Acute lymphocytic leukemia [ALL]

http://www.mayoclinic.com/health/acute-lymphocytic-leukemia/DS00558


by Mayo Clinic staff

Definition

Acute lymphocytic leukemia (ALL) is a type of cancer of the blood and bone marrow — the spongy tissue inside bones where blood cells are made.

The word "acute" in acute lymphocytic leukemia comes from the fact that the disease progresses rapidly and affects immature blood cells, rather than mature ones. The "lymphocytic" in acute lymphocytic leukemia refers to the white blood cells called lymphocytes, which ALL affects. Acute lymphocytic leukemia is also known as acute lymphoblastic leukemia and acute childhood leukemia.

Acute lymphocytic leukemia is the most common type of cancer in children, and treatments result in a good chance for a cure. Acute lymphocytic leukemia can also occur in adults, though the prognosis is not as optimistic.

Symptoms

Signs and symptoms of acute lymphocytic leukemia may include:

• Bleeding from the gums
• Fever
• Frequent infections
• Frequent or severe nosebleeds
• Lumps caused by swollen lymph nodes in and around the neck, underarm, stomach or groin
• Pale skin
• Shortness of breath
• Weakness, fatigue or a general decrease in energy

When to see a doctor
Make an appointment with your doctor or your child's doctor if you notice any persistent signs and symptoms that concern you. Many signs and symptoms of acute lymphocytic leukemia mimic those of the flu. However, flu signs and symptoms will eventually improve. If signs and symptoms don't improve as expected, make an appointment with your doctor.

Causes

Acute lymphocytic leukemia occurs when a bone marrow cell develops errors in its DNA. The errors tell the cell to continue growing and dividing, when a healthy cell would normally die. When this happens, blood cell production goes awry. The bone marrow produces immature cells that develop into leukemic white blood cells called lymphoblasts. These abnormal cells are unable to function properly, and they can build up and crowd out healthy cells.

It's not clear what causes the DNA mutations that can lead to acute lymphocytic leukemia. But doctors have found that most cases of acute lymphocytic leukemia aren't inherited.

Risk factors

Factors that may increase the risk of acute lymphocytic leukemia include:

• Previous cancer treatment.Children and adults who've had certain types of chemotherapy and radiation therapy for other kinds of cancer may have an increased risk of developing acute lymphocytic leukemia.
• Exposure to radiation. People exposed to very high levels of radiation, such as survivors of a nuclear reactor accident, have an increased risk of developing acute lymphocytic leukemia.
• Genetic disorders. Certain genetic disorders, such as Down syndrome, are associated with some increased risk of acute lymphocytic leukemia.
• Having a brother or sister with ALL. People who have a sibling, including a twin, with acute lymphocytic leukemia have an increased risk of ALL.

Preparing for your appointment

Make an appointment with your family doctor or a general practitioner if you or your child has signs and symptoms that worry you. If your doctor suspects acute lymphocytic leukemia, you'll likely be referred to a doctor who specializes in treating diseases and conditions of the blood and bone marrow (hematologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready, and what to expect from the doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
• Write down any symptoms you or your child is experiencing,including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes in your life or your child's life.
• Make a list of all medications, as well as any vitamins or supplements, that you or your child is taking.
• Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Time with the doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For acute lymphocytic leukemia, some basic questions to ask the doctor include:

• What is likely causing these symptoms?
• What are other possible causes for these symptoms?
• What kinds of tests are necessary?
• Is this condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• How can existing health conditions be best managed with ALL?
• Are there any restrictions that need to be followed?
• Is it necessary to see a specialist? What will that cost, and will my insurance cover it?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask the doctor, don't hesitate to ask questions during the appointment any time you don't understand something.

What to expect from the doctor
The doctor is likely to ask you a number of questions. Being ready to answer them may allow time to cover other points you want to address. Your doctor may ask:

• When did symptoms begin?
• Have these symptoms been continuous or occasional?
• How severe are these symptoms?
• What, if anything, seems to improve these symptoms?
• What, if anything, appears to worsen these symptoms?

What you can do in the meantime
Avoid activity that seems to worsen any signs and symptoms. For instance, if you or your child is feeling fatigued, allow for more rest. Determine which of the day's activities are most important, and focus on accomplishing those tasks.

Tests and diagnosis

Tests and procedures used to diagnose acute lymphocytic leukemia include:

• Blood tests. A blood test may reveal too many white blood cells, not enough red blood cells and not enough platelets. A blood test may also show the presence of blast cells - immature cells normally found in the bone marrow but not circulating in the blood.
• Bone marrow test. During bone marrow aspiration, a needle is used to remove a sample of bone marrow from the hipbone to look for leukemia cells. The sample is sent to a lab for testing. Doctors in the lab will classify blood cells into specific types based on their size, shape and other features. They also look for certain changes in the cancer cells and determine whether the leukemia cells began from the B lymphocytes or T lymphocytes. This information helps your doctor develop a treatment plan.
• Imaging tests. Imaging tests such as a chest X-ray and computerized tomography (CT) scan may help determine whether cancer has spread to the brain and spinal cord or other parts of the body.
• Spinal fluid test. A lumbar puncture test, also called a spinal tap, may be used to collect a sample of spinal fluid. The sample is tested to see whether cancer cells have spread to the spinal fluid.

Treatments and drugs

In general, treatment for acute lymphocytic leukemia falls into separate phases:

• Induction therapy. The purpose of the first phase of treatment is to kill most of the leukemia cells in the blood and bone marrow.
• Consolidation therapy. Also called post-remission therapy, this phase of treatment is aimed at destroying the leukemia cells remaining in the brain or spinal cord.
• Maintenance therapy. The third phase of treatment prevents leukemia cells from regrowing. The treatments used in this stage are often given at much lower doses.
• Preventive treatment to the spinal cord. People with acute lymphocytic leukemia may also receive treatment to kill leukemia cells located in the central nervous system during each phase of therapy. In this type of treatment, chemotherapy drugs are injected directly into the fluid that covers the spinal cord. This kills cancer cells that can't be reached by chemotherapy drugs given by mouth or through an intravenous line.

Depending on your situation, the phases of treatment for acute lymphocytic leukemia can span 2 1/2 to 3 1/2 years.

Treatments may include:

• Chemotherapy. Chemotherapy, which uses drugs to kill cancer cells, is typically used as an induction therapy for children and adults with acute lymphocytic leukemia. Chemotherapy drugs can also be used in the consolidation and maintenance phases.
• Targeted drug therapy. Targeted drugs attack specific abnormalities present in cancer cells that help them grow and thrive. One targeted drug, imatinib (Gleevec), specifically attacks cancer cells that have a certain abnormality called the Philadelphia chromosome. The drug dasatinib (Sprycel) works in a similar way. These drugs are approved only for people with the Philadelphia chromosome-positive form of ALL.
• Radiation therapy. Radiation therapy uses high-powered beams, such as X-rays, to kill cancer cells. If the cancer cells have spread to the central nervous system, your doctor may recommend radiation therapy.
• Stem cell transplant. A stem cell transplant may be used as consolidation therapy in people at high risk of relapse or for treating relapse when it occurs. This procedure allows someone with leukemia to re-establish healthy stem cells by replacing leukemic bone marrow with leukemia-free marrow.
  A stem cell transplant begins with high doses of chemotherapy or radiation to destroy any leukemia-producing bone marrow. The marrow is then replaced by bone marrow from a compatible donor (allogeneic transplant). In some cases, adults with ALL are able to use their own bone marrow for transplantation (autologous transplant). This may be possible if you go into remission and healthy bone marrow is then harvested for a future transplant.
• Clinical trials. Clinical trials are experiments to test new cancer treatments and new ways of using existing treatments. While clinical trials give you or your child a chance to try the latest cancer treatment, treatment benefits are still being evaluated. Discuss the benefits and risks of clinical trials with your doctor.

ALL in older adults
Older adults, such as those older than 65, tend to experience more complications from ALL treatments. And older adults generally have a worse prognosis than children who are treated for ALL. Discuss your options with your doctor. Based on your overall health and your goals and preferences, you may decide to undergo treatment for your ALL. Some people may choose to forego treatment for the cancer, instead focusing on treatments that improve their symptoms and help them make the most of the time they have remaining.

Alternative medicine

No alternative treatments have been found to cure acute lymphocytic leukemia. But some alternative therapies may help ease the side effects of cancer treatment and make you or your child more comfortable.

Alternative treatments that may ease signs and symptoms include:

• Acupuncture
• Aromatherapy
• Massage
• Meditation
• Relaxation exercises

Talk to your doctor if you're interested in trying alternative treatments. Some alternative therapies are safe, while others can interfere with your cancer treatments.

Coping and support

Although treatment for acute lymphocytic leukemia is typically very successful, it can be a long road. Treatment often lasts 2 1/2 to 3 1/2 years, although the first three to six months are the most intense. During maintenance phases, children can usually live a relatively normal life and go back to school. And adults may be able to continue working. To help you cope, try to:

• Learn enough about leukemia to feel comfortable making treatment decisions. Ask your doctor to write down as much information about your specific disease as possible. Then narrow your search for information accordingly. Write down questions you want to ask your doctor before each appointment, and look for information in your local library and on the Internet.
  Good sources include the National Cancer Institute, the American Cancer Society, and the Leukemia & Lymphoma Society. Also, consider bringing a recorder to appointments. Your doctor may present you with a lot of details in a single visit, and it can be helpful to capture those details and play them back later.
• Lean on your whole health care team. At major medical centers and pediatric cancer centers, your health care team may include psychologists, psychiatrists, recreation therapists, child-life workers, teachers, dietitians, chaplains and social workers. These professionals can help with a whole host of issues, including explaining procedures to children, finding financial assistance and arranging for housing during treatment. Don't hesitate to rely on their expertise.
• Explore programs for children with cancer. Major medical centers and nonprofit groups offer numerous activities and services specifically for children with cancer and their families. Examples include summer camps, support groups for siblings and wish-granting programs. Ask your health care team about programs in your area.
• Help family and friends understand your situation. Set up a free, personalized Web page at the not-for-profit website CaringBridge. This allows you to tell the whole family about appointments, treatments, setbacks and reasons to celebrate — without the stress of calling everyone every time there's something new to report. A Web page helps your family and friends understand what you're going through, and it allows them to send notes of encouragement, even when they live far away.

Efek Ketidakhadiran Ayah: Buruk!

https://balitakami.wordpress.com/2011/03/04/efek-ketidakhadiran-ayah-buruk/


Klinik Tumbuh Kembang
Ruang Diskusi Tumbuh Kembang dan Nutrisi Balita

Kebanyakan orang berpendapat, anak merupakan tanggung jawab ibu karena ayah mencari nafkah. Pertimbangkan lagi pandangan ini! Sebab, absennya ayah dalam proses pendidikan terbukti memiliki dampak luar biasa bagi perkembangan anak.

Menyerahkan pendidikan anak hanya kepada ibu tampaknya harus dikaji ulang. Kalau sambil bercanda, kita bisa bilang, "Bikinnya berdua, kok setelah jadi si istri disuruh bertanggung jawab sendiri?” Memang ada beberapa alasan serius yang perlu dipertimbangkan ulang.

Pertama, anak merupakan buah cinta yang direncanakan dan diinginkan bersama antara suami dan istri, yang kehadirannya diharapkan dapat mengokohkan dan memperteguh hubungan mereka sebagai sebuah keluarga. Dengan demikian, keberadaan anak merupakan tanggung jawab suami istri bersama-sama.

Kedua, pembagian kerja secara seksual (sesuai dengan jenis kelamin), urusan publik (mencari nafkah) menjadi tanggung jawab ayah dan urusan domestik (mendidik anak dan mengurus rumah tangga) menjadi tanggung jawab ibu, kini tidak relevan lagi. Kebanyakan ibu kini juga bekerja, di luar ataupun di rumah, untuk menghasilkan uang. Tidak tepat lagi jika pendidikan anak dipasrahkan hanya kepada ibu.

Ketiga, dalam proses tumbuh kembang, ternyata anak-anak membutuhkan kehadiran ayah dan ibu sebagai patron atau panutan dan sumber kasih sayang.


Ayah kadang-kadang
Di Jepang, sebagian orang mencemaskan pertumbuhan anak-anak kota besar yang timpang akibat absennya ayah dalam proses tumbuh kembang generasi kristal itu. Mereka hidup serumah, tetapi pagi-pagi sekali ketika ayah belum bangun, anak sudah berangkat sekolah. Malam hari ketika anak sudah tidur, sang ayah baru pulang.

Begitu kehidupan mereka setiap har sehingga anak-anak tidak punya kesempatan bertemu ayahnya. Dikhawatirkan anak-anak di negara paling makmur di Asia itu bahkan menyaksikan (yang berarti belajar) bagaimana ayah dan ibu berinteraksi pun tidak pernah bisa.

Jika demikian, apakah mereka bisa diharapkan mengerti bagaimana laki-laki dan perempuan berinteraksi secara baik? Lebih dari itu, bagaimana anak-anak dapat tumbuh sebagai pribadi yang utuh dan kuat jika kehadiran ayah nol besar?

Penggambaran situasi semacam itu mungkin berlebihan. Namun, hal itu bisa menjadi peringatan bagi orangtua yang mengharapkan anak-anak tumbuh sehat fisik dan mentalnya agar tidak mengabaikan kebutuhan anak akan kehadiran ayah.

Di Indonesia, kita bisa menyaksikan banyak pria yang hanya kadang-kadang saja menjadi ayah. Mengapa disebut kadang-kadang karena sehari-hari mereka tidak memberikan kontribusi terhadap kebutuhan anak saat menghadapi proses belajar dan pembentukan diri. Hanya kadang-kadang saja mereka teringat dan terlibat dalam urusan anak.

Hal itu terjadi akibat perceraian ataupun lemahnya komitmen ayah terhadap proses tumbuh kembang anak. Lain dengan di Barat, orangtua yang bercerai masih bisa berbagi dalam hal mengurusi anak, di Indonesia perceraian umumnya tidak memerhatikan hak anak. Kalaupun ada perhatian, sebatas soal biaya anak yang dikemukakan. Karena itu, kalau terjadi perceraian, biasanya anak kehilangan salah satu orangtuanya.

Berdampak buruk
Ada sejumlah hasil penelitian yang memperlihatkan efek ketidakhadiran ayah, seperti dikutip menweb.org. Dalam studi yang dilakukan oleh Kalter dan Rembar dari Children’s Psychiatric Hospital, University of Michigan, AS, dari 144 sampel anak dan remaja awal yang orangtuanya bercerai, ditemukan tiga masalah utama.

Sebanyak 63 persen anak mengalami problem psikologis subyektif, seperti gelisah, sedih, suasana hati mudah berubah, fobia, dan depresi. Sebanyak 56 persen kemampuan berprestasinya rendah atau di bawah kemampuan yang pernah mereka capai pada masa sebelumnya. Sebanyak 43 persen melakukan agresi terhadap orangtua.

Dalam studi yang dilakukan khusus terhadap anak-anak perempuan, ditemukan hasil yang kurang lebih sama: 69 persen mengalami problem psikologis, 47 persen punya masalah akademis, dan 41 persen melakukan agresi terhadap orangtuanya.

Dalam Journal of Divorce Harvard University, AS, Rebecca L Drill, PhD, mengatakan, "Akibat perceraian orangtua dan absennya ayah, setelah itu memiliki dampak luar biasa negatif terhadap perasaan anak. Sebagai contoh, perceraian orangtua dan kehilangan ayah terbukti berkaitan erat dengan kesulitan anak melakukan penyesuaian di sekolah, penyesuaian sosial, dan penyesuaian pribadi.”

Singkat kata, tanpa mengabaikan hasil-hasil penelitian lain yang memperlihatkan bahwa anak yang orangtuanya bercerai dapat berhasil dalam hidupnya, absennya figur ayah dalam kehidupan anak memiliki dampak yang buruk terhadap anak. Karena itu, sebaiknya para ayah tidak under estimateatau menilai diri terlalu rendah menyangkut perannya dalam proses tumbuh kembang anak.

Mulai hari ini
Jika Anda, para ayah, merasa memiliki komitmen yang rendah terhadap proses pendidikan anak sehingga hubungan antara ayah dan anak menjadi kurang dekat, buang jauh-jauh ide "sudah telanjur” dari benak Anda!
Prof Rob Palkovitz, konselor dan penulis buku tentang keterlibatan ayah, mengingatkan, "Hentikan berpikir tentang masa lalu dan pusatkan perhatian Anda pada ke mana Anda ingin melangkah!”

Berikut ini beberapa saran Palkovitz berdasarkan hasil risetnya, interaksinya dengan empat anaknya, dan pengalamannya membantu anak-anak yang ayahnya absen dari sisi mereka:

1. Pusatkan perhatian pada hal-hal yang benar dan positif bagi Anda dan anak. Sebagai contoh, katakan kepada diri Anda sendiri, "Betapa membanggakannya Ayah bekerja keras untuk menghidupi keluarga,” tanpa tambahan apa pun, dan betapa berbedanya kalau ada tambahan, "Tetapi, alangkah lebih baiknya kalau Ayah lebih sering berada di rumah." Sebaliknya, bicaralah kepada anak Anda, "Betapa bangganya menjadi ayahmu, Nak,” tanpa pernah menambahkan kalimat, “Tetapi, akan lebih membanggakan kalau kamu bisa membereskan kamarmu.” Jika Anda dapat memahami kedua hal tersebut, berarti dua langkah membangun hubungan sudah Anda lalui.
2. Butuh waktu bertahun-tahun untuk membangun hubungan. Karena itu, pahami saat ini Anda berada di titik mana dan ingin menuju ke titik mana.
3. Kehidupan ini dibangun oleh jutaan "sekarang juga". Jika Anda ingin membangun hubungan baik dengan anak-anak, mulailah sekarang juga.  
4. Pikirkan kalimat apa yang ingin diucapkan oleh anak-anak ketika mereka meninggalkan rumah: “Ayahku selalu…” Kata-kata apa yang Anda inginkan diucapkan anak-anak untuk melengkapi kalimat tersebut, maka itulah jalan untuk memulai perubahan sikap Anda sendiri. Mau jadi ayah yang baik?

Kriteria ayah yang baik
Dalam bukunya yang berjudul Involved Fathering and Men’s Adult Development: Provisional Balances,Prof Rob Palkovitz membuat kriteria tentang kualitas seorang ayah yang baik.  Simak dan periksa, apakah Anda termasuk di dalamnya!

Perceraian ayah dan ibu tidak dapat menjadi alasan yang cukup untuk menilai diri baik atau tidak sebagai ayah. Sebab, meskipun ada istilah “bekas istri” atau “bekas suami,” tidak ada “bekas ayah”.

•      Suportif
•      Menetapkan peraturan
•      Bertindak sebagai guru
•      Pembimbing moral
•      Menjadi model peran bagi anak
•      Memiliki kesabaran
•      Pendengar yang baik
•      Pemberi nafkah yang baik
•      Hidup sesuai dengan harapannya atas kehidupan anaknya
•      Tetap ingat bagaimana rasanya menjadi anak sehingga mengerti perasaan anak

@ Widya Saraswati

Tubuh Perlu Asam Lemak Esensial

http://health.kompas.com/index.php/read/2011/02/12/13051364/Tubuh.Perlu.Asam.Lemak.Esensial
Laporan wartawan KOMPAS.com Lusia Kus Anna

Sabtu, 12 Februari 2011 | 13:05 WIB

Kompas.com - Zat-zat gizi yang berasal dari makanan yang kita asup baru dapat digunakan oleh tubuh jika diserap dengan baik oleh sel-sel. Untuk meningkatkan penyerapan zat-zat gizi, tubuh memerlukan asam lemak esensial.

"Asam lemak esensial berperan untuk melenturkan sel membran sehingga sel mampu menyerap zat gizi dan mempermudah pengeluaran sisa metabolisme dari sel," papar dr.Fiastuti Witjaksono dari Departemen Ilmu Gizi Fakultas Kedokteran Universitas Indonesia (FKUI) dalam seminar 'Pentingnya Lemak Esensial dan Manfaatnya untuk Tubuh' di Jakarta (12/2/2011).

Asam lemak esensial juga menjadikan kualitas sel membran lebih baik dan tidak mudah rusak. Asupan lemak esensial yang seimbang dibarengi dengan pola makan sehat sejak dini dapat mencegah penyakit kardiovaskular.

Pada bayi dan anak, asam lemak esensial dibutuhkan untuk pembentukan sel-sel, membangun jaringan sel tubuh, serta membantu melenturkan membran sel untuk penyerapan gizi.

Asam lemak esensial dapat dikelompokkan menjadi beberapa jenis di antaranya Omega 3, Omega 6, DHA (Asam Dokosaheksaeoat), EPA (Asam Eikosapentaenoat), ALA  (Asam Alfalinolenat) dan GLA (Gamma Linolenic Acid). "Disebut esensial karena tidak bisa dibentuk oleh tubuh jadi harus kita penuhi dari makanan," kata Fiastuti.

Asupan asam lemak esensial dapat diperoleh dari beberapa jenis makanan. Sumber omega 6 antara lain makanan yang digoreng, sedangkan omega 3 berasal dari biji-bijian, minyak jagung, ikan laut dalam atau margarin yang diperkaya omega 3. 

Fiastuti juga menekankan, asam lemak esensial Omega 3 dan Omega 6 harus dikonsumsi dalam porsi seimbang. "Kedua asam lemak ini harus seimbang, supaya terasa manfaatnya," katanya.

Untuk penggunaan margarin yang diperkaya asam lemak esensial,  Fiastuti menyarankan agar hanya untuk olesan roti atau menumis dengan suhu tidak lebih dari 200 derajat celcius. Margarin juga bisa diberikan di atas makanan yang baru diangkat sehingga asam lemaknya tidak rusak.