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Asal usul asam urat

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Last Updated on Monday, 11 May 2009 15:30 Written by Administrator Monday, 11 August 2008 16:17

Saat ngebis ke semarang, saya nguping diskusi tetangga yang begitu seru. Bak seorang ahli memberi petuah pada muridnya. Mereka membicarakan soal asam urat. Beberapa yang bisa kutip : “Asam urat tuh sebenarnya bermula dari adanya sumbatan pembuluh darah. Lama-kelamaan sumbatan itu menjadi keras, makanya disebut urat, ya..membentuk seperti urat. Sumbatan tu juga menjadikan keadaan disana menjadi asam makanya disebut asam urat“. Begitu kata bapak yang bicara begitu semangat. Pembicaraan terus berlanjut. Tapi dalam benakku, apa teori udah berubah?? Mungkin gara-gara saya dah lama ga buka buku kali ya… Tadinya mau ku konfirmasi, tapi gara-gara takut dikemplangi, dan di cap anak sok tau. Saya diem aja dan membiarkan ia terus berkoar. Oleh karena itu, saya bertekat, khusus menulis artikel bertema Asam Urat untuk bulan ini.

Asam Urat adalah Hasil Katabolisme Purin

kristal urat
Apa sih maksudnya? Asam urat (uric acid-dalam bahasa Inggris) adalah hasil akhir dari katabolisme (pemecahan) purin. Purin adalah salah satu kelompok struktur kimia pembentuk DNA. Yang termasuk kelompok purin adalah Adenosin dan Guanosin. Saat DNA dihancurkan, purin pun akan dikatabolisme. Hasil buangannya berupa Asam urat.

Purin termasuk komponen non-esensial bagi tubuh, artinya purin dapat diproduksi oleh tubuh sendiri. Apabila kita mengkonsumsi makanan yang mengandung purin, maka purin tersebut akan langsung dikatabolisme oleh usus.(1) Urat (bentuk ion dari asam urat), hanya dihasilkan oleh jaringan tubuh yang mengandung xantin oxidase, yaitu terutama di hati dan usus. Produksi urat bervariasi tergantung konsumsi makanan mengandung purin, kecepatan pembentukan, biosintesis dan penghancuran purin di tubuh. Normalnya, 2/3 -3/4 urat di ekskresi (dibuang-red) oleh ginjal melalui urin. Sisanya memlalui saluran cerna.(2) Berarti semakin banyak makanan yang mengandung tinggi purin di konsumsi makan makin tinggi kadar asam urat yang diserap.

Sifat Kimia Asam Urat

Proses metabolisme purin

DNA secara skematis
Asam urat merupakan asam lemah dengan pKa 5,75. Urat cenderung berada di cairan plasma ekstraselular dan cairan synovial (cairan sendi-red). Sekitar 98% urat membentuk monosodium urat pada pH 7.4. Monosodium urat mudah disaring dari plasma.

Plasma terlarut monosodium urat pada konsentrasi 6,8 mg/dl pada 37oC. Pada kadar asam urat yang lebih tinggi, plasma menjadi jenuh dan potensial mengendap membentuk kristal urat. Akan tetapi, kadang-kadang pengendapan ini tidak terjadi meskipun kadar asam urat tinggi, hal ini kemungkinan karena adanya suatu zat pelarut dalam plasma.

Asam urat lebih larut di urin daripada di air biasa, ini karena adanya urea, protein dan mukopolisakarida di urin. pH urin sangat berpengaruh pada kelarutannya. Pada pH 5.0, urine mampu melarutkan asam urat dengan kadar antara 6-15 mg/dl. Pada pH 7.0, kelarutannya meningkat, bisa melarutkan asam urat antara 158 sampai 200 mg/dl. Bentuk ionisasi urat di urin dapat berupa mono- dan disodium, kalium, ammonium, dan calcium urat.

Kadar urat di darah tergantung usia dan jenis kelamin. Umunya, anak-anak memiliki kadar asam urat antara 3,0-4,0 mg/dl. Kadar ini akan meningkat dengan bertambahnya usia dan menurun saat menopause. Rata-rata kadar asam urat pada laki-laki dewasa dan wanita premenopause sekitar 6.8 dan 6,0 mg/dl. Kadar asam urat pada orang dewasa cenderung meningkat dengan bertambahnya usia, berat badan, tekanan darah, konsumsi alcohol dan gangguan fungsi ginjal.

source: http://cegahasamurat.blogspot.com/ 

 

 

Are we all getting it wrong – and right at the same time?

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Last Updated on Monday, 11 May 2009 13:32 Written by Administrator Thursday, 07 August 2008 02:29

By Dr Tam Llewellyn-Edwards  

Introduction  

This article is controversial – and is intended to be so.   However, it is not written simply to cause controversy but rather to stimulate thought and to draw practitioners, whatever their preferred therapeutic modality, to re-consider their treatment of patients, and the system they use to apply that treatment.  Read it through fully and think about it before condemning it.

 

The article makes the hypothesis that the method and modality used in treatment is not of great importance, and may not even be relevant.  Rather, it is suggested that the success of any particular treatment rests not on the treatment given, but in part (if not entirely) on the intent of the therapist.

 

The reader may think that this is an irrelevancy, as all treatment is carried out with the intent of healing the patient.  But is it?   How often is the form and regime of the treatment not based on an intent to heal the patient, but on an aim to comply with the protocol of the therapists chosen modality or to  provide therapy as it would have been provided by the founder of the therapists therapeutic school, or by some revered earlier therapist or teacher.   It is true that therapists strives to comply with the letter of  their particular modality’s method in the belief that it is the best (or even only) way to help the patient, but the intent is not to heal the patient, but to comply with the ‘method’ – granted for what is perceived as the patients highest good. These are not the same.  Think about it

 

At first this may seem to many as a novel and revolutionary idea (after all we were all taught that the method is the thing), but it is not the writer’s own idea – nor is it a new one.  I offer the quote :-

 “The therapist’s attitudes and feelings are more important than their theoretical orientation, procedures and techniques……” This is a quotation from Carl Rogers in ROGERS (1958) 

Let us continue by looking at a whole range of therapeutic modalities and considering the effectiveness of the therapists’ intent to heal, rather that to apply the concepts of the chosen modality.  We will start with conventional medicine, where the insistence of complying with set protocols is strongest, and work through various well known therapies to the more recent ‘New-Age Therapies’, where the concept of intent is often basic to the treatment.  In passing we will look at some of the current energy therapies which are developing so quickly that it is possible to measure their evolution against the concept of therapists’ intent to heal being paramount.

 

Conventional Therapy 

Conventional Therapy, by its very name is governed by the need to do things in a conventional manner.  Further, it is a very heavily regulated form of therapy and subject to the threat of expensive litigation should a practitioner err from the perceived norm and produce an undesirable result.  Conventional therapists also have the weight of powerful governing bodies hovering over them – bodies with immense power and the ability to end therapists’ careers should they be seen as stepping out of line.

 

To a great extent, Conventional Therapy works along fixed lines within this inflexible system.  A presenting patient is examined and a diagnosis is made based on standardised investigation and tests - such as blood studies and the culturing of the patients sample.  Once the diagnosis has been made treatment mostly takes the form of the application of standard drugs at strictly controlled doses under conditions and regimes that have been developed during extensive trials, and which allow little variation.

 

Given the above, it is clear that the Conventional Therapist’s intent is, mainly, not based on the healing of the patient, but on compliance with the standard procedure (which themselves are intended to heal).   This is not to decry Conventional Therapy, as the standard procedures have been set up to ensure that the treatment given is the best possible and such therapy usually is extremely effective.

 But does the Conventional Therapist’s intent to heal play any part towards the success of the therapy?   At first impression the answer is that it does not, as a good practitioner is simply one who is well enough versed to apply the ‘system’.  As, undoubtedly, the vast majority of Conventional Therapists are extremely well taught and effective in this area it could be assumed that the cure rate would be more or less constant for a particular ailment.  However, this is clearly not the case.  Cure rates are extremely variable and there is plenty of anecdotal evidence (but few hard statistics) suggesting that some individual doctors are far better healers that others.  It is difficult to suggest that these better healers are simply better trained as in many cases it is the older practitioners, said to have a ‘better bedside manner’ that are amongst those who produce the better results.  They are probably the poorest trained in the use of current techniques.  Could it be that they have the ‘intent to heal’ more to the fore in their treatment and the ability to apply the wonders of modern medicine in the pursuit of this intent?  

In some sectors of Conventional Therapy this is not the case.  Therapeutic Touch (TT) is a therapy used widely by nurses in a conventional medicine setting, and in it the concept of ‘intent to heal’ is fundamental (FRANK1961)

 Conventional therapy does provide us with a number of experimental investigations into the power of intent.  One of relevance to this paper is by Dolores Krieger of New York University, who is a teacher and a nurse.  In an experiment on patients in a hospital setting she demonstrated that when nurses did a laying on of hands (without actually touching patients) with the ‘intent to heal’ there were measurable improvements in their haemoglobin values compared with a control group with whom nurses simply spent time. This is reported in MILSHLOVE 1998. 

Homeopathy 

Classical Homeopaths are, if anything, more ‘stuck in their ways’ than Conventional Therapists.  The basics of Classical homeopathy were set out by Hahnemann in his Organon (HAHNEMANN 1810) which was published almost 200 years ago. Even though it went through six editions, the latest although published posthumously in 1921 was written in 1842.

 

The basic concepts of “Classical Homeopathy” still rest on this work.  To this day it is the Classical Homeopath’s aim to stay closely to the methods and techniques of Hahnemann as they were 200 years ago.  It is certainly the Homeopath’s aim to cure, but it is their intent to do as Hahnemann or Kent (another eminent 19th century homeopath) would have done.  Again it must be emphasised that this does not belittle the work of the homeopath (the writer is, himself, a Classical Homeopath) and it is clear that homeopathy, carried on in this way, produces successful cures in many cases. A homeopath works along these lines as they know, or have been taught, that is the best way to treat the client.

 

To move the hypothesis that the intent not the method is the important thing along, we must look at non-Classical forms of Homeopathy.  In HANHEMANN (1810) the method used for the preparation of homeopathic remedies is set out and they are still used almost without variation today, by homeopathic pharmacies.  However there are a growing number of otherwise ‘Classical Homeopaths’ who employ quite different production methods involving energy fields, which seem to produce active and effective remedies.  On the outer limbs of homeopathy are found therapists who claim an effective remedy can be produced simply by writing the name of the remedy required on a tube of blank pills.  It is even suggested that simply writing “What is required” on the tube will work equally well. 

 

For a classically trained homeopaths the surprise is that these remedies made using energy methods (and even those simply made by intent in writing out the name), actually work.  This leads to the suggestion that all that is needed is to have intent to produce healing.  Other aspects of the treatment may not be needed or may be needed for some other reason.

 

Energy Medicine 

When discussing this hypothesis with therapists of some modalities it is it is reported by them to be a basic self evident fact, and is not disputed in any way.  Reiki adepts report that, although healing can be produced without healing intent, the easiest and most successful healing takes place when the Reiki Master places hands on the patient with the specific intent of healing.  In Reiki there is still an insistence on ‘attunement’ and for the need to work through set routines of treatment, but these can be seen as the adjunct to the basic healers intent to heal rather than the fundamental method of healing.  (see MORRIS 1999)

 A similar situation is found in the ancient Chinese Healing Art of Qi Healing (Qi Gong).  Here a considerable part of the teaching of the Art is the development of the skill of producing an ‘intent to heal’.  This is presented in a simple and lucid way in MOONEY (1998) 

Thought Field Therapy (TFT) is one of the more recent energy therapies, developed by Dr Roger Callahan, an American Psychologist in the 1980’s. (CALLAHAN 1986 & 1996).  In its original form TFT therapy was carried out by reference to a ‘manual’.  Once the problem had been diagnosed the therapist tapped on the patient’s acupoints in a very strict routine, with a set number of taps and a set sequence of tapping depending on the script found in the manual.   Clearly the therapists’ aim was to heal the patient but the intent was to do so by rigidly complying with the routine specified.

 

TFT was complex in form and application and a number of other simpler therapies developed from it.  One, Emotional Freedom Techniques (EFT), was developed by Gary Craig in the 1990’s (CRAIG 1999).  In this therapy a single tapping routine stood to deal with all classes of problem.  As the therapy developed the sequence of tapping was found to be irrelevant to the success of the therapy, and more recently parts of the tapping routine were omitted without any detriment to the success of the treatment.  The latest developments in Australia seem to indicate that the tapping is not necessary at all and in US Gary Craig, in his workshops is talking more and more about intent.   

 

Another development from TFT is Be Set Free Fast (BSFF), which was developed in America by a Clinical Psychologist, Larry Nims.   This form of therapy was developed along side EFT (but distinct from it) and is particularly interesting as its development is particularly well documented in NIMS (2001).  In its original form, BSFF required the therapist to have the patient tap on various parts to their body, while reciting a set of phrases.  Nims, while continuing to require the tapping sequence was soon suggesting that it did not matter where on the body the patient tapped as long as the intent was there, and he even suggested that the patient could tap on anything as long as they tapped and had the intent.

 In the latest form of BSFF, Nims has done away with both the tapping and the phrases by simply having patients install a ‘key word’ in their unconscious mind and installing the unconscious instruction to clear the problem in mind whenever the ‘key word’ was uttered.  He claims equal success with this non-scripted form of his therapy and this would appear to be a completely protocol free therapy relying solely on ‘intention to heal’. Nims claims (NIMS2001) that he no longer need to even teach the patient the original procedure as they do not need to even be aware of the original protocol when using the key word New-Age Therapy 

Before concluding it is worth looking at the ‘New-Age’ Therapies.

 In recent year there has been a large number of ‘New-Age Therapies’ springing up.  Many claims to be re-discoveries or re-inventions of earlier healing modalities, and some have links with other movements.  A commonality runs through them in that they are often effective and that the idea of ‘intent to heal’ being all important.  Healers simply lay on hands or touch the effected part with the intention of healing and healing takes place.  Others evoke the help of guides or angels and claim that nothing more is required to affect a cure than intention 

Conclusions 

Where has all this led us?  It is certainly not proof (in the scientific sense) that the healing protocols in our modalities are irrelevant, but it may cause us to re-evaluate their importance.

 

However, as such protocols are so widely employed across most modalities, it could be argued that they must have some significance.  It is not suggested that we all drop our protocols.  It is difficult to see a patient accepting a therapist simply doing nothing during a therapy session except saying, “Trust me. I am a therapist and it is my intention to heal you”.  Perhaps here lies the key.  Perhaps it is not only that the therapist needs to have intent to heal, but that our patients must also have a belief that we intend to heal them and can.  Are our complex protocols simply to impress/re-assure the patient? This concept is also explored in FRANK1961

 This article was not intended to condemn the use of protocols nor was it to belittle any therapy.  If any process is seen to work for the good of the patient do it, but as we seek to apply our therapies, it would be interesting to think, “Is my intent to stick to the agreed protocol in order to heal the patient or is it simply to heal the patient”. The two are certainly not always the same.  If this article provokes thought and debate it has served its purpose.  

References  

Callahan, R (1985): “Five Minute Phobia Cure”

                        Pub: Enterprise

 

Callahan, R (1996): “Thought Field Therapy”

                        Pub: Int. J of Innovation in the study of the Taumatization Process”

 

Craig, G (1999): “Emotional Freedom Techniques”

                        Pub: Mediacopy 

Frank, J (1961): “Persuasion and Healing”

                        Pub: Johns Hopkins University Press

 

Hahnemann S (1810): “The Organon of Rational Healing” (Various editions)

 

Mooney, R (1998): “Qi Healing – A Primer”

                        Pub: New Press

 

Morris, JJ & WR (1999): “Reiki Hands That Heal”

                        Wheel Weiser

 

Mishlove, J (1998): “Thinking Allowed”

                        Pub: Intuition Network 

Nims L (2001): “Be Set Free Fast”

                        Pub: Nims

 

Rogers, CR (1958): “The Characteristics of a helping relationship”

                        Pub: Personnel and Guidance Journal, 37, 6-16