Signs and Symptoms of Myopathy:

Although symptoms depend on the type of myopathy, some generalizations can be made. Skeletal muscle weakness is the hallmark of most myopathies, with some noticeable exceptions, such as myotonia and paramyotonia congenita. In these two inheritable muscular disorders, the muscles become enlarged, rather than weakened and atrophied, and do not relax after contracting.In most myopathies, weakness occurs primarily in the muscles of the shoulders, upper arms, thighs, and pelvis (proximal muscles). In some cases, the distal muscles of the hands and feet may be involved during the advanced stage of disease.

Other typical symptoms of muscle disease include the following:

1. Aching.
2. Cramping
3. Pain
4. Stiffness
5. Tenderness\
6. Tightnes

Initially, individuals may feel fatigued doing very light physical activity. Walking and climbing stairs may be difficult because of weakness in the pelvic and leg muscles that stabilize the trunk.
Patients often find it difficult to rise from a chair. As the myopathy progresses, there may be muscle wasting.

Treatment for Myopathy:

Treatment for myopathies depends on the cause. The goals of myopathy treatment are to slow progression of the disease and relieve symptoms.

Treatments range from drug therapy for muscular dystrophies and inflammatory myopathies to avoiding situations that work the muscles too hard for metabolic myopathies. Some physicians recommend that patients with myopathy keep their weight down (a lighter body demands less work from the muscles) and avoid overexerting the muscles.
When breathing problems develop, an incentive spirometer can help improve breathing function in some patients. Unfortunately, there is no way to strengthen the breathing muscles.
Treatment for Muscular Dystrophies:
The goals of MD treatment are to slow progression of disease and relieve symptoms. Duchenne MD and Becker MD are the subjects of current medical research and clinical trials may be available for patients with either disease.
Corticosteroids (e.g., deflazacort, prednisone) seem to be the most effective medications. Both improve strength and walking ability for about 6 months in boys with Duchenne dystrophy. Following initial improvement, further progression of the disease may be delayed for 3 to 5 years in some cases.
Prolonged use of corticosteroids can cause severe side effects including the following:

• Bone loss (osteoporosis)
• Depression
• High blood pressure (hypertension)
• Thinning of the skin
• Weight gain

Calcium supplements and antidepressants may be prescribed to counteract these side effects.
Preventive treatment for permanent contraction of a muscle (contractures) includes physical therapy and bracing. There are currently no drugs available to prevent or treat contractures.
Heel cord surgery (also called tendon release) and spine-straightening surgery (i.e., rod insertion) may be necessary in cases of severe contractures. Heel cord surgery is performed when the patient is still able to walk. Braces are usually required following surgery.

Treatment for Endocrine Myopathies:

Often, treating the underlying condition helps relieve muscle weakness and pain associated with endocrine myopathies.
Treatment for Inflammatory Myopathies:

Inflammatory myopathies, such as polymyositis and dermatomyositis, are usually treated with drugs that suppress the action of the immune system. Prednisone is most commonly used to treat inflammatory myopathies. It is used initially in high doses (up to 100mg/day) and then slowly tapered to the lowest possible dose that relieves symptoms. Long-term use of prednisone can cause severe side effects, including bone loss, depression, and high blood pressure.

Treatment for Metabolic Myopathies:

The primary goal in treating metabolic myopathies is to avoid situations that tax the muscles and promote muscle pain and weakness, like strenuous exercise.

Dengue Symptoms and Signs

Primary symptoms of dengue appear three to 15 days after the mosquito bite and include the following:

• high fever and severe headache,
• with severe pain behind the eyes that is apparent when trying to move the eyes.

Other associated symptoms are:

• joint pain,
• muscle and bone pain,
• rash,
• and mild bleeding.

Many affected people complain of high knee pain and low back pain.

Dengue infection is a leading cause of death and sickness in tropical and subtropical parts of the world. Dengue is caused by one of four viruses that are transmitted by the bite of an infected mosquito. Dengue hemorrhagic fever is a more serious form of dengue infection.

Primary symptoms of dengue appear three to 15 days after the mosquito bite and include high fever and severe headache, with severe pain behind the eyes that is apparent when trying to move the eyes. Other associated symptoms are joint pain, muscle and bone pain, rash, and mild bleeding. Many affected people complain of low back pain. The lymph nodes of the neck and groin may be swollen. Young children and people infected for the first time typically have milder symptoms than older children and adults.

Dengue hemorrhagic fever starts with the typical signs and symptoms of dengue as described above. The fever lasts from two to seven days. After the fever begins to abate, symptoms occur that are related to increased permeability of the capillary blood vessels. These symptoms can include severe abdominal pain, prolonged vomiting, and breathing problems. Bleeding tendencies, including easy bruising, nosebleeds, bleeding gums, skin hemorrhages, and even internal bleeding may occur. The disease may progress to failure of the circulatory system, leading to shock and death.

The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower pots, plastic bags, and cans year-round. One mosquito bite can cause the disease.

The virus is not contagious and cannot be spread directly from person to person. It is mosquito-borne, so there must be a person-to-mosquito-to-another-person pathway. The full life cycle of the virus involves the mosquito as the vector (transmitter) and the human as the source of infection.

After being bitten by a mosquito carrying the virus, the incubation period for dengue fever ranges from three to 15 (usually five to eight) days before the signs and symptoms of dengue appear in stages.

 

 

Which are the food reduce the dengue fever:

• Kiwi fruit, fig, Pomogranates, papaya etc( these will increase the blood count )
• Juice made from young leaves of papaya.(daily have one time 5ml or 3ml- continue for 3-5 days).

 

A sarcoma is a rare kind of cancer. Sarcomas are different from the much more common carcinomas because they happen in a different kind of tissue. Sarcomas grow in connective tissue — cells that connect or support other kinds of tissue in your body. These tumors are most common in the bones, muscles, tendons, cartilage, nerves, fat, and blood vessels of your arms and legs, but they can happen anywhere.

Sarcoma Symptoms:

Soft tissue sarcomas are hard to spot, because they can grow anywhere in your body. Most often, the first sign is a painless lump. As the lump gets bigger, it might press against nerves or muscles and make you uncomfortable or give you trouble breathing, or both. There are no tests that can find these tumors before they cause symptoms that you notice.

Osteosarcoma can show obvious early symptoms, including:

• Pain off and on in the affected bone, which may be worse at night
• Swelling, which often starts weeks after the pain
• A limp, if the sarcoma is in your leg

Children and young adults get osteosarcoma more often than adults. And because healthy, active children and teens often have pain and swelling in their arms and legs, osteosarcoma might be mistaken for growing pains or a sports injury. If your child’s pain doesn’t get better, gets worse at night, and is in one arm or leg rather than both, talk to a doctor.

Sarcoma Treatments:

How your sarcoma is treated depends on what type you have, where in your body it is, how developed it is, and whether or not it has spread to other parts of your body, or metastasized.

Surgery takes the tumor out of your body. In most cases of osteosarcoma, the doctor can remove just the cancer cells, and you won’t need your arm or leg removed, too.

Radiation can shrink the tumor before surgery or kill cancer cells that are left after surgery. It could be the main treatment, if surgery isn’t an option.

Chemotherapy drugs can also be used with or instead of surgery. Chemo is often the first treatment when the cancer has spread.

Targeted therapies are newer treatments that use drugs or man made versions of antibodies from the immune system to block the growth of cancer cells while leaving normal cells undamaged.

Surviving Sarcoma:
Most people diagnosed with a soft tissue sarcoma are cured by surgery alone, if the tumor is low-grade; that means it is not likely to spread to other parts of the body. More aggressive sarcomas are harder to treat successfully.

The survival rate for osteosarcoma is between 60% and 80% if the cancer has not spread. It is more likely to be cured if all of the cancer can be removed by surgery.

Schwannomas are benign tumors that arise from the nerve sheath (covering) of cranial nerves along-side the cerebellum and brainstem.

The optimal treatment for the majority of symptomatic schwannomas is maximal surgical removal and/or focused radiation therapy (radiosurgery). Fortunately, for patients requiring schwannoma surgery, most large vestibular (acoustic) schwannomas can be removed through a retromastoid keyhole craniotomy while most trigeminal schwannomas can be removed through either a retromastoid approach or an endonasal endoscopic approach.

These tumors are typically benign and arise from the nerve sheath (covering) of cranial nerves along-side the cerebellum and brainstem. The most common schwannoma arises from the 8th cranial nerve (the vestibulo-cochlear nerve) or the 5th cranial nerve (the trigeminal nerve). In some instances, schwannomas are related to a genetic syndrome called Neurofibromatosis. Bilateral vestibular schwannomas are associated with NF-2.

 

What Are Gallstones?

They aren’t really stones. They’re pieces of solid material that form in the gallbladder, a small organ located under the liver.

You might not even know you have them until they block a bile duct, causing pain that you need to get treated right away.

Types:
The two main kinds are:Cholesterol stones. These are usually yellow-green in color. They’re the most common kind, accounting for 80% of gallstones.

Pigment stones. These stones are smaller and darker. They’re made up of bilirubin, which comes from bile, a fluid your liver makes and your gallbladder stores.

 

What Causes Gallstones?

There may be several reasons, including:

• Your genes
• Your weight
• Problems with your gallbladder
• Diet

Bile can be part of the problem. Your body needs bile, but if it has too much cholesterol in it, that makes gallstones more likely.

It can also happen if your gallbladder can’t empty properly.

Pigment stones are more common in people with certain medical conditions, such as cirrhosis (a liver disease) or blood diseases such as sickle cell anemia.

What are  Risk factors?

You’re more likely to get gallstones if:

You’re obese. This is one of the biggest risk factors. Obesity can raise your cholesterol level and also make it harder for the gallbladder to empty completely.

You take birth control pills, hormone replacement therapy for menopause symptoms, or are pregnant. The extra estrogen is the problem. It can increase cholesterol and make it harder for the gallbladder to empty.

You have diabetes. People with this condition tend to have higher levels of triglycerides (a type of blood fat), which is a risk factor for gallstones.

You take medicine to lower your cholesterol. Some of these drugs boost the amount of cholesterol in bile, which may increase your chances of getting cholesterol stones.

You lost weight too quickly. Your liver makes extra cholesterol, which may lead to gallstones.

You’re fasting. Your gallbladder may not squeeze as much.

What Are the Symptoms?

You might not notice anything, or even know you have gallstones, unless your doctor tells you. But if you do get symptoms, they usually include:

• Pain in your upper belly and upper back that can last for several hours
• Nausea
• Vomiting
• Other digestive problems, including bloating, indigestion and heartburn, and gas

What’s the Treatment?

Many people with gallstones get surgery to take out the gallbladder. There are two different kinds of operations.

Laparoscopic cholecystectomy. This is the more common procedure. The surgeon passes instruments, a light, and a camera through several small cuts in the belly. He views the inside of the body on a video monitor. Afterward, you spend the night in the hospital.

Open cholecystectomy. The surgeon makes bigger cuts in the belly to remove the gallbladder. You stay in the hospital for a few days after the operation.

If gallstones are in your bile ducts, the doctor may use ERCP to find and remove them before or during gallbladder surgery.

Ischaemic myelopathy is a condition where the blood supply to part of the spinal cord (the bundle of nerves that run inside the spine) is suddenly interrupted by a ‘clot’ that blocks a small artery (blood vessel). This is similar to a stroke or heart attack in people, except that it is the spinal cord that is affected rather than the brain or heart.

‘Ischaemia’ is a loss of blood supply, and ‘myelopathy’ is a form of damage to the nerves of the spinal cord. The cause of the blockage of the spinal cord blood vessels is poorly understood. In the majority of cases the ‘clot’ which blocks the artery is similar in structure to the material that forms the discs (the cushions between the bones of the spine). This disc material is called ‘fibro-cartilage’. It is assumed that some of this disc material somehow moves from its normal location to become lodged in the blood vessels of the spinal cord. This is the reason why the condition is commonly referred to as‘fibrocartilaginous embolism’ (shortened to ‘FCE’).

Other less common reasons why the blood supply to the spinal cord can be interrupted include either an abscess or a tumour, either of which can press on important blood vessels and prevent blood flow to the nerves.

 

What are the common signs of ischaemic myelopathy?

Ischaemic myelopathy most commonly occurs in large breed dogs, although it is also encountered in smaller breeds and, very occasionally, in cats. The onset of neurological signs is always extremely rapid and often occurs during vigorous exercise. Neurological abnormalities may vary from mild weakness or incoordination, through to an inability to walk. Paralysis, incontinence and inability to feel pain are possible in severe cases. Ischaemic myelopathy is a non-painful condition, although at the initial onset some patients may cry out or yelp. Neurological signs do not tend to progress after the first 24 hours.

 

How is ischaemic myelopathy diagnosed?

Ischaemic myelopathy is diagnosed by ruling out other causes of sudden onset neurological signs, such as a ‘slipped disc’ (see information sheets on cervical disc disease and thoracolumbar disc disease), traumatic disc extrusion or a spinal fracture.

Advanced diagnostic imaging investigations are necessary in order to diagnose ischaemic myelopathy and to rule-out other conditions – an MRI scan is the imaging technique of choice in these circumstances. MRI scanning uses high powered magnets and a computer to generate images of the spine (this is the same technique and the same equipment which is used for body scanning in human patients). It provides detailed information on the location and extent of any blood vessel-related injury to the spinal cord. Myelography is an alternative imaging technique which can also be used for investigating spinal injuries. This involves injecting a dye (contrast agent) around the spinal cord and obtaining multiple X-rays to assess the flow of the dye. Injecting around the spinal cord is not without risk of causing further damage to already compromised nerve tissue, however. Unlike an MRI scan, myelography will not show damage to the spinal cord caused by ischaemic myelopathy, although it will enable some other conditions to be ruled out as the cause of the spinal cord injury. MRI scanning is less invasive than myelography, and with less risk of side-effects, and for most patients MRI provides the best option for investigation. Both MRI and myelography require the dog to have a general anaesthetic.

 

MRI scan showing an ischaemic myelopathy (FCE) in the neck (arrow)

 

MRI scan showing an ischaemic myelopathy (FCE) in the back (arrow)

 

How can ischaemic myelopathy be treated?

There is no specific treatment for ischaemic myelopathy. Supportive care and nursing are essential in order to aid recovery. Bedding needs to be well padded in order to prevent bed sores. Regular physiotherapy and, in some cases, swimming at a hydrotherapy unit can help function to be regained and assist in building strength. Some patients may require a catheter to be placed in the bladder temporarily to aid urination.

What is the outcome for patients with ischaemic myelopathy?

The outcome in dogs with ischaemic myelopathy depends on two key factors – a) the location and b) the severity of the spinal cord injury. The findings on the neurological examination and MRI investigations can help to predict the chances of recovery. Dogs that are paralysed and also cannot feel pain in their limbs are unlikely to recover, unfortunately. However, the majority of less severely affected dogs will gradually improve over a period of weeks to months, to a point where they can freely exercise and have a good quality of life. A degree of weakness in one or more limbs may persist in some dogs. Recurrence of ischaemic myelopathy is very uncommon.

 

• Hyperglycemia is an abnormally high blood glucose (blood sugar) level.
• Hyperglycemia is a hallmark sign of diabetes (bothtype 1 diabetes and type 2 diabetes) and prediabetes.
• Diabetes is the most common cause of hyperglycemia.
• Other conditions that can cause hyperglycemia arepancreatitis, Cushing’s syndrome, unusual hormone-secreting tumors, pancreatic cancer, certain medications, and severe illnesses.
• The main symptoms of hyperglycemia are increased thirst and a frequent need to urinate.
• Severely elevated glucose levels can result in a medical emergency like diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS, also referred to as hyperglycemic hyperosmolar state).
• Insulin is the treatment of choice for people with type 1 diabetes and for life-threatening increases in glucose levels.
• People with type 2 diabetes may be managed with a combination of different oral and injectable medications.
• Hyperglycemia due to medical conditions other than diabetes is generally treated by treating the underlying condition responsible for the elevated glucose

 

Diabetic Ketoacidosis Symptoms

People with diabetes don’t have the luxury of that auto-sensing. Not enough insulin and the glucose levels in the blood stream start to rise; too much insulin, and they plummet.

The consequences of hypoglycemia are easy to understand. No energy source, no function – and the first organ to go is the brain. It needs glucose to function and without it, the brain shuts down quickly. Confusion, lethargy, and coma occur quickly. Blood sugar is one of the first things checked on scene of a comatose patient, because it’s so easy to fix and very embarrassing for an EMT to miss.

A number of medical conditions can cause hyperglycemia, but the most common by far is diabetes mellitus. Diabetes affects over 8% of the total U.S. population. In diabetes, blood glucose levels rise either because there is an insufficient amount of insulin in the body or the body cannot use insulin well. Normally, the pancreas releases insulin after a meal so that the cells of the body can utilize glucose for fuel. This keeps blood glucose levels in the normal range.

Type 1 diabetes is responsible for about 5% of all cases of diabetes and results from damage to the insulin-secreting cells of the pancreas. Type 2 diabetes is far more common and is related to the body’s inability to effectively use insulin. In addition to type 1 and type 2, gestational diabetes is a form of diabetes that develops in pregnant women. Studies show that between 2% to 10% of all pregnant women get gestational diabetes.

Sometimes, hyperglycemia is not the result of diabetes. Other medical conditions that can cause hyperglycemia include:

• Pancreatitis (inflammation of the pancreas)
• Pancreatic cancer
• Hyperthyroidism (overactive thyroid gland)
• Cushing’s syndrome (elevated blood cortisol level)
• Unusual tumors that secrete hormones, including glucagonoma,pheochromocytoma, or growth hormone-secreting tumors
• Severe stresses on the body, such as heart attack, stroke, trauma, or severe illnesses, can temporarily lead to hyperglycemia
• Taking certain medications, including prednisone, estrogens, beta-blockers, glucagon, oral contraceptives, phenothiazines, and others, can elevate blood glucose levels

Mild or transient hyperglycemia may not need medical treatment, depending upon the cause. People with mildly elevated glucose or prediabetes can often lower their glucose levels by incorporating diet and lifestyle changes. To assure that you chose the right dietary and lifestyle changes , you should speak with your health care professional or use reliable resources such as the American Diabetes Association.

Insulin is the treatment of choice for people with type 1 diabetes and for life-threatening increases in glucose levels. People with type 2 diabetes may be managed with a combination of different oral and injectable medications. Some people with type 2 diabetes also take insulin.

Hyperglycemia due to medical conditions other than diabetes is generally treated by addressing the underlying condition responsible for the elevated glucose. In some cases, insulin may be needed to stabilize glucose levels during this treatment.

Types of Dementia

Dementia is a general term for loss of memory and other mental abilities severe enough to interfere with daily life. It is caused by physical changes in the brain.

 

• Alzheimer’s disease
• Vascular dementia
• Dementia with Lewy bodies (DLB)
• Mixed dementia
• Parkinson’s disease
• Frontotemporal dementia
• Creutzfeldt-Jakob disease
• Normal pressure hydrocephalus
• Huntington’s disease
• Wernicke-Korsakoff Syndrome

 

Alzheimer’s disease

Most common type of dementia; accounts for an estimated 60 to 80 percent of cases.

Symptoms: Difficulty remembering recent conversations, names or events is often an early clinical symptom; apathy and depression are also often early symptoms. Later symptoms include impaired communication, poor judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking.

Revised criteria and guidelines for diagnosing Alzheimer’s were published in 2011 recommending that Alzheimer’s be considered a slowly progressive brain disease that begins well before symptoms emerge.

Brain changes: Hallmark abnormalities are deposits of the protein fragment beta-amyloid (plaques) and twisted strands of the protein tau (tangles) as well as evidence of nerve cell damage and death in the brain.

 

Vascular dementia:

Previously known as multi-infarct or post-stroke dementia, vascular dementia is less common as a sole cause of dementia than Alzheimer’s, accounting for about 10 percent of dementia cases.

Symptoms: Impaired judgment or ability to make decisions, plan or organize is more likely to be the initial symptom, as opposed to the memory loss often associated with the initial symptoms of Alzheimer’s. Occurs from blood vessel blockage or damage leading to infarcts (strokes) or bleeding in the brain. The location, number and size of the brain injury determines how the individual’s thinking and physical functioning are affected.

Brain changes: Brain imaging can often detect blood vessel problems implicated in vascular dementia. In the past, evidence for vascular dementia was used to exclude a diagnosis of Alzheimer’s disease (and vice versa). That practice is no longer considered consistent with pathologic evidence, which shows that the brain changes of several types of dementia can be present simultaneously. When any two or more types of dementia are present at the same time, the individual is considered to have “mixed dementia” (see entry below).

 

Dementia with Lewy bodies (DLB):

Symptoms: People with dementia with Lewy bodies often have memory loss and thinking problems common in Alzheimer’s, but are more likely than people with Alzheimer’s to have initial or early symptoms such as sleep disturbances, well-formed visual hallucinations, and slowness, gait imbalance or other parkinsonian movement features.

Brain changes: Lewy bodies are abnormal aggregations (or clumps) of the protein alpha-synuclein. When they develop in a part of the brain called the cortex, dementia can result. Alpha-synuclein also aggregates in the brains of people with Parkinson’s disease, but the aggregates may appear in a pattern that is different from dementia with Lewy bodies.

The brain changes of dementia with Lewy bodies alone can cause dementia, or they can be present at the same time as the brain changes of Alzheimer’s disease and/or vascular dementia, with each abnormality contributing to the development of dementia. When this happens, the individual is said to have “mixed dementia.”

 

Mixed dementia:

In mixed dementia abnormalities linked to more than one cause of dementia occur simultaneously in the brain. Recent studies suggest that mixed dementia is more common than previously thought.

Brain changes: Characterized by the hallmark abnormalities of more than one cause of dementia —most commonly, Alzheimer’s and vascular dementia, but also other types, such as dementia with Lewy bodies.

 

Parkinson’s disease:

As Parkinson’s disease progresses, it often results in a progressive dementia similar to dementia with Lewy bodies or Alzheimer’s.

Symptoms: Problems with movement are common symptoms of the disease. If dementia develops, symptoms are often similar to dementia with Lewy bodies.

Brain changes: Alpha-synuclein clumps are likely to begin in an area deep in the brain called the substantia nigra. These clumps are thought to cause degeneration of the nerve cells that produce dopamine.

 

Frontotemporal dementia:

Includes dementias such as behavioral variant FTD (bvFTD), primary progressive aphasia, Pick’s disease, corticobasal degeneration and progressive supranuclear palsy.

Symptoms: Typical symptoms include changes in personality and behavior and difficulty with language. Nerve cells in the front and side regions of the brain are especially affected.

Brain changes: No distinguishing microscopic abnormality is linked to all cases. People with FTD generally develop symptoms at a younger age (at about age 60) and survive for fewer years than those with Alzheimer’s.

 

Creutzfeldt-Jakob disease:

CJD is the most common human form of a group of rare, fatal brain disorders affecting people and certain other mammals. Variant CJD (“mad cow disease”) occurs in cattle, and has been transmitted to people under certain circumstances.

Symptoms: Rapidly fatal disorder that impairs memory and coordination and causes behavior changes.

Brain changes: Results from misfolded prion protein that causes a “domino effect” in which prion protein throughout the brain misfolds and thus malfunctions.

 

Normal pressure hydrocephalus:

Symptoms: Symptoms include difficulty walking, memory loss and inability to control urination.

Brain changes: Caused by the buildup of fluid in the brain. Can sometimes be corrected with surgical installation of a shunt in the brain to drain excess fluid.

 

Huntington’s Disease:

Huntington’s disease is a progressive brain disorder caused by a single defective gene on chromosome 4.

Symptoms: Include abnormal involuntary movements, a severe decline in thinking and reasoning skills, and irritability, depression and other mood changes.

Brain changes: The gene defect causes abnormalities in a brain protein that, over time, lead to worsening symptoms.

 

Wernicke-Korsakoff Syndrome:

Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). The most common cause is alcohol misuse.

Symptoms: Memory problems may be strikingly severe while other thinking and social skills seem relatively unaffected.

Brain changes: Thiamine helps brain cells produce energy from sugar. When thiamine levels fall too low, brain cells cannot generate enough energy to function properly.

During a routine Scale and Polish at Smiles Dental, your hygienist will thoroughly clean all deposits and stains from teeth. They will scale away tartar build-up from tooth surfaces and polish your teeth using special dental instruments. You can feel tartar build up on the backs of your teeth with your tongue.

Ultrasonic scalers are used to remove calculus rapidly from the tooth surface. The scaling tip vibrates in the ultrasonic range of 20-45 kHz (i.e. 20,000 to 45,000 times per second), with an optimum frequency between 18 kHz and 32kHz.

Treatment for iron-deficiency anemia will depend on its cause and severity. Treatments may include dietary changes and supplements, medicines, and surgery.