President Trump and the King of Saudi Arabia discussed the disappearance of the Saudi journalist
US President Donald Trump has suggested "rogue killers" could be behind the disappearance of Saudi journalist Jamal Khashoggi in Turkey.
Speaking to reporters after a phone call with King Salman, he said the Saudi leader had firmly denied knowing what had happened to Mr Khashoggi.
Secretary of State Mike Pompeo is flying to Saudi Arabia immediately.
Turkish police have, for the first time, been inside the Saudi consulate where Mr Khashoggi was last seen.
They entered the building around an hour after a group of Saudi officials.
Media captionPresident Trump and the King of Saudi Arabia discussed the disappearance of the Saudi journalist
US President Donald Trump has suggested "rogue killers" could be behind the disappearance of Saudi journalist Jamal Khashoggi in Turkey.
Speaking to reporters after a phone call with King Salman, he said the Saudi leader had firmly denied knowing what had happened to Mr Khashoggi.
Secretary of State Mike Pompeo is flying to Saudi Arabia immediately.
Turkish police have, for the first time, been inside the Saudi consulate where Mr Khashoggi was last seen.
They entered the building around an hour after a group of Saudi officials.
Turkish officials believe Mr Khashoggi was murdered in the consulate by Saudi agents nearly two weeks ago but Riyadh has always strongly denied this.
However, unconfirmed reports in the US mediasuggest Saudi Arabia is preparing to admit that Mr Khashoggi died as a result of an interrogation that went wrong and that the original intention had been to abduct him.
Meanwhile, Arabic channel Al-Jazeera quotes Turkey's attorney-general's office as saying it has found evidence to back claims that Mr Khashoggi was killed inside the mission.
The issue has strained Saudi Arabia's ties with its closest Western allies.
Mr Trump addressed snatched questions from reporters over helicopter engine noise at the White House, describing King Salman's denial as "very, very strong".
"It sounded to me like maybe these could have been rogue killers," he added. "Who knows?"
The president provided no evidence to back his comment.
A Turkish security source has told the BBC that officials have audio and video evidence proving Mr Khashoggi was murdered inside the building.
Secretary of State Pompeo's visit to Saudi Arabia will be followed by a stop in Turkey.
How are the Saudis reacting?
Diplomatic pressure is growing on the Saudis to give a fuller explanation.
On Monday, King Salman ordered an investigation into the case.
"The king has ordered the public prosecutor to open an internal investigation into the Khashoggi matter based on the information from the joint team in Istanbul," an official quoted by Reuters news agency said.
Saudi officials arrived before the Turkish investigators
The official said the prosecutor had been instructed to work quickly.
Turkey rejected that offer. The Sabah daily newspaper said investigators had wanted to search the building with luminol, a chemical which shows up any traces of blood. It is not clear whether that happened.
King Salman and Turkish President Recep Tayyip Erdogan spoke by telephone on Sunday evening, officials said, and stressed the importance of the two countries working together on the case.
Questions over crown prince
By Frank Gardner, BBC News
Encouraged by the state-controlled media, many Saudis have been rallying round their leadership. There is even a popular rumour that what happened in Istanbul is all a plot by Qatar and Turkey to discredit the blameless Saudi kingdom.
But privately, others are now questioning whether the 33-year-old Crown Prince Mohammed Bin Salman, the man once hailed as a visionary saviour of Saudi Arabia, has gone too far.
He has pitched his country into a costly and seemingly unwinnable war in Yemen. He is embroiled in a damaging dispute with neighbouring Qatar. He has quarrelled with Canada over human rights and he has locked up dozens for peaceful protest while alienating many in royal and business circles.
More conservative Saudis may well be hankering for quieter times.
Media captionCCTV footage shows missing Saudi journalist Jamal Khashoggi entering the Saudi consulate in Istanbul.
Mr Khashoggi, a critic of the Saudi government who has written for the Washington Post, was last seen walking into the consulate on 2 October.
Reports suggest an assault and struggle took place in the consulate after Mr Khashoggi went to get paperwork for his forthcoming marriage.
Turkish sources allege he was killed by a 15-strong team of Saudi agents but Riyadh insists that he left the consulate unharmed.
Mr Khashoggi was once an adviser to the Saudi royal family but fell out of favour with the Saudi government and went into self-imposed exile. He is a US resident.
What other reaction has there been?
The European Union has joined calls for a transparent investigation.
EU foreign policy chief Federica Mogherini briefed reporters after a meeting of the 28 foreign ministers.
"There was full consensus around the table on the fact that we expect transparency, we expect full clarity from investigations to be done by the Saudi authorities together and in full co-operation with the Turkish authorities," she said.
The international conference, starting on 23 October, has been dubbed "Davos in the Desert", though the World Economic Forum says it has nothing to do with its annual event in the Swiss Alps.
Officially entitled the Future Finance Initiative, the Saudi conference describes itself as an "international platform for expert-led debate between investors, innovators and governments as well as economic leaders".
Significantly, it was expected to showcase the reform agenda of Saudi Crown Prince Mohammed bin Salman.
The head of JP Morgan, Jamie Dimon, is one of the latest high-profile executives to pull out.
Ford chairman Bill Ford and Uber chief executive Dara Khosrowshahi are also among those who will not be attending the conference.
A page with a list of confirmed speakers has been deleted from the event's website.
It is still unclear whether US Treasury Secretary Steve Mnuchin will attend the conference. A Treasury spokesperson told the BBC they would "be evaluating the information that comes out this week".
When you think of all the difficult tasks you can engage in during your daily routine, brushing your teeth probably never comes up. After all, you’ve been doing it since you were little.
However, it’s easier than you think to make tooth brushing mistakes, putting your oral hygiene at risk.
Your Bristles Are Too Hard
Hard bristles are often too harsh for your teeth and gums, so most dentists don’t recommend them. Instead, choose soft or ultra-soft bristles that can gently get down under the gum line. Hard and medium brushes don’t do that and can actually abrade the gum.
Your Toothbrush Head Is Large
Your toothbrush should fit your mouth comfortably and it is best to go for smaller ones. Unless you have a large mouth, compact brush heads do a better job of helping you access those hard-to-reach and hard-to-see molars.
Failing To Brush Long Enough
The Nigerian Dental Association recommends brushing for two minutes, but many people fail at this, without even realizing it.
Different studies have timed people brushing their teeth and asked them how long they thought they did it for.
Some people thought they’d brushed for a couple of minutes, but it can be less than half a minute, an indication that our perception of how long we’re brushing is not very accurate.
Brushing Too Hard
If you brush your teeth like you are brushing your shoes, you’re doing more harm than good. When you press hard against your teeth and gums, you get a satisfying sensation that you’re really getting the teeth clean, but it’s not making your teeth cleaner.
The point of brushing is to remove plaque—a bacterial film—which is sticky but also soft, so you don’t need to go hard on your teeth to remove it. Pushing too hard can overstress the gum tissue and cause it to recede, exposing part of the tooth’s root.
That area can become sensitive to hot and cold. The root is also more susceptible to cavities than the hard enamel part of the tooth.
You’re Brushing At Wrong Angles
Brushing straight across like you’re playing the violin isn’t the best way to brush your pearly whites.
It is ideal to hold the toothbrush at a 45-degree angle—upward for your top teeth and downward for your bottom teeth—so the bristles can sweep and clean under the gum line where plaque can hide.
If you have an electric sonic toothbrush, you don’t need to angle the brush to 45 degrees. They’re designed to go straight on the tooth and you just hold it there for a few seconds.
It has now been two whole years since I had last heard his voice and even longer still since I’ve had the pleasure of being graced by his warm smile. Has it really been two whole years? Yes, it has and it still hurts like a son of a bitch. It’s time to shed a little light on a subject that not so many people have ever had the horror of dealing with; the death of your beloved Fiancé/Fiancée. No, I’m not talking about a widow and no there is absolutely no difference.
Losing my fiancé has been and will continue to be the most agonizing and trying experience of my life. I remember getting the call (it was a Thursday) that there had been an accident just one day before he was due to be home from his pre-deployment training. Three months before his 20th birthday. And just six months from our Wedding day. The month of March will forever rein infamy in my mind.
The first year after I had lost Josh can be summed up in one simple word. Blurry. The days seemed to mesh together and getting out of bed to face another day seemed like crueler punishment than it was worth. I had blocked so much pain and details of the actual event that I began to doubt my sanity.
Was I dreaming? Was he even real? I wasn’t sure anymore.
All that I knew was my high school sweetheart, my best friend, my Marine was not coming home and I couldn’t understand why.
Being a fiancée I found that I wasn’t as openly recognized as his parents and siblings. No one came to my home to see me. No one left pans of lasagna on my doorstep with a sceawled note to make sure I had eaten. For every one hundred sympathy cards the immediate family received I would hold tightly to ten of my own. I felt like I was being ostracized because we did not yet share a last name. Had I been a “widowed” my support system would have been ten miles high. And that’s the sad truth. I remember being asked by his mother if I thought that it would have been harder if we were actually married. The answer to that is no. Absolutely not, and it truly hurt me to think that this is what people thought.
As if my heart and my entire life weren’t already crushed enough.
An engagement ring on my finger did not automatically and miraculously make my Fiancé more important to me. My love grew for him with each and every passing day and I still find that to be true two years after his death. If I could turn back the hands of time I would gladly and unhesitatingly take his place. I don’t know of a love more pure than that.
We need to put a stop to how society sees us. I was deemed as insignificant being told just a few months after his passing that I am “young,” and that I will “move on.” was most definitely the last thing that I wanted to hear. In all honestly it made me feel about this big.
If I should one day decide that I would like to move forward in my love life that is my business and my business alone. The fact of the matter is that Joshua was an enormous part of my life and so he will remain until I give my final breath. And there is absolutely nothing wrong with that. Fiancées/Fiancés and girlfriends/boyfriends go under the wayside when it comes to grief. We loved them too. It is different than that of a parent’s love or even a siblings but that does not mean it is any less. Just different.
We loved them too. We always will. And we absolutely do not have to prove this to anyone else. I still ask myself “Why him?” “Why my Josh?” and then came the only explanation that seemed to make any sense at all…
When we are in a garden which flowers do we pick?
The most beautiful ones.
Read this: 13 Things To Remember When You Love A Person Who Has Depression
Read this: 10 Things Girls Who Have Lost Their Dads Want You To Know
Back pain and bloating can be a miserable and frightening experience when they occur together. However, the most common causes of back pain and bloating are usually due to relatively harmless, underlying conditions.
Although back pain and bloating are fairly common symptoms, it is a good idea to see a doctor if they last more than a few days.
Although the most common causes of back pain and bloating are relatively harmless, some of the less common reasons can be life-threatening.
Common causes of back pain and bloating
Back pain and bloating may occur together but may not always be related.
It is worth mentioning that these common causes are by far the most likely reasons that a person will develop back pain and bloating. Causes include:
hormonal shifts
pregnancy
back injuries
gas and gastrointestinal problems
stress
urinary tract infection (UTI)
A doctor will check for these conditions before looking for anything more serious.
Hormonal shifts
Hormones are the body's chemical messengers. As hormone levels swing, they can affect the way the body behaves. Both sexes are vulnerable to hormone shifts.
Many women experience back pain or cramping with bloating during or immediately before their period. If the symptoms follow a predictable pattern and do not cause severe problems, they are generally nothing to worry about.
People undergoing hormone replacement therapy (HRT) may also experience bloating and pain. They should discuss these symptoms with a doctor.
Pregnancy
Sometimes, pregnancy causes bloating, constipation, and gas. This is particularly true late in pregnancy when the uterus begins compressing the organs.
The additional weight at the front of the body can also put a strain on the back and hips. Anyone who is pregnant should tell their doctor or midwife about any symptoms they experience, since any conditions or problems that the pregnant woman experiences can affect the baby.
Most causes of bloating and back pain in pregnancy are harmless and typically clear up after delivery.
Back injuries
A wide range of back injuries, ranging from minor muscle sprains and strains to more serious injuries such as herniated discs, can cause back pain.
Sometimes the pain from a herniated disc radiates to other areas of the body, including the abdomen, and can create unusual sensations, such as bloating.
Gas and gastrointestinal (GI) problems
Most of the time, gas is no more than a minor annoyance.
However, gas occasionally produces intense pain that makes the entire abdomen feel full and tender. This pain can radiate to the back, causing back pain and bloating. Minor gastrointestinal problems, such as stomach viruses, may also cause intense gas pain.
Sometimes, GI issues can cause muscle pain. This can happen after straining to have a bowel movement or repeatedly vomiting.
Stress
Stress changes the body, not just the mind. Intense stress or anxiety can trigger both back pain and stomach discomfort, including bloating.
Back pain often occurs because some people who are experiencing stress tense their muscles unconsciously. Stomach pain and bloating are more common in people who have stress as well as an underlying condition, such as irritable bowel syndrome (IBS).
UTI
A UTI can cause back pain when it spreads to the kidneys. UTIs also trigger a frequent need to use the bathroom. Some people find that they feel like they need to use the bathroom again immediately after using it.
This sensation may feel like abdominal bloating, pain, or pressure. Severe kidney infections can also cause vomiting that leads to bloating.
Less common causes of back pain and bloating
The following issues may also cause back pain and bloating, but are much less common:
spinal injuries and disorders
pancreatic cancer
liver disorders
abdominal aortic aneurysms
serious gastrointestinal disorders, such as peritonitis and bowel obstruction
Although rare, these causes and conditions require prompt treatment. Anyone experiencing severe pain or who thinks they are at risk for a rare cause should see a doctor immediately.
When to see a doctor
A person should consult a doctor if their pain is severe or lasts several days.
Abdominal bloating and back pain are often just minor annoyances that go away on their own. In many cases, the two symptoms are unrelated.
For example, people with chronic pain in their lower back may periodically experience gas that makes their abdomen hurt and their back pain worse.
See a doctor if the pain does not go away on its own after a few days.
Someone should go to the emergency room if:
the pain is unbearable and comes on suddenly
the pain is accompanied by bleeding from the rectum
they have a severe medical condition, such as liver failure
they have recently suffered a serious injury, such as a spinal cord injury
See a doctor within a day if:
there is a fever along with the pain
the pain is getting worse
the pain is different from previous episodes of back or stomach pain
Treatment options
Treatment depends on the cause but may involve the following:
Treating infections and other causes
Bacterial infections, such as UTIs and kidney infections, require antibiotics. Appendicitis and some other causes of swelling in the abdominal cavity may need surgery. If an ectopic pregnancy is the cause of the symptoms, the pregnancy must be removed.
Treating an underlying condition
It is essential to treat any underlying conditions. People with liver failure may need a liver transplant, while those with diabetes may require insulinor diabetes medications.
What if the cause is unknown?
Before a doctor can treat the pain, they must determine the cause. To do this, the doctor may take a complete medical history, press on the abdomen or back to identify pain levels and position, perform blood work, or do imaging scans of the back or stomach.
Home remedies
Drinking plenty of water may help to treat bloating.
There are some home remedies that a person can try to ease back pain and bloating. However, if symptoms are due to a serious condition, such as liver failure, it is essential to talk to a doctor before trying any home remedies. Some treatments may be unsafe for people in organ failure or with other conditions.
If the problem is a minor one, such as gas or a stomach virus, it is usually safe to manage symptoms at home.
Strategies that might help include:
taking anti-gas medication
applying a heating pad to the back or stomach
drinking plenty of water
resting
deep breathing
over-the-counter pain relievers
Outlook
Most cases of bloating and back pain disappear on their own. Some, such as those due to kidney infections or appendicitis, require treatment but can easily be cured with medical care. Managing symptoms will require an ongoing approach in some cases.
Cancer, liver failure, and other serious disorders are more difficult to treat. Early intervention and prompt medical care improve the outlook in all cases.
Takeaway
Abdominal bloating and back pain are widespread complaints, with many possible causes. Unless the pain is intense or accompanied by other worrisome symptoms, it is usually safe to see if symptoms disappear on their own.
However, do not self-diagnose. Only a medical provider can determine the cause of the pain. With prompt treatment, even serious and life-threatening conditions can improve.
A new type of nerve stimulation therapy could provide long-term relief for chronic back pain that has not responded to other treatments, including spinal cord stimulation. It could also help certain people who need a non-drug form of pain therapy.
Up to a quarter of people in America experience low-back pain every year.
So, concludes a study from Rush University Medical Center in Chicago, IL, that featured recently at the 2018 annual meeting of the American Society of Anesthesiologists in San Francisco, CA.
The new therapy is called dorsal root ganglion (DRG) stimulation, and it works by targeting only the nerve fibers carrying signals from the source of pain. Unlike spinal cord stimulation, it avoids nerve fibers that convey messages from non-painful regions.
The recent study evaluated the impact on pain and disability of permanent DRG stimulator implants in people with chronic pain in their lower extremities and back.
Those who received the DRG stimulation says lead author Robert J. McCarthy, who is a professor of anesthesiology at Rush Medical College, "had tried numerous therapies, from drugs to spinal cord stimulation to surgery, but got little to no lasting pain relief."
They reported "significant improvement in pain even after a year, which is notable," he suggests, adding that, "For most, DRG stimulation really improved their quality of life."
A summary of the research is available in the ASA abstracts archive.
Chronic back pain
Although it often accompanies many persistent medical conditions, scientists increasingly believe that chronic pain is a "health concern on its own."
Chronic pain is pain that continues for at least 3 months. It arises when the pain signals that travel to the brain along nerve fibers persist, even though the source of the pain has disappeared.
Estimates for 2016 from the Centers for Disease Control and Prevention (CDC) suggest that around 1 in 5 adults in the United States. live with chronic pain, with around 8 percent having "high-impact chronic pain."
The total annual cost to the U.S. of chronic pain — including the cost of medical treatments, disability programs, and productivity loss — is estimated to be around $560 billion.
Every year, up to 25 percent of people in the U.S. experience some form of low-back pain. For some, the pain persists and becomes chronic, with a total cost of around $100 billion per year.
Spinal cord and DRG stimulation
Spinal cord stimulation treatment involves implanting a small device that sends low-voltage electrical impulses along a wire placed along the spinal cord. The effect is to block pain signals from reaching the brain.
Dorsal root ganglia are clusters of nerve cells — located on each side of the spinal vertebra — that relay pain and sensory signals coming from various parts of the body to the spinal cord and brain.
DRG stimulation disrupts the signals by delivering small electrical pulses through a wire placed alongside the specific DRG associated with the source of the pain. This replaces extreme pain with a more bearable sensation, such as numbness or tingling.
Scientists implant the device, which looks like a small pacemaker, in the lower back under the skin. A pain specialist sets the amount of current that it delivers according to the amount of pain a person experiences.
The idea of DRG stimulation is attractive because, unlike spinal cord stimulation, it only targets the affected nerves. Another reason is that it requires lower levels of electrical current since less spinal fluid covers the targeted DRG than covers the spinal cord.
Prof. McCarthy and his team investigated the effectiveness of DRG stimulation in 67 people with chronic back pain by following them for 3-18 months after implantation. Of these, 17 had the implant for at least 12 months.
'Clinically significant' improvement
People self-assessed their levels of pain on a scale of 1–10 — with 10 representing "the worst pain imaginable" — both before implantation and during follow-up meetings.
Before receiving their DRG implant, most of those in the study rated their pain at level 8. Afterward, the most common pain score was 5, which represents a drop of 33 percent. The researchers describe the improvement as "clinically significant."
There was also a similar decrease in self-reported disability, with a median drop of 27 percent. Researchers defined disability as "limitations in daily living" caused by pain.
When asked if the treatment was helpful, 94 percent of those receiving it said yes.
One person had to have the DRG stimulator removed because of a complication, two people had to have their devices removed following infection, and five others had to have the wires re-inserted.
Prof. McCarthy notes that the DRG stimulator device is not an easy option because of the difficulty involved in placing the electrodes accurately. It could be an alternative, however, for those people who have not experienced any benefit from other treatments.
It could also "reduce or eliminate the need for opioids," he concludes.
"There is a real need for non-drug therapy relief for people with chronic pain.
