Source:www.tsinoy.com
These are the three ways on how to name a
Chinese year:
1. By an animal (like a mascot). The new year is known as the Year of the
Rooster.
There are 12 animal names; so by this system, year names are re-cycled every 12
years.
2. By its Former Name.
The new year is the year of Yiyou. By this system, the Name of the Year is
repeated and re-cycled every 60 years.
3. It is Year 4702 by Chinese calendar.
The Roosters
Hardworking, resourceful, courageous and talented, Roosters are self-assured
people. They possess powerful personalities and are notoriously dominant. In
groups they are vivacious, amusing and popular.
But Roosters can be conceited, with a strong egotistical need to constantly be
the center of attention. Excellent at small talk, they can be the life of any
party. Roosters are talkative types, outspoken, frank, open, honest -- but a
little too blunt at times. With the
Rooster's dedication to work well done, he or she would also make a good
economist or a gifted administrator. They make good restaurant owners and
world travellers.
That's because they are born organizers, refined and elegant. The management of
finances is perhaps their strength. When it comes to money, Roosters are prudent
and careful. They are brilliant managers of other people's money; financial
advisers, bank managers, and accountants would all do well to be born in the
Year of the Rooster.
The Rooster has the reputation of finding money in the most unlikely places, like drawing blood from a stone.
A Rooster man likes to be in the company of
women, among whom he can boast on how clever he is. However, he rarely goes out
for a night with the boys; men bore him to extinction. His Hen counterpart also
likes the company of other women (not that she doesn't like men).
The Rooster will touch the heights and depths during the three phases of his
life, business-wise as well as romantically. He will go from poverty to riches,
from ideal love to the most sordid of emotional entanglements. The Rooster's old
age will be happy, however.
In love, the Rooster will often do himself harm to gain or to keep the affection
of the loved one.
October is the month of the Rooster. The time of the Rooster is from 5:00
p.m. to 6:59 p.m.; their direction of orientation is the west. The
Rooster's color is peach.
Famous people born in the Year Of The Rooster are Michael Aspel, Yoko Ono,Rod Stewart, Mia Farrow, Eric Clapton
A
GUIDE TO GIVING VALENTINE'S GIFT
Debby Sy
Flowercartmanila.com
1 . For Her
Floral Gifts for her: Valentine’s is just not complete without flowers. Add on any other item you wish, but don’t forget the flowers. Even the most conscientious Pinay who would tell you to save your money and not to bother with flowers has a hidden deep desire to receive beautiful flowers when the occasion calls for it. On this occasion, the floral gift need not be abundant or massive since prices of flowers shoot up during this time of the year, 3 red roses from a reputable flower shop can get the message across for now and send a more generous bouquet on some other occasion to emphasize
it!
However trite this may be the add–on gifts to the flowers should be symbolically sweet..like a box of chocolates or cake, simple jewelry like a locket pendant, or a stuffed teddy bear. Avoid sending appliance, cash, camera or cellphone, etc since these items are too practical to be sweet. Save those for a Christmas or birthday surprise or no-occasion gift.
If you want to be gallant on this occasion or if you are trying to ward off competition, upsize your gifts. For instance, send more than a dozen tulips instead and request the
florist to package it with a huge teddy bear or a more uncommon box of sweets as well as balloons. That way, you are sure that your gift will stand out from among the many roses she will receive.
2. For Him
Unless he likes flowers in particular, it is not necessary to send him flowers. Something sweet always does the trick, like chocolates or cake. As they say, the way to a man’s heart is through his stomach. But if you want to send a message across, blue roses is a popular choice. A more sophisticated man would appreciate a plant gift for his office
or a CD of classic love songs while other guys enjoy novelty items like a talking pillow, alarm clock that plays his fave tune, or other cool toys.
Since men are generally more practical, they would appreciate gifts with some functionality like clothes, appliance, or electronic gadgets. However, you would be sending a message inappropriate for Valentine’s if you send him these things unless, of course, you need to support him. But then, in that case, you should send such gifts some other time and avoid the Vday mad rush.
3. For our Mothers
Floral gift less the sweets is still the safest gift for mothers if you are not sure about her health condition. They would love the sweets but may not appreciate them if she has diabetes or high cholesterol levels. Flowers need not be limited to roses since the love message at this point is an understatement. Instead, send a big bundle of flowers to make any mother’s heart glow or a gift of a flowering plant symbolizes her nurturing spirit.
4. For the little Girl
The best way to give a little girl her best childhood memory of Valentine’s day is to send her some fancy treats on Valentine’s day. Have a box of heart shaped candies, a heartshaped box of chocolates or a heartshaped cake delivered to your favorite inaanak or niece. Balloons and a stuffed bear will add to her endless wonder and delight.
5. For A friend
If you are planning to send a message of love and thanks
to friends who have always been there for you, stay away from red roses since commercialization of
Valentine’s roses has resulted in its being associated it with the humdrum “ I love you’s.”
Try any other gift, flowers or chocolates, again, something sweet so they know you are trying to make them feel special on Valentine’s Day. And they will get the message….without your having to say anything more.
For the cost-conscious, you can always surprise your loved one with an advanced gift a week or 2 before the prices of gifts shoot up during the Valentine frenzy.
VALENTINE'S DAY HISTORY
There are varying opinions as to the origin of Valentine's Day. Some
experts state that it originated from St. Valentine, a Roman who was martyred
for refusing to give up Christianity. He died on February 14, 269 A.D., the same
day that had been devoted to love lotteries. Legend also says that St.
Valentine left a farewell note for the jailer's daughter, who had become his
friend, and signed it "From Your Valentine". Other aspects of the
story say that Saint Valentine served as a priest at the temple during
the reign of Emperor Claudius. Claudius then had Valentine jailed for defying
him. In 496 A.D. Pope Gelasius set aside February 14 to honor St. Valentine.
Gradually, February 14 became the date for exchanging love messages and St. Valentine became the patron saint of lovers. The date was marked by sending poems and simple gifts such as flowers. There was often a social gathering or a ball.
In the United States, Miss Esther Howland is given credit for sending the first valentine cards. Commercial valentines were introduced in the 1800's and now the date is very commercialised. The town of Loveland, Colorado, does a large post office business around February 14. The spirit of good continues as valentines are sent out with sentimental verses and children exchange valentine cards at school.
The History of Saint Valentine's Day
Valentine's Day started in the time of the Roman Empire. In ancient Rome, February 14th was a holiday to honor Juno. Juno was the Queen of the Roman Gods and Goddesses. The Romans also knew her as the Goddess of women and marriage. The following day, February 15th, began the Feast of Lupercalia.
The lives of young boys and girls were strictly separate. However, one of the customs of the young people was name drawing. On the eve of the festival of Lupercalia the names of Roman girls were written on slips of paper and placed into jars. Each young man would draw a girl's name from the jar and would then be partners for the duration of the festival with the girl whom he chose. Sometimes the pairing of the children lasted an entire year, and often, they would fall in love and would later marry.
Under the rule of Emperor Claudius II Rome was involved in many bloody and unpopular campaigns. Claudius the Cruel was having a difficult time getting soldiers to join his military leagues. He believed that the reason was that roman men did not want to leave their loves or families. As a result, Claudius cancelled all marriages and engagements in Rome. The good Saint Valentine was a priest at Rome in the days of Claudius II. He and Saint Marius aided the Christian martyrs and secretly married couples, and for this kind deed Saint Valentine was apprehended and dragged before the Prefect of Rome, who condemned him to be beaten to death with clubs and to have his head cut off. He suffered martyrdom on the 14th day of February, about the year 270. At that time it was the custom in Rome, a very ancient custom, indeed, to celebrate in the month of February the Lupercalia, feasts in honor of a heathen god. On these occasions, amidst a variety of pagan ceremonies, the names of young women were placed in a box, from which they were drawn by the men as chance directed.
The pastors of the early Christian Church in Rome endeavored to do away with the pagan element in these feasts by substituting the names of saints for those of maidens. And as the Lupercalia began about the middle of February, the pastors appear to have chosen Saint Valentine's Day for the celebration of this new feast. So it seems that the custom of young men choosing maidens for valentines, or saints as patrons for the coming year, arose in this way.
St. Valentine's Story
Let me introduce myself. My name is Valentine. I lived in Rome during the third century. That was long, long ago! At that time, Rome was ruled by an emperor named Claudius. I didn't like Emperor Claudius, and I wasn't the only one! A lot of people shared my feelings.
Claudius wanted to have a big army. He expected men to volunteer to join. Many men just did not want to fight in wars. They did not want to leave their wives and families. As you might have guessed, not many men signed up. This made Claudius furious. So what happened? He had a crazy idea. He thought that if men were not married, they would not mind joining the army. So Claudius decided not to allow any more marriages. Young people thought his new law was cruel. I thought it was preposterous! I certainly wasn't going to support that law!
Did I mention that I was a priest? One of my favorite activities was to marry couples. Even after Emperor Claudius passed his law, I kept on performing marriage ceremonies -- secretly, of course. It was really quite exciting. Imagine a small candlelit room with only the bride and groom and myself. We would whisper the words of the ceremony, listening all the while for the steps of soldiers.
One night, we did hear footsteps. It was scary! Thank goodness the couple I was marrying escaped in time. I was caught. (Not quite as light on my feet as I used to be, I guess.) I was thrown in jail and told that my punishment was death.
I tried to stay cheerful. And do you know what? Wonderful things happened. Many young people came to the jail to visit me. They threw flowers and notes up to my window. They wanted me to know that they, too, believed in love.
One of these young people was the daughter of the prison guard. Her father allowed her to visit me in the cell. Sometimes we would sit and talk for hours. She helped me to keep my spirits up. She agreed that I did the right thing by ignoring the Emperor and going ahead with the secret marriages. On the day I was to die, I left my friend a little note thanking her for her friendship and loyalty. I signed it, "Love from your Valentine."
I believe that note started
the custom of exchanging love messages on Valentine's Day. It was written on the
day I died, February 14, 269 A.D. Now, every year on this day, people remember.
But most importantly, they think about love and friendship. And when they think
of Emperor Claudius, they remember how he tried to stand in the way of love, and
they laugh -- because they know that love can't be beaten!
My Bloody Valentine
Beheading, bloodshed and confusion are the only certainties in the web of truth and lies known as Valentine's Day
By Mary Spicuzza from http://www.metroactive.com/papers/cruz/02.10.99/valentine-9906.html
ASSAULTED BY the barrage of love printed, packaged and sold this February, most frantic folks are exhausted by the time Valentine's Day finally rolls around. Victims of the multi-billion-dollar romance industry, they've spent countless hours hunting for that ideal gift or scrambling for the perfect clutch of long-stemmed hot-house roses imported from low-cost-labor foreign greenhouses.
Yet if more poor souls drowning in this spring's sea of cherubic cupids and hot-pink hearts took a moment to reflect on the bizarre and bloody origins of Valentine's Day, they might find some solace. Or at least take comfort in knowing they're not alone--confusion and heartache on Feb. 14 are centuries-old traditions.
The Valentine legend, as little bespectacled Sister Edwardina told my plaid jumper-clad fifth-grade class, traces the event to a priest named Valentinus. He lived in third-century Rome during the reign of Emperor Claudius Gothicus, who from 268 to 270 C.E. earned his title by slaughtering Gothic invaders. In his free time, the industrious emperor persecuted Christians refusing to worship the official Roman gods.
Emperor Claudius, learning that popular Valentinus was a priest and healer, ordered one of his top minions to keep him out of trouble. While keeping Valentinus under house arrest, the soldier brought his beautiful, bright and blind young daughter, Julia, to visit him with hopes that she might be cured.
Valentinus and Julia met numerous times and developed an intense relationship--which our tiny, wrinkled nun insisted was purely platonic. As he worked to cure her blindness, he taught Julia lessons in mathematics, literature and Christ's love. Wise Valentinus was known as a chaste man--suggesting a proper Valentine's Day would be a celebration of abstinence, much like a day-long "True Love Waits" rally.
Still, many of us young 'uns tugged at our navy knee socks, wondering whether Valentinus and Julia's relationship went beyond mere teacher-student devotion.
We were told the real trouble started when Emperor Claudius learned that Julia and her entire family had converted to Christianity. He sent his soldiers, who swiftly smashed Valentinus' herbal tinctures and tossed him in the death-row dungeon. Valentinus continued to see Julia even after he was thrown in the clink, and supposedly he passed the rest of his long days cutting paper into intricate shapes to stave off madness. He sent his creations as gifts to Julia. (Perhaps this is why several of the women in my class later dated men in prison--we somehow learned from Sister Edwardina that it's romantic to get cheap gifts from unstable men twice our age.)
The good nun's eyes welled with tears as she recounted how Valentinus was led off by soldiers to meet his fate on the morning of Feb. 14. He pleaded for a pen and scribbled a quick note to little Julia--who despite the long hours with her loving Valentinus was still completely blind.
Probably just as Valentinus' head was lopped off on the Via Flaminia, the busiest road in the Roman Empire, Julia took Valentinus' note from her father's hands and looked at the world for the first time through her own eyes. Her sight miraculously restored, she read Valentinus' proclamation of love, signed, "From Your Valentine."
THIS WELL-MEANING tale of the first Valentine's Day love letter is a topic of centuries of battle among scholars. As if engaged in an endless lovers' quarrel, religious scholars constantly bicker over the conflicting facts that leave the life of Saint Valentine a mystery.
The confusion undoubtedly lies in just how unlucky those named Valentine have been throughout the ages. Of the 12 saints Valentine recorded in The Book of Saints by the Benedictine monks of Saint Augustine's abbey, all but three met their end as martyrs. Nearly every one had his head lopped off, except for the poor female martyr Saint Valentina--of course the only noted virgin of the bunch--who was burned in a group sacrifice.
Most tales of the cursed Feb. 14 mention another martyr named Valentinus, a bishop from Terni, who was beheaded that day along the same road. Scholars, Sister Edwardina and the other nuns of Saint Robert School still spar over whether the two saints were truly one man. Some believe one Valentinus was imprisoned in two towns; others say his corpse got so much mileage after being scattered about the town after his untimely end that in different towns cults sprang up in his honor.
Several accounts say that young Julia was truly a blind little boy; others argue that the entire story was fabricated centuries later for theatrical entertainment. Another camp contends that Valentinus was killed for marrying young couples despite the emperor's ban on marriage, though that seems to be completely fabricated to up the romance factor.
Basically, when it comes to Valentine's Day, truth falls last on the priority list.
Both February martyrs have been honored as saints, whereas the Gnostic Valentinus, born a century earlier, was excommunicated by the church. Because his rational teachings fused Christianity with the logical teachings of Plato, he offended the church and was exiled to the isle of Cyprus.
It was this heretic Valentinus who wrote, "And the heart seems to me to be treated somewhat like an inn, for that it has holes and ruts in it, and is oft filled with dung by men who live filthily in it, and take no care of the place since it belongs to others."
Sister Edwardina never taught us about the rational Valentinus. The diminutive nun had an affinity for martyrs, which is probably why she got stuck with the lunchtime duty of inspecting the lunchroom garbage to make sure we ate every last Tater Tot.
Just like the life of the martyred symbol of love, Saint Valentinus' post-mortem period is wrapped in confusion. After he was bludgeoned, beheaded and dragged along the Flaminian Way, it's no surprise Valentinus' remains were scattered. Both the Church of St. Praxedus in Rome and a basilica in Terni display what are said to be Valentine's bones. Some stories say his head was purchased by British royalty as a good-luck charm; others that a group of English monks stole it. Regardless, Valentine's head makes appearances in 12th-century Britain, where it's credited with curing the blind, epileptics, the insane and sufferers willing to kiss the decaying relic.
In the tradition of Roman Catholic imperialism, Saint Valentine's name was used to take over the Feb. 15 pagan festival of Lupercalia. The frisky day consisted of nearly naked boys slaughtering goats and running through the streets playfully whipping young girls and boys with freshly made goat-skin thongs.
It wasn't until the Middle Ages that the mass-marketed consumerism sold as romance took over the feast day of Saint Valentine.
This messy tale of Saint Valentinus, though it doesn't fit the tidy Hallmark image, teaches modern sufferers that we're not alone. Whether spent listening to Mr. Wrong babble endlessly about himself over a cold plate of linguini, or sitting alone devouring copious amounts of Godiva truffles, Feb. 14 could be worse. Compared to Julia and her bludgeoned, beheaded Saint Valentinus, the dreaded Valentine's Day seems to have improved through the centuries. And folks probably have a better chance of finding Mr. or Ms. Right than they do of uncovering the truth about the ill-fated martyr known as Saint Valentine.
Emergencies Series
Editor: Warren B. Howe, MD
In Brief: Meningococcemia is a dangerous disease requiring early and aggressive treatment to prevent a potentially lethal outcome. It often occurs in relatively closed groups, including sports camps and athletic teams. A high index of suspicion must be maintained when evaluating acute febrile illness, particularly in people younger than 20. Treatment includes antibiotics and intensive care support. Prophylaxis in the intimately exposed population, and education about signs and symptoms of the disease for more peripheral contacts are critical for successfully limiting any outbreak.
The youngster looked ill. He was attending a summer sports camp and woke the trainer at 5:00 am to report feeling hot and having nausea and abdominal pain. The trainer alertly notified the camp physician, who saw the 10-year-old boy shortly thereafter and noted an ill-appearing patient with a temperature of 103°F, diffuse abdominal tenderness, and a 1.5-cm tender, ecchymotic lesion on his left lateral malleolus. He did not have signs of meningitis.
By the time the patient was transferred to the hospital, he had developed a number of petechial lesions on his limbs and trunk. Antibiotic treatment for septicemia was instituted, and the boy made an excellent recovery. Blood cultures later grew Neisseria meningitidis.
Almost simultaneously with the patient's hospital admission, a friend of the patient--with whom the patient had attended a swim meet 2 days before departing to camp--was admitted to the same hospital with similar symptoms. This second 10-year-old boy was also successfully treated for meningococcemia. As is usually the case in outbreaks of invasive meningococcal disease, the camp administration and the parents of children attending the camp were considerably dismayed about the implications of this infection. The camp physician spent more effort in arranging prophylaxis for those exposed and educating the entire population involved about the disease than was spent in treating the index case.
No further cases occurred. The successful outcome, achieved without significantly interrupting the camp's activities, was satisfying for all concerned.
Outbreaks of meningococcal disease occur sporadically and may, as in this case report, involve athletes and sports situations. This is a dangerous disease that demands early and aggressive treatment, vigorous measures to control spread, and reassurance for the larger population that may feel threatened by the outbreak.
Neisseria meningitidis is a gram-negative diplococcus whose reservoir is the human nasopharynx. Serogroup A is associated with large-scale epidemics, particularly in developing countries, while serogroups B and, increasingly, C are currently associated with localized outbreaks in North America. Jackson et al (1) have documented 21 outbreaks of serogroup C disease in the United States between 1981 and 1993, with dramatically increasing frequency since 1990. The emergence of new, increasingly virulent strains has also been associated with outbreaks (1,2).
The organism can be cultured in 5% to 15% of healthy people and spreads when people inhale droplets of contaminated upper-respiratory secretions. During outbreaks, this percentage rises significantly in the affected population, although only a small number of those carrying the organism will develop clinical meningococcal disease. The incubation period is 1 to 10 days, usually 4 days or less.
Most cases of invasive meningococcal disease occur in patients younger than 20, and the risk of contagion seems to vary with the closeness and persistence of contact; it is highest in household members. Outbreaks have been reported in populations in other relatively closed settings, such as military camps, day care centers, and colleges. However, many patients cannot recall exposure to symptomatic individuals.
Few, if any, symptoms attend nasopharyngeal infection by meningococci. In the early stages of invasive disease, meningococcemia usually presents as an acute febrile illness with malaise, nausea, myalgia or arthralgia, significant fever, and chills. Instead of the rapid resolution of symptoms usually associated with self-limited infections, the patient with meningococcemia usually becomes progressively and impressively sicker with toxemia and prostration.
Rash occurs in most patients, and because it can develop very quickly, should be searched for repeatedly. It is initially macular, erythematous, and located mainly on the extremities; petechiae and purpura subsequently develop. Other symptoms depend on where the meningococci localize after hematogenous spread.
Meningitis, with symptoms such as a stiff neck, severe headache, back pain, and mental status changes, is the most common localized manifestation. Meningococcal pneumonia, endocarditis, myocarditis, pericarditis, pleurisy, peritonitis, and arthritis may also occur. Approximately 10% of patients with meningococcemia develop Waterhouse-Friderichsen syndrome, characterized by a fulminant septicemia with shock, widespread purpura (purpura fulminans), congestive heart failure, and progressive, usually irreversible, collapse.
Laboratory abnormalities typically include significant leukocytosis with left shift, but leukopenia may occur in overwhelming disease. Coagulopathy may be demonstrable. If meningeal infection has occurred, purulent spinal fluid is encountered with elevated cerebrospinal fluid protein and decreased glucose. Cultures of blood and cerebrospinal fluid will usually be positive for meningococci; serogroup and serotype identification can aid epidemiologic investigation (1).
The key to effective intervention is a high index of suspicion at the early stage, particularly during periods of increased respiratory disease in the community, since meningococcemia also seems to peak at such times. Once meningococcemia is suspected, antibacterial treatment must be instituted promptly, because early treatment seems to improve prognosis (3). Urgent hospitalization for intensive care and support is mandatory.
Blood cultures can be obtained as the intravenous (IV) line is being placed. For adults, IV penicillin G, 2 million units every 2 hours around the clock, is appropriate. The dose for children is 250,000 units/kg/day administered every 2 hours in divided doses.
If penicillin-resistant meningococci are suspected, alternatives include IV ceftriaxone sodium (adults 4 g/day, children 100 mg/kg/day; doses every 12 hours) or chloramphenicol (adults and children 100 mg/kg/day, maximum 4 g/day; doses every 6 hours). Ceftriaxone is preferred as initial therapy in children, because septicemia with Haemophilus influenzae can produce a clinical picture similar to that of meningococcemia. Chloramphenicol is especially useful in patients who have a history of anaphylactic reaction to penicillin; its use is otherwise limited by potential hematologic toxicity.
Preventing the spread of the disease and treating new cases early are critical. This is an urgently reportable disease in all states. Once the diagnosis is made, the early symptoms of meningococcemia should be widely publicized, and people in the potentially exposed population should be urged to seek immediate medical evaluation if they contract a febrile illness.
Patients who have meningococcemia should be isolated during the first 24 to 36 hours of antibacterial therapy. Household members are at greatest risk for contagion, followed by contacts within the relatively closed populations mentioned earlier. People in close contact with the patient should receive chemoprophylaxis aimed at eradicating meningococci from the nasopharynx. More peripheral contacts are not routinely treated, although I have adopted the philosophy of treating any peripheral contact who requests prophylaxis.
Currently recommended medications for prophylaxis include the drug of choice, rifampin, and also minocycline, ceftriaxone, ciprofloxacin, and--when the organism is known to be sensitive to it-sulfadiazine (table 1). Remember that rifampin stains body fluids orange, including tears, so permanent staining of soft contact lenses can result. Because meningococci can often be recovered from the nasopharynx of treated meningococcemia patients, they must also receive chemoprophylaxis before being discharged from the hospital (5).
| Table 1. Meningococcal Disease Chemoprophylaxis for Children and Adults | ||||
| Drug | Dosage Adult, Child 13 Yr or Older |
Dosage Child 1-12 Yr |
Dosage Child Under 1 Yr |
Comments |
| Rifampin | 600 mg orally every 12 hr, 4 doses | 10 mg/kg (max 600 mg) orally every 12 hr, 4 doses | 5 mg/kg orally every 12 hr, 4 doses | Preferred drug |
| Sulfadiazine | 1,000 mg orally every 12 hr, 4 doses | 500 mg orally every 12 hr, 4 doses | 500 mg orally every 24 hr, 2 doses | Only if index organism sensitive to this drug |
| Ciprofloxacin | Age 18 yr or older: 750 mg as single oral dose (4) | NA | NA | Not recommended for under age 18 yr |
| Minocycline | 200 mg orally followed by 6 100-mg oral doses every 12 hr | Age 8 yr or older: 4 mg/kg orally followed by 6 2-mg/kg oral doses every 12 hr | NA | Avoid in pregnancy and under age 8 yr |
| Ceftriaxone sodium | 250 mg, single dose | 125 mg, single dose | 125 mg, single dose | Intramuscular |
| NA=Not applicable | ||||
Meningococcal vaccine effective against serogroups A, C, Y, and W-135 (but not serogroup B) is available. It is used routinely in the military, and is recommended for travel to endemic areas. Patients who may have impaired resistance--such as those who have no spleen or are deficient in terminal--component complement-should be offered immunization. Universal immunization is not practiced, but the vaccine is recommended by some authorities as a supplement to chemoprophylaxis for controlling outbreaks involving a vaccine-sensitive organism (1).
By educating themselves about common manifestations of the disease, physicians can raise their index of suspicion for meningococcal disease in patients affected by febrile illness, which can result in early diagnosis. Then quick action can be taken to treat the afflicted person and help prevent the spread of the disease.
Dr Howe is the team physician at Western Washington University in Bellingham, Washington, and a member of the editorial board of The Physician and Sportsmedicine. Address letters to Warren B. Howe, MD, 4222 Northridge Way, Bellingham, WA 98226; e-mail to warrenbh@mem.po.com
Temporomandibular Joint (TMJ) Syndrome
Source:
eMedicine Consumer Health <--http://www.emedicinehealth.com/articles/14227-1.asp
TMJ Overview
Temporomandibular joint (TMJ) syndrome or TMJ joint disorders are medical
problems related to the jaw joint. The TMJ connects the lower jaw to the skull
(temporal bone) under your ear. Certain facial muscles control chewing. Problems
in this area can cause head and neck pain, a jaw that is locked in position or
difficult to open, problems biting, and popping sounds when you bite.
The TMJ is comprised of muscles, blood supplies, nerves, and bones. You have 2
TMJs, one on each side of your jaw.
Muscles involved in chewing (mastication) also open and close the mouth. The
jawbone itself, controlled by the TMJ, has 2 movements: rotation or hinge
action, which is opening and closing of the mouth, and gliding action, a
movement that allows the mouth to open wider. The coordination of this action
also allows you to talk, chew, and yawn.
If you place your fingers just in front of your ears and open your mouth, you
can feel the joint and its movement. When you open your mouth, the rounded ends
of the lower jaw (condyles) glide along the joint socket of the temporal bone.
The condyles slide back to their original position when you close your mouth. To
keep this motion smooth, a soft disc lies between the condyle and the temporal
bone. This disc absorbs shock to the temporomandibular joint from chewing and
other movements. Chewing creates a strong force. This disc distributes the
forces of chewing throughout the joint space.
TMJ Causes
TMJ can be caused by trauma, disease, wear due to aging, or habits.
Trauma: Trauma is divided to microtrauma and macrotrauma. Microtrauma is
internal, such as bruxism (grinding the teeth) and clenching (jaw tightening).
This continual hammering on the temporomandibular joint can change the alignment
of the teeth. Muscle involvement causes inflammation of the membranes
surrounding the joint. Teeth grinding (bruxism) and clenching are habits that
may be diagnosed in people who complain of pain in the temporomandibular joint
or have facial pain that includes the muscles involved in chewing (myofascial
pain). Macrotrauma, such as a punch to the jaw or impact in an accident, can
break the jawbone or damage the disc.
Bruxism: Teeth grinding as a habit can result in muscle spasm and inflammatory
reactions, thus causing the initial pain. Changes in the normal stimuli or
height of the teeth, misalignment of the teeth, and changes in the chewing
muscles may cause temporomandibular joint changes. Generally, someone who has a
habit of grinding his or her teeth will do so mostly during sleep. In some
cases, the grinding may be so loud that it disturbs others.
Clenching: Someone who clenches continually bites on things while awake. This
might be chewing gum, a pen or pencil, or fingernails. The constant pounding on
the joint causes the pain. Stress is often blamed for tension in the jaw,
leading to a clenched jaw.
Osteoarthritis: Like other joints in the body, the jaw joint is prone to have
arthritic changes. These changes are sometimes caused by breakdown of the joint
(degeneration) or normal aging. Degenerative joint disease causes a slow
progressive loss of cartilage and formation of new bone at the surface of the
joint. Cartilage destruction is a result of several mechanical and biological
factors rather than a single entity. Its prevalence increases with repetitive
microtrauma or macrotrauma, as well as with normal aging. Immunologic and
inflammatory diseases contribute to the progress of the disease.
Rheumatoid arthritis: Rheumatoid arthritis causes inflammation. As it
progresses, the disease can cause destruction of cartilage and erode bone,
deforming joints. It is an autoimmune disease involving the antibody factor
against immunoglobulin G (IgG). Chronic rheumatoid arthritis is a multisystem
inflammatory disorder with a persistent symmetric joint involvement. Certain
infectious diseases may be the cause of rheumatoid arthritis.
TMJ Symptoms
Pain in the facial muscles and jaw joints may radiate to the neck or shoulders.
Joints may be overstretched. You may experience muscle spasms from TMJ. You may
feel pain every time you talk, chew, or yawn. Pain usually appears in the joint
itself, in front of the ear, but it may move elsewhere in the skull, face, or
jaw.
TMJ may cause ear pain, ringing in the ears (tinnitus), and hearing loss.
Sometimes people mistake TMJ pain for an ear problem, such as an ear infection,
when the ear is not the problem at all.
When the joints move, you may hear sounds, such as clicking, grating, and/or
popping. Others may also be able to hear the sounds. Clicking and popping are
common. This means the disc may be in an abnormal position. Sometimes no
treatment is needed if the sounds give you no pain.
Your face and mouth may swell on the affected side.
The jaw may lock wide open (then it is dislocated), or it may not open fully at
all. Also, upon opening, the lower jaw may deviate to one side. You may find
yourself favoring one painful side or the other by opening your jaw awkwardly.
These changes could be sudden. Your teeth may not fit properly together, and
your bite may feel odd.
You may have trouble swallowing because of the muscle spasms.
Headache and dizziness may be caused by TMJ. You may feel nauseous or vomit.
When to Seek Medical Care
Occasional pain in the jaw joint or chewing muscles is common and may not be a
cause for concern. See a doctor if your pain is severe or if it does not go
away. Treatment for TMJ should begin when it is in early stages. The doctor can
explain the functioning of the joints and how to avoid any action or habit (eg,
chewing gum) that might aggravate the joint or facial pain.
If your jaw is locked open or closed, go to a hospital's emergency department.
The open locked jaw is treated by sedating you to a comfortable level. Then the
mandible is held with the thumbs while the lower jaw is pushed downward,
forward, and backward.
The closed locked jaw is treated by sedating you until you are completely
relaxed. Then the mandible is gently manipulated until the mouth opens.
Exams and Tests
Medical history: In diagnosing your jaw problem, the doctor will ask the
following questions:
What kind of pain do you have?
Is it an ache or a throbbing pain or a sharp stabbing pain?
Is the pain continuous or intermittent?
Can you outline the area of pain on your face with your finger?
What helps to alleviate the pain? What aggravates the pain?
Do you grind or clench your teeth? Do you bite your nails or chew on any
objects, such as pens or pencils?
Do you hold the telephone with your shoulder against your ear for a long time?
Do you chew gum often? For how long?
Do you have any oral habits that you have not mentioned?
Physical examination: During the physical examination, the doctor will examine
your head, neck, face, and temporomandibular joints, noting any of the
following:
Tenderness (pain) and its location
Sounds, such as clicking, popping, grating
The mandible (lower jaw) range of motion and whether it is easy to open and
close and can move from side to side and forward-backward without any pain
Your assessment of pain on a scale from 0 (no pain) to 10
Wear on buccal cusps of the mandibular teeth, especially the canine
The rigidity and or tenderness of the chewing muscles
How your teeth fit together: normal, open bite, crossbite, overbite, dental
restorations, or skeletal deformity
Imaging: X-rays may be taken of the mouth and jaw. CT or MRI may also be used.
The MRI was designed for soft tissue and, therefore, will show the location of
the TMJ disc in relationship to the jaw and skull bones. That will give the
doctor a better idea as to the proper treatment approach.
TMJ Treatment
|Self-Care at Home|
Many people, more women than men, have TMJ. However, the full TMJ disorder
develops in only a few. Most of the symptoms disappear in 2 weeks because your
jaw joint rests and recovers when you are unable to chew.
Anti-inflammatory pain medications such as aspirin or acetaminophen (Tylenol) or
ibuprofen (Motrin, Aleve) may ease the pain of TMJ.
Eat a diet of soft foods.
Apply warm compresses on the area of pain. Home therapy includes mandible (lower
jaw) movements, such as opening and closing the jaw from side to side. Try this
after a warm compress is applied for 20 minutes. The lower jaw movements should
be repeated 3-5 times a day, 5 minutes continuously each time, for about 2-4
weeks.
|Medical Treatment|
Most cases of TMJ are temporary; thus, treatment is usually conservative.
Early therapy starts simply with resting the jaw, using warm compresses (ice
packs at first if an injury is present), and pain medication. Jaw rest can help
heal temporomandibular joints. Eat soft foods. Avoid chewing gum and eating hard
candy or chewy foods. Do not open your mouth wide. Your doctor may show you how
to perform gentle muscle stretching and relaxation exercises. Stress reduction
techniques may help you manage stress and relax your jaw along with the rest of
your body.
The doctor may fit you with a splint or bite plate. This is a plastic guard that
fits over your upper and lower teeth, much like a mouth guard in sports. The
splint can help reduce clenching and teeth grinding, especially if worn at
night. This will ease muscle tension. The splint should not cause or increase
your pain. If it does, do not use it.
If conservative and noninvasive techniques do not work, you may consider more
invasive techniques.
A more invasive procedure can be performed in the doctor’s office or clinic
under local anesthesia. This is carried out by inserting 2 needles in the
temporomandibular joint to wash it out. One needle is connected to a syringe
filled with a cleansing solution, and the fluid exits via the other syringe.
This procedure can be done in the office. Most people find relief from the pain
and return to almost normal. Sometimes, pain medication can be injected into the
joint in a similar procedure.
A last option, surgery, is often irreversible and should be avoided when
possible. If necessary, surgery can be used to replace the jaw joints with
artificial implants. The National Institute of Dental and Craniofacial Research
(NIDCR) advises that if surgery is recommended, you get other independent
opinions before proceeding.
NIDCR advises that other irreversible treatments are of little value and may not
cure the problem. These include orthodontia to change the bite, restorative
dentistry, and adjustment of the bite by grinding down teeth to bring the bite
into balance.
Next Steps
|Follow-up|
Follow your doctor's specific instructions for taking any medication prescribed
and for home care with compresses or gentle jaw exercise.
You may be instructed to follow up with a specialist such as an oral and
maxillofacial surgeon, a general dentist, or a pain specialist physician.
Dentists are often the first to diagnose TMJ. They are familiar with
conservative treatments. Specially trained facial pain experts can be helpful in
diagnosing and treating TMJ.
|Prevention|
If you tend to have occasional bouts with jaw pain, avoid chewing gum or biting
on objects, such as pens or fingernails. Avoid eating hard or chewy food. When
you yawn, support your lower jaw with your hand.
See your dentist if you grind your teeth at night or find yourself clenching
your jaw. The dentist can make a splint for you.
|Outlook|
Most people do well with conservative therapy, such as resting the jaw or using
a mouth splint. The success of treatment depends on how severe the symptoms are
and how well you comply with treatment.
Only about 1% of patients require joint replacement.