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Dr. Prashanth Patil

Radiologist, Bangalore

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Dr. Prashanth Patil Radiologist, Bangalore
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To provide my patients with the highest quality healthcare, I'm dedicated to the newest advancements and keep up-to-date with the latest health care technologies....more
To provide my patients with the highest quality healthcare, I'm dedicated to the newest advancements and keep up-to-date with the latest health care technologies.
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Dr. Prashanth Patil is one of the best Radiologists in Mathikere, Bangalore. You can consult Dr. Prashanth Patil at Family Hospital in Mathikere, Bangalore. Save your time and book an appointment online with Dr. Prashanth Patil on Lybrate.com.

Lybrate.com has a number of highly qualified Radiologists in India. You will find Radiologists with more than 28 years of experience on Lybrate.com. You can find Radiologists online in Bangalore and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Family Hospital

#432/2, 60 Feet Road, 1st Main, 1st Stage, 1st Phase, Gokula, Mathikere Main Road. Landmark: Behind SBMBangalore Get Directions
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Family Hospital

No.423/2, Mathiker Main Road, 1st Mian, 1st Stage, Gokula 1st Phase, Mathikere, Bangalore - 560054 Landmark : Behind State Bank Road.Bangalore Get Directions
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Disk Pain

MSPT (Master of Physical Therapy), BPT
Physiotherapist, Gurgaon
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Hi I am Dr. Kirti Yadav, senior physiotherapist from Mat-Harbor family clinic, Gurgaon.

Today I want to talk about a very common problem which every one, if we count about the population 100% then 70% of people they talk about Disk pain. So I want to enlighten this topic today. If there is a normal pain and ache in your neck or back you go to a doctor and the doctor assess you and tells you to get an MRI done. Whenever you get an MRI done there is some level of disk involvement and the doctor ask you to take rest, not to do exercise and all those things and then just being fear of disk pain you don’t exercise for the rest of your life.

So just to come onto that area, just to enlighten this topic, as a physiotherapist I want to tell you about the fact. Disk pain, YES it happens but it happens in 20% of the cases. The rest 50% of the cases have been misdiagnose, they take disk pain and they don’t do exercise all of their life. Now we don’t exercise, we don’t strengthen up our muscle that is the problem that we get these pains and aches and the muscle is being stretched which is counted to be as the disk pain. Now when we talk about this, when you get an MRI done even today if I get my MRI done I will have some level of disk involvement whether the disk is causing you pain or not that is more important. The nature of pain tells you about the disk involvement.

So if you have tingling sharp shooting burning kind of pain which travels through a nerve, which travels through area, it dignifies, it signifies the disk pain. But if you have a localized dull, aching kind of pain please don’t take it as a disk pain and don’t take it as a nerve pain. So just coming to the treatment part. About 50% of the people who don’t have disk pain, who says we have cervical spondylitis but they don’t have cervical spondylitis they have trapezius muscle involvement. In that case what we do please strengthen up your trapezius muscle, please strengthen up your shoulder muscle so that you don’t have these pains and aches again and again. Why this happens? This happens because of repetitive strain injuries that happens because of more of computer use more of mobile use, texting and other sedentary live cells which we are going in. So the ultimate solution for pains and aches muscular is strengthening the particular part.

If you want to know more about this, if you want to talk more about it you can contact me through Lybrate.

3733 people found this helpful

I have slip disc l4, l5 Should I avoid carrying weights. More over what are the exercise I must follow?

MBBS, MS, DNB, FNB (SPINE SURGERY)
Orthopedist, Chennai
Hi. You should avoid forward bending activities, especially while lifting weights. Learn spinal and core strengthening exercises from a physiotherapist and do them regularly. You should also learn about proper posture and follow it during daily routine activities.
1 person found this helpful

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

  • Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
  • Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
  • High risk of primary or consequential damage to neural, bony or disc element
  • Increased wedging, deformity & increase incidence of adjacent VB
  • Chronic pain of altered spine mechanics
  • Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
  • Cost of surgery and hospital treatment
  • Cost of implants
  • Phobia of surgery
  • Prolonged recovery period & Extensive rehabilitation
  • Changed spinal mechanics & transition syndrome
  • Major surgery & anesthesia with its own complications

Results / Outcome

  • PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
  • Different studies show an immediate pain relief in (85 – 90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
  • PVP does augment height of VB but ideal would be kyphoplasty
  • Patient is either off medicine or on reduced doses.
  • Patient feels so well that he almost forgets if he had VB
     

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are  Metastatic VB,  Multiple myeloma VB, VB haemangioma,  Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF)   which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis.  Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient  back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

  • Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
  • Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
  • GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
  • High risk of primary or consequential damage to neural, bony or disc elements.
  • Increased wedging, deformity & increase incidence of adjacent VB
  • Chronic pain of altered spine mechanics.
  • Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.

Morbidity and complication of spinal surgery 

  • Cost of surgery and hospital treatment
  • Cost of implants
  • Phobia of surgery
  • Prolonged recovery period & Extensive rehabilitation
  • Changed spinal mechanics & transition syndrome
  • Major surgery & anesthesia with its own complications

Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

  • Cementing of fragments.
  • Thermal neurolysis of VB nerve ending due to heat of polymerization.
  • Washing away of nociceptor chemicals.
  • Neurolytic action of liquid monomer.
  • By allowing early ambulation decreasing pains of immobility & bed rest.

Complications 

  1. PVP is generally safe with low risk.
  2. Ectopic cement leak is frequent but generally inconsequential.

Outcome 

  1. PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
  2. Different studies show an immediate pain relief in (85 – 90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
  3. PVP does augment height of VB but ideal would be kyphoplasty.
  4. Patient is either off medicine or on reduced doses.
  5. Patient feels so well that he almost forgets if he had VB

In case you have a concern or query you can always consult an expert & get answers to your questions!

4342 people found this helpful

Suffering From Breast Cancer - Alternative Therapies That Can Help!

MBBS, MS - General Surgery, FBD (Fellowship in Breast Diseases), UICC Fellowship
Oncologist, Pune
Suffering From Breast Cancer - Alternative Therapies That Can Help!

Being diagnosed with cancer is a scary thought but with medical intervention, most breast cancer cases can be treated. The most common forms of treatment are radiation and chemotherapy. Along with this, there are many forms of alternative and complementary treatment that may be followed. This can help reduce the side effects of chemotherapy and radiation and boost the immune system. Here are some things you can do as an alternative and complementary form of treatment.

  1. Have a special diet: Having a healthy, well-balanced diet is necessary for everyone. This becomes more important when a person is recovering from cancer. Foods that have a high level of saturated fats and salt should be avoided. Intake of smoked, highly processed and pickled foods should also be reduced. On the other hand, you should increase your intake of vegetables, fruits and other foods derived directly from plants.
  2. Get your antioxidants: Antioxidants can protect a person from the damage caused by free radicals. This aids in the treatment of breast cancer and speeds up the healing process. Some of the antioxidants that can be beneficial in treating breast cancer are vitamins A, C and E, Lycopene and Beta Carotene. This can be found in wild blueberries, pecans, dark chocolate, kidney beans and goji berries. You can also increase your antioxidant consumption with dietary supplements. However, consult your doctor before taking any antioxidant supplements as it can interact with other drugs.
  3. Massage therapy: Massages can help relax the mind. They also have a number of other benefits. They are known as immunity boosters and can ease fatigue and pain. Thus a massage can also reduce the need for pain medication. It also helps increase the concentration of white blood cells in cases where women are being treated for stage I and stage II breast cancer.
  4. Acupuncture: Acupuncture is an alternative form of treatment that is considered part of traditional Chinese medicine. This involves the placement of sterile, needles that are very thin into specific points on the skin. These are then gently moved to stimulate the nervous system. In some cases, herbal supplements may also be incorporated into the treatment. Acupuncture is believed to help relieve fatigue, control vomiting and hot flashes and reduce pain.

It is important to note that these forms of treatment should not replace medical treatment but should be carried out along with it. You must also ensure that your doctor is aware of any supplements of alternative forms of treatment that you may be taking along with the medical treatment.

In case you have a concern or query you can always consult an expert & get answers to your questions!

2983 people found this helpful

Sir I am suffering from. L4-5 problem since 2 years there is any treatment with out operation please help me.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Kindly show me a photograph of the affected part. Rule out diabetes & vit. D deficiency or any other metabolic disorder. Sleep on a hard bed with soft bedding on it. Spring beds, folding beds or thick matress are harmful Do hot fomantation. Paracetamol 250mg od & sos x 5days. Caldikind plus 1tab od x10. Do neck, back & general exercises. It may have to be further investigated. You will need other supportive medicines also. Make sure you are not allergic to any of the medicines you are going to take. If it does not give relief in 1 wk, contact me again. Do not ignore. It could be beginning of a serious problem.
1 person found this helpful
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Breast Cancer Prevention - How To Reduce Your Risk?

MBBS, DGO, DNB - Obstetrics & Gynecology
Gynaecologist, Noida
Breast Cancer Prevention - How To Reduce Your Risk?

While you cannot cure breast diseases, family history and maturing, but there are some hazards or risks that you can control. Keeping in mind the fact that there is no certain approach to forestall breast cancer, there are things you can do that may bring down the hazard. Here are five approaches to ensure your breast's well-being:

  1. Watch your weight: Being overweight or hefty expands breast cancer chances. This is particularly true after menopause and for women who have put on weight as grown-ups. After menopause, the vast majority of your estrogen originates from fat tissue. Having more fat tissue can heighten your chances of getting breast cancer by raising the estrogen levels. Additionally, women who are overweight have a tendency to have more elevated amounts of insulin, than other hormones. Higher insulin levels have been associated with a few tumors, including breast cancer.
  2. Exercise routinely: Many reviews have found that exercise is the sign of having a healthy breast. Studies show that one to two hours of energetic walking each week, lessened a woman’s cancer risk by eighteen percent. Walking ten hours seven days decreased the hazard all the more.
  3. Constrain liquor: Women who have two to five mixed beverages every day have a higher danger of breast cancer than women who have just one drink a day or none . As much as three to six glasses of wine seven days have been found to somewhat increase breast cancer chances. It is not clear how or why liquor raises the hazard. In any case, constraining liquor is particularly essential for women who have other hazard variables for breast cancer, like, breast cancer running in their families.
  4. Restrain time spent sitting: Research has shown that sitting time, regardless of how much exercise you get when you are not sitting, increases the probability of growing cancer, particularly for women. Women who sit six hours or more a day outside of work have a ten percent more serious risk for breast cancer compared to the ladies who sit under three hours a day, and an increased hazard for other cancer types as well.
  5. Stay away from or confine hormone substitution treatment: Hormone Replacement Treatment (HRT) was utilized frequently in the past to control night sweats, hot flashes, and other troublesome manifestations of menopause. In any case, specialists now realize that postmenopausal ladies who take a blend of estrogen and progestin might probably create breast tumors or cancer. Breast cancer disease seems to come back within five years in the wake of ceasing the blend of hormones. Therefore, get a breast cancer test even if you feel a small lump. Consult an Expert & get answers to your questions!
3538 people found this helpful

Breast Cancer - What Possibly Can Trigger It?

MD - Obstetrics & Gynaecology, DGO, MBBS, MCPS
Gynaecologist, Mumbai
Breast Cancer - What Possibly Can Trigger It?

Breast cancer is a type of cancer which occurs due to the development of cancerous cells in a person's breasts. Women are usually affected by breast cancer and breast cancer is one of the most common forms of cancer after skin cancer. Usually fatal if not diagnosed in its early stage, breast cancer is a very serious medical ailment. Read on more to find all about the different symptoms, causes, preventive measures and treatment of breast cancer.

1. Symptoms

Breast cancer has a few distinct characteristics and if you have a few or all the following symptoms you could be more likely to suffer from breast cancer. 

a) The formation of a lump in your breast which is different from the surrounding tissue and usually more thickened.

b) The discharge of bloody fluid  material from the nipples.

c)  Sudden change of the size, shape and appearance of the breast.

d) Certain distinct changes to the skin over the breast for example an indentation in the skin similar to that of a dimple.

e) Appearance of an extra nipple which is inverted.

f)  If the darkened area around the nipples known as the areola is flaking or peeling off.

 

2. Causes

Studies and researches remain inconclusive on what causes breast cancer. Breast cancer occurs due to abnormal division of the cells located in the breast which over time accumulate and form lumps. They
might spread to other parts of the body. Breast cancer is caused mainly due to a complex interaction of personal genetics, environment and lifestyle choices. Breast cancer can also be caused due to genetics as about 5% to 10% of cases are due to gene mutations which pass onto generations.

3. Risk factors

There are certain factors which increase the probability of contracting breast cancer. Increasing age, personal and family history of breast cancer, obesity, radiation exposure, pregnancy at an older age, post-menopausal hormone therapy are some of the factors that increase the chances of breast cancer.

4.  Treatment

Several forms of surgical methods exist to treat breast cancer. Depending on the condition and spread of the disease a suitable surgery is performed. These include mastectomy, lumpectomy, axillary lymph node dissection and removal of both breasts. Other forms of treatment include chemotherapy or the use of high doses of drugs to destroy cancerous cells. Radiation therapy where X-rays are used to destroy the cancer cells is also effective.

In case you have a concern or query you can always consult an expert & get answers to your questions!

2821 people found this helpful

Uterine Cancer - Ayurvedic Treatment For It!

BAMS
Ayurveda, Dhubri
Uterine Cancer - Ayurvedic Treatment For It!

Ayurveda is a form of medicine that has been practiced for thousands of years and has many effective cure for some of the most complex diseases. Cancer, in this day and age, is one such complex disease and its incidence is increasing rapidly. It is always recommended to consult a Ayurveda specialist for severe cancer. Some of the common ingredients for treatment of uterine cancer through Ayurveda are mentioned here.

  1. Turmeric: Already a staple spice in many Indian dishes, turmeric as a herb in raw form and as a spice in powdered form, is touted the new wonder herb all across the world. It has been used as a traditional healing herb in India since ages. It has also been seen to be a very effective anti-inflammatory agent and thus it is very effective in stopping the growth of cancer cells.
  2. Green tea from the Camellia Sinensis plantGreen tea has been known to be effective in treating multiple types of cancer, aid in weight loss and also facilitate detoxification. Regular consumption of green tea from the Camellia Sinensis plant is known to fight the growth of cancer cells within the body; thus is a very effective in treating uterine cancer as well.
  3. Ashwagandha: This herb is not only used in Ayurveda, but has also been adopted by homeopathy as conventional medicine to make extracts. Ashwagandha is an adaptogen, which means it can adapt to the requirements of the body and then make the changes to provide support to the necessary areas. It is also very good at preventing the growth of cancer cells.
  4. Garlic: This spice is known to be good for multiple forms of cancer as it contains allicin, which is being hailed as one of the best fighters of inflammatory diseases. It also contains other types of phytochemicals and thus helps in detoxifying the body. It is very effective in fighting cancer cells and can arrest the growth of cancer within the body.
  5. Ginger: Ginger is extremely effective in the treatment of many ailments, if consumed regularly in controlled amounts. It has been known to be very effective in the treatment of colon cancer. Due to its properties, it is also known to be effective in the prevention of uterine and many other forms of cancer.

Ayurvedic Thrapies

Ayurveda, an enigmatic yet enthralling science offers numerous treatment methods for uterine cancer. Here are a few: 

  1. Matra Basti: Matra Basti is a special treatment in traditional ayurveda for chronic constipation, low back pain, rheumatoid arthritis, obesity, and various neurological disorders like multiple sclerosis, epilepsy, dystrophy and atrophy of nerves and muscle. In this treatment, certain herbal oils and herbal extracts are applied through the rectum on a daily basis. Matra Vasti has a lubricating, balancing, nourishing, strengthening and pacifying effect. It also works as rejuvenator, immune-modulator and nutrient and subdues elevated vata dosha. The treatment lasts for a period of 3 to 7 days.
  2. Pichu Dharanam for Soothing at Advance Stages of Uterine Cancer: It is a special treatment modality in Ayurveda where sterile medicated cotton swab is kept inside the vagina for a specific period of time. This comes under local treatment modalities specific to gynaecological diseases in females and is also done in ante natal care. Pichu means “cotton ball”. Yoni pichu is the application of a sterile cotton swab soaked in medicated oil or ghee in the vagina.
  3. Abhyanham: Abhyanga is a form of Ayurvedic medicine that involves massage of the body with large amounts of warm oil. It’s a complete body massage and really effective. The Abhyangam massage therapy is very beneficial and prevents degeneration and ceases the aging process. This therapy needs more positions to massage and comparing to other massage therapy, Abhyangam is very special. It usually involves oils prepared with specialized Ayurvedic herbs and essential oils for lymph drainage, detox, and relaxation. It has seven positions and it treats the whole body. It assures new healthy physical changes. 
  4. Nasyam: Nasyam or errhine therapy is an Ayurvedic treatment excellent remedy for chronic sinusuitis, headache, throat diseases, epilepsy, catarrh, migraine, voice constraint, eye diseases and cervical spondylitis. In Ayurveda, the application of medical oils or powders through the nostrils is called Nasya. It is said in classical texts that the nostrils are the doorway to the brain. Nasya is an important method of treatment for illnesses of the cranial region. Nasya treatment - the forehead and neck regions of the patient are gently massaged with a suitable oil to induce sweating. Thereafter the patient is made to lie down on his back with his head bent slightly back. Warm oil is then dripped into both nostrils which the patient draws in.

Breast Cancer - Local and Systematic Form of Treatment!

MBBS, DNB (Obstetrics and Gynecology), MNAMS, Training In USG
Gynaecologist, Delhi
Breast Cancer - Local and Systematic Form of Treatment!

Breast Cancer - What exactly is it?
‘Breast cancer’ is a term that is used to refer to a malignant tumour, which has developed from cells present in the breast. Generally, all tumours can be divided into two categories i.e. benign and malignant and it is the malignant tumour that is responsible for causing cancer. Breast cancer generally originates in the cells the  milk producing glands of the breast's or the passage, which carries milk from the glands to the lobules. Additionally, breast cancer can also originate in the stromal tissues, including the fibrous and fatty connective breast tissues.

Breast Cancer: Treatment Options
Treatment for breast cancer depends upon two things: the exact type of the cancer and how advanced the cancer is. Treatment options for breast cancer can thus be broadly divided into two categories as Local treatments and Systemic treatments.

Local Treatments
Treatments that target the tumour without having any effect on the rest of the body are called local treatments. The following types of local treatment options are available for treating breast cancer:

  1. Surgery: Surgical breast cancer treatment involves removal of the malignant cancerous tumour in an operation. Smaller tumours can be removed using a surgical process referred to as ‘lumpectomy’, wherein the tumour along with a small amount of healthy tissue surrounding the tumour is removed. For larger tumours, removal of the entire breast becomes mandatory, in a surgical process known as ‘mastectomy’. Women who undergo mastectomy can choose to undergo reconstructive plastic surgery for reconstruction of the removed breast(s).
  2. Radiation Therapy: This basically involves using radiation to kill cancer cells present in the body. Radiation therapy is a long-drawn process that usually involves a set number of treatments administered over a long period of time. Radiation therapy is also generally the follow-up procedure after a lumpectomy, or more rarely, a mastectomy.

Systemic Treatments
Treatments involving drugs that are administered via either the mouth or direct injection into the bloodstream are called systemic treatments. These include:

  1. Chemotherapy: This includes using drugs to destroy the cancer cells present in the body by stopping the cancer cells from growing and dividing. Chemotherapy can be administered using either an IV (intravenous) tube or via pills that can be swallowed.
  2. Hormone Therapy: This treatment option is used for treating tumours which have tested positive for progesterone or oestrogen receptors. Blocking hormones that fuel the tumour’s growth is the basis of this therapy.
  3. Targeted Therapy: This targets specific proteins and genes which contribute to growth and survival of the cancer cells. Targeted therapy is an extremely focused treatment, and is very effective in blocking the growth and division of cancer cells, as well as minimizing damage to surrounding healthy cells.
2587 people found this helpful

I got. L4 and L5 disc prolapse. Doing physio therapy exercise. But could not walk or jogging exercise due to ankles and knee problem. And could not bend myself too. What to do?

MPT, BPT
Physiotherapist, Noida
Do the cat/cow stretch. Get on all fours, with your arms straight and your hands directly under your shoulders; your knees hip-width apart.
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