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Move your thumb or fingertips very gently across the grain of the muscle generic 25 mg aromasin mastercard, perpendicular to buy discount aromasin 25 mg online the fibers discount 25 mg aromasin, all along its course cheap aromasin 25mg free shipping. Intersperse your gentle frictions with effleurages every 20 to 30 seconds to drain the area. Be aware that if you friction over the muscle spindle too vig orously or with too much pressure, it will stretch the muscle spin dle and cause the muscle to react by contracting (this feature is used to strengthen weak muscles; see neuromuscular technique, page 106). Follow up with thorough drainage (wringings, effleurages) to bring in new blood, nutrients, and oxygen and to remove toxins from the site. The horse should be lightly exercised for 5 to 10 minutes (longeing, walk/trot) immediately after the treatment. When the horse is warm, use stretching exercises to further the release of the affected muscle groups (see chapter 8). If you do not see any improvement after working on a stress point for 3 to 5 minutes, stop. Especially in chronic tension cases, it sometimes takes several treatments to relieve a stress point. After all, these kinds of stress points have been there for a while; it may take up to five treatments to bid them adieu! If inflammation is present, use hydrotherapy after your treatment to cool the nerve 114 Equine Massage endings and elicit vasodilation. If underworked, a stress point will still present the same symptoms with little or no improvement. Overworking a stress point is more dramatic, resulting in stronger inflammation (heat, swelling, pain). The Origin-Insertion Technique the origin-insertion technique, which is derived from the neuro muscular technique, is applied on both tendons and will assist in releasing muscle contractures (hypertonicity) and muscle spasms, or when dealing with muscle weakness (hypotonicity). The term “origin-insertion” refers to the origin and the inser tion tendons of a muscle. The origin tendon anchors to the most stable, least movable bone, whereas the insertion tendon attaches the muscle to the movable part, so that during contraction the insertion is brought closer to the origin. The origin tendon is usu ally stronger and bigger than the insertion tendon because its anchor attachment sustains greater stress. It is a hypertonic state in which muscle fibers cannot let go of their contractile power. Due to high stress, pain, and inflamma tion, many motor nerve impulses cause the muscle fibers to con tract indefinitely. Contractures are responsible for the decrease of muscle action, which results in congestion (lack of fluid circulation in the muscle fibers) and in a restricted movement (shorter stride). By thoroughly massaging the origin and insertion tendons, we stretch the sensory nerve endings, which send relaxation impulses to the brain. In response, the corresponding motor nerve signal causing the muscle to remain contracted will cease, releasing the spasm. This release might occur quickly, depending on the stress level, the severity of the spasm, and whether the spasm is associ ated with a trauma or a wound. Your knowledge of the muscle group you are working on, where muscles attach and their direction, is most important to the effectiveness of the treatment. After you locate the problem and ascertain which muscle you need to work, start by lightly stroking the area to soothe and com fort the horse. Then use light effleurages, wringings, and knead ings to stimulate circulation and warm up the area. To release a spasm or a contracture, begin by using a gentle but firm double-thumb kneading over the origin tendon, pressing it against the bone (away from the belly of the muscle). Apply pres sure at approximately 5 to 10 pounds (15 to 20 on large muscle groups) for approximately 2 or 3 minutes. Depending on the severity and degree of inflammation present in the tissue, the origin-insertion technique should not continue more than 10 minutes. It is better to repeat the treatment several times over a few days than risk irritating the nerve endings or worsening the inflammation in the muscle fibers on the first treatment. In most acute stages, the contracture or spasm will release shortly after the first treatment—within 30 minutes or a couple of 116 Equine Massage hours. If the contracture is in a chronic stage, it might take several treatments to produce a positive result. In the case of a torn muscle, the origin-insertion technique is contraindicated in the acute stage. When using this origin-insertion technique to strengthen a healthy muscle, you must reverse the direction of your pressure by pressing over the tendon area (see neuromuscular technique, page 106) toward the belly of the muscle. In this case you may apply the technique for about 5 to 10 minutes at a time, proportional to the muscle size. Repeating the treatment several times over a few days will show tremendous improvements. The vasoconstriction followed by the vasodilation reaction will flush the toxins from the muscle and provide new nutrients and oxygen. The origin-insertion technique is used a lot in maintenance and preventative massages to stimulate and strengthen weak mus cles. The technique also reduces hypertonic muscles and fine tunes muscle groups under constant stress. It gives you the proper approach for warming-up and for draining any area you wish to work on. Then follow with two to three effleurage passes (2 to 3 pounds of pressure) to thoroughly cover the entire area draining towards the heart. Now apply gentle wringing (2 passes back and forth, using 3 pounds of pressure) over the whole area.

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At the same time discount aromasin 25 mg amex, determine the time frame of the applications; for example order aromasin 25mg fast delivery, the treatment of chronic tension should require a 45-minute massage session plus 15 minutes of hydrotherapy (one half before and one half after massage) once a day generic aromasin 25mg overnight delivery, every day for 5 days effective 25mg aromasin. Give such details as the pressure to use, the type and fre quency of hydrotherapy to apply, and the type of stretching exer cises. Maintenance For this section, you determine the maintenance program in con junction with the recovery process. For example, it might require light exercising such as walking or longeing, circles, figure eights, sand pit work, and so on. Keeping Records 321 Updates Systematically update your case history by recording the details of each treatment you give to the horse. Note the evolution of the condition, what you did during each treatment, the reaction of the animal, and your prognosis for further treatments and recom mended exercises. A case history will serve as a guide for further therapy and also as a record which may be of use in the future. Once you are comfortable with learning how to recognize and describe abnormalities, the time to perform the complete examina tion and the taking of notes will be greatly reduced. Maintaining good clinical records of treatment will make it possi ble for you to accurately discuss problems with veterinarians or other equine therapists. Always consider the recommendations of the veterinarian when determining the course of treatment. A good case history will show your professionalism and will greatly contribute to your success. We encourage you to review this educational mate rial with your health care professional as this information should not replace the recommendations and advice of your doctor. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization’s resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product. If you or someone you know has just been diagnosed with Crohn’s disease or ulcerative colitis, you may feel a bit overwhelmed by the news. But now that you have, or even if you have been living with infam matory bowel diseases for quite a while, you will want to learn as much as possible about them—including which medications can help control the diseases. The ongoing infammation leads to symptoms that may already be familiar to you: abdominal pain, cramping, diarrhea, rectal bleeding, and fatigue. Although Crohn’s disease and ulcerative colitis share a lot of symptoms, they do have some marked diferences. Another distinguishing feature of ulcerative colitis is that it starts in the rectum and extends from there in a contin uous area of infammation. These dif ferences are important for deciding whether infammation of the intestinal tract is from Crohn’s disease or ulcerative colitis. In 10 per cent of cases there are overlapping features 2 of both ulcerative colitis and Crohn’s disease, a condition called indeterminate colitis. While multi ple contributing factors have been found, the exact cause of these diseases is unknown and currently there are no cures for Crohn’s disease and ulcerative colitis. This makes the role of the Crohn’s & Colitis Foundation in supporting research so critical. The Foundation has pio neered the research of these difcult to under stand digestive diseases for over a half-century. When considering medication options, it is im portant to work together with your provider to make the best choice of treatment that aligns with your personal goals and preferences. Please keep in mind the following: •Symptoms of these long-term diseases may range from mild to severe and may include, but are not limited to, diarrhea, abdominal cramping, nausea, pain, rectal bleeding, and fever. Remission occurs when symptoms either dis appear completely or lessen considerably and good health returns. Doctors will customize treat ment to the individual’s needs based on the type and severity of symptoms. Medications may be given in diferent dosages, formula tions, and for diferent lengths of time. Topical therapies are administered rectally, as suppositories, enemas, creams, and ointments. What works at one point during the disease may not be efective during another stage. It is important for the patient and doctor to thoroughly discuss which course of therapy is best, balancing the bene fts and risks of each treatment option. During these discussions, patients should feel comfortable asking their doctor about other available treatment options. Even so, these important prescription medications may not eliminate all of your symptoms. Naturally, you may want to take over-the-counter medications in an efort to feel better. Before doing so, speak with your doctor, as sometimes these symptoms may indicate a worsening of the infammation that may require a change in your prescription. Other times these symptoms do not refect a worsening of the condition and can be treated with over-the-counter medications. For exam ple, your doctor may recommend loperamide (Imodium) to relieve diarrhea, or anti-gas products for bloating. Prescription Medications Some medications used to treat Crohn’s dis ease and ulcerative colitis have been around for years. These medications work by inhibiting certain pathways that produce substances that cause infamma tion. They work best in the colon and are not particularly efective if the disease is limited to the small intestine.

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Daily care of your horse can speed up the recovery by 40 per cent aromasin 25mg without a prescription, a considerable benefit that not only helps your animal feel better aromasin 25 mg with mastercard, but also gets him back to aromasin 25 mg generic work faster buy 25mg aromasin with amex. Your devoted atten tion in that particular time of pain will strengthen your bond. If your palpation over the horse’s back has shown some abnor mality in the alignment of the spinous and transverse processes of the vertebrae, or of the ribs, consult an equine chiropractor. Realigning the spine will greatly contribute to the overall recov ery from a cold back. Warning When the back muscle inflammation can be traced to an ill-fitted saddle over the withers, be aware that it can cause the tissues to become bruised. This is serious as there is a contusion, meaning a 304 Equine Massage trauma to the blood vessels of the skin and/or muscles attaching onto the withers, with extravasation (leaking) of blood into the tissues. It is characterized by some swelling, heat, and pain, in vary ing degrees of severity proportional to the damage. However, cold hydrotherapy (ice cup massage technique, ice packs, or cold clay poultices; see chapter 4) is a very efficient way to reduce swelling and inflammation and permit blood clotting. More rarely, an ill-fitted saddle over the withers can cause an inflammation of the bursa located on top of the backbone in the region of the withers. If untreated, this condition may develop into a more serious condition known as fistulous withers (swelling or abscesses at the withers). Otherwise, first apply cold packs or use the ice cup massage technique to relieve the inflammation symptoms (see chapter 4). When in the subacute or chronic phase, follow with the massage swelling technique (see chapter 5) and lots of drainage to clear the excess fluid. Understanding the importance of a good saddle helps you to take better action in the prevention of, or clearing of, a sore back condi tion. Some types of conformation are structurally bet ter suited to perform in certain disciplines, and some breeds are better suited as well. For example, the breeds listed below excel in specific sports or disciplines: Appaloosas and Paints: endurance, eventing, western per formance Arabians: show under saddle, endurance Ponies: hunter, jumper, driving, mounted games Quarter Horses: western performance, hunter, jumper, racing Saddlebreds: show under saddle, driving Thoroughbreds: dressage, hunter, jumper, eventing, racing Warmbloods: dressage, hunter, jumper, eventing Each discipline or sport demands the best of the horse’s physi cal capabilities, and of course, some classes demand more than others. The competitive nature of horse sports makes it necessary for the animal to use his entire body at once. Specific activities definitely trigger the development of particular stress sites, particularly when the horse’s conformation is not ideal for the work undertaken. For example, a longer-backed horse may be prone to develop more stress points than a shorter-backed horse. Similarly, a horse with a long cannon bone will tend to be more prone to tendon and ligament problems than a horse with a shorter cannon bone and proportionally shorter tendons and lig aments. Hydrotherapy: Apply cold before and after treatment if acute inflammation is present. Massage: Use the stress point check-up routine to evaluate any potential stress points, and the stress point technique (see chapters 10 and 5, respectively) to treat and thoroughly drain them. Apply any specific massage technique or routine you judge nec essary (see chapters 5 and 6). In the case of exhaustion, use the recuperation routine to remove lactic acid buildup. Always start with a light pressure and pay attention to your horse’s feedback signs. Frequently drain the area with lots of effleurages (every 20 or 30 seconds) and always finish with soothing strokings. Stretching: Stretching exercises (see chapter 8) should be used as appropriate to assist the relaxation of the muscle groups. The typical activities and disciplines described below will give you an idea of the nature of the stress encountered by a horse tak ing part in them. Since all muscles work simultaneously to pro duce smooth and coordinated action, you will rarely find just one stress point. Most likely, you will find several points in various parts of the body due to compensation. School Horses School horses can be any breed; they are usually calm and reliable with strong endurance qualities. Often they are older horses with lots of character and plenty of miles on their legs! School horses spend hours each day moving in circles at all gaits (mostly walk/trot) with fairly inexperienced riders on their backs. New riders tend to ride with a heavy hand, which may cause the horse to become tense in the neck. Until beginner riders learn to bal ance on a moving horse, they tend to bounce around in the sad dle, causing tenderness and perhaps inflammation in the horse’s back muscles. Areas of Stress Specific to Each Discipline 307 Problem Areas: Due to the nature of their activity, school horses will most often show neck and back problems in response to stress caused by inexperienced riders. The muscles along the spine (ilio costalis dorsi and longissimus dorsi) show tension, stress points and, occasionally, inflammation. Shoulder and hindquarter stress points need to be checked when the horse is involved in jumping or is frequently used for lessons. Often you will find that older school horses show arthritic pain; gentle massage around the arthritic joint will help them feel better. Pleasure Horses Because pleasure horses are ridden by several members of a fam ily, they will experience problems similar to those faced by school horses. Sometimes an irregular schedule can cause extra stress: for example, little riding in winter, a lot of riding in spring, little training during the week, a lot of exercise on the weekend. Since family members are often involved in a variety of activities, a pleasure horse may be expected to participate in jumping or west ern performance. Even though pleasure horses are versatile, they will develop areas of tenderness as a result of the demands made on them dur ing “fair weather” months, or as a consequence of irregular train ing schedules and the number of people riding them.

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You do not have to buy 25 mg aromasin amex do everything on your own: environmental hygiene is a matter of teamwork order 25mg aromasin with mastercard. To address specifc gaps in children’s knowledge and practice sustainably buy discount aromasin 25 mg on-line, you could arrange joint meetings with teachers and parents cheap 25 mg aromasin mastercard, or their representatives, or send out formal communications. Contact between school and home will create a link between education at school and at home (34). Collect children’s and parents’ views and engage them in extracurricular activities to help to monitor and improve the facilities in schools. Community and user perceptions can provide more insight into on the accessibility of toilets and contribute to making maintenance effcient and sustainable over time (26, 34, 44). Routine cleaning record sheet See also the collection of practical tips for pupils in Annex 2. In particular, they are often limited in primary schools; this is an issue for the many girls who start menstruating before entering secondary school. In many countries, girls face challenges due to a lack of privacy, inadequate toilet doors or cubicles and shared toilets. An emerging issue is also lack of access to and affordability of menstrual hygiene products (49), with consequences for school attendance (50, 51). In the United Kingdom, for instance, one in seven girls surveyed had experienced diffculty with affording menstrual hygiene products and one in fve had changed to a less suitable product because of the cost (52, 53). Hygiene education, even where included in national education policies, is often not integrated into the school curriculum. If your country has no national programme for menstrual hygiene and puberty education, you can still include it in your school’s curriculum and in extracurricular activities to support the well-being of female pupils. Poor menstrual hygiene can lead to urinary or reproductive tract infections, as well as affecting the well-being of pupils (47, 54). Girls may avoid attending school during their period owing to fear of bullying and inadequate toilet facilities; in the case of menstrual pain, they may feel less able to concentrate (47, 55). Allowing girls to manage their period hygienically through provision of adequate menstrual hygiene facilities, including freely available menstrual hygiene products, is a key aspect of ensuring equity in school participation and equal learning opportunities. Avoiding used products being mixed in general trash bins ensures protection from infections that might be transmitted by blood. For example, if separate toilet areas are not available for boys and girls, reserve at least one toilet cubicle for girls. A small improvement can signifcantly increase feelings of safety and the overall experience of visiting the toilets. Menstrual hygiene management n How to address the sensitive topic of menstrual hygiene Ask girls about their perceptions of the situation at school – their experiences, problems and ideas; for example, through a dedicated meeting with student representatives or an anonymous survey. Summarize the results in key bullet points and include these in the agenda for a meeting with school staff and/or parents. Include girls’ ideas when planning improvements and try to implement easy actions, at minimum, quickly to make them feel heard. Ensure a friendly and open atmosphere, and value the girls’ sharing of experiences and opinions. Cultural and societal taboos about menstruation are not an argument against menstrual hygiene education but make it even more necessary. Educate boys and girls together and make menstruation something normal and fun with engaging activities. For example, let children discuss in groups what they know, ask them to brainstorm what they would associate menstruation with, organize a thematic drawing class or set up roleplays or other small-group work. Engaging with boys about menstruation allows them to understand an essential part of womanhood that should not be concealed or be a reason to tease classmates. Establish school rules that allow girls to have access to menstrual hygiene products and access to toilets when needed. Rules should make sure that girls have access to hygiene products and that they know how to access these and ensure that school schedules and class rules facilitate visiting toilets without discomfort. Assign a focal point from female staff members or an older girl pupil in your school, whose advice girls can ask on menstrual issues or issues with facilities, and whom they know they can trust. Learning intimacy from primary school age is important so that pupils can learn about their own bodies and respect those of others (36). Girls can start menstruating before secondary school and it is thus necessary to provide timely menstrual hygiene education, before they experience it, as well as basic provisions for consumables, menstrual hygiene products and adequate facilities at primary school. It is better to start with one step at a time, and to continue to build on improvements as resources are made available, than to rush to do everything with too few resources (10, 56). The school engaged with pupils to determine the best method to distribute the products and made the initiative the subject of assemblies for female pupils. Views were then obtained through questionnaires for staff, pupils and parents and two focus groups. The two groups engaged themselves further, calling themselves the “Period posse”, and later adopted Pedro the Panda as their mascot, becoming the “Panda posse”. Menstrual hygiene products were made available with other hygiene products in storage units in the toilets of changing rooms for physical education, in pupil support offces and in a named classrooms on each corridor. Stalls were held during lunch breaks in the run-up to the summer break reminding pupils to collect supplies for the “holiday period”, and travel packs were provided for school trips. In addition to pads and tampons, discreet paper bags and other items such as hair ties, cotton wool pads and tissues were provided, along with information booklets on periods. After implementation of the initiative, pupils reported feeling more comfortable talking about periods and felt that they had grown in confdence. The Panda posse has grown, involving more students and providing strong leadership opportunities for pupils. Finally, the Scottish Government committed to make sanitary products available free of charge in schools and succeeded in this aim.

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