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!

Hypoglycemia is the disease of low sugar level in blood. It primarily occurs when the sugar level is below 4 mmol/L (72mg/dL).

What is hypoglycaemia?
It is the decrease in the blood sugar amount to a certain level. If the disease is identified at an early stage, then the treatment can make the person free of the disease quickly. It affects people having diabetes as well as arthritis, increased blood pressure, high cholesterol and many others.

Early signs of the disease

Weakness
Hungry
Blurred vision
Increased heart rate
Increased sweating
Extreme levels of tiredness
Pale face
Bewilderment
Convulsions
Coma in the last stage
Anxiety
Headaches
Problems with sleeping
Who are the people risk of having this disease?
People who take this three medications have a higher risk of having the disease:

Insulin
Sulphopnylureas (such as glibenclamide, gliclazide, glipizide, glimepiride, tolbutamide)
Prandial glucose regulators (such as repaglinide, nateglinide)
Diabetes medications pose a more significant threat to patients of having hypoglycaemia.

Causes of the disease:

Exercise
Delayed meals
Alcohol drinking
High dose of insulin
Tremendous levels of stress
Deficiency of enzymes
Not balanced hormonal levels
Treatment:

At first, the patient must take a blood test to catch up with the levels of blood sugar
Intake of 15-20 kg of carbohydrates is necessary every day. You can get a stabilized carbohydrate content from a bread slice, a banana and a bar made of cereal.
Drink sugar-filled drinks such as Pepsi, etc. Glucose tablets and juice ease the disease rapidly. The patient can also eat sweets in this case. Take a balanced level of sugar content drinks such as 160 ml of cola or lemonade or 200 ml of fruit juice.
Natural treatment through diet:

Liquorice roots: Cut the roots and boil it. Drink the water every day for controlled sugar level.
Apple- It has magnesium and chromium which regulates the sugar level
Wild yam
Tomatoes
Sunflower seeds
Pumpkin seeds
Gentian Root
Barley
If a person is attacked by seizures. It s not possible to give such medications at that time. At that time a pillow or cushion should be placed below the patients head. The seizure goes away in about 5 min if holds up more time. The person needs to get admitted to a hospital.

Hypoglycemia doesn t have its adverse side effects if captured at an early stage. The person gets recovered with the above-stated home medications. Although slow realization of the disease can take the person to the stage of a comma. The disease engulfs body s maximum energy and few essential body functions also get hampered. But it is treatable with regular natural medications. People having diabetes receives the highest threat of the disease. The sugar levels have to be maintained for proper body working. If the person s blood sugar level is not right, he/she may have the tendency to get hypoglycaemia and hyperglycemia. Having both this disease is the root of having diabetes. It would make the body weak, and the person will crave for more sugar. It will also weaken the nerve cells and tissues of the brain. Weight will be lost gradually which is a terrible sign. Therefore don t be late if you are having this above-stated signs go to the doctor and have the proper diagnosis of the disease.

Hypoglycemia - Signs & Symptoms You Should Not Ignore!

Anger is among the gamut of emotions we exhibit as a reaction to a situation, and it is a'normal' emotion too as long as it is kept under control. Some people have the propensity to explode when pushed to the extreme. They keep swallowing their emotions until they can finally do it no more, and erupt like a volcano. Others dealing with extreme anger are like a ticking time bomb. You'll never know what you unwittingly say or do can trigger an explosion. In either case, anger that cannot be controlled comes with a physical reaction.

Your heart beats faster preparing you for both action and reaction. Your breathing quickens. You may clench your fist, tighten your shoulders and go into a defensive position. The problem arises out of the fact that it is almost impossible to feel anger and empathy at the same time. An angry person is seldom sensitive to the well being of his victim, and hence may lash out verbally and sometimes physically. Such things done in the heat of the moment mostly leaves us with regrets. So here are a few ways to deal with extreme anger.


	Acknowledge it: the first step in solving a problem is recognizing that you have one. The fundamental problem here is that people believe they are on the right track and refuse to budge from their views. It is essential to realize that this step is not about deciding whether you are right or wrong, but acknowledging the fact that your reaction to the situation can be channeled in a better way. When getting someone to acknowledge their anger problem, be careful as to not use negative words like wrong, false and shouldn't. Instead, influence with positive words like can and should. Instead of saying'you are wrong to react like this, you can say'i understand what you are feeling. Is there a way we can resolve this situation'
	Recognize the signs: once you know that your problems exist, you can try devising ways that will work for you in dealing with the situation. You can count to 10 to calm yourself or simply decide to not speak until you can calm yourself. Knowing that you may enter into an argument in a situation, you can list down the points that you feel strongly about and discuss each of them one by one. Working your way through a finite list gives a better opportunity to reach closure at the end.
	Find ways to let it go: not all arguments end in closure. A lot of unsaid justifications cloud our mind repeatedly leaving us seething from the inside. Research has shown that the neurological anger response lasts less than two seconds. Beyond that it takes a strong will to stay angry. Once you realize how much your anger is consuming your mind, decide to free your mind with meditation and other calming exercises. Tell yourself that some people and issues simply don't deserve your anger, emotion, reaction or time.


If you or someone you know is suffering from anger management issues, consult a doctor today.


How To Control Extreme Anger

You're strong, fierce and independent and no one has the ability to force-feed you into eating/drinking more than you wish to. Make your eating decisions wisely.

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Nobody can force-feed you into eating/drinking more than you wish to

Panic disorder is a condition that strikes without reason or caution and can be serious. Indications of panic disorder usually include sudden attacks of panic and anxiety, in addition to physical side effects, such as sweating and a pounding heart. During a fit of panic, the reaction is based on the circumstances, which may not be threatening in general, but triggers a feeling of panic. After some time, a person with a panic disorder builds up a consistent fear of having another fit of anxiety, which can influence the every day functioning and lifestyle in general. Panic disorder usually occurs alongside other conditions like depression, liquor abuse, or drug abuse.

You might experience the ill effects of a panic disorder if you:

Encounter frequent, unforeseen fits of anxiety that are not attached to a particular circumstance or event
Stress over having another fit of anxiety
Are trying to avoid the places of your precious panic attacks
The most common symptoms of a panic disorder are as follows:

Trouble relaxing and feeling uneasy most of the time
Beating heart or abdominal pain with a feeling of nervousness
Serious irrational and emotional fear
Feeling as if you are out of breath
Feeling as if you are being choked or smothered
Dizzy spells
Trembling or shaking
Sweating constantly
Feeling nauseous or having a stomach ache
Shivering or numbness in the fingers and toes
Sudden chills or hot flashes
A fear that you are losing control or are about to die
While a single panic attack may just last a couple of minutes, the impact of the experience can leave a long lasting impression and make you susceptible to more such attacks. In case you have this issue, the repetitive fits of panic take an emotional toll. The memory of the fear that you felt during these attacks can affect your self-confidence and cause interruption to your regular day-to-day existence. In the end, this prompts to the following panic disorder effects:

Expectant uneasiness: Instead of feeling like yourself in the middle of panic attacks, you feel tensed and on edge. This uneasiness originates from a dread of having future attacks of anxiety. This fear is seen more often than not, and can be extremely disabling at times.
Phobic avoidance: You start to stay away from specific circumstances or situations. This might happen since you are maintaining a strategic distance because of your previous panic attack. On the other hand, you may stay away from areas where escape would be troublesome or help would be inaccessible in case you had a fit of panic.
Medicines: Medicines can be used to control or decrease a majority of the side effects of panic disorder. Even if medicines do not form a part of the main treatment, when combined with other treatments, medicines are very effective. Eg. therapy and lifestyle changes.

Panic Disorder - 12 Signs You Are Suffering From it!

It is a slowly and gradually progressing disease in which healthy liver tissue is replaced with scar tissue, hence preventing the liver from proper functioning. The developed scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver. Cirrhosis is a complication of liver disease which involves loss of liver cells and irreversible scarring of the liver. In other words, Cirrhosis is a condition in which the liver does not function properly due to long-term damage. Typically, the disease comes over months or years.

Although there are many other causes for cirrhosis, the commonest is excessive use of alcohol, viral hepatitis B and C infections and non-alcoholic fatty liver disease. Thus the scarring is most often caused by long-term exposure to toxins such as alcohol or viral infections.

According to the National Institutes of Health, it is the 12th leading cause of death. Men are more prone to develop cirrhosis than women. Globally approximately 57% of cirrhosis is attributable to either hepatitis B (30%) or hepatitis C (27%).Alcohol consumption accounting for about 20% of cirrhosis.

Persons most commonly affected: Adults of both sexes.

Unani approach to Cirrhosis of Liver (Talayyuf-e- Kabid)-

In Unani literature Cirrhosis of the liver is known as  Talayyuf-e- kabid ,  Sighr-al- kabid  or  Jigarki laghari . It is of two types.

1. AcuteType of Cirrhosis of Liver (Talayyuf-e- Kabid Hadd)-

It is rare but very dangerous. It is also called Yarqaan-e- khabees or Huzaal-e- asfar. Mainly occurs due to inflammation in hepatic cells, in which hepatic cells squeeze in few days resulting in improper functioning of liver. It is a disease in which cells throughout the liver are destroyed. Although they are replaced by areas containing normal new cells but also by much scar tissue, which alters the structure of the liver.

Causes and risk factors: Excessive use of alcohol/ chronic alcoholism, poor nutrition, highly toxic condition of the body system, viral infections caused by chronic viral hepatitis (types A, B and C), metabolic diseases such as alpha-1-antitrypsin deficiency, galactosemia and glycogen storage disorders,inherited diseases such as Wilson's disease and hemochromatosis, biliary cirrhosis, toxic hepatitis due to severe reactions to prescription drugs or prolonged exposure to environmental toxins and repeated bouts of heart failure with liver congestion etc.

Signs and Symptoms: The main signs and symptoms of this type are jaundice, pain at the site of liver, vomiting, headache, dizziness, increased body temperature, increased pulse rate, brownish coloured and dry tongue, increased thirst, initially whitish coloured diarrhoea, later on, colour becomes blackish due to contamination of blood, urine passes in less quantity and reddish in colour due to contamination of yellow bile in it,  haemorrhage from nose, stomach, intestine and uterus even abortion in women are seen. The size of the liver feels small on palpation.

2. Chronic type of Cirrhosis of Liver (Talayyuf-e- KabidMuzmin)

This type of the disease occurs due to the improper blood supply to the hepatic cells resulting in the size of liver very small in appearance but liver cells stay normal.

Causes and risk factors: The main causes of this type are the application of permanent pressure at the site of the liver such as ascites, alcohol abuse, hepatitis C virus infection, cardiomegaly, poor nutrition, highly toxic condition of the body system, peritoneal inflammation, improper diet in old age and starvation etc. Other causes which develop this disease are, obstruction of the external bile duct by stone, scar, inborn defect or tumour, use of certain medications, syphilis and passive liver congestion. Obesity has recently been recognized as a risk factor in non-alcoholic hepatitis and cirrhosis.

Signs and Symptoms: It is a slowly progressing disease. In early-stage symptoms, of indigestion like flatulence, constipation and diarrhoea may be present. General weakness, the feeling of being unwell, loss of appetite, loss of weight, and a loss of interest in sex may also be there. There may be a dull abdominal ache, nausea and vomiting. Eventually, the patient dies due to anaemia or ascites. The feeling of dullness is the peculiar sign of the disease. Other symptoms and signs include low-grade fever, bad breath, jaundiced skin and bloated and swollen abdomen.

Complications and Risks associated with Cirrhosis of Liver (Talayyuf-e-Kabid)-

Ascites (retention of fluid in the abdominal cavity) is the most common complication of cirrhosis and is associated with a poor quality of life, increased risk of infection and a poor long-term outcome. Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma) and bleeding from oesophageal varices. Cirrhosis is generally irreversible, and treatment usually focuses on preventing progression and complications. In advanced stages of cirrhosis, the only option is a liver transplant.

Preventive measures for cirrhotic patients (Talayyuf-e- Kabid ke Mareezon ke liye Ehtiyaati Tadaabir):

Cirrhotic patients must completely avoid alcohol. Alcohol accelerates liver failure and hastens death in cirrhotic patients.
Avoid liver toxins. Acetaminophen (Tylenol), should be avoided because they can be toxic in cirrhotic patients.
Juice therapy helps the liver to detoxify toxins from the body. Cirrhotic patients should mix one part of pure juice with one part of water before drinking.
Cirrhotic patients are strongly advised to eat smaller meals. To avoid overworking the liver, five or six smaller, lighter meals per day are recommended.
Avoid fatty foods and processed foods, especially foods prepared with animal fats or hydrogenated oils. These types of foods put additional load on the liver.
Cirrhotic patients are also advised to eat only lean proteins (containing no fats) and in limited amounts.
Vegetable proteins are very beneficial in Cirrhotic patients. High protein intake causes increases of ammonia levels in the blood, possibly resulting in mental confusion, and in severe cases, coma. However, do not severely limit protein intake, as this may cause protein deficiency and impair the healing process.
Routinely increase consumption of fruits and steamed vegetables as fruits and vegetables are easy to digest, thus less work for the liver. In addition, they are good sources of vitamins, minerals, and antioxidants that help the liver detoxify and heal.
Cirrhotic patients are advised to practice intermittent fasting.
They are also advised to protect against hepatitis B, C and E.
Fundamentals of Management in Unani Medicine-

Identify the cause of the disease and treat it accordingly
Correct the digestive processes
Use hot dresses
Use mild and early digestible diet
In case of ascites treat it
Management/ Treatment-

In Unani medicine, very effective treatment is available for the Cirrhosis of Liver by strengthening the Liver cells and restoring normal size and functions of the Liver. In Unani medicine, there is a number of hepatoprotective drugs that protect the Liver either acute or chronic type.

SootshekharRas Swarna yukta 125 Mg twice a day
PittariAvleh 10 gm twice a Day
Duration of the treatment: 3 to 6 months or it depends upon the condition of the patients. If the patients with cirrhosis have diabetes, then the treatment may take long time for curing the disease. Diet plays a key role along with Unani Medicines. Hence, it is strictly advised to follow a proper diet plan.

Talayyuf - E - Kabid Or Cirrhosis Of The Liver - Know More About It!

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