Did you wake up this morning and say "As-Salaamu Alaikum" to your spouse or your child?
Or did you greet them with a "Good Morning" or even a casual "hi"?
Have we been teaching our children the importance of greeting each other with salaam?
Or when we see them off to school, do we send them off with a 'bye', instead of "As-Salaamu Alaikum", the dua for peace and blessings?
For some of us, this may seem a minor issue.
Or it may even be a 'progressive' issue.
But, in our haste to 'adapt', we forget that saying "As-Salaamu Alaikum" is the best greeting there could ever be.
This was the practice and teaching of Prophet Muhammad (Sal Allaahu Alaihi WA Sallam), the best example for mankind.
And it was Allaah Himself that prescribed the manner of greeting among Muslims as "As-Salaamu Alaikum" [not 'salaams' or 'good morning' or 'hey' or 'hi' or whatever]
"When those who believe in Our Ayaat (proofs, verses, signs, etc.) come to you, say: "Salaamun Alaikum" (peace be on you)..…" (Surah al-An'aam:54)
Ibn al-Qayyim says:
"Allaah, the Sovereign, the Most Holy, the Peace, prescribed that the greeting among the people of Islam should be 'As-Salaamu Alaikum', which is better than all the greetings of other nations which include impossible ideas or lies, such as saying, 'May you live for a thousand years,' or things that are not accurate, such as 'An'im sabaahan (Good morning),' or actions that are not right, such as bowing in greeting.
Thus the greeting of salaam is better than all of these, because it has the meaning of safety which is life, without which nothing else can be achieved…." (Badaa'i' al-Fawaa'id)
"As-Salaamu Alaikum" is the best Dua.
The word 'salaam' comes from the root 'salema', which implies to disassociate oneself from evil and harm.
Thus, when we greet other Muslims, the greeting means: "No harm shall come to you from me (may no evil come to you, may no harm come to you)
And since As-Salaam is also one of the Beautiful Names of Allaah, the greeting of salaam also means, "May the blessing of His Name descend upon you, may Allah be with you, may Allah guide and protect you."
What a beautiful greeting!
Yet, it is utterly tragic to see that some of us have exchanged something so beautiful for something ugly, when we stopped saying Assalaamu Alaikum and started with 'Good Morning' or 'Hi'.
It is especially sad to see some of our youth, who don't even know how to say the words clearly and properly.
Some say 'Saakum", some just mumble something incomprehensible under their breath and some don't even bother to say anything at all!
And if they are being really nice to you, they just might throw you a 'hey' from afar.
And even those of us who do say salaam, some of us are so stingy or hesitant in doing so.
Although, at the time of the Prophet (Sal Allaahu Alaihi WA Sallam) the Sahaabah would compete with each other to see who could give salaams first.
They would go to the market just to say salaam to people they knew and to the people they did not know.
The Prophet (Sal Allaahu Alaihi WA Sallam) said: "The best of the two persons is the one who begins with salaam." (Related by an-Nawawi)
BENEFITS OF "AS-SALAAMU ALAIKUM."
1."As-Salaamu Alaikum" is a means of immense reward
A man passed by the Messenger of Allaah (Sal Allaahu Alaihi WA Sallam) while he was sitting with others, and said, "As-salaamu 'alaykum."
The Prophet (Sal Allaahu Alaihi WA Sallam) said, "[He will have] ten hasanaat."
Another man passed by and said, "As-Salaamu Alaikum WA Rahmatullaah (peace be upon you and the mercy of Allaah)."
The Prophet (Sal Allaahu Alaihi WA Sallam) said, "[He will have] twenty hasanaat."
Another man passed by and said "As-Salaamu Alaikum WA Rahmatullaahi WA Barakaatuh (peace be upon you and the mercy of Allaah and His blessings)."
The Prophet (Sal Allaahu Alaihi WA Sallam) said, "[He will have] thirty hasanaat."
2."As-Salaamu Alaikum" is an aspect of Imaan.
Once a man asked the Prophet (Sal Allaahu Alaihi wa Sallam) about which aspect of Islam was best. The Prophet (Sal Allaahu Alaihi wa Sallam) replied: "Feeding the hungry, and saying salaam to those you know and those you don't know." (Bukhaari and Muslim)
3. "As-Salaamu Alaikum" is a means of entering Jannah.
The Prophet (Sal Allaahu Alaihi wa Sallam) said: "You will not enter Paradise until you believe, and you will not believe until you love one another. Shall I not tell you about something which, if you do it, you will love one another? Spread salaam (the greeting of peace) among you." (Muslim)
4. "As-Salaamu Alaikum" gets rid of sins
The Prophet (Sal Allaahu Alaihi WA Sallam) also said, "When two Muslims meet (give salaam), and shake hands, they are forgiven their sins before they part (with each other)." (Abu Dawud)
5. "As-Salaamu Alaikum" is the greeting of the people of Jannah
"Then, those that feared their Lord shall be driven in companies into Paradise. When they draw near its gates will be opened, and its keepers will say to them: "Salaamun 'Alaikum" (Peace be upon you), you have done well. Enter and live in it for ever." (Surah Zumar:73)
6. Even Allaah (swt) says "As-Salaamu Alaikum"
Allah sends His Salaam upon the people who believe in Him, especially the prophets such as Nuh, Ibraheem, Ismaeel, Musa, etc.(Surah as-Saaffaat) as well as other pious people.
Jibreel came to house of the Prophet (sal Allahu alayhi wa sallam) and Khadeeja was there. Jibreel said: "Allah sends his salaam to Khadeeja." The Prophet (sal Allahu alayhi wa sallam) said: "O Khadeeja, Allah is sending His salaams to you." She said, "Allah is As-Salaam. And upon you O Jibreel, be as-salaam and upon you Rasulullah be as-salaam." [Bukhaari]
It is obligatory to return the greeting of "As-Salaamu Alaikum".
"The Muslim has five rights over his fellow-Muslim: he should return his salaams, visit him when he is sick, attend his funeral, accept his invitation, and pray for mercy for him & [say "Yar ha'mu kallaah"] when he sneezes." (Bukhaari, Muslim)
We should say "As-Salaamu Alaikum" when we enter our homes
"When you enter houses, greet (with peace) one another with a salutation from Allah, blessed and good. As such Allah makes clear to you His verses so that you understand." (Surah an-Nur: 61)
"As-Salaamu Alaikum" is also to be said at time of leaving.
The Prophet (Sal Allaahu Alaihi wa Sallam) said: "When one of you joins a gathering, he should greet those present; and when he leaves them he should salute them, because the first salutation is not better than the last one." (Abu Dawud and Tirmithi)
Why would you want to give up something beautiful for something ugly??
It is sad to see that when it comes to the matters of Dunya, we strive our utmost to give our families and friends the best. Yet when it comes to greetings, we forget the most beautiful and comprehensive greeting "As-Salaamu Alaikum", which is also a prayer….a prayer of peace and blessing….of security and protection from all harm and all evil…..a blessing that Allaah Himself sends down to His beloved slaves……a greeting of the people of Jannah itself.
Important note: The head should NEVER be bent or bowed as a sign of greeting. We bend our heads only to Allah.
It must also be emphasized that other body gestures in any form or shape (for example, raising eyebrows, extending the arms, smiling, winking, etc.) cannot replace the beautiful greeting of "As-Salaamu Alaikum".
'Even 'Salaam' Greeting word is present in Bible.
Greet you in the same manner as Jesus (pbuh) greeted in Hebrew , 'Sholam alay kum' Luke 24:36
Islamic greeting in Arabic Assalaamu alai kum.
Both meaning, 'Peace be on you'
By Asma bint Shameem with inputs by Adil Khan.
Did you wake up this morning and say "As-Salaamu Alaikum" to your spouse or your child?
Examining the Fingernails When Evaluating Presenting Symptoms in Elderly Patients
Human fingernails, located on the dorsal aspect of the terminal 40% of the distal phalanx of each finger, are complex structures involving 3 different layers:
The nail plate (the nail). This is the keratinized structure, which grows throughout life;
The nail bed (ventral matrix, sterile matrix). This is the vascular bed that is responsible for nail growth and support. It lies protected between the lunula (the "half moon" seen through the nail) and the hyponychium (the posterior part of the nail bed epithelium); and
The eponychium (cuticle). The epidermal layer between the proximal nail fold and the dorsal aspect of the nail plate.
The primary purpose of the nail is protection. Abnormalities of the nail are often caused by skin disease and infection (most often fungal) but may also indicate more general medical conditions. This discussion does not address localized trauma or nail infections but offers examples of nail abnormalities that may occur with systemic disease.
Check to see whether the nails are normal by looking at the following (Figure 1):
Softness and flexibility of free edge;
Shape and color;
Quality of paronychial tissue; and
Growth rate (about 6 months from cuticle to free edge). Time of events can be estimated from location.
Examining the Nails
Elderly people carry the last 6 months of their medical record on the approximately 10 square centimeters of keratin comprising the fingernails. Examining the fingernails can help the clinician detect a number of general and specific factors, including the following:
Inner emotional state;
Occupations and hobbies;
Rheumatic conditions; and
The patient's manicure can reveal state of health, nutritional status, past events, personality, occupation, and one's inner state. Systemic illness should show the nail changes in each of the nails on one hand. The thumb may reveal more extensive changes given its increased size.
It is useful to follow the following sequence when examining the nails:
Check the nail shape;
Examine the nail color;
Survey processes around the nails;
Compare hands; and
Note skin conditions.
It is critical to examine the nails in adequate light. Gently rotate the nail in the light so that the reflection highlights all aspects of the nail. Notice the lunula, the pale crescent moonlike coloration at the base of the nail. Leukonychia stria and a pointed tent-like lunula suggest an excessive manicure and pushing on the cuticle. Paronychias suggest stress and poor attention to hygiene. This can reflect depression, dementia, or psychiatric illness.
Nail growth is continuous. It takes about 6 months for a fingernail in an elderly person to completely grow out. Cold temperature can slow growth rates but not to any clinically significant degree (pun intended). The middle finger nail grows the fastest, followed by the forefinger and ring finger. Aging slows the growth rate from approximately 3 months in childhood to 6 months in 70-year-olds. Nails in elderly people are also thicker than in younger people. Thin nails in a postmenopausal woman raise the possibility of metabolic bone disease. The nails of the dominant hand grow slightly more quickly than the nondominant nails, probably because minor trauma accelerates nail growth. Conversely, immobility slows the growth rate of fingernails. Understanding the growth rate is important because the time interval from a critical event can be estimated from the location of a nail lesion. For example, a white line appearing transversely halfway up the nail suggests an acute illness 3 months earlier. Regular observation will demonstrate its progression to the end of the nail edge.
Distance from base and line of polish gives approximate date of application (nails grow 0.1 mm/day). Picking at polish reflects nervousness and agitation. Toenail polish suggests unusual flexibility or a friendly helper.
Observing the Nail Shape and Surface
Clubbing involves a softening of the nail bed with the loss of normal Lovibond angle between the nail bed and the fold, an increase in the nail fold convexity, and a thickening of the end of the finger so it resembles a drumstick.
To determine whether nails are clubbed, have the patient place both forefinger nails together and look between them. If you can see a small diamond space between them (Schamroth's window) then the nails are not clubbed (Schamroth's sign) (Figure 2).
Figure 2. Schamroth's sign.
Causes of clubbing (not exhaustive) include the following (Figure 3):
Pulmonary and cardiovascular causes (80%)
Lung cancer, pulmonic abscess, interstitial pulmonary fibrosis, sarcoidosis, beryllium poisoning, pulmonary arteriovenous fistula, subacute bacterial endocarditis, infected arterial grafts, aortic aneurysm
Gastrointestinal causes (about 5%)
Inflammatory bowel disease, sprue, neoplasms (esophagus, liver, bowel)
Hyperthyroidism (about 1%)
Note: Chronic obstructive pulmonary disease does not cause clubbing.
Figure 3. Example of clubbed fingernails.
Koilonychia are spoon-shaped concave nails (Figures 4A, 4B). This occurs normally in children and usually resolves with aging. To determine whether a nail is spooned, perform the water drop test. Place a drop of water on the nail. If the drop does not slide off, then the nail is flattened from early spooning. An experienced clinician can look at the nail and perform a "mental" water drop test. Causes include the following:
Protein deficiency, especially in sulfur-containing amino acids (cysteine or methionine);
Exposure to petroleum-based solvSystemic lupu
Figure 4B. Spooned nail.
In 1846, Joseph Honoré Simon Beau described transverse lines in the substance of the nail as signs of previous acute illness.. The lines look as if a little furrow had been plowed across the nail. Illnesses producing Beau's lines include the following:
Intermittent doses of immunosuppressive therapy or chemotherapy can also produce Beau's lines. Severe zinc deficiency has also been proposed as a cause of Beau's lines. By noting its location on the nail, the approximate date of the illness associated with it can be determined (Figures 5A, 5B). Moreover, the depth of the line provides a clue to the severity of the illness.
Figure 5A. The location of Beau's lines half way up the nail suggests illness 3 months ago.
Figure 5B. Two Beau's lines suggest illnesses about 2 months apart.
Thin Brittle Nails
Thin, brittle nails can indicate the following (Figure 6):
Metabolic bone disease (nail thinness is correlated with osteopenia);
Systemic amyloidosis (indicated by yellow waxy flaking); and
Figure 6. Note the thin nails in this woman with severe osteopenia.
Onychorrhexis is the presence of longitudinal striations or ridges (Figure 7). It can simply be a sign of advanced age but it can also occur with the following:
Peripheral vascular disease;
Lichen planus; and
Darier's disease (striations are red/white).
Central ridges can be caused by:
Folic acid deficiency; and
Figure 7. Example of a central nail ridge.
Central Nail Canal (Median Nail Dystrophy)
When a central nail canal is present, the cuticle is usually normal (Figure 8A). Central nail canal is associated with:
Severe arterial disease ("Heller's fir tree deformity" -- a central canal with a fir tree appearance -- may occur with peripheral artery disease (Figure 8B);
Severe malnutrition; and
Figure 8A. Example of central nail canal.
Figure 8B. Central nail canal with Heller's fir tree deformity.
Nail pitting -- small punctate depressions -- are caused by nail matrix inflammation, which can be the result of:
Psoriasis (random appearance of pits) (Figure 9);
Alopecia areata (geometric rippled grid) (Figure 10);
Figure 9. Indication of psoriasis.
Figure 10. Indication of alopecia areata.
With nail beading, the beads seem to drip down the nail like wax (Figure 11). It is associated with endocrine conditions, including the following:
Addison's disease; and
Vitamin B deficiency.
Figure 11. Nail beading.
Rough Nail Surface
When nails look sandpapered and dull, consider (Figure 12):
Chemical exposure; and
Figure 12. Example of a rough nail surface.
Slow nail growth produces thickness (Figure 13). In such cases, the following should be considered:
Peripheral vascular disease;
Yellow nail syndrome; and
Figure 13. Example of a nail thickening.
Onycholysis is distal separation of the nail plate from the underlying nail bed (Figure 14). It is associated with the following:
Toxic exposures (solvents);
Blistering from autoimmune disease; and
Porphyria cutanea tarda (onycholysis and skin blistering from sun exposure).
Figure 14. Traumatic onycholysis (involving only 1 nail).
Severe Nail Curvature (Beaked Nails)
Curved or beaked nails are caused by resorption of distal digit (Figure 15). Consider the following:
Figure 15. Example of severe nail curvature.
Complete Nail Destruction
Complete local nail destruction can be caused by local mechanisms, including trauma and paronychia. Generalized conditions that might cause complete nail destruction include the following:
Toxic epidermal necrolysis;
Bullous diseases; and
Observing Nail Color Abnormalities of the Lunula
If the lunula is absent, consider anemia or malnutrition (Figure 16). A pyramidal lunula might indicate excessive manicure or trauma (Figure 17). A pale blue lunula suggests diabetes mellitus. If the lunula has red discoloration, consider the following causes among others (Figure 18):
Collagen vascular disease; and
Figure 16. Absent lunula.
Figure 17. Pyramidal lunula.
Figure 18. Lunula with red discoloration.
Transverse White Lines (Mee's lines)
Any acute illness can produce transverse milky white lines. In addition, they might be caused by heavy metal toxicity (classically arsenic) or chemotherapy. The time of event may be determined from the location of the lines on nail (Figure 19).
Figure 19. Note the Mee's line approximately one third of the way up the nail, suggesting a significant illness 2 months previously.
Leukonychia striae are white splotches caused by minor trauma to the nail matrix (Figure 20). The timing can be determined by the location of the splotches on the nail.
Figure 20. Example of leukonychia striae. Note location of white splotches, which can indicate timing of the traumatic event.
Longitudinal Brown Lines
Longitudinal brown lines form because of increased melanin produced by nail matrix melanocytes (Figure 21). They are associated with:
Nevus at the nail base;
Melanoma (check for periungal pigmentation); and
Figure 21. Longitudinal brown lines.
Splinter hemorrhages are caused by hemorrhage of the distal capillary loop (Figure 22). Note the thickness of these areas. They are associated with the following:
Subacute bacterial endocarditis;
Systemic lupus erythematosus;
Pityriasis rubra pilaris;
Figure 22. Splinter hemorrhages tend to be fat.
Terry's Half and Half Nails
With Terry's half and half nails, the proximal portion is white (edema and anemia) and the distal portion is dark. These nails imply either renal or liver disease (Figures 23A, 23B).
Figure 23A. This example of Terry's half and half nails suggests liver disease (no brown lines).
Figure 23B. Half and half nails imply renal disease when there is a brown band at the junction of the erythema and the free edge. Image courtesy of www.dermnet.com Used with permission.
Generalized Discolorations of the Nail Plate
Nail discoloration is a useful method for identifying potential problems.
White nails can be caused by anemia, edema, or vascular conditions (Figure 24). Consider the following:
Figure 24. Example of white nails.
Pink or Red Nails
With pink or red nail discoloration, the following should be considered (Figure 25): Polycythemia (dark);
Systemic lupus erythematosus;
Carbon monoxide (cherry red);
Figure 25. Example of pink and red nails.
Brown-gray nails may suggest the following (Figure 26):
Vitamin B12 deficiency;
Topical agents, including hair dyes, solvents for false nails, varnish, and formaldehyde (among many others)
Figure 26. Example of brown-gray nails.
Yellow nails suggest the following (Figure 27):
Median/ulnar nerve injury;
Thermal injury; and
Consider yellow nail syndrome if a patient has lymphedema and bronchiectasis.
Figure 27. Example of yellow nails. Image courtesy of www.dermnet.com Used with permission.
Green or Black Nails
Green or black nails indicate the following (Figure 28): Topical preparations, including chlorophyll derivations, methyl green, and silver nitrate (among others);
Chronic Pseudomonas spp infection; and
Figure 28. Example of black nails.
Processes Around the Nail
Paronychial Inflammation Paronychia is associated with separation of the seal between the proximal nail fold and the nail plate that provides entry for bacteria and leads to a localized infection of the paronychial tissues of the hands (Figure 29). Symptoms may include inflammation, swelling, and/or scaling.
Figure 29. Example chronic paronychial inflammation.
Periungal Telangeictasia Periungal telangeictasia is caused by dilated capillary loops and results in atrophy of the cuticle (Figure 30). It is strongly associated with collagen vascular disease, including the following:
Systemic lupus erythematosus;
Dermatomyositis (especially with Gotton's papules over knuckles); and
Figure 30. Example of periungal telangeictasia. Image courtesy of www.dermnet.com
Mucus Cyst A mucous or myxoid cyst is a collection of degenerative collagen that can cause swelling and ridging of the nail above the cyst, forming a "gutter" (Figure 31).
Figure 31. Example of a mucus cyst.
The following are examples of patients in whom examining the fingernails may help identify their conditions.
Slide 2. 84-year-old man with a painful ankle.
Slide 3. 68-year-old man with esophageal cancer.
Cancer Update from Johns Hopkins :
billion. When doctors tell cancer patients that there are no more cancer cells in their bodies after treatment, it just means the tests are
unable to detect the cancer cells because they have not reached the detectable size.
2. Cancer cells occur between 6 to more than 10 times in a person's lifetime.
3. When the person's immune system is strong the cancer cells will be destroyed and prevented from multiplying and forming tumours.
4. When a person has cancer it indicates the person has multiple nutritional deficiencies. These could be due to genetic, environmental,
food and lifestyle factors.
5. To overcome the multiple nutritional deficiencies, changing diet and including supplements will strengthen the immune system.
6. Chemotherapy involves poisoning the rapidly-growing cancer cells and also destroys rapidly-growing healthy cells in the bone marrow,
gastro-intestinal tract etc, and can cause organ damage, like liver, kidneys, heart, lungs etc.
7. Radiation while destroying cancer cells also burns, scars and damages healthy cells, tissues and organs.
8. Initial treatment with chemotherapy and radiation will often reduce tumor size. However prolonged use of chemotherapy and radiation do not
result in more tumor destruction.
9. When the body has too much toxic burden from chemotherapy and radiation the immune system is either compromised or destroyed, hence
the person can succumb to various kinds of infections and complications.
10. Chemotherapy and radiation can cause cancer cells to mutate and become resistant and difficult to destroy. Surgery can also cause cancer
cells to spread to other sites.
11. An effective way to battle cancer is to starve the cancer cells by not feeding it with the foods it needs to multiply.
WHAT CANCER CELLS FEED ON:
a. Sugar is a cancer-feeder. By cutting off sugar it cuts off one important food supply to the cancer cells. Sugar substitutes like
NutraSweet, Equal,Spoonful, etc are made with Aspartame and it is harmful. A better natural substitute would be Manuka honey or molasses
but only in very sma ll amounts. Table salt has a chemical added to make it white in colour. Better alternative is Bragg's aminos or sea salt.
b. Milk causes the body to produce mucus, especially in the gastro-intestinal tract. Cancer feeds on mucus. By cutting off milk and
substituting with unsweetened soy milk, cancer cells are being starved.
c. Cancer cells thrive in an acid environment. A meat-based diet is acidic and it is best to eat fish, and a little chicken rather than
beef or pork. Meat also contains livestock antibiotics, growth hormones and parasites, which are all harmful, especially to people with cancer.
d. A diet made of 80% fresh vegetables and juice, whole grains, seeds, nuts and a little fruits help put the body into an alkaline
environment. About 20% can be from cooked food including beans. Fresh vegetable juices provide live enzymes that are easily absorbed and reach
down to cellular levels within 15 minutes to no urish and enhance growth of healthy cells. To obtain live enzymes for building healthy cells try
and drink fresh vegetable juice (most vegetables including bean sprouts) and eat some raw vegetables 2 or 3 times a day. Enzymes are destroyed at
temperatures of 104 degrees F (40 degrees C).
e. Avoid coffee, tea, and chocolate, which have high caffeine. Green tea is a better alternative and has cancer-fighting properties.
Water-best to drink purified water, or filtered, to avoid known toxins and heavy metals in tap water. Distilled water is acidic, avoid it.
12. Meat protein is difficult to digest and requires a lot of digestive enzymes. Undigested meat remaining in the intestines become putrified
and leads to more toxic buildup.
13. Cancer cell walls have a tough protein covering. By refraining from or eating less meat it frees more enzymes to attack the protein walls of
cancer cells and allows the body's killer cells to destroy the cancer cells..
14. Some supplements build up the immune system (IP6, Flor-ssence, Essiac, anti-oxidants, vitamins, minerals, EFAs etc.) to enable the
body's own killer cells to destroy cancer cells. Other supplements like vitamin E are known to cause apoptosis, or programmed cell death, the
body's normal method of disposing of damaged, unwanted, or unneeded cells.
15. Cancer is a disease of the mind, body, and spirit. A proactive and positive spirit will help the cancer warrior be a survivor. Anger,
unforgiveness and bitterness put the body into a stressful and acidic environment. Learn to have a loving and forgiving spirit. Learn to relax
and enjoy life.
16. Cancer cells cannot thrive in an oxygenated environment. Exercising daily, and deep breathing help to get more oxygen down to the cellular
level. Oxygen therapy is another means employed to destroy cancer cells.