Monday, December 17, 2007

LIBURAN !!!!

generic bangets yah judul post nya huahuahuahah
so... besok malem, ehm... tol cikampek puasti macet!!! bandung itu khan everybody destination to be huahuah..ge er..(Secara aku yang mau ke bandung geto..) .bukan itu sih yang pengen aku critaiin. aku mau cerita soal jadwal liburan anak-anak yang ga seragam ama liburan ortu hihihi... mungkin kebetulan aku ajah yg beda,karena di sekolahannya faiz jakarta libur dari tanggal 17 des - 7 januari. sekolahan anaknya mbak ivo dari tgl 20 ampe minggu pertama januari.lha,sekolah dawwi liburnya itu tgl 20,21 masuk,22 libur lagi ampe 25 trus 26-29 nya EHB .. bagi aku mah jadwal ini ga efektif,sebab bagi raportnya nanti tgl 12 januari terus libur lagi dua minggu... kan aku jadi kejar-kejaran liburannya. sempet aku cancel semua agenda libur..dan nini di bandung ngomel-ngomel..pusing kan gue (emang sih beliau mah yang penting cucu nya bukan gue hahahaha...).ayah juga sempet manyun,ya iya lah kapan lagi punya libur enak tapi ga ketemu anak nya hehehe...
sambil ngomel,aku bilang mbok ya kalo libur itu blassss... semua libur sekalian gitu! kan ga pusing begini,cape tau reserve-cancel tiket ama travel.. tapi pikir-pikir,kesian pabrik dong ga operasi hahahah..kantor gue kagak ada sales duonk! ...mengutip kata tasya di FS nya "we can't win them all! bener sih... masa yang gini ajah ga ada jalan keluarnya heheh.. setujuuuuu????? ..mestinya gue bersyukur, karena semua distributor bisnis gue di indonesia liburnya cuman tgl 20,25 dan 1januari!!!! lebih kecian tho? hehehehe...so anyway,alhamdulillah deh! kalo ga karena alma yang mau kawinan di bandung tanggal 29 besok pasti gue ga akan ke bandung hahaha....
so,anyway everybody.. selamat liburan panjang yah.. selamat tahun baru..selamat ulang tahun yang ultah di bulan desember ini (kalo pd baca MP gue hihi..) Jay,anti,Firzal,kiwing,endah,prima (anaknya teh ros), Zee (anaknya sarah di aceh) dan gue off course hahahaha....
aku cabuts dulu ya ke bandung... muacchhh everyone!

Friday, December 7, 2007

Dawwi minta adik..

hiks...
sebenernya mah kalo berurusan lagi dengan "dawwi's wish" (again) yang ini lagi. aku harus jawab apa. kan bikin "adik" ga mungkin sendirian hahahaha...

Dawwi ku sayang, cinta ayah bunda.
Ayah bunda juga juga pengen abang segera jadi kakak..(supaya kalo abang ntar camping pramuka dan ayah dinas ke luar kota, bunda ga sendirian hihihi...)
Mungkin ayah bunda terlalu banyak pertimbangan
Mungkin ayah bunda terlalu hati-hati .. tau kan kenapa,bang?

Bunda geli kalo denger abang bilang "Mayl udah ga bayi,ga lucu lagi! " hihihi.. iya lah,tapi Mayl tetap lucu lho..Mayl udah besar ya,bang! udah bisa jalan,kalo kesel Mayl udah bisa mukul.. abang kehilangan "baby" Mayl yah hehehe... demikianlah Allah membesarkan kita,sayang..

Bunda tergelitik kalau abang ganti permintaan, "ga usah adik bayi deh,bunda.Dawwi mau kaka ajah,kakak yang udah SD" ... hehehhe.. sungguh bunda tersindir kalo ini!. janngan-jangan kamu kesepian di rumah,sayang? duh,mau ga abang sabar tunggu beberapa bulan lagi? sebab nanti bunda mau jadi Full-Time mom lagi buat abang,sementara ini abang berbagi bunda dengan para manager yah ..I love you abang!

Dawwi,matahari ayah bunda..
Doaiin ayah dan bunda diberi kekuatan dan kesehatan untuk bisa menerima amanah Allah lagi ..(eh,tau ga ayah udah punya nama kalo adik dawwi nanti perempuan heheh..). mudah-mudahan Abang segera jadi kakak yah...

Tuesday, November 27, 2007

Heeehhh ?!?!?1

this is something from a friend I barely knew :
1. having abortion on her 4rd pregnancy -- they could not handle the cost for another child and the wife feels so exhausted raising the three children.
2. slamming the door at each other if they don't have thing in the same direction.mostly about "bed routine" (ngerti maksyut kyuuu...)
3. scold at her son only when "daddy" at the office
4.hanging around with other friend at anytime they like,just leave the children with boxes of milk with Granny and it's okay leaving them 2-3 day for just undestinied pleasure (beehhh...maksutnya???)
5. search over each other bag or purse or cellphone anytime each of them come home late...(hoping to see hotel's bill,"someone" number,hotel souvenirs or weird sms)
6. zoo inventory madness in front of the kids..

bagi aku ini aneh... how come not "cross by" in my marriage-realtionship? which one is normal? tapi suer aku juga ga mau ini kejadian ama aku. maksut ku,if we fight,can we stretch until we found a children-proof chamber????, atau bicarakan dengan baik2 -- nada suara yg baik,maksud yg baik,cara yg baik dan tujuan yg baik -- we adult train to do so,right??? pernah ga mereperasi pintu?? mahal apa murah..tau ga kalo engsel nya aja yg murse harganya minimal 60rb/engsel (ada merknya carrefour tuh..) how about fixing a on-whole door?? it's an expensive fight!!!. abortion? aaaa.... aku no comment! but..(comment juga!) should there be a condom,spiral, sterill tissue,calendar system..ato outside E? isn't children is the best gift ever? okay..enough...

I have another friend, everytime he fight with his wife. istrinya selalu minta cerai. abis gitu mah baikan lagi.. how easy that is to say,divorce me!!! beehhh????
setiap mereka abis berantem selalu press-release ama tetangga..

Okay, so how a marriage couple fight should be?

Sunday, November 11, 2007

Dentist Tour Begin

pas ke dr.endang bulan kemaren, beliau muji gigi dawwi rapi bagus dan sehat.wuih ! bunda banggaaaa hahahahah.... dan sejak itu dia jadi ikon gigi bagus di rumah hehehe. tapi kayaknya impian jadi model pepsodent buyar deh! kamis kemaren,pulang sekolah jam 11 an dawwi kepeleset di carport,pas lagi godaiin mayl yang sedang makan di gendongan baby sitternya.jatuhnya itu melintir lagi dan dagunya nabrak lantai carport.tadinya sih aku pikir dia clumpsy..biasa,dawwi geto lhooo..super gerak boy.tapi tangisnya kesakitan banget. baby sitternya Mayl ampe ngejerit. pas aku ambil dawwi,ternyata mulutnya berdarah dan banyak serpihan putih di bibirnya.masa sih kotoran dilantai putih????? aduuuhhhh ...ternyata gigi anakku patahhh..kesian buanget.kebayang ga sih,kalo gigi kita kejeduk sikat gigi ajah ngilu,ini kejeduk lantai,lantai gitu lho! keras banget.pasti rasanya pusing,sakit dan ngilu. dawwi bener2 kesakitan. langsung deh aku cari dentist yang praktek saat itu juga...tapi dasar panik,yg aku cari drg di rumah sakit! pdhal sekitar rumah juga ada.dodol!!!
sampai di rs, lampu dan airnya mati,alhasil dentist nya cuman bisa liat,bersihin juga ga bisa (tapi udah bersih ama air ludah di dalam mulut) dan cuman ganti kapas yg digigit aja. di kasih antibiotik ,aku tanya kenapa dikasih antibiotik,kata drg nya soalnya pulva nya sudah terbuka dan syarafnya bisa kena,untuk mencegah infeksi maka dikasih Clabat.oke,make sense!nanti kalo udah sembuh apabila perlu ditambal harus dilakukan.
Sepanjang hari dawwi rewel, badannya suhunya anyep dan ga mau makan minum,susu aja ga masuk. tidur nya duduk hehehe (ini aku belum ngerti). terus aku konsul by phone ama alma di bandung,dia bilang lebih baik aku cari drg anak buat ngliat kondisi dawwi,harus cepet di tindak.kesian anak kecil,even masih gigi susu cuman kalo infeksi kan bahaya. Nah,selanjutnya aku pusing nyari drg SPA! ternyata di semarang cuman ada satu drg SPA,(Busyettt...bukan pilihan populer kah ini?) dan berdasarkan crita ibu2 di rainbow dulu, drg SPA ini galak.Nah lho.... gue ga suka dokter galak.kebayangkan,buat anak dentist itu kan sensitive.apalagi menurut suster di hermina anak2 dibawah 5 taun pasti nangis kalo diperiksa,belum berhubungan dengan bor yg bunyinya zhinggggggggggggg begitu. ga deh! kata alma,kalo ga ada Pedo,cari aja drg senior yg bisa handlle anak kecil. pfffffffff.....pusying! tapi aku inget,dawwi dulu pernah ke drg.arimbi pas cek gigi yg ternyata cuman sariawan .dawwi ga nangis dan rela buka mulut.hei,patut dicoba lagi kan? so, besoknya aku hunting di drg.arimbi praktek.dawwi malah exciting diajak ke dokter gigi hahaha..karena dia tau dia harus disembuhkan hahaha.. makanya,pas diperiksa ama drg.arimbi (baik,cantik,lembut dan sabar buanget,cucunya pasti seneng ama dia tuh) dawwi buka mulut dan ga nangis,Co-operative buanget deh.aku takjub! hahaha...
Oke, ternyata meski gigi dawwi dalam kondisi patah tapi dudukan giginya kuat dan ga ada luka sekitar gusi nya.pulvanya memang terbuka,tapi karena ini gigi susu maka ga terlalu mengkhawatirnya dan lukanya pun so fa so good,jadi drg.arimbi mau liat beberapa hari lagi setelah Clabat nya abis.kalo perlu di tambal ya dilakukan meskipun kayaknya ga terlalu expected karena mudah lepas..paling,harus dirawat dengan baik sampai gigi susunya tanggal...
so, inilah perjalanan tour dentist (yg semua anak akan lalui) dawwi yang akan segera di mulai heheheh dan bubye pepsodent model dream! hahahaha

Tuesday, September 18, 2007

What ?!?!??!

Waks,basi banget yah ga pernah buka blogs ampir 3 bulan. belated news are.. Dawwi sukses di TK barunya, he has many good friends...he likes Dira more (gadis kecil cantik--mukanya jawa buanget n ayuuu..) dia juga punya sparing partner namanya ade,anaknya kecil tapi cabe rawit,beberapa minggu lalu dawwi yg iseng masuk ke gulungan karpet langsung di jungkir balikin ama ade sampe bibirnya berdarah.aku sedih sih..but it's kid playin' dan mereka bermain saat bu ati sedang story telling..bigggg lesson! ada juga anissa yg rajin keluar masuk kelas and she make dawwi back and forward too,tapi kalo nissa ga masuk,dawwi bisa tertib all scholl-hour in the class heheh... oh ya, selain ibu ati yang suaaabbbbaaarrr buanget itu,ada guru pendamping namanya ibu ira (konon orang bandung) cantik kayak cheche kirani.the moms selalu call sign her as cheche hehehe.. good progress is dawwi mulai mau ikut senam atau berbaris setiap pagi tapi pas ada dancing class..kumat!!! mojok! kayaknya dia ga comfort kalo ga menguasai things (know what I mean???) tapi kan ga ada org yg langsung pinter kan,harus ada proses menuju pintar! nah, in the middle of the class bu ati mau kasih stamp buat yg menari,trus dawwi ask my help for having a stamp without going dancing..hehe.. ga! no pain no gain! aku bilang di depan bu ati & dawwi bahwa he shall not have a stamp unless being rewarded for learning dancing.dawwi know well when i said no.so,he tried so hard minggle with the crowds,goyang sesuka hatinya -- which is lama-lama dia nari juga geto lho..-- sampai selesai! horee..dia bangga banget dengan stamp nya dan aku kasih pelukan ciuman 7x hehehe... di perjalanan pulang dawwi cerita kenapa dia malas ikut menari,katanya lagu nya ga enak kayak lagu anak-anak,lebih bagus lagunya tasya! hehehe.. who are you kiddo? dawwi..dawwi a 4 years old grown-up wanna be! hehehe..

Sunday, August 5, 2007

Jangan Rusak Perkembangan Anak

from : Pikiran Rakyat, 18 Desember 2005

TUGAS orang tua sebetulnya bukanlah mempercepat tumbuh kembang anak, tetapi membantu tumbuh kembang anak. "INGIN mencetak anak cerdas, kreatif, dan genius? Temukan caranya di sini! Kembangkan bakat kecerdasan anak Anda sejak dini melalui konsep multiple inteligence! Flash card, cara ampuh untuk mengajari anak Anda membaca sejak dini!" Demikian bunyi pesan-pesan sponsor di media yang kerap terdengar. Derasnya informasi seperti ini umumnya memiliki niatan serupa: menjanjikan percepatan tumbuh kembang untuk menjadikan seorang anak menjadi anak berbakat, genius, atau cerdas. Teori perkembangan dan pembelajaran yang diterapkan serta tren pendidikan di Indonesia pun kini semakin beragam. Sekolah-sekolah plus dan program pendidikan sejak usia dini kian menjamur. Namun, apakah semua informasi, metode, maupun kurikulum pendidikan yang beragam dan banyak ditawarkan tersebut cocok untuk si anak? Bagaimana kita menyikapi derasnya iming-iming produk percepatan tumbuh kembang, teori, dan tren pendidikan yang ada tersebut? Permasalahan ini diungkap secara mendalam dalam seminar online WRMommies yang ke-4 dengan tema "Peranan Orang tua dan Praktisi dalam Membantu Tumbuh Kembang Anak Berbakat Melalui Pemahaman Teori & Trend Pendidikan" pertengahan November 2005 lalu. Adi D. Adinugroho M.A., selaku narasumber, kini sedang menyelesaikan program doktoral dalam bidang special education di Purdue University, Amerika Serikat. Sedangkan nara sumber kedua, Dr. drg. Julia Van Tiel Ms. yang memiliki anak berbakat, kini bermukim di Belanda. Peserta seminar kali ini dibatasi hingga 358 peserta, yang tersebar di berbagai benua, Eropa, Amerika, Asia, Australia, dan Afrika. Peserta terbanyak tentu saja dari Indonesia, Jakarta khususnya. Kedua narasumber mengatakan, akibat maraknya informasi yang menjanjikan paket untuk mencerdaskan anak tersebut, orang tua kerap menjadi "panas". Orang tua merasa khawatir dan panik karena perkembangan anaknya tidak "secepat" perkembangan anak lainnya. Padahal, proses tumbuh kembang adalah proses individual dan bukan merupakan suatu "lomba balap" siapa cepat dia paling super. Intervensi berlebihan kepada anak dengan membombardir mereka melalui beragam paket tumbuh kembang yang menggiurkan, tanpa disadari malah dapat menjadi tindak penganiayaan fisik dan psikis bagi anak. Kesalahan persepsi Bila dipandang dari pengertian ilmu keberbakatan ilmiah atau scientific, sebetulnya telah terjadi miskonsepsi tentang pengertian keberbakatan (giftedness) di masyarakat. Menurut Julia Van Tiel dalam makalahnya yang berjudul "Pengembangan Keberbakatan Gifted Children," anak berbakat (gifted children) adalah mereka yang memenuhi persyaratan yang telah ditetapkan oleh ahli keberbakatan di dunia. Seorang anak berbakat haruslah memiliki inteligensia yang tinggi di atas rata-rata (IQ > 130), kreativitas yang tinggi, motivasi, serta komitmen kerja yang tinggi. Faktor inteligensia adalah faktor yang stabil, sulit dipengaruhi dari luar karena merupakan faktor bawaan (genetik). Sementara, kreativitas dan motivasi merupakan faktor yang dapat dipengaruhi dari luar (lingkungan). Jadi, slogan yang mengatakan "semua anak pada dasarnya cerdas atau berbakat" adalah sangat keliru, karena jauh dari berbagai temuan ilmiah tentang tumbuh kembang anak. Selain itu, teori perkembangan dan pembelajaran yang masih kontradiktif seperti teori multiple inteligence (MI) milik Howard Gardner, juga banyak dijadikan landasan pegangan sekolah-sekolah maupun panduan tumbuh kembang anak di Indonesia. Padahal, para akademisi pendidikan di dunia internasional telah menyatakan bahwa teori MI ini masih belum bisa dibuktikan pengukuran dan pembuktian empirisnya (pseudoscience). Yang dijelaskan oleh Gardner hanyalah kedelapan intelligence (keping-keping intelektual) miliknya tersebut. Sejauh ini belum ada sistematika dan acuan aplikasi teori MI. Begitu pula dengan alat pengukur keping-keping intelektual yang dijabarkan dalam MI. Parameter pengukur kemajuan kepingan intelektual tersebut dan pengaruhnya terhadap pertumbuhan anak secara menyeluruh serta dampaknya terhadap intelektual-intelektual lainnya pun belum ada. Apakah memang MI ini benar dapat memberikan manfaat? Project Zero, projek penelitian milik kelompok Gardner sudah belasan tahun tidak pernah menghasilkan bukti empiris. Bukti-bukti yang diberikan Gardner hanyalah berbagai testimoni dari para guru kelas. Akibatnya, yang terjadi di lapangan adalah trial and error, terserah kepada praktisi lapangan bagaimana menginterpretasi MI. Bahayanya, selain hanya membuang-buang waktu, kita juga tidak tahu lagi kapan harus berhenti menstimulasi. Padahal, hal ini bisa jadi malah menimbulkan abusing terhadap anak. Menjadi advokat tangguh Jadi bagaimana menyikapi segala persoalan ini? "Hal penting yang perlu diingat adalah, tugas orang tua sebetulnya bukanlah mempercepat tumbuh kembang anak, tetapi membantu tumbuh kembang anak. Kita tidak bisa menciptakan, mempercepat, maupun mengabaikan tahapan kesiapan anak di dalam proses tumbuh kembang. Karena semua itu merupakan suatu keunikan individu. Tentu boleh menetapkan harapan pada seorang anak, namun tetap harus melihat tahapan perkembangan berdasarkan range usia, kondisi anak, dan tahapan pertumbuhannya. Untuk itu, kita perlu memahami prinsip tumbuh kembang, memahami teori-teori dasar tumbuh kembang dan pembelajaran," tulis Adi. D. Adinugroho dalam makalahnya yang berjudul "Membantu Tumbuh Kembang Anak dengan Memahami Teori & Trend pendidikan". Adi pun menganjurkan, untuk mengendalikan arus informasi yang dikemas secara masif dan ekstrapersuasif tersebut, jadilah advokat yang tangguh bagi anak-anak kita. Menjadi advokat tangguh berarti selalu kritis dalam menyerap serta memilah informasi. Jadi, kita bisa tahu persis apakah metode tersebut benar-benar efektif atau hanya "kelihatannya efektif" tapi tidak bisa diukur. Alhasil, keputusan bisa diambil dengan meminimalkan risiko trial and error. Jangan lupa, kita perlu selalu mempertimbangkan kepentingan anak, menyesuaikan kebutuhan dan kemampuan anak, serta mengkaji dampak positif maupun negatif bagi kelangsungan hidup mereka di masa depan. Dengan demikian, anak pun dapat menikmati proses tumbuh kembangnya dengan baik, karena tak lagi merasa terbebani dengan "lomba balap" yang kerap diciptakan orang tua maupun lingkungannya.

Saturday, June 23, 2007

birthday project 4 : finale

D Day 2st :
ayah udh dateng dr tadi malem, jadi setelah bagi raport tadi pagi.aku langsung ambil kue Thomas dan running fast home prepare everything,karena rencananya harus ke kantor juga.tapi ga jadi krn dawwi agak pilek dan ga mau bobo siang, jadi aku skip ga ngantor hehehe..

jam 3 sore,everybody hustle-bustle preparing to the party hahaha.. baju seragam merah2 .aku di protes,kok casual bener baju ku,kata temen2 biasanya emak nya yang ultah dandannya ga kalah cakep ama yg ultah,aku bilang anakku udah cakep dan aku ngikutin gaya dia.hauhauha..kali,kalo anak nya cewek, bisa didandanin kayak cinderella, aku juga bisa pake gaun ngkalee..hehe tapi anak cowo mah t-shirt,hem ato kaos,itu juga paling bagus bisa di spot lewat brand yang di print gede ato gambar tokoh yang lagi in -- which bajunya asli ato ga jadi value (masa sih..who cares deh hehe..)..nanti aku bisa kelewat keren lagi,disangkaiin yg ultah aku bukan dawwi hahah..

anyway,pestanya seru juga.. tapi dawwi rada ga hepi. sebab dia ga suka kursi kebesarannya.it's feel like prison. he feels different! oh, dia ternyata lebih suka berada di tengah teman-temannya.makanya pas waktunya makan dia hepi banget karena bisa duduk dengan teman-temannya.

tante Tian dari McD juga pinter bawaiin acaranya,semua anak-anak enjoy termasuk ibu guru yang dateng.sementara emak-emak sibuk di bagian belakang ngurusin kostum buat acara perpisahan besok hehehe..

nah, setelah makan.aku kasih kesempatan anak-anak 'merusak' kue ulang tahun.semua diijinkan mencolek cream kue nya..haha.bahagia bener mereka sementara ibunya pada bingung dan tereak "aduh..jangan,ntar rusak!".. hehe.. ga papa ntar sampe rumah creamnya aku buangin karena kita2 di rumah juga ga suka kok Creamnya ,biasanya begitu! sementara anak-anak juga bisa menghilangkan rasa penasaran dari cream diatas kue yg lunak-lunak menggoda itu aku juga membiarkan mereka bisa enjoy suasana pesta.

Pas magrib,acaranya selesai.timing nya enak anak-anak pulang pas i puncak seneng dan biasa, dawwi juga feels good kalo pas bagiin goody bags hehehe...

Finish! finish! malem ini aku bisa tidur enak (ngkalee.....)

Tuesday, June 19, 2007

birthday project 3 : D-Day

D Day 1st :
ada insiden,tangan eyang kesiram minyak panas pas masak kerupuk buat nasi dus dawwi.sedih aku,semangat banget eyang.jadi sebelum ke venue aku temenin eyang ke rumah sakit karena luka bakarnya luas hampir 20 cm panjangnya ditangan kanan.untung cepet,jadi ditangani dokter dgn baik.selain dirawat mama juga dikasih obat antibiotik mencegah infeksi dan obat analgesik.makasih yah ma for helping,bantuan mama bener2 tiada duanya...
anyway,acaranya seru dan rame banget.mamadeks jadi Mc nya..oke deh! seru and the kids love her.acaranya ga lama sih,cuman satu setengah jam.itupun dawwi keliahatan lelah,mungkin karena seru jadi banyak energi keluar.tapi aku seneng dia hepi,apalagi pas buka kado malam hari nya di rumah,it means a lot to him.

lucunya ketika acara tiup lilin anak2 berebut niupin kuenya,jadi first kick nya ga dapet! hehehe.. kasian juga!Btw,dawwi keukeuh harus pake baju superman padahal aku udah beliin dia baju the cars tadi malem.ya sutra lah,yang penting dia enjoy acaranya.

trus dawwi gumun karena kadonya banyak belum lagi dapet mobil2an gede dari opa n eyang. Mukanya kayak yang ga percaya that the car is his!..hehe..lucu deh muka amaze nya.sebagian kadonya aku simpan karena kebanyakan mainan,sayang banget daripada hancur serentak heheh..lebih baik aku kasih sedikit-sedikit. Dawwi supaya tetep semangat meski udah rada ruwet pas baggin goody bag,he like being a a star today ;)

Happy Birthday, Son! doakan Ayah dan Bunda diberi kemampuan oleh Allah swt untuk menjaga,merawat,mendidik,membesarkan mu sesuai dengan amanahnya..Amien!

Sunday, June 17, 2007

Birthday project (2)

Jadinya begini, ada 2x party, satu dikantor tgl 19 juni (anak-anak sales force yg kenal dengan dawwi) trus tanggal 22 juni sore,setelah paginya bagi raport..horeeyy.. terbayang repotnya--cerita mundur,aku kesel sebab setelah OK telp McD Citraland booking untuk tanggal 23 (sabtu) segera aku datang ke Mcd untuk bayar DP nya, ternyata para staff ultah nya miskom! jadi,kalo hari sabtu aku ga bisa party in-store sebab di McD Citraland kalo sabtu ruammee banget.nah,kesel tho? wis aku koar2 pesta ne sabtu,aku harus begimana? langsung hunting McD yg lain,dapet di ADA banyumanik tapi dapetnya jumat sore.ya sudah lah,dawwi nya gagal aku bujuk mindahin McD ke rumah daripada perang dan menginventaris "bunda bohong" sama dawwi lebih baik maju terus pantang mundur..
Party 1 = 32 invitee (times parents..guess how many? )
Party 2 = 20 invitee (times parents..guess how many? )
jadi hari ini aku shoping day,beli segala sesuatu yang berkaitan dengan goody bags,baloon,kue & makanan..Siang,keliling kota cari tempat sampah plastik yg ada gambar spiderman,barbie & minnie mouse. (Readers,if it's happen to you,jangan pernah bikin goody bag on list! selalu lebihin..jgn lupa kasih ibu guru dan tante ultah di McD). Sore, ke supermarket beli snacks buat isi goody bag.malem setelah anak-anak tidur dibantu adeks mulai bikin goody bags..hehehe..itung-itung refreshing dari kerjaan di kantor..

Friday, June 15, 2007

Bithday Project (1)

sekarang aku ngerti kenapa makin marak event orgizer untuk acara anak-anak.Because,it's not easy to arrange that event!. aku terkagum-kagum oleh keadaan,secara aku terbiasa bikin event-event di kantor,it's so different planning a birthday party for my boy!. Oke,ini kali pertama aku dan aa berencana bikin serius birthday party buat dawwi,since birthday 1 family only,birthday 2 just neighbour around,birthday 3 tiup lilin aja karena semua dana kesedot ke rs gara-gara dia sakit dan this birthday,I want it (not perfect) hillarious! hahah. kepengennya (ibunya) partynya yg unik dan beda,apa daya di awal bulan temen sekolahnya ultah di McD,and Guest What? betull...dawwi minta dirayaiin di McD juga.pertamanya sih aku iyaiin,cuman McD lah.tapi ternyata? hohohoho..... banyak hal yg musti dipertimbangkan. maksud hati mau temen-temen sekolah dawwi ajah yang diundang.Oke..plus parent & babysitter,masih oke. ternyata ada anak-anak manager di kantor yang akrab ama dawwi..Hmmm..ga undang,ntar dawwi ember bocor,ga enak,ga diundang buntutnya banyak.ternyata kalo ngundang satu harus ngundang semua kalo ga,ga enak ama emak nya--secara hubungan bisnis yg every aspect harus di retain gitu lho.Waduh! langsung mumet begitu jumlah anak yang akan jadi invitee ketemu 48 anak! busyet! Pesta ultah anak apaan dengan tamu sebanyak itu? plus parent(s) & nanny or babysitter @ McD,How much does it will cost????? God!,'feel such a wasted and that's not simple anymore!
Ada ide,party nya tetep di Mcd,tapi cut the guest list,temen-temen sekolah only! tapi kan semarang kecil,berencana bikin party di McD dan banyak SF Tupperware seliweran di kota semarang yang lagi jalan-jalan di Citraland melintas mcD :"Eh,mbak sasa lagi party ultahnya dawwi,kok kita ga diundang ya?:" hehehe... semuanya kembali ke hubungan bisnis yang harus di retain di segala aspect. seandainya aku bukan SP DB, I will not care what people say! hanya aja,keadaannya yah begini ini,berkaitan dengan kerjaan. apapun yg aku aku lakukan pribadi m maupun bukan berkaitan dengan menjaga hubungan baik dengan para SF di kantor --apalagi keadaan lagi sensitif banget.
Pf..... sumpah,rieut!

Monday, May 7, 2007

Today Blinks: jatuh dari motor itu ternyata mahal

menghabiskan few hundreds thousand hari minggu kemaren rasanya super weird!well, tapi lebih enak lho,daripada harus dihabiskan di rumah sakit! stuju tho? jatuh dari motor dengan gaya sliding di minggu pagi yang sepi di jakarta juga merupakan pelajaran berharga yang lebih mahal dari angka yg kami habiskan di plangi beberapa jam kemudian.alhamdulillah kita cuman jatuh berdua ,ga bawa dawwi,kalo iya? aku bisa nangis bombay histeris kali dan penyesalannya seumur hidup!kedua,alhamdulillah kami hanya menderita luka2 ringan (walau sempet ga bisa tidur malemnya karena periiihhh dan keseleo) dibanding dengan 'cerita' perihnya sakaratul maut kelak,naudzubillahimindhalik..ketiga,alhamdulillah kami masih sanggup balik lagi ke kost aa dengan motor tersebut kendati ditemani bunyi2an kelitik mesin dan masih sanggup membersihkan luka,mandi,makan dan menenangkan diri.ke empat,alhamdulillah,sesudah itu kami masih bisa sholat walaupun harus super sakit ruku dan sujud.kelima,alhamdulillah kami diperingatkan allah dengan kecelakaan itu,berapa banyak dosa yg belum kita minta ampunkan pada Allah swt dan "perpanjangan" waktu ini adalah second chance untuk memperbanyak tobat,ibadah,mempertinggi keimanan &ketakwaan . Trakhir,But not least and not important :P...alhamdulillah,kami diberi rizqi untuk bisa membeli pakaian baru (terpaksa,sebab aku harus balik ke semarang sore harinya,ga mungkin banget travel balik dengan kostum kotor ber oli dan bau hihihihi...gue bangets!!) dan menghibur diri mensuplai tubuh dengan makanan yg alhamdulillaaaaaaaahhhh enak banget...

ya,hari minggu kemaren was a very stunning and colorful day! Pengalamam tersebut menyadarkan kami harus lebih hati2 di jalan setelah ini. Ada hal yang perlu diperhatikan kalo naik motor (maaf telat taunya!) helm itu bukan hiasan kepala ato pengganti wig! hehehe..gunakan dengan benar luka di kepala pada saat kecelakaan adalah penyebab pertama untuk say goodbye to the world!. sarung tangan,kaos kaki dan manset tangan harus dipake--bukan untuk menjaga tangan dari sun-burn aja--tapi melindungi kulit dari parahnya gesekan kulit dengan aspal.jaket + rompi antangin,bisa jadi bumper ketika tubuh terbentur aspal.sepatu, menjaga posisi kaki lebih baik dari posisi rawan terkilir.kaca mata hitam? biar gaya deh---selain bikin mata adem hehehehe......

oke,biasalah..aku juga salah satu mahluk yang juga ternyata 'baru belajar' setelah kejadian. but,at least yet from all of bleshing in disguise tadi di atas..aku belajar banyak--banyak--banyak hal! dan bonus nya juga, aku belajar lebih empati terhadap rasanya nyeri yang diderita orang lain.belajar menghargai saudara2 dengan kebutuhan khusus yang bisa ngetik komputer dengan 1 tangan ato hanya beberapa jari dan lebih ga su'udzon ama pengamen bis kota--ga semua dari preman jahat ato ga manusiawi--2 dari seribu pengamen yg aku suka anggap sebelah mata itu adalah yang membantu aku dan aa saat jatuh.

Sunday, April 29, 2007

Asthma Medications for Kids

The annual direct health care cost of asthma is approximately $11.5 billion; indirect costs (e.g. lost productivity) add another $4.6 billion, for a total of $16.1 billion dollars. Prescription drugs represented the largest single indirect cost, at $5 billion. The value of lost productivity due to death represented the largest single indirect cost at $1.7 billion.1

INHALED BRONCHODILATOR MEDICATIONS

Inhaled bronchodilator medications are highly effective in opening airways narrowed by asthma. In addition, they have few severe side effects when used in the recommended dose and frequency. They are available by both metered dose inhaler and nebulizer.

Inhaled bronchodilator medication produces much fewer side effects than theophylline and is preferred over theophylline for routine use, for severe episodes and for prevention of exercise-induced asthma. In certain cases both may be used.

For children with mild asthma this is often the only medication they will need. Inhaled bronchodilators are highly effective, and they have also proven to be the bronchodilator medicine of choice for moderate and severe asthma when used with other medications.

Because inhaled bronchodilator medications are very effective with few or no side effects, some patients tend to overuse them, which can be very dangerous. Overuse of these medications can delay proper evaluation and treatment of severe asthma episodes.

Some studies suggest that overuse of these medications may worsen the asthmatic condition and increase the possibility of death from asthma. It should be remembered that under-medication is far more likely to cause severe asthma and death than over medication.

There are now long acting inhaled bronchodilators which are prescribed for use in the morning and evening. It is now recommended that this be used as add on medication from a person who is taking inhaled corticosteroids. REMEMBER:

1. If you need to use inhaled bronchodilator medication more often than prescribed, this is a sign that your asthma is not in control and you should consult your doctor.

2. When medications fail to control asthma and it becomes more severe, immediately call your doctor or emergency room -- day or night.

ANTI-INFLAMMATORY MEDICATIONS

Anti-inflammatory medications are recommended by the National Heart, Lung, and Blood Institute (NHLBI) expert panel for children with mild persistent, moderate and severe asthma as the cornerstone for daily routine medical management. This panel recommend that one of these medications be given daily to control airway inflammation. They are considered safe and effective for long-term use.

Cromolyn (Intal) has been used for 30 years and has very few side effects. An inhaled anti-inflammatory; nedocromil, may also be prescribed. Inhaled corticosteroids are the most used medication. They are very effective and safe but should always be given with a spacer device in the recommended dose to prevent side effects, primarily throat irritation due to yeast infection.

Both of these anti-inflammatory medications must be taken regularly to be effective. These medications frequently fail because they are not taken consistently. These medications do not have an immediate effect and therefore are mistakenly discontinued. Their beneficial effects occur gradually over weeks and months of consistent use.

Therefore, it is important for children to take these medications regularly.

Note: NEVER take more medication than your physician prescribes and always notify him/her of possible side effects.

SYSTEMIC BRONCHODILATOR MEDICATIONS

Systemic bronchodilator medications, prinicipally theophylline, are effective but have more associated side effects that can be unpleasant although rarely life threatening. These medications are available in slow release tablets or capsules that are effective for 12 to 24 hours. These are especially helpful for nocturnal or night-time asthma. They are also used for daily control of asthma symptoms.

Side effects can be a problem and should be brought to the attention of your doctor.When taking theophylline, blood levels are monitored periodically to help reduce side effects and ensure proper dose.

SYSTEMIC CORTICOSTEROID MEDICATIONS

Systemic corticosteroid medications are highly effective in controlling asthma and reversing severe episodes. Unfortunately they can cause serious side effects when used for prolonged periods, and their use is therefore limited to severe episodes or chronic severe asthma which cannot be controlled with the first three groups of medication listed above.

Corticosteroid is a class of normal hormone of the human body and is produced by the adrenal gland. It is very effective in the control of allergies, asthma and many other diseases. It is not like performance enhancing "steroids."

When your child is having a severe allergy or asthma episode, his or her adrenal gland responds by producing more corticosteroids (up to ten times more). In this way, the body can help control asthma.

When asthma is not controlled, despite maximal therapeutic doses of bronchodilator medication, additional corticosteroids must be given. A short course of systemic corticosteroids for less than two weeks is rarely associated with significant side effects. For most children, 5 days of use is adequate.

It must be remembered that severe uncontrolled asthma is potentially fatal; and therefore, a much greater risk than 1 to 2 weeks of systemic corticosteroid. If the asthma is severe, your child may also require hospitalization so that more intensive therapy can be given.
Whenever possible, long-term use of corticosteroids should be avoided. However, severe uncontrolled asthma might require corticosteroids on a regular basis for months or even years. In this case, the risks of chronic uncontrolled asthma are greater than the possible side effects of systemic corticosteroids.

Corticosteroids may be given every other day in the morning, greatly reducing some of the long-term side effects.

INHALED MEDICATION DELIVERY SYSTEMS

Inhalers must be used properly to be effective. Studies demonstrate that inhaled bronchodilator medication is very efficiently delivered by the hand-held metered dose inhaler; however, this requires that the instructions be followed carefully.

Approximately half of asthma patients do not properly use their inhaler and this problem is overcome by the use of a spacer device.

Spacer devices or "spacers" allow the metered dose inhaler to first be sprayed into this container (usually 6 to 16 ounces in size) and then the patient breathes in the inhaled medication from the spacer. This is almost foolproof, thus improving proper use of inhalers from 50 percent to almost 100 percent.

Some authorities recommend spacers for all children. Spacers should be used with inhaled corticosteroids if sore throat or yeast overgrowth (thrush) is a problem.

Pulmonary nebulizer machines or "nebulizers" are also very helpful. They are used to give routine medication treatments of inhaled bronchodilators and/or cromolyn to very young children or any adult who have difficulty using metered dose inhalers and spacers.

Nebulizer machines may also be recommended for anyone with asthma with a severe asthma episode to ensure maximal delivery of bronchodilator medication.

Proper selection and use of inhaled medication, metered dose inhaler, spacer and nebulizer will be provided by your physician and his or her nursing staff. Be sure to carefully follow their instruction for use and cleaning.

NEW MEDICATIONS

Leukotriene modifiers are a new class of oral anti-inflammatory asthma drugs recently approved by the U.S. FDA. Sold under the names Accolate, Singulair and Zyflo, these are also available by prescription.

In July of 2003, The Food and Drug Administration approved a new drug patients with serious asthma. Xolair, is the first in a new class of therapies that are bioengineered to target IgE (the antibody behind allergic asthma) in the treatment of allergic disease.

If your child is not on one of these medications, you should ask your physician if this should be added.

Q & A: KIDS' ASTHMA MEDICINES

HOW ARE ASTHMA MEDICINES PRESCRIBED?


Check with your doctor about your child's medicine needs. Each child has special needs. For instance, if your child has mild asthma and very few episodes, he/she may take a bronchodilator medicine at the first sign of symptoms (such as wheezing or coughing) to keep the symptoms from getting worse.

Your child may take the medicine for about a week after the symptoms end. If your child has more severe asthma and many episodes, he/she may need to take medicines every day, including one or more anti-inflammatory medicines.

HOW LONG DOES IT TAKE FOR BRONCHODILATOR MEDICINES TO WORK DURING AN EPISODE OF ASTHMA?

For bronchodilator sprays prescribed by your doctor, you can tell they are working within 5 to 10 minutes. At that point, your child should begin to feel better. (There are some sprays that are preventive and are prescribed by the doctor even when a child has no symptoms that you can "see." These are anti-inflammatory sprays and they help to prevent asthma episodes from starting.)

For liquids, it usually takes one hour for the medicines to work. For pills and capsules, the time varies, so check with your doctor or pharmacist.

ARE ASTHMA MEDICINES SAFE?

The medicines, including corticosteroids, are safe and highly effective if taken in the recommended doses. No drugs are without some risk or side effect. This is important. All medicines can be harmful if they are not taken properly. Children do not become addicted to asthma medicine.

IF SIDE EFFECTS OCCUR FROM MEDICINES, HOW CAN THEY BE CONTROLLED?

Call your doctor. If your doctor cannot be reached, reduce the dose by half, or skip the next dose. Do not stop the medicine completely. This may cause the asthma to get worse.

For asthma medicine taken by mouth, never have your child take this medicine on an empty stomach. If your child gets nauseous or vomits, try to give the medicine with some milk or food. Be sure to tell your doctor you are doing this because giving the medicine with food or milk can change its effectiveness.

If the side effects, such as vomiting, do not go away, talk to your doctor about changing the dose or the type of medicine. Vomiting is an urgent danger sign.

TO CONTROL ASTHMA SYMPTOMS

Asthma medicine needs to be adjusted if your child has symptoms (such as wheezing or coughing) with exercise, at rest, at night, or early in the morning. According to the NAEPP Expert Panel Report, peak flow meters may be most helpful for people with moderate or severe asthma. A meter reading will tell you your peak flow zones, which are based on the colors of a traffic light. The green zone signals that your asthma is in good control, the yellow zone signals caution and is a sign to use quick-relief medicine to relieve symptoms, and the red zone signals a medical alert that means you should contact your doctor about changing the dose or type of medicine.

TO MANAGE A BAD EPISODE

At the first sign that your asthma is out of control, you will need to take action right away. It is important to know the warning signs that tell you when emergency medical care is needed:

  • Monitor throughout the day if you feel any comfort from taking your medicine. If there in no sign of some relief and it's is becoming harder to breath seek emergency assistance.
  • Stay calm, refer to your asthma management plan, take your medicines as prescribed.
  • If your symptoms get worse, call 911 and get help right away.

TIPS FOR CORRECT USE OF "AS NEEDED" MEDICINE

For "as needed" medicines, give them within five minutes after symptoms begin. It takes less medicine to stop an episode in the early phases of asthma rather than later on.

If your doctor agrees, give the medicine at the first sign of a cold or influenza even if you don't hear wheezing or coughing. Continue giving medicine until all signs of the cold or influenza are gone.

TIPS FOR CORRECT USE OF PREVENTIVE MEDICINE

For medicines taken daily (to prevent asthma), these should be given even if your child does not have symptoms. The medicines reduce airway swelling and make it less likely that another episode will occur.

Controlling Your Child's Asthma

HOW DO YOU CONTROL ASTHMA?

First, it is important that you and your child understand what control means. To completely control asthma is to reduce its frequency and severity, so that the asthma does not interfere with normal activities.

The degree of control varies with each child as some children with severe asthma are extremely difficult to control.

Control of asthma begins by learning which trigger factors are important to your child. Since no two children with asthma are alike, an individualized comprehensive evaluation must be made of your child to determine his or her trigger factors. The child's history is by far the most important part of the evaluation.

Your physician may recommend that you see a lung or an asthma/allergy specialist to help him with this evaluation. Skin testing may be required to determine which allergens may be important. Special diets and careful challenges with suspected foods usually will detect food allergies.

Other laboratory studies, including pulmonary function studies, may be requested by your physician. Pulmonary function studies are performed to determine the severity and reversibility of your child's airway obstruction.

After the evaluation, your physician will outline those factors that are important in your child's asthma and prescribe an individual treatment program.


WHAT IS THE TREATMENT PROGRAM?

Treatment includes:

Avoidance of Trigger Factors

Asthma Medications

Allergy Injections When Indicated

Team Approach/Patient Education

1. Avoidance

Avoiding trigger factors can make a great difference in your child's condition. If your child could avoid exposure to all of his or her allergies (such as house dust, molds, pets, etc), he or she might still have asthma; however, the severity would be lessened.

Trigger factors, such as viral respiratory infection and running, could still provoke asthma symptoms. Whenever possible, your child should avoid such trigger factors as cigarette smoke and other inhaled irritants.


2. Medications

Medications that control asthma are available. The amount, frequency and duration of medications depend on your child's asthma.

Some children only have asthma episodes a few times a year associated with colds, while others have episodes daily during spring and fall when there is increased exposure to outdoor allergens.

Some children wheeze only with exercise, while others wheeze daily for no apparent reason. Several different approaches might have to be tried before the proper medication program is achieved (see the "
Asthma Medication Groups For Kids" section).

Fortunately there are many excellent medications with few side effects. Asthma can usually be controlled with safe effective medications.

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3. Allergy Injections

Scientists still do not agree on whether allergy shots are useful in asthma. Hyposensitization, allergy shots, immunotherapy or desensitization are synonyms for injection treatments which reduce sensitivity to those unavoidable allergens.

Small quantities of proven allergens are given in gradually increasing dosage until the child is able to better tolerate his or her allergies. This form of therapy has been shown to decrease the allergy antibody level and to increase the protective or blocking antibody level.

Usually a one-year series of allergy injections is prescribed to determine their effectiveness. Hyposensitization is not always recommended.

If proven effective, injections are then continued on a schedule determined by your physician. Allergy injections are no substitute for avoidance of allergens or medication. You must continue allergen avoidance measures even when your child's asthma is controlled or the problem may again worsen.

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4. Team Approach/Patient Education

Emphasis is now placed on improved patient/parent education and goal setting. Physicians and nursing staff are spending more time teaching patients about the subtleties of asthma management. Major emphasis is placed on peak flow monitoring as a guide to treatment and a way to better understand the dynamics of asthma.

Peak flow monitors are inexpensive devices which measure the peak air flow and thus reflect the degree of airway obstruction. Sometimes patients are unaware that they are gradually getting worse.

By recording the peak flow two or three times daily, the patient and doctor can better determine the need to increase or decrease medication.

When the peak flow fluctuates a great deal, this indicates poor control and need for adjustment of medication. When the peak flow drops and responds poorly to inhaled bronchodilator medication, additional treatment is needed. This should be done by the patient only when a course which has been determined by the physician is to be followed, otherwise the physician must be consulted.

Frequently, three or four visits are required just to teach these fundamental principles. This may be done in a group setting or with a nurse who specializes in asthma care. Through this process the patient and/or parents are empowered to control asthma during most situations.

With improved asthma management, emergency room visits are much rarer because children and their parents stay ahead of problems. Parents learn when to call their physician, day or night, which can prevent many hospital visits.

There are many other aspects of asthma management that should be taught to the child and parents to better prepare them to deal with asthma directly and efficiently. By better understanding their treatment program, they can comply much better and this is a major step toward asthma control.

The physician, nurse, child and parents should set specific goals and follow up on these each visit. With this type of team approach, asthma usually comes under excellent control so that sleep and activities are rarely interrupted by asthma. Most children with asthma can fully participate in sports and not be bothered by unwanted medication side effects.



WHY DOES ASTHMA TREATMENT FAIL?

If the parents or caregivers do not understand the problem, they surely cannot carry out the treatment program. It is your responsibility to read and reread the materials provided by your physician.

Allergy management is often important for the continued control of asthma. Frequently, parents forget about allergy avoidance measures when the asthma is controlled with medication or allergy injections.

You might buy a new pet or furniture to which your child is or becomes allergic. You might forget about house dust and mold control in the home. Continuation of avoidance measures is crucial for good control in the allergic child with asthma.

Poor compliance with other treatment measures (routine medicines, allergy injections, follow-up visits) also leads to uncontrolled asthma.

1.) Some studies demonstrate that only 50% or less of patients take their inhaled corticosteroid as prescribed.

2.) Inhaled corticosteroids control airway inflammation very effectively, but take weeks to be maximally effective. For many reasons parents and their children perceive that the medication "doesn't do anything." They prefer the "quick relief" they get from their bronchodilator inhaler. They need to learn that the inhaled corticosteroid medication is safe and will work, but they need to use it daily as prescribed by the doctor.

Although seldom fatal, deaths from asthma do occur. Inner city children with asthma, especially African-Americans, have a three to five times greater asthma mortality rate. Many cases of fatal asthma appear to be related to under-medication. Many of these deaths are probably avoidable.

Also, research into asthma fatalities indicates that children with recurrent, acute, severe asthma episodes and those with major psychological problems, especially depression, are at increased risk of death from asthma. This should be discussed with your physician.

Do not hesitate to ask questions about anything that is not completely clear. It is important that you fully understand your child's condition and its management.

Your child should be taught about his/her asthma treatment program. Older children should be responsible for their own treatment program as much as possible. They should recognize and learn to avoid their triggers, and know about their medication, its use and how to administer it.

Working together with your child and your doctor can help to insure the effectiveness of asthma treatment.


CONCLUDING COMMENTS

Frustration and despair will accompany the many problems of the chronically ill child. Always try to avoid the negative aspects and remember that the majority of children will improve as they grow older.

Take a positive approach to your problem, for learning asthma control can be a stepping-stone for your child's personal development. Your child will gain confidence as he or she learns to control the asthma.

Qualities such as self-discipline and personal responsibility are frequently learned through struggles with any chronic illness.

Encourage physical activity within your child's limits. Fortunately, the vast majority of children with asthma can participate in most activities, including track, basketball and soccer. The very few children with extremely severe asthma may wish to participate in an activity such as swimming, which is the least likely to provoke asthma symptoms.

Other activities which do not involve prolonged running will also be tolerated better. Encouragement and praise in these activities will kindle an inner desire for personal development in these and other activities.

REMEMBER:

Maintaining control is the key. When your child's asthma is controlled, you will seldom notice asthma symptoms. Don't be satisfied until your child's asthma is controlled, thus allowing full physical, mental and emotional development.

ABOUT CHILDHOOD ASTHMA

Asthma is one of the most common chronic diseases of childhood.

In 2004, an estimated 4 million children under 18 years old have had an asthma attack in the past 12 months, and many others have "hidden" or undiagnosed asthma.1 Asthma is the most common cause of school absenteeism due to chronic disease and accounted for an estimated 14 million lost school days.2

Even though asthma cannot be cured, it can almost always be controlled. For this reason, the American Lung Association has chosen control of childhood asthma as one of its top priorities.

The better you and your child understand asthma and its treatment, the better you will be able to control it.

HOW DO NORMAL LUNGS FUNCTION?

Lungs allow oxygen to enter the body in exchange for its waste product, carbon dioxide. As the air passes through the nose and mouth, it is rapidly warmed and moistened to avoid injury to the delicate lining of the airways.

The nose and airways also trap large particles (dust, pollen, molds, bacteria) and chemicals (smoke, sprays, odors), which could cause serious injury to the lungs.

The air is then transported through smaller airways. These airways branch like a tree, so that millions of small airways can carry oxygen to the tiny air sacs called alveoli.

The airways have a delicate cellular lining (mucosa), which is coated with a thin layer of mucus, as is present in the nose. Foreign particles are trapped by the sticky mucus and eventually removed from the airways through the normal cleansing process.

The process is assisted by the movement of tiny "whip-like" structures called cilia which move the mucus and trapped foreign particles up toward the mouth and nose where they are coughed and sneezed out or swallowed.

Bundles of muscles surround the airways, and the contraction of these muscles allows airways to selectively direct the flow of air.

WHAT IS ASTHMA?

Asthma is an inflammatory condition of the bronchial airways. This inflammation causes the normal function of the airways to become excessive and over-reactive, thus producing increased mucus, mucosal swelling and muscle contraction.

These changes produce airway obstruction, chest tightness, coughing and wheezing. If severe this can cause severe shortness of breath and low blood oxygen.

Each individual suffers a different level of severity. Virtually, all children with asthma, however, do enjoy a reversal of symptoms until something triggers the next episode.

WHAT IS THE CAUSE OF ASTHMA?


Inflammation of the airways is the common finding in all asthma patients. Recent studies indicate that this inflammation is virtually always causative in the asthmatic condition. This inflammation is produced by allergy, viral respiratory infections, and airborne irritants among others.

Childhood asthma is a disorder with genetic predispositions and a strong allergic component. Approximately 75 to 80 percent of children with asthma have significant allergies.3

Studies indicate that allergic reactions produce both immediate and late phase (delayed) reactions. Research indicates that approximately half of the immediate allergic reactions to inhaled allergens are followed by a late phase reaction.

This late phase reaction produces more serious injury and airway inflammation. This airway inflammation leads to irritability or hyperresponsiveness of the airways. In addition, prolonged airway inflammation can cause scarring.

WHAT ARE THE SIGNS AND SYMPTOMS?

Wheezing, though characteristic of asthma, is not the most common symptom. Coughing is noted especially with even "hidden" asthma when wheezing may not be apparent to the patient, his or her family or the physician.

Any child who has frequent coughing or respiratory infections (pneumonia or bronchitis) should be evaluated for asthma.

The child who coughs after running or crying may have asthma. Recurrent night cough is common, as asthma is often worse at night.

Infants who have asthma often have a rattly cough, rapid breathing and may have an excessive number of "pneumonias," episodes of bronchitis or "chest colds." Obvious wheezing episodes might not be noted until after 18 to 24 months of age.4

Chest tightness and shortness of breath are other symptoms of asthma that may occur alone or in combination with any of the above symptoms. Since these symptoms can occur for reasons other than asthma, other respiratory diseases must always be considered.

In a young child the discomfort of chest tightness may lead to unexplained irritability.

Remember: Any child who has frequent coughing or respiratory infections (pneumonia or bronchitis) should be evaluated for asthma.

WHAT ABOUT HIDDEN ASTHMA?

Until rapid breathing, wheezing and coughing become obvious, the condition of many children with asthma will go undetected. These children with asthma usually suffer some degree of airway obstruction; and unless it is brought under control, the children may suffer respiratory illness more frequently than necessary.

Hidden asthma, however, can produce so few recognizable symptoms that even the physician might not be able to distinguish abnormal breath sounds with his or her stethoscope but it may cause subtle problems such as limitation of physical activity. Pulmonary function testing usually reveals these cases of airway obstruction.

WHAT USUALLY TRIGGERS ASTHMA?

Episodes of asthma often are triggered by some condition or stimulus. Common triggers of asthma are:

Exercise

Running can trigger an episode in over 80 percent of children with asthma. Bronchodilator medications used before exercise can prevent most of these episodes. With proper control of asthma, most children with asthma can participate fully in physical activities.

There might be exceptions, such as prolonged running, especially during cold weather, allergy season or illness from a "cold." Swimming seems to be the least asthma-provoking form of exercise. However recently there has been concern about excessively chlorinated pools precipitating asthma episodes.

Infections

Respiratory infections, including the flu, frequently trigger severe episodes of asthma. Research indicates that these infections are most frequently produced by viruses, rather than bacteria. Antibiotics are of no benefit for viral infections and thus may be of little value in an asthma episode. It is important for all children with asthma to get vaccinated for the flu each year. American Lung Association Research has shown that the vaccination itself will not precipitate an attack.

Bronchodilator medication, good hydration, and when indicated, corticosteroids are required to control an asthma episode triggered by viral infections. Therefore, a parent should not be surprised if the physician does not prescribe an antibiotic when a child is having a respiratory infection and asthma. On the other hand, the doctor may decide to use an antibiotic if he or she suspects bacterial infection, such as sinusitis or bronchitis.

Note: Chronic sinusitis in childhood due to bacteria can be a very stubborn chronic trigger for asthma. Treatment for 10 days with antibiotics may not be effective. In these children, sinus x-rays are frequently required to diagnose the underlying condition.

Antibiotic treatment for 3 to 4 weeks or longer may be required to completely eradicate these infections. Asthma may also be triggered by an ear infection or bronchitis which would also require antibiotic therapy.

Allergy

Asthma symptoms of many children with asthma are triggered by allergies. Allergic children suffer reactions to ordinarily harmless material (pollen, mold, food, animals).

During an allergic reaction, chemicals such as histamine are released from specialized cells. This may produce swelling of the lining of the airway, excessive mucus secretion and muscle contraction in the airways. In this way, an allergy can provoke an asthma episode.

The allergens involved are common indoor inhalants (dust mites, feathers, molds, pets, insects (especially roaches), outdoor inhalants (molds and pollens), or ingested foods (milk, soy, egg, etc.). Foods are much less frequent causes of asthma. These allergens may produce low-grade reactions which are of no obvious consequence: however, daily exposure to these allergens may result in a gradual worsening of asthma.

Allergy may be the cause of unrecognized or hidden asthma. Minor allergic reactions can be more important than more obvious or severe reactions, in that an allergic person tends to avoid exposure to allergens that have caused severe reactions, while ignoring the minor allergens.

For instance, if your child is highly allergic to cats and develops severe wheezing when he or she is around them, you'll probably avoid cats at all costs. But what about your dog that sleeps with your child and doesn't cause obvious wheezing? This could be an important factor. If so, skin testing usually will reveal any reaction the child has to the dog. The child would then do better with both the cat and dog removed from his or her environment.

Irritants

Cigarette smoke, air pollution, strong odors, aerosol sprays and paint fumes are some of the substances which irritate the tissues of the lungs and upper airways. The reaction (cough, wheeze, phlegm, runny nose, watery eyes) produced by these irritants can be identical to those produced by allergens.

Cigarette smoke is a good example, because it is highly irritating and can trigger asthma. Most people are not allergic to cigarette smoke; that is, there is no known immunologic reaction. Nevertheless, this irritant can be more significant than any allergen.

Secondhand smoke can cause serious harm to children. An estimated 400,000 to one million asthmatic children have their condition worsened by exposure to secondhand smoke.5

Irritants must be recognized and avoided. Cigarette smoking certainly should be avoided in the home of any child with asthma. It has been shown that when the parents of a child with asthma stop smoking, the child's asthma often improves.

Weather

Children with asthma have cited a number of climatic conditions as trigger factors. Many identify cold air as triggering asthma. Pulmonary function studies demonstrate that breathing cold air provokes asthma in most children with asthma.

Precautions may be necessary to avoid inhalation of cold air, such as wearing a special ski mask designed for this purpose. A heavy scarf, worn loosely over the nose and mouth, will also help avoid cold air induced asthma.

The weather affects outdoor inhalant allergens (pollens and molds). On a windy day more allergens will be scattered in the air, while a heavy rainfall will wash the air clean of allergens. On the other hand, a light rain might wash out pollen, but actually increase mold concentration.

There does not seem to be one best climate for all children with asthma, and moving to a new area to reduce asthma severity often is met with disappointment in the long run, even after initial improvement.

Emotions

A common misbelief is that children with asthma have a major psychological problem that's caused the asthma. Emotional factors are not the cause of asthma; however,emotional stress can infrequently trigger asthma.

A child's asthma might only be noticeable after crying, laughing or yelling in response to an emotional situation. These normal "emotional" responses involve deep rapid breathing which in turn can trigger asthma, as it does after running.

Emotional stress itself (anxiety, frustration, anger) also can trigger asthma, but the asthmatic condition precedes the emotional stress. Therefore, a child's asthma is not "in his or her head," as many people believe.

Emotions are associated with asthma for another reason. Many children with asthma suffer from severe anxiety during an episode as a result of suffocation produced by asthma. The anxiety and panic can then produce rapid breathing or hyperventilation, which further triggers the asthma.

During an episode, anxiety and panic should be controlled as much as possible. The parent should remain calm, encourage the child to relax and breathe easily and give appropriate medications.

Treatment should be aimed at controlling the asthma. When asthma is controlled, emotional stress will be reduced and other emotional factors can then be dealt with more effectively. Any chronic illness, especially if uncontrolled, can have associated secondary psychological problems. More severe psychological problems require a specialist to help the child and his or her family.

REMEMBER

Asthma is...

  1. An inflammatory condition of the airways caused by allergens, irritants and respiratory infections.
  2. Triggered by many different stimuli (trigger factors) that activate an over-reactive airway system.

Is reversible and controllable (with only a few rare exceptions.)

Tuesday, April 10, 2007

A C A : Antibodi Antikardiolipid

Keguguran berulang dengan tanpa sebab yang jelas bisa jadi karena antibodi antikardiolipid (ACA). Antibodi itu juga bisa menyebabkan stroke dan infark jantung pada usia muda. Demikian diungkapkan pakar hemostasis dan trombosis Prof Dr dr Karmel L Tambunan SpPD KHOM dari Bagian Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia (FKUI) dalam jumpa pers menjelang Kongres Nasional Perhimpunan Hematologi dan Transfusi Darah Indonesia (PHTDI) IX, Selasa (4/9), di Jakarta.

Kongres itu, menurut Ketua PHTDI dr Zubairi Djoerban SpPD KHOM, akan diselenggarakan tanggal 7-9 September 2001 di Semarang. Selain diikuti anggota PHTDI dari seluruh Indonesia, juga akan dihadiri para ahli dari Kanada, Australia, Selandia Baru, Inggris, Belanda, Perancis, Thailand, dan Singapura.

Pembicara lain dalam jumpa pers adalah Prof Dr dr A Harryanto Reksodiputro SpPD KHOM, dr Djumhana Atmakusuma SpPD KHOM, dan Kepala Unit Transfusi Darah Palang Merah Indonesia dr Auda Aziz.

"Antibodi antikardiolipid mendorong terjadinya trombosis atau pembekuan darah dalam pembuluh darah. Jika terjadi di plasenta, bekuan darah akan mengganggu pasokan zat gizi dan oksigen bagi janin sehingga terjadi keguguran pada usia kehamilan tiga atau empat bulan. Jika tidak keguguran, biasanya janin tidak berkembang atau meninggal dalam kandungan," urai Tambunan.

Dalam tiga tahun belakangan ini, lebih dari 240 pasien yang mengalami keguguran berulang, ada yang empat kali keguguran, dirujuk. Setelah diobati, 95 persen membaik dan bisa mempunyai anak.

"Stroke" dan "infark" jantung

Sindrom antifosfolipid yang diakibatkan ACA ini jika terjadi di vena akan menyebabkan emboli pada paru, di arteri jantung menyebabkan infark jantung, di otak menyebabkan stroke, di pembuluh darah mata menyebabkan buta, dan di pembuluh telinga menyebabkan tuli.

Kasus yang ditemui Tambunan antara lain, pemuda berusia 18 tahun mengalami infark jantung dan wanita berusia 22 tahun mengalami stroke. "Jadi infark jantung dan stroke bukan lagi monopoli orang lanjut usia," kata Tambunan.

Selain itu, bentuk sindrom antifosfolipid adalah migrain yang tak kunjung sembuh. Setelah diobati dengan antikoagulan atau antipembekuan darah, ternyata migrain sembuh.

Penyebab sindrom ini ada dua, primer -yaitu genetik- serta sekunder akibat infeksi virus termasuk toksoplasmosis, infeksi bakteri, atau disebabkan obat-obatan. Jika penyebabnya faktor genetik, obat harus diminum seumur hidup.

Selama ini faktor risiko trombosis yang umum diketahui adalah kadar kolesterol tinggi, diabetes, asap rokok, homosisteinemia, serta tingginya faktor pembekuan darah dalam tubuh.

Faktor-faktor itu merangsang proses pembekuan darah berlebihan jika terjadi perlukaan pada dinding pembuluh darah. Trombus atau gumpalan darah yang menempel di dinding pembuluh darah bisa terlepas dan menyumbat pembuluh darah. Jika tak segera diobati, bisa menyebabkan kematian.

"Perokok, termasuk perokok pasif, berisiko lima sampai sepuluh kali mengalami trombosis dibanding bukan perokok. Oleh karena itu, di negara maju merokok dilarang di tempat umum," ujar Tambunan.

sumber : kompas

Tuesday, April 3, 2007

Early Warning Signals

You and your child can become experts in spotting the early signals of Asthma. Maybe you're experts already! As one alert parent said to her child: "Asthma may not be a friend, but if it's an enemy, at least it isn't sneaky. It always gives a warning."

Every child with asthma has a built-in early warning system that signals when symptoms are on the way. Those signals can be seen, heard, and felt. Every child has his or own pattern of signals. But parents and children can make keen observation a habit and learn how to recognize those patterns -- the body's messages to get going and head off those symptoms before they get bad.

WHAT TO LOOK FOR:

  • Anxious or scared look
  • Cough, especially at night
  • Unusual paleness or sweating
  • Flared nostrils when the child tries to get some air
  • Pursed lips breathing
  • Fast breathing
  • Vomiting
  • Hunched-over body posture; the child can't stand or sit straight and can't relax
  • Restlessness during sleep
  • Fatigue that isn't related to working or playing hard
  • The notch just above the child's Adam's apple;when some children are having an asthma episode, this notch sinks in as they breathe in
  • Spaces between the ribs; these areas may sink in when the child breathes in

WHAT TO LISTEN FOR:

  • Coughing when the child has no cold
  • Clearing of the throat a lot
  • Irregular Breathing
  • Wheezing, however light
  • Noisy, difficult breathing

HOW TO LISTEN:

  • Put your ear to the child's back and your hand on his or her chest. You'll feel the chest go up as the child inhales, drawing in air, and you'll feel the chest go down as the child exhales, releasing air.
  • Listen for squeaking or any unusual noises. They may mean asthma, bronchitis, or a chest infection. Only a doctor can tell for sure. So regard any noisy breathing as a signal that help may be necessary.
  • Note: If the child is having symptoms and there are no chest sounds, it's a sign of a bad, fixed chest that requires medical attention. Call your doctor immediately.

WHAT TO DO IMMEDIATELY:

  • Reassure the child by your tone of voice, your attitude of being able to manage and your confidence. All these qualities are catching. Your child will take cues from you and relax.
  • If the doctor has recommended a medicine when signals appear, use it. (Don't give the child a special dose unless the doctor said to.)
  • Encourage normal fluid intake. Excessive fluid intake may be counter productive.

ADDITIONAL STEPS TO TAKE:

  • Help your child relax
  • If you can find out what triggered the symptoms, remove it -- or the child from the area
  • Your experience and judgement can help you decide what further measures to take in addition to calling the doctor.

FIVE EMERGENCY SIGNS

Having any one of these signs means medical care is needed. Call your doctor or get emergency medical care if your child exhibits any of these signs.

Wheeze, cough, or shortness of breath gets worse, even after the medicine has been given time to work. Most inhaled bronchodilator medications produce an effect within 5 to 10 minutes. Discuss the time your medicines take to work with your child's doctor.

Child has a hard time breathing. Signs of this are:

  • Chest and neck are pulled or sucked in with each breath.
  • Struggling to breathe.
  • Child has trouble walking or talking, stops playing and cannot start again.
  • Peak flow rate gets lower, or does not improve after treatment with bronchodilators, or drops to 50 percent or less of your child's personal best. Discuss this peak flow level with your child's doctor.

Lips or fingernails are gray or blue. If this happens, GO TO THE DOCTOR OR EMERGENCY ROOM RIGHT AWAY!