Our bones and joints make us functional on a day to day basis. It is, therefore, imperative that we should take good care of them at all times. There are many conditions that can affect our skeletal system and one of them is, Gout. While the link between the two may not be that obvious, gout happens to be a condition, which is sometimes related to arthritis. Therefore, it is sometimes known by the name 'gouty arthritis'.

While the issue may be severely painful, it does not mean that it cannot be reduced. And of course, when a person has the option and cutting the pain caused by gout drastically, his or her natural response is likely to be 'why not?'

Why Does It Happen?

The main reason for the occurrence of gout is too much uric acid being present in the body. The limbs of the body swell up, especially the extremities and this is known to be very painful. In many cases of gout, the swelling is especially evident in the big toe. Flare ups can last hours on end and may even get longer.

The people who wish to get the gout that is putting him or her through so much pain treated, there are quite a few options at their disposal. There are pain relievers that can be consumed under the advice of a medically qualified professional. While these pain relievers do not treat gout, but can reduces the intensity of the symptoms. Daily doses can be recommended as per the requirement and severity of the situation.

How to Get Rid of Gout?

While some anti-inflammatory drugs may have their effect, but no matter how bad the pain, aspirin is a drug that needs to be avoided. Intake of aspirin can make the problem even worse, which is the last thing a person would want!

The severe problems of gout can be dealt with the chemicals known as corticosteroids. Now, while these can provide some very effective pain relief, using them can be tricky due to certain side effects. One of these side effects is that since these chemicals are injected into the joints, they can significantly weaken them. The other side effect is that they slow the healing process of the wound. Both of these side effects are highly undesirable for any patients. These chemicals are usually prescribed by the doctors after a thorough analysis of patient's condition and history.

A person who drinks alcohol and suffers from severe condition of gout should look to scale back the amount which is consumed by him or her. This is because alcohol increases the amount of uric acid which is present in the blood.

Gout and Its Treatments

The bones are a porous matrix which is filled with minerals like calcium and phosphorus which make them strong. Over a period of time, the mineral content is lost and therefore the matrix gets brittle. Bones are more likely to fracture in these people.

Causes/Risk factors:

The bones get fragile and brittle with age in most people, and people over 60 years of age are likely to be affected
Asian women about the age of 45 are prone to osteoporosis
Reduced vitamin D intake (either by sun exposure or through diet) also makes bone porous and prone to fracture
Sedentary lifestyle with minimal or no exercise
Lower levels of estrogen, especially post menopause
Cigarette smoking
Reduced testosterone levels
With fracture, there is severe pain, loss of mobility, and need for prolonged nursing.
Foods which can help control/prevent osteoporosis:

Yoghurt: Derived from milk, it is rich in animal protein and also contains good amounts of vitamin D and B2, calcium, phosphorus, and magnesium. It helps in maintaining estrogen levels during menopause, thereby preventing osteoporosis. They also provide a good supply of gut bacteria, which improves immunity.
Milk: Similar to yoghurt, this is also rich in various minerals that are essential for bone health. The vitamin D in it also improves calcium absorption, thereby prolonging the occurrence of osteoporosis.
Fish and meat: Lean meat and fish are good sources of oils and protein and form an essential part of diet for preventing osteoporosis. Sardines and salmon are ideal as the tiny fish are rich sources of calcium.
Eggs: This contains good amounts of natural protein, minerals, and vitamins essential for bone health. It also helps in estrogen formation, which has a bone-protective effect.
Cabbage: Any form of cabbage is good for preventing osteoporosis. It promotes bone metabolism and has calcium which help in strong bone formation.
Bananas: Another effective food in preventing osteoporosis, it helps improve absorption of calcium and other essential nutrients to ensure bones are formed and maintain health. It also has natural oils, potassium, and vitamins A and C in good quantity.
Almonds: It forms an integral part of preventing osteoporosis by increasing bone density and promoting bone health. It also has good oil content, which is also essential for bone health.
Legumes: Beans and other legumes are rich source of proteins and minerals and therefore prevent onset of osteoporosis.
Chickpeas: Another great source of various minerals and vitamins, it is very low in calories and sugar and is great to lose weight. It also improves bone health by increasing density.

Osteoporosis - How A Healthy Diet Can Reduce Its Risk?

Cervical spondylosis is fast becoming the bane of modern life. An age-related wear and tear problem affecting the spinal discs in your neck, cervical spondylosis is increasingly affecting the young because of the use of cell phones, laptops and the like.

Cervical spondylosis is a general term used to define shrinkage of discs in between vertebrae in the neck region. Along with disc degeneration, bony projections also form in the area and are called bone spurs.
Other causes of cervical spondylosis are dehydrated discs. Discs are thick, pad-like cushions in between vertebrae that act as shock absorbers. They are made of a gel- like material that can dry over time. This causes the spinal vertebrae to rub together causing pain. The discs also crack which allows the internal gel-like material to spill out and impinge on spinal nerves causing symptoms.

There is a narrowing of the space required by the spinal cord and nerves that emanate in the upper spine to go to various parts of the body. Pinching of these nerves can cause alarming symptoms like

Numbness and weakness in your arms, hands, legs and feet
Lack of coordination and difficulty in walking
Loss of bladder or bowel movement
Stiffness and pain in neck
Treatment and management
Usually, cervical spondylosis doesn t cause any symptoms. But when you start experiencing pain, stiffness and weakness of muscles, it s best to go to a doctor who will diagnose the problem and then treat it.
Treatment for cervical spondylosis depends on the severity of your symptoms. Its goal is to get rid of pain, allow you to carry on your daily activities and prevent any permanent damage to your spinal cord and nerves.

Medicines

Anti-inflammatory drugs are prescribed to reduce pain and inflammation. Example Ibuprofen.
Corticosteroids are oral medications to get rid of the severe pain. If these don t work, your doctor can suggest steroid injections.
Muscle relaxants medicines relax the muscles in the upper part of the spine and help in curing neck pain and stiffness
Anti-seizure medications are also prescribed to dull the pain of damaged nerves in the spine. These include epilepsy medications, such as gabapentin and pregabalin.
Physiotherapy

Non surgical treatments are usually very effective in treating cervical spondylosis and surgery is usually not required. Physiotherapy is a bulwark for patients as it helps manage the condition very well.
Neck exercises that help stretch and strengthen muscles in your neck and shoulders can help manage debilitating symptoms of cervical spondylosis.
Few patients also benefit from traction, which can help provide more space for nerve roots within the spine.
Surgery

Surgery is the last resort for treating cervical spondylosis.
It is suggested when non-surgical treatments fail and the pain and neurological signs such as weakness in your arms or legs get worse.
It is done to create more room for your spinal cord and nerve roots.
Cervical spondylosis surgery typically involves removing:

Herniated disk
Bone spurs
Part of a vertebra

Cervical Spondylosis - How to Treat It?

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!

Why osteoporosis and osteopenia are fast turning into diseases of the young

Did you know that osteoporosis causes more than 8.9 million fractures worldwide every year? what is frightening is many of these fractures are now taking place among the youth due to deficit diet and poor lifestyle coupled with genetic predisposition. Both osteoporosis and osteopenia are two forms of bone loss conditions, with the latter being a precursor to the former. To distinguish between the two a bone mineral density test is usually performed.

What is the difference between osteoporosis and osteopenia?

A BMD (bone mineral density) t-score between -1 sd and -2.5 sd indicates osteopenia with a high chance of osteoporosis. On the other hand, a t-score of -2.5 sd and below stands for osteoporosis. A higher bone density (above -1sd) is usually indicative of stronger bones. Fragility index is more accurate way to assess the risk of fractures.

In osteoporosis the bone loss or weakening of bones take place over a long period of time, and results in unexpected fractures and severe bone problems. Disfigurement, fractures in the spine, loss of mobility and independence are usual characteristics of this bone disease once it progresses further.

Prevention is better than cure, always!

To keep bones strong and healthy, calcium and phosphate is continuously absorbed by the body. But after 30, the body?s ability to absorb calcium slows down and there?s a decrease in the production of new bones. In contrast, bone desorption (the process of transferring calcium from the bone to the blood) continues unabated.

When the body starts absorbing the store of calcium in the bones to meets its needs, it leads to calcium depletion and is one of the causes of the weakening of the bone.

At present, the age limit (50-60 years) for osteoporosis has seen a drop with many younger people increasingly suffering from the ailment. Factors like unhealthy lifestyle, late-night shifts, smoking and alcohol consumption have been found to be the culprits behind the rise in osteoporosis cases among the young. Recent studies have identified vitamin d deficiency as a major factor for poor bone health and bone mass density in the young.

How to keep your bones strong and healthy? and manage osteo - penia/porosis complications:

Bone loss can be prevented by adopting these very simple but effective ways:

- exercising can help in building strong bones and muscles, while preventing bone loss.

- maintaining a calcium intake of 1000 mg for pre-menopausal women and 1200 mg for women post menopause.

- staying out in the sun for 20 minutes to produce requisite amount of vitamin d for calcium absorption and using supplements of vitamin d.

- there are many safe medicines available to prevent and treat osteoporosis like alendronates, calcitonin, parathyroid, teriparatide preparation etc.

- in osteoporosis induced /associated fractures we have to to modify implants to negate weak purchase of implants in bone and improve mobility. We have been using these modifications in established osteopenia/porosis case in fractures treatment/joint replacement/ arthroscopic fixations and MIS spine fracture management.


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Are Osteoporosis and Osteopenia fast turning into diseases of the young?

If you suffer from rheumatoid arthritis, you may be at a high risk of developing Carpal tunnel syndrome. This is a very painful condition in which the hands and wrists are affected. The Carpal tunnel refers to a structure which is formed by the bones present in the wrist and the surrounding connective tissues, through which the nerves and tendons controlling the thumb movement pass. Carpal tunnel syndrome occurs when the connective tissues get swollen because of inflammation and the nerves passing through the tunnel are crowded and squeezed.

Ways to get relief from Carpal tunnel syndrome:

Here are some common ways by which a patient with Rheumatoid arthritis can get relief from any discomfort caused due to Carpal tunnel syndrome:

Get your Rheumatoid arthritis treated. Carpal tunnel syndrome is commonly caused because of an underlying sickness such as rheumatoid arthritis. Medicines such as disease modifying anti-rheumatic drugs are used to manage the condition and for reducing inflammation which causes carpal tunnel syndrome.
Getting enough rest is also very important. You must avoid using that hand or wrist, which has been affected for some weeks. This will allow the inflamed tissue to heal. 
You may wear a wrist splinter. A splint is suggested for resting your wrist therefore, it is kept in a neutral position. It can be worn during the day or when you are sleeping.
You can take prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief. These also help in reducing the swelling of tissues within the carpal tunnel.
A Cortisone shot may also be effective for easing the carpal tunnel syndrome. These steroid injections are given directly into the carpal tunnel. You will be able to get temporary relief from pain.
A set of Carpal tunnel exercises have been developed by doctors. These are designed for stretching the wrists and for keeping them limber. You must perform these exercises on a regular basis for best results. Yoga is also effective for easing carpal tunnel syndrome. Performing regular yoga will help you to improve your wrist pain. The upper joints of the body are strengthened. 
Take breaks at work on a regular basis. By changing your position and taking short breaks, your Carpal tunnel symptoms are bound to improve. This is more essential for people who do a job where great stress is placed on the wrists. If you are into typing, you need to take breaks and stretch your wrists.
There are several alternative therapies for easing carpal tunnel syndrome, which  are being studied and researched on. They include the likes of acupuncture, chiropractic care, magnets, botox treatments and vitamin B6 supplements. 

Carpal Tunnel Syndrome - 7 Ways to Ease the Pain

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