Insomnia is the condition of acute sleeplessness, and it takes a heavy toll on your mood, your energy levels, and your ability to concentrate and work during the day. Some of the most common symptoms of the condition are:

You find it difficult to fall asleep even if you are tired
Once you wake up in the middle of the night, you cannot get back to sleep
You cannot work or concentrate on anything during the day
You stay mostly fatigued, or irritated throughout the day
You have to depend on pills or alcohol to fall asleep.
You wake up very early in the morning, no matter how late you sleep

What could be the causes for insomnia?

Insomnia might last just a few days if it is induced by some temporary cause, like stress at your workplace, or any other personal issue you can be facing. However, when the cause is a long rooted one, insomnia might persist for a long time. There can be a mix of many causes for that to happen:

Psychological stress or other emotional discomforts

Common psychological problems like anxiety, depression, chronic work stress, grief, and also bipolar disorder can be the causes for insomnia.

Illness or other medical problems

There can be many medical causes or other illnesses at the root of insomnia like allergies, acute asthma, hyperthyroidism, Parkinson's disease, kidney related diseases and cancer as well.

Medications

There can be many drugs, which might be prescribed by your doctor, but still be responsible for insomnia. These include antidepressants, corticosteroids like thyroid hormone medicines, few blood pressure medications, certain contraceptives and stimulants for ADHD (Attention Deficit Hyperactivity Disorder).

Sleep Disorders

Insomnia, though in itself is a sleep disorder, can also be the symptoms for other sleep disorders like sleep apnea, restless leg syndrome, and other disorders related to jet lag or if you are working on a late night shift.

In addition to these causes, some daily lifestyle habits might act as triggers to insomnia, which include:

Consumption of large amounts of caffeine on a regular basis
Developing irregular sleep schedules
Taking your smartphone to bed and ending up spending a lot of time with it in the night
Eating late in the evening

Causative Factors Behind Insomnia

Sleep is a natural part of the daily biological functions and we spend some time of the 24 hours sleeping.

Sleep cycles are different for different persons and while 5 to 6 hours of sleep may be enough for some people, others may need up to 8 hours of sleep to feel refreshed. How you sleep is as important as the duration. This is one area which is often neglected by people.

Why sleeping positions are important?

Sleeping positions are very important as you stay in a single position for hours at a time every day, and if these habits are bad, they can contribute to spinal problems. Thus, many of the spinal problems can also be alleviated by sleeping correctly.

Some of the bad sleeping positions that may adversely affect your spine are as follows.

On your stomach - This position is in overall a bad position as it curls up the spine, especially where the neck meets the spine and can cause spinal deformities over a long period of time. Certain adjustments to this position can lessen the effects, but it is important to try to change habits and sleep in a better position.

The fetal position - Although this is one of the more natural positions and most babies are crouched up in this form in the mother's womb; as a sleeping position, it has its disadvantages as well. The lower spine is especially put under a lot of stress when someone curls up in this position.

On your side - Although this is safer compared to the other two, sleeping on your sides straight would cause blood circulation issues and also put a lot of stress on the relevant organs, depending on the side you were sleeping on.

In all of the cases, slight adjustments to these positions will lessen the stress on the spine and also help you sleep better.

Some of the adjustments that you can make are:

1. Sleep with a pillow between your knees to align your hips and cause less strain on the spine.
2. If you don't have sleep apnea, put a pillow under your knees to raise them while lying on you back.
3. If you sleep on your back, try to consciously change your position to sleep on the side.
4. Try and actively change your posture throughout the day to ensure good sleeping position at night.

How Badly Sleeping Postures Can Affect Your Spine and Ways to Undo It

Pneumonia is an inflammation and infection of the lungs. This is a condition where the alveoli or the air sacs located in the lungs fill up with fluid and pus. It is because of this that oxygen cannot reach the infected individual s bloodstream. People with pneumonia generally have cough, fever, and breathing problems. At times, it can also result in chest pain.

This is a condition that can affect one or both the lungs. There are different forms of this disease. Pulmonary infection is considered one of the most common causes of this disease. It is a kind of infection related to gram-negative or gram-positive bacteria and viruses. Certain infectious agents sharing the similarities of bacteria and viruses might also result in pneumonia.

Symptoms of pneumonia in adults
The symptoms of pneumonia in adults include:

Fatigue
Fever
Coughing up slightly bloody, brown or green mucus
Weakness
Vomiting
Nausea
Headaches
Loss of appetite
Diarrhoea
Wheezing
Chills
Rapid breathing
Shortness of breath
Chest pain
The milder forms of this disease do not disturb the regular functions of the affected individual and are called  walking  pneumonia.

Signs of pneumonia in children
Unlike adults, kids suffering from pneumonia might not experience a fever or a nagging cough. They might have more subtle signs of this infection. However, children have relatively higher chances of being infected because they do not have fully-developed immune systems. Overall, the signs of pneumonia vary according to the age of an individual.

Pneumonia caused by bacteria like Chlamydophila pneumoniae and Mycoplasma pneumoniae generally result in milder signs of the disease in kids. This kind of pneumonia is called walking or atypical pneumonia and is generally found among school-going children. Children suffering from mild pneumonia might not feel very sick, but they can have one or more of the following symptoms:

Low-grade fever
Dry cough
Tiredness
Headache
Irrespective of the age of an individual, it is always important to consult a specialist after determining the symptoms of pneumonia. Remember, it is a deadly disease and needs timely treatment.

How To Recognize The Symptoms Of Pneumonia?

We're all guilty of making fun of snorers, but sometimes this snoring can be a symptom of sleep apnea. Sleep apnea is a condition where breathing is not continuous and may start and stop many times while asleep. This affects the quality of your sleep and in turn can affect many aspects of your health including your cardiovascular health. Here's how:

High blood pressure
When a sleep apnea patient's breathing stops, the oxygen levels in the blood also suddenly fall. This can increase your blood pressure. High blood pressure means that the heart muscles need to work harder to pump blood through the body.

Cardiomyopathy
As a result of high blood pressure, the heart walls may become thicker and the heart muscles become stiffer. This is known as cardiomyopathy. As this condition worsens, the heart becomes weaker and is unable to maintain a regular rhythm. This can eventually lead to heart failure.

Arrhythmia
An irregular heartbeat is also known as arrhythmia. This may also be related to the changes in the heart's structure that follow the drop in blood oxygen levels. In many cases, arrhythmia has no visible symptoms and can often go undiagnosed. This can result in the formation of blood clots in the atria which can lead to a stroke.

Sleep apnea is easy to diagnose. If the doctor feels that you show symptoms of sleep apnea, you may be asked to stay on the hospital overnight and undergo a sleep evaluation. This tests a variety of body functions including brain activity, eye movements, heart rate, breathing patterns and blood oxygen levels.

Treatment for sleep apnea depends on the causes for this condition. If you are overweight, regular exercise and a change in diet can help you lose the excess weight and cure sleep apnea. Similarly, if your sleep apnea is triggered by an allergy, treating the allergy can help cure the sleep apnea. Other forms of treatment for sleep apnea may include:

Continuous positive airway pressure (cpap)
This is a machine which pumps air into the body through a nasal mask. By keeping the pressure in the machine higher than normal air pressure the upper airway passages are kept open and hence the quality of your sleep is improved. An auto cpap machine can modulate the air pressure such that it is higher when you inhale and lower when you exhale.;

Oral devices
Your doctor may suggest oral devices that allow you to keep your mouth open while you sleep. This is easier to use than cpap machine but less effective. Surgery is the last resort when it comes to treatment for sleep apnea.

Sleep Apnea and Its Link to Heart Failure

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!

A hand fracture is a condition characterized by broken bones of the hand. The bones in the hand include the bones that are present in the fingers and the wrists. A fracture of the hand tends to occur when you bend or twist your hand in the wrong manner. It may also be caused by injuries related to sports and falls.

Symptoms
Symptoms of swelling and pain are the most common of them all. The range of motion for the affected hand will be reduced as well. The knuckle bone may appear to have been sunken in. Most obviously, it will be difficult in carrying out regular tasks which need the hands.

Therapies
The initial treatment for a hand fracture will be focused on reducing the pain. Pain relieving medications such as ibuprofen will be administered which provides relief from the pain. The next step will be to keep the affected hand immobilized so as not to hamper the recovery process. Once stability is restored, therapeutically relevant exercises are prescribed to help normalize the regular hand movements.

The following exercises are relevant in case of a hand fracture:

Wringing a towel: This is an exercise wherein you wring a towel to improve flexibility and strength in the hand. Simply grab a towel and twist it in both directions; imagine wringing water from the towel.
Rolls of the wrist: Wrist rolls aim to increase the ROM (range of motion) in your wrists and the hands. Hold the hand steady and rotate your wrists both clockwise and anticlockwise. You can also hold a light weight in your hand to make it more challenging.
Prayer stretch: A prayer stretch is another exercise that can help boost your wrist flexibility. You start by positioning the palms together like in a prayer, then hold up the elbows while pushing the hands against each other. You should feel a stretch in your wrists and hands.
Grasping: This is a technique wherein you grasp objects to improve your grip strength. Try gripping objects such as tennis ball or stress balls to get your gripping ability up to normal levels.


4 Effective Therapies Post Hand Fracture!

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