Real People #4

Today I'd like to share another story from someone I have been able to become good friends with. Janet is another young lady who I have watched flourish and grow and I am so proud of the positive attitude she has adopted that also helps me stay positive. 

Janet Ngan, 24, Phoenix, Arizona, USA



When were you diagnosed with Stargardt's disease and how did it affect you at that time?

I was first officially diagnosed with Stargardt's disease when I was 15 years old.  It feels much longer than that because I remember getting my first pair of glasses when I was in first grade (age 6). I always had vision problems and I spent most of my childhood going to different doctors and getting new glasses. I remember never being able to read the board at school and having issues adjusting to light from the sun after recess. However, after seeing so many doctors and getting new prescriptions for my glasses I felt like it should help so I started pretending like it really worked. I would go to school early or stay late so I could copy notes from classmates and sit in the front of the classroom as close to the board as possible. I would even pretend to forget my glasses so I could get someone to read me what was on the board. This worked out okay for a couple years but then as schoolwork started getting more difficult it got really hard to hide my vision. When I was a sophomore in high school, we had our annual health fairs to test your vision, hearing, etc and I did so bad on the vision part that they sent a letter home to my parents saying that I needed to see a doctor. When I went to see my doctor, she didn't understand what was wrong with me so she sent me to a “special doctor” (ophthalmologist). I remember it was the summer of 2006 and I was sent to about six or seven different doctors performing special tests on my eyes. Finally, when I saw my ophthalmologist again, he told me that I had a rare eye disorder called Stargardt's disease. The rest of that summer was so hard and I had so many emotions. I cried almost everyday, blaming myself, feeling like the biggest failure in the world, and just could not bring myself to accept it. But after awhile things cleared up and I learned to find the positivity inside of me. Even though I was healing from my emotions I still felt ashamed to tell my friends about it at the time. I hid the secret from my friends, classmates, and teachers. This only lasted for a little while because when I started doing very poorly in my algebra class I knew I had to tell someone. Thankfully, my algebra teacher at the time had noticed that something was wrong with me and I confronted her about my vision. She contacted the school and found two faculty members who worked with students with disabilities such as those with a visual impairment to work with me. They provided me with different resources such as using a CCTV, magnifiers, enlargement my textbooks/exams, extra time to complete my exams, and a note taker to help me in class. This was like being in a new world for me. I was still kind of embarrassed by all the attention of carrying textbooks that were almost three times its size. But I did find that these accommodations were helping me tremendously in my classes. I worked really hard and my grades were finally picking up and it actually didn't feel dreadful to go to class everyday. So at the time I was diagnosed I felt like the disease made me weaker but I've realized that it was what I needed to make me stronger. It was definitely a struggle and some days it still feels rough but I've learned to not give up and try my very best in everything I do. I've learned to ask for help when I need it even though I don't want to. Most of all, I learned that Stargardt's doesn't define me, it is my attitude and how I choose to react to it that makes me who I am. I can't change something that is beyond my control but I do have control on how I live my life.

What parts of your life have you adapted because of this disease?

I think Stargardt's has affected many aspects of my life but the most recent and hardest part was the inability to drive a car. I was diagnosed at the age where I was supposed to get my instruction permit to start learning how to drive but I was unable to because I failed the eye exam portion of the test. So I never really had that experience of driving throughout my teenage years and having a car during college. When I was in college, I lived close to campus so I could ride my bike or take the shuttle to school so it wasn't a big deal. When I went out with my friends, they usually picked me up so I didn't have an issue until after I graduated. I learned that a driver's license was the ticket to EVERYTHING from going to places on your own to getting a job! I did not prepare myself for this struggle when I was in school so I felt super lost at the time. I thought I could just ride the bus but I didn't realize how scarce, unreliable, and time consuming the public transportation system can be. So I ended up talking to my doctor/low vision specialist and they told me I was able to drive with bioptics. Bioptics are these lenses that have a telescope on top that magnifies like a binocular. I was really excited for this and I felt like I was finally able to drive and be more independent. I spent my year off from school doing the bioptic training and it was just a huge struggle. At some moment I was really happy and felt like I was doing a good job. However, because of the safety and how my vision fluctuates I had to give up the driving. This was probably the second biggest hurdle I had to overcome since my diagnosis and it left me devastated. I didn't know what I was going to do with my life if I couldn't drive and get a job. It almost felt like the summer of 2006 again. But I didn't let it get to me as I picked myself back up and I talked to the local vocational rehabilitation about resources for the visually impaired. My vision hasn't gotten bad enough to the point for me to use some of the resources. I found a part time job working in retail and learned how to take the bus there by myself to work. This was my way of feeling like I could be independent no matter the challenges that Stargardt's brings. During this time I also reached out to people about my issue and explored the different options for me to find success. I knew I didn't want to move back in with my parents for them to take care of me for the rest of my life. I was passionate with public health and helping people improve their quality of life which was what I studied for my undergraduate degree but jobs were incredibly hard to find since I needed to be able to drive in order to perform the job in the community. So in a way I had to adapt my career to fit me as well. During this time period I worked on classes and applications for graduate school for occupational therapy. So in the beginning, not being able to get my driver's license felt like the end of the world to me because so many things I wanted to do revolved around that. But I was able to find a way to make it work and continue to grow stronger and adapt to the hardships that Stargardt's brings.

What are your goals and where do you want to be in ten years time?

This is a very good question! I know time goes by fast but I have no idea where I will be a whole decade from now! A lot can happen in that period of time and life is just unpredictable. So it is hard to imagine me at 34 years old (ew I'm going to be OLD!) when I barely know what is happening tomorrow. However, my biggest goal right now is to make it into graduate school and get my Master's in Occupational Therapy. I expect that in ten years I should be an occupational therapist and loving my job. I really want to be able to make an impact in people's lives. I want to help the visually impaired and other people with disabilities be able to find the independence and fulfillment in their lives. I want to reach out to people who may feel as lost and confused as I once was and show them that anything is possible and nothing is worth giving up on their dreams. Also, in ten years’ time I hope to have traveled more (hopefully meet you in Australia!) and cross off more things on my bucket list. I guess I'm pretty simple. In ten years’ time I just want to be someone that I can look at and be proud of. I want to be happy and make everyone around me happy. Sounds cliché, I know.

What inspired and motivated you to get you to where you are now on your journey?

Honestly, I feel like this disease itself has impacted me so much to become who I am today. Yes, it did bring me a lot of stress and challenges to get over. But what is life without these experiences that make you different from everyone else? Being able to go through each hurdle that comes my way and ending up here is super inspiring to me. There were actually times where I felt like I could never make it this far but I continue on this journey learning so much. I spent some time being angry at why out of the billions of people in the world it had to be me, but I don't think I would be the same person as I am without Stargardt's. It has really taught me to cherish life and to put in 110 percent in working harder to achieve my goals. I never wanted to take things for granted and just want to make use of all the vision I have to create a spectacular vision for the future. It has also given me the compassion to want to help others who may have similar problems get through it because I understand what a pain it can be. This was a huge reason why I want to pursue a career in Occupational Therapy and stay in the healthcare field. I used to think Stargardt's was the biggest curse of my life but I've learned to see it as a blessing. It makes me unique, I mean how many people have awkward stories of walking in the wrong car or not recognizing someone instantly while you're having a conversation with them?  Maybe that part is not much of a blessing but to people who know me and understand, it gives us something to laugh about later. Having Stargardt's also gives me the drive and determination to do anything and turn the “impossible” into “I'M Possible.” I know I'm always going to have those days where I feel depressed that I'm not living up to where I should be based on where I see other people but this just makes me want to try even  harder to get to where I want to be. Also, I think the more I understand this disease (such as from my diagnosis), the better I feel because I realized it is just a part of me and that I wasn't going crazy because I didn't have the same vision as everyone else. I actually found it very inspiring when I first read your blog and found that there was someone in the world who felt and experienced exactly what I endured. Even though we literally live on opposite sides of the world and we've never even had a cup of tea together, I feel this sense of closeness and energy with you because of the one thing we do have in common. I'm the type of person where I can get easily motivated and enthusiastic at life because I get my energy off of other people. So being able to share our experiences with each other has helped me significantly because I know that I'm not alone. I know that I can continue growing stronger than ever no matter what comes my way.




If you would like to connect with Janet on Facebook click here.

Thank you for sharing your experience. Despite our distance, you have been a huge support for me and motivate me to keep doing what I'm doing. 

The Stargardt's community we have all contributed to is incredible. Thank you to everybody who has been a part of it and keep all the emails, Facebook messages, tweets and Instagrams coming! 

DISEASE IMPOTENS



        DISEASE IMPOTENSI

DEFINITIONS

Impotence (Erectile Dysfunction) is the inability to initiate and maintain an erection.
CAUSE

Impotence is usually the result of:
# Abnormalities of blood vessels
# Disorders of innervation
# Drugs
# Abnormalities of the penis
# Psychological problems that affect sexual arousal.

Cause physical is more common in older men; while psychological problems are more common in younger men.
Increasing the life of a man, it is increasingly frequent impotence, although impotence is not a part of the aging process, but the result of a disease that is often found in the elderly.
Approximately 50% of men aged 65 years and 75% of men aged 80 years experience impotence.

In order to erect, penis requires adequate blood flow. Therefore vascular disease (eg, atherosclerosis) can cause impotence.
Impotence can also occur due to a blood clot resulting from surgery or blood vessels that lead to the disruption of arterial blood flow to the penis.


Nerve damage leading to and leaving the penis can cause impotence.
This nerve damage can occur due to:
# Injury
# Diabetes mellitus
# Multiple sclerosis
# Stroke
# Drugs
# Alcohol
# Diseases lower spine
# Rectal or prostate surgery.

Approximately 25% of cases of impotence caused by drugs (especially in older men who consume lots of drugs).
Medications that can cause impotence are:
- Anti-hypertensive
- Anti-psychosis
- Anti-depressants
- Sedative
- Cimetidine
- Lithium.

Sometimes impotence occurs due to low testosterone levels.
But the decline in levels of male hormones (which tend to occur due to aging), usually more often causes a decrease in sexual desire (libido).

Several psychological factors that can cause impotence:
# Depression
# Anxiety
# Guilt
# Fear of intimacy
# Indecision about sex.

SYMPTOMS
Patients are not able to start and maintain an erection.


DIAGNOSIS
Diagnosis based on the symptoms.
Physical examination is done to look for any changes in male sexual characteristics, such as breast, testicles and penis size, as well as changes in the hair, voice and skin.

To determine abnormalities in the arteries in the pelvis and groin (which supplies blood to the penis), the measurement of blood pressure in the legs.

Other tests that may need to be done:
# Blood tests complete
# Examination of blood sugar for diabetes
# The level of TSH
# USG penis.

TREATMENT
Impotence can usually be treated without surgery.
The type of treatment depends on the cause.

Special exercises performed by patients with impotence due to psychological problems, namely the so-called 3-phase Mechanical centering sensation.
This technique encourages intimacy and emotional warmth, which is focused on building a relationship:

1. Phase I: courtship, the couple concentrate to please each other without touching the pubic region.
2. Phase II: the couple began touching the pubic region or other erotic areas, but not the act of intercourse.
3. Phase III: the act of intercourse.

Each achieve comfort at each stage of intimacy before continuing to the next stage.
If these techniques are not successful, the patient may need to undergo psychotherapy or sexual behavior therapy.
If patients are depressed, may be given antidepressants.

Sildenafil is a drug that can meningkatkanaliran blood to the penis.
This medication taken 30-60 minutes before sexual intercourse, is only effective if accompanied by sexual arousal.
Should not be taken together with nitrates because it can cause serious side effects.

If impotence or loss of sexual desire occurs due to low testosterone levels, patients should undergo hormone replacement therapy.
Testosterone is injected every week or given in the form of plaster.
The side-effect is an enlarged prostate and an excess of red blood cells that can cause a stroke.

Fastener or suction tool is often used to achieve and maintain an erection, but this tool should not be used by people with bleeding disorders or patients who take anticoagulant drugs.
Tool binder (a rope or ring made of metal, rubber or leather) mounted at the base of the penis to slow the flow of blood from the penis.
Vacuum (in the form of a hollow box and pump) is mounted on the penis. Vacuum pressure helps blood flow into the penile arteries. When the penis is erect, a fastener tool installed to prevent drainage of blood from a vein. The combination of these two devices can maintain an erection for 30 minutes.
Sometimes tool fastener causes problems when ejaculation, especially if tied too tight. For the sake of security, preferably after 30 minutes the device is released.
If overused, the suction device may cause bruising.

Impotence can also be treated with an injection of a special medicine that done by the patient.
This drug is injected directly into the erectile tissue of the penis (corpus cavernous. Erection occurs within 5-10 minutes after the drug is injected and can last for 60 minutes.
The side effects are bruised and sore. In addition, the injection can also cause priapism (persistent and painful erection).

If impotence does not respond to various treatments above, can be done transplant penis or use a prosthesis (an artificial penis).
One of the tools that transplanted stem stocky form inserted into the penis to produce an erection that is settled. Other tools in the form of a balloon that is inserted into the penis and inflated before the patient had sexual intercourse

Bone Diseases




                                                  Bone Diseases

Bone disease is often not recognized by someone. Usually people have realized after bone condition no longer possible to be treated.

So to reduce the potential for someone to experience a variety of complaints on the bones, it takes a complete and adequate information from health workers.

Bone Health will support the activities of the people and improve performance.


A. Bone

Before learning more about the various bone diseases, it helps us to be aware of human bone structure.

Bone is a buffer body and consists of collagen, a protein that besisi Kalsum and ka phosphate mineral that gives strength to support the entire organ.

The combination of collagen and calcium makes bones strong and flexible enough to withstand the pressure due to human activities. More than 99 percent of the body's calcium is in the bones and teeth. And one percent is found in the blood.

There are two types of bone that

1. Cortical

Solid and strong. Is the outermost part of the bone.

2. Trabecular

The inside of the bones, hollow, and forming the overall structure

Throughout human life, the bone continues to experience growth and repair. The process is carried out bone resorption and formation.

During resorption, old bone cells will be damaged and replaced by specialized cells called osteoclasts.

In the process of bone formation, new bone tissue will replace the old bone cells. Cells that perform this process are osteoblasts.

Osteoclasts and osteoblasts during bone repair process requires a variety of hormones and vitamins, namely:

* Calcitonin
* Parathyroid
* Vitamin C
* Hormones estrogen (in women)
* Hormone testosterone (in men)


B. Here are some of the bone disease that is often experienced:

Osteoporosis

That is a disease that causes decreased bone density. Osteoporosis undermined the strength of the trabecular bone so that its strength is reduced drastically, also bone cortical thinning and overall bone will break easily. The disease is stalking people who already advanced and women entering menopause.


Osteomalacia

This disease results in bones becoming weak due to shortages
vitamin D or errors of metabolism in the body. As with osteoporosis, osteomalacia also has the potential to make rapid bone fractures.


Rickets

Rickets is often experienced by children who are growing. Bone formation in patients with abnormal rickets, which is a buildup of calcium in the bones due to eating too much calcium milk or as a result of solar radiation.


Osteomyelitis

This infection attacks the bone and caused by bacterimia, or sepsis, that spreads and reduced bone strength.


C. Bone Disease Prevention and Treatment

1. Exercising regularly will reduce the risk of bone disease. With a lot of moving, bone composition will be solid and unavoidable loss or fracture.
2. Food intake should be a nutritious and high in fiber. Usahan to consume high calcium milk
3. If you feel no complaints about the bones or joints, immediately consult a doctor.
4. Perform a balanced diet by eating foods rich in calcium and vitamin D
5. It is recommended not to smoke and consume alcoholic beverages
6. Perform routine testing of bone strength


B. Here are some of the bone disease that is often experienced:

Osteoporosis

That is a disease that causes decreased bone density. Osteoporosis undermined the strength of the trabecular bone so that its strength is reduced drastically, also bone cortical thinning and overall bone will break easily. The disease is stalking people who already advanced and women entering menopause.


Osteomalacia

This disease results in bones becoming weak due to shortages
vitamin D or errors of metabolism in the body. As with osteoporosis, osteomalacia also has the potential to make rapid bone fractures.


Rickets

Rickets is often experienced by children who are growing. Bone formation in patients with abnormal rickets, which is a buildup of calcium in the bones due to eating too much calcium milk or as a result of solar radiation.


Osteomyelitis

This infection attacks the bone and caused by bacterimia, or sepsis, that spreads and reduced bone strength.


C. Bone Disease Prevention and Treatment

1. Exercising regularly will reduce the risk of bone disease. With a lot of moving, bone composition will be solid and unavoidable loss or fracture.
2. Food intake should be a nutritious and high in fiber. Usahan to consume high calcium milk
3. If you feel no complaints about the bones or joints, immediately consult a doctor.
4. Perform a balanced diet by eating foods rich in calcium and vitamin D
5. It is recommended not to smoke and consume alcoholic beverages
6. Perform routine testing of bone strength

Skin Diseases



                        Skin Diseases

Info regarding some types of skin diseases which are prevalent in the human body, some types of skin diseases is ongoing due to various causes, starting because of a virus, contaminated environment and there are many more.

As for some types of skin diseases which are as follows.

1. eczema (dermatitis).
major signs of eczema patients perceived that too excessive itching of the skin. then coupled with reddened skin, scaly and cracked, raised small bubbles contains water or pus. hands, feet, groin and ear which side of the body is very often affected by eczema. Eczema is divided into two, namely dry and wet eczema. on wet eczema, will feel hot and cold on the skin that is too excessive.

eczema due to allergies to specific stimuli like chemicals that are in detergents, soap, medicines and cosmetics, sensitivity to specific types of foods like shrimp, fish, eggs, chicken meat, alcohol, MSG (msg), and so on. eczema can also be caused due to an allergic pollen, dust, rangangan climate, especially emotional problems.

eczema often attack in people who have allergies talent. This disease often take place repeatedly or relapse. by because it should be noticed to avoid the subject or several ingredients that could cause allergies (allergens.) However, with the right cure, this disease can be controlled properly to reduce the recurrence rate. in some problems, eczema can disappear along with the growing age of the patient.

2. Boils (furuncles).
Boils are skin infections shaped lump, look red, which can be enlarged. pus filled bumps, as well as feeling hot and throbbing. Boils can grow throughout the body. but more and more grows in moist parts of the body, like, groin, between the buttocks, more or less neck and armpit, as well as the head.

ulcers caused due to bacterial infection staphylococcus aureus on the skin pass through the hair follicles, sebaceous glands, sweat glands, and then cause local infection. factor that adds to the risk of ulcers include poor hygiene, infected wounds, weakening diabetes, cosmetics that clog pores, as well as the use of chemicals.

to avoid ulcers, good personal hygiene and keep protecting the environment, as well as nutrient consumption must really be noticed. because good nutrition can strengthen the immune system.
skin disease

3. measles (rubella).
Measles is an acute infectious disease caused by a virus. generally affects children. early signs of measles include fever, runny nose, sneezing, body feels lethargic, headache, appetite naturally decline striking and eye inflammation. after several days of these signs are itchy red rash, become bigger, spread to parts of the body.

4. mange (scabies).
Scabies is a parasitic disease caused by the itch mite Sarcoptes scabiei var hominis. infected with scabies skin more and more taking place in slums and not to protect the cleanliness of the body. signs of scabies is intense itching that there is so great at night, especially in between the toes, hands, under the armpits, genitals, waist and so on. Scabies is very contagious to others, with no immediate or not immediate.

immediately it is definitely passing touch exposed skin with skin scabies others. by not immediately be transmitted pass through a towel or clothing used interchangeably with patients with scabies. step is very easy to avoid scabies is certain to protect the cleanliness of the environment and the body.

5. ringworm. ringworm takes place due to the fungus.
generally as the symptoms are not so thin skin and the embossed leather circles increasingly obvious, flaky, moist and juicy and feel itchy. then in circles can occur white patches. ringworm arise due to lack of hygiene protects the skin. hand ringworm of the body which are generally attacked the nape, neck, and scalp.

6. psoriasis.
countless psoriasis skin disease that is difficult to diagnose. side of the body commonly affected by eczema equally well with the usual sides of the body affected by psoriasis, plus scalp, lower back side, palms, and soles of the feet. stress, trauma, and low calcium levels can lead to psoriasis.

Psoriasis is not only infectious diseases, but the natural shape of the decline. signs of psoriasis, namely the emergence of red blotches on which there is no white scales thin and embedded in layers. if scratched, the scales can fall out. originally, the surface area of ​​skin affected only a small, and increasingly widening.

7. melanoma.
Melanoma is the most serious skin cancer, can lead to death if untreated. melanoma is the type of cancer that resulted in change of moles on the skin, can be risky if visible on the neck or scalp. in the course of signal mole melanoma is enlarged. not only it lasted color change in moles and marks visible signal of inflammation in the skin in less moles.

8. impetigo.
impetigo is contagious skin disease is generally caused by bacteria. impetigo cause skin to be itchy, fluid-filled blisters and the skin to be red. impetigo very easily take place in children aged two to six years old .. bacteria usually enter the skin in passing insect bites, cuts, or scrapes. Absolute cleanliness is very natural for people impetigo.

9. Acne
according to the study, approximately 80% of all first humans have acne. acne as between a skin disease caused by bacteria that grow in the skin as well as connecting the pores with oil glands under the skin. Acne can develop when healing is not done in step inception. Acne is not just growing in the face, but it can also grow other parts of the body especially the back

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