When you think about a healthy diet, you wonder how much carbohydrate, protein, fats and minerals you need to stay fit. However, are you neglecting the importance of vitamins in your daily diet? Research suggests that vitamins play a crucial role in muscle building and bone health.

Here is a look at the different vitamins that will help you enhance your muscles and bones using vitamins.

1. Vitamin D-

You may have heard about the importance of calcium for proper bone health. However, only consuming calcium-rich foods will not help you develop stronger bones. If you do not have enough vitamin D in your body, you will not be able to use the excess calcium for bone health. Vitamin D helps your body utilize the calcium for bone growth and enhancement.

Apart from strengthening your bones, vitamin D also works wonders for your muscles. It helps the body absorb calcium and phosphorus, both of which are essential elements in the production of adenosine triphosphate or ATP. ATP is the only form of energy that your muscles can use during movements and activities.

Best sources for vitamin D are cheese, egg yolk, certain fatty fish, shrimp, mushrooms, soya milk, orange juice and cereals.

2. Vitamin K2-

Vitamin K2, also known as menaquinone, improves your cardiovascular health. Vitamin K2 is also a coenzyme that helps your bone use proteins. Additionally, a study performed in 2013 revealed that vitamin K2 improves bone metabolism in post-menopausal women. At such an age, women s bone health starts to deteriorate and osteoporosis sets in. Therefore, vitamin K2 becomes all the more important for women at such an age.

Best sources of vitamin K2 are butter, cheese, egg yolk, dark chicken meat, and fermented soy.

3. Vitamin C-

Vitamin C is a great choice if you work out regularly. A powerful antioxidant, it helps your body metabolise proteins in the body, leading to muscle growth. Additionally, vitamin C helps in the absorption of iron, which is an essential component of blood.

Best food sources for vitamin C are citrus fruits, such as oranges, lemons and more. Additionally, green capsicum, broccoli, and blackcurrants also provide ample amounts of vitamin C to your body.

Even though vitamins have a role to play in building stronger bones and muscles, the only diet will not be enough for a fit body. You need to start exercising along with eating a balanced diet if you want to stay healthy. Furthermore, exercising helps improve your musculoskeletal health.

Vital Vitamins For Musculoskeletal Health!

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 

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

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

Osteoporosis is a disease of the bones. It occurs when the mesh-like structures present inside the bones becomes thin. This is a condition in which the bones become extremely fragile and have a tendency of breaking easily. The broken bones cause extreme pain. There are artificial medicines available in the markets for treating this condition. However, treatment of osteoporosis can be best done by the naturally produced Parathyroid hormone (PTH). 

It is secreted by the parathyroid glands in our body. It is an 84-amino acid polypeptide. The most interesting thing about PTH treatment is that it actually builds new bones. Other medications for osteoporosis only reduce the rate of loss of bones. PTH helps in increasing the amount of calcium in body. It also prevents bone loss due to osteoporosis. It is often considered to be an anabolic agent. If an osteoporosis patient is given low doses of PTH, his or her bones get strengthened. It also helps in increasing the bone mass.

Why a doctor recommends PTH for osteoporosis? Is it better than other drugs?
Traditionally, bisphosphonates were used to treat osteoporosis. However, it has been observed in a number of cases that bisphosphonates only help in slowing down the loss of bone density. However, PTH increases bone mineral density. Therefore, it is a better option for the treatment of osteoporosis. It is usually given to patients who have extremely low bone mass. It has been found effective in cases where other medications failed to show results. Moreover, it also works for postmenopausal women. 

Doctors believe that it can also be used for treating men with osteoporosis who are at high risk for fracture. It improves the microarchitecture of the bone and can do wonders in altering the bone size. Moreover, it has lesser side-effects on the health of the patient. It is known to cause dizziness and nausea and no major discomfort. It has also been noticed that patients who are being treated with PTH develop less back pain. These are also cost-effective for the long term treatment of osteoporosis.

Parathyroid Hormones - Is It a Better Treatment For Osteoporosis?

People with spine problems face tough choices when considering treatment. Depending on the severity and scale of the disorder, you will have to decide which treatment works the best for you, and keep an eye out for its long-term impact. Owing to the numerous myths and misconceptions surrounding spine surgery, many patients are unreasonably reluctant to consider this as a treatment option.
Before you make your mind, learn the truth behind these myths about spine surgery. 

  Myth: Spine surgery invariably leads to paralysis

Fact: With the introduction of modern technology in the field of medical science, the efficacy and success rates of spine surgery has improved significantly. The chances of paralysis following surgery are less than 1%. Latest advancements in operating techniques have made the procedure safer and more effective than before.

  Myth: You might require multiple surgeries following spine surgery in the future

Fact: In over 90% of all cases, one successful spine surgery at the right time is all you need to treat the disorder. Majority of patients can do without a second surgery. However, it is essential that patients follow all the instructions and preventive measures to make the surgery successful. The post-treatment guidelines include simple things, such as   eating healthy, reducing and maintaining body weight, exercising regularly, quitting tobacco etc. In rare cases, failing to keep up with these instructions may lead to the need for a second surgery.

  Myth: Spine surgeries are painful

Fact: This was once true when open spine surgeries requiring long incisions were performed   but not anymore. Spine surgeries are now relatively painless as compared to earlier times   all thanks to technological advancements. The modern-day minimally invasive procedure has made spine surgery less painful with no or minimal complications, as you need not go under the knife, literally. In fact, patients do not require anaesthesia before opting for the procedure.

  Myth: You will be bed-ridden for life after the surgery

Fact: The common belief among people is that they will never be able to walk again after spine surgery. But that is not true. With minimally invasive techniques and keyhole surgery, the patient is able to walk the very same day of the surgery. In most cases, they are discharged in a few hours following the procedure. Moreover, pain management techniques and physiotherapy have made it easier for patients to move about without much difficulty.

  Myth: The complication rates are very high in the case of surgery

Fact: With advancements in technology, the overall rates of complications have reduced drastically   less than 3% precisely. The state-of-the-art neuro-monitoring system monitors every nerve during the surgery and allows no scope for error. Surgeons have reportedly been able to avoid all nerve-related complications and offer a 100% success rate using this technique.
The decision to undergo spine surgery can be difficult and the misconceptions floating around do not make it easier. Nevertheless, distinguishing the facts from myths is important. Be sure to discuss any concerns or questions you may have with your physician. They can clear your doubts and help you find out if surgery is the appropriate approach to treat your condition.

Myths About Spine Surgery - Debunked!

Neck cancer refers to the formation of cancer cells in the throat or neck region of your body. Neck cancer is commonly seen in people above sixty years of age. But people above forty can also have the chances of getting neck cancer. Though the symptoms of neck cancer can vary from one person to the other, 

Some of the common symptoms are stated as follows:

 Neck cancer affects the voice box, so a change in your voice can be noticed.
 Weight loss is also a symptom for neck cancer.
 A person suffering from neck cancer can also suffer from dysphagia or difficulty in swallowing.
 Sore throat in some cases can be considered as a symptom of neck cancer
 Bleeding from mouth or through your nose is also a common symptom for neck cancer.
 Ear pain in some cases is a symptom of neck cancer.
 Coughing persistently is also regarded as a symptom of neck cancer.
 Sometimes a lump in the neck is also noticed and it is usually painless.
 Some people also encounter breathing problem.
 In some cases a swelling of the neck, jaw or eyes can also be noticed.

Neck cancer involves certain risk factors too. Neck cancer can be treated in many ways. The following are few treatments available for neck cancer:

 Surgery: your doctor can conduct a surgery for removing the tumors from your neck region. The doctor may decide to do either a microsurgery or laser treatment or endoscopy.
 Chemotherapy: if the tumor spreads to other regions or is large in size, then your doctor may recommend chemotherapy. 
 Radiation: it is used to destroy the malignant cells. It is usually conducted after removing the tumor.

These three are the common treatments followed by doctors. Your doctor may also take help of other treatments like administering drugs to control the growth of cancer cells. But, sometimes treatments fail to work if the process of metastasis starts. So you should not ignore it, as soon as you encounter any of the symptoms stated above, visiting an oncologist is highly recommended.


Neck Cancer Symptoms and Treatment

Anterior Cruciate Ligament (ACL) injury is one of the most common knee injuries. Athletes who play high strain sports like football, rugby and basketball are more at risk in developing this kind of injury.
The ACL is one of the four primary ligaments in your knee. The injury occurs when the ligament is overstretched.

Signs and Symptoms
ACL happens in steps:
a) First, you might hear or feel in your knee a 'pop' sound
b) Next, you might experience pain and an inability to move or continue with your activity
c) Then your knee will swell up
d) Lastly, hemarthrosis develops

Causes
The ACL injury can happen in various ways. Injury may occur if
1. You change directions quickly
2. You stop suddenly
3. You slow down while running
4. You jump and land incorrectly
5. You are tackled, like in football, through direct collision or contact

Diagnosis
The doctor will use the following tests to diagnose ACL injury:
1. Pivot-shift test: This test is done to check for instability
2. Anterior drawer test: This test is done to check for the suspected tear in the ACL
3. Lachman test: This test more or less resembles the anterior drawer test. It is considered far more superior in diagnosing ACL injury than the anterior drawer test.

Treatment
Treatment of ACL depends on the patient's age and lifestyle. A younger patient, who is involved in sports will need surgery to restore agility. An older patient can heal without surgery.
1. Conservative Management: This is recommended for people who are older and lead a quieter lifestyle. Also if the knee is overall stable, the doctor might opt for this treatment. Bracing and physical therapy is enough in this case. To protect the knee stability, braces are given. Crutches are also used to keep from exerting weight on the injured leg. When the swelling subsides, some exercises are performed. This is part of the rehabilitation program. Exercises will strengthen leg muscles that surround the knee.
2. Surgery: If the patient is young and has a very active lifestyle, surgery is very much needed. There are three surgical methods:
a. Primary repair- this method is not recommended barring bony avulsions, which are typically seen in adolescents
b. Extra-articular repair- generally includes a tenodesis of the iliotibial tract
c. Intra-articular reconstruction- this is the standard treatment for ACL injuries.

All About Anterior Cruciate Ligament Injury

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