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!

Drug addiction is a condition, which is abnormal or pathological and occurs due to excess use of alcohol, drugs, smoking or other such addictive substances. The different effects of addiction are acute drug use, drug-seeking behavior, relapsing vulnerability, slow response to natural stimuli, and last but not the least, low motivation in life.

Drug addiction is regarded as a community disease as it leads to crimes, violence, failure in school, child-abuse, the loss of productivity and domestic violence. That is why it is very important to eradicate this problem from the society; especially the teens should be educated on the same.

Madatya in Ayurveda
In Ayurveda, the problems of drug addiction is dealt under the heading of Madatya, meaning  intoxication . The state of individual occurs due to continuous use of drug, alcohol, tobacco or any substance of high intoxication. Madatya is relative to the third and fourth stage in the addiction process i.e., drug dependence and drug abuse. Madatya kills the will to live a happy and healthy life because it is a total opposite of  ojas , which means a source of energy. Madatya and wellness can t go hand-in-hand in a body.

Addiction and doshas
The Ayurvedic states that the doshas are aggravated by the overdose of drugs into one s body. They are Vata (Air), Kapha (Water), Pitta (Fire) or a combination of all three doshas termed as Tridosha.

Treatments in Ayurveda
In Madatya, Ayurveda balances the aggravated doshas. It first detects the doshas, and then treats them. Ayurveda uses herbal remedies to treat the symptoms, discards the toxins (ama) collected in the body and motivates and regenerates cells and tissues. There is a phase in the de-addiction process where the patient becomes confused because their intelligence level drops due to drug abuse. Ayurveda treats this problem with the use of herbs like Yashtimadhu (Glycyrrhizaglabra), Brahmi (Bacopamonnieri), Shankhpushpi (Convolvulus pluricaulis) and Guduchi (Tinosporacordifolia).

In Ayurveda, treatment of Sattva Guna, meaning the quality of goodness, is done to promote mental health. The patients are made to follow strict healthy practices like consumption of natural vegetarian food, practice Yoga, and meditation and follow a daily routine of less anxiety and stress. Activities like wearing neat and clean clothes, walking and spending time in natural flowery ambiance with good friends, listening to good music and all other forms of natural relaxants and entertainment are also a part of treatment. These will boost the soul and mind of the patients and make them grateful to God for their lives.

Rehabilitation From Drug Abuse Ayurveda!

Cold sores are typically caused by the herpes simplex virus and are characterized by small blisters that develop around the lips and mouth. However, some people do not showcase any symptoms at all. The mouth is the most affected area as the skin in this area is not as resistant to the virus as skin on other parts of the body. It can also occur on the chin, nose or cheeks. Cold sores are communicable through skin contact. This condition can also be triggered by stress. 

The first time this virus affects is a person is known as the primary infection. Some of the symptoms of cold sores are 
- Blisters on the mouth, lips, tongue, throat or gums. These blisters may be dry or oozing. 
- Pain while swallowing or eating due to ulcers and blisters.
- Swollen neck glands.
- High fever accompanied by body ache.

An outbreak of cold sores usually lasts about a week. Once the primary infection is over the virus is not eliminated from the body, but remains dormant in a nerve sheath. Recurrent cold sores may not cause severe mouth infections as with primary infections, but can be quite unpleasant. In most cases, recurrent cold sores erupt in the same area as the primary infection. 

Some of the ways to treat primary infections are:
- Painkillers: Over the counter painkillers such as ibuprofen or paracetamol can help ease the pain.
- Chlorhexidine mouthwash: This can be used in place or brushing in case of painful sores inside the mouth. It can also prevent plaque buildup and secondary gum infection. 
- Antiviral medication: If taken at the onset of a cold sore infection, this can reduce the pain associated with it and shorten the duration of the infection. This also prevents the virus from multiplying. 

As cold sores are communicable, it is important to prevent it from spreading. Some ways of containing this infection are:
- Wash your hands with soap and water after touching your mouth or the sores.
- Avoid touching the cold sores
- Abstain from oral sex
- Do not share items that come in contact with the infected area like lip balms, towels, cutlery etc. 

If the symptoms do not subside within 5 days, visit a doctor immediately. Consult a doctor if you have frequent bouts of cold sores or suffer from a severe case of the disease. Pregnant women and mothers with young babies who suffer from the disease should also seek prompt medical attention.

What You Must Know About Cold Sores + Treatment

Getting a good night s sleep is essential for a healthy lifestyle. When a person is asleep, the body rejuvenates itself. Some people can fall asleep as soon as their head touches the pillow but others can find it hard to sleep. Conditions that affect a person s ability to sleep properly over a long period of time are known as sleep disorders. There are many different types of sleep disorders.

Obstructive Sleep Apnea
Sleep apnea is a very common sleep disorder. This is marked by frequent interruptions in the person s breathing. It may cause the person s breath to become shallow or even stop briefly. In many cases, the person may not be aware of this happening while they sleep. Obstructive sleep apnea is caused by a partial or complete obstruction of the upper airway. This makes the chest muscles and diaphragm work harder to pull air into the lungs.

Insomnia
Insomnia can be described as an inability to fall asleep. Waking up frequently in the middle of the night and finding it difficult to go back to sleep or waking up earlier than planned in the morning are also characteristic signs of insomnia. There are two types of insomnia; primary and secondary insomnia. Primary insomnia refers to the inability to sleep that is not connected to any other disease. If the person s inability to sleep stems from another disease, it is known as secondary insomnia. There are a number of factors that could cause insomnia. This includes life changes such as shifting to a new home, death of a loved one or change of jobs, emotional discomfort, environmental factors such as light or noise, jet lag, stress, etc.

Restless Leg Syndrome
This sleep disorder is also classified as a neurological disorder. It is characterized by an overwhelming urge to move one s legs while sleeping. This may be felt as a scratchy itchy, burning, pulling or throbbing sensation. Massaging the legs or moving it only provides temporary relief. The exact cause of this condition is not known but suffering from an iron deficiency, kidney failure, diabetes, Parkinson s disease or peripheral neuropathy can increase the risk of this sleep disorder.

Narcolepsy
This can be described as the brain s inability to control its sleep cycle. This can make a person fall asleep unexpectedly during the day while falling asleep at night becomes more difficult. In most cases, this sleep disorder is caused by reduced levels of a neurotransmitter known as hypocretin.

So, if you are experiencing any of the above symptoms or have difficulty sleeping, it is advised not to self-medicate and delay the treatment. Seek help from a professional right away and enjoy peaceful sleep.

Sleep Disorder - Know Its Types And Causes!

You might have a wonderful morning routine to keep you healthy. However, do you know what really determines health is also your bed time routine? Each night you end one day and stand at the brink of starting a new one. It is therefore crucial how you organize your bed time.

Here are 7 things to adopt for your bed time- 

1) Plan for next day: Preparing in advance always gives you more time and leaves you stress free. Things like looking for keys, deciding what to wear etc make you late and add to your morning stress. Prepare also for breakfast or what to cook the next day. Planning at night doesnt take much time and makes your next day start on a good note.

2) Shut out the buzz: Most of us say goodnight to family and head to bed only to spend the next hour checking Facebook and social media. Or you end up watching a funny video or movie late into the night. If you keep yourself distracted, you can't go off to sleep early or get quality sleep. The light from your gadget's screen can be harmful and stress inducing. It is best to give yourself an hour away from your mobile phone or other gadgets before you sleep.

3) Write a 'Thank-You' Diary: There are many ways to become a more positive person and the best is to have appreciation. Try finding out that 1 thing (more is better) that you are thankful for. Do it everyday. This practice right ahead of your sleep time calms you down, makes you feel happy, satisfied and goes on a long way in contributing to a heathy lifestyle.

4) Stretch it out: Like most people do you also have a job where you keep sitting for long hours? Stretching really works, it helps lengthen tendons and muscles and can reduce the frequency and severity of cramps ensuring you get a better night's sleep.

5) Try meditating: Our work life has become ever so demanding, we are constantly bombarded with information via the television, social media, the internet, friends and work which results in stress and anxiety! Few minutes of meditation before bed, slows down your brain activity which results in a deeper and more peaceful sleep. You will wake up feeling well-rested, energized and ready to take on the day!

6) Book by your side: Reading before bed is has amazing benefits. Firstly, it calms the nerves by eliminating excess sound and vision stimulus (exactly the opposite of what you get from watching television!). It helps you to wind down and sleep better, it also improves brain function, your memory and the thinking process overall.

7) Sleep is crucial: Foremost is to simply make sleep a priority. It is not as simple as it sounds. Sleep deficiency directly relates to increased stress, weight gain and productivity loss. Going to bed late and managing with 5 or 6 hours sleep sets a bad tone for your day.

Your happiness and general wellbeing is controlled by how relaxing you make your bed time.

Click on Consult Privately to ask me a private question on this topic or a related one.

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Dr. Sapna Zarwal Tells You How To Improve Your Bed-time Routine

Pelvic inflammatory disease (PID) refers to the infection that occurs in the female reproductive organs. It happens when sexually transmitted bacteria infect the uterus, ovaries or fallopian tubes on spreading from the vagina. Generally, the cervix plays the role of preventing the bacteria from entering the vagina and infecting the reproductive organs. But when the cervix becomes exposed to an STD, it loses its power to put a stop to the spread of these microorganisms to the reproductive organs.

What causes this condition?
STDs like gonorrhea and chlamydia have been found to be responsible for about 90% of PID cases.

Some of the other causes include
- Abortion
- Childbirth
- Pelvic procedures

The condition is only detected later in life when you face difficulty in getting pregnant or have chronic pelvic pain complaints. If you experience symptoms like vomiting, high fever, pain in the lower abdomen and instances of fainting, you should immediately seek a doctor.

What puts you at risk for PID?
Certain factors may put you at a higher risk for PID and these are:

- Instances of sexually transmitted diseases like Chlamydia (an STD that can occur from anal, oral or vaginal sex) and gonorrhea (a condition that causes discharge from the vagina or urethra) can make you prone to developing PID.

- Douching on a regular basis can increase your risk of PID as it disrupts the equilibrium of good and bad bacteria in your vagina, and may hide the symptoms of the condition as well.

- Even a previous history of PID can increase your chances of having another episode of PID.

- Compared to older women, teenagers who are sexually active are more prone to developing PID.

- Having multiple sexual partners can also put you at a greater risk for PID and STDs.

If you would like to consult with me privately, please click on 'Consult'

Could you be at a risk of pelvic inflammatory disease (PID)?

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