The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.
Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in   Acute radicular pain due to irritation or inflammation.

Symptomatic herniated disc with failed conservative therapy
Acute exacerbation of discogenic pain or pain of spinal stenosis
Neoplastic infiltration of roots
Epidural fibrosis
Chronic LBP with acute radicular symptoms
Epidural- lumbar injection
ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

There is minimal or no radiological finding.
Multilevel imaging abnormalities
Equivocal neurological examination finding or discrepancy between clinical & radiological signs
Postop patient with unexplainable or recurrent pain
Combined canal & lateral recess stenosis.
To find out the pathological dermatome for more invasive procedures, if needed
Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

Procedures That Can Help Treat Slip Disc & Sciatica!

Anger is an emotion found in every human being. There is nothing wrong with being angry. However, if it gets out of hand there might be serious consequences. Knowing a few things about anger management might help the next time you are struggling to manage anger. 

The Wrong Approach
Before knowing, what are the right things to do, it is necessary to know what doesn t work well. This will give a better insight on anger management. 

Often, we think suppressing anger might be the right thing to do. But, it is not. Trying not to react to a situation and keeping it under wraps, might affect your health and can even be the root cause of heart disease. However, suppressing it often lessens the intensity of the anger.
Just like suppressing it is not a good idea, venting it out completely is not the right approach as well. Venting might help you to cool down faster later on, but initially, it might hurt the other person and also have a negative impact on health. Venting anger occasionally will also make the person aggressive in nature.
Thinking or using words like always, never, should/shouldn t, must/mustn t do not usually help. Thinking about  he should never talk to me like that  or  they are always being unfair to me , brings about negativity and doesn t help in calming down.
The Right Approach

Counting to 10, the age old approach to anger management often helps in cooling down and giving a clear perspective. When we are angry, we end up saying and doing things we don t mean to. Counting gives us some time and helps us calm down a bit.
Breathe slowly when you are angry, say experts.  Instead of talking or reacting to the situation, just breathe in and out slowly. When you breathe out more, your body will calm down and make you relax.
Talk to someone who understands you when you are angry. Instead of venting out or suppressing it, talk it out with a friend or a family member. Tell them your feelings and why you are angry. This will help you a lot in relaxing. It works as a counselling session.
To manage anger, in the long run, one should always lead a healthy lifestyle. It means not just having a healthy diet, but also having proper sleep, not being stressed about anything, doing exercise, etc. 
Doing something creative often takes your mind away from angry feelings. Join a dance class, an art workshop, start keeping a journal, it will definitely help in the long run.
Leave the place immediately for few moments and drink water slowly when angry. Don't prolong the anger, come back and start conversation normally.

Anger Management - What Works and What Doesn't

Exercises for Sciatica
Sciatica is often distinguished not as a medical condition but as a set of symptoms that underlie a more serious medical concern such as a slipped disc, degeneration of the spine or the lumbar region etc.
It is important to note the symptoms of Sciatica, as these are quite distinct -
1.Constant pain in one of the buttocks or leg (rarely are both legs affected)
2.The pain worsens on sitting
3.The pain is often described as a sharp & searing pain similar to a burning sensation
4.The pain is often accompanied by a heaviness or numbness that makes movement difficult
5.Shifting of postures (sitting to standing and back to sitting) becomes painful and laborious
An alternative to surgery would be to supplement the oral medication with certain specific exercises.
Reflexology, Acupuncture and Chiropractic manipulation are all considered effective to alleviate the pain to a large extent.
Patients are often encouraged to partake in daily exercise routine, incorporating strengthening and stretching exercises.
The strengthening exercises target the core or abdominal muscles along with the back muscles to provide more support to the back.
The stretching exercises will help to “loosen up” the surrounding muscle groups such as the hamstrings, which then allow for more blood and oxygen circulation alleviating the pain and giving the immune system a much needed boost.
When patients engage in a regular programme of gentle stretching and strengthening exercises, they can recover quickly (in comparison to those who do not exercise) from the flare ups and over time the painful episodes are known to reduce significantly, both in frequency as well as intensity.
Ancient holistic practices such Yoga and Tai-chi are often considered the best form of exercises for the afflicted because of the balanced and slow but controlled movements that complement the ‘breath’ rather than causing further exertion to the already fragile bone density.
It is recommended that expert advice be sought and the exercises should be undertaken only under trained supervision. Please do not attempt to “experiment” with Yoga or Tai-Chi on your own, as improper or wrong posture could lead to irreparable damage to the spine. 


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 Exercises for Sciatica To Keep It Under Check

Testosterone is the most important hormone that drives most of the male characteristics from their physique, stamina, energy, vigor, voice, to sexual performance. Higher the testosterone level, greater the masculine characteristics. It is no wonder then that most men want more testosterone flowing in their system. There are simple ways to increase testosterone flowing in your system; read on to know more.

Eat more fat: While staying away from fat is the most common thing to do when body building, remember that testosterone is mainly made of cholesterol. So, a diet rich in fat directly translates to more testosterone. Mono-saturated and saturated fats are proven to be extremely beneficial for good testosterone production. Red meat, eggs, coconut oil, dark chocolate, cheese, peanut butter, fish, avocados, almonds, olive oil are all proven to be highly beneficial in improving testosterone levels.
Include ingredients for testosterone: Include foods that are rich in zinc, vitamin D, D-aspartic acid, Di-indolyl-methane (DIM). Foods rich in zinc promote higher levels of testosterone production and so are advisable. Vitamin D is the most important vitamin in the production and availability of free testosterone in the body and is highly recommended for people wanting to have higher testosterone levels. D-aspartic acid is an amino acid that is essential for proper functioning of the neurotransmitters that control testosterone synthesis and release into the system.
Modified gym routine: Contrary to what most people may think, long hours in the gym does not help you stay in better shape. Regular, drawn-out workouts with long rest periods and too many exercises aimed at building endurance are not necessarily good for testosterone levels. Optimal duration is about an hour, after which cortisol levels (stress hormones) go up and testosterone levels go down. Shorter rest periods between sets are also shown to be more effective. Also, there are specific exercises and workouts which are aimed at improving the testosterone levels. These workouts could be aimed at the legs, arms, back, chest, or shoulders. These moderate to high-intensity protocols stress large muscle masses, which stimulate testosterone production.
Beat the stress: None of our lives are free of stress, but the trick lies in managing them well. Whether you have physical or mental stress, try and work on reducing it, by meditation, music, or any relaxation technique that works for you. Even cardio exercises, if not overdone, are a good way to relax. Try not to fatigue yourself during your workout. Have a well-balanced meal and a good sleep to manage stress better.
Talk to your instructor to know more about ways to improve testosterone production. Higher levels of testosterone take the quality of life to a different level.

4 Ways to Boost Your Testosterone Levels!

Gastro-oesophageal reflux disease (GERD) refers to a health condition wherein the stomach acids tend to leak backwards from your stomach into the oesophagus, causing the latter to experience a good amount of irritation, thereby triggering a number of other problems. GERD has a way of affecting people irrespective of their age or gender. Patients who suffer from asthma are at greater risks of encountering the problem of GERD, and some asthma medicines tend to worsen reflux symptoms. However, the effects are indeed two-way in this regard. Acid reflux worsens asthma symptoms by deeply affecting the lungs and airways. Allergic reactions might also be brought about as a result of such a condition.

Symptoms 

GERD is a condition that everyone has experienced at one point or the other in their lives. It generally happens when on burping you are left with a bit of an acid taste that lingers in your mouth, followed simultaneously by a case of heartburn. A sure way to ascertain this condition is to check for the following symptoms: 

Sudden and excessive rise in saliva
Acid regurgitation
Gums show inflammation
Sore throat that is chronic
Bad breath
Cavities
Encountering pain or difficulty while swallowing
Hoarseness or laryngitis
Chest pain
How can it be treated?

The prime treatment measure for GERD is to adopt necessary lifestyle changes so that you may nurture better health. In case you happen to be overweight, it is important that you look into the matter of weight loss. 

Medicines must be taken along with a lot of water, and doctors must ensure that prescribed medications do not actually worsen your heartburn.
Over-the-counter medications and antacids can be used every once in a while after meals, but it does one good to remember that the effects don t last for long. Side effects of excessive dosage of antacids include constipation or diarrhoea. 
Proton pump inhibitors might also be recommended in acute cases of GERD to reduce the total amount of acid that is manufactured in your stomach. H2 blocker is another antidote that aims at reducing the level of acid that is released in your stomach.
Anti-reflux surgery is also prescribed for those people whose symptoms persist despite a change in medications and lifestyle patterns. An endoscopic surgery is another important procedure that may be opted for in order to correct GERD.


GERD - 4 Different Ways It Can Be Treated!

Hair health is not isolated from your overall health. If you are not very healthy overall, it will show on your hair as well. However, there are many lifestyle mistakes that also result in the damage of hair. If you are losing hair very fast and don t know why it is happening, watch out for the following mistakes you might be unknowingly doing-

1) Hot Water Shower:  Hot water damages your hair. It strips your scalp of the natural oils and dehydrates your hair, making them brittle. Use mildly warm or regular water for head showers.

2) Combing Wet Hair: Your hair is highly prone to breakage when it is wet. Combing or brushing wet hair weakens the roots and causes hair fall. To maintain healthy texture, it is safe to leave the hair to dry naturally. Also, don't brush your hair harshly.

3) Tight Tie-ups: Tightly fastened hair braids or ponytails cause tension to the roots and follicles. Pulling the hair too tight causes damage and must  be avoided, esp. at night.

4) Heat Treatment: Every time you blow dry your hair or use other heated styling tools, the scalp is subjected to undue heat. Such intense heat weakens the roots instantly. Switch to cool drying or stick to natural drying.

5) Using Styling Products: Hair styling gels and sprays make your hair stiff and sticky. A prolonged use of such products may cause major damage to the hair because the moisture has been drained out and there is friction every time you comb or brush the hair.

6) Not Oiling: Oiling your hair might be very unglamorous to look at but oils of coconut, mustard, olive, amla or sesame deeply nourish the hair follicles. Massaging your scalp with oil twice a week helps improve circulation thus contributing to overall hair health.

7) Bad Eating Habits: Skipping meals or taking improper nutrition has a direct impact on hair health. Healthy hair demand good consumption of proteins and other vitamins. Make salads, fish, lentils, beans, eggs, etc. a part of your daily diet.

Have any further questions on hair loss or hair care? Click on consult privately to ask me.

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Stop Making These 7 Mistakes To Prevent Hair Loss

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