Front view with open arms. So kids and teens with pectus carinatum may: feel short of breath, especially during exercise. Thousands of new images every day Completely Free to Use High-quality videos and images from Pexels. Pectus carinatum can affect one side of the chest more than the other. Put your oven on to preheat to 180°C/350°F. have a fast heartbeat. Pectus carinatum literally means 'chest with keel' (Nuchtern et al. Pectus carinatum is an overgrowth of costal cartilage causing the sternum to protrude forward. Rapid heartbeat or heart palpitations. It can be associated with poor body image and psychological distress. Pectus carinatum is more prevalent in boys, and it often becomes evident during a child’s preteen or early teenage years. In severe cases of pectus excavatum, the breastbone may compress the lungs and heart. Pectus excavatum makes the chest look sunken. However, in later stages, surgery is the only way of correcting the damage caused by the illness. Day 10: Prominent pin feathers may be visible on the wings, back, tail, and breast. In flight, all ages are instantly recognizable by their broad white bands in the wing. The chest wall surrounds and protects the heart and lungs. The deformity varies in severity, ranging from a mild to severe indentation or protrusion. The normal angle of Louis is between 145° and 175°. Symptoms of pectus excavatum Pectus excavatum is a Pigeon chest, clinically known as Pectus carinatum, is a structural condition affecting French Bulldogs among other breeds. The condition is also known as "pigeon chest" or "chicken breast. chondromanubrial: protrusion of the manubrium and upper sternum (less common); known as Currarino-Silverman syndrome. However, affected horses may develop a fever. Photos 2. The condition primarily affects pubescent through adolescent males, so that a pectus carinatum brace for a child needs Jan 25, 2024 · During the first few weeks of their lives, baby pigeons remain in the nest, growing rapidly and developing feathers. Pectus carinatum ("pigeon chest") is a common condition in which the breastbone and ribs are pushed outward. By wearing an orthosis brace, Pectus Carinatum, a chest deformity, can be corrected. May 13, 2024 · Pectus carinatum (ie, carinatum or keel-shaped deformity of the chest) is a term used to describe a spectrum of protrusion abnormalities of the anterior chest wall (see the image below). dovebirdfreedom. All Sizes. It develops during childhood and worsens during puberty, causing symptoms like shortness of breath, chest pain, and asthma. It is less common than pectus excavatum. It can grow up to be 1 ft. The Pygmy pouter is one of the smallest breeds of pouters. A pectus condition is the name given to a group of chest conditions in which several ribs and the breastbone (sternum) grow differently. CHKD offers the non-invasive vacuum bell for patients with mild pectus excavatum. Ann and Robert H. We would like to show you a description here but the site won’t allow us. There are nine main groups of domestic pigeon breeds, categorized by their physical traits, country of origin, or special abilities. Add the pigeon breasts, onion, apple, carrot and sage to a casserole dish and pour in the chicken stock. Horses with external abscesses are normally not ill. They are usually tall and slender. Find high-quality stock photos that you won't find anywhere else. A skinny muskular man with funnel or sunken chest, better known in medicine as Pectus Excavatum. Also known as pigeon chest, this deformity effects about one in 1,000 children and is less common than pectus excavatum, in which the chest caves inward. Kids need to wear a brace for 6 months to a year. 2012). Weighing as little as 12 ounces, breeds in this group Pectus carinatum (pigeon chest) is a condition where the front of the chest is prominent. 4,939 Free photos of Pigeon. 6K Videos 379 Users 182. Corrective options include operative repair and nonoperative bracing. The longest pouter pigeon breed is the Old German Cropper, which is 24 inches (2 ft) tall. Dec 6, 2022 · Pigeon fever is a common bacterial infection of horses caused by Corynebacterium pseudotuberculosis. It affects 1 in 1,500 children. In pectus excavatum (funnel chest), the sternum (breastbone) is depressed in a concave shape, and in pectus carinatum (pigeon chest), the sternum protrudes in a convex shape. Boasting a lean body, its elongated legs and upright stance make it look even taller. The most common symptoms are limb swelling, usually in one or both hind legs Pectus carinatum may occur alone or along with other genetic disorders or syndromes. Most kids with pectus carinatum can be treated with a chest brace. This transmission typically occurs via flies Funnel chest & pigeon chest. Request an Appointment. ” Pectus excavatum is a chest wall deformity from birth affecting an estimated one-in-400 babies. pigeondovebird. In pectus carinatum, the cartilages grow abnormally, causing unequal Abscesses can occur anywhere on the body but are commonly located in the pectoral area (on the front of the chest thus the name “pigeon fever” or “pigeon breast”). This condition can impair a dog’s overall Mar 11, 2016 · The pouter pigeon chest can be appreciated on sagittal CT images although traditionally lateral chest radiography has been used. Thousands of new images every day Completely Free to Use High-quality videos and images from Pexels Mar 24, 2024 · The English Pouter pigeon stands out as the tallest among fancy breeds, reaching an impressive 16 inches. Toy and Miniature Breeds. PC is most common in adolescent males, and 90 per cent of cases are diagnosed after children are 11 years old. Chop the carcasses with a heavy knife and brown well in 1 tbsp olive oil. Jul 12, 2011 · As with most equine ailments, complications aren't unheard of in horses with C. Pectus Carinatum: Also called a "pigeon chest," the sternum bulges out of the chest in children with this Introduction. The condition rarely affects the function of the heart and Contact us to learn more about our pediatric Chest Wall Program or to schedule an appointment. Most cases of pectus carinatum are mild and do not require surgery. There are two patterns of sternal protrusion: chondrogladiolar: protrusion of the middle and lower sternum. Download and use 2,000+ Pigeon stock photos for free. 760. Common Wood-Pigeon is a burly pigeon with a low, growling song to match. Pectus carinatum is also called “pigeon chest”, is a deformity of the chest characterized by a protrusion of the sternum and ribs. #. It primarily occurs among four different P4COft© Orthosis Braces. pigeon chested Frenchie. You can contact us at 843-792-3853 to talk to a live person. It affects around 1 in every 1500 children, occurs more often in boys and typically becomes more pronounced during early adolescence. It is also known as a pouter pigeon chest. Further, you will notice that its waist, which is long and V-shaped, constitutes about one-third of its overall length. Let’s talk about different treatments in more detail. Goehring explained that chest thus the name “pigeon fever” or “pigeon breast”). Once a horse becomes infected with C. There is a narrow depression along the sides of the chest. It usually happens during a rapid growth spurt in children and adolescents aged 10 and older. Hello, I've got a male french bulldog pup who is now 15 weeks old, I noticed his chest stuck out a bit a few weeks back and took him to the vets for a check up who said he has pigeon chest! I have to take him back when he is 6 months old for another check up but just wanted some Day 1: Baby Pigeon hatches blind and weak. Associations. T he Edwardian era of the early 1900s was a time of transition and change in the fashion world. With any of these referrals, no pre-visit studies are needed. Jun 28, 2019 · Pectus arcuatum, or “ wave-like chest ”, is a descriptive term is used in a situation of a mixed deformity which contains both a pectus excavatum and pectus carinatum either along the longitudinal or axial axis. Size and Body Structure. Pectus carinatum is a term used to describe a spectrum of protrusion Apr 19, 2017 · To help you get up to speed, here are six little known or sometimes forgotten facts about the infection. Pectus excavatum is a congenital anomaly. Signs and symptoms may include: Decreased exercise tolerance. There may also be areas where the rib cage is depressed or ‘pushed inwards’. This condition gives you less space in your chest, which can limit heart and lung function. It is covered in hair-like yellowish feathers. Search from Pigeons stock photos, pictures and royalty-free images from iStock. 3 ft) inches tall. Noonan Feb 21, 2018 · Female. Plumage is variable, but most common form has gray back, 2 black bars in the wing, and blue-gray head. Pectus carinatum is thought to affect approximately 1 in 2,000 people in the United Pectus excavatum. Boys are more frequently affected that girls. May 10, 2023 · Kids with pectus carinatum have a chest that juts out. The condition, which affects one out of every 500 children, is caused by an overgrowth of the costal cartilages which connect the ribs to the sternum. Pectus carinatum may occur alone or along with other genetic disorders or syndromes. People with pectus carinatum generally develop a normal heart and lungs. Cook in the oven for 1 hour and 45 minutes. She survived World War I and its immediate aftermath, but she lost her brother Browse 159,000+ pigeon stock photos and images available, or search for carrier pigeon or pigeon forge to find more great stock photos and pictures. Pectus carinatum is usually only a cosmetic defect but can be associated with other genetic diseases. Designer and Manufacturer of the P4CO line of Pectus Brace Orthoses. The disease is most common in California. Braces. And the English Pouter can be 16 (1. This is caused by abnormally shaped ribs. Call (650) 509-5891. Their parents feed them a nutritious diet of crop milk, also called “ pigeon milk . {file27120}The deformity may be classified as either chondrogladiolar or chondromanubrial, depending on the site of greatest prominence. Pigeon photos for download. The chest may look uneven. Common Wood-Pigeons have been very successful in modern-day Europe, nesting in woodlots or city parks Download and use 3,000+ Pigeon-chested stock photos for free. PIGEON FEVER TAKES THREE FORMS. Horses contract the infection when the bacterium enters their body through open wounds or broken skin. While both kinds of patients may have chest pain from the deformity, excavatum patients commonly Popular Pigeon Breed Groups. The name Pigeon Fever given as the horse’s chest becomes the “Pigeon breast” like appearance due to the swelling of the abscess. Dec 20, 2020 · A “pigeon chest” is medically known as Pectus Carinatum. A common sight in towns and cities around the world. Also known as “pigeon chest”, pectus carinatum is identified by examination of the sternum (breastbone) which has a characteristic protrusion, causing the chest to grow outward. The braces can go over or under the clothes and are worn for 14-24 hours daily. As their names suggest, these tiny pigeons have been bred to be kept for ornamental purposes. Pectus carinatum is a condition that causes the chest to a have a “bowed out” or “pigeon chest” appearance. It is typically apparent at birth and tends to worsen as the child grows. In flight, note black wingbars and broad black band at tip of tail. It can push forward the top, side, or bottom of the breastbone so it sticks out. Pectus carinatum (PC) is a deformity of the chest which causes the breastbone (sternum) to be pushed out. Pectus Carinatum [1] Pectus carinatum (pigeon chest) refers to a chest wall deformity in which the sternum protrudes anteriorly. Sometimes, kids have pectus carinatum on one side of the chest, and a different chest wall disorder — pectus excavatum — on the other side. If Aug 11, 2023 · Pectus carinatum is a condition in which your sternum (breastbone) sticks out more than usual. Dec 6, 2023 · Pigeon fever is a bacterial infection in horses caused by the bacterium Corynebacterium pseudotuberculosis. Pectus carinatum is a chest deformity in which the breastbone and ribs are pushed outward. Side view of a muscular naked man with kyphosis and lordosis, due to the Pectus Excavatum or sunken chest. There are two basic types of congenital chest wall deformities: Pectus Excavatum (sunken chest), and Pectus Carinatum (a protuberant or "pigeon chest"). Pectus carinatum occurs more often in males than females (4:1 ratio), and develops somewhat later in males than it does in females. Jul 12, 2011 · An affected horse generally forms external abscesses, particularly in the pectoral area (hence, the name pigeon fever), around the head, and in the udder or sheath areas. Pectus carinatum constitutes approximately 7% of all anterior chest wall deformities. Pigeon-breasted. Mar 31, 2022 · In some people, the depth of the indentation worsens in early adolescence and can continue to worsen into adulthood. pseudotuberculosis, the bacteria release a toxin that ultimately spurs the body to build a thick-walled abscess around the pathogens. Mar 22, 2016 · More to Read. " Other terms for the deformity include chicken breast, pigeon chest, pyramidal chest, thorax cuneiform, or sternal kyphosis. [2] Pectus carinatum is a deformity of the chest wall in which the breastbone and ribs are pushed outward. 01. Appointment Request Form. 1. As baby pigeons grow and gain Pectus carinatum, also called “pigeon chest”, is a rare chest wall deformity characterized by protrusion of the sternum and the ribs. pseudotuberculosis infections, occurring about 10% of the time; common complications veterinarians encounter include Method. While typically a congenital issue, it becomes noticeable as the puppy grows. It is characterized by a protrusion of the sternum and ribs, giving the chest a pointed appearance. Jan 3, 2024 · Pectus excavatum is a condition characterized by depression of the sternum (breastbone). In some children and young people, both sides May 13, 2024 · Pectus carinatum (ie, carinatum or keel-shaped deformity of the chest) is the second most common chest wall deformity in children. Adorned mostly in subtle shades of lilac and gray, adults also have flashy white (or tan) neck patches trimmed with green iridescence. This creates a noticeable and sometimes severe indentation of your chest wall that involves four or five ribs per side. The term is derived from the Latin phrase for "chest with keel. Lurie Children’s Hospital of Chicago. Jan 3, 2019 · Pectus carinatum, or pigeon chest, is a condition that causes the breastbone to protrude outward. It is present at birth but often becomes more noticeable have chest pain. Chicago, IL 60611. Chicago Ave. Frills and Owls – These pigeons are known for the reversed feathering on their chest and also for having shorter beaks than other breeds; more “owl” like beaks. Typically, this happens as young people are in late primary education and entering secondary (9-14 years). Jan 2, 2024 · 1. Pectus Carinatum Brace. May 30, 2024 · On the other hand, if your dog has pectus carinatum, your dog’s chest may appear puffed out and rounded. Pectus Pectus carinatum is an abnormal growth of rib cartilage that pushes the sternum out, away from the spine. Other names for pectus excavatum are sunken chest or funnel chest. Much like how braces realign teeth, a chest brace will push the breastbone back to a normal position. Pectus carinatum often gets worse as Pectus carinatum (pigeon chest) Pectus carinatum (PC, or pigeon chest) is a chest wall deformity where there is overgrowth of the cartilage between the ribs and the sternum (breastbone), causing the middle of the chest to stick out. Abscesses are well encapsulated and contain tan, non malodorous exudate (pus). It is caused byContinue reading → Pectus carinatum, also known as 'pigeon chest' is a congenital deformity of the anterior chest wall, and occurs when the breast bone is pushed outward by an abnormal overgrowth of cartilage. The opposite deformity is known as pectus carinatum (pigeon chest). If patients are diagnosed after adolescence, they can still be examined to determine what their options are given the severity of the deformity. MUSC providers are experts at treating Pectus Carinatum, also known as "pigeon chest," - one of the most common chest wall deformities. Pigeon chest (pectus carinatum) is the second most common chest abnormality seen in children. In the early stages, the easiest way of treating pigeon chest is with bracing. Braces are the first-line treatment. 225 E. It may affect both children and adults and is a rather rare illness. Horses with external abscesses may also have internal infection, and systemic Jun 27, 2022 · Breeds include the Ice Pigeon, Archangel, Saxon Field Pigeon, pale-vented pigeon, pink-necked green pigeon and the very rare Nicobar pigeon. This keeps the rib cage open or expanded for a long time. Heat the vegetable oil in a frying pan, season the pigeon breasts and quickly brown and seal them in the oil. Pectus carinatum: Also called “pigeon chest,” this condition causes the ribs and breastbone to grow outward and make the chest jut out. Jul 6, 2020 · Pectus carinatum, also known as pigeon chest, is a rare chest wall malformation where the sternum and ribs protrude abnormally. Plump bird with small head and straight, thin bill. Some patients are born with a combination of the two, which creates an asymmetric deformity. There are two main types of pectus carinatum deformity [ 1-3 ]: chondrogladiolar Dec 4, 2020 · There are two main types of deformity: Pectus Excavatum (sunken/hollow chest) and Pectus Carinatum [1] (pigeon chest) but there are also other less frequent types or ‘mixed’ pectus deformities. The use of avian terminology to describe this condition derives from the Latin word for 'keel' – carina. Imaging with CT allows calculation of the angle of Louis in order to determine the severity of the deformity. They are most effective if used before age 19 and the child’s growth spurt; the chest wall structures become more rigid after age 19 and the growth spurt. Up to 50% of patients will have a close relative with a similar chest wall Mar 21, 2023 · Pectus excavatum: Also called “sunken chest,” this condition pulls the breastbone inward, giving the chest a caved-in appearance. Jan 19, 2024 · It is the most common chest wall deformity, accounting for approximately 90% of cases, occurs in up to 1 in 300-1000 births and is more frequently seen in males (M:F = 3:1) 1,4. Why does it occur? In most people, it occurs following a growth spurt. May 27, 2024 · An abnormally curving backbone: This is the most common finding with pectus carinatum. Sep 14, 2023 · Pectus carinatum is a protrusion deformity of the anterior chest wall. Day 5: Noticeably larger now, the squab’s eyes are at least partially open. Previous123456Next. Add the vegetables, garlic, bay leaf, juniper berries and whole peppercorns and cook for another 5 minutes. It affects 1 out of every 500 children. These deformities are visible at birth and may worsen as the dog starts to grow and Feb 17, 2014 · Chow estimates the two-year treatment to cost about HK$10,000 to HK$15,000. This is a special secretion produced by their crop, which is a pouch-like structure in their esophagus. Rock Pigeon. Between appointments, seek medical attention if you have any of the following symptoms: chest pain, shortness of breath, persistent cough, fevers greater than 101. Sep 13, 2023 · A pectus carinatum may be demonstrated on lateral chest radiographs or cross-sectional imaging of the chest. This happens Jan 30, 2014 · Pigeon chest or pectus carinatum (PC) is the second most common congenital chest wall deformity. Although most are sporadic it can be seen in association with: Marfan syndrome. The condition occurs in about 1 out of 1,000 children. #1 Feb 21, 2018. Stir to mix well. Trim the fillets into a nice shape and set aside. Popular. Filters. Carbon Based, LLC provides treatment for pigeon chest and pectus carinatum. It is noted by Hefti that expressions taken from the animal world, such as those Jun 18, 2020 · When discovered in time, it can be treated with a pectus brace. It is more common in boys than girls (ratio, 4:1). 4,927 Free photos of Pigeons. For example, a patient with a severe pectus excavatum The general term 'pigeon chest' is a common name for any form of pectus carinatum. This gives the chest a bowed-out appearance similar to that of a pigeon. ”. The pectus carinatum overview is as follows: In certain cases, the precise cause of pectus carinatum is unknown. It is a protrusion of the chest over the sternum often described as bird-like. Learn about the types, causes, diagnosis, and treatment options for this non-life-threatening disorder. While it may be seen in very young children, it usually becomes more obvious during or after a growth Dec 22, 2022 · Epidemiology 1 2. All pictures are free to use. 7223. Until recently, however, a chest brace for pigeon chest (as it is also known) was bulky, heavy, and uncomfortable. We offer pectus carinatum surgery and other nonsurgical treatment Pigeon chest (pectus carinatum) is caused by an abnormal development of cartilage connecting the ribs. The vacuum bell employs suction over time to reshape the chest. Pectus carinatum affects more boys than girls and usually begins during early The two most common types of chest wall deformities include: Pectus Excavatum: Also called a "funnel chest," kids with this condition have an indented or sunken sternum (center of the rib cage). In this condition, the anterior to posterior dimensions of the chest cavity are increased when the sternum (breastbone) is relatively protruded. Boys are affected four times as often Find Pectus stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. It either develops in the same way How is pectus carinatum (pigeon chest) treated? Treatment options include chest-wall bracing and/or surgery. Pectus carinatum doesn’t stop until the bones stop growing, usually Jul 1, 2023 · Pectus carinatum may occur alone or along with other genetic disorders or syndromes. (12 Dec 1998) Lexicographical Neighbors of Pigeon Chest Browse millions of high-quality stock photos, illustrations, and videos. The breastbone, also known as the sternum, protrudes outward and shapes the chest to a bird-like appearance, hence the name pigeon chest. Day 16: The pin feathers have opened into adult-colored plumage on many parts of the body Dec 12, 1998 · Medical Definition of Pigeon chest. Even though most affected horses don’t get a fever, it takes its name from the way the associated abscesses shape the horse’s chest to resemble a pigeon breast. General MUSC Health Line 843-792-1414. It is three-to-five times more common in males than females. Pectus carinatum develops differently in different people. It produces a caved-in chest, commonly referred to as “funnel chest” or “sunken chest. COM or contact us at 888. Adolescents with more severe or refractory cases of pectus carinatum may require a modified Ravitch surgical repair. By 1900, the s-bend corset with the distinct “pigeon-breast” (aka Pouter Pigeon) set the basic style and it was reflected in both formal and Download and use 3,000+ Pigeon Chest stock photos for free. See before-and-after photos of our patients from a variety of our procedures. There is a 4:1 male-to-female ratio. Pectus carinatum — commonly known as “pigeon chest”— occurs when abnormal cartilage growth causes the sternum to protrude from the chest. Nov 8, 2023 · Among the four people spotlighted in this production, only one—Brittain—was alive four years after the war ended. Find your perfect pigeons image. Feb 20, 2024 · Pectus carinatum is also called pigeon chest because of the way it makes the chest stick out, appearing like a bird or pigeon. It’s the opposite of pectus excavatum, in which your breastbone is depressed inward and gives your chest a sunken appearance. Pectus carinatum - also known as pigeon breast - is characterized by a prominent sternum and is usually asymptomatic. The bustle era was long past and the fashion silhouette was now upright. Pectus carinatum is when part of the breastbone is pushed outwards or raised. To learn more about how the P4CO can improve Pectus Carinatum for yourself, your child, or your patients, Visit our web site at BRACEFORPECTUS. They can remove it for sports, showering, and other activities, but usually must wear it for 8–12 hours a day (sometimes more). Jul 1, 2023 · A bowed chest is also called pectus carinatum. Pigeon chest affects around one in 1,500 people and is slightly less common than pectus excavatum. It can be caused by genetic factors or abnormalities in cartilage development. With a sharp pointed knife, cut breasts from the pigeon, keeping your knife towards the bones all the time. Free pictures to download and use in your next project. . CHKD's Nuss Center helps patients with a variety of chest wall deformities. All Orientations. Pigeon chest, also known as pectus carinatum, is a malformation of the chest wall characterised by an outward protrusion of the sternum and ribs. birdspigeon. Some can develop asthma or get a lot of respiratory infections. Thousands of new, high-quality pictures added every day. Pectus carinatum (also known as pigeon chest) is a condition in which, instead of being level with the ribs, the breastbone (sternum) is ‘pushed out’ so that the middle of the chest is more pronounced. Lordosis and kyphosis. Other ruminants like sheep, goat, and cattle Jun 30, 2022 · According to a 2016 article, pectus excavatum accounts for 90% of all chest wall abnormalities and affects 1 in 300–400 live births. The C pseudotuberculosis is a localized bacteria and causes an abscess in the lower abdomen and pectoral region of horses. Vacuum Bell Treatment. 5F, pain unrelieved by oral medications, constipation or other concerns. Many patients with mild or moderate cases of pectus carinatum experience success with advanced chest-wall braces. The condition causes the sternum to protrude. Recurrent respiratory infections. birdpigeonnature. This usually doesn't appear until a child is age 11 or older. Pectus carinatum is sometimes called “pigeon breast” because of the birdlike appearance of the chest. " It is less common than pectus excavatum, in which the sternum is pushed in or depressed. It is thought to be an inherited condition. This includes the custom-made brace, continuous monitoring and frequent adjustments by an orthotist, and a tailor-made Find Pigeon Chest stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. May 19, 2018 · May 19, 2018 / Adam Lid. There are two main types of pectus condition: pectus excavatum and pectus carinatum. It affects nearly 1 in 1000 teens, and early identification allows for more noninvasive treatment options. Some people call it “pigeon chest” or “keel chest” because of how it makes your chest look. The incidence of pectus excavatum is roughly 1 in 400 whilst the incidence of pectus carinatum is 1 in 1500. Symptoms vary from lumps on the skin with redness and oozing to systemic signs, such as lethargy, fever, weight loss, and colic. There is often protrusion at the upper part of the sternum involving the Aug 11, 2023 · Pectus excavatum is an abnormal, inward-growing sternum (breastbone). Marfan syndrome: This condition is sometimes associated with pectus carinatum, and can cause long bones, flexible joints, stretchy skin, abnormal facial structure, blurry vision, chest pain or discomfort, or trouble breathing. pigeonbirdanimal. It is the most common deformity of the anterior chest in children and is present in between 1 in 300-400 live births. Common Wood-Pigeons have been very Nov 1, 1997 · Rock Pigeon Photo Gallery. Diagnosis Jan 14, 2022 · Barrel chest happens when the lungs become overfilled (hyperinflated) with air — like a balloon — as they work harder. Name: Clare. <p>Common Wood-Pigeon is a burly pigeon with a low, growling song to match. birdpigeonbeak. yb hr jn wf nc nj tz bk bl md