Wednesday, May 18, 2011

What I learn today: Sialolithiasis

Sialolithiasis: the formations of stones within the salivary gland or duct in which drains the salivary gland. Salivary duct stone formations are the accumulation of calcium and phosphate crystals. 

There are three salivary glands(the parotid, the sublingual or the submandibular gland) all of which functions include saliva secretions, which is what helps to moisten and digest the food that we eat.  

Parotid glands: lie basically in front of the ears or just behind the jawline. 
Submandibular and Sublingual glands: sit deep within the floor of the mouth.

The chemical composition of the stones also varies from one gland to another. Submandibular gland stones tend to have higher concentrations of calcium, which explains why 85% of submandibular stones are visible on x-ray, whereas only 15% of parotid duct stones are visible.

  • Since chewing promotes release of saliva, symptoms tend to increase during meals. A palpable lump or visible swelling in the area of the gland is often noted.
  • In some instances the patient may have difficulty opening the mouth or swallowing.
  • The saliva helps break down starches and when the water of our saliva is decreased, the calcium and phosphate in the saliva can cause formation of a stone. Stones are much more likely to develop when the water content of saliva is decreased. Thereby a person who is dehydrated is at much higher risk of stone formation. 
  • Any disorder that thickens saliva can predispose to stone formation. These disorders include autoimmune attack of the saliva gland, such as seen with sicca syndrome, Sjogren's syndrome, lupus, and other autoimmune connective tissue disorders. Drying medications are also frequent causes and include antidepressants, antihistamines, diuretics, etc. Dehydration also plays a prominent role, particularly in older individuals.
  • The long-term effects are very much determined by whether or not chronic bacterial infection sets into the gland because of the obstruction. Stones that pass spontaneously will create little, if any, difficulty. Should they, however, injure the lining of the duct, then a narrowing of the duct can occur which prevents good salivary flow from the gland, with either induction of additional stone formation or gland infection. Stones can occur in the duct and cause a complete obstruction. If the gland does not become infected, then it may involute and stop making saliva. Sometimes the stone may wear a hole in the duct and extrude into the tissue. In that location it may get walled off or spread the infection into the soft tissue. Should the gland not drain well and not respond to conservative treatment, such as hydration, gland massage, and saliva stimulants, it may become chronically symptomatic. For those individuals who develop a bacterial infection and the gland is incapable of effectively draining, chronic and recurrent bacterial salivary gland infection can result. The longer the infection continues, the more scarring there is in and about the gland and the greater difficulty exists in removing it should it be necessary.
  • Surgical removal of the stone sitting at the duct opening may lead to complete scarring of the duct opening, with subsequent failure of the gland to further drain. This could lead to additional stone formation, infection, and/or gland involution. Should the entire submandibular gland, duct, and the offending stone need to be removed, the complications are related to the adjacent structures. For example, just on the outside surface of the submandibular gland is a small branch of the facial nerve that stimulates lower lip movement. If this nerve is injured, then lower lip paralysis can result. Two other nerves sit underneath the saliva gland. One is the hypoglossal nerve, which controls that side of the tongue. Above the hypoglossal nerve is the lingual nerve, which supplies sensation to the front part of the tongue. If these nerves are injured, there is paralysis and loss of sensation respectively. The main difficulty arising from removal of the parotid gland is injury to the facial nerve. The facial nerve controls the muscles in the face and thus injury to the main trunk of the nerve results in complete facial paralysis. Interruption of specific branches will cause paralysis in that part of the face innervated by that particular nerve branch. Since the damaged glands are usually not very functional, no significant mouth dryness usually results.
  • In the individual suffering from thickened saliva, regardless of its mechanism, adequate hydration using six to eight glasses of water per day and sucking on sour drops will help maintain a good flow of saliva.
  • For those who have successfully recovered from a previous stone or who suffer from autoimmune attack on the saliva gland, massaging the gland forward after meals helps clear any thickened, saliva from the gland itself.

  • For small stones, hydration, moist heat, NSAIDs(ex: aspirinibuprofen, and naproxen) occasionally, and having the patient take any food or beverage that is bitter and/or sour. Sucking on citrus fruits, such as a lemon or orange, may increase salivation and promote spontaneous expulsion of the stone.
  • Some stones may be massaged out by a specialist.
  • An ENT or maxillofacial surgeon may canulate the duct to remove the stone (sialotomy).
  • A surgeon may make a small incision near the stone to remove it.
  • SialendoscopyThe salivary glands are located around the mouth and the throat. These glands may at times be blocked, usually because of stones. Sialendoscopy involves the use of a flexible tube (endoscope) to enter a salivary gland and to visualise and remove the stone.
  • To prevent infection while the stone is lodged in the duct, sometimes antibiotics are used. In some cases when stones continually reoccur the offending salivary duct is removed.

Lesson Learned:
So, drink water...DRINK LOTS OF WATER! It is needed by our body to function well 'coz Dehydration or lack of water is what causes most illnesses.

Update 05/19/11: Dr. Esperanza's advise:  Observe for 1 week with soft diet: increase in spicy, salt and citrus fruits + water + warm compress + massage on the affected area. Take pain reliever only when cannot tolerate the pain. Followed her instructions very well. The swelling eventually subsides! but have to continue eating sour oranges and drinking more than 2 liters a day for the next few days to make sure the stone is totally dissolved.

Wednesday, May 4, 2011

The Sesame Girls

Several soon-to-be-mothers are roaming around the office with their baby bumps and so today I had a thought about our first Kids' Day. The company is indeed growing!

Mickey and friends waiting for the kids.

Jollibee entertains.

Kids on the floor.

A little sleepy.

bad boy huh?!

Coco and her angels.

I among the kids.

Presenting...the Sesame girls! =D
with Jo-e.

I'm the cookie monster.

Dudeth is one of those with baby bumps!

Tuesday, May 3, 2011

What I learn today: A Reason to Love

There's this young couple whose love story inspired me and made a difference in my life…

Dale and Anna.

They're walking along the street towards her home when she asked out of the blue, “WHY DO YOU LOVE ME?”. A question she asks from time to time but only receives the same gesture… a smile and a kiss to her hand.

One foggy night, a car was caught in an accident, it nearly wrecked the car. Remarkably, there was a sign of life. The news has reached Dale and he got the shock of his life when he learned that Anna was one of the passengers. As soon as he knew it, he rushed to the hospital. 

She regained consciousness after a week and as she slowly opened her eyes, she saw her mum and Dale at her bedside.

But the accident made her feel really sorry for herself. For that, she instructed her family not to let anyone see her especially Dale. She told her mother to send him away. “I don't love you anymore, get out and don't ever come back!” these were her last words thrown at him… but deep inside, she’s hurting. She loves him still, so much. She's just so afraid that someday Dale might just leave her anyway… so might as well, she thought, end their relationship now.

Anna still can't accept what happened and furiously asks God why she has to suffer that way. The accident made her bitter and bitter everyday. She did nothing but shed tears as much as she misses him.

However, knowing her for such a long time, he knew she didn’t mean every single thing she had said. It didn't affect him at all for he knew how she loves him. He gave her all the time she needs to ease the pain because He fully understand the struggles she's going through. So he fled away to give her time to heal. 

She heard nothing about him since then. Months have past, Anna misses him so badly but knew she can never take back all the things she had said. There’s nothing she could do but cry and regret every word that she told him.

On the day of their supposedly fifth anniversary came, she went out to the porch and started reminiscing. Trying not to think about "them" but cannot control her thoughts. She closes her eyes and think about how they celebrate special occasions, how he put a smile on her face in gloomy days, how he had made her feel special in so many ways. She savors the moment and for the first time since the accident, she felt the butterflies flying around her stomach.

She can’t stop hoping that somehow he would pass by and at least say “Hello” but the moon started to shine and her little hope faded. “Perhaps he already had forgotten me”, she felt the sadness of her heart as the breeze of the evening comforted her.

She was about to enter the house when suddenly a little boy came running towards her and handed her a bunch of white roses together with a letter. As she went through the letter, she felt the coldness of the night embracing her as tears fell from her eyes:

“it’s been awhile and I should admit… I’ve missed you a lot.
            Remember the question you’ve always asked?
                        'WHY DO I LOVE YOU?'

I’ve been thinking about it a hundred times. And it seems like ‘twas the hardest question I have yet to answer. You see, you’re so pretty when I met you, you have one of the most beautiful faces I’ve ever seen with such soft skin… but in a split of a second, it was full of scars and stitches.

We love walking along the shore and jog almost every morning; we enjoyed riding our bikes in the afternoon and the next thing I’ve learned? You are in a wheelchair…

You are kind, very outspoken but sweet and affectionate girl. That characteristics of yours have captured my heart 5 years ago but you let the bitterness of the accident changed you of who you are and threw me away just like that.
If those things were my reasons to love you, then right there at that very moment of the accident when I knew that things will be at its worst, my heart could have stopped loving you, because the reasons why I have loved you were gone…

You assumed that it took away everything, changed everything, ruined everything… No! No. I tell you, it didn't changed a thing… you are alive and you are still YOU… the one that I have loved before, the one I will always long for. What happened may have caused you so much heartache and may have destroyed your dreams but my love for you had never vanished.

I love you and I will always do, for the rest of our earthly and heavenly life…. For my love for you HAS NO REASONS AT ALL, IT'S JUST PURE LOVE.”

Before she knew it, Dale was standing right by her side, wearing the same tuxedo he wore when they first met each other on a school dance. As he wiped her tears, he looked at her with a smile and kissed her hand. He gets down on his knees, showed the ring and proposed.

It reminded me of the real reason of loving… LOVE, just love, for love knows no reason.

Category: Fiction: Short Story. 1999.

Monday, May 2, 2011

Random Thoughts: A Fairy Tale Wedding

My ultimate crush and first love already got married on the 29th of April. Watching their romantic and solemn wedding broke my heart but at the same time I feel very happy for them. Congratulations Duke and Duchess of Cambridge!

The British Royal Family 2011.
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