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!

Applying coriander juice to your scalp helps in boosting your hair growth and also fights hair loss. It is a natural and essential nutrient enabling good hair growth. To make your hair strong and long, apply coriander juice on your scalp and leave it for an hour before washing it off with shampoo. Also, you may also mix other natural substances to this juice to further enhance the benefits of this mixture. Based on your hair density, you must follow this procedure once a week to give that bouncy look to your hair.

Coriander juice for hair growth

Depression is possibly regarded as the first sign of Alzheimer s disease. According to a research, the connection between Alzheimer s disease and depression is very interesting. It has been found that the life of people who are suffering from dementia is affected in 2 different ways. Individuals who have suffered from depression in their lives are at a greater risk of developing dementia. It has also been observed that people suffering from dementia also have depression. The health condition should be treated immediately because if it is ignored it can damage the quality of life and result in worst conditions like memory loss. Temperament, as well as behavioral changes, may precede memory problems in people with the disease.

Risk factor of dementia
The significant risk factor for dementia or common form of Alzheimer s is developing depression at a younger age. The other reasons for the link are not very clear, however, it has been speculated that the inflammation that occurs in depression is a contributing factor to the Alzheimer s disease. The risk of dementia also increases with certain proteins which spiral with depression. The common signs of Alzheimer s disease include lack of appetite, sadness, agitation, weight loss, and anxiety. People suffering from this condition are unable to tell if they are depressed, but their actions help in communicating a message. It is always better to seek the assistance of a physician as doctors can make use of tools to assess the neurological disorder.

Best way to treat patients with Alzheimer s
The best way to treat patients suffering from dementia and who are depressed is to engage them in activities. It is important that they step out and do some exercises. They should go out in the sunshine. It is necessary to engage them in activities and conversations and help them to lead a higher quality of life. Some of the symptoms of dementia and depression are alike but not all of them. The major symptoms of depression include feeling tired most of the times, feeling restless, irritable, feeling worthless/guilty, unplanned weight gain and trouble in focusing. These symptoms often occur for more than 2 weeks or longer.

Difficulties caused by Alzheimer s disease
In the case of Alzheimer s disease, it becomes very difficult for the individual to communicate, learn or remember mainly because the damage is caused to the brain. Due to the brain damage, there is a possibility of changes in the personality and moods of individuals suffering from this health condition. The quality of life is affected by depression as well as Alzheimer s disease. Hence, it is always better to treat the condition immediately. For that reason, it is very important to set up a pleasant environment around and help patients suffering from this condition by helping them do enjoyable tasks and make them feel positive about life.

Alzheimer's Disease & Depression - How They Are Related?

Gastro-oesophageal reflux disease (GERD) refers to a health condition wherein the stomach acids tend to leak backwards from your stomach into the oesophagus, causing the latter to experience a good amount of irritation, thereby triggering a number of other problems. GERD has a way of affecting people irrespective of their age or gender. Patients who suffer from asthma are at greater risks of encountering the problem of GERD, and some asthma medicines tend to worsen reflux symptoms. However, the effects are indeed two-way in this regard. Acid reflux worsens asthma symptoms by deeply affecting the lungs and airways. Allergic reactions might also be brought about as a result of such a condition.

Symptoms 

GERD is a condition that everyone has experienced at one point or the other in their lives. It generally happens when on burping you are left with a bit of an acid taste that lingers in your mouth, followed simultaneously by a case of heartburn. A sure way to ascertain this condition is to check for the following symptoms: 

Sudden and excessive rise in saliva
Acid regurgitation
Gums show inflammation
Sore throat that is chronic
Bad breath
Cavities
Encountering pain or difficulty while swallowing
Hoarseness or laryngitis
Chest pain
How can it be treated?

The prime treatment measure for GERD is to adopt necessary lifestyle changes so that you may nurture better health. In case you happen to be overweight, it is important that you look into the matter of weight loss. 

Medicines must be taken along with a lot of water, and doctors must ensure that prescribed medications do not actually worsen your heartburn.
Over-the-counter medications and antacids can be used every once in a while after meals, but it does one good to remember that the effects don t last for long. Side effects of excessive dosage of antacids include constipation or diarrhoea. 
Proton pump inhibitors might also be recommended in acute cases of GERD to reduce the total amount of acid that is manufactured in your stomach. H2 blocker is another antidote that aims at reducing the level of acid that is released in your stomach.
Anti-reflux surgery is also prescribed for those people whose symptoms persist despite a change in medications and lifestyle patterns. An endoscopic surgery is another important procedure that may be opted for in order to correct GERD.


GERD - 4 Different Ways It Can Be Treated!

Can scratching your head lead to hair loss? (and how to banish that nagging itch without scratching)

Yes! scratching your head actually leads to hair loss so you should avoid doing it.

Scratching your head with your fingernails for as little as 90 minutes is enough to remove all your cuticular scale. A cuticular scale is a protective covering on every individual strand of hair. The loss of this covering leaves your hair shaft weak and damaged and hence leaves your hair susceptible to easy breakage and hair loss.

There are several ways you can deal with itchiness in your scalp that does not include scratching your head. These alternative ways will help ensure you don't suffer from any hair loss.

These include

1. Instead of scratching, pat or rub the sensitive area with the flat of your fingers.

2. Having a dry scalp can also increase itchiness. It would bee a good idea to use natural oil on your hair before you wash it if that's the reason behind your itch.

3. Sensitivity to a new product may be causing a sudden itchiness in your scalp. So, if you have switched to a new shampoo, mousse or anything else, do try abstaining from applying it for a few days to see if the itchiness subsides.

4. When your scalp feels itchy, try and distract yourself. The more you think about how itchy your scalp is, the more it will itch.

While scratching your hair does lead to hair loss, the good news is your hair will grow back because the damage is not permanent. However, it is not advisable to keep scratching your head because you'll just lose more hair.

If you would like to consult with me privately, please click on 'consult'.
Related Tip: Should You Oil Hair When You Have Dandruff Problem?

Can scratching your head lead to hair loss? (And how to banish that nagging itch without scratching)

Be it burgers, bagels, muffins, sandwiches or simple toasts, bread has made headway into the diets of a huge portion of the populace. Although a staple diet for many since time immemorial, the consumption of bread has increased extensively in the recent past. But, which type of bread should we intake to incur the best health impacts is a question that bothers many. The general assumption is that the wholegrain variety is the best alternative. However, the barrage of marketing tactics makes it impossible to distinguish the best variety from the others. 

There are a whole lot of myths surrounding the best variety of bread and you must choose wisely before settling for one particular type. It is expedient to look beyond the overt appearance or the name of the bread, one needs to be wary of the ingredient before taking a call.

Mostly, white bread is made out of refined flour which is often striped off essential nutrients and fibers. To worsen the situation, white bread is often bleached with certain chemicals to enhance its appearance.
Certain assumptions deem brown bread as the healthier option. Unfortunately, it isn't true always. More often than not, brown bread is simply white bread with artificial coloring added to it or is caramelized. They essentially add no surplus nutritional value.

Similarly, multigrain bread can often mislead the consumers about its health impacts. Unlike whole wheat bread, multigrain breads are usually chemically treated with softened grains. This does not effectively recover the lost nutrients of the bread.

Whole wheat bread has more pronounced health benefits. It contains more wheat germ and fibers in comparison to the more processed varieties of bread. Having evaded the toxic additives, it has relatively healthier effects on our blood sugar levels.

As you realize that the bread that you eat does not necessarily affect your health favorably, wisdom lies in seeking out the least harmful variety. In that context, rye bread or spelt bread contains greater amount of minerals. Besides, bread made from barley, oats and millets have greater mineral content than the commercially hybridized varieties and promote better health.

Brown Bread Vs White Bread Vs Whole Grain?

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