Minggu, 29 Mei 2016


A few months ago, we reported on an innovative creation from Israeli firm, Neurokeeper. The company has developed a portable device that’s able to detect a person’s risk of suffering from a stroke.
Well, it turns out the Israelis are pretty prominent in this area, as doctors at the Assaf Harofeh Medical Center in Tel Aviv have hit on a significant new discovery.

Hyperbalic Oxygen.

If you’re unfamiliar with the term, it’s basically pure oxygen. It’s used in hyperbaric oxygen treatment, where patients enter a pressurized chamber and breathe pure oxygen.
Because the air pressure in these chambers is up to three times higher than normal air pressure, the body sucks in more oxygen. This speeds the healing process – and, in turn, recovery time.
First used in the 1960s, the therapy is widely used to cure decompression sickness and a variety of other injuries that require faster healing (ones that affect sports players, for example).
It’s also used to treat stroke victims. But the Israeli team has uncovered a remarkable improvement to the process
Oxygen Rush: A Damaged Brain’s Wake-Up Call
In addition to being used on recent stroke victims, tests have revealed that hyperbaric oxygen treatment is even proving effective on patients who suffered strokes up to 20 years ago.
The fact that intensive, concentrated oxygen therapy can reawaken parts of the brain previously considered untreatable for so long is a major breakthrough.
The discovery is so significant, it’s even surprised Dr. Shah Efrati, head of R&D and the hyperbaric unit at Assaf Harofeh Medical Center: “I have been taught in medical school that such neuroplasticity [the brain’s ability to recover from trauma]so late after the acute injury cannot happen, but we see it.”

Together with scientists from the University of Tel Aviv, Efrati and his team are now treating 70 stroke patients with “metabolically dysfunctional” regions of the brain. Patients whose brains doctors have always believed were permanently damaged. And they’re blasting these areas with a 10-fold spike of oxygen to stimulate electrical signals in brain neurons.

According to Efrati, “The cells in this location… have enough energy to stay alive, but don’t have the energy needed for action potential – for full activity – and this is where hyperbaric treatment can help… With the hyperbaric therapy, when the metabolic function is being regained, the patient can speak again, and if it’s the motor area of the hand, then the hand will start moving years after the acute injury, which is something that was unbelievable to me.”
One patient whose brain damage left her unable to read and with memory loss calls the hyperbaric oxygen treatment “amazing… a miracle.” Another has regained the ability to walk and talk, following the therapy.
According to the American Heart Association, 795,000 Americans suffer a stroke every year. But Efrati believes his intensive hyperbaric oxygen treatment could help many stroke patients who believe it’s too late for further treatment.
He also says the ability to repair damaged cells could help improve the symptoms of Alzheimer’s and dementia sufferers.

Source : CURE HEALTH, May 21, 2016

Rabu, 25 Mei 2016


While more people are surviving strokes, many still face long-term disability. But Johns Hopkins research finds promising ways to retrain the brain and regain independence. Here’s what experts have learned about the power of physical rehab.

Another Potential Key to Stronger Stroke Recovery
In the research, Johns Hopkins expert Steven Zeiler, M.D., Ph.D. and colleagues also found that lower levels of a protein called parvalbuminindicated that the premotor cortex had rewired after stroke. Parvalbumin marks the activity of a special class of nerve cells called inhibitory interneurons.

Low levels of parvalbumin, and therefore lowered levels of inhibitory activity, is thought to help uninjured parts of the brain take over the injured parts, say researchers. This finding suggests that reducing inhibition in certain parts of the uninjured post-stroke brain (perhaps by using different medications and/or electrical stimulation) might promote recovery.

The good news about stroke: More people are surviving the initial stroke. The bad news about stroke: More people are surviving the initial stroke with disabilities which might have been minimized if they had received the kind of early, intensive physical rehabilitation that researchers find can improve function and reduce long-term disability. In fact, as many as 60 percent are left with diminished use of an arm or leg.

“When we speak about recovery we’re really talking about how the nervous system adapts to the brain missing a part of functioning tissue,” explains Johns Hopkins expert Steven Zeiler, M.D., Ph.D. “We’ve done all we could in the acute period, but the damage is done and it’s irreversible.” The question then becomes, “How do you get the remainder of the nervous system to adapt?” In other words, can we get other parts of the brain to pick up the slack? Turns out that yes, we can.

Retraining the Brain

A groundbreaking Johns Hopkins study from Zeiler and his colleagues confirmed what clinicians have long suspected—we can rewire the brain so that one part takes over functions typically handled by another, now damaged, area.

In studies conducted with mice, the researchers first taught the mice a special way to reach for food. The task is typically directed by a part of the brain called theprimary motor cortex, which is involved in physical coordination.
Then they gave the mice mild strokes that damaged this motor cortex. As expected, the mice could no longer perform the reaching task with their pre-stroke level of precision. Two days after the stroke, however, researchers began retraining the mice and, after a week, the mice performed the task just as well as before the stroke.

 The damaged part of the brain hadn’t recovered, says Zeiler. Instead, another part of the brain called the medial premotor cortex took over. To show that, researchers gave the mice strokes in that part of the brain and saw the reaching ability again disappear. But, once again, the mice relearned the task as yetanother part of the brain stepped in to handle the job of the medial premotor cortex

The damaged part of the brain hadn’t recovered, says Zeiler. Instead, another part of the brain called the medial premotor cortex took over. To show that, researchers gave the mice strokes in that part of the brain and saw the reaching ability again disappear. But, once again, the mice relearned the task as yetanother part of the brain stepped in to handle the job of the medial premotor cortex.

In a similar study, the researchers found that the earlier retraining started, the better. “If you retrained the mice after a one-day delay they got better, but after a seven-day delay they didn’t improve,” Zeiler says.

Johns Hopkins’ Kata Project, a collaboration between neuroscientists, engineers, animal experts, artists and entertainment industry experts, has designed an immersive experience for post-stroke patients who will try to “swim” as a virtual dolphin named Bandit. Upcoming clinical trials will determine if this unique experience helps patients recover motor function faster than the current conventional treatment of repetitive exercises.

The Power of Stroke Rehab

The take-home message of the research, says Zeiler, is that “early and intense” rehabilitation—even while still hospitalized—is critical in stroke recovery. Unfortunately, that’s not always the standard practice, he says. “As a medical community we need to push for immediate and intense change in rehabilitation.”

Rehab paired with healthy living will help stroke recovery and help prevent a second stroke. If you experience an ischemic stroke (caused by a lack of blood flow to a part of the brain), your doctor will recommend aspirin or another anti-clotting medication, Zeiler says. If you have atrial fibrillation, talk to your doctor about an anticoagulation medication such as warfarin. Other smart steps to take

Source : CURE NOTE, Massachusetts, USA

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Selasa, 08 Maret 2016



Akhir akhir ini dimasyarakat dikenal istilah Cuci otak atau Brain washing ataupun Brain Spa. Sebenarnya yang dimaksud adalah pembersihan pembuluh darah yang tersumbat dengan method DSA.  (Digital Subtraction Angiography).

DSA otak merupakan pemeriksaan baku dari pembuluh darah otak untuk melihat aliran darah di pembuluh darah arteri sampai ke jaringan lalu ke pembuluh vena secara langsung dan terus menerus menggunakan alat angiografi.

DSA otak merupakan sebuah metode untuk mendeteksi atau melihat adanya kelainan pembuluh darah otak. Kelainan itu berupa penyempitan, sumbatan, pelebaran pembuluh darah yang terjadi pada arteri dan vena.

DSA dilakukan dengan cara memasukkan selang atau kateter ke dalam pembuluh darah yang akan menuju lokasi di mana terjadi masalah di pembuluh darah.

Keuntungan dari DSA ini ialah bisa melihat kondisi pembuluh darah secara langsung karena selang kateter diletakan lalu dimasukan ke pembuluh darah
di pangkal paha. Lalu didorong menuju otak. Kateter pun terlihat memasuki otak, lantas ditarik dan ganti diarahkan ke bagian lain.
Radiologi intervensi ini adalah bidang kedokteran yang mempergunakan alat imaging untuk membantu memasukkan alat ke tubuh pasien, melalui lubang alamiah atau lubang buatan untuk penanganan kasus pembuluh darah, syaraf dan tumor.
Digital Subtraction Angiography (DSA) awalnya adalah teknik yang dilakukan untuk menggambar pembuluh darah, dengan menyemprotkan zat kontras ( IODINE) agar bisa dideteksi oleh sinar X. DSA bisa diaplikasikan pada pembuluh jantung, kepala, kaki, perut, hati, dll. Penggunaan iodine ini dilakukan karena cairan tersebut terlihat jelas pada sinar X, serta dapat dengan mudah diserap dan dikeluarkan oleh tubuh melalui air seni.
Saat pembuluh darah menyempit, rusak atau abnormal dalam berbagai hal, masalah dapat muncul termasuk migran dan stroke. Angiography dapat membantu dokter untuk membedakan sumber dari masalah dan menjabarkan kerusakan dari segmen pembuluh darah yang sedang diperiksa.

DSA Lebih Nyaman
Pada DSA konvensional, untuk menggambar pembuluh otak, cairan kontras disemprotkan melalui pembuluh leher sebagai pembuluh terdekat dengan otak.

Kini dengan teknologi terkini dan sistem digital yang terkomputerisasi, DSA bisa mendeteksi abnormalitas pada pembuluh darah secara lebih jelas dan terukur, serta penggunaan cairan kontras seminimal mungkin.

Sehari sebelum tindakan dilakukan pemeriksaan darah lengkap atas Kholesterol lengkap, trigeleserida, fungsi ginjal (ureum, creatinin), asam urat, gula sewaktu (tanpa puasa), Hb, Natrium dan Kalium.
Diingatkan juga agar pasien tidak mengkonsumsi obat pengencer darah, sehari sebelum tindakan SDA.

Kemudian datang para dokter spesialis untuk melakukan pemeriksaan melalui gambar thorax jantung, rekaman jantung  (walaupun gambar MRI jantung baik) internis dan paru paru.
Pemeriksaan oleh dokter spesialis ini dilakukan di ruangan yang tersedia khusus untuk pasien yang akan melakukan tindakan DSA.

Jika hasil laboratorium dan pemeriksaan para dokter spesialis tersebut diatas menemukan sesuatu yang tidak normal, maka tindakan SDA akan ditunda sampai suatu saat kondisi pasien dalam kondisi normal.

Hasil laboratorium, foto MRI, foto Brain mapping dan pemeriksaan oleh para dokter spesialis tsb diatas kemudian diserahkan kepada dokter radiology yang akan melakukan tindakan DSA.
Waktu pemeriksaan darah di laboratorium hingga pemeriksaan para dokter spesialis memakan waktu setengah hari, jika pemeriksaan dimulai sepagi mungkin sekitar jam 7.30.

Biaya yang dibutuhkan untuk pemeriksaan darah lengkap dan biaya para dokter spesialis relatif terjangkau, sebesar Rp 3.800.000-  (Awal bulan Maret 2016)

Tindakan DSA

Pagi hari pasien ditempatkan diruangan sendiri dan disana dilakukan pengecekan dokter atas kondisi keseluruhan pasien termasuk mengukur tekanan darah, angkat tangan dan kaki, senyum, lidah dan juga periksa mata oleh dr mata dimana alatnya dibawa keruangan tersebut.

Kemudian pasien didorong pakai tempat tidur keruang tindakan SDA, lalu dipindahkan oleh 2 asisten dokter ke tempat tidur yang menjadi satu dengan perangkat DSA.

Proces :
Proses tindakan DSA mulai dilakukan seperti urutan berikut ini :

Mula mula menyayat beberapa centimeter di pangkal paha buat tempat kateter yang sangat halus dimasukkan. Pertama, zat berwarna dimasukkan untuk melihat bagian bagian otak yang bermasalah (tersumbat).
Lalu obat disemprotkan/ditembakkan ke pembuluh darah melalui kateter yang sangat kecil hingga mencapai jantung dan juga mencapai leher, yang paling dekat dengan otak. Selanjutnya dari leher menyebar keseluruh penjuru otak termasuk pembuluh darah yang tersumbat.

Ketika obat mencapai otak kanan, maka disekitar mulut akan terasa rasa mint untuk beberapa saat. Ketika obat melewati otak sebelah kiri, akan terasa sedikit hangat. Pada saat itu dokter bertanya :”Ada rasa mint” dan “Ada rasa hangat?”.

Dokter juga mengamati kateter yang bergerak baik ke jantung maupun kea rah leher dan juga melihat aliran obat di monitor komputer disamping kiri atas tempat pasien dibaringkan. Diluar ruang tindakan ada juga staf yang memonitor seluruh tindakan di komputer.

Jumlah tube obat yang disemprotkan bervariasi tergantung luasnya cakupan. Bisa sampai belasan tube seperti yang saya dapatkan. Satu orang asisten dokter siap selalu menerima tube obat yang kosong dan memberikan tube pengganti yang baru.

Si pasien tetap terjaga, tidak dibius dan relax sambil mendengarkan musik instrumentalia yang damai dan prosesnya hanya berlangsung sekitar 30 menit.
Asisten dokter mengingatkan pasien agar kepala tidak bergerak dan menutup mata untuk menghindari radiasi.
Sedang dokter sendiri kadang berkomunikasi dengan pasien dan sesekali bergumam mengikuti irama instrumentalia.

Saya mendengar ada pasien yang bergerak karena bersin mengganggu proses tindakan. Padahal sebelum tindakan suster sudah meanyakan apakah pasien allergy.
Ada juga pasien yang kedinginan didalam ruang tindakan.

Beberapa orang keluarga pasien diijinkan masuk keruangan tindakan dengan memakai jacket khusus yang beratnya sekitar 7 kg dan mereka diijinkan mengabadikan foto atau video.

Mendekati proses selesai, ada rasa ingin buang air kecil, asisten dokter membantu memberikan pispot. Kemungkinan karena banyaknya cairan obat yang disemprotkan akan membuat pasien ingin buang air kecil.

Paska tindakan:
Selama 4-6 jam pasien didorong kembali keruangan sendiri untuk dilakukan pementauan sebelum meninggalkan Rumah Sakit karena tidak perlu menginap.

Selama 4 jam tersebut, pasien akan sering buang air kecil dan keluarga pasien akan membantunya dengan pispot mengingat pasien sedang diinfus diatas tempat tidur.

Tiga orang dokter dan beberapa perawat melakukan pemeriksaan termasuk dokter radiology dan dokter mata dengan alat periksa matanya.
Mereka berpesan agar:
- Banyak minum air putih untuk membersihkan obat yang disemprotkan.
- Kaki, paha kanan jangan dilipat sampai 90 derajat selama 2 sampai 4 hari agar pangkal paha yang dilukai tidak sakit/bengkak.
- Selama seminggu tidak dilkukan physico therapy, tidak membawa mobil atau sepeda motor.

Dampak yang saya langsung segera setelah tindakan DSA adalah :
- Tangan dan jari tangan kiri serta tengkuk tidak kaku lagi.
- Tidur menjadi pulas
- Kedua belah mata menjadi lebih jelas membaca, sesuai pula dengan hasil pengecekan mata dengan alat oleh dokter mata.
- Kaki kiri lebih ringan dan sedikit bisa diangkat

Metode terapi cuci otak ini menuai kontroversi terutama dari kalangan medis.
"Di Indonesia, brain washing dipromosi sebagai sarana mengobati stroke. Itu dilakukan oleh seorang dokter radiology.
Jadi istilah brain washing sebagai terapi cuci otak menyesatkan, jauh menyimpang dari maksud aslinya," tulis Prof. Dr. dr. Moh Hasan Machfoed, Sp.S(K), M.S, Ketua Umum Perhimpunan Dokter Spesialis Saraf Indonesia.

Padahal semua obat dan cara pengobatan medis baru harus dibuktikan terlebih dahulu melalui penelitian secara bertahap. Mulai dari percobaan pada hewan, uji klinis pada manusia, hingga publikasi ilmiah. Namun prosedur cuci otak ala Indonesia ini nampaknya tidak mengindahkan kaidah ilmiah tersebut.

Tidak ada pasien stroke yang berobat langsung ke radiologi karena keahlian radiologi adalah dalam bidang penunjang medik. Jadi tidak menerima pasien baru langsung, namun pasien rujukan dari spesialis saraf atau bedah saraf.

Tidak ada istilah brain washing atau cuci otak untuk pengobatan stroke, melainkan Endovascular treatment atau Neurovaskular intervensi. Pihak yang mengerjakannya juga bukan radiologi, tapi juga bisa seorang Kardiolog, Neurolog atau Bedah Syaraf yang mendalami bidang Endovascular treatment/Neuro intervensi/Radiologi intervensi.

Nama tekniknya adalah DSA, Digital Substraction Angiography untuk diagnostik, yang bisa dilanjutkan atau bersamaan dilakukan tindakan Coiling atau Stenting, Balloning atau Embolisasi atau Trombolisis, tergantung jenis patologinya.
Selain itu, teknik DSA ini juga bisa digunakan untuk menangani penyakit kanker. Dalam pengobatan tumor atau kanker, intervensi membuat kita bisa mencari pembuluh darah yang paling banyak memberi makan pada sek-sel abnormal tersebut. Setelah ketemu, disitulah obat antikanker diberikan, sehingga efeknya terlokalisasi hanya pada sel tumor tersebut dan tidak mengenai/menybar ke sel lainnya yang sehat.

Bagi penderita stroke tidak mempermasalahkan adanya kontroversi intern kedokteran, yang penting dilakukan oleh para tim dokter ahli di Rumah Sakit terkenal dan sudah dikenal luas dalam masyarakat.

Jangankan berobat ke Rumah Sakit, ke klinik, ke pengobatan alternatif juga penderita berusaha mendapatkan pengobatan dan selalu ramai, entah pengobatan itu punya izin ataupun tidak.
Bagaimana perkembangan sebulan kemudian setelah latihan bersama psyco therapy akan saya update kemudian. Atau silahkan email :
Pinondang Situmeang......c2_pin@rocketmail.com

Senin, 29 Februari 2016


Smiling nurse


Every institution or organization dealing with services always doing their job with human touch, smile, polite, gentle, fast and kept nice to the costumers.

Services in health sector including Hospitals got a special attention because related with human fate. Every worker got comprehensive training how to treat costumers, including follow the manual book or SOP, Standard Operation Procedure.

What we get in practice, might be different, the nurses work based on manual book but  less in human touching such as fake smile, less communication, less feeling. They preferred to watch the instruments then talk to the sick instead.
Their aim are how to get credit, recognized, promotion from superiors.

In daylight activities they are quite busy with work load, administrative, bathing, feeding etc, then the time less for caring sick people, what they feel, what are their pain.

Then late at night most of them take a nap or chatting each other to kill the time, while sick people assumed sleep well. Actually most of them just closed eyes, try hard to get sleep while endure the pain, careless.
Ironically, the more high nurses position, the more less interact with sick people. They tend to assigned younger nurses or even job trainers to do the job. The boss only to control the job done by the subordinates.

But when doctors come to visit, the boss come forward to accompany and described everything what they done so far, even the boss didn't interacted with the sicks, not even entered the room, but got the credit.

We may classified nurses in ICU rooms/Intermediate room and regular/VIP rooms. In ICU/Intermediate rooms are selected, skillful nurses more than regular rooms because dealing with life and death. Generally speaking, used to see the critical even passed people every day, so their feeling tend to careless.

Unbelievable something anomaly may happened in ICU, the family be careful, not complain  of the nurses behavior, worry if the nurses less attention to the sick. Family tend to carry foods or fruits fore nurses in charge in order to give more attention to their sick family.
Only few senior nurses behave kind, communicate to the sick, but generally they are careless, less communication with desperate patients who need special attention from the nurses.

Nurses in regular rooms behave more polite, care and communicative with the sick and the family. The pain could be ease or communicate with doctors related. In regular rooms we may ring anytime for help that impossible done in ICU. 

Our status in regular rooms categorized as normal sick in stable condition after critical period is over. Nurses more relax and more attention dealt with sick and the family.
In regular rooms may we met some kind, helpful and communicate nurses. Once, when a nurse realized that I am a poet she asked me to write her a poem. When I hand over a poem to her, she is crying.

Hospital management should take more special attention to train nurses about human behavior factor, not behave as a robot doing work mechanically by the book but more human touching, feeling, symphatetic, true smile, polite and other positive human being.

This is my own experiences in certain hospital in Jakarta, but I thought it happened across the country, even a friend of mine hospitalized several times in Singapore hospital told the similar experiences with mine. Unfortunately he went go for good.