Gout: a brief idea

In the simplest of words gout can be defined as the inflammation of joints due to continuous accretion of urate crystals. An excess of uric acid can make a person suffer from gout. There could be a higher percentage of uric acid in a person's blood due to two chief reasons; an inept excretory system that fails to rid your body of surplus acid and also greater production of the acid. Arthritis is of three kinds; gout is one of those three. Homeopathy is known for its efficacy in treating gout. 
   
Homeopathic remedies for gout:
1. Urtica urens can cure gout: This homeopathic medicine is prescribed by a professional practitioner if the person is susceptible to cold. Urtica urens can work on a patient if he or she is allergic to snow,  air, touch and water. Hive like eruptions on your ankles, wrists, and shoulders can be treated through regular consumption of this medication.
   
2. Ledum can relieve you of pain: A painful, swollen area that develops on the small joints such as the joints of your toe fingers can be cured with the use of Ledum. The sensation of shooting pain in your limbs or feet can also be dealt with Ledum. Apart from that swollen small joints can be given momentary respite by falling back upon the cold compression therapy. Patients are advised to take this medicine if they exhibit intolerance to external warmth. 
 
3. Lycopodium is effective on sore joints: Chalky deposits of urate can be found in a person's knees. This results in chronic gout. Chronic gout has symptoms like limited urination. The urine may or may not have red sediments. People have also been reported with symptoms like extreme backache. Lycopodium successfully cures cases of unceasing gout.
     
4. Try out benzoic acid for a big toe: If your gout is accompanied by stinking yellow urine you probably need Benzoic acid. Gout could be so severe that it might result in a stiff limb. In certain cases it makes a person limp. The thumb of your feet might get swollen making you have a big toe. A big toe usually kills you with tearing pain.
    
5. Arnica deals with bruises: Arnica is your go to solution in case of a throbbing, stinging pain in any part of the body. This medication is a cherished answer to aches in every household. When gout is tender and it hinders free movement, this medicine comes to your aid. The medicine also heals bruised eruptions.

Homeopathy and Gout

A meniscus tear is a common injury associated with the knee. The meniscus acts a defensive shield, providing a much-needed cushion to the knees, keeping it stable and injury free. Each knee joints contain two menisci located between the tibia and the femur. In this article, we will discuss important details related to meniscus tear to help you understand the injury better.

Facts related to a Meniscus Tear

A meniscus tear can affect all and sundry. However, sports persons (especially those associated with soccer, tennis, football, and basketball) and aged people are more susceptible to the condition.
As per Boston Children's Hospital, of late there has been a steady rise among children suffering from the meniscus tear.
Osteoarthritis may act as a catalyst, accelerating the chances of a meniscus tear.
In most of the times, a meniscus tear occurs when you exert immense pressure on the knee joints such as lifting a heavy object or suddenly standing up from a squatting position. With age, the meniscus is known to suffer from a natural wear and tear resulting in the injury.
As already mentioned, there are two menisci present in each knee joints. The one present inside the knee joint is called Medial Meniscus. Lateral Meniscus is the one present on the outer part of the joint.
Depending on the extent and severity of the injury, a meniscus tear may be
A minor tear: This is a small injury accompanied by mild pain and swelling which may last for not more than 2-3 weeks.
A moderate tear: The injury results in pain that are concentrated mainly around the center or the sides of the knee. The swelling goes from bad to worse over the next 2-3 days, with the person facing discomfort while bending their knee. The knee also stiffens. You may be relieved of the symptoms within a week or two but overusing the knee or twisting it may cause a relapse.
A severe tear: True to its name, your knee is the worst affected in this case. The cartilage tear may be such that the torn pieces get lodged in between the joint spaces causing the knee to lock, pop or even catch. A person experiences unbearable pain and discomfort along with stiffness and swelling (can be immediately following the injury or within 2-3 days). In the case of a severe meniscus tear, a person may not be able to straighten the knee at all (without treatment and medical intervention)
Treatment for a meniscus tear may be surgical or nonsurgical.
The nonsurgical treatment involves the application of cold compress on the affected area. The person needs to take ample rest exerting minimum pressure on the affected knee. Physiotherapy and strengthening exercise can go a long way in improving the condition. To reduce the pain and swelling, the doctor may prescribe painkillers and NSAIDs (Nonsteroidal Anti-Inflammatory Drugs). Keep the knee elevated. The use of elastic wraps may be helpful.

In extreme cases, surgery may help to treat the injury and the associated symptoms.

Facts About a Meniscus Tear!

Muscle cramps often occur in the calf muscle of the back of the lower leg. It is often characterized by a momentary sharp pain along with a muscle lump beneath the skin. Just like its sudden appearance, muscle cramp disappears the same way without any botheration. However, a doctor should be consulted if you see any of the following symptoms:

    The pain keeps coming back
    The cramps result in weakening of the muscles
    It causes frequent discomfort
    It results in changed skin color, redness or swelling of the skin
    The condition doesn t improve with normal care
    Cramps are not associated with obvious causes such as playing, exercising and jogging

What causes muscle cramps?
Any strain on muscle, dehydration, muscle overuse or simply standing for a prolonged time can lead to muscle cramps. The exact cause of muscle cramps is not known in a lot of cases. There could be the following medical conditions that could lead to such muscle cramps:

    Blood supply: At times when the arteries narrow down resulting in an inadequate blood supply in the leg, a sharp pain can be felt followed by muscle cramps. This can happen while exercising or playing. It disappears as soon as one rests their legs.
    Mineral depletion: Shortage of magnesium, potassium and calcium in the body can lead to muscle cramps. Even medication for high blood pressure can lead to cramps in the legs.
    Nerve compression: Nerve compression of the spine can produce sharp pain on the leg muscles. The pain worsens with longer durations of walk. The symptoms, however, can be delayed a bit if the walking posture is changed, like the way one walks while carrying a shopping cart.

What are the risk factors associated to muscle cramps?

    Dehydration: Muscle cramps often happen among athletes when they get dehydrated and fatigued while performing in hot temperature.
    Age: People over the age of 60 often lose mass in the muscle. The remaining mass gets stressed out soon, resulting in muscle cramps.
    Pregnancy: Pregnant women face frequent muscle cramps due to the sudden increase of body weight and restricted movements in the pregnancy period.
    Medical conditions: Certain medical conditions such as nerve disorder, thyroid problems, liver failure, diabetes etc. greatly increase the chance of muscle cramps.

Some common ways to treat muscle cramps:

    A brisk walk followed by stretching relaxes the muscles and greatly helps in staying away from cramps.
    A diet consisting of magnesium on a regular basis gives relief from muscle cramps.
    A wet cloth soaked in hot water often shows magical results and gives instant relief from muscle cramps.
    Being hydrated throughout the day helps with muscle cramps. It is necessary to consume enough amount of electrolytes so that muscle contraction does not happen.

Why You Get Muscle Cramps?

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!

Facial paralysis is a loss of facial movement because of nerve damage. Your facial muscles may seem to hang or may become distinctly weak. It can happen on one or both sides of the face. Usual reasons for facial paralysis include:

Infection or swelling of the facial nerve
Head injury
Head or neck tumor
Stroke
Facial paralysis can increase all of a sudden or happen slowly over a span of months (mostly if one has a head or neck tumor). Based upon the cause, the loss of movement may keep going for a short or a long period of time. However, physiotherapy can prove to be very beneficial. Here is how:

1. Electrical stimulation: A few specialists suggest utilizing electrical stimulation and biofeedback as technique for physiotherapy for facial paralysis, yet different specialists believe that it does help in recovery. Talk with your specialist or advisor about whether electrical stimulation is ideal for you. Electrical stimulation uses little amounts of electricity to relieve the muscles in your face. This causes your muscles to jerk as though electrical signals from your brain reacted to them. During this time, your face is most incapacitated, which might be the main cause for you to enact these facial muscles.

2. Manual massage: Face rub can be performed in conjunction with other treatment choices. It is possible to enhance mental relief. Massage methods on the face include:

Effleurage
Finger or thumb massage
Tapping
Stroking
3. Kabat rehabilitation: Kabat recovery is a sort of engine control restoration procedure. During Kabat, specialists increase the compression of the weakened muscle by applying a global stretch and then massaging the solid segment. They encourage movement by verbal info and manual contact. While performing Kabat, there are namely three phases - the upper (temple and eyes), intermediate (nose), and lower (mouth). Before Kabat, ice compression needs to be performed to the particular regions, with a specific end goal to build its contractile power.

4. Icing: Ice helps in decreasing the aggravation surrounding the facial nerve, which might be in charge of the loss of nerve movement or conduction leading to facial paralysis. You can either use an ice pack or any cold compressor.

5. Facial exercises: These include doing essential activities with the distinctive muscle surrounding your face. In case you consult a specialist or physical advisor for your facial paralysis, he or she will suggest particular exercises for your level and stage of paralysis. If not, have a go at flexing the different muscles in your face through and through. Frown, raise your eyebrows, gradually flicker your eyes, and proceed down to your jaw.

Facial Paralysis - How Can Physiotherapy Help You Get Better?

An abnormal swelling in the neck can be symptom of various problems. While it can be something as non-threatening as a swollen gland due to a cold that can be cured with simple medication, a swollen neck can also turn out to be a cancerous lump in the neck. When faced with an irregular swelling in the neck, it is best to not panic or jump to conclusions until you consult with an Ear-Nose-Throat Specialist. The possible problems that a swelling in the neck can indicate are:

Swelling or enlargement of the salivary glands: The salivary glands may become enlarged due to an infection or due to foreign materials getting stuck in them. While foreign objects or formation of stones in the salivary glands might require surgical removal, they can often be dissolved with medication and other non-invasive treatments. And infection in the salivary glands is often treated with antibiotics or other medication. These treatments can be prescribed and administered by ENT Specialists.
Thyroid disease: The thyroid gland may swell up and cause a swelling of the neck. These are often called goiters in colloquial language and are a result of thyroid diseases such as hypothyroidism and hyperthyroidism. They usually require a series of medication and treatment and are not considered an ENT problem despite the swelling of the neck.
Benign cysts: Benign cysts can form in any part of the neck or in the glands, much like it can form in any part of the body. An ENT Specialist can prescribe a surgical removal of the cyst lest it turns cancerous later in life. It should also be removed in case it grows or relocates, going on to cause other problems.
Lumps in the muscles: Lumps in the neck muscles are formed by injury or torticollis. These usually aren t considered ENT problems and can be treated by general physicians and sometimes chiropractors.
Cancerous cysts or growths: One of the most daunting problems posed by a swelling of the neck is the possibility of cancer. While thyroid cancers as well as cancerous growths in the salivary glands are slow to develop, a swelling in the neck should immediately be investigated by an ENT Specialist in order to rule out all possibilities.

Neck Swelling - When It's An ENT Disease!!

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