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Extracorporeal Shock Wave Therapy (ESWT) is a highly effective and innovative treatment option in a variety of fields, from urology to cosmetology including orthopedics. This is a non-invasive method that employs high-energy shockwaves to bring about the healing of the affected tissues. It has been found to provide good results for recalcitrant orthopaedic problems like frozen shoulder to certain chronic degenerative or tendon conditions such as Achilles tendinitis (injury of the Achilles' tendon due to overuse) and plantar fasciitis in heel pain.
How does it work?
The procedure is basically an outpatient/ daycare job. It involves the application of a non-invasive probe to the affected tissue. This is followed by the external generation of shockwaves focused on the target area. The shockwaves cause a force to be created that brings about healing. Although it's still not clear as to why this kind of therapy works, the dominant understanding is that shockwaves render an improvement in the flow of blood so as to promote the body to fix and heal itself.
Depending on individual cases, high or low energy waves may be employed. While pain may occur during the transmission of high energy waves and would require short general anaesthesia, low-energy ESWT is carried out without anesthesia.
What problems can this form of therapy effectively tackle?
ESWT can be used to treat a number of musculoskeletal disorders. From plantar fasciitis (heel pain), tennis elbow, shoulder rotator cuff, degenerated tendons (Achilles' tendon) to hip and knee pain, the therapy has been found to reduce pain as well as accelerate healing in individuals.
Complications are very few and far between with this therapy. Individuals who suffer from hypersensitivity or poor sensation in the affected area are usually not recommended this procedure. Even individuals with heart conditions, seizures and open sores need to consult a doctor before going forward with the therapy.
The therapy has also been found to be very effective in bone healing as well as treatment of bone necrosis (a disease that occurs due to permanent or temporary loss of blood flow to the bones). Additionally in place of surgery, ESWT may also be a valuable option for non-healing fractures. In case you have a concern or query you can always consult an expert & get answers to your questions!
I am suffering from slip disc problem can you suggest some precaution it is in first stage and can you give tips for exercising .as of now I am taking bed rest since 2 weeks as suggested by rheumatologist dr.
Breast Cancer Prevention:
Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.
Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer. Different ways to prevent cancer are being studied, including:
Changing lifestyle or eating habits. Avoiding things known to cause cancer. Taking medicine to treat a precancerous condition or to keep cancer from starting.
General information about breast cancer:
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. Breast cancer is the second most common type of cancer in india
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.
Enlarge Drawing of female breast anatomy showing the lymph nodes, nipple, areola, chest wall, ribs, muscle, fatty tissue, lobe, ducts, and lobules.
Anatomy of the female breast. The nipple and areola are shown on the outside of the breast. The lymph nodes, lobes, lobules, ducts, and other parts of the inside of the breast are also shown.
Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter lymph and store white blood cells that help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.
Avoiding risk factors and increasing protective factors may help prevent cancer. The following are risk factors for breast cancer:
Older agea personal history of breast cancer or benign (noncancer) breast diseasea family history of breast cancerinherited gene changesdense breasts
The following are protective factors for breast cancer:
Less exposure of breast tissue to estrogen made by the bodytaking estrogen-only hormone therapy after hysterectomy,
Estrogen-only hormone therapy after hysterectomyselective estrogen receptor modulatorsaromatase inhibitors and inactivators
Risk-reducing mastectomy ovarian ablationgetting enough exercise
It is not clear whether the following affect the risk of breast cancer:
Factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk
Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.
A personal history of breast cancer or benign (noncancer) breast disease
Women with any of the following have an increased risk of breast cancer:
A personal history of invasive breast cancer, ductal carcinoma in situ (dcis), or lobular carcinoma in situ (lcis). A personal history of benign (noncancer) breast disease.
A family history of breast cancer
Women with a family history of breast cancer in a first-degree relative (mother, sister, or daughter) have an increased risk of breast cancer.
Inherited gene changes:
Women who have inherited changes in the brca1 and brca2 genes or in certain other genes have a higher risk of breast cancer, ovarian cancer, and maybe colon cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors.
Men who have inherited certain changes in the brca2 gene have a higher risk of breast, prostate, and pancreatic cancers, and lymphoma.
Having breast tissue that is dense on a mammogram is a factor in breast cancer risk. The level of risk depends on how dense the breast tissue is. Women with very dense breasts have a higher risk of breast cancer than women with low breast density.
Increased breast density is often an inherited trait, but it may also occur in women who have not had children, have a first pregnancy late in life, take postmenopausal hormones, or drink alcohol.
Exposure of breast tissue to estrogen made in the body
Estrogen is a hormone made by the body. It helps the body develop and maintain female sex characteristics. Being exposed to estrogen over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating.
A woman's exposure to estrogen is increased in the following ways:
Early menstruation: beginning to have menstrual periods at age 11 or younger increases the number of years the breast tissue is exposed to estrogen. Starting menopause at a later age: the more years a woman menstruates, the longer her breast tissue is exposed to estrogen. Older age at first birth or never having given birth: because estrogen levels are lower during pregnancy, breast tissue is exposed to more estrogen in women who become pregnant for the first time after age 35 or who never become pregnant.
Taking hormone therapy for symptoms of menopause:
Hormones, such as estrogen and progesterone, can be made into a pill form in a laboratory. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy (hrt) or hormone therapy (ht). Combination hrt/ht is estrogen combined with progestin. This type of hrt/ht increases the risk of breast cancer. Studies show that when women stop taking estrogen combined with progestin, the risk of breast cancer decreases.
Radiation therapy to the breast or chest:
Radiation therapy to the chest for the treatment of cancer increases the risk of breast cancer, starting 10 years after treatment. The risk of breast cancer depends on the dose of radiation and the age at which it is given. The risk is highest if radiation treatment was used during puberty, when breasts are forming.
Radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast.
For women who have inherited changes in the brca1 and brca2 genes, exposure to radiation, such as that from chest x-rays, may further increase the risk of breast cancer, especially in women who were x-rayed before 20 years of age.
Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy.
Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises.
The following are protective factors for breast cancer:
Less exposure of breast tissue to estrogen made by the body
Decreasing the length of time a woman's breast tissue is exposed to estrogen may help prevent breast cancer. Exposure to estrogen is reduced in the following ways:
Early pregnancy: estrogen levels are lower during pregnancy. Women who have a full-term pregnancy before age 20 have a lower risk of breast cancer than women who have not had children or who give birth to their first child after age 35. Breast-feeding: estrogen levels may remain lower while a woman is breast-feeding. Women who breastfed have a lower risk of breast cancer than women who have had children but did not breastfeed.
Taking estrogen-only hormone therapy after hysterectomy, selective estrogen receptor modulators, or aromatase inhibitors and inactivators
Estrogen-only hormone therapy after hysterectomy
Hormone therapy with estrogen only may be given to women who have had a hysterectomy. In these women, estrogen-only therapy after menopause may decrease the risk of breast cancer. There is an increased risk of stroke and heart and blood vessel disease in postmenopausal women who take estrogen after a hysterectomy.
Selective estrogen receptor modulators:
Tamoxifen and raloxifene belong to the family of drugs called selective estrogen receptor modulators (serms). Serms act like estrogen on some tissues in the body, but block the effect of estrogen on other tissues.
Treatment with tamoxifen lowers the risk of estrogen receptor-positive (er-positive) breast cancer and ductal carcinoma in situ in premenopausal and postmenopausal women at high risk. Treatment with raloxifene also lowers the risk of breast cancer in postmenopausal women. With either drug, the reduced risk lasts for several years or longer after treatment is stopped. Lower rates of broken bones have been noted in patients taking raloxifene.
Taking tamoxifen increases the risk of hot flashes, endometrial cancer, stroke, cataracts, and blood clots (especially in the lungs and legs). The risk of having these problems increases with age. Women younger than 50 years who have a high risk of breast cancer may benefit the most from taking tamoxifen. The risk of having these problems decreases after tamoxifen is stopped.
Taking raloxifene increases the risk of blood clots in the lungs and legs, but does not appear to increase the risk of endometrial cancer. In postmenopausal women with osteoporosis (decreased bone density), raloxifene lowers the risk of breast cancer for women who have a high or low risk of breast cancer. It is not known if raloxifene would have the same effect in women who do not have osteoporosis. Talk with your doctor about the risks and benefits of taking this drug.
Aromatase inhibitors and inactivators:
Aromatase inhibitors (anastrozole, letrozole) and inactivators (exemestane) lower the risk of a new breast cancer in women who have a history of breast cancer. Aromatase inhibitors also decrease the risk of breast cancer in women with the following conditions:
Postmenopausal women with a personal history of breast cancer. Women with no personal history of breast cancer who are 60 years and older, have a history of ductal carcinoma in situ with mastectomy, or have a high risk of breast cancer based on the gail model tool (a tool used to estimate the risk of breast cancer).
In women with an increased risk of breast cancer, taking aromatase inhibitors decreases the amount of estrogen made by the body. Before menopause, estrogen is made by the ovaries and other tissues in a woman's body, including the brain, fat tissue, and skin. After menopause, the ovaries stop making estrogen, but the other tissues do not. Aromatase inhibitors block the action of an enzyme called aromatase, which is used to make all of the body's estrogen. Aromatase inactivators stop the enzyme from working.
Possible harms from taking aromatase inhibitors include muscle and joint pain, osteoporosis, hot flashes, and feeling very tired.
Some women who have a high risk of breast cancer may choose to have a risk-reducing mastectomy (the removal of both breasts when there are no signs of cancer). The risk of breast cancer is much lower in these women and most feel less anxious about their risk of breast cancer. However, it is very important to have a cancer risk assessment and counseling about the different ways to prevent breast cancer before making this decision.
The ovaries make most of the estrogen that is made by the body. Treatments that stop or lower the amount of estrogen made by the ovaries include surgery to remove the ovaries, radiation therapy, or taking certain drugs. This is called ovarian ablation.
Premenopausal women who have a high risk of breast cancer due to certain changes in the brca1 and brca2 genes may choose to have a risk-reducing oophorectomy (the removal of both ovaries when there are no signs of cancer). This decreases the amount of estrogen made by the body and lowers the risk of breast cancer. Risk-reducing oophorectomy also lowers the risk of breast cancer in normal premenopausal women and in women with an increased risk of breast cancer due to radiation to the chest. However, it is very important to have a cancer risk assessment and counseling before making this decision. The sudden drop in estrogen levels may cause the symptoms of menopause to begin. These include hot flashes, trouble sleeping, anxiety, and depression. Long-term effects include decreased sex drive, vaginal dryness, and decreased bone density.
Getting enough exercise:
Women who exercise four or more hours a week have a lower risk of breast cancer. The effect of exercise on breast cancer risk may be greatest in premenopausal women who have normal or low body weight.
It is not clear whether the following affect the risk of breast cancer:
Certain oral contraceptives contain estrogen. Some studies have shown that taking oral contraceptives (" the pill") may slightly increase the risk of breast cancer in current users. This risk decreases over time. Other studies have not shown an increased risk of breast cancer in women who take oral contraceptives.
Progestin -only contraceptives that are injected or implanted do not appear to increase the risk of breast cancer. More studies are needed to know whether progestin-only oral contraceptives increase the risk of breast cancer.
Studies have not proven that being exposed to certain substances in the environment, such as chemicals, increases the risk of breast cancer.
Studies have shown that some factors do not affect the risk of breast cancer.
The following do not affect the risk of breast cancer:
Having an abortion. Making diet changes such as eating less fat or more fruits and vegetables. Taking vitamins, including fenretinide (a type of vitamin a). Cigarette smoking, both active and passive (inhaling secondhand smoke). Using underarm deodorant or antiperspirant. Taking statins (cholesterol -lowering drugs). Taking bisphosphonates (drugs used to treat osteoporosis and hypercalcemia) by mouth or by intravenous infusion.
Cancer prevention clinical trials are used to study ways to prevent cancer.
Left paracentral L5-S1 disc protrusion causing compression of left traversing nerve roots associated with diffuse L1-L2 Disc bulge. Now what is best treatment for me.
It is perfectly normal for women to experience the periodic monthly bleeding cycle. However, if a woman experiences uterine bleeding which is abnormal and dysfunctional, it could be a symptom of infection. Other causes of abnormal uterine bleeding include hormonal imbalance, infection in cervix and cancer of the uterus. Many women can also experience abnormal uterine bleeding during first trimester of pregnancy.
The following are considered to be abnormal or dysfunctional uterine bleeding:
- A menstrual cycles occurs between 21 to 35 days, anything shorter or longer than this is abnormal
- No period for 3–6 months (amenorrhea) is abnormal
- Spotting or bleeding between periods
- Spotting or bleeding after intercourse
- Bleeding that is heavier or lasts longer than usual
- Spotting or bleeding after menopause
What can cause such a situation?
Some of the common causes leading to abnormal bleeding are as follows:
- Ectopic pregnancy
- Cervical or uterine infections
- Hormonal imbalances
- Problems with blood clotting
- Polycystic ovarian
- Endometrial hyperplasia
- Cancer of the reproductive tract
How to Diagnose it?
Most women tend to ignore abnormal bleeding, taking it as something to do with age or hormones. A detailed physical examination and history is done to understand menstrual cycle patterns and family history. In addition, the following would be used.
- Ultrasound: The pelvic organs are examined through sound waves to locate the problem area
- Hysteroscopy: Through a thin device that is inserted into the vagina, the doctor takes a look at the inside of the organs and identify the cause for the bleeding
- Endometrial biopsy: The uterine lining tissue is removed and examined under microscope to look for tissue changes that could be causing the bleeding
How Best to Treat It?
This would depend on the reason for the abnormal bleeding. However, in most cases, combinations of the following are useful in treatment.
- Hormone replacement can be done depending on the age and gynecological history, the type and the dose of the hormone would be decided upon. These could be in the form of tablets, vaginal creams, injections, or through an intrauterine device
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are useful in reducing bleeding and controlling cramps during excessive menstrual bleeding.
- Antibiotics may be useful if there is infection of the pelvic organs.
- Polyps, cysts, cancers, and other growths can be removed via hysteroscopy and sent for biopsy to confirm they are not cancerous.
- Endometrial ablation where the endometrial tissue is treated with heat can be used to control bleeding permanently.
- Hysterectomy would be done if other forms of treatment have failed. This could depend on their gynecologic history and other considerations as she cannot get pregnant after this.
Do not ignore if you see a change in the pattern of your uterine bleeding. It definitely calls for medical attention and if identified early, can be managed in much simpler ways. If you wish to discuss any specific problem, you can consult a gynaecologist.
The symptoms caused due to herniated disc can be very severe and can also cause a bit of disability. The disc of the spine is like a cushion and separates the set of bones on the backside. The discs are shock absorbers of the spine and are mainly composed of 2 parts, a soft jelly-like centre called the nucleus and a tough outer covering called the annulus.
Effects of Herniated Disk
A herniated or cracked disc is a severe condition and it seems to happen most commonly in the lower back or neck. It happens when a fraction of the soft centre gets pushed through the destabilized area due to degeneration, trauma or by putting pressure on the spinal column.
Nerves located at the back of every disc are responsible for transmitting pain, motor impulse, bladder control etc. in our body. While a disc gets herniated, the external covering of the disc tears and creates a bulge. The soft jelly gets shifted from the centre of the disk to the region where the damage has occurred on the disc. Most commonly, the bulge occurs in areas where the nerve is located and it causes strain and irritation of the affected nerve. It has been observed that individuals may or may not feel any painful sensations even if their disc gets damaged. Other symptoms may be weakness of muscle groups or difficulty in controlling the bladder.
When is surgery recommended for herniated disc?
Surgery for herniated disc is recommended only after options like rest and pain relievers do not work. If the pain persists even after these options, then it becomes important to go for surgery. Surgery is also considered early if there is weakness of muscle groups or acute problem in bladder control. At times, emergency surgery is also required to avoid paralysis in a patient.
However, there are certain risks involved in this surgery like infection, bleeding or nerve damage. There are chances that the leftover disc may bulge out again. If you are a patient suffering from degenerative disc disease, then there are chances that problem occurs in other discs. It is very important that a patient maintains healthy weight to prevent any further complications.
The main factor that increases the risk of herniated disc is excess body weight, which causes a lot of stress on the lower back. A few people become heir to a tendency of developing this condition. Even individuals with physically demanding jobs are prone to this condition.
Activities like bending sideways, pushing, twisting, repetitive lifting can increase the risk of a herniated disk. If you wish to discuss about any specific problem, you can consult a Neurosurgeon.
Breast cancer is an abnormal growth of cells in the tissues of the breast. Mainly it occurs in females but less than 1% of all the breast cancer cases develop in males. The majority of breast cancers start in the milk ducts. A small number start in the milk sacs or lobules. It can spread to the lymph nodes and to the other parts of the body such as bones, liver, lungs and to the brain.
With more reliable early detection methods as well as the trend towards less invasive surgery, there is hope that even more women with breast cancer will be treated successfully and will go on to resume their normal lives.
Signs & Symptoms
It is painless, especially, during the early stage. Watch out for the following changes in the breast:
- A persistent lump or thickening in the breast or in the axilla.
- A change in the size or shape of the breast.
- A change in the colour or appearance of the skin of the breast such as redness, puckering or dimpling.
- Bloody discharge from the nipple.
- A change in the nipple or areola such as scaliness, persistent rash or nipple retraction (nipple pulled into the breast).
Consult a doctor immediately if you notice any of these changes.
Being a woman puts you at risk of getting breast cancer. There are certain factors that increase the risk of breast cancer. Some of them have been listed below:
- The risk increases with age; most cases of breast cancer develop after the age of 50
- Genetic alterations in certain genes such as BRCA1 and BRCA2
- Family history of breast cancer
- Being overweight
- Early menarche (onset of menstruation before the age of 12)
- Late menopause (after the age of 55)
- Never had children
- Late childbearing
- No breast feeding
- Excessive consumption of alcohol
- Use of hormonal replacement therapy (HRT) for a long period of time
However, most women who have breast cancer have none of the above risk factors. Likewise, not having any of these risk factors does not mean that you will not get breast cancer.
Early Detection and Screening
More treatment options are available when breast cancer is diagnosed at an early stage and hence the chances of recovery is also higher. So regular breast screening is important for early detection even if there are no symptoms. Following are the ways of screening:
- Breast Self-Examination (BSE): Perform BSE once a month about a week after your menses are over. If you no longer menstruate, choose a date each month which is easy to remember e.g. your date of birth or anniversary.
- Clinical Breast Examination: Get a breast specialist to examine your breast once a year if you are 40 years and above.
- Mammogram: Go for a screening mammogram once a year if you are 40 to 49 years old and once every two years if you are 50 years and above even if you do not have any symptom. It is not recommended for younger women (less than 40 years of age) as they have dense breasts, making it difficult for small changes to be detected on a mammogram. So ultrasonography of the breasts is advisable to them.
Types of Breast cancer
- Non-Invasive Breast cancer: These are confined to the ducts within the breasts. They are known as Ductal carcinoma in-situ (DCIS).
- Invasive Breast cancer: It occurs when cancer cells spread beyond the ducts or lobules. Cancer cells first spread to the surrounding breast tissue and subsequently to the lymph nodes in the armpit (Axillary lymph nodes). These cells can also travel to the other parts of the body such as bones, liver, lungs or brain and hence known as metastatic breast cancer.
Making A Diagnosis
If you notice any unusual changes in your breasts, you should see a doctor immediately. He will examine you clinically and may ask you to undergo some tests so that a definitive diagnosis can be made. Further, the staging work up is done to find out the stage of the disease and management accordingly.
Treatment of breast cancer may include various methods such as surgery with or without breast reconstruction, chemotherapy, radiation therapy, hormonal therapy and targeted therapy. Treatment options offered, depend upon the number of factors such as the stage of cancer and likelihood of cure, your general health and your preference.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Blockage in heart is a common term used for narrowing of coronary arteries. Coronary arteries are vessels, which supply blood and thus oxygen and food to continuously working heart muscles. Heart muscles, which are not tired working from the birth till death, however, cannot sustain long without blood supply.
A reduction in blood supply gives rise to ischemia of heart muscles commonly manifested as chest discomfort or angina. A sudden complete shutdown of blood supply leads to heart attack leading to permanent damage to heart (if blood flow not reestablished promptly).
But what causes these arteries to block? Sedentry lifestyle is the most primary reason of these blockages. Cigarette smoke increases the rate of atherosclerosis in the arteries of the heart, legs, and the aorta -- the largest artery in the body. Also, there is an increase in the risk of heart attack if a first-degree relative (parent or sibling) has had a heart attack or stroke. That is mainly seen when the relative has had a heart attack before the age of 45 if they are male, 55 if they are female.
High levels of ''bad'' cholesterol, or low-density lipoprotein (LDL), are also the major contributors to arterial plaque formation. Having high blood pressure also increases the rate at which arterial plaque builds up. It also hastens the hardening of clogged arteries. LDL a normal component of blood (upto certain limit) starts depositing in arteries as early as 10 years of age!
Deposition of billions of LDL molecules over several years on inner surface of arteries gives rise to visible narrowings in these arteries. Flow ahead of these narrowings is reduced in proportion to the narrowing. At a level of 70 % narrowing the flow is reduced to give ischemia (and angina) during exercise. Gradually increasing degree of narrowing reduces the exercise needed for ischemia and angina; a narrowing of more than 90 % can give symptoms at rest. A sudden clot formation at any of these stages can block the flow suddenly giving a heart attack.
If LDL is a normal component of blood, why it is deposited in the arteries at first place?
LDL above a certain limit in blood starts depositing in the arteries. Diabetes, Hypertension, smoking, less exercise and genetics makes it more sticky thus making narrowing faster. This is why these risk elements need to be properly attended for prevention from heart disease. For treatment medicines are important for stopping the progression of narrowings; angioplasty is a method of fast resolution of blockage; and bypass surgery is the method of creating a whole new blood supply for the affected part of the heart. If you wish to discuss about any specific problem, you can consult a Cardiologist.
Myth: Brain damage is always permanent.
Fact: The brain can repair or compensate for certain losses, and even generate new cells.
People once believed that we were born with a finite number of brain cells, and that was it for life; if you damaged any of them you could never get them back. Similarly, many scientists believed that the brain was unalterable; once it was" broken" it could not be fixed.
Now, of course, we know that the brain remains plastic throughout life, and can rewire itself in response to learning. It can also generate new brain cells under the right circumstances.