Sometimes, when it comes to problems in the abdominal area, an ultrasound is not clear enough for a diagnosis. In such cases, an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed. This procedure gives the doctor a clear view of the duodenum, bile duct, pancreatic ducts, gallbladder and papilla of Vater.

This procedure is usually performed under intravenous sedation without general anesthesia. This procedure involves the use of a duodenoscope, which can be described as a thin, long, flexible tube with a camera at one end. It also has a fiber optic bundle that transmits lights to the camera and a chip to transmit video images to a TV screen.

This is inserted through the patient s mouth and sent down the throat through the food pipe to the stomach and duodenum while the patient is lying on his or her back. The air pipe is left undisturbed so as to not interfere with the patient s breathing. Since the patient is not under general anesthesia, he or she can move and turn according to the doctor s needs. The papilla of Vater is a small nipple like structure with an opening to the bile duct and pancreatic duct. Once this has been identified, a small plastic catheter is passed through the duodenoscope into the bile duct or pancreatic duct through the papilla. Dye is then injected into the area and X-rays are taken of the bile ducts and pancreatic duct. In cases where a biopsy is needed, other instruments can also be passed through the endoscope. Plastic or metal stents can also be passed through this to relieve obstructions in the bile ducts and pancreatic ducts.

ERCP can be used to diagnose and treat a number of conditions in the liver, bile ducts, gall bladder, pancreas and papilla of Vater. These include:

  Blockage of the bile duct by gallstones, cancer, scars, tumors or compression from adjacent organs.

  Jaundice due to an obstructed bile duct. This can also cause light stools and dark urine.

  Persistent upper abdominal pain

  Unexplained weight loss and loss of appetite

  Diagnosing a Dysfunctioning Sphincter of Oddi within the Papilla of Vater

ERCP can also be used to confirm pancreatic cancer and cancer of the bile duct. Once the diagnosis is confirmed, the doctors can customize treatment according to the patient s needs.

Endoscopic Retrograde Cholangiopancreatography - Procedure and Results

There are instances when a kid doesn t show the usual signs of development compared to their peers. Most parents take it casually thinking that their child will catch up in due course only to find a larger problem associated with it. It is therefore extremely important to discuss speech and language related delays with a medical practitioner to find out whether a child is immature or has a genuine problem which requires medical help. A child can show different signs as per age:

Different age group:

Within the first 12 months, a baby should be able to relate to his environment and make babbling and cooing sound. It is often observed that by month 9, a baby is capable of stringing sounds after seeing things. If a baby is intently watching objects, but is unable to make any sound, this may be an early symptom of speech or language related problem.
Between the 12th and the 15th month, a baby should be capable of making a wide array of sounds including few commonly used words. Babies should also be able to take few basic instructions and oblige those.
Between the age of 18th and 24th months, a baby becomes smart enough to pronounce anywhere in the range of 20 to 50 words. They also start combining words and make simple sentences. They should be capable of identifying common objects and remember their names.
By the age of 3, a toddler should be smart enough to combine 4-5 words and form sentences. Kids of this age also become smart enough to take straightforward instructions and perform them comfortably. Any deviation on this should be immediately reported to the Doctor.
What are the warning signs?
If a child between the age of 1-2 is not able to do the following things:

Fails to use gesture
Use more gesture than vocalising by the age of 18 months
Produce no voice by 18th-month
Fails to perform simple instructions
A child between the age of 2-3 needs evaluation if:

Capable of imitating words but isn t spontaneous in vocalising
Repeats certain words multiple times
The tone of voice is unusual compared to his peers
Possible causes of speech and language delay:

Problems with palate leading to oral impairments
Short frenulum restricting sufficient tongue movement to produce speech
Oral-motor problems leading to speech limitation
Problems related to hearing
Chronic infection of the ear leading to speech delay
What does the pathologist assess?

What can the child speak?
What can the child understand?
Oral-motor status
Clarity of speech
Post the above evaluation a pathologist directs a plan of action. Sometimes speech therapy sessions are recommended in order to improve kids  skill. For a motor related problem, a doctor can state a plan of action and limit the expectation of parents.

Speech & Language Delay - Spot The Signs!

BAHA Implant
Bone Anchored Hearing Aid (BAHA) is a device surgically implanted to help people suffering from a loss of hearing. Most conventional hearing aids transmit sound through air conduction. The BAHA device is suitable for conductive or mild-moderate mixed hearing loss.

Problems with hearing in the middle or outer ears can be helped with the BAHA device. The sound waves received by the BAHA device bypass the middle ear and get delivered straight to the functioning cochlea in both ears.

A BAHA device comprises of two parts:
a) The processor 
b) A fixture which is surgically implanted behind the ear in the bone.

The implant is embedded in the bone. The processor, which remains outside, is attached to the implant. There is a microphone on the processor that picks up sounds. The sounds are passed on to the implant. The implant vibrates which triggers the Cochlear. You can consider wearing a BAHA implant if other conventional hearing aids do not work for you. BAHA implants are also given to people with collapsed or irritated ear canals.

Cochlear Implant Surgery

A complex, small electronic device that helps hearing in people with severe hearing loss or deafness is used in the Cochlear Implant Surgery. The cochlear implant comprises of an external piece behind the ear and another piece that is surgically implanted under the skin. A cochlear implant comprises of four parts:
1. A microphone which picks up sounds from the surroundings
2. A speech processor which chooses and arranges the sounds the microphone picks up
3. A receiver/stimulator and transmitter that picks up signals from the speech processor and changes them into electric impulses
4. An electrode ray, a bunch of electrodes, receives impulses the stimulator sends and transmits them to different areas of the auditory nerves.
The implant does not cure deafness; it only gives you a useful portrayal of sounds in the environment and considerable aid in understanding speech.

The surgery is done in the following way:
i. The area around the site of the implant is shaved or cleaned
ii. The patient's vital signs are monitored through cables, patches and monitors attached to him or her
iii. General anaesthesia is administered through IV or through a face mask
iv. After the device is implanted, the patient is taken to the recovery room for the anaesthesia effect to lessen.

BAHA Implant and Cochlear Implant Surgery

How Physiotherapy Can Help with Neurological Disorders

Neurological disorders are problems with any one or a combination of the central nervous system or any of its peripheral systems such as cranial nerves, neuromuscular junctions, and the autonomic nervous systems among others.

Some extreme examples of neurological disorders are:

- Dementia
- Alzheimer's disease
- Parkinson's disease
- Epilepsy
- Disorders brought on by strokes
- Multiple sclerosis and others

What is physiotherapy and how can it help?

Physiotherapy is a form of treatment where practitioners use physical forms of treatment such as massages, exercises, heat treatment and other controlled forms of external stimuli to treat physical disorders.

This method of treatment can be very effective in correcting neurological disorders.

Some of the physiotherapy techniques, which can be implemented to help patients, are as follows:

Electrical Stimulation: This method is commonly used to treat muscular problems, especially incurred after an accident or any other form of injury. In this method, controlled electric stimulation is given to specific nerve areas over the skin to stimulate them.

Heat treatment: This method involves applying heat to parts of the body such as joints or muscles where there is nerve or muscular damage. This treatment is especially effective for muscle related problems.

Ice or cold treatment: Vertically opposite to the principle of heat treatment, ice or cold treatment is used to contract muscles within the body. This is especially effective where inflammation needs to be controlled.

Manual therapy: Possibly the most common form of physiotherapy, this method employs massages, pressure points, stretching and hands on strengthening exercises and helps regularize nerve impulses to areas where they have been affected.



How Physiotherapy Can Help with Neurological Disorders

Aging comes with many health problems including mild hearing loss. Usually, this mild hearing loss does not come alone. According to medical studies, adults, particularly males with hearing loss, mild or severe, are at a higher risk of developing Dementia and Alzheimer s disease. The risk increases as the hearing loss worsen. People with mild hearing loss are at twice the risk of developing dementia compared to people with normal hearing.

Dementia is a group of symptoms and diseases that affects the thinking, memory and social abilities that interfere with the daily functioning of an individual. However, memory loss alone does not mean that one has Dementia. Out of the many causes, Alzheimer s disease is usually the cause of Dementia. Alzheimer s disease is a progressive disease that affects the brain cells to degenerate and dies, destroying memory and other mental functions. 

How Hearing Loss Causes Alzheimer s?

According to medical studies, hearing loss causes several brain changes which increase the risk of developing Dementia. Hearing loss can lead to brain shrinkage, the process in which the section of the brain responsible for hearing becomes inactive. This condition leads to loss of tissues and alterations in the brain structure, developing as the first connection between hearing loss and Alzheimer s. Studies show that the brain of people shrinks more quickly who have hearing loss as compared to the brain of an individual with normal hearing. 

The second link created with an overwhelmed or overloaded brain. In hearing loss, the brain works overtime in understanding what others are saying. When the brain strains too much only for hearing every time and every day, it exhausts an individual s mental energy and snatches the brainpower required for other important mental functions, such as thinking, remembering and acting. This can further lead to Dementia, Alzheimer s and other mental disorders. 

Hearing Aids to prevent Dementia and Alzheimer s

According to various studies, hearing aids are not only helpful in improving one s hearing but they can also preserve an individual s mental and emotional health. Early diagnosis and treatment of a possible hearing loss help reduce risks later in life.

At times, the symptoms of undiagnosed hearing loss are mistaken with the symptoms of Alzheimer s. Hearing impairment makes it challenging for an individual to listen and respond to verbal signs. It increases the feeling of confusion, paranoia, and isolation. 

Hearing aids can relieve the symptoms of Alzheimer s. According to a study hearing aids slow down the rate of memory loss and improve an individual s quality of life.

Takeaway

Adults, especially males with hearing loss have a greater tendency of developing Dementia and Alzheimer s. Hearing loss causes brain to overwork leading to the loss of important mental functions. Hearing impairment can worsen the symptoms of Dementia and Alzheimer s. 

Hearing aids do help in improving the condition and symptoms of Alzheimer s and improve one s quality of life. A timely diagnosis can make a big difference.

Dementia And Alzheimer's Disease In Elderly - Could Hearing Loss A Reason?

Borderline personality disorder (bpd) is a mental illness. A patient suffering from bpd maintains unstable relationships with other people, shows inappropriate emotional reactions and possesses suicidal or self-harm tendencies. It is purely a personality disorder caused due to multiple factors. Patients suffering from bpd may find it difficult to stay alone. They fear abandonment and loneliness. Yet they have a tendency of showing mood swings, sudden emotional outburst or anger and hostility. This prevents them from having a long lasting relationship in life.

It usually starts affecting the patient's life from early adulthood. It however seems to improve with age. The patient also has distorted self-image. He or she is unclear about what they want from life or what they are in reality. Even minor incidents can trigger intense reactions in people with bpd.

Symptoms of borderline personality disorder.

The signs of suffering from bpd are listed below:

Intense and frantic effort to avoid abandonment or loneliness
Unstable relationships with people and changing the attitude towards them drastically. It can change from being in immense love with each other to intense hatred.
Developing paranoid thoughts and having dissociative feelings-the patient often lacks the feeling of self and suffers from identity crisis.
Suicidal feelings and attempts
Tendency to cause self harm or destruction by drug abuse, driving irresponsibly or be having unprotected sex
Reflecting intense depression
Chronic boredom
Sudden anger and hostility
Causes for borderline personality disorder.

Borderline personality disorder can be caused due to multiple reasons. Usually it has been found by researchers that it occurs to patients who have had a disturbed childhood. Complex and unpleasant happenings in the childhood may leave a deep impact on the patient's personality, which comes back as a disorder in his or her early adulthood. From mental, physical to sexual abuse in the childhood can lead to this condition in adults.

Besides, researchers have discovered recently that this illness has hereditary links. Some genes may be responsible for bpd. Improper functioning of the brain is also another factor. Especially, the portion of brain that controls emotions might not be functioning properly in co-ordination with other parts of it.

Diagnosis.

There is no particular clinical test that can diagnose bpd. It can be diagnosed by a series of interactive session with the patient by a psychiatrist.

Treatment.

The treatment of bpd involves three steps- psychotherapy, medications and support from peer and family. Dialectical behavioral therapy, cognitive behavioural therapy and psychodynamic psychotherapy are used in treating the patient. There are no specific medicines to cure identity crisis, boredom and loneliness. However, other symptoms like mood swings, depression and anxiety can be treated with anti-depressants and mood stabilizers. Antipsychotic drugs are also helpful to a certain extent. In extreme cases, hospitalization may be needed.

A Guide to Borderline Personality Disorder

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