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!

A swelling of breast tissues in men due to estrogen and testosterone hormonal imbalance. This swelling in the chest could often resemble a breast. In babies and newborns, gynecomastia is caused by the estrogen from the mother. Breast buds and tissues are common in baby boys. They go away after a few months naturally. However, in some babies, they tend to stay. The result can be the enlarged breasts.

In teenage years, the estrogen-producing hormones naturally tend to get into an overdrive mode and in many instances, if they are hyperactive the swelling in the chest region can occur during puberty. It usually goes away within 6 months to 2 years. In some extreme cases, the swelling can also be as a result of lung or liver cancer. Also, it depends on a little on lifestyle. Drug abuse and excess alcohol can cause gynecomastia. This may also be common in older adults where the skin loses its natural elasticity and tend to sag. Apart from it, their lifestyle also plays a detrimental part in its forming.

Very few people put on weight uniformly all over their body. Some people put on weight around the abdomen and develop bellies while others put on weight on their thighs. For some, fat could also be deposited on the chest, while it may not be much of an issue for a woman but it can make male breasts protrude abnormally. Clinically, this is known as gynecomastia. Gynecomastia is not a serious condition and does not hamper a man s health but it can damage his self-esteem. In the long run, this can also be harmful for his psychological and emotional health. Thankfully dealing with it is easy.



What are the symptoms and diagnoses?
Gynecomastia is associated with enlarged breasts and in addition to that, it could feel rubbery or firm. Sometimes only one of the regions either the left or right side may experience this problem while the other side stays firm. It is diagnosed purely by a physical examination. Also, the lump may be checked for biopsy.

Treatment
90% of the cases in babies go away on its own. There is no treatment required. However in young adults, if the conditions do not go away then surgery is the most treatable option under the circumstances. Getting medications and drugs that can decrease the tissue structure is not advisable as indirectly you might be playing with the hormones and they can tend to get risky after some time. Also, surgeries of the day are not just like taking out the enlargement. They also do concentrate on the features and shape too. You can technically sculpt the region while opting for such breast reduction surgeries.

However, contrary to popular belief, surgery is not the only recourse. In fact, though surgically removing the fat deposits can have faster effects; these fat deposits may develop again over time. Thus, surgery is not a long-term solution. So, let s look at an alternative form of treatment which is Ayurveda as this can be very effective against gynecomastia. This is a holistic form of treatment that not only addresses the symptoms showcased, but attacks the root cause of the problem. In this case, fat deposits are caused usually by weight gain and slow metabolism, which makes it essential for the person to lose weight in order to treat this condition.

Before you start on weight loss regime, starving yourself is no solution for this. Instead, one must eat food according to one s body type and needs. According to Ayurveda, there are three different types of doshas present in the body. An imbalance of these doshas could contribute towards weight gain and in turn gynecomastia. Depending on your body type, an Ayurvedic doctor will be able to advise you on the type of foods to eat and avoid so as to maintain a balance of the doshas.

In addition to this, you must also exercise regularly. The best time to exercise is in the early morning. This raises your metabolism rates and helps your body utilize energy being created through the day instead of simply storing it as fat. Aim for at least half an hour s exercise each day. There are a number of yoga asanas that target the chest muscles and can help treat gynecomastia. These include the Dhanurasana, Gomukhasana and Natrajasana. These asanas burn fat in the chest and tighten chest muscles. When it comes to yoga, it isn t enough to simply perform the asanas, they must be practiced in the right way. Thus, it is always advisable to practice under a teacher s guidance.

One of the biggest advantages of treating gynecomastia with Ayurveda is the absence of side effects. Unlike surgery, there is no hospitalization needed and you may continue your normal lifestyle as you get treatment. Once treated, there is a very low chance of the condition recurring and hence, this is a permanent solution.

Self-care:
While people do opt for weight reducing measures to keep gynecomastia under check it doesn t always work like that. The reason is these are not exactly what causes the enlargement. They are as a direct result of hormones. Hence weight reduction plans and medications may not work out efficiently. Also, experts would suggest going in for a surgery before going for an exercise regime in a gym. Some people do have a misconception that hitting the gym can take care of the swelling. However, it may not be beneficial and it would give out the desired impact.

For complete treatment of your problem, you can Consult the doctor. 

Weight Loss - Can It Help Reduce Male Breast?

Most mental and emotional health issues are inconspicuous in nature and, therefore, cause more harm than they otherwise should, most people still live with a number of symptoms of depression without even realizing it or do little to address it. When the depressive symptoms last for more than 2 weeks and affect the individual's personal, social or occupational life, it is known as clinical depression or major depression. There is often a delay in opting for the treatment because of the social taboo associated with depression.

Depression makes a person miserable, disappointed, restless or numb for long and tedious timeframes, and is debilitating, particularly when they can't demonstrate their feelings and worries to anybody. It can meddle with their productivity and can become a concern not only in workplaces, but also in social circles.

So here's how to deal with a friend or family member in a depressed state of mind:

Be considerate: Do understand that depression doesn't mean" trouble". Melancholy is a condition with an assortment of side effects like exhaustion, confused mind state and rest issues. These are all side effects of melancholy. Crabbiness is an exceptionally basic side effect, which once in a while is encountered by many individuals, and can lead to an expanded sensitivity. Normally, it's difficult to be sympathetic with someone who is behaving grumpily. But you need to make a conscious effort to still see the positive in depressed individuals and lead them to hope.
Encourage and support: Try not to shame people for being negative. Dejection changes the world into a scene of pessimism. Discouraged individuals don't just focus on the negatives, but they also disregard the positives.
Do validate: Approval can help manage a depressed state, and can wean a friend or family member out of depression. Remember that someone with dejection is not living in the same universe as you. The laws that oversee your universe don't exist in theirs.Depressed individuals require your understanding, your empathy, and your affection, considerably more when they are having a troublesome day, week or month. It is hard, but possible. Discouraged individuals value a positive backing in particular.
Never say 'you're too much': When someone with depression is told "you're too much" particularly by somebody near them, it can send them spiralling into blame and nervousness and bitterness. Being encouraging and empowering is likewise useful.
Be patient with the treatment process: A certain amount of trial and error in treatment is to be expected, Baer said. But the good news is that doctors can often help people with depression feel better and function better with a combination of medication and talk therapy, he added. With time and treatment, depression can lift.


Tips for Dealing with a Depressed Family Member

The problem of morning back and neck pain may be due to the position of sleeping or it may be related to inflammatory arthritis which can be familial. Morning back pain is largely related to wrong sleeping posture and less commonly due to arthritic conditions like Ankylosing Spondylitis or Rheumatoid Arthritis. Whatever be the cause- this condition requires attention by an Orthopedic doctor as it may worsen in due course of time and should not be taken lightly. 

Some common factors causing this are: 

Mattress: Too soft or too hard a mattress might induce back ache after sleep. For people with waist and hips of equal proportion, a firmer mattress would do well. For those with narrower waist than their hips, a flexible and softer mattress that can move with the pelvic weight would be a perfect choice. Refrain from using old hardened mattresses. 
Pillow: The pillow you use must be able to render support to your neck naturally. Instead of using excessively firm or soft pillow, try substituting it with memory foam pillows, refillable water pillows or cervical support pillows. 
Posture: Not changing your position while sleeping or sleeping on the belly exerts strain on the back muscles, causing pain. On the other hand, sleeping on the back or on the sides causes comparatively less strain on the spine. 
Other causes such as strenuous workouts or physical activities or sitting at a stretch during the day might cause pain while sleeping or after getting up from bed. 
Remedies for Morning Back Pain: 

Fortunately, there are some home remedies to cure the morning back pain. 

Switching your mattress is a more expensive remedy for back pain, but may often be the ultimate cure. Most people sleep the best on medium-firm mattresses. Be sure to try out the mattress before you buy it. 
For occasional back pain after sleeping, apply heat to your back to relax your muscles before you go to bed and when you get up in the morning. 
Massage your back with pain relieving creams and apply heat on it with a heating pad for quick relief. 
Specific spinal stretching exercises and Planks (a type of exercise) can greatly help in easing back pain, if done on a regular basis. 
It is always recommended to CONSULT an Orthopaedic doctor if you suffer from morning back pain.

Morning Back Pain And Neck Pain

Are you suffering from chronic pelvic pain? Well, then it is time to consult your doctor. Chronic pelvic pain can be the indication or symptom for other serious disorders. It is often difficult to figure out the exact cause of the pain. Chronic pelvic pain refers to the persistent pain in the pelvic region that has been lasting for over six months. Your doctor needs to carefully examine your symptoms to know the source of the pain.

Here are some of the causes that lead to chronic pelvic pain:

Endometriosis: In this disease, cells that form the lining of the uterus grow abnormally. These cells grow on organs like the ovaries, urinary bladder or rectum. Symptoms that can be accompanied with pelvic pain in Endometriosis.

Pelvic pain or cramps before or during your period
Pain during or post sex
Pain at the time you ovulate
Pain during bowel movements
Rectal bleeding during period
Pain during urination
Lower back pain
Infertility
Spotting in between periods
Bloating
Adenomyosis: This disease is similar to endometriosis. Cells lining the uterus tend to invade the uterus and muscle tissues of the uterine wall. In many cases, women with adenomyosis are devoid of any symptoms. Some of the common symptoms are:

Pain during period
Pressure on bladder or rectum
Massive periods
Long periods
Interstitial Cystitis: Women suffering from interstitial cystitis have inflammation of the urinary bladder. The inflammation is due to any infection. This affects women as a result of their aging. Symptoms:

Need to urinate very often
Discomfort during urination
Pain at the time of sex
Urinary Tract Infection
Bacteria cause urinary tract infections. This, in turn, leads to pelvic pain. Infections can affect any part of the urinary tract. It can also affect the kidneys, bladder, and urethra. Urinary tract infections are common in women mainly. Symptoms:

Pressure in lower pelvis
Pain or a burning sensation during urination
Needing to urinate frequently
Cloudy urine
Blood in urine
When to visit a doctor?
It is difficult to know and assess the right time to visit the doctor. But the pain may be very irritating. It can also lead to fatal and chronic disorders. Therefore, it is best to consult a doctor if the pain persists for a long period and doesn t vanishes with the home-based remedies or medication. The doctor may conduct lab tests, laparoscopy, or radiological tests to come to a conclusion.

Chronic Pelvic Pain - Common Causes Behind It + Related Symptoms!

A dysfunction or health problem which affects your physical relation with your partner is an issue that may occur at any period of the intercourse cycle. These issues affect both, men and women.

Sexual dysfunction in men can be a consequence of a physical or mental issues, including stress.

The problems men may encounter include:

    Erectile dysfunction (ED): ED can be a cause of medications, for example, diabetes or hypertension, or by anxiety about engaging in sexual relations. Dejection, weariness, and anxiety can add to it.
    Ejaculation issues: These include untimely (discharge that happens too soon during intercourse) and the powerlessness to discharge by any means. The causes include medicines, like antidepressants, nervousness about sex, a past filled with sexual injury and trauma, (for example, an accomplice being unfaithful), and guilt.
    Low libido: Mental issues like anxiety and tension about engaging in sexual relations can prompt a diminished or no sexual craving. Diminished hormone levels (especially if testosterone is low), physical ailments, and pharmaceutical symptoms can lessen the testosterone.

In many cases, sexual dysfunction in women might include:

    Vaginal dryness: This can lead to issues with excitement and craving, as sex can be painful when the vagina is not lubricated. Vaginal dryness can come about because of hormonal changes that happen during and after menopause or while breastfeeding, for instance. Mental issues, similar to tension about sex, can also cause vaginal dryness.
    Low drive: Absence of sexual yearning can be created by lower levels of the hormone estrogen. Exhaustion, misery, and tension prompts low charisma.
    Trouble achieving orgasm: Failure to have an orgasm can influence both men and women. Once more, some stimulant drugs can likewise bring about a solution for these issues.
    Pain during sex: Known as vulvodynia or vulvar vestibulitis, and even vaginismus, these conditions can bring about spasms that lead to pain during intercourse.

If you are encountering sexual health problems, raise your worries with your specialist. You can regularly redress your issue by:

     Getting the best possible treatment of any hidden therapeutic condition
    Speaking with your partner transparently about your sexual relationship
    Keeping away from liquor, smoking, and medication use
    Overseeing anxiety, uneasiness, and gloom
    If you think you are suffering from any other ailment, discuss with your specialist about therapy that can help you in such a case.
    Restorative treatment: This includes treatment of any physical issue that might add to a man's sexual problems.
    Drugs: Medications, for example, Cialis, Levitra, Staxyn, Stendra, or Viagra may enhance erectile capacity in men by improving the blood stream to the penis.
    Mental treatment: Therapy with a prepared advisor can help address sentiments of uneasiness, apprehension, or blame.
    Education about sex and sexual practices and reactions may also help.

Common Sexual Health Problems and Ways to Treat Them

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