Sputum production and chronic cough for at least three months in a year, consecutively for two years is termed as Chronic Bronchitis. Emphysema and Chronic Bronchitis are different from each other but are covered under the same umbrella COPD, which means Chronic Obstructive Pulmonary disease and that is because both are diseases related to respiration.

How is Chronic Bronchitis different from Emphysema?
Both of them occur when the airways in the lungs get damaged due to the inflammation of the airways. Emphysema is the result of air sacs break down whereas Chronic Bronchitis is the result of excessive mucus formation and inflammation in the Bronchi. Some people show either of the symptoms while some people show combined symptoms.

Symptoms of Chronic Bronchitis:
The following symptoms are seen in people with Chronic Bronchitis:

Long-term cough
Excessive mucus production
Sudden weight gain
Tight chest
Feeling breathlessness even when you are taking rest
Sometimes, these symptoms will be neglected by many people treating them as symptoms of cold weather, or attributing these symptoms to the presence of too much smoke or fumes around them. But it is always good to consult a doctor if the symptoms persist for a long time.

Physiotherapy and Chronic Bronchitis:
The main goal of your physiotherapy involves exercises that improve tolerance, education, mucus clearance, increase lung volume, reduce exacerbations, and reduce hospitalization.

Exercises that improve tolerance:
Upper and lower limb tolerance training have shown tremendous results in preventing, controlling and managing Chronic Bronchitis. This training helps in airway clearance, reduces airflow obstruction, mucus removal, and increased energy levels.

Postural draining:
Usage of different postures for moving the mucus through the throat and removing it through the mouth. There are different postures used for different patients. It is basically done by placing the affected part at a lower height and the unaffected part comparatively higher.

Autogenic draining:
This technique will help in proper and normal airflow through the bronchi. There will not be any blockage of the airway. Retention of carbon dioxide in the lungs will be reduced, the mucus will be removed and airflow through the airways will improve with this technique.

Percussion:
This technique is used by the physiotherapist along with the postural drainage technique. This is also a technique used for clearing the mucus that got stuck in the airways. Many patients find this technique really useful in mucus removal. In Percussion, the physiotherapist claps on the chest of the patient or on the back of the patients. It depends on how the patient prefers. This gives a relaxing and soothing effect on the patients and helps them release out mucus that got stuck in the airways.

Educating:
Finally, educating the patients about its causes and physiotherapy treatments can help them recover faster.

Chronic Bronchitis - What Should You Expect From A Physiotherapist?

A broken wrist is known as a wrist fracture and it may occur due to a variety of causes starting from undue pressure on the wrist which can result in an injury as well as debilitating conditions like arthritis, which makes the bones and joints prone to fractures. There are also non displaced breaks, which are stable kinds of fractures and in which, the wrist remains in its place. Let us find out more about the kinds of fractures and the procedures for treatment of the same.

Type of Fracture: The wrist is basically made up of eight small bones that connect the two long arm bones, which are known as the radius and ulna and create the forearm. The broken wrist can take place in any of these bones. A hand surgeon will generally take a look at this kind of fracture and determine whether it is displaced, stable or open. As discussed earlier, a wrist fracture can be of various types. While a non displaced wrist fracture is a more stable kind that does not really require much more than rest or medication, a displaced wrist fracture is a non stable kind where dislocation happens.

Other Factors: There are a variety of other factors that will be taken into consideration in order to repair this kind of a fracture. To begin with, the Orthopaedic specialist will consider your age and the kind of job, hobbies and other kinds of activities that you indulge in. Also, the doctor will try to ascertain whether or not you are in good health on an overall basis. The presence of other injuries will also be taken into account for this kind of an injury in there has been a bike or car accident that has caused the fracture.

Treatment: The method of treatment will vary as per the considerations listed above. A padded splint may be installed in order to align and support the bones and wrist respectively, so that there is ample relief from the acute pain as well. Further, an unstable fracture will require a cast as to support the entire forearm and give proper rest to the region so that the bone can grow back together and get aligned again. Surgery may also be required for very severe cases, and pins, screws, metals and plates may also be used depending on the exact location and type of fracture.

Recovery: Remember to move your fingers as much as you can so as to prevent them from getting stiff while they are held up in a splint or a cast.
Hand therapy will be helpful in gaining back motion and function of the wrist.

Wrist Fracture Procedure - Facts You Should Know About 

A stomach ulcer or gastric ulcer refers to the defects or breakdown in the mucosal lining in the stomach. The stomach contains acid, which helps in digestion and any break in the tissue lining may result in severe pain or bleeding in some cases. The pain is usually felt in the abdomen.
Stomach ulcers cause great discomfort and should be treated effectively. Here are the primary ways for treating stomach ulcers:
Antibiotics: In the case of H. pylori infection, you should take a course of more than two antibiotics, to be taken twice a day and must be continued for a week. Antibiotics such as amoxicillin, clarithromycin or metronidazole may be used in case of such stomach ulcers. However it is always recommended to consult a specialized doctor before consuming any of these medicines. After several weeks of using the antibiotics, you should get a test done for detection of H. pylori bacteria. If they are still present, you have to take different antibiotics.
Proton Pump Inhibitors: Proton pump inhibitors or PPIs helps in the reduction of the amount of acid produced by the stomach. This prevents damage to the ulcer and lets it heal naturally. PPIs are generally taken for four to eight weeks. The most common PPIs which are used for treating stomach ulcers are omeprazole, pantoprazole and lansoprazole.
H2 Receptor Antagonists: H2 receptor antagonists reduce the production of stomach acid and function the same as PPIs. The most common H2 receptor for treating stomach ulcers is ranitidine.
Antacids/ Alginate: All measures to treat stomach ulcers take several hours to show results. Your doctor may prescribe antacid medications for neutralizing the stomach acid. This will provide relief for the moment, but the relief is quite temporary and for a short span of time. By this time, the strong medicines most likely start working. There is a certain antacid medicine known as alginate. This develops a protective coating on the stomach lining. Antacids are available at all over the counter medicine stores and you should consult your doctor to get the best antacid which would work effectively on your stomach ulcer symptoms. You should take antacids before going to sleep or after taking meals.
Natural Remedies: Stomach ulcer can also be treated at home using natural remedies. Medicines may sometimes cause further digestive complications, so home remedies are much more easy to follow and do not have side effects. The best way is to follow a proper diet, which is comprised of certain food items that help in curing stomach ulcers. You should consume bananas, honey, garlic, green leafy vegetables like cabbage, licorice and capsaicin.
Stomach ulcers cause great pain and also bleeding in several cases. Proper treatment procedures should be taken in case of stomach ulcer. There are many medical remedies, as well as home remedies for treating stomach ulcers.

Ways to Treat Stomach Ulcers

3 Yogic positions for a better sex life

Doing yoga on a daily basis can give your sex life the boost that you may be looking for while improving the overall quality of both you and your partner's sex life. The dividends that you and your partner reap can range from an increase in flexibility, stamina and sensitivity to improved self-confidence. Thus, in addition to an improvement in the sexual aspect, you can expect improvement in physical and mental aspects too. So, here are some sex positions that you can try to make yourself relaxed and lithe, enabling your body to function properly.

1. Wide-legged straddle pose - This pose is beneficial for improving blood flow to the pelvic area, leading to an increase in sex drive.

To do this, find a comfortable spot to sit in. When you've done this, spread each leg at a 45-degree angle. While stretching your upper body, take in a deep breath. When letting out the air, bend forward and to touch your toes. All the while, keep the spine stretched to its maximum.

2. Squat pose - This yoga position works by improving your pelvic joints and targets your inner thigh muscles, abdominals, and your pelvic floor. The pose is also found to be beneficial in stimulating your spleen and sex glands (gonad).

For this, you need to stand with your feet wide apart and your toes facing outward. Join your palms together in front of your heart, and slowly bring them down in the direction of the mat, stopping just before you touch the floor. Position your biceps behind your knees so that they are spread out while helping your spine to maintain its stretched position.

3. Chair pose - In this pose, your pelvic region is targeted and helps you to establish a better control over your sexual organs. It works by lifting your pelvic floor as you go about lowering your tailbone.

Begin by bringing your feet together before assuming a sitting position. Keep your tailbone stretched when you lift your pelvic floor to stretch the spine.



3 Yogic Positions for a Better Sex Life

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!

Nosebleeds can be frightening and dramatic. Luckily, most cases of nosebleeds can be dealt with fair ease. Nosebleeds can be classified into two types depending upon the origin of the nose bleed, namely anterior and posterior.

Anterior bleed is the most common, and the bleeding is from a blood vessel which is present in the front part of the nose. These bleeds can be easily controlled by simple measures taken by doctors or at home.
Posterior nose bleeds are usually indicative of something more complicated and occur mostly in adults or elderly. The bleed can be caused by a rupture in arteries in the posterior part of the nose. These nosebleeds can get severe and may require admission to a hospital for treatment and management. They are the most common in kids in the range of 2 to 10 years and adults older than 50 years.
What can cause nosebleeds?

The most common cause of a nosebleed is probably trauma or an injury to the nose. External trauma includes a sharp blow to the nose, whereas internal injury comprises of injury from picking your nose continuously or irritation from cold.
Less frequently, an underlying condition can also result in nosebleeds. These conditions include diseases that make clotting difficult. The inability of blood to properly coagulate and clot can be contributed by blood-thinning agents like aspirin and warfarin. 
Disease in the liver can also cause problems in the clotting of blood. Rarely, cancer in the nose or abnormal blood vessels present in the nose can contribute to bleeding. Another cause of nosebleeds can be high blood pressure, but it is rarely the only reason.
What are the symptoms of nosebleeds?

Nosebleeds usually occur from one nostril. Sometimes, if the bleeding is excessive, the nostril can get filled with blood and it can cross the nasopharynx and overflow into the other nostril and result in bleeding from both nostrils. The blood can also go into the throat and one may spit out blood from the mouth or vomit out blood (hematemesis).
Excessive blood loss can cause dizziness, confusion, lightheadedness, and can also cause fainting. Excessive blood loss from nosebleeds is not very common.
Although, nosebleeds are rarely a complication, it is advised to consult a doctor if the occurrences are too frequent.

Nose Bleeding - Things That Can Cause It!

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