, go home. But if you have it in you to complete the 120-minute workout, eat a piece of fruit, stretch a bit, and complete the workout. Your weights will now be lighter and your rep sets higher (10 to 15 reps per set)

-3 Sets Weighted Chest Dips

-4 Sets Dumbbell Pullovers

-4 Sets Cable Crossovers

-5 To 10 Minutes Of Stretching

This workout is not for the faint of heart. You will be sore the next day. Initially, you may need a day off following this routine for the central nervous system (CNS) to recover. Each week, you should be able to add one more day like this to your training regimen until you’re doing 4 to 5 days of 120-minute routines.

Have your post workout nutrition ready ahead of time (whey shake with dextrose) and consume 15 minutes after training with cold water. Hit the showers. Drive home and tackles a very protein-rich, carb-rich meal. Spaghetti and meatballs will beat out a chicken salad any day after this routine. Training for 120 minutes per body part is only recommended for advanced athletes who have all nutritional, sleep, and supplementation bases covered. See if it’s right for you!

Cancer, Epigenetics, and Nutrigenomics – How Food Affects Your Cancer Genes

One of the causes of cancer is abnormal genes. Cancer causing genes are called oncogenes and genes that prevent cancer are called tumor suppressor genes. Cancers can occur when the normal genes are not functioning normally. Genes, as you know, are the blueprints to the body. They tell a cell what it will be and what it will do. We could not function if the process did not run well. There is a system in place that is designed to keep good genes running and suppress bad genes. This process is called epigenetics.

Epigenetic changes are modifications to the genome that are heritable during cell division but do not involve a change in DNA sequence. Expression of genes is not regulated by the DNA sequence, which is the same in every cell, but by epigenetic marking and packaging. This process regulates chromatin structure through DNA methylation, histone variants, post-translational modifications, nucleosome positioning factors or chromatin loop and domain organization.

How can this cause cancer? Well, if a tumor suppressor gene is abnormally turned off, or an oncogene is turned on, then cancer (carcinogenesis) can occur. One key is a chemical change to the DNA called methylation. First, we need to define the process to make it clearer.

DNA contains four bases: adenine, guanine, cytosine, thymidine, but there is a fifth base methylated cytosine. DNA methyl-transferase (DNMT) produces methyl-cytosine where cytosines precede guanine (CpG). The CpG areas are not symmetric but clustered in CpG islands located at promoter regions. The promoter region is the region at the beginning of a gene and it controls the start of gene transcription. If the promoter is off, then the gene never is expressed.

Abnormal methylation in cancer has been known for 20 years. Hypo-methylated areas turn on normally silent areas such as virally inserted genes or inactive X-linked genes. Hyper-methylated areas silence tumor suppresser genes.

We know that cancers have abnormal levels of methylation and we know foods can help prevent cancers. Is there a link between foods and epigenetics? Yes!

The study of food nutrients and their effect on disease through epigenetics is known as nutrigenomics. This is a growing field, in fact, it is exploding. A Google search for the term nutrigenomics produces 127,000 entries.

Epidemiologic studies suggest there are bad foods and good foods. BAD: red meat, processed meat, grilled meat, dairy, animal fat, partially hydrogenated fats. Good: Fish, fruits, vegetables, tree nuts, omega-3 fatty acids, whole grains.

You can study the epigenetic effects of bad or good foods. I’m going to talk about some of the cancer preventing foods and how their mechanisms include epigenetic effects.

Foods with epigenetic effects include green tea, cruciferous vegetables, and grapes. Usually we hear about antioxidants and foods. Antioxidants are important but there are beneficial substances in foods called polyphenols which can affect genes. Of the polyphenols, different forms exist but flavonoids are the most highly cited for health benefits and are found in a variety of vegetables and fruits. Types of flavonoids include flavanols in tea, isothiocyanate in cruciferous vegetables, anthocyanidins in grapes and berries, flavonone in citrus fruits, flavonols in onions, isoflavones (genistein) in soy.

All tea contains polyphenols, but the highest levels are in green and white tea. Green tea has been well studied and appears to have anti-cancer benefits. In China, green tea drinkers are 50% less likely to develop gastric or esophageal cancer (Carcin 2002; 23 (9): 1497), and 2 cups daily added to topical tea extract reversed oral leukoplakia (J. Nutri Biochem 2001; 12 (7): 404).

Green tea has powerful antioxidant effects but it also helps to balance normal methylation in DNA. In fact, one study in esophageal cancer cells demonstrated that EGCG from green tea is able to turn on tumor suppressor genes that had been chemically silenced by methylation (Cancer Research 2003;63:7563).

Cruciferous vegetables include broccoli, cauliflower, kale, Bok choi and their anti-cancer effects have been demonstrated in epidemiologic studies. These powerful vegetables not only induce enzymes that break down carcinogens but they also inhibit DNA methylation allowing tumor suppressor genes to thrive. Inhibiting abnormal methylation also helps cruciferous vegetables to inhibit the cancer causing action of tobacco smoke by preventing the formation of nitrosamine-DNA adducts.

Grapes, which contain reserveratrol, are excellent for heart health and they have anti-cancer activity. Grapes work by preventing the formation or initiation and promotion of cancers. They don’t have methylating actions as discussed above but they work by modulation histones.

Histones are the chief protein component of the DNA chain (chromatin). They act as spools for the DNA to wind around which then shortens the length of the DNA to 30,000 times shorter than an unwrapped strand. This process not only allows the long DNA chain to fit into a cell but also plays a role in gene expression because how the genes are wound affects which are exposed and available for turning on or off. Rolling the spool a different way would expose other genes and change their expression.

Histones are modified after translation by acetylation, methylation, phosphorylation, ubiquitination. The changes occur at lysine residues (except for phosphorylation of serine or threonine). When the histone is acetylated the charge is changed and the histone loosens its grip on the DNA strand and the DNA unwinds, exposing the genes to be transcribed, or repaired.

When histone tails (H3,H4) are acetylated, genes are transcribed, when they are deacetylated, genes are turned off. Histone deacetylases work to maintain deacetylated sites.

Resveratrol, found in grapes, activates Sirtuins; SirT1 (Sir2 proteins). There are at least 7 Sir2-like proteins and they are histone deacetylators. Sirtuins are induced in animals during starvation states. They seem to have a life preservation effect. Interestingly, when an animal is starved, it can live longer. When the calorie intake of rodents was decreased by 40% in rodents, they actually lived 50% longer and appear to have fewer chronic diseases. The same benefit occurs when rodents when they are given resveratrol in their diet.

Resveratrol deacetylates histones causing tighter packing of the chromatin and a lower level of transcription of DNA. This silencing of the DNA is thought to be the mechanism of life prolongation, heart health, and its beneficial actions to prevent cancers. This is why grapes or red wine is beneficial to your health. How much red wine should you drink? No one knows for sure, but any beneficial effects might be negated after two glasses a day because of the alcohol. I wouldn’t advise drinking more than this until more is known. The data is very promising, but more research is needed.

Our knowledge of disease expanded in the genomic era due to the human genome project but the study of genes is not enough. Epigenetics is a very important and complicated concept that helps explain how genes are turned on or off. As more studies are completed we will be able to unlock the mechanisms to diseases and produce new therapies that could turn off bad genes and turn on good genes. More importantly, these studies will demonstrate how foods affect your genes and can prevent or reverse diseases or cancers. Nutrigenomics, the study of how food chemicals (nutrients) affect genes, is a growing field and promises to change the way we look at and eat our meals. Some of the most beneficial foods include green tea, cruciferous vegetables and grapes, but don’t stop there. The more fruits and vegetables the better when it comes to your health.

Cardiac Asthma Treatment – Get The Facts Right

Cardiac asthma is wheezing due to congestive heart failure and in the true sense it is not asthma. Clinically it is a condition caused by severe reflexive blocking and or by edema of the lungs. It is an asthmatic-type breathing caused by sudden blockage of the pulmonary circulation. The bronchial spasm in cardiac asthma is caused by back pressure from the left side of the heart to the lungs. Symptomatically cardiac asthma is quite similar to lung asthma.

Patients with heart failure or heart valves that do not open properly experience shortness of breath not necessarily accompanied by wheezing, coughing, increased rapid and superficial breathing, increased blood pressure and heart beat rate and a feeling of uneasiness. Symptoms usually occur with exercise or at night after going to bed. Cardiac asthma is usually due to a major mechanical fault of the heart. The reduced pumping efficacy of the heart leads to a build up of fluid in the lungs. This build up of the fluid causes the air passages to narrow up and eventually cause wheezing and other related symptoms. It is a life-threatening condition and one must seek medical advice immediately on experiencing any symptoms.

The key to effective management of cardiac asthma is right diagnosis, which includes differentiation between patients who wheeze only due to acute heart failure and those who wheeze from other disorders, such as asthma, chronic obstructive pulmonary disease, pneumonia or acute respiratory distress syndrome. Treatment is directed at improving the pump function of the heart along with medications.

Treatments mainly focus on controlling the night coughs, control of the edema, control of inflow load and the amount of residual blood in the left ventricle. Diuretics (water pills) free the lungs of excess fluid and other medications such as morphines, nitrates help the heart muscles pump more effectively. The wheezing gradually stops when the heart failure has been well controlled.

In some patients who suffer from asthma and heart failure simultaneously, treatment is required for both conditions. A combination of bronchodilators, supplementary oxygen is generally effective in controlling the asthmatic symptoms in addition to treating heart failure in such patients. Corticosteroids are prescribed only when the patient with acute cardiac asthma has not responded well to initial therapy. Corticosteroids usually take long hours to give peak effect. If the asthma is caused by a heart valve that is not working properly or a hole between the heart chambers, surgery or other procedures may be suggested.

Acid Reflux Cough – How to Identify and Put an End to It

One of the symptoms of acid reflux that’s often overlooked is a chronic cough. This is because at first glance there appears to be little or no relationship between the two. It can also be attributed to the fact that a cough is a relatively common occurrence and the result of numerous other causes, such as a cold, the flu, bronchitis, etc.

The truth, however, is that acid reflux is the third leading cause of a chronic cough, following on the heels of bronchial asthma and post-nasal drip (when the sinuses produce too much mucus).

Gastroesophageal reflux disease (GERD) is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compounds: acid, bile, and pepsin. Stomach acid is used in the digestion of food and can be a major irritant to the esophagus due to its tendency to damage tissues.

The symptoms of acid reflux include nausea, belching, a sore throat, wheezing, difficulty swallowing, a pain in the chest that’s often mistaken for a heart attack, and in some cases chronic coughing. In fact, nearly three out of every four sufferers experience night time symptoms (such as coughing, snoring, and chest pain) that are not generally thought of as typical acid reflux symptoms. An acid reflux cough is one of these. It’s caused when acid reaches the vocal cords and is passed to the lower airway.

Even in relatively small quantities, this can trigger coughing. Since such small quantities can initiate an acid reflux cough, sufferers are often unaware that they even have GERD. In fact, they may not have heartburn in the traditional sense, considering that there’s little or no damage to the lining of the esophagus when the acid level is so limited.

So, how can you be sure that your nagging cough is not cold or flu related? If you have none of the other typical symptoms, such as the sniffles, a slight fever, throat irritation, heaviness in the chest, etc., accompanying your cough, then you need to consider other causes. Though you can experience an acid reflux cough without experiencing any of the other symptoms of GERD, if you’re experiencing both, then it’s time to visit with your doctor. He can help you determine whether or not your cough is acid reflux related.

There’s another clue that you might want to consider as well. Most people will turn to cough syrup when they have a nagging cough. Surprisingly, an acid reflux cough probably won’t respond to cough syrup. However, it may very well respond to an antacid. If you find that’s the case in your situation, then that’s a big time clue of the cause behind your cough.

Beyond antacids, your physician may want to prescribe something stronger. If your acid reflux is severe, this may include a proton pump inhibitor such as Nexium, Prevacid, Prilosec, Protonix, or Aciphex. These medications are designed to block acid production, which allows the lining of the esophagus an opportunity to heal. Side effects, however, can include abdominal pain, diarrhea and headaches.

If your acid reflux is relatively mild, all it may take to put an end to your chronic cough is some lifestyle changes. For instance, you’ll want to eat more often throughout the day, with your meals being smaller. You’ll want to allow at least three hours after your last meal before you go to bed (this reduces the odds that stomach acid will rise into the esophagus). You’ll want to avoid foods that are commonly associated with GERD, such as chocolate, dairy products, fried foods, and citrus fruits. These little changes may very well be all you need to put an end to your acid reflux cough.

Essential Oils – The Ancient Oil Known as Onycha – A Great Wound Healer

Onycha (Styrax benzoin) is mentioned only once in the Bible:

“The Lord said to Moses: Take sweet spices, stacte,[another name for myrrh] and onycha, and galbanum, sweet spices with pure frankincense and make an incense blended as by the perfumer, seasoned with salt, pure and holy; and you shall beat some of it into powder, and put part of it before the covenant in the tent of meeting where I shall meet with you; it shall be for you most holy. When you make incense according to this composition, you shall not make it for yourselves; it shall be regarded by you as holy to the Lord.” Exodus 30:34-36

Benzoin was used both as medicine and as incense in the ancient world. They used it in perfume and blended it in holy anointing oils, and used it as an ointment to heal skin wounds. Since the 16th century however, it has been used as a tincture for respiratory complaints and for cuts and skin conditions. To make a tincture, the oil is placed in alcohol. Benzoin is a rather sticky substance that has a characteristic vanilla-like fragrance. The oil comes from the benzoin trees that grow up to 65 feet in height. These are tropical trees that come from places like Java, Sumatra and Malaysia. To get the oil, solvents must be used and later removed from the oil.

How Can Onycha (Styrax Benzoin) Be Used Today for Healing ?

Modern uses of onycha (benzoin) include stimulating renal output, relieving colic, flatulence, and constipation and it may help control blood sugar levels. Onycha can be inhaled for sinusitis, bronchitis, colds, coughs and sore throats. It is anti-inflammatory and is used for dermatitis and skin wounds. This oil can relieve stress when used in massage. As a nurse, I used tincture of benzoin countless times for wound dressings, and when patients were diaphoretic, I used it to help tape to stick to the skin.

Onycha can be inhaled, used in massage, and applied topically in wound dressings. It is a non-toxic, non-irritating oil but some may be sensitive. Want to learn more about this healing oil and many others? Consider becoming a certified aromatherapist. Educational courses in healing energy and aromatherapy can help you understand how essential oils heal the body/mind/spirit. The Institute of Spiritual Healing & Aromatherapy is offering courses throughout the United States.

Back Pain – What is Axial Back Pain?

Axial back pain is the most common type of low back pain. It is usually non-specific – meaning that the anatomical structure responsible for the pain need not be identified because symptoms are usually self limited and resolve. Unlike other low back issues, this type of pain does not travel into the buttock, legs and feet, or other areas of the body. Axial back pain can vary widely from sharp or dull pain, constant or intermittent pain, or mild to severe pain.

Following are characteristics of axial back pain:

  • Low back pain that gets worse with certain activities, such as certain sports.
  • Low back pain that gets worse with certain positions, such as sitting for long periods.
  • Low back pain that is relieved by rest.

An exact diagnosis as to which structure is causing the low back pain rarely has significance to treatment. Further evaluation is only necessary when the pain is severe and chronic. A variety of structures in the lower back can cause axial or mechanical lower back pain, such as a degenerated disc, facet joints problems, and damage to soft tissues – muscles, ligaments, and tendons – and it is often difficult to identify which anatomical structure(s) is the underlying cause of the pain.

As a general rule of thumb, if your back pain is bad enough that it wakes you up from deep sleep, you should consult a physician to rule out possible serious conditions, such as an infection, tumor or fracture.

Treatment for axial back pain is conservative (not requiring surgery). Treatment may include one or a combination of the following:

  • A short period of rest (e.g. one or two days)
  • Physical therapy and active exercise and stretching
  • Ice and/or heat application for activity related pain relief
  • Appropriate medications for pain relief
  • About 90 percent of patients with axial low back pain recover within six weeks. If axial
  • low back pain persists for more than six to eight weeks, then additional testing and/or injections may be useful in diagnosing and treating the source of the pain.

Jerusalem’s Best Hospitals

Jerusalem, the capital of Israel, lies in the Judean Mountains nestled between the Mediterranean Sea and the Dead Sea. Together with East Jerusalem it forms the largest city of the country. It is a great tourist attraction for religious and cultural reasons.

Bikur Cholim Hospital is situated in the heart of the city at the junction of Strauss and Hanevi’im, Jerusalem, 492. It was set up in 1826 and over the years it has emerged as one of the largest and most important hospitals of Israel. The branches of medicine for which the hospital offers treatment are surgery, pediatrics, ENT, internal medicine, obstetrics and gynecology, nephrology, neurology and urology. The hospital also has an Alternative Medicine Clinic, Neonatal Intensive Care Unit, Baby Welfare Clinic and a Women’s Clinic. The emergency department at the hospital offers quality services to its patients and is also the largest emergency department in Israel.

The Shaare Zedek Medical Center located at Jaffa Road is a century old hospital that provides high quality medical care. The hospital started as a modest healthcare center with 20 beds and is now a modern hospital with state of art infrastructure. It is a multidisciplinary hospital of international repute which specializes in the following fields: cardiology, cardiothoracic surgery, women’s health, medical genetics, neonatology, pediatric neurology, oncology and palliative medicine, laparoscopic surgery and Gaucher’s Disease. The Emergency Department at the hospital is well equipped and this department includes the Kennedy Leigh Trauma & Resuscitation.

The ALYN Pediatric and Adolescent Rehabilitation Center was set up as a voluntary organization by Dr. Henry Keller, an American orthopedist in 1932.  The multidisciplinary hospital is dedicated to providing modern and advanced care to children. The hospital provides an array of medical and paramedical services that include physiotherapy, speech therapy, rehabilitation, cerebral palsy, acquired brain damage, respiratory disorders, and psychosocial problems. It is also is the leading pediatric orthopedic clinic in the country treating both simple and highly complex cases. 

The St John of Jerusalem Eye Hospital Group is part of the Foundation of The Order of St John which is the oldest charity in the world. This hospital is known for its high level of services and specialization in eye related ailments throughout the West Bank, Gaza and East Jerusalem. The hospital has an ISO accreditation and is staffed by well trained doctors and paramedical staff from within the country and from offshore countries as well. This modern hospital runs a 24 hours emergency room and also runs an outpatient department and treats patients regardless of their ability to pay. The hospital specializes in Retinal, Corneal and Pediatric services. The address and telephone number for the hospital are; Nashashibi Street, Sheikh Jarrah, Jerusalem 97200; Tel: 00 972 (0)2 5828325    

Hadassah’s Medical Organization has two medical centers at Jerusalem; one is at Ein-Karen and the other is at Mount Scopus. Both the hospitals have a large team of doctors and support staff which makes them ready to deal with all kinds of medical emergencies and routine procedures and care. The Hadassah is known for its proficient services and contemporary infrastructure. Both the centers are multidisciplinary and the medical branches for which they provide services are orthopedic surgery, neurosurgery, oncology, rehabilitation, dermatology, E.N.T, endocrinology, hematology, genetics and metabolic disease, bone marrow transplant and psychiatry. The hospitals are also outfitted with Emergency Rooms, Trauma Units, Pain Clinics and Blood Banks. The Emergency Department at Ein-Karen provides comprehensive and quick care to patients for a large range of medical problems and is supported by modern technology. The Mount Scopus Emergency Department receives a large number of patients each year owing to its highly specialized care especially in the neurological and cardiac surgery field.

Everything You Need to Know About Physiotherapy

It is a suitable form of treatment for people of all ages, as it helps them to minimize their pain and take the peaceful path to recovery.

1. Various areas of Physiotherapy

Physiotherapists are actually well trained to heal care professionals who specialize in musculoskeletal problems. Some of the areas that this healing technique covers include intensive care, mental health, neurology and strokes, long-term conditions like arthritis and breathing problems.

Other areas are men’s and women’s health, orthopedics and trauma, sports medicine, workplace health, pediatrics, and caring for the elderly as well as education and health promotion.

Some physiotherapists spend their spare time volunteering with a multi-disciplinary team that does pro-Bono work for hospitals and community based free clinics. These services can be found at private hospitals, doctor’s clinics as well as most sports clubs.

2. Body systems that this technique heals

Physiotherapy centers help you deal with a lot of your physical health problems and treat them by linking them to the body’s systems. Some of these include the musculoskeletal system that includes bones, joints and soft tissues of our body. The neuromuscular one covers the human brain and the central nervous system, while the cardiovascular system controls the way the heart functions and the blood circulation. The respiratory system is one of the most important areas of all with organs that help us breathe.

3. What physiotherapists precisely do

Physiotherapy centers are run by accomplished professionals who help people who are in need for their services. Those affected by pain, ailments or even paralysis can approach some of these places to heal by means of movement and exercise.

Physiotherapists work systematically by taking into account a patient’s current level of fitness, mental and physical health and considering their specific requirements in question. You could try some manual therapy techniques in which the healer works with you using their hands and body heat in order to relieve your tired muscles of pain and stiffness. Doing this encourages blood circulation and makes blood flow to the injured part of your body.

An innovative and new form of physiotherapy is aquatic therapy. It is carried out in the water with a number of other techniques to help ease the pain of a patient. Several other techniques like the use of heat, ice and even the art of acupuncture can help clients a very great deal.

People may visit these therapists for preventative as well as therapeutic reasons. The best part is that you do not need a doctor’s referral to see a therapist. Problems like sitting, or walking, being unable to hold a pen are all included with their physical therapy and you can rest assured that you will be cured in time.

People who are plagued with problems that are a lot more sinister like speech impairment, memory loss, even bladder control issues have been known to benefit from physiotherapy. You basically heal by retraining muscles to do their primary movements like they way doctors rehabilitate stroke patients. The severity of your pain will be deciding factor when it comes to the amount of time it will take for you to recover.

Acid Reflux and the Phrenic Nerve

“Doc! Since you started adjusting me I haven’t had any acid reflux!” I hear this almost every day. It’s either heartburn, acid reflux, tightness in the chest or whatever. This even happens in cases that have persisted for years.

Recently, one patient happily informed their medical doctor about the abrupt stop to 15 years of heartburn problems after starting chiropractic care, to which the family physician responded that there is no connection between the spine and acid reflux, so that’s impossible. I was surprised with that response. Perhaps the patient misunderstood the doctor, or simply the doctor wasn’t sharp on their anatomy.

The explanation is actually quite simple, and is the reason that so many people over the past century have seen this same result after chiropractic care.

As a matter of fact, here’s a quote from a paper written over 50 years ago on the topic:

“Many a patient has presented to the doctor of chiropractic in a state of desperation, having already spent thousands of dollars on cardiac and gastrointestinal testing that proved negative. Their elusive symptoms included tightness in the chest, restricted breathing, heartburn, acid reflux and a bounding pulse in the abdomen. Not only were they miserable, but frightened at the lack of a diagnosis. The chiropractor’s unique and hands- on examination found pressure, irritation and tenderness along the patient’s neck at the level of cervical vertebrae 3, 4 or 5. Following the chiropractic analysis and adjustment of the misaligned spine, the symptoms subsided, often readily.”

So what’s the connection between the neck and acid reflux disease? The phrenic nerve.

The phrenic nerve passes from the cervical spine, levels C3, C4 and C5, down through the lungs to the diaphragm. In school, the saying “C3, 4 and 5 keep the diaphragm alive!” was used to help remember the details about the phrenic nerve.

This nerve controls the diaphragm, a thick sheet of muscle that forms a floor beneath the lungs and heart. In order for food to get to your stomach, it has to pass through the diaphragm to get there.

It is commonly understood that the spine can pinch a nerve and cause a spasmed neck or back, tingling or burning arm or leg. When it pinches or irritates the phrenic nerve; the diaphragm, being a muscle, it is subject to tension and spasm. This restricts breathing, and if spasm of the diaphragm is pronounced, the opening through which food passes is altered, causing acid reflux from the stomach and possibly what is called a hiatal hernia. Likewise, the same muscle tension can close upon the aorta and vena cava, causing a throbbing heartbeat.

Asthma, heartburn, or tightness and aching under the ribs are often the result of a diaphragm under tension because of spinal pressure on the phrenic nerves.

Chiropractic is the logical first step in resolving any of these problems, or to prevent them so that one can do as the music professor instructed- “use your diaphragm!”

Martial Arts – Pressure Points on the Body

In my last article I covered pressure points of the arm. In this article I will discuss points on the rest of the body. I understand that there are about 108 pressure points or tsubos used in the martial arts. Great! I can easily memorize the location of just 108 points, right? Not so fast there, cowboy. Just knowing where the points are located does not mean you can use them in a fight. Points must be struck at the proper angle and direction and at the proper depth in order for them to be truly effective.

The use of these points, regardless of the mechanism that causes them to work, is an in depth study that is not just limited to remembering where the dots are located. Some points can only be used if you set them up by the activation of other points. Some points are hard to access due to their location on the body. Some points are effective only if you strike them, others only if you press, rub or knead them. Getting accurate and reliable information is difficult.

Examining an 8″ x 10″ page with the outline of a person on it, covered with dots and a generic description of the point, its location and resultant effects just does not cut it. It is too generalized. In acupuncture the tsubos are stimulated with a needle. Accuracy is a must. In striking the points there is a little leeway but you still need to be accurate and employ the right angle and direction of the strike. How hard you hit is also a factor in determining the effectiveness of the strike.

Another problem is too little knowledge is a dangerous thing. Learning the points then blasting a training partner just to see if it works is not a good idea. Severe and permanent damage can occur and death is a real possibility. DON’T HIT SOMEBODY JUST TO SEE IF IT WORKS. You also need to know the revival techniques of restoring energy flow. If you don’t know, don’t do it.

THE HEAD

The head is a massive arena for pressure points. Even the ear is a cornucopia of pressure points, yea, a microcosm of the entire human body’s points. Let us examine just a few of the more effective points.

FACE

Starting at the crown of the skull the following points are available:

1. Governing Vessel 21, 22, 23, 24

Strike is downward toward the center of the head.

Weapon: Hammer fist, elbow,

Loss of consciousness/death can result due to over stimulation of the cranial nerves.

2. Governing Vessel 26

The point is located below the nose and above the upper lip. This is generally used as a rub point. Severe injury can result if struck in a down and inward motion. I’m not going to tell you the position it must be struck from for liability purposes but it will break the neck.

Weapon: Back fist, knife hand, elbow

3. Conception Vessel 24

The point is located below the lower lip, centered on the jawbone. It is struck toward the center of the head and downward.

Loss of consciousness: over stimulation of the cranial nerves.

Weapons: Hammer fist, regular fist, knife hand

4. Conception Vessel 23

The point is located above the hyoid bone. If struck with sufficient force death is instant. It is one of the eight magic points. If you break the hyoid bone and it severs the Vagus nerve the heart and lungs stop working.

Weapon: knife hand, regular fist, ridge hand, spear hand.

5. Gall Bladder 1

This point is located at the outside corner of the eye. It is the beginning of the Gall Bladder meridian. A strike here can be done from a 45° angle to the head in an upward and inward direction.

Unconsciousness is caused by over stimulation of the cranial nerves. The orbital bone in this area is one of the easiest, if not the easiest bones in the human body to break.

Weapons: regular fist, palm heel, elbow, knee, back fist.

6. Triple Warmer 23

This point is also located at the outside corner of the eye. It is struck at a 45° angle to the head in an upward and inward direction. If this point is used in conjunction with GB 1 and the strike is from rear to front of the skull it may dislodge the eyeball from its socket.

Unconsciousness is caused by over stimulation of the cranial nerves.

Weapons: Regular fist, palm heel, elbow, knee, back fist.

7. Gall Bladder 14

This point is located just above the center of the eyebrow. It is struck with an inward direction to the skull.

Loss of consciousness is a result of over stimulation of the cranial nerves.

Weapons: regular fist, palm heel, elbow, knee.

8. Gall Bladder 3

This point is located one inch in front and one inch up from where the top of the earlobe joins the skull. This is the thinnest part of the skull. There is no known resuscitation technique for a temple strike. You get to go to the hospital and have holes drilled in your head to relieve the pressure from a ruptured temporal artery.

Weapons: regular fist, single knuckle fist, palm heel, elbow, knee.

BACK OF HEAD

BASE OF SKULL

1. Gall Bladder 20

This point is located bilaterally on the outside base of the skull. Also known as the Plane of Willis. It is the flat spot at the base of the skull. It is struck at a 45° angle inward and upward to the center of the head.

Unconsciousness is due to overstimulation of the cranial nerves.

Weapons: Hammer fist, elbow, regular fist, Willow Leaf Palm (cupped palm), back fist.

2. Triple Warmer 17

This point is located behind and below the ear in that little grove behind the jawbone. Some authorities indicate that this is an extreme death point. It is utilized with both strikes and presses. If you strike this point from rear to front there is a good possibility of dislocating the jaw. It is best pressed with a single knuckle fist. Grind back and forth as you press inward to the center of the skull.

Loss of consciousness is a result of overstimulation of the cranial nerves.

Weapons: Regular fist, one knuckle fist, back fist (open hand strike).

3. Bladder 10

This point is located bilaterally on the spine below the skull. Strike inward to the center of the head.

Loss of consciousness is due to over stimulation of the cranial nerves.

Weapons: Palm heel, regular fist, elbow, Willow Leaf Palm.

4. Governing Vessel 17

This is the occipital notch. Strike this point in an upward and inward direction.

Loss of consciousness is due to the overstimulation of the cranial nerves. A strike here may also cause a severe concussion.

Weapons: Willow leaf palm, palm heel, regular fist, elbow, knee

NECK

1. Stomach 9/10

These two points are struck at the same time. They are located over the carotid sinus on the medial anterior portion of the neck.

Loss of consciousness can be explained by several mechanisms. Pick one.

a. Striking two points on the same meridian can cause unconsciousness.

b. Disrupting the blood flow to the brain. A strike can cause backpressure that the brain cannot handle and unconsciousness ensues.

c. Below the carotid sinus is a bareceptor that monitors blood pressure. When struck with sufficient force it sends a message to the brain that the blood pressure is too high. A message is then sent to the heart to slow down or stop and the result is unconsciousness.

Weapons: regular fist, one knuckle fist, knife hand, spear hand, elbow.

2. Large Intestine 18

This point is located on the leading edge of the Sternocleoidmastoid muscle about half way up the neck. This is a good grab point for Spirit Throw and Japanese Full Nelson.

Weapons: regular fist, one knuckle fist, elbow, fingertips.

This is not an all-inclusive list. There are a multitude of points in this region of the neck. These are just the ones I use on a regular basis.

TORSO

1. Conception Vessel 22

This point is located at the top of the sternum in the notch. The strike to this point is done with the fingertips generally inward and downward. It is fairly safe to press this location but strikes can be serious.

Loss of consciousness is caused by trauma to the trachea.

Weapons: Fingertips, single knuckle punch.

2. Conception Vessel 15

This point is the solar plexus. It is called the solar plexus because of its central location. Organs affected would include heart, lungs, liver, kidneys, and stomach. Breaking the xiphoid process can lacerate the liver and cause internal bleeding, which if not treated, can be fatal.

Loss of consciousness is from trauma to the above named organs. There can also be a loss of motor function.

Weapons: regular fist, single knuckle fist, elbow, knee, ball of foot.

3. Conception Vessel 4

This point is located about two inches below the umbilicus (belly button). It is struck in a 45° downward direction. If struck with sufficient force you can cause an opponent to soil their shorts.

Loss of consciousness is caused by trauma to the small intestine and bladder.

Weapons: regular fist, palm heel.

4. Spleen 21

This point is located in the medial lateral portion of the rib cage. An easy way to find this point is to place two fingers under your nipple and trace a line straight around to the center of the rib cage. If you locate this point on a partner and press on it with a single knuckle fist you will get a substantial reaction.

Loss of consciousness results from trauma to the lungs and associated nerves. It will also shut down the lungs, stop breathing and circulation.

Weapons: regular fist, one knuckle fist, heel, palm heel, elbow, back of hand/wrist, knee and just about anything else you have!

5. Stomach 28

This point is located two finger widths below the nipple. Strike this point in a downward angle of 45°.

Loss of consciousness is cause by trauma to the lungs and associated nerves. You may also break some ribs in the process.

Weapons: regular fist, single knuckle fist, palm heel. Knife hand, front kick (kick them in the knees first!).

6. Liver 13

This point is located on the tip of the 11th rib. An attack to this point is from a 45° angle to the body and downward at a 45° angle. If struck in an upward motion with sufficient force to break the rib (and they break easily!) the blow can be lethal if it lacerates the liver.

BACK

1. Governing Vessel 15

This point is located on the spine between the shoulder blades. Attack this point in an inward direction.

Loss of consciousness is a result of trauma to the spinal cord, aorta, heart and lungs. A heel stomp as in Rear Reverse [ Ushiro gyaku a.k.a. Wellington Sheep Hold] can be fatal.

Weapons: regular fist, elbow, palm heel, heel, knee.

2. Gall Bladder 25

This point is located over the kidney just below the rib cage. This is a nasty point to get hit on all by itself. Used in conjunction with a GB 20 strike produces a knockout that I can personally attest to. Strike is done from a 45° degree angle to the body from the rear.

Loss of consciousness is a result of trauma to the kidney and associated nerves.

Weapons: regular fist, shin kick, roundhouse kick, elbows, back of hand.

3. Governing Vessel 3

This point is located on the tip of the coccyx. Attack this point in an upward motion.

Loss of consciousness is caused by trauma to the entire spinal cord.

Weapons: front kick, knee strike.

LEGS

1. Gall Bladder 31

This point is located medially on the outer thigh. It is located over the Ilio-tibial tract of ligaments and the vastus muscle. This is a favorite target for kick boxers and when kicked properly can cause the leg to quit functioning.

Weapons: Shin kick, knee, regular fist.

The knee has a multitude of points on and around it. A solid side thrust kick will hit something!

2. Spleen 10

This point is located on the inner thigh about three inches above the knee. Strike inward toward the center of the leg and downward. This will cause the knee to collapse. I have heard of ki sickness being caused by kicking this point with the ball of your foot.

Weapons: knees, instep, shin, heel, regular fist.

3. Bladder 57

This point is located at the juncture of the gastrocnemius muscle and the Achilles tendon. The point is attacked from the rear of the leg to the front. According to the Bubishi if this muscle is split it causes dementia.

Loss of consciousness is trauma to the tibial artery and nerve.

Weapons: side thrust kick, front kick.

There are a multitude of points on the foot but accessing them in the dynamics of a fight is not likely. A good stomp to the instep can do wondrous things to the attitude of an opponent.

The last point I want to indicate out is Kidney 1. It is located in the center of the foot. Ashi Katsu is performed on the left foot. By slapping this point vigorously you may be able to quickly restore someone about to faint. I can personally attest to this as I used it on my team sergeant, who was about to faint, after getting shots prior to going to jungle training in Guam, 1985 (watch the trailer on my website).

This is by no means an inclusive list. These are just the points I use in my martial art. There is much to learn in applying the Kyusho techniques to the various arts. It requires study of not only TCM but also western medicine, physiology, physics, anatomy, and a great deal of practice. It requires the conscious effort during practice to apply the principles to your techniques and a concerted effort to make the art your own. The study of the martial arts is a harsh mistress, but worth it.

Train hard!

Water Exercises For Herniated Discs – Top 3 Basic and Simple Exercises to Release the Pain

Water exercises are a good way to get rid of the pain caused by a herniated disc. Water-based exercises basically offer the same benefits you get from the associated land-based exercises. One great advantage to exercise in the pool is that water makes it easier for pain-patients to perform the movements.

This is due to some great property that water has:

  • It takes the pressure away from the discs while you exercise
  • It diminishes the risk of unwanted injuries due to inapt movements
  • It makes exercising feel easy and even relaxing

Here are some of the most basic water exercises for herniated disc problems that help relieve the acute pain:

  1. Marching or Running Exercise – Either in place or from one end to the other of the pool move your legs as if you were marching or running. Bring your knees as high as you can while doing it. While this exercise would be unthinkable on land for most of the herniated disc sufferers, in water it is a very useful and effective training method. If executed regularly, this routine helps stretching the back and thus making it more flexible.
  2. Leg Raising Exercise – Grab hold of the pool side with one hand. Stand on one leg (bend this on a little) while outstretching the other one in front of you for a few seconds. Repeat this movement 5 to 10 times and then do the same with you other leg. This exercise strengthens and stretches your lower back and hip muscles at the same time.
  3. Knee Raising Exercise – Again, hold tight on the side of the pool either with one hand or with both hands & your back to the wall. Lift one knee as close to the chest as you can and wait for a few seconds than put your leg back down and repeat with the other one then with both. Do it all over again for a number of times.

When you exercise in the water regularly you help release a lot of the acute pain caused by your herniated disc. Do not stop after you feel better, your pain will most certainly come back. These exercises along with other on-land herniated disc exercise options are designed to help you combat the symptom and not the root cause of the problem.

Home Remedies For Common Cold, Nasal Blockage, Sinus Infection

A cold and nasal blockage is very common and irritating problem that mainly occurs in cold weather or due to seasonal change. Common cold can also cause by consuming refrigerated foods and drinks. People with weak immune system are the target of this condition. Cough, throat pain and headache make this condition even worst. You can treat this annoying condition using simple yet highly effective home remedies.

Cold Home Remedies

Below are some of the popular home remedies for cold and cough. The ingredients used in these home treatments are completely natural and herbal and can be easily found in your kitchen cabinet or backyard.

1. Take 10 grams of bishop’s weed (ajwain) in a clean cloth and tie all ends of the cloth with a rubber band. Heat this cloth in a vessel. Now sniff this. Nasal blockage is cleared by this home remedy.

2. Mix 5 ml fresh garlic (lahsun) juice with holy basil (tulsi), four black peppers (kali mirch), a clove (laung) and a teaspoon of honey. Consume this mixture twice a day to relieve this condition.

3. Suck liquorice (mulethi). This is an effective home remedy for cough, cold and throat irritation. You can also take mulethi along with honey 2-3 times daily.

4. Garlic (lahsun) is a valuable herb in the treatment of cough and cold. The fresh juice of garlic (10-15ml) along with an equal amount of honey is a useful home remedy.

5. Drink lukewarm water, especially after meals. This will relieve and calm throat irritation and sore throat.

6. Nasal blockage can be cleared by putting eucalyptus oil (3 drops in each nostril). It will also clear up sinus affections.

7. Tea prepared from holy basil (tulsi) and garlic (lahsun) is beneficial to soothe the agitated respiratory passage.

8. Avoid exposure to cold winds. Keep your head and chest fully covered with woolen garments.

9. Boil 500mg cinnamon (dalchini) powder in milk. Add 5ml of clarified butter (ghee) and drink this milk to provide relief in cold at bed time.

10. Eat bread of whole grams with clarified butter (ghee). Drink a glassful of lemon juice mixed in hot water afterward to get much strength and relief. It will clear nose, reduce sneezing spells and soothe the throat.

Disclaimer: The reader of this article should exercise all precautionary measures while following instructions on the cold home remedies from this article. Avoid using any of these products and ingredients if you are allergic to it. The responsibility lies with the reader and not with the website or the writer.

Copyright © Ryan Mutt, All Rights Reserved. If you want to use this article on your website or in your ezine, make all the urls (links) active.

Do NOT Do This To Remove Tonsil Stones

I don’t have to tell you that dealing with Tonsil Stones is a serious hassle. Whether it’s the on-again off-again sore throats and feeling of something stuck back there, or the truly nasty breath, there are no shortage of reasons for feeling like you simply want them out of there. The bad breath alone can be very disruptive to life, not to mention embarrassing. It’s can make you feel desperate and like you’d try just about anything to get them out. Luckily there are a variety of safe methods for removing and preventing tonsilloliths. But…

This Can Damage Your Tonsils

If you spend much time at all researching remedies that you can do at home, you will eventually hear about people using irrigation to remove tonsils. In a nutshell, irrigation is just shooting a stream of water at the tonsil stone to dislodge it. You will hear some people giving advice to use a water pick for this purpose. But do not use a water pick to remove tonsil stones. Let me repeat this for you: do not user a water pick or any mechanical device to remove tonsil stones.

There are safe ways to use irrigation to remove tonsil stones (which I’ll get to in a second) but aiming a water pick at your tonsils is not one of them. Here’s why. The jet of water from a water pick – even on its gentlest setting – is strong enough to actually tear the tissues of your tonsil. Trust me, tearing a tonsil is not pleasant. It hurts, and it can bleed quite a lot. If you Google tonsil stones and water pick you will find people who have removed tonsil stones this way, but you will also find numerous accounts of people who accidentally tore their tonsil even on the lowest setting. This is not a rare occurrence.

How To Safely Use Irrigation To Remove A Tonsillolith

Don’t let the horror stories about injuring your tonsils with a water pick scare you away from using irrigation. There is a very safe method of using irrigation to get the job done. Instead of a water pick you use a small plastic syringe with a curved tip. You may have seen one of these if you’ve ever had a tooth extracted as some dentists provide them with the after care instructions. You can also generally find them at the pharmacy or medical supply store. They are simply a plastic tube with a plunger on one end and a narrow, curved plastic tip on the other.

The technique is simple. You just fill the barrel with some warm water (some people say salt water works well), aim the tip at the tonsil stone and push the plunger to start squirting it with water. The key to avoiding injury is to just start off gently. If it starts to feel uncomfortable, stop. Try to hit the tonsillolith from different angles. This method is not only safer but more effective than using a water pick because you have much more control over the force and direction of the stream of water.

There Are Many Good Ways To Remove A Tonsil Stone

If the technique above just isn’t working, don’t make the mistake of pushing harder. There are many safe ways to remove a tonsil stone. If irrigation isn’t working it’s just time to try something else.