tag:blogger.com,1999:blog-67377797516341210782024-03-13T02:57:18.003+03:00Omurga sorunlarıOmurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.comBlogger54125tag:blogger.com,1999:blog-6737779751634121078.post-32399848010653876652020-09-29T09:18:00.000+03:002020-09-29T09:18:08.937+03:00Skolyoz cerrahisinde gerdirme tekniği kullanımı: Yeni sonuçlar ışığında bu tekniğe devam edilmeli mi?<p>Skolyoz cerrahisinde, özellikle iskelet gelişimini tamamlamamış hastalarda birkaç yıldır kullanılmaya başlanmış bir teknik olan ‘önden iple gerdirme’ konusuna daha önce de <a href="https://omurgadoktoru.blogspot.com/2016/06/skolyoz-cerrahisinde-gerdirme-ip.html" target="_blank">değinmiştim.</a> O yazımda bu tekniğin en iyimser gözle “deneysel” olarak değerlendirilebileceğini belirtmiş ve etkinliği tam olarak kanıtlanmamış bir tekniğin kurtarıcı olarak sunulmasının sakıncalarına dikkat çekmiştim.</p><p><br /></p><p>Aradan geçen zaman içinde, önden iple gerdirme konusunda bir miktar bilgi birikimi oldu ve bu yeni bilgilerin ışığında konuyu tekrar ele almak istedim. Tekniğin en az 1 yıllık sonuçlarını raporlayan son zamanlarda yayınlanmış birkaç çalışmayı özetlersek:</p><p><br /></p><p>Yazarlarının ortalama 27 ay olmak üzere en az 1 yıl boyunca izlenmiş 31 hasta üzerindeki deneyimlerini paylaştıkları ilk çalışma ülkemizden. <i>Alanay ve arkadaşları</i> tarafından yayınlanmış bu araştırmanın . sonuçlarına baktığımızda, uygulamanın değişik yaş ve gelişmişlik gruplarında değişik sonuçlar verdiğini, <b>4 hastada (%12.9) akciğer sorunları ile, 6 hastada (%19.4) ise fazla düzelme, implant yetmezliği gibi mekanik sorunlarla karşılaşıldığını görüyoruz. Bir hastanın (%3.2) yeniden yatırılması, iki hastada ise (%6.5) yeniden cerrahi uygulanması gerekmiş.</b></p><p><br /></p><p>İkinci çalışma ABD’den, <i>Hoerncshemeyer ve arkadaşları</i> tarafından yayınlanmış. Bu yazarlar da en az 1 yıl izlenmiş 29 hastayı rapor ediyor ve <b>klinik başarı oranını yüzde 74 olarak</b> veriyorlar. 1<b>4 hastada (%48) implant kırılması şeklinde mekanik komplikasyon görülmüş ve 6 hastada (%21) revizyon cerrahisi gerekmiş.</b></p><p><br /></p><p>Paylaşacağım son çalışma ise yine ABD’den, <i>Newton ve arkadaşları</i> tarafından yayınlanmış. Bu yazarlar gerdirme tekniği uyguladıkları 23 hasta hastayla, arkadan füzyon tekniği uygulanan aynı yaş grubundaki 26 hastanın 2 ila 5 yıllık sonuçlarını karşılaştırarak paylaşıyorlar. Son izlemde <b>gerdirme hastalarında skolyoz dereceleri ortalama 33 derece olarak bulunurken, füzyon hastalarında ortalama bu sonuç 16 derece olarak ortaya çıkmış. Gerdirme hastalarının 12sinde (%52) implant sorunları çıkmış, 9 revizyon cerrahisi gerekmiş. Füzyon grubunda ise hiç revizyon gerekmemiş.</b></p><p><br /></p><p>Doğal olarak, çok az sayıda komplikasyon bildiren, aralarında Pehlivanoğlu ve arkadaşları tarafından yapılan yayının da olduğu başka birkaç araştırma da mevcut. Ancak genel eğilime bakıldığında önden iple gerdirme tekniği ile ameliyat edilmiş genç skolyoz hastalarının, geleneksel arkadan (posterior) füzyon tekniği ile ameliyat edilmiş hastalara göre daha yüksek oranlarda komplikasyon ve tekrarlayan cerrahilere maruz kaldığı ve son tahlilde skolyozlarının düzeltilmesinde elde edilen başarının füzyon yapılmış olanlara göre daha düşük olduğu görülüyor.</p><p><br /></p><p><b>Bu bilgiler ışığında; </b></p><p><b>•<span style="white-space: pre;"> </span>Hem cerrahların hem de hastalar ve ailelerinin bu yöntemin uygulanması konusunda ısrar etmeleri ne kadar doğru?</b></p><p><b>•<span style="white-space: pre;"> </span>Yetersiz bir yöntemin yetersiz olduğunu artık kabul etsek mi?</b></p><p><i><br /></i></p><p></p><ol style="text-align: left;"><li><i>Alanay ve ark, Spine 2020 Aug 1. doi: 10.1097/BRS.0000000000003643</i></li><li><i> Pehlivanoğlu ve ark, J Pediatr Orthop. 2020 May 15. doi: 10.1097/BPO.0000000000001590</i></li></ol><p></p><p><br /></p>Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-2824517909499212002020-05-10T17:20:00.001+03:002020-05-10T17:20:46.733+03:00Omurga sorunu olan hastalarda cinsel hayat (3): Kızımın skolyozu cinsel hayatını nasıl etkiler? Çocuk doğurabilir mi?<p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Bu soru genellikle anneler tarafından sıklıkla soruluyor.. Anlayabildiğim kadarıyla bu konuda o kadar çok hurafe var ki, aileler çocuklarında skolyoz olduğunu öğrendiklerinde, cinsel işlev ve doğurganlıklarının etkileneceğinden de ciddi endişe duyuyor.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR">Başlıktaki soruların kısa ve net cevapları şöyle:<o:p></o:p></span></b></p><p class="MsoListParagraphCxSpFirst" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;"><span lang="TR" style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><b><span lang="TR">Skolyoz hastalığı cinsel hayatı etkilemez.<o:p></o:p></span></b></p><p class="MsoListParagraphCxSpLast" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;"><span lang="TR" style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><b><span lang="TR">Skolyoz hastalığı gebe kalmayı ve çocuk doğurmayı da etkilemez.<o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR"> </span></b></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Bazı ekstrem durumlarda istisnalar olabilir. Mesela skolyoz nedeniyle ciddi gövde küçüklüğü veya akciğer ve kalp hastalığı olması gibi. Ama ana hatlarıyla, skolyoz ile cinsel hayatın ve doğurganlığı ilgisi yok. Telaşa da gerek yok.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR">Nasıl doğum yapılmalı?<o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Doğum konusunda genel bir standart yok. Kısaca izlemi yapan ve doğumu gerçekleştirecek olan ebe ya da hekimin tercihi neyse o şekilde olmalı. Eğer hem hekim hem de hasta normal doğumun uygun olacağını düşünüyorsa, anne adayının skolyozunun olması normal doğum yapılmasına bir engel oluşturmaz. Başka nedenlerle sezaryen tercih edilecekse, skolyoz bu tip bir cerrahiye de engel oluşturmaz.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Bu konuda tartışılabilecek en önemli nokta nasıl bir ağrı kontrol yönteminin uygulanabileceği. Bel bölgesinde çok ileri bir skolyoz olmadıkça, skolyozu olan hastalara epidural anestezi uygulanmasında herhangi bir sakınca yok. Bel bölgesi çok deforme ise, epidural anestezi uygulanması teknik olarak çok zor ya da imkansız olabilir. Yalnızca bu durumda caudal ya da pudental blok gibi diğer lokal ya da genel anestezi uygulamalarına gerek duyulabilir.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR">Ya skolyoz ameliyatı geçirmiş kadınlar?<o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Skolyoz ameliyatı geçirmiş olan kadınlar da rahatlıkla doğum yapabilirler. Bu konuda da izlemi yapan ve doğumu gerçekleştirecek olan ebe ya da hekimin tercihi neyse o şekilde davranılmalı. Anne adayının skolyoz ameliyatı geçirmiş olması normal doğum yapılmasına bir engel oluşturmaz. Başka nedenlerle sezaryen tercih edilecekse, geçirilmiş skolyoz cerrahisi bu tip bir cerrahiye de engel oluşturmaz.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Yine benzer şekilde, skolyoz ameliyatının bel bölgesine uzanmadığı anne adaylarında epidural anestezi uygulanmasında hiçbir sakınca yoktur. Ancak bel bölgesinde geçirilmiş cerrahi var ise o zaman caudal ya da pudental blok gibi diğer lokal ya da genel anestezi uygulamalarına gerek duyulabilir.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR">Sonuç;</span></b><span lang="TR"> skolyoz ile cinsel hayat ya da doğurganlık arasında aslında gerçek bir ilişki yok. Her zaman söylediğim bir sözü tekrarlayayım;<o:p></o:p></span></p><p class="MsoListParagraph" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;"><span lang="TR" style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><b><span lang="TR">Skolyozlu kişi esasen tümüyle normal bir insandır. Skolyoz, çok istisnai durumlar dışında kalıcı bir sakatlıkla ya da cinsel işlev bozukluğu ile sonuçlanmaz.<o:p></o:p></span></b></p>Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-53209347088755980722020-05-08T10:10:00.000+03:002020-05-08T10:10:04.147+03:00Omurga sorunu olan hastalarda cinsel hayat (2): Belinden ya da boynundan cerrahi geçirmiş hastalarda cinsel hayat<p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Sıkça akla gelen ancak genellikle dillendirilip soru haline getirilemeyen bir konu. Aslında bu sorunun cevabı, ‘<a href="https://omurgadoktoru.blogspot.com/2020/05/omurga-sorunu-olan-hastalarda-cinsel.html" target="_blank">ağrım olmasına rağmen cinsel aktivitem olsun mu</a>?’ sorusundan daha kolay. Serimizin <a href="https://omurgadoktoru.blogspot.com/2020/05/omurga-sorunu-olan-hastalarda-cinsel.html" target="_blank">birinci yazısında </a>tartışıp özetlediğim ağrılı bel ya da boyun yaklaşımı burada da geçerli. Esas olan ne kadar ağrı ve rahatsızlığınız olduğu ve doktorunuzun ne kadar kısıtlama önerdiği. Cerrahi sonrasında da eğer doktorunuza direkt olarak sormaktan çekiniyorsanız, doktorunuzun genel yaşam için verdiği öneri ve sınırlamaların cinsel aktivite için de geçerli olduğunu düşünün.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR">Peki, cerrahiden ne kadar zaman sonra cinsel aktiviteye geri dönebiliriz?<o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Bu konuda da herkese uygun bir standart yok. Birincisi, ne büyüklükte bir cerrahi geçirmiş olduğunuz önemli. Örneğin, yalnızca bel ya da boyun fıtığı için mikro cerrahi geçirdiyseniz, kendinizi rahat hissettiğinizde genellikle 1 ya da 2 hafta içinde cinsel aktiviteye geri dönebilirsiniz. Ama mesela, büyük bir kanal darlığı açılması ve implant yerleştirilmesi ameliyatı sonrasında kendinizi rahat hissetme süreniz 3 ila 6 haftaya (hatta bazen birkaç ay) uzayabilir.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">İkincisi, kişisel etkenler. Bazı insanlar herhangi bir travmadan sonra hayatlarına daha erken döner, bazıları biraz daha uzun bir nekahat dönemine ihtiyaç duyar. Zaten herhangi bir durum için kesin tarihler veremememizin nedeni de bu. Her kişinin kendini rahat hissetme zamanı farklıdır.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR">Nasıl?<o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Bu konuda da kesin bir rehber olmamakla birlikte, esas olanın eşlerin birbiri ile iletişimi ve ne yapılınca rahat ya da rahatsız olunduğunun fark edilmesi ve paylaşılması olduğunu düşünmek uygun. Cerrahi sonrasında da interneti dikkatli kullanın. Hem yalan yanlış kısıtlamalar önerilebiliyor, hem de herkese uygun olacağı varsayılan öneriler aslında düşünüldüğü kadar uygun olmayabiliyor.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR">Sonuç;</span></b><span lang="TR"> doktorunuz tarafından aksi yönde görüş bildirilmedikçe, cerrahi sonrası cinsel aktiviteye ne zaman ve nasıl döneceğinize eşinizle birlikte kendiniz karar verin. Ne zaman ve nasıl rahat hissederseniz o zaman ve öyle.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR">Bir soru daha: Ameliyat olmak cinsel işlevlerimizi olumsuz yönde etkileyebilir mi?<o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Az bir ihtimal olmakla birlikte, evet, olabilir.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Bu iki şekilde mümkün;<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;"><span lang="TR" style="font-family: symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="TR">Ameliyattan tam ya da kısmi felç ile çıkmak. Bu durumda, felç olan diğer hareket sağlayıcı sinirleriniz çalışmadığı gibi, cinsel işlevinizi yöneten sinirleriniz de çalışmayacaktır. Çeşitli nedenlerle felç olmuş hastalarda bildiğimiz anlamda cinsel işlev tümüyle ortadan kalkabiliyor. Neyse ki oldukça düşük bir ihtimal.<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;"><span lang="TR" style="font-family: symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="TR">Özel olarak L5-S1 bölgesine önden yaklaşımlarda, bu bölgede yer alan tül gibi bir sinir ağının zedelenmesi. Bu sinir ağı erkeklerde penisin ağzından meni boşalmasını, kadınlarda ise ilişki sırasında vajinanın kanlanmasını ve ıslanmasını yönetiyor. Yaralanırsa erkeklerde meninin dışarı çıkmaması, kadınlarda ise ıslanma kaybı olabiliyor. Bu tip cerrahi oldukça nadir kullanılıyor ancak yine de bilmekte yarar var. Böyle bir cerrahi sonrası bildirilen sinir yaralanması olasılığı yüzde 1 ile 18 arasında değişiyor.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR">Sonuç;<o:p></o:p></span></b></p><p class="MsoListParagraphCxSpFirst" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;"><span lang="TR">1.<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="TR">Omurga cerrahisi sonrası cinsel hayata geri dönmek mümkün. Ne zaman ne nasıl olacağına eşler doktorlarının önerileri doğrultusunda kendileri karar vermeli.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;"><span lang="TR">2.<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="TR">Omurga cerrahisi cinsel işlevlerde bir iyileşmeye neden olabilir.<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="font-family: calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;"><span lang="TR">3.<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><span lang="TR">Omurga cerrahisi, ciddi bir komplikasyon olarak, nadiren cinsel işlevlerde bozulmayla da sonuçlanabilir.<o:p></o:p></span></p>Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-48689363027720129972020-05-06T20:54:00.000+03:002020-05-06T20:54:35.493+03:00Omurga sorunu olan hastalarda cinsel hayat (1): Belinde ya da boynunda ağrılı sorunlar olan hastalarda cinsel hayat<p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Sıkça akla gelen ancak genellikle dillendirilip soru haline getirilemeyen bir konuya birkaç farklı açıdan yaklaşacağım.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoListParagraph" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;"><b><span lang="TR">1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="TR">Belimde ya da boynumda fıtık, darlık, vb. ağrılı bir sorunum var. Cinsel hayatım olabilir mi? Olursa nasıl olmalı?<o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Öncelikle, bu konuda genel bir kural olmadığını belirtmek gerekli. Ana yaklaşım, diğer hayat aktivitelerinizde ne kadar kısıtlama gerekiyorsa, cinsel aktivitenizin de o kadar kısıtlanmasının uygun olacağı yönünde. Örneğin; herhangi bir hareketle ortaya çıkan çok şiddetli ağrı durumlarında, eğer doktorunuz bir süre mutlak istirahat öneriyorsa, bu durumun cinsel aktivitelerinizi de kapsadığını düşünmek uygun olur. Bu süreç genellikle kısadır ve çok ciddi sorun ya da yoksunluklara neden olmaz.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Ağrınız çok şiddetli değilse ve doktorunuz tarafından da özel bir kısıtlama önerilmemiş ise, bunun da cinsel aktiviteleri de kapsadığını düşünmek uygun olur. Bu durum daha çok kronik (sürekli) ağrısı olan hastalarda ortaya çıkıyor ve cinsel aktivitenin zararlı olduğunun düşünülmesi yoksunluğa ve sosyal sorunlara neden olabiliyor.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR">Sonuç;</span></b><span lang="TR"> eğer doktorunuza direkt olarak sormaktan çekiniyorsanız, doktorunuzun genel yaşam için verdiği öneri ve sınırlamalar varsa bunların cinsel aktivite için de geçerli olduğunu düşünün.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR">Nasıl?<o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Bu konuda kesin bir rehber olmamakla birlikte, esas olanın eşlerin birbiriyle iletişimi ve ne yapılınca rahat ya da rahatsız olduğunun fark edilmesi ve paylaşılması olduğunu düşünmek uygun. İnternette “şuranız ağrıyorsa böyle yapın” gibi bazı bilgiler var ama, bunların herkese uygulanabileceğini düşünmüyorum.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR">Sonuç;</span></b><span lang="TR"> belirli durum ve pozisyonlarda sizin ya da eşinizin ağrısı oluyorsa o durumlardan kaçının, daha rahat olduğunuz şekilleri deneyin.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoListParagraph" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt 36pt; text-indent: -18pt;"><b><span lang="TR">2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="TR">Belimde ya da boynumdaki sorun cinsel aktivitemi etkileyebilir mi? Tedavi ya da ameliyat olursam cinsel hayatım da iyileşebilir mi?<o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><b><span lang="TR">Evet</span></b><span lang="TR">, özellikle bel ve boyun darlıkları, yani spinal stenoz, ya da tıbbi dilde ‘cauda equina sendromu gibi beldeki büyük fıtıklar nedeniyle ortaya çıkan sinir basıları ’ hem erkeklerde hem de kadınlarda cinsel işlevleri olumsuz yönde etkileyebilir. Bu durum erkeklerde genellikle ereksiyon güçlüğü ya da kaybı, kadınlarda ise uyarılma ya da ıslanma kaybı olarak ortaya çıkıyor.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Bu durumlardan cauda equina sendromu ani gelişen gerçek bir tıbbi acildir ve çok hızlı bir şekilde cerrahi tedavi edilmesi gerekir. İşlevlerin geri dönmesi genellikle ne kadar hızlı cerrahi müdahale yapıldığına bağlıdır. Neyse ki oldukça nadir bir durumdur.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR">Daha sık rastlanan spinal stenoz yani omurga kanal darlıklarındaysa cerrahi ile darlığın giderilmesinin hastaların cinsel hayat ve işlevlerinde olumlu etkiye sahip olduğu biliniyor. Tabii burada bahsedilenin tedavi olan tüm hastalarda ortalama bir iyileşme olduğunu belirtmek gerek. Tek tek her hastada ne kadar iyileşme olacağını bilmek mümkün değil. Tedavinin geciktirilmesinin de ne kadar önemli olduğunu net olarak bilemiyoruz ama, ciddi ve kalıcı sinir hasarı ortaya çıkmadan yapılan müdahalelerin daha iyi sonuçlar vereceğini düşünmek uygun olur.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: 12pt; margin: 0cm 0cm 0.0001pt;"><span lang="TR"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0cm 0cm 0.0001pt;"><b style="font-size: 12pt;"><span lang="TR">Sonuç;</span></b><span lang="TR"><span style="font-size: 12pt;"> evet, omurga sorunları, özellikle sinirlere baskı yapıyor ise cinsel işlev bozukluklarına neden olabilir. </span><a><span style="font-size: 12pt;">Ve</span><span style="font-size: 10.6667px;"> </span></a></span><span lang="TR" style="font-size: 12pt;">evet, sinir basısı ortadan kaldırılınca kaybedilmiş cinsel işlevler tekrar geri dönebilir.<o:p></o:p></span></p><div><hr align="left" class="msocomoff" size="1" width="33%" /><div><div class="msocomtxt" id="_com_1" language="JavaScript"><a name="_msocom_1"></a><p class="MsoCommentText" style="font-family: Calibri, sans-serif; font-size: 10pt; margin: 0cm 0cm 0.0001pt;"><br /></p></div></div></div>Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-15162597302885041312020-03-22T13:26:00.000+03:002020-03-23T11:35:50.761+03:00Corona günlerinde bilim (2): Bu insanlar neden uyarılara rağmen sokakta dolaşıyor?<div dir="ltr" style="text-align: left;" trbidi="on">
Corona virüs hastalığı (COVID-19) üzerine yazılarımın bu ikincisinde, bana hep ilginç gelmiş bir soruyu tartışmak istiyorum.<br />
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<b>Soru şu: </b><br />
Toplulukların şok ya da acı karşısında tepkileri kişilerin tepkileri gibi incelenebilir mi?<br />
ya da daha teknik bir ifade ile, kayıp ya da hastalık ile karşılaşıldığında verdiğimiz tepkileri tanımlayan ve evrelendiren Kübler-Ross modeli topluluklara uygulanabilir mi?<br />
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<b>Bu soru nerden aklıma geldi?</b><br />
Hep birlikte, COVID-19 hastalığı konusunda yapılan uyarı ve telkinlere uymamakta ısrar eden birçok insanın basında ve sosyal medyada teşhir edilişini ve neredeyse lanetlenmesini izliyoruz. Bir kısmımız bu insanların cahil olduklarını, diğerlerimiz ise umursamaz olduklarını düşünüyor. Ne kadar cahiliz tartışmasına hiç girmeden, acaba bu davranış şeklinin temelinde başka bir faktör olabilir mi diye düşündüm ve kendime şu soruyu sordum; bu durum cehaletten mi ya da umursamazlık dan mı kaynaklanıyor, yoksa daha bilimsel bir açıklaması olabilir mi?<br />
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<b>Önce, Kübler-Ross modeli</b><br />
Elisabeth Kübler-Ross 2000'in üzerinde ölmekte olan hasta ve yakınları üzerinde yaptığı, bu kişilerin tepkilerini ölçen ve standardize eden çalışmasını 1969 yılında bir kitap olarak (On Death and Dying, Scribner, 1969; Ekin Uşaklı tarafından Türkçe çevirisi: Ölüm ve Ölmek Üzerine, April yayıncılık, 2011) yayınladığında bu konuda yeni bir devir açıldı ve bu gibi derin yas ve elem durumlarında verilen tepkilerin aslında standart bir evrelendirme sistemi ile incelenebileceği anlaşıldı. Kübler-Ross'a göre bu evreler şu şekilde gelişmekte:<br />
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<ol style="text-align: left;">
<li>Şok ve inkar</li>
<li>Öfke</li>
<li>Pazarlık</li>
<li>Depresyon</li>
<li>Kabullenme</li>
</ol>
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Bu evrelerin zamana yayılımı, ve bu süreç içinde kişinin moral ve enerji durumu kısaca aşağıda şekilde özetlenebilir:</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0yLw2TQhZy_6IV1Vr2A0BFGRMBP9cvJ53zxcSPy0ttlE29AwByvh2dq6088H6K4d1ooxz5k1Su8W7PKxaYhjbf_uHEPc4wAynwrfyj83TnknvIuiARL9dR1PFRv9Bivdjr3sPopDNONc/s1600/Ku%25CC%2588bler-Ross+modeli.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="997" data-original-width="1354" height="235" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0yLw2TQhZy_6IV1Vr2A0BFGRMBP9cvJ53zxcSPy0ttlE29AwByvh2dq6088H6K4d1ooxz5k1Su8W7PKxaYhjbf_uHEPc4wAynwrfyj83TnknvIuiARL9dR1PFRv9Bivdjr3sPopDNONc/s320/Ku%25CC%2588bler-Ross+modeli.png" width="320" /></a></div>
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Görülebileceği gibi, ani ve beklenmeyen bir acı ile karşılaşıldığında, kişilerin ilk tepkileri inkar etmek oluyor ve açıkçası bu evrede kişinin enerjisi ya da moral düzeyi oldukça yüksek olabiliyor. İzleyen evrelerde bu enerji ve moral düzeyi neredeyse depresyon olarak adlandırılabilecek seviyeye kadar düşüyor, ta ki, acı kabul edilip onunla birlikte yaşamaya uyum sağlanana dek. Tabi, bu evrelerin süreleri kişilerde farklı olarak ortaya çıkabileceği gibi, bazı kişiler bazı evrelerde takılıp daha ileri gidemeyebilirler de.</div>
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<b>COVID-19'a verilen tepki bu modele uyar mı?</b></div>
<div>
<b>Açıkçası, bilmiyorum. </b>Bu konuda bir kaynak araştırması yaptım ama modelin topluluklara uyarlanması üzerine herhangi bir kaynağa ulaşamadım. Ama yine de, COVID-19'a verilen toplumsal tepkiye bakınca ilk aklıma gelen Kübler-Ross modeli oldu diyebilirim. </div>
<div>
<i><b>Acaba, birçok insanın bu hastalığa inanmaması ya da ciddiye almaması 'şok ve inkar' evresinde olmaları ile açıklanabilir mi? </b></i></div>
<div>
<i><b>Hastalığın nedenleri konusunda acayip fikirler öne sürmek (yarasa yemek, fuhuş, homoseksüeller vb.) ve cezalar kesmek öfkemizin yansımaları mı?</b></i></div>
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<i><b>Ya da, bir önceki yazımda vurguladığım değişik tedavi yöntemlerinden medet ummak pazarlık evresinin?</b></i></div>
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Bu gözle bakıldığında henüz ülkemizde çok ortaya çıkmamış ancak hastalıkla bizden daha önce tanışmış ülkelerde (ör. İtalya) ciddi bir toplumsal depresyon (her ne kadar balkonlarda şarkı söyleyenler de varsa da) geliştiği de görülebilir.</div>
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Kabullenmiş ve uyum sağlamış toplumlar olarak da Çin ve Güney Kore örnekleri verilebilir belki.</div>
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<br /></div>
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Sonuç:</div>
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Bu yazımın amacı, yalnızca COVID-19 hastalığına karşı verdiğimiz ya da vermediğimiz tepkilerin kişisel değil, aslında bilimsel bir model üzerinden açıklanabilecek tepkiler olabileceğini düşündürebilmek. Doğal olarak, bu önermemin mutlaka doğru olduğunu iddia edemem, sonuç olarak bir Sosyal Bilimci değilim.</div>
<div>
Ancak yine de, 'inkarcı ve uyumsuzlar'a bakışımızda farklı bir açı oluşturabilir, belki.</div>
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Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-8445849239009902222020-03-22T11:25:00.000+03:002020-03-23T11:15:47.677+03:00Corona günlerinde bilim (1): Corona virüs hastalığının (COVID-19) mucizevi bir tedavisi var mı?<div dir="ltr" style="text-align: left;" trbidi="on">
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<span lang="TR">Corona virüs hastalığının (COVID-19) dünyanın her yerinde olduğu gibi ülkemizde de yaygınlaşmaya başlaması görebildiğim kadarıyla iki ana toplumsal tepkiye neden oldu. Bunlardan biri hastalığın tedavisi için mevcut ilaçlardan mucizevi çözümler beklemek (bu yazının konusu), diğeri ve daha yaygın olanı ise hastalığı veya hasta olma olasılığını azımsamak, inkar etmek (serinin ikinci yazısının konusu).<o:p></o:p></span></div>
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<span lang="TR">Mucizevi tedaviler içinde önemli bir kısmı geleneksel tıp ya da beslenmeye dayanan öneriler. Bu grup yaygın olmakla birlikte, neyse ki, toplumsal bir inanılırlık ve güvenilirlik kazanma konusunda başarısız görünüyorlar. Televizyon ekranlarının fonksiyonel tıp ya da beslenme vb. uzmanlarından büyük ölçüde temizlenip şöyle ya da böyle tekrar bilim insanlarına açılmasını bu açıdan olumlu bir gelişme olarak bile değerlendirebiliriz.<o:p></o:p></span></div>
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<span lang="TR">Ancak, bilimsel görünen veriler ve bulgular da yanıltıcı olabiliyor, bu yazıda esas olarak bu durumu incelemek istiyorum, yakın zamanda ortaya atılan ‘hidroksiklorokin (Plaquenil)’ örneği üzerinden.<o:p></o:p></span></div>
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<b><span lang="TR">Hidroksiklorokin (Plaquenil) COVID-19 tedavisinde gerçekten yararlı mı?<o:p></o:p></span></b></div>
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<span lang="TR">Bu sorunun cevabını, böyle bir olasılığın mümkün olabileceği şeklinde vermek gerekli. Ama gerçekten o noktada mıyız ve hastalarımıza ya da sağlıklı insanlara bu ilacı verelim mi, bu ayrı bir tartışma.<o:p></o:p></span></div>
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<span lang="TR">Hidroksiklorokin (HKl) kullanımı bir süredir sosyal medyada (kısıtlı da olsa) giderek artan bir destek buluyordu, ancak ABD başkanı Donald Trump’ın Tweeter hesabından paylaştığı bir <a href="https://twitter.com/realDonaldTrump/status/1241367239900778501" style="color: #954f72;">mesaj</a> ile, bu desteğin daha da artması beklenmeli. Trump, HKl ve Azitromisin (bir antibiyotik) kombinasyonunun hastalığı önlemede mucizevi sonuçlar doğurduğunu ve ABD halkına derhal uygulanması gerektiğini söylüyor. Gerçekten öyle mi, bakalım:<o:p></o:p></span></div>
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<span lang="TR">İddianın kaynağı Gautret ve arkadaşlarının International Journal of Antimicrobial Agents dergisinde 20 Mart tarihinde yayınlanan bir yazısı (tam metin için<a href="https://www.medrxiv.org/content/10.1101/2020.03.16.20037135v1.full.pdf" style="color: #954f72;"> tıklayınız</a>). Bu yazıda, randomize edilmemiş toplam 36 hastanın (20 HKl, 6 sında ek olarak Azitromisin kullanılmış; 16 kontrol) 14 gün içinde hastalığın nedeni olan </span><span lang="TR" style="font-size: 11.5pt;">SARS-CoV-2 virüs yükünden kurtulma oranları inceleniyor ve özellikle KHl + Azitromisin gurubunda 3. günden başlayarak virüsten temizlenmenin anlamlı olarak daha fazla olduğu sonucuna varılıyor. Buraya kadar iyi, böyle bir iddianın ABD başkanı tarafından kabul görmesinde de pek sorun yok.<o:p></o:p></span></div>
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<b><span lang="TR" style="font-size: 11.5pt;">Ancak;<o:p></o:p></span></b></div>
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<span lang="TR" style="font-size: 11.5pt;"><a href="https://www.medrxiv.org/content/10.1101/2020.03.16.20037135v1.full.pdf" style="color: #954f72;">Yazı</a> daha ayrıntılı incelendiğinde, bazı sorunlar ortaya çıkıyor.<o:p></o:p></span></div>
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<span lang="TR" style="font-family: "symbol";">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><span lang="TR">Yazarlar aslında 26 tedavi (HKl) hastası ile başlamışlar ve 6 hastayı takip edemediklerinden çalışmadan atmışlar. Takip edilememe nedenleri:<o:p></o:p></span></div>
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<span lang="TR" style="font-family: "courier new";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><span lang="TR">3 hastanın yoğun bakıma naklinin gerekmesi,<o:p></o:p></span></div>
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<span lang="TR" style="font-family: "courier new";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><span lang="TR">1 hastanın ölmesi,<o:p></o:p></span></div>
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<span lang="TR" style="font-family: "courier new";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><span lang="TR">2 hastanın da kendi istekleri ile tedaviyi sonlandırması (muhtemelen HKl kullanımını tolere edememeleri nedeniyle)<o:p></o:p></span></div>
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<span lang="TR" style="font-family: "symbol";">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><span lang="TR">Yazıdaki rakam, tablo, figür ve istatistik değerlendirmeler bağımsız araştırmacılar tarafından doğrulanamıyor (ilgilenenler için PubPeer değerlendirmeleri <a href="https://pubpeer.com/publications/3B1F9EAD4982C64445A60F5E83CCFE" style="color: #954f72;">burada</a>)<o:p></o:p></span></div>
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<span lang="TR" style="font-family: "symbol";">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><span lang="TR">Yazarlar hastaları 14 gün takip etmek üzere başlayıp 6. günden daha ileri takip sonucu vermiyorlar.<o:p></o:p></span></div>
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<span lang="TR" style="font-family: "symbol";">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><span lang="TR">Yazı yayınlanmadan önce gerçek bir bilimsel değerlendirme (bu gibi yazılar için standart olan ‘peer review) yapılmamış ve yazarlardan biri yayınlandığı derinin editörü.<o:p></o:p></span></div>
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<span lang="TR">Tüm bu sorunlara bakıldığında, ABD başkanı tarafından da refere edilmiş olan bu yazının bilimsel değerinin çok çok düşük olduğu görülüyor.<o:p></o:p></span></div>
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<b><span lang="TR">Tabi başka sorunlar da var;<o:p></o:p></span></b></div>
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<span lang="TR" style="font-family: "symbol";">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><span lang="TR">Dünya genelinde 300.000’den fazla hasta sayısı olmasına rağmen yalnızca 36 hastanın çalışılmış olması,<o:p></o:p></span></div>
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<span lang="TR" style="font-family: "symbol";">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><span lang="TR">Başarılı sonuç kriterinin gerçek bir klinik sonuç değil (mesela ölüm ya da sağkalım) bir indirekt (proxy) sonuç üzerine kurgulanmış olması,<o:p></o:p></span></div>
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<span lang="TR" style="font-family: "symbol";">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><span lang="TR">En önemlisi, <a href="https://www.worldometers.info/coronavirus/" style="color: #954f72;">dünya genelinde</a> %4.2 (308.594 vakada 13.069 ölüm) ve <a href="https://twitter.com/drfahrettinkoca/status/1241454374284677121?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1241454374284677121&ref_url=https%3A%2F%2Fwww.gazeteduvar.com.tr%2Fgundem%2F2020%2F03%2F21%2Fkorona-virusunden-olenlerin-sayisi-21e-yukseldi%2F" style="color: #954f72;">ülkemizde</a> %2.2 (947 vakada 21 ölüm) olduğu düşünüldüğünde, %3.8 (26 vakadan 1’i) ölüm ve %11.5 yoğun bakım (26 vakadan 3’ü) oranının başarılı bir tedaviyi işaret etmekten uzak olması, gibi.<o:p></o:p></span></div>
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<span lang="TR">Tabi, HKl kullanımının neden olabileceği yan etkilerden bahsetmiyoruz bile (<a href="https://www.drugs.com/sfx/plaquenil-side-effects.html" style="color: #954f72;">İngilizce</a> ve <a href="https://www.ilacrehberi.com/google/?k=plaquenil-200-mg%20yan%20etkileri" style="color: #954f72;">Türkçe</a> kaynaklar).<o:p></o:p></span></div>
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<b><span lang="TR">Sonsöz:<o:p></o:p></span></b></div>
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<span lang="TR">Bu gibi kriz durumlarında çıkmadık candaki umutlara sarılmak kadar doğal bir şey olamaz. Ancak yöneticilerin ve özellikle hekimlerin görevi halkı doğru ve sağlıklı şekilde bilgilendirmek ve tedavi etmek olmalı. Her duyduğumuza inanmayalım, COVID-19 tedavisinde de gerçek bilimi referans alalım.<o:p></o:p></span></div>
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Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-64004670031170925082018-09-25T09:19:00.001+03:002018-09-25T09:20:11.726+03:00Skolyoz ameliyatı sonrası; çocuğum ya da ben nasıl iyileşeceğiz, neler beklemeliyiz?<div dir="ltr" style="text-align: left;" trbidi="on">
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<!--StartFragment-->
<br />
<div class="MsoNormal">
<span style="mso-ansi-language: TR;">Geçen günlerde bir hasta
yakınının uyarısı ile, skolyoz (ya da herhangi benzer omurga) ameliyatları
sonrası seyir ve rehabilitasyon konusunda yeterli bilgilendirme bulunmadığını
farkettim. Aslında bu konuda bir hastam ile yaptığım bir söyleşi internette
mevcut (<a href="https://www.youtube.com/watch?v=Xru58ZLdfZ0">https://www.youtube.com/watch?v=Xru58ZLdfZ0</a>)
ve çok olumlu geri dönüşler alıyorum ama yine de, bu kez yazılı olarak tekrar
özetlemek istedim.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-ansi-language: TR;">Genel şemamız şöyle;<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="mso-ansi-language: TR;"><br /></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b>Ameliyat günü:</b> Hasta ameliyattan odasına (ya da az
bir olasılıkla Yoğun Bakım Ünitesine) çıkar. Öncelik ağrı kontrolü ve hastanın
rahat ettirilmesidir. Yatak içi hareketlerine izin verilir, hatta özendirilir.<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: TR;"><i>Günün önceliği:
Ağrı kontrolü</i><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<span style="mso-ansi-language: TR;"><i><br /></i></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b>Sonraki ilk gün:</b> Hasta artık yatağında nispeten
rahattır ve kendine gelmiştir. Yataktan çıkarılıp ayakta durma ve birkaç adım
yürüyerek oturma egzersizleri yapılır.<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><i><span style="font-family: "courier new"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span></span><!--[endif]--></i><span style="mso-ansi-language: TR;"><i>Günün
önceliği: Yataktan çıkma</i><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<span style="mso-ansi-language: TR;"><i><br /></i></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b>2. gün:</b> Artık hasta yataktan çıkıp (yardımla) en
azından oda içinde gezinecek durumdadır. Genellikle drenleri ve idrar kateteri
(sonda) çekilir. Hasta koridorda gezmeyi arttırır ve tuvaleti kullanır.<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><i><span style="font-family: "courier new"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span></span><!--[endif]--></i><span style="mso-ansi-language: TR;"><i>Günün
önceliği: Tuvalete gitme</i><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<span style="mso-ansi-language: TR;"><i><br /></i></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b>3. gün:</b> Hastanın pansumanı (ciddi bir sorun yok
ise) açık bırakılır. Ağrısı (makul ölçülerde) kontrol altında ise hastaneden
eve gider. Şehir dışından gelen hastalarımızın 2 gün daha şehirde kalmalarını
öneririz ama mutlak bir zorunluluk değil.<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><i><span style="font-family: "courier new"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span></span><!--[endif]--></i><span style="mso-ansi-language: TR;"><i>Günün
önceliği: Ağrı kontrolü, hareketlenme, eve dönme</i><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<span style="mso-ansi-language: TR;"><i><br /></i></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b>4. gün: </b>Hastamız evinde (ya da çıkmamışsa
hastanede) duş şeklinde banyo yapar. Yaranın üzerinden su akıtılmasında bir
mahsur yoktur, ancak yaranın 3. haftanın sonuna dek suya sokulmamasını
öneririz.<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><i><span style="font-family: "courier new"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span></span><!--[endif]--></i><span style="mso-ansi-language: TR;"><i>Günün
önceliği: Banyo</i><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<span style="mso-ansi-language: TR;"><i><br /></i></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b>Sonraki 2-3 hafta:</b> Hasta evde hareketliliğini
giderek arttırır, kısıtlı ve kontrollü olarak ev dışında gezer.<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><i><span style="font-family: "courier new"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span></span><!--[endif]--></i><span style="mso-ansi-language: TR;"><i>Öncelik:
Hareketlenme, form tutma</i><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<span style="mso-ansi-language: TR;"><i><br /></i></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b>3. hafta ile 6-8. hafta arası:</b> Ağrı büyük ölçüde
rahatlamıştır. Hasta daha serbest olarak dışarı çıkar. Okula dönmesi
gerekiyorsa 4. haftanın sonundan itibaren dönebilir.<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><i><span style="font-family: "courier new"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span></span><!--[endif]--></i><span style="mso-ansi-language: TR;"><i>Öncelik:
Normal hayata geri dönme</i><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<span style="mso-ansi-language: TR;"><i><br /></i></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b>2. aydan sonra:</b> Ağrı sorunu kalmamış olması
beklenir. Normal günlük aktivitede herhangi bir kısıtlanma getirilmez, mümkün
olduğu kadar aktif olmak özendirilir. Yalnızca sportif ve benzeri aktiviteler
kısıtlanır.<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><i><span style="font-family: "courier new"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span></span><!--[endif]--></i><span style="mso-ansi-language: TR;"><i>Öncelik:
Normal günlük hayat, kısıtlı spor</i><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: TR;"><b>Spor
programı:</b><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "wingdings"; mso-ansi-language: TR; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><i>ilk 3 ay:</i> Sınırsız yürüme, 3. haftadan sonra
serinlemek amaçlı (sakin) suya girme (istenirse), hafif ağırlık çalışma<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "wingdings"; mso-ansi-language: TR; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><i>3-6 ay arası: </i>Sınırsız yürüme, bireysel koşular
(hafif tempo), sınırsız yüzme, hafif ağırlık çalışma<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "wingdings"; mso-ansi-language: TR; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-variant: normal; font-weight: normal; line-height: normal;"><i> </i></span></span></span><!--[endif]--><i>6-12 ay arası</i>: Sınırsız yüzme, koşma, yüzme, bisiklete
binme, ağırlık çalışma. Hafif ve sakin düzeyde bireysel sporlar (tenis, kayak
vb.)<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -18.0pt;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b>1. yıl sonu: </b>Hastanın son rutin kontrolü yapılır
(röntgen dahil). Herhangi bir sorun yok ise tüm aktivitelerinde serbest
bırakılır. Genelde herhangi bir kısıtlama getirmeyi sevmiyorum ama, yine bazı
sporların yapılmamasını öneriyorum.<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: TR;"><i>Öncelik:
Tümüyle normal hayat</i><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "wingdings"; mso-ansi-language: TR; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: TR;">İstisnalar dışında kısıtsız spor<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "wingdings"; mso-ansi-language: TR; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: TR;">Kısıtsız sosyal ve iş hayatı<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "wingdings"; mso-ansi-language: TR; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: TR;">İstendiği taktirde gebelik ve sonrasında doğum
(ilk sene içinde gebe kalınmamasını öneriyorum).<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="mso-ansi-language: TR;"><i>İstisnalar:</i><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "wingdings"; mso-ansi-language: TR; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="mso-ansi-language: TR;">Çok yüksek enerjili ve hızlı sporlar/aktiviteler
(buz hokeyi, döğüş sporları vb.)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "wingdings"; mso-ansi-language: TR; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><u><span style="mso-ansi-language: TR;">Profesyonel düzeyde</span></u><span style="mso-ansi-language: TR;"> takım sporları (profesyonel futbol, basketbol,
hentbol vb.)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -18.0pt;">
<span style="mso-ansi-language: TR;"><br /></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b>Sonrası:</b> Hasta gevşek olarak, kendi isteğine göre
(bir sorun hissederse) kontrol yaptırır. Rutin kontrol önerilmez.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Son olarak <b>birkaç konu</b>nun
altını çizmek isterim:<o:p></o:p></div>
<div class="MsoNormal">
<span style="mso-ansi-language: TR;"><br /></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span><!--[endif]-->Bu şema benim
<b>kendi şemam</b>, başka hekimler değişik programlar önerebilir. O iyidir bu kötüdür
diye karşılaştırılması muhtemelen doğru değil.<o:p></o:p></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo2; text-indent: -18.0pt;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span><!--[endif]-->Verdiğim şema
<b>ortalama bir şemadır, hasta özelliklerine göre değişir</b>. Örneğin:<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo2; text-indent: -18.0pt;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: TR; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b>Hasta yaşı önemli</b>, hasta ne kadar genç ise bu
program içinde o kadar hızlı ilerler. Aksine, yaş ne kadar ileri ise o kadar
yavaş ilerler. Mesela çocuklarda ağrı genellikle 3-4 haftada tümüyle ortadan
kalkıyor, erişkinlerde ise 3 ila 6 ayı bulabiliyor.<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: TR; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Hastanın <b>ameliyata gelmeden önceki form durumu da
önemli</b>. Günlük aktivitesi kısıtlanmamış ve daha da iyisi, aktif egzersiz yapan
hastalar çok daha hızlı iyileşiyorlar. Buna karşın, aktivitesi çok kısıtlı,
yürümesi çok azalmış hastalarda normal hayata kısıtsız geri dönme 6 ayı hatta
bazen 1 yılı bulabilir.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-ansi-language: TR;">Çok uzun bir yazı oldu,
kusura bakmayın. Merak edilenlere bir nebze de olsa açıklık getirebildiğimi
umuyorum.<o:p></o:p></span></div>
<!--EndFragment--><br /></div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-16509915874684508782017-12-14T14:22:00.002+03:002017-12-14T14:22:27.029+03:00Soru: Eğri oturmak skolyoza neden olur mu? Cevap: Hayıııır<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Uzun zamandır bu
köşedeki yazılarıma ara vermiştim, bu sabah eşimin bana gösterdiği bir gazete
haberi nedeniyle kendimi daha fazla frenleyemedim ve yazmaya karar verdim. Bahse
konu haber bir sağlık personeli ile söyleşi yapan bir gazeteciyi içeriyor. <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Sağlık
personeli diyor ki; çocukların düzgün oturmaması skolyoza neden olur…..</i></b>
<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Ne diyeyim? <b style="mso-bidi-font-weight: normal;">İnsan ne yapacağını şaşırıyor.</b> <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;"><b>Birincisi;</b> <b style="mso-bidi-font-weight: normal;">bu görüş, tümüyle, %100 safsatadan ibaret.</b>
Normal, sağlıklı bir çocuğun ya da erişkinin düzgün oturmadığı için omurgasının
eğrileceğini gösteren hiçbir gerçek delil yok. Böyle bir şey ancak çok çok
ekstrem durumlarda; mesela uzun süre aynı pozisyonda bağlı kalmak (bu konuda
hayvan deneyleri var, eski, hayvan haklarına aykırı), ya da gövde felci olan
kişilerde olabilir, bahsi geçen normal çocuklarda mümkün değil. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Bildiğimiz, en sık gördüğümüz ergen skolyozu
ailevi bir hastalıktır, oturma pozisyonu ile uzaktan yakından ilgisi yok.<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Tekrar
söyleyelim; çok ciddi bir felç sorunu olmayan çocuğunuz, doğru oturmadığı için
skolyoz olamaz.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;"><b>İkincisi; </b>bu kişi
bunu neden söylüyor diye de düşünmeden edemiyor insan. Cehalet deseniz,
cehaletin böylesi mümkün mü? Bir hekim magazin sayfalarından elde ettiği
bilgiyi nasıl bilimsel bir gerçekmiş gibi anlatabilir? Kasıt deseniz, demeyelim.
Sağlık sektörümüzün etik düzeyinin bu denli aşağılara inmiş olduğunu kabul
etmek istemem doğrusu.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="TR" style="mso-ansi-language: TR;">Şimdi, tekrar söyleyelim:<o:p></o:p></span></i></b></div>
<div class="MsoNormal">
<br /></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 9"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="0" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Mention"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<!--EndFragment--><br />
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Çok ciddi bir felç sorunu olmadıkça, çocuğunuz doğru oturmadığı için skolyoz olamaz.<o:p></o:p></span></b></div>
</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-39647952571126538152017-08-14T14:56:00.002+03:002017-08-14T14:56:26.362+03:00Why do we need to discuss scoliosis?<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<span lang="EN-GB" style="mso-ansi-language: EN-GB;">I haven’t
been able write on spinal problems for some time. Don’t think that it is
because I had an episode of laziness though, I worked on and prepared a YouTube
channel (<a href="https://www.youtube.com/channel/UC506qxzLUjpcbLEK4P-mRSg)">https://www.youtube.com/channel/UC506qxzLUjpcbLEK4P-mRSg)</a>
that is dedicated to patient education on scoliosis. Now that it is pretty much
complete and there are some matters to be discussed, I am back.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Why do we talk scoliosis?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="mso-ansi-language: EN-GB;">I had
provided basic information on the natural history and frequency of scoliosis in
my previous blogs as well as YouTube videos. Briefly, we know that it is fairly
frequent (1% of girls), but we also know that most go unrecognised for
prolonged times without causing any real disturbances. For those recognised,
most of these also go ahead with their lives without any real problems apart
from concerns about appearance. In essence then, the chances that scoliosis
advances to a stage that may require a relatively dramatic solution (surgery)
is probably around 1%.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Why all this fuzz then?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="mso-ansi-language: EN-GB;">This is a
question that I fail to find an objective answer. I write and talk about
scoliosis because an overwhelming majority of the patient question directed to
me comes from families in panic; things like “disaster, what are we supposed to
do now?” I recognise a real fear from this condition in the families of
involved kids, and it gets ever worse as they revert to (often grossly
exaggerated) information provided by the sources in internet. Families panic
when their kids are diagnosed with scoliosis. It is very common even for those
who are not diagnosed but knowledgeable of the condition to seek advice on how
to prevent it. Which exercises should we do? Should we start physical therapy? <b style="mso-bidi-font-weight: normal;">As you may imagine, this is a big market.<o:p></o:p></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Conclusion:<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="mso-ansi-language: EN-GB;">I write on
scoliosis because this is one of the major areas that is being ruthlessly
abused; the other being disc herniations. I’ll start writing on these as well.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="mso-ansi-language: EN-GB;">Let me
clearly state again. Scoliosis is a condition that is very well known to us. We
know the natural course, that it does not require any treatment for most people
involved, and even if it does require treatment, that it is treatable. The only
major exception to this is scoliosis with very early onset.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">So, <o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Don’t be scared of scoliosis<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Don’t scare people about scoliosis<o:p></o:p></span></b></div>
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<!--EndFragment--><br />
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<!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Don’t succumb to attempts to scare you of scoliosis.<o:p></o:p></span></b></div>
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Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-16801634508792296992017-08-14T14:51:00.000+03:002017-08-14T14:51:47.053+03:00Skolyoz hastalığını neden tartışıyoruz?<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Omurga
konusundaki yazılarıma bir süre ara vermiştim. Bu süre içinde boş durduğum
düşünülmesin, skolyoz hastalığı üzerine bir YouTube kanalı oluşturup (<a href="https://www.youtube.com/channel/UC506qxzLUjpcbLEK4P-mRSg)">https://www.youtube.com/channel/UC506qxzLUjpcbLEK4P-mRSg)</a>
hasta bilgilendirme etkinliklerimi başka bir ortama taşımıştım yalnızca. Ama,
biraz da tekrar tartışılacak konular çıktığı için geri dönmeye karar verdim.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Neden skolyozdan bahsediyoruz?<o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Hem daha önceki
yazılarımda hem de YouTube videolarımda skolyoz hastalığının sıklığı ve seyri
hakkında bilgiler vermiştim. Her ne kadar oldukça sık (kızlarda %1) görülen bir
hastalık olsa da, biliyoruz ki hastaların çoğu, skolyozlarının farkında bile
olmadan ve hastalıktan hiçbir zarar görmeden yaşayıp gidiyorlar. Frakında
olanların da çoğu, görüntü dışında fazla bir zarar görmeden yaşamlarını
sürdürüyorlar. Böylece, aslında, hastalığın nispeten dramatik diyebileceğimiz
bir sonuca varması (mesela ameliyat) olasılığı tüm skolyozların %1’i gibi
hesaplanıyor.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">O zaman bu gürültü niye?<o:p></o:p></span></b></div>
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<br /></div>
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<span lang="TR" style="mso-ansi-language: TR;">Bu soruya net bir
yanıt bulmak benim için çok zor. Ben skolyoz konusunu yazıyor ve anlatıyorum
çünkü bana gelen hasta sorularının büyük bir çoğunluğunu panik içindeki
ailelerden gelen “felaket, ne yapacağız şimdi?” soruları oluşturuyor. Hastalar
ve aileleri arasında ciddi bir korku var ve internetten gelen (büyük ölçüde
yanlış) bilgilerle de bu korku pompalanıyor da pompalanıyor. Çocukları skolyoz
teşhisi aldığında bütün aileler paniğe kapılıyorlar. Hastalığı bilen annelerin
içi titriyor, acaba çocuğumda skolyoz olur mu, diye. Öyle bir yere geldik ki
aileler normal çocuklarının skolyoz olmaması için tavsiye istiyorlar; hangi
egzersizleri yapsın? Fizik tedaviye götürelim mi? <b style="mso-bidi-font-weight: normal;">Takdir edersiniz ki, bu çok büyük bir pazar. <o:p></o:p></b></span></div>
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<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Sonuç:<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Skolyoz konusunda
yazıyorum çünkü bildiğim en fazla istismar edilen konulardan biri. Diğeri bel
ve boyun fıtıkları, yakında o konuya da girmeyi istiyorum.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Tekrar açıkça
belirteyim. Skolyoz, seyrini iyi bildiğimiz, genellikle tedavi gerektirmeyen,
gerektirdiğinde de tedavi edilebilen bir hastalıktır. Bunun istisnaları çok
nadirdir, büyük ölçüde de çok erken başlayan vakalardır.<o:p></o:p></span></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Korkmayalım, korkutmayalım, korkutulmayalım.<o:p></o:p></span></b></div>
</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-26591671515366063342016-12-02T15:54:00.002+03:002016-12-02T15:54:43.448+03:0070 yaş ve üzeri hastalarda omurga cerrahisi; değer mi?<div dir="ltr" style="text-align: left;" trbidi="on">
Bir süredir iş yoğunluğum nedeniyle ara verdiğim yazılarıma yeni bitirdiğimiz 70 yaş üzeri hastalarda omurga (özellikle eğrilik) cerrahisi konulu bir çalışmamızı özetleyerek geri dönmek istiyorum. Benzeri bir konuyu daha önce de incelemiştim ama şimdi elimde daha fazla veri var.<br />
<br />
Soru: <b>75 yaşındaki annem (babam), öne eğilme ve şiddetli bel ve bacak ağrıları nedeniyle rahatsız. Ne yapalım? ne yapılabilir?</b><br />
<br />
Son 10 yıla dek bu sorunun alışılmış cevabı; fazla bir şey yapılamaz, anneniz kaderine razı olsun şeklindeydi. Buna karşın son yıllarda bu tip hastaları daha fazla amelşiyat eder hale geldik. Biz bu cerrahileri yaptıkça, hem hasta yakınları hem de hekim meslekdaşlarımızdan yoğun eleştiriler almaya başladık; <b>"ileri yaş grubundaki hastalarda omurga cerrahisi ÇOK risklidir, yapmaya DEĞMEZ".</b><br />
<br />
<b>Öylemiymiş, kendi çalışmamızda görelim:</b><br />
<br />
<ul style="text-align: left;">
<li>Çalşıma grubumuzun veri tabanında 70 yaş ve üzeri 181 hasta mevcut, 85 hasta cerrahi, 96 hasta cerrahi olmayan (Fizik Tedavi, ilaç, enjeksiyon vb.) tedavi görmüş. Bu hastalardan 2 yıllık izlemi dolduran 90 kişiyi (69 cerrahi, 21 cerrahi dışı tedavi) inceledik.</li>
<li>Cerrahi uyguladığımız hastalar diğerleri ile kıyaslandığında yaş olarak farklı değil (ortalama 75 yaşında) buna karşın çok daha sıkıntılı durumdalar.</li>
</ul>
<ul style="text-align: left;">
<li>Bu <b>hastaların 47sinde (%77) toplam 135 adet komplikasyon</b> (istenmeyen olay; iltihap, akıntı, metal kırılması, akciğere pıhtı vb.) ortaya çıkmış. <b>Hastalarımızın %60ında bir yada daha fazla ek ameliyat gerekmiş.</b></li>
</ul>
<ul style="text-align: left;">
<li>Buna karşın, hastalarımız cerrahi yapılmayan hastalar, komplikasyonu olan cerrahi hastaları ve komplikasyonu olmayan cerrahi hastaları olarak sınıflandığında, hastanın olarak iyileşmesi olasılığı;</li>
<ul>
<li><b>komplikasyonu olmayan cerrahi hastaları grubunda en yüksek;</b></li>
<li><b>komplikasyonu olan cerrahi hastaları grubunda yüksek</b>; ve</li>
<li><b>cerrahi yapılmayan hastalar grubunda ise çok düşük</b> olarak bulundu.</li>
</ul>
</ul>
<div>
Bu durumda, elde ettiğimiz sonuçlar;</div>
<div>
<ul style="text-align: left;">
<li><b>70 yaş ve üzeri hastaların omurga cerrahilerinin nispeten riskli olduğu doğrudur.</b></li>
<li><b>Ancak, hastalarda iyileşme olması için cerrahi dışında gerçekçi bir seçenek yoktur</b>, şeklinde.</li>
</ul>
<div>
Sorumuza ne cevap verelim, değer mi? </div>
</div>
<div>
<b>Kesinlikle DEĞER.</b></div>
</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-50111851072543473392016-08-27T11:26:00.005+03:002016-08-27T11:26:58.035+03:00Hasta dayanışma ve tartışma grupları (Forumlar); Neden yararlı, sınırları ne olmalı?<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Uzun zamandır
yazamamıştım, izninizle bugün yeni bir konu açarak ara verdiğim yerden tekrar
başlamak istiyorum. Bu yazımda internet ortamında çeşitli hastalıklar için
oluşturulmuş hasta gruplarını (Forumlar) incelemek istiyorum. İlginç bir konu,
<b>forumlar hem son derece yararlı, hem de nispeten tehlikeli olabiliyor;
incelemeye değer.</b><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;"><b>Forumlar neden
önemli ve yararlı?</b><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
</div>
<ul style="text-align: left;">
<li><span lang="TR" style="font-family: Symbol; text-indent: -18pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal;"> </span></span><span lang="TR" style="text-indent: -18pt;">Toplumda çok iyi bilinen birçok hastalık
(kanser, kalp hastalıkları vb.) yanında bir de az bilinen hastalıklar var
(örneğin skolyoz, yada Perthes hastalığı). Bu hastalıklar ile karşılaşan
kişilerin <b>daha önce karşılaşmış ve tedavi süreci geçirmiş kişilerin
tecrübelerinden yararlanması </b>forumlar aracılığıyla hem mümkün oluyor, hem de
kolaylaşıyor.</span></li>
<li><span lang="TR" style="font-family: Symbol; text-indent: -18pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal;"> </span></span><span lang="TR" style="text-indent: -18pt;">Forumlara katılan hastalar, kendileri gibi
birçok insan ile karşılaşıp <b>yalnız olmadıklarını fark ediyorlar.</b></span></li>
<li><span lang="TR" style="font-family: Symbol; text-indent: -18pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal;"> </span></span><span lang="TR" style="text-indent: -18pt;">Forumlar <b>hastalar arasında bir dayanışma
ortamı sağlıyor</b> ve bazı yönünü kaybetmiş hastalar için, başka hastaların
tecrübelerinden faydalanma olanağı veriyor.</span></li>
<li> </li>
</ul>
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<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;"><b>Forumlar neden
aynı zamanda tehlikeli?</b><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo2; text-indent: -18.0pt;">
</div>
<ul style="text-align: left;">
<li><span lang="TR" style="font-family: Symbol; text-indent: -18pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal;"> </span></span><span lang="TR" style="text-indent: -18pt;">Yukarıda da bahsettiğim gibi, konuya çok
vakıf olmayan kişilerin başvuru araçları
oldukları için, <b>foruma giren hastalar, özellikle forum yöneticileri karşısında
savunmasızlar, </b>doktorların karşısında oldukları gibi.</span></li>
<li><span lang="TR" style="font-family: Symbol; text-indent: -18pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal;"> </span></span><span lang="TR" style="text-indent: -18pt;">Ancak hastalarımız, <b>özellikle başka
hastaların tecrübeleri adı altında sunulduğu için, </b>forumların öneri yada
yönlendirmelerine, doktorlarınkilerden<b> çok daha fazla açık ve savunmasızlar.</b></span></li>
<li><span lang="TR" style="font-family: Symbol; text-indent: -18pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal;"> </span></span><span lang="TR" style="text-indent: -18pt;">Böylece, maddi veya manevi nedenlerle,
bilerek veya bilmeden, iyi yada kötü
niyetle yapılan yönlendirmeler ile <b>hastalarımız ciddi tıbbi hatalar yada
yetersiz/yanlış tedavilere maruz kalabiliyor.</b></span></li>
</ul>
<!--[if !supportLists]--><br />
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<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;"><b>Ne yapalım?</b><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: Symbol; mso-ansi-language: TR; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;"><b>Forum yöneticileri için;</b><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="TR" style="font-family: "Courier New"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;"><b>Tarafsız
ve objektif olalım,</b> hastalarımıza yardım ederken kendi görüş ve yönelimlerimizi
onlara empoze etmeye çalışmayalım.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: "Courier New"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Her
ne olursa olsun, forumumuzun konusu ile ilgili herhangi bir kişi yada kurum ile
<b>maddi yada manevi ilişkiye</b> girmeyelim.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: Symbol; mso-ansi-language: TR; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; line-height: normal;"><b> </b></span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;"><b>Hastalarımız için;</b><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: "Courier New"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">İnternet
hem yararlı hem de tehlikeli bir ortamdır. <b>Forumların da yararları olduğu kadar
zararları da olabilir; bunları bilelim.</b><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: "Courier New"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">İnternetten
(yada kişilerden, hekimlerden) edindiğimiz bilgileri <b>başka kaynaklardan da
araştırıp teyit edelim.</b><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level3 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: Wingdings; mso-ansi-language: TR; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Bu hastalığın tek tedavisi gerçekten bu
mu?<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level3 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: Wingdings; mso-ansi-language: TR; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Bu tedaviyi yalnız ve yalnız bu kişi mi
yapıyor?<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level3 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: Wingdings; mso-ansi-language: TR; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Bana önerilen tedavi yetersiz yada
deneysel/etkinliği bilinmeyen bir tedavi olabilir mi?<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Bu konu biraz
daha su kaldırabilir sanırım, zaman zaman tekrar tartışırız. Tüm hastalarımıza
ve hekim arkadaşlarıma iyilikler ve mutlu, huzurlu günler dilerim. Bir sonraki
yazımda görüşmek üzere.<o:p></o:p></span></div>
</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-21856765671918430972016-08-03T16:10:00.000+03:002016-08-03T16:10:00.448+03:00Skolyoz gerçekleri 2: Hangi skolyozlardan korkmalıyız?<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Bir önceki
yazımda skolyoz hastalığının hastaların önemli bir kısmında korkulacak
sorunlara neden olmadığından bahsetmiştim. Peki, <b style="mso-bidi-font-weight: normal;">korkulması (yada mutlaka tedavi edilmesi) gereken skolyozlar yok mu?
Var.<o:p></o:p></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Skolyoz hastalığı hangi durumlarda ciddi sorunlar
oluşturabilir?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Öncelikle, daha
önce de bahsettiğim bir konuya, bu hastalığın doğal seyrine kısaca bakalım. <b style="mso-bidi-font-weight: normal;">Skolyoz iki nedenle ilerler demiştik:</b></span></div>
<div class="MsoNormal">
</div>
<ol style="text-align: left;">
<li><span style="text-indent: -18pt;">Çocuklarda
boy büyümesi ile beraber (Ergenlik yada doğuştan skolyozlar)</span></li>
<li><span style="text-indent: -18pt;">Omurganın
çökmesi ile beraber (Kas hastalıklarının skolyozları ve erişkinlerin ileri
skolyozları).</span></li>
</ol>
<br />
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Bu durumda, hangi
skolyozların mutlaka izlenmesi ve gerekli durumlarda tedavi edilmesi
gerektiğini kestirmek nispeten kolay:<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: Symbol; mso-ansi-language: TR; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Erken yaşlarda ortaya çıkan skolyozlar mutlaka ciddiye alınmalı; <o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: "Courier New"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Çünkü
hastanın önünde uzun bir boy uzaması dönemi var.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: Symbol; mso-ansi-language: TR; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Çocukların çok hızlı ilerleyen skolyozları mutlaka ciddiye alınmalı;<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: "Courier New"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Çünkü
hem kritik derecelere ulaşması ihtimali yüksek, hem de altında bazı sinir
sistemi yada omurilik hastalıkları çıkabilir.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: Symbol; mso-ansi-language: TR; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Yaş ne olursa olsun belli dereceleri (Sırtta 50 derece, Belde 40 derece)</span></b><span lang="TR" style="mso-ansi-language: TR;"> <b style="mso-bidi-font-weight: normal;">geçen
skolyozlar ciddiye alınmalı;<o:p></o:p></b></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l2 level2 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: "Courier New"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Çünkü
bu dereceleri geçen skolyozlar büyüme bitmiş bile olsa hayat boyu
ilerleyebilir.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l2 level2 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: "Courier New"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Çünkü
bu skolyozlar ciddi kozmetik sorunlara neden olabilir.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: Symbol; mso-ansi-language: TR; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Yaş ne olursa olsun 80 derecenin üzerindeki skolyozlar (tedavinin
yagınlaşması ile artık daha az göreceğimizi umuyoruz) ÇOK ciddiye alınmalı;<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l2 level2 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: "Courier New"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Çünkü
bu derecelerin üzerinde skolyoz ileri yaşlarda solunum sorunlarına neden
olabilir,<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l2 level2 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: "Courier New"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Yaşam
beklentisini azaltabilir.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: Symbol; mso-ansi-language: TR; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Kas hastalıkları ve diğer ciddi hastalıklarla birlikte ortaya çıkan
skolyozlar ÇOK ciddiye alınmalı;<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l2 level2 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: "Courier New"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Çünkü
çok çok hızlı ilerleyebilir ve hayat kalitesini çok olumsuz etkileyebilirler.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Görüldüğü gibi, bazı
<b style="mso-bidi-font-weight: normal;">skolyozlar ciddi kozmetik yada hayat
kalitesi sorunlarına neden olabiliyor, hatta hayatı bile tehdit edebiliyor</b>.
Ama tersten düşününce de, <b style="mso-bidi-font-weight: normal;">burada
sayılanların dışındakiler de herhangi bir sorun oluşturmayabiliyor</b>.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Bu konuda uzmanların görevi</span></b><span lang="TR" style="mso-ansi-language: TR;">, tüm skolyoz hastalarını ve ailelerini
korkutup istismar etmek yerine, <b style="mso-bidi-font-weight: normal;">gerçek
bir risk ve tehlike analizi yapıp hasta ve ailelerine etik ve samimi rehberlik
sağlamak olmalı. <o:p></o:p></b></span></div>
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<br /></div>
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<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Bir sonraki yazıda görüşmek üzere, sağlıcakla
kalın.<o:p></o:p></span></b></div>
</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-57878568847951254722016-07-12T14:20:00.000+03:002016-07-12T14:20:01.658+03:00Skolyoz gerçekleri: Skolyoz hastalığından ne kadar korkmalıyız?<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="p1">
<span class="s1"><span style="font-family: Arial, Helvetica, sans-serif;">Hastaların korkutularak istismar edilmeleri konusu üzerine daha önce de yazmıştım. Ancak son aylardaki gözlemlerim, özellikle skolyoz hastaları için durumun giderek daha kötüye gittiği yolunda, bu yüzden bu konuya tekrar dönmek istiyorum.</span></span></div>
<div class="p2">
<span style="font-family: Arial, Helvetica, sans-serif;"><span class="s1"></span><br /></span></div>
<div class="p1">
<span class="s1"><b><span style="font-family: Arial, Helvetica, sans-serif;">Sorun ne?</span></b></span></div>
<div class="p2">
<span style="font-family: Arial, Helvetica, sans-serif;"><span class="s1"></span><br /></span></div>
<div class="p1">
<span class="s1"><b><span style="font-family: Arial, Helvetica, sans-serif;">Yaygın klişeler mevcut: </span></b></span></div>
<ul style="text-align: left;">
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1"><b>Aman, kızınız skolyoz olabilir.</b></span></span></li>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1"><b>Aman, başlangıç evresinde skolyozu var, ilerleyebilir.</b></span></span></li>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1"><b>Aman, skolyoz ameliyatı olması bile gerekebilir.</b></span></span></li>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1"><b>Aman, şimdi 20 derece ama, ilerlerse kalbine baskı yapıp kızınızı öldürebilir.</b></span></span></li>
</ul>
<div class="p2">
<span style="font-family: Arial, Helvetica, sans-serif;"><span class="s1"></span><br /></span></div>
<div class="p1">
<span class="s1"><span style="font-family: Arial, Helvetica, sans-serif;">Basit mantık, <b>her korkutmanın arkasında bir çıkar</b> aramayı gerektirir. Ne öneriliyor?</span></span></div>
<ul>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1">Şöyle <b>mükemmel bir skolyoz teşhis cihazımız var, cüz-i bir ücret.</b> Bundan sonraki 5-6 yıl her 3 ayda bir görelim.</span></span></li>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1">Bizim <b>süper bir elektrik uyarı/korse/egzersiz programımız var,</b> gelin 3 yıl bizimle beraber olun, bakın kızınızı nasıl dümdüz yapacağız.</span></span></li>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1">Aman, <b>ameliyat olmayın. Ölür, felç olur, bunlar kasap.</b> Ben sizi egzersizlerle 5 yılda düzeltirim, küçük bir ücret karşılığı.</span></span></li>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1">Aman, <b>skolyoz ameliyatınızı şu kişiden başkasına yaptırmayın</b>. Diğerlerinin hiç tecrübesi yok, nöromonitorizasyon bile kullanmıyorlar; <b>halbuki hocamız 2-3 kesili ameliyatlar yapar, her yıl binlerce kişiyi sağlığına kavuşturuyor.</b></span></span></li>
</ul>
<div class="p2">
<span style="font-family: Arial, Helvetica, sans-serif;"><span class="s1"></span><br /></span></div>
<div class="p1">
<span class="s1"><b><span style="font-family: Arial, Helvetica, sans-serif;">Peki, gerçek nedir? Daha önce de yazdım ama, tekrarlıyayım:</span></b></span></div>
<div class="p2">
<span style="font-family: Arial, Helvetica, sans-serif;"><span class="s1"></span><br /></span></div>
<ol class="ol1">
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1">En sık rastlanan skolyoz türü olan <b>ergenlik skolyozu ailevi bir hastalıktır,</b></span></span></li>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s1"><b>Kızlarda %1 oranında görülür, bu kızların da %1 ila 10’u cerrahi</b> gerektirecek düzeye dek ilerler (genel popülasyonun yaklaşık bin ila onbinde biri)</span></span></li>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1"><b>Hızlı büyümesi devam eden ve eğriliği 20-40 derece</b> arasında olan bir hasta grubunda <b>korse kullanımı</b> ilerlemeyi durdurmakta etkindir.</span></span></li>
<ol class="ol2">
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1">Başka hiçbir tedavinin hastalığın doğal seyrini değiştirdiği ispatlanamamıştır.</span></span></li>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1">Daha ileri yaşlarda yada daha büyük skolyozlarda korsenin de etkinliği yoktur.</span></span></li>
</ol>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1">Büyüyen çocuklarda genellikle 40, büyümesini tamamlamış çocuklarda genellikle 50 derecelerde Cerrahi önerilir. <b>Bu derecelerde cerrahi, büyük ölçüde kozmetik bir tedavidir.</b></span></span></li>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1"><b>Hiç tedavi edilmese bile, ergenlik çağı skolyozlarının çok küçük bir bölümü (belki yüzbinde bir) akciğer ve kalp sorunlarına</b> neden olabilecek 100 derece civarına ilerleyebilir.</span></span></li>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1">Skolyoz hastalığının öne eğilen şiddetli kamburluk ile seyreden <b>“ankilozan spondilit” hastalığıyla uzaktan yakından ilgisi yoktur.</b></span></span></li>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1"><b>Modern skolyoz cerrahisi ülkemizin birçok ortopedi kliniğinde yapılmaktadır;</b> yeni teknolojiler ile beklenen (hastalarımıza söylediğimiz) <b>hayati tehlike riski binde bir, felç riski binde bir ila beş</b> arasındadır.</span></span></li>
<li class="li1"><span style="font-family: Arial, Helvetica, sans-serif;"><span class="s2"></span><span class="s1">Skolyozu olan hastalar, <b>cerrahi geçirseler de geçirmeseler de; NORMAL hayatlar sürerler. Yaşam süresi beklentileri NORMALDİR. </b>Yalnızca ileri skolyozu olup tedavi edilmemiş hastalarda kozmetik nedenlerle bazı sosyal kısıtlanmalar bildirilmiştir.</span></span></li>
</ol>
<div class="p2">
<span style="font-family: Arial, Helvetica, sans-serif;"><span class="s1"></span><br /></span></div>
<br />
<div class="p1">
<span class="s1"><b><span style="font-family: Arial, Helvetica, sans-serif;">Skolyoz gerçekleri böyle olunca, gerçekten skolyozdan korkmalı mısınız? Bazı istisnai durumlar dışında bence korkmayın ama, yine de siz bilirsiniz.</span></b></span></div>
<div class="p1">
<span class="s1"><b><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></b></span></div>
<div class="p1">
<span class="s1"><b><span style="font-family: Arial, Helvetica, sans-serif;">Bir sonraki yazımda istisnai (korkulması gereken) durumlardan bahsedeceğim.</span></b></span></div>
</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-16642599946413841642016-06-24T10:33:00.000+03:002016-06-24T10:33:43.073+03:00“Çaresiz kalan” skolyoz hastaları ve aileleri ne yapmalı?<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Son iki gündür,
twitter üzerinde benim de istemeden dahil ve neredeyse taraf olduğum bir
tartışma sürüyor. Bu yazımı bu konuya ayıracağım.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Kısaca özeti
şöyle; <b style="mso-bidi-font-weight: normal;">@skolyozforum</b> adlı bir grup
tarafından <b style="mso-bidi-font-weight: normal;">“skolyoz 4 yıl beklemez” </b>isimli
bir change.org kampanyası başlatıldı. Marmara Üniversitesinden bir skolyoz
cerrahı, mesai dışı çalışması nedeniyle ameliyat günlerinin azaltıldığını, bu
nedenle de 400 hastalık bir bekleme süresi oluştuğunu bildiriyor, @skolyozforum
da bu kampanyayı düzenliyor. Bu uygulamalarını eleştirince de <b style="mso-bidi-font-weight: normal;">“bu hastalar çok mağdur, başka kimse
ilgilenmiyor, biz de bu hekime yönlendiriyoruz”</b> cevabı alıyoruz. Twitter’da
beni yada forumu izleyenler bu tartışmayı görmüştür.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Sorun ne?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Bloglarımı takip
edenler bu konudaki görüşümü bilirler, <b style="mso-bidi-font-weight: normal;">skolyoz
hastalığının en fazla hasta suiistimali olan hastalıklardan biri olduğunu</b>
ve aslında çok az bir kesimi dışında (tüm skolyozların %10undan az) ne sağlık
ne de kozmetik olarak ciddi bir sorun oluşturmayacağını söyleyegeldim. Bu
durumda, bence şu sorunlar var:<o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
</div>
<ul style="text-align: left;">
<li><span lang="TR" style="text-indent: -18pt;">1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal;"> </span><span style="font-family: "Times New Roman"; font-stretch: normal;">Bu 400 s</span></span><span lang="TR" style="text-indent: -18pt;">kolyoz
hastasının <b>mağduriyetleri gerçek mi,
yoksa manipüle edilmiş bir mağduriyetleri mi var?</b> Mesela bu hastalara <b>“sizin evre I skolyozunuz var, hemen
müdahale edilmezse mazallah ilerler ve kalbinize baskı yapar” </b>diyenler var
mı? Bu hastaların mağduriyetleri ölçüldü mü?</span></li>
<li><span lang="TR" style="text-indent: -18pt;">2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal;">
</span></span><b style="text-indent: -18pt;"><span lang="TR">Skolyoz ameliyatı yapan yada hastalarla
ilgilenen bir tek bu hekim mi var?</span></b><span lang="TR" style="text-indent: -18pt;"> Böyle bir iddia diğer hekimlere ciddi bir hakaret içeriyor. Bütün büyük
şehirlerde skolyoz tedavisini samimi olarak uygulayan bir çok merkez ve hekim
var.</span></li>
<li><span lang="TR" style="text-indent: -18pt;">3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal;">
</span></span><span lang="TR" style="text-indent: -18pt;">Söz
konusu hekim, neden hastaları mağdur etmemek için mesai dışı aktivitelerini
bırakmıyor? Hepimiz biliriz, <b>özel
çalışan bir hekim muayenehanesi temelli bir uygulama yada ölçüm yapmaya başlar
ise,</b> tekel konumunda olduğu devlet hastanesinde <b>aniden uzun bekleme sıraları oluşur. </b>Burada da böyle bir durum
olabilir mi? Bu durumda @skolyozforum da buna alet oluyor olabilir mi?</span></li>
<li><span lang="TR" style="text-indent: -18pt;">4.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal;">
</span></span><span lang="TR" style="text-indent: -18pt;">@skolyozforum
gibi gruplar (yöneticileri) <b>hastaları
herhangi bir hekime yönlendirme yetkisini nereden alıyor?</b> Bu yetkisiz etki,
bir süre sonra hasta simsarlığına dönüşebilir mi?</span></li>
</ul>
<!--[if !supportLists]--><br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Gördüğünüz gibi,
aslında son derece masum gibi görünen bir kampanya, biraz düşünüp eşeleyince
nerelere varıyor. Umarım sorularıma verilecek mantıklı cevaplar vardır,
bekleyeceğim.<o:p></o:p></span></div>
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<!--StartFragment-->
<!--EndFragment--><br />
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Tüm skolyozlu çocuk ve gençlere ve ailelerine
manipülasyonsuz huzurlu ve mutlu günler dilerim.</span></b><span lang="TR" style="mso-ansi-language: TR;"> Merak etmesinler, kafalarını kaldırıp çevrelerine
baksınlar, araştırsınlar. <b style="mso-bidi-font-weight: normal;">Ülkemizde “etik”
skolyoz tedavisi yıllardır en iyi şekilde uygulanıyor, uygulanmaya da devam
edecek.<o:p></o:p></b></span></div>
</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-63802012962726470242016-06-17T15:41:00.000+03:002016-06-17T15:41:22.844+03:00Skolyoz cerrahisinde Gerdirme (ip) tekniği kullanımı. Ne kadar etik?<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Bir süredir
yazılarıma ara vermiştim, birkaç gün önce internet üzerinden sorulan bir soru
üzerine tekrar yazmayı istedim.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Söz konusu olan,
skolyoz cerrahisinde önden <b style="mso-bidi-font-weight: normal;">“gerdirme”
yada yaygın Türkçe adıyla “ip” yöntemi.</b> Aslında mantık olarak yerinde
görünüyor, hastanın göğüs kafesine bir-iki delikten endoskop ile giriyorsunuz
(yapanlar ayna ismi veriyorlar), eğriliğin olduğu omurlara yan taraftan vidalar
yerleştiriyorsunuz, sonra da bu vidaları biraz da gerdirerek bir bant ile
birbirlerine bağlıyorsunuz.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Ne oluyor? <b style="mso-bidi-font-weight: normal;">Hem eğriliğin dış tarafı kısaltıldığı için
eğrilik bir miktar düzeliyor, hem de çocuk büyüdükçe mevcut bant uzamayacağı
için teorik olarak zamanla bu düzelme daha da fazla oluyor.<o:p></o:p></b></span></div>
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<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Peki, sorun ne?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Daha önceki
birkaç yazımda bu ve benzeri tedaviler konusunda yorum yapmıştım. Oturduğumuz
yerden bize mantıklı gelen birçok tedavi olabiliyor. Böyle bir <b style="mso-bidi-font-weight: normal;">“buluş”</b> yaptığımızda, standart bir yol
izleriz. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo1; text-indent: -18.0pt;">
</div>
<ul style="text-align: left;">
<li><span lang="TR" style="font-family: Symbol; text-indent: -18pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="TR" style="text-indent: -18pt;">Önce buluşumuz (örneğimizde “bant”) <b>laboratuvarda mekanik olarak incelenir,</b>
yeterliği test edilir.</span></li>
<li><span lang="TR" style="font-family: Symbol; text-indent: -18pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="TR" style="text-indent: -18pt;">Daha sonra insana yakın büyüklükte <b>hayvanlara (koyun yada domuz) uygulanıp
canlı içinde uzun dönem sonuçlarına bakılır.</b></span></li>
<li><span lang="TR" style="font-family: Symbol; text-indent: -18pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="TR" style="text-indent: -18pt;">Sonra (bu iki test başarıyla geçilir ise),
uygulamanın <b>deneysel olduğu hasta ve
yakınlarına net olarak bildirilerek kısıtlı sayıda hasta</b> üzerinde
uygulanır. Bu aşamanın resmi yada gayrı-resmi kurumlar tarafından <b>yakın denetimi şarttır</b>, aksi halde
uygulamayı yapanların sonuçları buluşları lehine manipüle edebileceğinden
korkulur.</span></li>
<li><span lang="TR" style="font-family: Symbol; text-indent: -18pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="TR" style="text-indent: -18pt;">Son olarak da, her testi başarıyla geçen
“buluş” yaygın uygulamaya kazandırılır.</span></li>
</ul>
<span style="text-indent: -18pt;"> </span><br /><ul style="text-align: left;">
<li><b><span lang="TR">Sorun şu: İp tekniği bu basamakların hangisinde?</span></b></li>
</ul>
<br />
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<br /></div>
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<span lang="TR" style="mso-ansi-language: TR;">Ben bilemiyorum.
Bu konuda bir literatür taraması yaptım, karşıma hiç yayın çıkmadı.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Bu durumda, yine
önceki yazılarımda da vurguladığım gibi, bir kaç soru sormakta yarar var:<o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
</div>
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<li><span lang="TR" style="font-family: Symbol; text-indent: -18pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="TR" style="text-indent: -18pt;">Acaba bu yöntem ile <b>hastalar üzerinde
deney yapıyor olabilir miyiz?</b></span></li>
<li><span lang="TR" style="font-family: Symbol; text-indent: -18pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="TR" style="text-indent: -18pt;">Bu uygulamanın <b>bir ruhsatı yada
denetleyicisi var mı</b>?</span></li>
<li><span lang="TR" style="font-family: Symbol; text-indent: -18pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="TR" style="text-indent: -18pt;">Uygulamanın başarısız olduğu anlaşılırsa
<b>doğacak maddi ve manevi zararları nasıl karşılayacağız</b>?</span></li>
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<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Dikkat ederseniz,
<b style="mso-bidi-font-weight: normal;">bu uygulama iyidir yada kötüdür demek
istemiyorum,</b> çok iyi bir yöntem olduğu zaman içinde anlaşılabilir. Söylemek
istediğim tek şey:<o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="font-family: Symbol; mso-ansi-language: TR; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Çocuğunuzun etkinliği ispatlanmamış bir yöntem ile tedavi edilmesine razı
mısınız?<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="TR" style="font-family: "Courier New"; mso-ansi-language: TR; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Razıysanız, sorun yok.<o:p></o:p></span></b></div>
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Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-80582181126578354522016-03-15T13:28:00.000+02:002016-03-15T13:28:49.727+02:00Ülkemizde yazılı ve görsel sağlık gazeteciliği ne durumda? Basında yer alan bilgilerle omurga sağlığımızı koruyabilir miyiz? <div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Bu yazımda biraz
değişik bir konuya değinmek istiyorum; basınımızda sağlık konularının işlenmesi
ve halka yansıtılması konusu. Nedeni derseniz, bu konunun bir süredir
yazageldiğim sağlık sistemimizde kalite ve hasta hakları konularının önemli bir
parçası olduğunu düşünmem olduğunu söyleyebilirim. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">İki soru ile başlayalım:<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraph" style="mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Yazılı ve görsel basınımızda (radyoyu da
televizyon ile birlikte görsel olarak düşünüyorum), <b>omurga</b> <b style="mso-bidi-font-weight: normal;">sağlığı konusunda verilen bilgilerin kaynakları nelerdir? <o:p></o:p></b></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span lang="TR" style="mso-ansi-language: TR;">Cevap:<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Uzman
görüşleri<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Ansiklopedik
(popüler) bilgiler (genellikle popüler tıp kitaplarından çeviriler)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Sağlık
kurumları tarafından dağıtılan basın bültenleri<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraph" style="mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Bu durum neden önemli ve bize ne zararı var?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span lang="TR" style="mso-ansi-language: TR;">Sırasıyla görelim:<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Uzman görüşleri:</span></b><span lang="TR" style="mso-ansi-language: TR;"> Çoğunlukla gerçekten alanlarında uzman kişiler
tarafından yazılır. Ancak <b style="mso-bidi-font-weight: normal;">bir kişinin
alanında uzman olması mutlaka size sunduğu önerileri tarafsızca yaptığı
anlamına gelmez.</b> Bu nedenle de, hem TV hem de yazılı basında yer alan
“uzmanına soralım” program yada köşeleri, kişi yada kurumlar tarafından <b style="mso-bidi-font-weight: normal;">para ile alınıp satılan ve örtülü reklam
amacıyla kullanılan mecralar haline gelebilirler. </b>Bu durumda, uzman kişi,
sizi kendi kurumunda yapılan “deneysel” kabul edilebilecek uygulamalara
yönlendirebilir, bu konuya daha önce değinmiştim.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Popüler bilgi:</span></b><span lang="TR" style="mso-ansi-language: TR;"> Bir yandan daha zararsız izlenimi veriyor (çünkü
arkasında bir uzman olmadığı –bazen- biliniyor), ama bir yandan da ciddi
hasarlara yol açabilecek bir uygulama. İki nedenle:<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l1 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -108.0pt;">
<!--[if !supportLists]--><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>i.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Uzmanlar da ansiklopedik bilgi verebilir, bu
durumda bizler de popüler bilgiyi bilimsel bilgi sanabiliriz.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l1 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -108.0pt;">
<!--[if !supportLists]--><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>ii.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Bu grup bilgi, <b style="mso-bidi-font-weight: normal;">tüm dünyada milyonlarca izleyicisi olan tutkulu akımlara yol açıp ciddi
hasarlar verebilir.</b> Örnek; Zerdeçal tozunun, kanserden romatizmaya, kalp
hastalığından yüksek tansiyona<span style="mso-spacerun: yes;"> </span>her derde
deva olduğunu, hatta belinizdeki ciddi ağrıları gidermek için başka hiç bir
tedaviye gerek olmadığını duyabilirsiniz. Hayallerinizi yıkmak istemem ama,
doğru değil. Olsaydı insanlar bin yıllardır kanserden kaybedilmez, ağrılarının
giderilmesi için cerrahi tedaviye başvurulmazdı. Bütün Omurga Hastalarına
zerdeçal verirdik, hekimlik de süper kolay olurdu.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Ve basın bültenleri.</span></b><span lang="TR" style="mso-ansi-language: TR;"> Aslında bence, <b style="mso-bidi-font-weight: normal;">en samimi olanı bu diyebiliriz, bir koşulla. O koşul, bilginin
kaynağının basın bülteni olduğunun açıklanması.</b> Filanca hastane, şu
hastalığınız için falanca tedaviyi öneriyor; reklam, ama reklam olduğu belli.
Aksi taktirde, bülten bilgisini genel bir bilgi olarak topluma yansıtan basın
kuruluşunun ciddi bir etik ihlali yaptığını söylememiz gerekir.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Ne yapalım?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Bence iki şey yapalım:<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Bize sağlığımız hakkında verilen her
bilgiyi enine boyuna sorgulayalım, </span></b><span lang="TR" style="mso-ansi-language: TR;">sorgulamadan bilgi veren basın kuruluşlarına ve popüler sağlık
programlarına itibar etmeyelim.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Doğru sağlık bilgisini talep edelim.</span></b><span lang="TR" style="mso-ansi-language: TR;"> Örneğin, ciddi gazete ve televizyon kanallarında
oldukça <b style="mso-bidi-font-weight: normal;">düzgün ve doğru bilgi içeren
ekonomi programları var, ama Sağlık konusunda neredeyse hiç yok. <o:p></o:p></b></span></div>
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<div class="MsoListParagraphCxSpLast">
<span lang="TR" style="mso-ansi-language: TR;">Daha
önce de söylemiştim;<span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">ekonomi konusunda doğruya ulaşma çabamız,
sağlık konusundaki ilgi ve çabamızdan misli misli daha yüksek.<o:p></o:p></b></span></div>
</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-41053248114346118782016-02-03T14:04:00.001+02:002016-02-03T14:26:55.686+02:00Çocuğunuza yada size, "nöro-monitorizasyon" olmadan omurga cerrahisi yapılabilir mi? Yapılmalı mı?<div dir="ltr" style="text-align: left;" trbidi="on">
Bir süredir ara verdiğim hasta hakları üzerine yazılarıma "nöro-monitorizasyon" konusunu tartışarak geri dönmek istiyorum. Yine yakın zamanda konuştuğum bir hasta nedeniyle.<br />
<br />
Öncelikle, nedir bu nöro-monitorizasyon, ne işe yarar? Nöro-monitorizasyon ileri teknolojili ülkelerde on yıllardır kullanılan, omurga yada beyin ameliyatları sırasında sinir iletimini kontrol ederek, eğer bir sorun varsa çok erken farketmemizi ve en kısa zamanda düzeltici önlemler almanızı sağlayan bir sistem. İki yaygın tipi var SSEP ve MEP; çok fazla teknik ayrıntılarına girmeyeceğim.<br />
<br />
Bu teknoloji, özellikle MEP konusunda sadeleştirilerek (son 10 yılda) neredeyse ameliyat yapan cerrahın kendisi tarafından kullanılabilecek hale getirildi ve son derece yaygınlaştı.<br />
<b><br /></b>
<b>Bundan üç yıl kadar önce de, tam doğru endikasyonlarla olmasa bile (ki o zaman başkanı olduğum Türk Omurga Derneği bu konuda itirazını iletmişti), SGK tarafından da listeye alınarak yaygın kullanıma kavuştu.</b><br />
<br />
<b>Yaygın kullanımın ne yararı oldu?</b><br />
<br />
<ul style="text-align: left;">
<li>Özellikle standart skolyoz yada kifoz ameliyatlarında <b>felç riski %1 civarından yaklaşık %0,1 (binde bir) civarına geriletilebildi.</b></li>
<li>Monitorizasyon sayesinde, daha önce <b>çok riskli olduğu düşünüldüğü için yapılamayan bazı ameliyatlar </b>(mesela omurganın kesilerek şekillendirilmesini sağlayan osteotomiler) konunun uzmanları tarafından yaygın olarak <b>yapılabilir hale geldi.</b></li>
<li>Ülkemizde de omurga cerrahisi birkaç adım ileriye gitti.</li>
</ul>
<div>
Şimdi, niye bu yazıyı yazıyorum? Birkaç ay önce, SGK aniden daha önce (mesela) 5 birim olarak yaptığı ödemeyi 1 birime indirme kararı verdi. Niye daha önce 5 veriyorduk da şimdi aniden veremedik? Bilmiyoruz. Bildiğimiz, bunun geçici bir düzenleme olduğunun söylendiği idi; ancak anlaşılıyor ki kalıcı hale geliyor. </div>
<div>
<br /></div>
<div>
<b>Peki sorun ne? </b></div>
<div>
<br /></div>
<div>
Sorun, 1 birim ödeme ile bu sistemlerin SGK tarafından satın alınamaması. <b>Kısaca, birkaç aydır, SGK hastanelerinde nöro-monitorizasyon kullanılamıyor. SGK anlaşmalı özel hastanelerde ise hastanın ücretini (5 birim) kendinin ödemesi ile kullanılabiliyor. </b></div>
<div>
<br /></div>
<div>
<b>Bunun ne önemi var?</b></div>
<div>
<ul style="text-align: left;">
<li><b>Birçok hasta nöro-monitorizasyon olmadan ameliyat ediliyor</b>, tekrar on yıl öncesine döndük.</li>
<li>Ne yazık ki, <b>ancak parası olanlar uygun cerrahi teknolojiden yararlanabilir noktasına geldik.</b></li>
<li>Bir vahim sorun daha var. <b>Birçok hastane ve hekim, hastaları bu konuda bilgilendirmiyorlar.</b></li>
</ul>
</div>
<div>
Yazıya başlarken bir hasta vesilesiyle demiştim, anlatayım. Hastam kendisine <b>ameliyat sırasında uyandırılarak ayaklarına bakılması şeklinde "yeni" bir yöntemin uygulanacağının</b> ve böylece felç olmayacağın söylendiğini belirtiyor. Bu yöntem, <b>en az 25 yıldır ülkemizde uygulanan ve nöro-monitorizasyonun gelmesi ile nispeten geri olduğu için terkedilen bir yöntem.</b> Ama görüyorsunuz, tekrar ısıtılıp, piyasaya sürülüveriyor.</div>
<div>
<br /></div>
<div>
Şimdi, tekrar soralım: <b>Bu hastada bir felç durumu gelişirse sorumlusu kim?</b></div>
<div>
<ul style="text-align: left;">
<li>Nöro-monitorizasyon sistemlerinin ücertini ödemeyen SGK mı?</li>
<li>SGK ya 1 birime sistem satmayı reddeden firmalar mı?</li>
<li>Hastayı ileri teknoloji diye kandırıp ameliyata razı eden hekim mi?</li>
<li>Haklarının farkında olmayıp nöro-monitorizasyon kullanılmadan ameliyat edilmesine izin veren hastamız mı?</li>
<li>Kader?</li>
</ul>
<div>
<b>Buyrun bakalım, size yeni ahlak ve tüketici hakkı soruları.</b></div>
</div>
</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-2868456230473400682016-01-15T09:15:00.003+02:002016-01-15T09:15:53.022+02:00Skolyoz kremi !<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Sağlık hizmetlerinin kalitesini
arttırmanın yollarından biri olarak düşündüğüm tüketici hakları olarak
değerlendirilmesi konusuna bir süredir ara vermiştik, çok yakın zamanda sosyal
medyada rastladığım bir ilan nedeniyle bu konuya tekrar dönmek istedim. İşte
size çarpıcı bir örnek.<o:p></o:p></span></div>
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<span lang="TR" style="mso-ansi-language: TR;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_3QQeTq9jZ2cWvUjhUuy4r2Itrfbyn1JdqG6ysvr1YY0YYz4aFO20Es2vz2Df4agPBBxJUmAyL1sYFYsxMcKxuVlSxP4W01mvs30JF4C4Hxu8_DChMlQCpPu3UJYQqXNgXGx32Tbfr5w/s1600/skolyoz+kremi.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_3QQeTq9jZ2cWvUjhUuy4r2Itrfbyn1JdqG6ysvr1YY0YYz4aFO20Es2vz2Df4agPBBxJUmAyL1sYFYsxMcKxuVlSxP4W01mvs30JF4C4Hxu8_DChMlQCpPu3UJYQqXNgXGx32Tbfr5w/s640/skolyoz+kremi.png" width="200" /></a></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;"><br /></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Şekilde
gördüğünüz sosyal medya ilanı <b style="mso-bidi-font-weight: normal;">“Annenizin
Kremi” markasının ÖZENLE HAZIRLANMIŞ skolyoz kremini</b> tanıtıyor.<span style="mso-spacerun: yes;"> </span>Görülebileceği gibi, bu krem <b style="mso-bidi-font-weight: normal;">skolyoz</b> ile birlikte <b style="mso-bidi-font-weight: normal;">tüm fıtıklar</b>, <b style="mso-bidi-font-weight: normal;">disk kaymaları, sinir sıkışmaları, fibromyalji, sinir sistemi
gerginliği , dolaşım bozuklukları, kas spazmı, kireçlenme,</b> aklınıza ne
gelirse hepsine iyi geliyor.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Bu örneği iki
nedenle çarpıcı bulduğumu söyleyebilirim:<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Son derece <b style="mso-bidi-font-weight: normal;">fütursuz bir şarlatanlık,</b> ancak bilebildiğim kadarıyla elimizde şu
anda Sağlık Bakanlığının konuyu farkedip kamuoyunu aydınlatması dışında bu
durumu önleyebilme yetisi yok. Genellikle farkedilip yasaklanana dek iş işten
geçmiş oluyor. Tüketici hakları bu konularda hasta haklarına göre çok daha
ileri, <b style="mso-bidi-font-weight: normal;">tüketicilerimizi hastalarımızdan
çok daha iyi koruyoruz.<o:p></o:p></b></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="TR" style="mso-ansi-language: TR; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="TR" style="mso-ansi-language: TR;">Daha
önemlisi, konuyu bir sağlık hizmeti alıcı (hasta) açısından değerlendirirsek,
konuyu biraz bilen her hastamızın bunun şarlatanlık olduğunu anlaması mümkün
olabilir. Ancak <b style="mso-bidi-font-weight: normal;">her şarlatanlık bu
örnekte olduğu kadar bariz olmayabiliyor ve hatta bazılarına (ne yazık ki)
hekimler de aracı olduklarından tanınmaları çok zor olabiliyor.</b> Bu durumda,
özellikle skolyoz konusunda bu gibi uygulamalar ciddi olarak yaygınlık
kazanabiliyor.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Şimdi, izninizle
sormak isterim, hiçbir bilimsel dayanağı olmayan bir çok skolyoz tedavisi bu
kremden daha mı etkili? Bu krem, örnekte olduğu gibi “Annenizin Kremi”
tarafından değil de “Hoffring “ firması tarafından üretilmiş ve Dr.
Mittelheimer tarafından pazarlanıyor olsaydı (her ikisi de farazi isimler,
kesinlikle bir benzetme kastım yok), yazılı olanlara bir çok hastamız (ne yazık
ki) inanmaz mıydı? <b style="mso-bidi-font-weight: normal;">Böyle bakılınca
“....... egzersizleri” yada “.......... korsesi” çok mu farklı? <o:p></o:p></b></span></div>
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<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Kreme kızıyoruz
ama, kremden daha tehlikeli ve maliyetli daha neler var. Hep söylüyorum,
kendimizi yararı teyid edilmemiş tedavilere karşı koruyalım.<o:p></o:p></span></div>
</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-19755768650885141462015-12-24T11:39:00.004+02:002015-12-24T11:39:40.538+02:00Tüketici hakları 2: Sizce hata kimde?<div dir="ltr" style="text-align: left;" trbidi="on">
Bugün bir önceki yazıma gelen tepkiler ışığında o yazıda bahsettiğim sağlık hizmetleri ile tüketici hakları arasında olabileceğini düşündüğüm kazan-kazan ilişkisini biraz daha açmak istiyorum.<br />
<br />
<b>Sağlık hizmetlerinin tüketici hakları kapsamına girmesi neden ve kimler için hem yaralı hem de gerekli olabilir?</b><br />
<br />
Öncelikle <b>sağlık hizmeti alıcıları için</b> aldıkları hizmetin sürekliliği ve kalitesine ciddi bir iyileşme ancak bu şekilde sağlanabilir diye düşünüyorum. Ama, <b>hekimlerin de ciddi yararlar sağlayacaklarını düşünüyorum</b>.<br />
<br />
Kendi mesleğim olan Omurga Cerrahisinden bir örnek vereyim: Muhtemelen konu ile direkt ilişkisi olanların haberi yoktur ama, yakın zamanda Sosyal Güvenlik Kurumu <b>omurga cerrahisi sırasında kullanılan omurilik izleme (nöro-monitorizasyon) sistemlerinin geri ödemelerini o kadar düşük bir seviyeye çekti ki, artık SGK hastalarında bu sistem pratik olarak kullanılamıyor.</b> Hastaların kendi ceplerinden bu masrafı ödemeleri mümkün ama, hem etik değil (neden kendileri ödesinler), hem de mevzuata aykırı (doktor hastasından açıktan para ister durumuna düşüyor).<br />
<br />
Bu durumda seçenekler;<br />
<br />
<ul style="text-align: left;">
<li><b>Hastaneler ve doktorlar biz bu durumda omurga ameliyatlarını yapmayacağız diyebilirler</b>, zaten bir kısmı da bunu söylüyor. Ama bu da sorunlu, hem ameliyatı siz yapmazsanız kim yapacak? Hem de yarın bu sefer ameliyat yapmaktan kaçındığınız için de ceza alabilirsiniz.</li>
<li><b>Sanki nöro-monitorizasyon hiç olmamış gibi ameliyatlara devam edilecek. </b>Ya komplikasyon oluşur ve <b>hasta ameliyattan felç olarak çıkarsa; hata (suç) kimde?</b></li>
</ul>
<div>
Yine seçeneklerimiz var:</div>
<div>
<ul style="text-align: left;">
<li><b>Doktorda;</b> nöro-monitorizasyon olmadığını bile bile ameliyat yapmamalıydı.</li>
<li><b>Hastada;</b> nöro-monitorizasyon olmadığını bile bile (bildiğini varsayarak) ameliyat olmamalıydı.</li>
<li><b>Nöro-monitorizasyon sistemini ithal eden ve satan firmada;</b> SGK ne fiyat belirlerse razı olmalıydı. Sonuçta bu bir kamu hizmeti, portakal satmak ile karşılaştırılamaz ki canım.</li>
<li><b>SGK'da olabilir mi? Yok canım, nasıl olabilir? Aklınıza dahi getirmeyin.</b></li>
</ul>
<div>
Buyrun bakalım, size bir problem; <b>çözümü bir sonraki yazıya.</b></div>
</div>
</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-91281351614469580492015-12-09T14:17:00.001+02:002015-12-09T14:17:02.302+02:00Hasta hakları tüketici hakları kapsamına girmeli mi? <div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Bugün de nispeten
tartışmalı bir konu üzerinde görüşlerimi sizlerle paylaşmak istiyorum. Muhtemelen
hepimiz biliyoruz, ülkemizde ve uygar dünyanın her yerinde, halk (tüketiciler)
satın aldıkları mal ve hizmetleri kendilerine sağlayan kurumların kötü niyetli
uygulamalarına karşı kanunlarla korunurlar. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Buna karşın, konu
<b style="mso-bidi-font-weight: normal;">sağlık (yada eğitim, ama, eğitim
konusuna girmeyeceğim) olduğunda alınan hizmetin kalitesinin düşüklüğü yada
ayıplı olması durumunda tüketicinin (hasta ve yakınları) nasıl korunacağı
konusunda herhangi bir kanuni düzenleme, benim bilebildiğim kadarıyla yok.</b>
Tüm sağlık kuruluşlarında Helsinki Hasta hakları bildirgesinin bulundurulması
ve teşhir edilmesi zorunlu, ama uyulmadığı taktirde<span style="mso-spacerun: yes;"> </span>ne şekilde bir cezai yaptırıma gidileceği
(ruhsat iptali vb. gibi bazı düzenlemeler dışında) oldukça muğlak. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Diyeceksiniz ki,
bu konu nereden çıktı?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Katıldığım bazı
eğitim kursları yada toplantılarda, özellikle ülkemizde, gözlemlediğim bir
eğilim mevcut. Şöyle ki<b style="mso-bidi-font-weight: normal;">; bazı kişi yada
gruplar, tıbbın bazı alanlarını fethedilmesi gerekli nüfuz alanları gibi
algılıyorlar ve son yıllarda bu durum giderek pekişiyor.</b> Mesela, kendi
konumdan bir örnek, daha önce de bahsetmiştim. Omurga cerrahisini Ortopedistler
mi yapmalı, yoksa Beyin ve Sinir cerrahları mı? Bu sorunun cevabını, özellikle
bu konu üzerinde eğitim alarak her ikisi de diye vermiştik hatırlarsanız. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Ama mesela bir
ülkede, bir grup, bir konuda eğitim almamış olmakla birlikte (örneğin skolyoz
yada omurilik tümörleri ameliyatları) biraz da kafa göz yararak ve daha önce de
bahsettiğim gibi hastalar üzerinde yaptıkça öğreniriz diye düşünerek ameliyat
veya girişim yapmakta ısrar ediyor ve bundan da gurur duyuyor.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Şimdi bu durumda,
<b style="mso-bidi-font-weight: normal;">hastalar başarısız girişimler ve
gereksiz risklerle karşı karşıya kaldığında, onları koruyacak mekanizma nedir?</b>
Diyelim ki bir skolyoz ameliyatı oldunuz ve <b style="mso-bidi-font-weight: normal;">ameliyatınızı yapan cerrahın aslında daha önce hiç böyle bir cerrahi
yapmadığını ve bu durumu size cerrahi öncesi açıklamadığını (yada yanlış
açıkladığını) fark ettiniz, ne yapmalısınız?</b> <b style="mso-bidi-font-weight: normal;">Ortada ciddi bir komplikasyon olmasa bile sizin üzerinizde deney yada
eğitim yapılmasına razı mısınız?</b><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Acaba bu gibi
durumlara karşı bir <b style="mso-bidi-font-weight: normal;">tüketici gibi
korunmak iyi bir fikir olabilir mi?</b><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
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<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Tahmin
edebileceğiniz gibi, <b style="mso-bidi-font-weight: normal;">benim cevabım,
EVET, olabilir.</b> <o:p></o:p></span></div>
</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-73281706035350955452015-11-23T15:59:00.000+02:002016-12-02T15:26:50.874+03:00Bir Omurga Merkezi neden gerekli? Ne işe yarar?<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgD5hwzFs9CSel-Iofsb5ivTpqKtYfffk7d9stiSzL23BGtrsrYVWGdR90haF5jxKswyoqSqQTwLWjuCh_WqvyutDiE9FmumrEWD3ivyUIlkUUTXIFd7NwaSfz4XtSwxY2S-MerMdiDo3A/s1600/OOM2.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="196" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgD5hwzFs9CSel-Iofsb5ivTpqKtYfffk7d9stiSzL23BGtrsrYVWGdR90haF5jxKswyoqSqQTwLWjuCh_WqvyutDiE9FmumrEWD3ivyUIlkUUTXIFd7NwaSfz4XtSwxY2S-MerMdiDo3A/s320/OOM2.png" width="320" /></a></div>
<span lang="TR" style="mso-ansi-language: TR;">Bugün Omurga
Cerrahisinin hastalarımıza en fazla güvenlik ve etkinlik sağlamak üzerine
kurulu bir örgütlenmesinin nasıl olabileceği konusunu tartışmak istiyorum.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Öncelikle, bir
omurga sorunumuz olduğunda ne yaptığımızı düşünelim. <b>Örneğin bel ağrımız olsun.
</b>Çok acil bir durum algılıyorsak, hemen bir hastanenin Acil bölümüne gidiyoruz.
Ama daha sık olarak, <b>eşimizden dostumuzdan bize “iyi” bir doktor önermelerini
istiyoruz ve bu doktora ulaşarak tedavi olmayı istiyoruz. </b><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;"><b>Bunun ne zararı
var? </b><o:p></o:p></span></div>
<div class="MsoNormal">
<a href="https://www.blogger.com/blogger.g?blogID=6737779751634121078" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Birkaç zararı
var. Birincisi, alttaki şekilde gördüğümüz gibi, <b>omurgamızın sorununu
çözebilecek hekimler arasından, tanışıklık esasına göre yalnızca biri ile
karşılaşıyoruz</b> ve bundan sonraki seyrimiz bu kişinin yönlendirmesine kalıyor. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGA4879q6dPGyPV4-zl2iHFK_azeGq1EhXPYbQZhON4hz5DVWGYkhbntsoB7tUVUmJNH5nSO4P9IrE3XxKJqWpVz-gxV4_9d-H5zmqd5ncFfYXl1mlJ91OhRJXFv1RqhTTQ1cYZy-6TBU/s1600/OOM1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="206" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGA4879q6dPGyPV4-zl2iHFK_azeGq1EhXPYbQZhON4hz5DVWGYkhbntsoB7tUVUmJNH5nSO4P9IrE3XxKJqWpVz-gxV4_9d-H5zmqd5ncFfYXl1mlJ91OhRJXFv1RqhTTQ1cYZy-6TBU/s320/OOM1.png" width="320" /></a></div>
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">İlki ile
bağlantılı olan ikinci sakınca ise, başvurulan kişinin bizi tek bir gözlükle
incelemesi sonucu bazen de doğru olmayan yada yetersiz tedaviler ile
karşılaşmamız. Sonuçta <b>doğru yaklaşımı bulmak biraz deneme/yanılma yöntemi ile
gerçekleşiyor, ama ne yazık ki, burada üzerinde deneme/yanılma yapılan biziz.</b><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;"><b>Ne yapmalı?</b><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Bu sakıncaları
ortadan kaldıracak bir yapılanma bulunabilir. Bu yapılanmaları <b>“Omurga ve
Omurilik Merkezleri (OOM)” </b>olarak adlandıralım isterseniz. OOM içindeki bütün
sağlık birimleri yatay (eşit) olarak örgütlendiklerinden, <b>bir hasta OOm’ne
başvurduğunda, konunun uzmanı bir hekim tarafından yapılan kısa bir
değerlendirme sonrasında ihtiyaç duyduğu sağlık personeli ile en kısa zamanda
buluşturulabiliyor. </b>Yukarıdaki örgütlenmeden farkını belirtmek için aşağıdaki
şekle bakmakta yarar var:<o:p></o:p></span></div>
<div class="MsoNormal">
<br />
<br /></div>
<div class="MsoNormal">
<div class="separator" style="clear: both; text-align: center;">
</div>
<span style="mso-no-proof: yes;"><span class="msoIns"><ins cite="mailto:emre%20acaroglu" datetime="2015-11-11T11:08"><!--[if gte vml 1]><v:shape
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<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;"><o:p><br /></o:p></span></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Görüldüğü gibi bütün
ekip, her bir hasta için en iyi tedavi yaklaşımının nasıl olması gerektiğini
düşünüyor ve uyguluyor. Bu durumda deneme ve özellikle yanılma olasılığı en aza
indiriliyor.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Ek olarak <b>“Hastama
önereceğim tedavi benim bildiğim tedavidir; uysa da, uymasa da” yaklaşımı
tümüyle ortadan kalkıyor.</b><o:p></o:p></span></div>
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<br /></div>
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<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">İlginç değil mi?
Belki bundan sonra sağlık sorunlarımıza çözüm aradığımızda bu yaklaşım bize
rehber olabilir.<o:p></o:p></span></div>
</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-4792953481746134762015-10-27T13:25:00.000+03:002015-10-27T13:26:13.053+03:00Omurga ameliyatları kimler tarafından yapılmalı, kimler tarafından yapılmamalı?<div dir="ltr" style="text-align: left;" trbidi="on">
Bugün özellikle ülkemizde yıllardır devam eden bir tartışmayı sizlerle paylaşmak istiyorum. Büyük soru şu:<br />
<br />
<b>Omurga cerrahisi kimler tarafından yapılmalı?</b><br />
<br />
Aslında bu sorunun tek başına fazla bir mantığı ve hatta iler tutar bir yanı yok, <b>mantıklı cevabı da son derece basit:</b><br />
<br />
<b>Kimler daha biliyor ve yapıyorsa onlar tarafından yapılsın.</b><br />
<br />
Ancak, burada bir sorun ortaya çıkıyor ve omurga cerrahisi paylaşılamayan değerli bir varlık gibi her tutanın elinde kalmaya başlıyor. Bu durumun bir çözümü var mı? Var, gelin görelim.<br />
<br />
Tıp biliminde bazı ana dallar var, Dahiliye, Çocuk hastalıkları gibi. Ancak yıllar içinde bilimin içerdiği bilgi ve tecrübe o kadar büyüyor ve genişliyor ki, ana dallardan yavruların ortaya çıkması kaçınılmaz hale geliyor. En iyi örnek, 50 yıl öncesine kadar tek bir dal olan Cerrahinin (Hariciye) şu anda birçok ana dala dağılmış olması (Beyin ve Sinir Cerrahisi, Ortopedi, Kulak Burun Boğaz vb.). İşte aslında omurga cerrahisi de geleceğin ana dal olmaya en yakın adaylarından biri. <b>Muhtemelen Avrupa Birliği Tıp Dalları Kurumu tarafından 1-2 yıl içinde bir alt dal (ortopedi, beyin ve sinir cerrahisi ve belki de girişimsel radyolojinin) olarak tanınacak.</b><br />
<br />
<b>Bu siz hastalarımızı neden ilgilendirsin?</b><br />
<br />
Çok basit, Omurga Cerrahisinin bir dal olarak tanımlanmasının anlamı, özel olarak bu alanda eğitim almamış kişilerin, yalnızca ana dallardan (ortopedi, beyin cerrahisi vb.) birinin mensubu olmalarına dayanarak "Omurga Cerrahı" olamayacakları anlamına geliyor. <b>Bu özel bir uzmanlık ve ortopedi yada beyin cerrahisi üzerine özel eğitim gerektiriyor.</b><br />
<br />
İlginç bir şekilde, omurga cerrahisinin <b>bazı alanları (örneğin skolyoz yada kifoz cerrahisi) bilgi ve beceri olarak ortopedistlere daha yakın</b>, <b>bazı alanları ise beyin ve sinir cerrahlarına (örneğin omurilik tümörleri). </b>Diğer alanların yaklaşık eşit olarak paylaşılabileceğini söyleyebiliriz. Zaten bu nedenle de artık tüm disiplinlerin beraber çalıştığı omurga merkezleri giderek ön plana çıkıyor.<br />
<br />
Bu durumda, uzun sözün kısası:<br />
O<b>murga ameliyatımı kim yapsın? Kökenin ne olursa olsun, bu konuda eğitim almış ve en iyi bilen cerrah. Hatta tercihan, tüm disiplinlerin beraber olduğu bir Omurga Merkezinde.</b><br />
Mantıklı değil mi?</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-35435998743657286862015-10-21T15:34:00.000+03:002015-10-21T15:34:27.913+03:00Skolyozu olan kızım Tenis oynayabilir mi? Hangi sporları yapamaz?<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Bugün birkaç gün
önce gördüğüm bir hastamın bana hatırlattığı bir konu üzerine yazmak istiyorum.
Daha önce de skolyoz ile ilintili efsaneleri tartışmıştık hatırlarsanız.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Soru şu: Fizyoterapistimiz skolyozu olan kızımın
tenis oynamasının sakıncalı olduğunu söylüyor, doğru mu?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Cevap: Doğru değil.<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Biraz açalım
isterseniz. Buradaki mantık, skolyoz hastalarında omurganın bir yöne doğru
dönmüş (daha doğru ifade ile burulmuş) olmasını esas alıyor. Eh, omurgamız bir
tarafa doğru burulmuş ise, tenis oynarken de topa vurma eylemi benzer bir
dönmeyi içerdiğine göre, tenis oynamak zararlı olsa gerek. Halbuki, daha önce
de defalarca benzer görüşleri tartıştım hatırlarsanız, <b style="mso-bidi-font-weight: normal;">skolyoz bu şekilde düz mantıklarla açıklanabilecek bir hastalık
değildir.</b> <b style="mso-bidi-font-weight: normal;"><span style="color: black; mso-themecolor: text1;">Tenisin yada benzeri diğer sporların skolyozlu hastalara
zararlı olduklarına dair en ufak bir kanıt yok.<o:p></o:p></span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Üstelik,
muhtemelen bunu söyleyenler hiç tenis de görmemişler. Bir kere tenis
seyrederseniz kolaylıkla görürsünüz ki sporcular her iki yöne doğru yaklaşık
olarak eşit döner ve her iki kollarını da kullanırlar. Nereden baksanız tutar
yanı yok yani.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="TR" style="mso-ansi-language: TR;">Peki zararlı spor var mı?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="TR" style="mso-ansi-language: TR;">Muhtemelen evet. <b style="mso-bidi-font-weight: normal;">Vücudun fizyolojik sınırlar üzerinde
(anormal) ağırlıkla yüklenmesi herkes için zararlı, skolyoz hastalarımız için
ayrıca zararlı.</b> Bu durumun en iyi örneğini Halter sporcularında görüyoruz.
Diğer sporları yaparken kuvvet arttırmak için hafif/orta ağırlık çalışmak
başka, halter sporu yapmak başka. Sürekli çok ağır yük kaldıran yada taşıyan
çocuklarda omurgada kalıcı hasar ortaya çıkabiliyor, skolyoz hastalarına da
kesinlikle önermiyoruz.<o:p></o:p></span></div>
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<br /></div>
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<span lang="TR" style="mso-ansi-language: TR;">Özet olarak,
birkaç istisna dışında, skolyoz hastaları için özellikle zararlı bir spor muhtemelen
yok, tenis de zararlı değil gibi görünüyor. <b style="mso-bidi-font-weight: normal;">Çocuğunuz spor yapmak istiyorsa bırakın yapsın.<o:p></o:p></b></span></div>
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Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0tag:blogger.com,1999:blog-6737779751634121078.post-6817156601576596742015-10-17T12:11:00.000+03:002015-10-17T12:11:03.778+03:00Okul çantaları: skolyozla ilgileri var mı?<div dir="ltr" style="text-align: left;" trbidi="on">
Bugün izninizle her yıl okullar açılınca yinelenen bir tartışma konusu üzerinde yazmak istiyorum.<br />
<br />
<b>Okul çantası skolyoza yada başka omurga eğriliklerine neden olur mu?</b><br />
<br />
Bu konu o kadar tartışılıyor ve ne yazık ki her konuda olduğu gibi o kadar istismar ediliyor ki, artık neredeyse skolyoz dostu okul çantası pazarlamasına kadar geldik. Okul çantaları gerçekten skolyoz yada kamburluk oluşumunu arttırır yada ilerlemesine neden olur mu?<br />
<br />
<b>Cevap: Hayır. Skolyoz bir hastalıktır, çanta vb. etmenlerden etkilenmez.</b><br />
<br />
Peki <b>neden böyle bir düşünce var?</b><br />
<br />
Bu düşünce bir kaç postür çalışmasına dayanıyor sanırım. Vücudun çeşitli bölgelerine işaretler yerleştirilerek yapılan postür çalışmalarında, mesela, el çantasını sağ elde taşıyan çocuklarda bu esnada sağ omuzun sol omuza göre daha düşük olduğu, yada sırt çantasının tek omuzda taşınması ile yine benzeri bir etki görüldüğü belirtiliyor. Peki, bu etki çocuk çantasını elinden bırakınca da devam ediyor mu? İlginçtir, bu konuda bilgi yok.<br />
<br />
Sonuçta objektif bir gözle bakarsak, <b>evet, çocuklarımız çanta taşırken çanta tarafına doğru eğilirler. Peki bu eğilme kalıcı olabilir mi? Kesinlikle hayır.</b> Çanta taşıyan ilk nesil bizim çocuklarımız değil ki, okullar varolduğundan beri çanta taşıma da var, <b>şimdiye kadar hiç bir skolyoz çalışması etkenin bu olduğuna dair en ufak bir belirti dahi vermedi.</b><br />
<br />
<b>Peki, çanta tümüyle masum mu? </b><br />
<b><br /></b>
Bu sorunun cevabı da <b>hayır. </b>Çanta çocuğun omurgasının şeklini bozmaz ama, ağırlığı arttıkça giderek artan bel ve sırt ağrısına neden olur. Şöyle ki, <b>vücut ağırlığının %10u kadar</b> ağır bir çantayı (mesela vücut ağırlığı 40 kg ise çantası 4 kg yada daha hafif) t<b>aşıyan bir çocukta bel ağrısı olma olasılığı çanta ağırlığı %15 yada %20 olan çocuklara göre misliyle az.</b><br />
<br />
Yani, çocuklarımıza bir iyilik yapmak istiyorsak, sık aralıklarla çantalarının ağırlığını kontrol edelim ve içindeki gereksiz ağırlıkları temizlemesi için teşvik edelim. <b>Mümkünse çanta ağırlıkları vücut ağırlıklarının %10unu aşmasın.</b> Çantayı nasıl taşıdıkları konusunda ise gereksiz gerginliklerden kaçınalım.</div>
Omurga sorunlarıhttp://www.blogger.com/profile/08609158311182034832noreply@blogger.com0