Mharidzo kubva kuna Mary Shomon
Chimwe chezvinhu zvinopesana zvikuru zvinotarisana nevarwere vehutori muUnited States uye munyika yose ndeyekuti varwere vanofanira kuzvirapa pachavo kuti vararame zvinetso zvehutano, uye kunyanya, utachiona husingaitiki / hypothyroidism. Apo ini ndikati "kuzvirapa," ndinoreva kutenga mishonga yemishonga yeHymone replacement mishonga pasina mushonga wechiremba, uye wotora mishonga iyoyo pasina kutarisira chiremba.
(Handisi kureva varwere avo vane vanachiremba vanorapa mishonga yekirori asi zvino vanobvumira varwere kuti vaende kana kuti pasi muyero pakati pekushanyira.)
Kuzvipira-kurapa kwe hypothyroidism zvakajeka kune zvimwe zvipingamupinyi zvakajeka kune varwere.
Chokutanga, kana munhu asina kuonekwa se hypothyroid, asi panzvimbo pacho, kuzviratidza, ipapo chimwe chiitiko chinogona kushayikwa - uye kuenda usina kutorwa. Zviratidzo zvakadai sokuneta, kuwedzera kuwedzera, uye kuora mwoyo zvinowanzoitika mu hypothyroidism, asiwo zviratidzo zvezvimwe zviitiko - zvimwe zvakakomba. Kukundikana kuongororwa zvakakodzera uye kurapwa kunogona kuva dambudziko kumurwere anokanganisa kuzvidzivirira uye kuzviratidza-mishonga inonzi hypothyroidism.
Chechipiri, utachiona hunoshanda hahuna hwakasimba nguva dzose. Vanhu vanogona kuva nenguva yenguva pfupi ye hypothyroidism nekuda kwemishonga, thyroiditis, kana postpartum thyroid nyaya mushure mokuva nechecheche, kuteverwa nekudzoka kuhutano hwemazuva ose.
Nhamba yakakodzera yekurapa inogona kukurumidza kuve yakanyanyisa kana utachiona huchichinja.
Chechitatu, pane dambudziko rekuita basa. Kuzvidzivirira kunowedzera dambudziko kune mamwe mamiriro ezvinhu akawanda kusanganisira chirwere chemwoyo, kuneta, uye kuora mwoyo. (Zvechokwadi, kugamuchira kurapwa zvachose nokuda kwe hypothyroidism kunewo mungozi mukuru wezvinetso zveutano.)
Asi chechina uye chikuru chinonyanya kukoshesa vazhinji ndiyo njodzi yokuti avo vanozviti-mishonga vachapfekedzwa . Kutora utachiona hwakawandisa hwemishonga inoshandiswa mishonga kunogona kukonzera zviratidzo zvakasiyana-siyana, kusanganisira kuzvidya mwoyo, kutyisidzira, kunetseka, kurwara kwemashure, kukwirira kweropa, tachycardia (kukurumidza mwoyo kutengesa), kutapudza mwoyo, mwoyo arrhythmia, uye mwoyo unogona kunge wakaipa unhu husingazivikanwi hunozivikanwa sean atrial fibrillation . Atrial fibrillation - dzimwe nguva inonzi "a-fiber," inogona kukonzera kushungurudzika, izvo zvingaguma nekuremara kusingaperi uye kunyange rufu.
Vamwe varwere vanofunga kuti kuzvipira kunorapwa chero bedzi varwere vanoziva. Ndinoziva varwere vanoverengeka vakabudirira kuzvibata. Panguva imwecheteyo, ndakanzwa zvakare kubva kune vakawanda vane chirwere chetachiona vakapedzisira vari mumakamuri ekukurumidzira vachitambura neAirrial fibrillation mushure menguva yekuzvipira. Vakawanda vevarwere ava vakanga vakanyatsoziva uye vachiverengwa zvakanaka pamusoro pechirwere chetachiona, uye vakafunga kuti ivo vanoziva zvikuru pamusoro pekuzvibata kwavo hypothyroidism. Kunyange zvakadaro, vakaguma vachinetseka uye vaifanira kusangana nematambudziko makuru ehutano.
Kunyange zvazvo varwere vakawanda - kunyange avo vanovimba nehutano hwavo - vanoziva kuti pane mungozi yekuzvidavirira, chiito ichi chiri kuitika nokuti varwere vanotarisana nezvipingamupinyi zvakawanda zvinovadzivirira kuti vawane yakarurama uye inobudirira yehutano kuongororwa uye kurapwa .
Ndezvipi zvipingamupinyi?
Kutanga, kune vanhu vakave vaongororwa ne hypothyroidism munguva yakapfuura, asi ndiani asingachakwanisi kubhadhara kurapa kwachiremba. MuUnited States chete, tine mamiriyoni evanhu vasina kuvimbiswa, mamiriyoni evanhu vakwegura pamari yakagadziriswa, uye mamiriyoni akawanda eAmerica avo vakarasikirwa nemabasa panguva yekuderera kwehupfumi. Vanhu vazhinji havakwanisi kubhadhara muhomwe yechiremba. Munyika yose, kuwanika kune vanachiremba vakanaka uye kurapwa mune mishonga ibasa redura, uye kunobva pane geography, hupfumi, hutano hwehutano hwehutano, uye hutano hwemunhu.
Chechipiri, vanachiremba vazhinji vanoramba vachivhiringidzika pamusoro pekududzira hutachiona hunokurudzira hormone (TSH) muedzo - muedzo ivo pachavo vanonzi "yegoridhe" yekutarisa hypothyroidism.
Kana murwere ane zviratidzo zve hypothyroidism, uye ane chirwere chekuedza chinowira muTSH test ye "limbo" nzvimbo - pamusoro pe2,5 uye pasi pe 4.0 kusvika ku5-5.5 - mugumisiro weTSH wemurwere wakanyorwa nemarabhu eUnited States se " iyo rapo yebazi. A TSH mumutengo iwoyo inofungidzirwa se subclinically hypothyroid nedzimwe nyanzvi, zvisinei. Endocrinologists vave vachirwisana uye vachikakavadzana nyaya iyi kwemakore anoda kusvika gumi, kubvira apo American Association of Clinical Endocrinologists (AACE) yakakurudzirwa kutanga kwa2003 kuti inowanzorehwa rutivi rwekuyera kweTSH inoderedzwa kusvika ku3 kusvika ku03 . Vanachiremba vazhinji, zvisinei, vachiri kutevera cutoff point yekare, uye vanozoongororesa uye vabata hypothyroidism kana murwere ane TSH yakareba kupfuura 4.5 kusvika ku6.0.
Chechitatu, pane varwere vane hypothyroidism zviratidzo, uye ndiani anonzi zviitiko "zvekare" pane kuedza kweTSH- kuwira chero kupi zvayo pakati pe33 kusvika ku6.0 - asi avo vakakwidziridza zvirwere zvehutano zvinoratidzira chirwere cheHashimoto chemoto. Vanachiremba vazhinji havana kuziva - kana kuti havaiti maererano ne - tsvakurudzo inoratidza kuti mune vamwe varwere-vane zvirwere zvakanaka, utachiona hwehutano hunogona kubvisa zvirwere zve hypothyroid uye kudzivirira kufambira mberi kwekuwedzeredza hypothyroidism.
Chechina, pane varwere vane "TORV" chaiyo, asi chaizvoizvo kupararira kwemajoni ehomoni - Free T4 uye Free T3 - kuratidzira kushayikwa zvakajeka mune aya mahomoni. Vanachiremba vakawanda vanoramba kubvuma kuti kushaya kwakakwana kana maitiro akadzama e Free T4 uye / kana Free T3 - pamwe nekukwirira kwemashure ekudzoka T3 kana kusina kukodzera kweReverse T3 / Free T3 - zvinoratidza hypothyroidism. T4 inoshandurwa kuT3 - iyo inoshandisa utachiona hormone pamagetsi. Vanachiremba vakawanda vanofunga, zvisinei, kuti munhu wose anogona kutora T4 kusvika kuT3 zvakanaka uye zvakaenzana. Panguva iyi, vanachiremba vanobatanidza, uye mamwe mazano ekugumira endocrinologists, vanobvuma kuti vamwe varwere vangave vane zvirwere, zvirwere zve enzyme, kukanganisika kwezvokudya, kana kuparara kwepanyama kunokanganisa T4 kusvika kuT3 kutendeuka, uye kuti kupererwa uku kunogona kubvumidza mushonga.
Chechipiri, varwere vakawanda vanorapwa neravothyroxine drug - kureva, Synthroid, Levoxyl, Levothroid, Eltroxin, kana generic levothyroxine / l-thyroxine, asi vachiri pachena kuti hypothyroidism zviratidzo, kunyange mushure mekurapa kwadzorera zvirwere zvehutano hwehutachiona hwehutano ku " zvakajairika. " Vamwe vevarwere ava vanokumbira kuwedzerwa kwemishonga yeT3 - kureva, Cytomel (liothyronine), kana nguva-yakabudiswa T3 - kana kukumbira mishonga yemhando yakasikwa yakarongerwa utachiona - kureva, zvombo, Nature-Throid, kana Erfa. Kushandiswa kweT3 kunokakavadzana, asi , uye vanachiremba vakawanda havatendi mukushandisa T3 mishonga kana mishonga yemakiriniki chaiwo chero ipi zvayo. Vanachiremba ava vanowanzotaura kuti hapana mishonga yemishonga inowedzera inodiwa nokuti zviratidzo hazvisi zvehutachiona, kana kuti zviratidzo zvinoratidza hutano hwehutano hwepfungwa uye kuronga kusagadzikana kwepfungwa. Kazhinji, tinonzwa "hapana munhu anoda T3 kana utachiona hwepanyama" nekuti "munhu wose anotendeuka maitiro eT4 kusvika kuT3 zvakakwana." Izvi "hazvidi iwe / munhu wose anotendeuka T4 kusvika kuT3" mantra inozivikanwa uye inogara ine myt
h in hypothyroidism treatment. Vamwe vanachiremba vanoramba kurayira T3 uye / kana mishonga yemasikirwo emusango nokuti vanonzwisisa kuti mishonga iyi inoisa mungozi yemigumisiro yomuviri yevanhu vose. Asi njodzi dzinenge dzisingabatsiri apo mishonga inoshandiswa zvakakodzera uye yakatemerwa. Kune vamwe varwere vane utano hwakanaka, njodzi yeT3 uye mishonga yemakemikari yemhuka ndeipi kana murwere wacho akapererwa zvakanyanya. Vanachiremba vanonzwisisika vakangwarira kunyange zvakadaro vane varwere vakwegura nevarwere vane hutano hwemoyo hwepakutanga huripo / chirwere chemoyo, sezvo zvikamu izvi zvingave zvakanyanya kufanana neT3 kana kuti mishonga yemasikirwo emunhu ane T3. (Zvinonakidza, kunewo tsvakurudzo inoratidza kuti kusatorwa kwe hypothyroidism kunowedzera mukana wechirwere chemwoyo .)
Chechitanhatu, kune vamwe varwere vanovharwa nehutano hwehutano masangano (HMOs) kana inshuwarisi yezvehutano, avo vanachiremba vanoramba kuedza kunyange kuongorora hypothyroidism, vanoramba kubata borderline / subclinical hypothyroidism, vanoramba kubata chirwere cheHashimoto chega, vanoramba kuedza kana kuti kubata T4 Free / Free T3 kusawirirana / kusagadzikana, uye / kana kuramba kuronga mishonga T3 uye / kana mishonga yemasikirwo chaiwo. Vamwe vevarwere vachiona vanachiremba ava vane mari vasingakwanisi kubhadhara muhomwe kuti vashanyire kune chiremba ane chirwere-savvy.
Pakupedzisira, kunze kweU.S., kuzvirapwa kunenge kudikanwa kune vamwe varwere. MuUnited Kingdom, somuenzaniso, vazhinji vagari vanoshandisa National Health Service (NHS) pakurapa kwavo. Vanachiremba veNHS vanodiwa, zvisinei, kutevera zvakasimba-zvimwe vangati, nguva yakareba uye munguva dzakawanda dzisina kunaka - zvidzidzo pakuongorora nekurapa hypothyroidism. Panguva imwecheteyo, kune vashoma vanachiremba voga kuti vaongorore uye vabata hypothyroidism, uye vanachiremba ivavo kazhinji vanodhura zvikuru.
Chinetso Chevarwere Venyu
Saka, pamagumo, inofanirwa here kuti varwere vape-mishonga, kana kwete? Ini ndangobva kukonzera kushushikana pakati pevarwere vanozviti-mishonga nokuti ndati handisi kutsigira kuzviritira, uye kuti Save Natural Thyroid Coalition - boka randakagadzira munguva yezhizha ra 2009 kubatsira varwere kukunda kushayikwa, kusawanika uye FDA kukanganiswa kwezvinhu zvakasikwa zvakarongwa nemishonga yehutachiona - uyewo haitsigiri kuzvirapa.
Hapana mubvunzo kuti varwere vari mumamiriro ezvinhu akaoma. Uye inonzwisisa zvakakwana kwandiri kuti vamwe varwere vanonzwa kuti havana imwe nzira kunze kwekuti-mishonga. Handisi kutsoropodza sarudzo yega yega-mishonga - icho chinhu icho munhu mumwe nomumwe anofanira kuzvisarudzira. Zvinoshungurudza kuti vamwe vanhu vanomanikidzwa nemamiriro ezvinhu kuti vaite chisarudzo icho, uye ndinoshatirwa pamusoro pekuti madzimai anoona sei zvirwere zvehutori, maitiro anoita kuti vamwe varwere vaite chisarudzo ichocho. Ini ndinotarisirawo nomwoyo wose kuti avo vanozviita-mishonga vanoita saizvozvo nekuchenjerera kukuru uye vanogona kudzivisa chero matambudziko.
Nharo yevamwe varwere ndeyekutenda kwandinoita kukurudzira kuzvipira-uye kunyanya, kukurudzira kuzvishongedza nehutachiona hwehutachiona hwemhuka - pakupedzisira kunogona kurwisa zvinetso zvevarwere zvehutano.
Takatotarisana nenguva inoshungurudza yehutachiona hwehutachiona hwekunyanya kuva shomanana kana zvachose kubva pamusika , kusanzwisiswa kwekushayikwa kwezvinhu zvakasvibiswa, uye kusanganisa kunoshamisa kunoratidzika kunotungamirirwa nemashure-e-zvikamu zveDAA zviito. Maitiro emasikirwo emasikirwo akasiyana-siyana anowanikwawo muRWA yakatora nguva yakawanda ye "zvinodavirwa" zvinodhaka izvo zvichange zvichitomanikidzwa kupinda munguva inopedza uye inodhura nzira. Iyo FDA yakaratidza pachena kuti utachiona hwepanyama mishonga isingagamuchirwi, uye haina kuberekwa, uye kuti pakupedzisira inofanira kupfuurira kuburikidza nemvumo yekubvumirana kuitira kuti urambe uri pamusika. Nguva uye kuti sei izvo zvichaitika zvichiri kusarudzwa. Dare rekuita sarudzo yeDAA yezvibvumirano zvisingabvumirwi nemishonga hazvirevi pachena. Zvatinoziva ndezvokuti zvematongerwo enyika uye zvezvematongerwe enyika mushure mezviitiko - masimba asina hanya nehutano hwehutano - anowanzofambisa kusarudza kwekuita.
Vamwe vanachiremba, uyewo vakuru vakuru veDFA vakanditaurira, kubva panhoroondo, kuti vanofunga kuti kushamwaridzana kusina kunaka - kusanganisira mumabhuku ezvokurapa - pamusoro pehutachiona kuzvirapwa kwave kuchienda zvakasvibiswa nemishonga yekemikirini mumutambo usina kudiwa - uye wakaguma mukati mavo vachiwana kuongororwa kwakanyanya neDefA.
Chimwe chipingamupinyi kumishonga yemakemikari echisikigo ndeche Dr Sidney Wolfe weZvizvarwa Zvose, uyo akasarudzwa kuDAA's Drug Safety uye Risk Management Advisory Committee. Nokuda kwechimwe chikonzero icho chisati chisinganzwisisiki, chakavhiringidzika Dr. Wolfe - uyo dzimwe nguva akataura zvakananga kuti utachiona hwepanyama ndihwo huwandu hwekuwedzera (hausi), uye hunoitwa kubva kumhou (ndiyo porcine, kubva munguruve) - - ari muvengi anokakavara wehutachiona hwehutachiona hwemhuka (kana kuti chero chii chaanotenda iye zvino chaiwo chaihwo chetachiona yakashandiswa kuti ave.) Akabudisa diatribes yakazara-kukanganiswa neHurus Thyroid muHurumende dzeVanhu "Worst Pills, Best Pills" nhepfenyuro nguva refu vasati vaiswa kushanda paDare reDFA. Iye zvino ari mukana wekusarudza kuti zvipi zvinodhaka zvinopedzisira zviri mumasangano eDrams for FDA's Unapproved Drugs campaign.
Uye chipingamupinyi chikuru chinoramba chichirongwa che "chitubu" - uye tarira ndinosanganisira endocrinologists, vanachiremba vanowanzogadzirwa, mapepa ezvechirongwa chetachiona, FDA, vamwe vezvematongerwo enyika, uye makambani makuru emishonga anoita levothyroxine - avo vanofara chete kubata uye kuita uswa kunze kweZVO uye kushamiswa kwose kusina kunaka, mhedzisiro yakaipa, kana zvinetso zvinonzwisisika nehutano hwepanyama uye / kana T3 kurapwa, vachitarisira kushandisa nhau dzakaipa senzira yekuita kuti mishonga iyi ibve pamusika. Zvinosuruvarisa, asi hazvishamisi kuti "zvinetso" kakawanda hazvina chokuita nehutano hwehutano uye zvose zvinoita nekutarisira, kufara kwemari, chikwata chetachiona, kana kuti zvisiri izvo.
My Thyroid Advocacy Mission: Kushanda Kuti Kukurire Thyroid Groupthink
Somurevereri ane mwoyo murefu, ndinoda kuisa pfungwa dzangu pakubatsira kudzidzisa nekusimudza nekuziva, uye kutsigira kuchinja kune imwe nzira pachayo. Pakupedzisira, ndinoda kuti tive munyika umo varwere vashoma vanoita zvechisimba kuti vasarudze kusarudza pakati pekuzvipira-uye zvinetso zvayo zvinoenderana nekubatsira-uye vasina kurapwa.
Usaita chisina kukanganisa, ichi chinangwa chakaoma. Kurwisana nenyika inotenderera ye endocrinology, uye "bhizimisi" remishonga yekodhi - uye vanachiremba vanoverengeka vakambotaura nezve "udzvinyiriri hweTSH" - yakaoma. Iyo hondo vazhinji vedu tanga tichirwira kwemakore anopfuura gumi. Takaona zvimwe zvigadziridzo, uye zvimwe zvipingamupinyi munzira.
Sezvatinoziva, kubva mune zvehutano / zvezvesayenzi, vazhinji magumo endocrinologist uye masangano endocrinology vanononoka kutora kuchinja, uye, zvinosuruvarisa, kazhinji vanoita sevanofarira zvikuru nhamba pamushumo webazi kupfuura mune murwere akagara pamberi pavo uye kana murwere uyu ari kufara chero hupi hwehupenyu. Vanachiremba vanotenderera pamuedzo weTSH - kuedza kwechipiri kwehomoni yepituitary - kuongorora uye kugadzirisa hypothyroidism, pavanonzwa vachikodzera kuregeredza zvachose mazinga eT3 Free - hormone inoshandiswa iyo inopinda mumasero kunopa oxygen nesimba. Vanachiremba vazhinji havatotambudziki nekuedza majekiseni ehutachiona - izvo zvingatiudza kana utachiona huri mukusakundikana kwega.
Panguva iyi, zvizvarwa zvakasiyana-siyana zvemaprotinologist uye vanachiremba vakamboudzwa kuti kugadzira thyroxine (T4) - inozivikanwa se levothyroxine / l-thyroxine - kana kupfuura, kazhinji, nezita rokuti Synthroid - ndiyo imwe nzira yekugadzirisa. Vakataurirwa kuti levothyroxine yoga inokunda kurapwa kwemaawa ne synthetic triiodothyronine (T3) - inozivikanwa se liothyronine (Cytomel). Vakataurirwa kuti utachiona hwechirwere hwakanga huripo - hwaive, kwehafu yezana remakore chete hypothyroidism kurapwa - "yekare-kare," "isina kugadzikana," uye yakaderera kune yakagadzirirwa thyroxine. Icho chaiyo sayenzi inenge iri munzvimbo yose, zvisinei, uye chero chirongwa chinorapwa chinonzi chiremba anotsigira - kana iri levothyroxine monotherapy, yakagadzirirwa T4 / T3 therapy inoratidzika, kana kushandiswa kwehutachiona hwehutachiona hwakakosha - kune dzidzo dzinogona kusimbisa nzvimbo yakasarudzwa. Uye kana chiremba achitarisana nechidzidzo chinopesana nemafungiro ake, iwe unowanzovanzwa vachiti, "zvakanaka, 'zvakaipa' kudzidza."
Kunze kwekurwisana kwezvokurapa / yesayenzi, mishonga yemishonga inoita mari inokonzera kukanganisa pamagariro evanhu vane utachiona.
Hazvisi chakavhiringidzika kuti hutachiona hwehutano hwehutano-kureva, American Thyroid Association, uye American Association of Clinical Endocrinologists - kuwana mazana emazana emadhora gore negore muzvipo, mari, rubatsiro, uye zviitiko zvinotsigirwa kubva kune vanogadzira Synthroid. Uye vazhinji vechiremba vane hutungamiri mabasa mumasangano aya anogamuchirawo mari kubva kuSystemroid's manufacturer.
Izwi reSyroidroid reLevothyroxine rave riri mishonga yakatengesa zvikuru muUnited States kwemakumi emakore, uye inobatsira zvikuru. Pazvikoro zvezvokurapa, mahofisi ekupedzisira, uye mumaharafeteri evashandi munyika yose, masikati emateresi uye muffin mabhasikiti anosvika nguva dzose, anorayirwa neStyroid's manufacturer, senzira yekubatsira kuti zviratidzo zvavo zvehutano hwehutano - izvo zvisingasanganisi T3 uye utachiona hwepanyama - ndiyo iyo vanachiremba, vanamukoti, vashandi vehofisi, vadzidzi vezvokurapa uye vanachiremba vaduku vanonzwa. Uye usakanganwa mapurisa ekutengeserana - pamwe chete nemasikirwo emishonga asingabhadharwi uye swag semakango, mugs, mabhuku, mabhadharo ezvinyorwa, mapiritsi emhando yeplastiki, nezvimwe zvinhu - kuti mishonga yezvemishonga inoshandiswa nezviuru vhiki imwe neimwe kumahofisi echiremba , uye kugovera pamisangano yese yehutano yehutano.
Mugumisiro wekupedzisira: tine zvizvarwa zvakasiyana-siyana zvechiremba vanofamba muchivharo-chechi, vachitenda-uye vachiramba vari kunzwa shoko kwose kwose kwavanoenda-iyo Synthroid ndiyo yekugadzirisa imwechete yevanhu nevose vane hypothyroidism, iyo yose inotendeuka T4 kusvika kuT3 zvakakwana, kuti hapana munhu anoda T3, uye kuti hapana chakaita chechisikiro chakasikwa chetachiona mu hypothyroidism kurapwa.
Chirwere chekotosi uye kukanganisa kwevamwe vanachiremba kune huwandu hwemari hwakawanda kwazvo zvokuti kune vamwe vepedocinologists uye vanachiremba vanopomera pachena uye vanowedzera vamwe vavo vanachiremba vanopa mishonga T3 kana mishonga yehutano yepanyama kune varwere.
Kuita chipi nechipi chandinokwanisa kubatsira kubvisa uku kufunga kwakasimba-kufunga kuti izvo zvinoshora vanhu vazhinji kuhupenyu hwehutano - ndicho chinangwa chikuru chekukurudzira kwangu.
Basa rangu nderokukurudzira kuzivikanwa kwehuwandu hwakazara hwehutano husarudzo hunogona kurongerwa zviri pamutemo - kusanganisira T3 uye mishonga yemasikirwo emuviri. Chinangwa changu ndechekushandira kune nyika umo huwandu hwakazara hwehutano hwehutano hwepamusoro huchava huri nani kunzwisiswa, hunozivikanwa, huri nani hunogamuchirwa, huripo, uye hunowanikwa zviri pamutemo ... nyika umo kune kunzwisisa kukuru pakati pechiremba, vekuchengetedza, pharmacies, mishonga yezvokurapa, uye varwere vane huwandu hwehutano hwakanaka hwehutano hwehutano. Uye nekuwedzera, basa rangu nderokubatsira kuchengetedza izvi zvisarudzo zvinopesana nekurwiswa neboka dzakasiyana-siyana dzinofarira dzinoda kuvaona vachibviswa pamusika.