Discussion Response Essay Example | Topics and Well Written Essays - 250 words - 1

Discussion Response - Essay Example Government machinery was deployed in both cases to ensure that the leaders’ ideologies were implemented. This took the form of mass violence, the establishment of concentration camps, and strict control of every aspect of the people’s lives as you rightly state. I have learnt from you one main difference between Hitler and Stalin that never was on my mind; the faà §ades they presented in public. I like the way you put it; Stalin’s speech and presentation in public light was positive while the actions he did or oversaw were quite the opposite, unlike Hitler who never minded what others thought of him. That said, I will like to add a point to your post in relation to the differences of the two regimes. While both regimes were oriented toward the good of the state as opposed to the individual, they were different in the sense that the Nazi movement focused on eliminating inferior races and people from the country while the Soviet regime was focused on eliminating class differences as noted by Kershaw and Moshà © (1997). In some sense, therefore, the two regimes used the same means (violence and strict controls) to meet different ends (establishing a pure Aryan state versus eliminating class

Carl Rogers Theory Essay Example | Topics and Well Written Essays - 1750 words

Carl Rogers Theory - Essay Example Furthermore Rogers believed that if the clients turned inwards and examined themselves they would find the means to end hurting. This treats persons as inimitable, values their dreams and goals and elevates their particular feelings about the world. Rogers sees the role of the therapist primarily as an empathic listener who must enters into the client's journey of self-actualisation. Jones and Butman in Modern Psychotherapies succinctly describe the goal of the self-actualisation process. It is the ongoing process of bringing self-view, the ideal self and the real self into line with one another. DeMarinis in her book, Pastoral Care, Existential Health and Existential Epidemiology attempts to conceptualise pastoral care. In her research she noted several themes that most people accept as belonging to pastoral care. The main ones of these are care of the soul and inner life, primarily Christian, spanning the complete life cycle, under the direction of God, providing a shelter from a hard world, connects God to life, is part of the whole work of the church not only in specific sessions and is not to be confused with psychology. This essay will keep in mind these main themes as it explores the helpfulness of Roger's approach. Jones and Butman begin their exploration of Roger's theory by claiming that the emotional content of person centred therapy is intuitively appealing. They have a valid point here. Person centred counselling differs from the mainstream notion of psychotherapists as distant experts and is alluring in its humanity based ideas. It promotes a positive view of humankind and its central tenet is that humans are, at heart, good and filled with the possibility to change and achieve anything. Furthermore it concentrates on goals and dreams and endorses the need for positive regard for others. In addition Roger's theories are based on his clinical work and endless research. Rather than remaining a fixed theory he developed his ideas as they were tried out, constantly responding to criticism and results. This dedication to base his hypothesis on what actually worked enhances the appeal of the theory and lessens the distance between pure theory and practical administration. Finally, the simplicity of Roger's theory and the fact that it is accessible to everyone gives it credibility. Its founding principles are not complicated and so the majority of people can follow his train of logic and see how he came up with his conclusions. Person Centred Therapy's Contributions to Pastoral Ministry Roger's contribution to psychotherapy has traditionally been attractive to a religious audience because his formulation of a helping relationship embodies the Christian ideal of a loving servant to others. Rogers and Butman notice how it, 'appears to give us valuable clues and guidance on how to respond to those in misery or distress, or how to concretely 'love the brothers and sisters'.1 It is a guide for the pastoral worker because it treats people as inimitable, complete beings in the same way that Christianity would. The pastoral worker takes this view because she believes humans are made in God's image and must be treated with the appropriate respect. The qualities that a therapist must have to undertake this kind of help are almost identical with the qualities the Bible describes a Christian should have; grace, unconditional love, servant-like. Moreover it focuses on 'unconditional regard'

Stakeholder Analysis- Fracking Essay Example for Free

Stakeholder Analysis- Fracking Essay Pursuing hydraulic fracturing as a top manager of Chevron, I will describe the dilemmas that are associated with fracking. The first problem with this procedure is finding the appropriate land and leasing it from the landowners. With talk around the country, it can be difficult finding land because of landowners’ personal experience with the practice of hydraulic fracturing. In southwestern Pennsylvania there have been cases of animal birth defects, faucet erosion, stomach pains, and other health issues; in response, according to the New York Times, â€Å"Range Resources maintains that a D. E.P. study from 2010 indicates no air pollution of any kind† (Griswold, 2011). The country is torn in the middle of believing in natural gases and not believing. According to Huffington Post, â€Å"A report that the Congressional Research Service, which provides policy and legal analysis to the U.S. Congress, published in November also seems to support the industry’s sales pitch: ‘Given existing data, most indications point to the changes in the natural gas industry as positive to the overall U.S. economy’ (Peeples, 2013) but there are still skeptics. The issue that my company is facing in expanding the operations within this industry is, mainly, the uncertainty of the long term effects the fracking procedure is possibly contributing to. According to msnbc, â€Å"fracking is causing earthquakes. Federal scientists presented a new study this week to the American Geophysical Union that suggests natural gas drilling is the likely culprit behind a skyrocketing number of earthquakes in the Raton Basin in Colorado and New Mexico†¦ companies began injecting what’s called ‘wastewater fluid’ from natural gas drilling into the Earth† ( Gentile, 2012). Different publications are distributing articles of studies of health effects and environmental issues that hydraulic fracturing are causing. This in response is effecting the possible growth for Chevron. My team is conducting a stakeholder analysis and we have determined several stakeholders which include: the government, D.E.P., media, owners, shareholders, environmentalists, general public. Also established are the interests of each stakeholder. With the general public interests being in their health, voting is one power they could use to voice their concerns. Environmentalists and the D.E.P. are interested in the pollution fracking is causing and the D.E.P. could use their legal power to help regulate the pollution. The concerns of the shareholders are the profits of the company and voting is their power they could use to fix problems within the organization. With the power of economics, the owners are interested in the success of the company. The media is concerned with the public knowing both sides of the issue. Lastly, one main interest in the government is the reconstructing of the economy and what hydraulic fracturing could create in jobs. The stakeholders that are most likely to resonate with the public are the general public, media, and the environmentalists. With media producing stories of the public being affected by the pollution and the environmentalists undergoing studies on the environment, this could create a negative image on fracking companies. Considering all the stakeholders, the one stakeholder that holds the most urgency is the general public that is being affected. The general public is the most urgent because they are being victimized and their voices are being heard throughout the country which is causing confrontational issues. Different coalitions could be formed by the environmentalists and the government. Different politicians could lobby to get a bill pass and environmentalists could form to fight bills. My recommendation for the company’s consideration is to invest in more resource of the different affects fracking is causing and to fix the environmental issues that are caused. Ideally, Chevron should follow the triple bottom line perspective because all three elements (planet, profit, and people) are strongly involved. But with the uncertainty of the new procedures and all the different effects, the stakeholder approach is more realistic for Chevron. Chevron could prioritize their stakeholders and focus on each of their needs. This company holds ethical responsibility to the general public because of the health hazards that are surrounding the drill sites. The legal responsibility the company has is to follow the regulations that are formed by the D.E.P. Works Cited 1.) Grizwold, E. (2013). The Fracturing of Pennsylvania. http://www.nytimes.com/2011/11/20/magazine/fracking-amwell-township.html?pagewanted=all_r=1 2.) Gentile, S. (2012). Fracking is transforming our energy economy- but its also causing earthquakes. http://tv.msnbc.com/2012/12/08/fracking-transformed-our-energy-economy-but-its-also-causing-earthquakes/ 3.) Peeples, L. (2013). Fracking in Pennsylvania Sets Up Dilemma For Locals: Quick Money Or Long Term Health Concerns. http://www.huffingtonpost.com/2013/01/25/fracking-pennsylvania-natural-gas-lease-landman_n_2546824.html?ir=greenutm_campaign=012513utm_medium=emailutm_source=Alert-greenutm_content=FullStory

Hypertension And Blood Pressure

Hypertension And Blood Pressure Hypertension is a common and major cause of stroke and other cardiovascular disease. There are many causes of hypertension, including defined hormonal and genetic syndromes, renal disease and multifactorial racial and familial factors. It is one of the leading causes of morbidity and mortality in the world and will increase in worldwide importance as a public health problem by 2020 (Murray and Lopez 1997). Blood pressure (BP) is defined as the amount of pressure exerted, when heart contract against the resistance on the arterial walls of the blood vessels. In a clinical term high BP is known as hypertension. Hypertension is defined as sustained diastolic BP greater than 90 mmHg or sustained systolic BP greater than 140 mmHg. The maximum arterial pressure during contraction of the left ventricle of the heart is called systolic BP and minimum arterial pressure during relaxation and dilation of the ventricle of the heart when the ventricles fill with blood is known as diastolic BP (Guyton and Hall 2006). Hypertension is commonly divided into two categories of primary and secondary hypertension. In primary hypertension, often called essential hypertension is characterised by chronic elevation in blood pressure that occurs without the elevation of BP pressure results from some other disorder, such as kidney disease. Essential hypertension is a heterogeneous disorder, with different patients having different causal factors that lead to high BP. Essential hypertension needs to be separated into various syndromes because the causes of high BP in most patients presently classified as having essential hypertension can be recognized (Carretero and Oparil 2000). Approximately 95% of the hypertensive patients have essential hypertension. Although only about 5 to 10% of hypertension cases are thought to result from secondary causes, hypertension is so common that secondary hypertension probably will be encountered frequently by the primary care practitioner (Beevers and MacGregor 1995). In normal mechanism when the arterial BP raises it stretches baroceptors, (that are located in the carotid sinuses, aortic arch and large artery of neck and thorax) which send a rapid impulse to the vasomotor centre that resulting vasodilatation of arterioles and veins which contribute in reducing BP (Guyton and Hall 2006). Most of the book suggested that there is a debate regarding the pathophysiology of hypertension. A number of predisposing factors which contributes to increase the BP are obesity, insulin resistance, high alcohol intake, high salt intake, aging and perhaps sedentary lifestyle, stress, low potassium intake and low calcium intake. Furthermore, many of these factors are additive, such as obesity and alcohol intake (Sever and Poulter 1989). The pathophysiology of hypertension is categorised mainly into cardiac output and peripheral vascular resistant, renin- angiotensin system, autonomic nervous system and others factors. Normal BP is determined and maintained the balance between cardiac output and peripheral resistant. Considering the essential hypertension, peripheral resistant will rise in normal cardiac output because the peripheral resistant is depend upon the thickness of wall of the artery and capillaries and contraction of smooth muscles cells which is responsible for increasing intracellular calcium concentration (Kaplan 1998). In renin-angiotensin mechanism endocrine system plays important role in maintain blood pressure; especially the juxtaglomerular cells of the kidney secrete renin in order to response glomerular hypo-perfusion. And also renin is released by the stimulation of the sympathetic nervous system which is later convert to angiotensin I then again it converts to angiotensin II in the lungs by the effect of angiotensin- converting enzyme (ACE). Angiotensin II is a potent vasoconstrictor and also it released aldosterone from the zona glomerulosa of the adrenal gland which is responsible for sodium and water retention. In this way, renin-angiotensin system increases the BP (Beevers et al 2001). Similarly, in autonomic nervous system sympathetic nervous system play a role in pathophysiology of hypertension and key to maintaining the normal BP as it constricts and dilates arteriolar. Autonomic nervous system considers as an important in short term changes in BP in response to stress and physical exercise. This system works together with renin-angiotensin system including circulating sodium volume. Although adrenaline and nor-adrenaline doesnt play an important role in causes of hypertension, the drugs used for the treatment of hypertension block the sympathetic nervous system which had played proper therapeutic role (Beevers et al 2001). Others pathophysiology includes many vaso active substance which are responsible for maintaining normal BP. They are enothelin bradikinin, endothelial derived relaxant factor; atrial natriuretic peptide and hypercoagulability of blood are all responsible in some way to maintain the BP (Lip G YH 2003). The seventh report of the Joint National Committee (JNC-VII) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines some important goals for the evaluation of the patient with elevated BP which are detection and confirmation of hypertension; detection of target organ disease (e.g. renal damage, congestive heart failure); identification of other risk factors for cardiovascular disorders (e.g. diabetes mellitus, hyperlipidemia) and detection of secondary causes of hypertension (Chobanian et al 2003). Most hypertensive patients remain asymptomatic until complications arise. Potential complications include stroke, myocardial infarction, heart failure, aortic aneurysm and dissection, renal damage and retinopathy (Zamani et al 2007).The drug selection for the pharmacologic treatment of hypertension would depend on the individual degree of elevation of BP and contradictions. Treatment of non-pharmacologic hypertension includes life-style, weight reduction, exercise, sodium, potassium, stop smoking and alcohol, relaxation therapy and dietary improvements, followed by pharmacology therapy. Commonly used antihypertensive drugs include thiazide diuretics, ÃŽ ²-blockers, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, direct vasodilators and ÃŽ ±-receptor antagonists which are shown in the following table. Diuretics have been used for decades to treat hypertension and recommended as first-line therapy by JNC-VII guidelines after antihypertensive and lipid-lowering treatment to prevent heart attack trail (ALLHAT) success. They reduce circulatory volume, cardiac output and mean arterial pressure and are most effective in patients with mild-to- moderate hypertension who have normal renal function. Thiazide diuretics (e.g. hydrochlorothiazide) and potassium sparing diuretics (e.g. spironolactone) promote Na+ and Cl- excretion in the nephrone. Loop diuretics (e.g. furosemide) are generally too potent and their actions too short-lived, however, they are useful in lowering blood pressure in patients with renal insufficiency, who often does not respond to other diuretics. Diuretics may result in adverse metabolic side effects, including elevation of creatinine; glucose, cholesterol, triglyceride levels, hypokalemia, hyperuricemia and decreased sexual function are potential side effects. The be st BP lowering response is seen from low doses of Thiazide diuretics (Kaplan 1998). Î’-blocker such as propranolol are believed to lower BP through several mechanisms, including reducing cardiac output through a decrease heart rate and a mild decrease in contractility and decreasing the secretion of renin, which lead to a decrease in total peripheral resistant. Adverse effects of b-blockers include bronchospam, fatigue, impotence, and hyperglycemia and alter lipid metabolism (Zamani et al 2007). Centrally acting ÃŽ ±2-adrenergic agonists such as methyldopa and clonidine reduce sympathetic outflow to the heart, blood vessels and kidneys. Methyldopa is safe to use during pregnancy. Side effect includes dry mouth, sedation, drowsiness is common; and in 20% of patients methyldopa causes a positive antiglobulin test, rarely haemolytic anaemia and clonidine causes rebound hypertension if the drug is suddenly withdrawn (Neal M J 2009). Systemic a1-antagonists such as prazosin, terazosin and doxazosin cause a decrease in total peripheral resistance through relaxation of vascular smooth muscle. Calcium channel blockers (CCB) reduce the influx of Ca++ responsible for cardiac and smooth muscle contraction, thus reducing cardiac contractility and total peripheral resistant. Thus long-acting members of this group are frequently used to treat hypertension. There are two classes of CCB dihyropyridines and non- dihyropyridines. The main side effect of CCB is ankle oedema, but this can sometimes be offset by combining with ÃŽ ²-blockers (Lip G YH 2003). Direct vasodilators such as Hydralazine and minoxidil lower BP by directly relaxing vascular smooth muscle of precapillary resistance vessels. However, this action can result in a reflex increase heart rate, so that combined ÃŽ ²-blocker therapy is frequently necessary (Neal M J 2009). ACE inhibitors works by blocking the renin-angiotensin system thereby inhibiting the conversion of angiotensin I to angiotensin II. ACE inhibitors may be most useful for treating patients with heart failure, as well as hypertensive patients who have diabetes. Using ACE inhibitors can lead to increased levels of bradikinin, which has the side effect of cough and the rare, but severe, complication of angioedema. Recent study demonstrated that captopril was as effective as traditional thaizides and ÃŽ ²-blockers in preventing adverse outcomes in hypertension (Lip G YH 2003). Angiotensin II antagonists act on the renin-angiotensin system and they block the action of angiotensin II at its peripheral receptors. They are well tolerated and very rarely cause any significant side-effects (Zamani et al 2007). Another helpful principle of antihypertensive drug therapy concerns the use of multiple drugs. The effects of one drug, acting at one physiologic control point, can be defeated by natural compensatory mechanism (e.g. diuretic decrease oedema occurring secondary to treatment with a CCB). By using two drugs with different mechanisms of action, it is more likely that BP and its complication are controlled and with the low dose range of combined drugs also help to reduce the side-effects as well (Frank 2008) . The following two-drug combinations have been found to be effective and well tolerated which are diuretic and ÃŽ ²-blocker; diuretic and ACE inhibitor or angiotensin receptor antagonist; CCB (dihydropyridine) and ÃŽ ²-blocker; CCB and ACE inhibitor or angiotensin receptor antagonist; CCB and b-diuretic; ÃŽ ±-blocker and ÃŽ ²-blocker and other combinations (e.g. with central agents, including ÃŽ ±2-adrenoreceptor agonists and imidazoline- I2 receptor modulators, or between ACE inhib itors and angiotensin receptor antagonists) can be used (ESH and ESC 2003). If necessary, three or four drugs may be required in many cases for the treatment. The use of a single drug will lower the BP satisfactorily in up to 80% of patients with hypertension but combining two types of drugs will lower BP about 90%. If the diastolic pressure is above 130 mmHg then the hypertensive emergency is occurred. Although it is desirable to reduce the diastolic pressure below 120 mmHg within 24 hours in accelerated hypertension, it is usually unnecessary to reduce it more rapidly and indeed it may be dangerous to do so. This is because the mechanisms that maintain cerebral blood flow at a constant level independent of peripheral BP are impaired in hypertension. However, it is important to reduce the BP quickly by giving the intravenous drugs but caution should be taken to avoid cerebrovascular pressure inducing cerebral ischemia (Grahame-Smith and Aronson 2002). In conclusion, hypertension emerges as an extremely important clinical problem because of its prevalence and potentially devastating consequences. The major classes of antihypertensive drugs: diuretics, ÃŽ ²-blockers, CCB, ACE inhibitors and angiotensin receptor antagonists, are suitable for the initiation and maintenance of antihypertensive therapy which helps in reduction of cardiovascular morbidity and mortality.

Betrayed by Constanin Costa-Gavras :: Movie, Film

The opening lyrics to America the Beautiful, ï ¿ ½O beautiful for spacious skies, for amber waves of grain,ï ¿ ½ demonstrate how agriculture and wheat farming have been ingrained, to almost mythical proportions, as quintessentially ï ¿ ½Americanï ¿ ½ amongst citizens in the United States. As the Great Plains of the Midwest helped establish the U.S. as a major economic superpower throughout the twentieth century, the nation grew by distributing vast amounts of grain across the globe, providing those farming in the region both a secure and profitable existence. But with the proliferation of farming technologies enabling foreign nations to establish a foothold in a new global economy, the U.S. and its farmers faced increased competition, and their stranglehold on grain exportation waned. ï ¿ ½You just canï ¿ ½t make a living growing wheat anymore,ï ¿ ½ says Greg Grenz, a farmer in Eureka South Dakota, as many ï ¿ ½U.S. farmers are increasingly under pressure as Americaï ¿ ½s ru n as a wheat powerhouse, and the dominant player in global agriculture, is under attack from a crop of newly emboldened, low-cost international rivals who are striking at one of the main pillars of American economic might: food exportsï ¿ ½ (Roger Thurow, 2004). Security and prosperity it seems are dwindling in the nationï ¿ ½s fertile plains. In most cases, with little recourse available, todayï ¿ ½s farmers are faced with a frightening decision: change their farming practices, via planting new crops or utilizing new techniques, or quit farming outright, forfeiting lands that may have been in families for generations and, more importantly, losing an identity that many consider to be most ï ¿ ½American.ï ¿ ½ ï ¿ ½Constanin Costa-Gavras, in his film Betrayed (1988), uses this framework of economic hardships caused by a declining farming industry to present his audience with some farmers who have decided on another option, lashing out violently at people who they believe are responsible for their plight. The film about ï ¿ ½star-crossed love [and] death and danger in white-picket-fence Americaï ¿ ½ (Kemply, 1988), involves a fictional community that employs white supremacist ideology to spread hate and intolerance as they blame Jews, non-whites, and the government for the economic conditions which they endure. The film also demonstrates the early use of the computer to branch out and connect these hate mongers, forecasting the use and proliferation of the internet to recruit new white supremacists around the country. As Randy Blazack, sociologist from Portland State University, elaborates in American Skinheads (2007), ï ¿ ½whether youï ¿ ½re recruiting people to be suicide bombers or recruiting foot soldiers in the racial holy war, youï ¿ ½re going after the same set of people, youï ¿ ½re going after people who feel like theyï ¿ ½re at the end of their rope, and the only recourse left is one of violenceï ¿ ½ (Geographic, 2007).

Cloning :: essays research papers

The Issue of Cloning & Bioengineering   Ã‚  Ã‚  Ã‚  Ã‚  There have been many breakthroughs in bioengineering lately. In 1998, scientists at the Roslin Institute in Scotland, cloned the first ever mammal, a sheep named Dolly. Scientists can now isolate a gene, and put it into an animal of a completely different species. This opens up new windows in many of the world's industries, such as medicine and agriculture. In the paragraphs ahead, the processes, possible applications, and the consequences of the biotechnology industry will be covered.   Ã‚  Ã‚  Ã‚  Ã‚  First off, I'll get into cloning. The definition of a clone is an organism that is derived from another organism by an asexual reproductive process. The result is an exact copy, basically a genetic twin, of the organism being cloned. Cloning is still very faulty. The success rate of the process is extremely low. I've broken down the whole process to better explain it:  · Take an unfertilized egg from a female, and take the nucleus out.  · The cell from the specimen to be cloned is put in a petri dish and cultured for 7 days.  · Starve the cultured cells to put them into a dormant state.  · The egg and the cell are put next to each other in a dish.  · Then an electric current is passed through them to fuse them together.  · The reconstructed embryo is cultured and grown for 7 days.  · The embryo is put into the female that is at the same stage of the estrous cycle. She then becomes pregnant. There is a lot more to making a clone than what I described, but this brief summary of the process gives a basic idea as to what happens.   Ã‚  Ã‚  Ã‚  Ã‚  Many uses and benefits have been speculated as a result of these new innovations. For example, organs for transplants are in great shortages. In the past, animal-to-human organ transplants have been a big failure. The average amount of time a person would live after receiving an animal organ was about 2 weeks to a month, simply because the body would reject them. It is now possible to alter animals in such a way that the tissues of the organs will register as human organs when they are put into the body. Research is still in the early stages, but it is a definite possibility in the future.   Ã‚  Ã‚  Ã‚  Ã‚  Human therapeutic proteins can also be produced through bioengineering. These proteins are used to treat a variety of human diseases, but they are hard to produce and run the risk of contamination and disease through traditional methods.

Which Is More Effective In Reducing Arm Lymphoedema For Breast Cancer Patients

Breast cancer treatment involves different aspects like through surgery, radiation therapy, chemotherapy, endocrine therapy, bone marrow transplant, oophorectomy, and adrenalectomy. With this kind of treatments, the patient may develop arm lymphoedema due to the surgery to remove lymph nodes or radiotherapy to the lymph nodes in the armpit. If lymphoedema is not treated, it will get worse. It can be painful and make it difficult to move the arm. This complication can lead to systemic infections and localized swelling that will be very hard to bear. But today, lymphoedema is becoming less common. This is because specialists now try to avoid giving women both surgery and radiotherapy to the armpit. Having surgery and radiotherapy to the armpit greatly increases the risk of damaging the lymph nodes and causing lymphoedema. It is important that the patient know about his or her disease and the risk of developing lymphoedema. Poor drainage of the lymphatic system due to surgical removal of the lymph nodes or to radiation therapy may make the affected arm or leg more susceptible to serious infection. Even a small infection may lead to serious lymphoedema. Patients should be taught about arm care after surgery and/or radiation. It is important that patients take precautions to prevent injury and infection in the affected arm because lymphoedema can occur 30 or more years after surgery. Breast cancer patients who follow instructions about skin care and proper exercise after mastectomy are less likely to experience lymphoedema. As management of lymphoedema, compression bandages and manual lymphatic drainage are the mostly used care for such patients. Statement Of Fact After treatment, some things can increase fluid collection in your arm and increase your risk of lymphoedema. These include Infection in a cut or graze, insect bites, severe sunburn, putting too much strain on your arm too early. But this can be prevented by not using your arm for anything heavy until you are told you can, not letting anyone take blood, give injections or take your blood pressure from the treated arm, unless it is an emergency and there is no alternative, wearing gloves when gardening or doing housework, taking care when playing with pets, using insect repellent and high factor sunscreen, using nail clippers rather than scissors and not pushing your cuticles back, using an electric razor rather than a manual one if you shave under your arms, avoiding anything that will increase the temperature of your skin, like very hot baths or showers, sitting too close to a heater, saunas, steam rooms and sun beds, using a non scented moisturizer or oil on your skin each day to help it stay moist and supple, using a thimble when sewing, continuing to do the arm and shoulder exercises you were taught after your surgery. If you do get a cut or scratch on your arm, however small, wash it well and cover it un til healed. If you see any redness or swelling around the cut, see your GP straight away. You may need antibiotic. Lymphoedema can start at any time after there have been treated for breast cancer. It is important to take these precautions for the rest of life. If lymphoedema has occurred already, it can be managed by exercises that help the fluid to drain from your arm, compression bandages or by manual lymphatic drainage. Definition of Terms: 1. Lymph – a pale coagulable fluid that bathes the tissues, passes into the lymphatic channels and ducts, is discharged into the blood by way of the thoracic duct, and consists of a liquid portion resembling blood plasma and containing white blood cells but normally no red blood cells. 2. Lymphatic – a vessel that contains or conveys lymph, that originates as an interfibrillar or intracellular cleft or space in a tissue or organ. 3. Lymph node – any of the rounded masses of lymphoid tissue that are surrounded by a capsule of connective tissue , are distributed along the lymphatic vessels, and contain numerous lymphocytes which filter the flow of lymph passing through the node. 4. Arm Lymphoedema – swelling of the arm and armpit due to the treatment of breast cancer by surgery or radiation. 5. Lymphoedema – edema due to faulty lymphatic drainage. 6. Breast cancer – a carcinoma in the breast 7. Axillary lymph clearance – operative management for disease control in invasive breast cancer, obtaining prognostic information and influencing postoperative therapy including the choice of breast cancer trials. Main Body The management of lymphoedema consists of compression bandages, manual lymphatic drainage, or by exercises but shou ld be done by trained or specialist person. Mostly used now are the compression bandages and the manual lymphatic drainage. In using the management of lymphoedema, the patient should have passed the axillary lymph clearance. Axillary node clearance is the established operative management for disease control in invasive breast cancer, obtaining prognostic information and influencing postoperative therapy including the choice of breast cancer trials.Dying of Breast Cancer in the 1800s Axillary node clearance can be defined as clearing the axillary contents bounded by the axillary skin laterally, latissimus dorsi, teres major and subscapularis posteriorly, the lower border of the axillary vein superiorly, pectoralis muscles anteriorly, and the chest wall medially. The levels of axillary nodes are anatomically defined as level one (inferolateral to pectoralis minor), level two (posterior to pectoralis minor) and level three (superomedial to pectoralis minor). There are alternatives to level one, two and three axillary node clearance for breast cancer. Some surgeons simply excise the lower axillary nodes (level one), others believe, particularly for small or impalpable cancers, that an axillary node sample taking a minimum of 4 nodes is a satisfactory alternative. Most recently the concept of sentinel node biopsy (reviewed by McIntosh and Purushotham in 1998) has been exciting great interest. Current recommendations, by a range of surgical and oncological groups, are that some form of axillary surgery, and hence axillary staging, should be performed in all patients who undergo operative treatment for breast cancer. It is no longer acceptable to ignore the axilla if performing surgery for breast cancer. The axilla is one of the area with lymph nodes mostly affected by breast cancer and the patient who finished the axillary lymph clearance will then be undergoing the management of compression bandages or the manual lymphatic drainage. There is no cure for lymphoedema, which makes proper care and treatment of the affected arm even more important. Compression bandaging, also called wrapping, is the application of several layers of padding and short-stretch bandages to the involved areas. Short-stretch bandages are preferred over long-stretch bandages (such as those normally used to treat sprains), as the long-stretch bandages cannot produce the higher tension necessary to safely reduce Lymphoedema and may in fact end up producing a tourniquet effect. During activity, whether exercise or daily activities, the short-stretch bandages enhance the pumping action of the lymph vessels by providing increased resistance for them to push against. This encourages lymphatic flow and helps to soften fluid-swollen areas. Compression bandages gives comfort to the patient through giving pressure and compression in the affected area specifically in the arm and armpits. It serves as a support in the said area preventing further swelling and redness. Practitioners may want to encourage long-term and consistent use of compression bandages by women with lymphoedema. Its advantage is in terms of support and comfort to the patient and less invasive. Compression bandages may also protect the extremity from injuries such as burns, lacerations and insect bites. The compression bandage has its benefits such as it is less costly and patient does not need further effort to use it because it is for support and pressure in the specified area. In contrast to compression bandages, another management to lymphoedema is through manual lymphatic drainage. One of the main treatments for lymphoedema is a massage-like technique called manual lymphatic drainage that helps to stimulate the lymphatic vessels. However, massage, the way people generally think of massage, is a vigorous technique that can cause an increase in fluid production. The type of massage that is used to treat lymphoedema is a very gentle technique. Lymphatic massage is directed towards the heart from the fingertips, up the arm, towards the shoulder, and there are very specific directions and strokes that are used in this particular massage. A very specialized type of massage called manual lymphatic drainage (MLD) is an important part of the treatment of lymphoedema. To be effective in treating lymphoedema, it is important to use the correct technique. The aim of the massage is to stimulate or move the excess fluid away from the swollen area so that it can drain away normally. Massage also encourages and improves drainage in the healthy lymphatics (which helps keep fluid away from swollen areas). Manual lymphatic drainage differs from ordinary massage – it is very gentle and aims to encourage movement of lymph away from swollen areas. MLD is particularly useful if there is swelling in the face, breast, abdomen, genitals or elsewhere on the trunk. As this is a specialized form of massage, it should be given only by a trained therapist. There are some other different techniques including the Vodder, Foldi, Leduc or Casley-Smith methods. Therapists should be trained in at least one of these. The aim of this massage is to stimulate the lymph channels on the trunk to clear the way ahead so excess fluid can drain away. The skin is always moved away from the swollen side. You will find it easier to start with one hand, and then swap to the other as you move across the body. Before and after MLD, breathing exercises can help to stimulate lymphatic drainage. This can be done by letting the patient sit upright in a comfortable chair or lie on your bed with your knees slightly bent. Rest his hands on ribs and let patient take deep breaths to relax. This exercise should be done 5 times and there should be short rests before getting up to avoid dizziness. Manual lymphatic drainage is improved during exercise; therefore, exercise is important in preventing lymphoedema. Breast cancer patients should do hand and arm exercises as instructed after mastectomy. Patients who have surgery that affects pelvic lymph node drainage should do leg and foot exercises as instructed. The doctor decides how soon after surgery the patient should start exercising. Physiatrists (doctors who specialize in physical medicine and rehabilitation) or physical therapists should develop an individualized exercise program for the patient. The advantage of the manual lymphatic drainage as management of lymphoedema is that it gives opportunity for open wounds to drain with gentle massage and excess exudates to drain freely without pressure. In terms of the disadvantage side of the management of lymphoedema, it differs also. In compression bandages, there is an exemption in placing it especially if the affected area has an open wound or has an ample amount of drainage in the area or with pus. The pressure given by the compression bandage can even more contribute to the entry of microorganisms or infection to occur. This may cause another disease process to start and give greater complications to the patient. Compression bandages are probably the most difficult problem is in the maintenance and control of lymphoedema before, during and after treatment. Patients may be noncompliant with using compression garments because the garments are unsightly, uncomfortable, difficult to put on and expensive. Customized, lightweight and colourful garments may be an option for comfort and wear. As for the manual lymph drainage, its disadvantage is in terms of the inaccurate use of the MLD of the one giving care which can also rupture other lymph nodes in the area and also as well as the hygienic process in giving the manual lymphatic drainage. Some patients also experience some discomfort on such procedure as the drainage is in its process. The preference in such procedures is by the patient by giving proper education and explanation on each management. Conclusion Both compression bandages and manual lymphatic drainage as management of arm lymphoedema gives comfort and benefit to the patient giving different of care to the patient in relieving such discomfort. Both have advantages and disadvantages to consider but what matters most is the greater care and comfort the patient gets in being free of pain and swelling in such areas which would be very difficult for the patient to do the activities of daily living with an arm that cannot be moved and with great amount of pain being experienced. It also is extremely important to remember that a certified lymphoedema therapist needs to either perform the treatment or educate the patient and/or family members in self-care techniques, once the patient has gone through an intensive treatment program. The therapist will design the treatment plan based on the severity of the lymphoedema. It can also depend on the type of reimbursement patients can get from their health plans. In my practice, for example, we would treat a patient with a mild upper extremity lymphoedema for a five-day period, including of manual lymphatic drainage (MLD), bandaging, exercise, and also education in self-care. So by the end of the five days, usually the patient is able to manually drain the limb and follow a home program. There is no greater comparison on both management, the physician orders such management for the patient’s welfare and fast recovery yet this lymphoedema does not have the accurate cure but just the rehabilitation to the pain and swelling to the arms and its surrounding areas. It may be done by compression bandage or manual lymph drainage, it all points out to the care of the patient that lessens the access of infection, occurrence of pain and swelling.