Brahm Shakti Hospital & Research Centre

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Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time.

As long as it happens infrequently, it does not cause for concern. However, you might be diagnosed with premature ejaculation if you:

• Always or nearly always ejaculate within one minute of penetration
• Are unable to delay ejaculation during intercourse all or nearly all of the time
• Feel distressed and frustrated, and tend to avoid sexual intimacy as a result
• Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed talking about it, premature ejaculation is a common and treatable condition. Medications, counseling and sexual techniques that delay ejaculation — or a combination of these — can help improve sex for you and your partner.

Symptoms- 

The main symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem might occur in all sexual situations, even during masturbation.

Premature ejaculation can be classified as:

Lifelong (primary)- Lifelong premature ejaculation occurs all or nearly all of the time beginning with your first sexual encounters.
Acquired (secondary)- Acquired premature ejaculation develops after you've had previous sexual experiences without ejaculatory problems.
Many men feel that they have symptoms of premature ejaculation, but the symptoms don't meet the diagnostic criteria for premature ejaculation. Instead, these men might have a natural variable premature ejaculation, which includes periods of rapid ejaculation as well as periods of normal ejaculation.

There is a myth that whitening erases all the damage they’ve done to their teeth over their lifetimes. The opposite is true — the better you’ve cared for your teeth, the greater the results. If you have kept up on your dental appointments, brushed and flossed regularly,  and avoided damage and discoloration, the whiter your teeth will appear after treatment.  

Too much whitening gel too fast will permanently damage teeth.  Over-whitening can make them look translucent or discolored 

Ultra-violet (UV) light is a frequency of light that works by accelerating the whitening gel to act faster.  This process is FDA regulated and only offered under dentist supervision. Caps and veneers will neither whiten nor stain.  Immediately after whitening (regardless of the product you use),  your teeth are more susceptible to restaining. The pores in your teeth are slightly more open and can more easily allow stains in.

 Teeth Whitening: 

Know Before You Go-If you have extrinsic discoloration (i.e. staining from things like coffee and tea) it can be removed by cleaning the teeth with professional teeth cleaning. Bleach will not work well on extrinsic discoloration. If you have intrinsic yellowing, no amount of stain-removing toothpaste can lighten the intrinsic color of the tooth. You’ll need to whiten your teeth using a bleaching gel that is held up against the teeth.

What we think & what happens actually 

After whitening treatment  it is completely normal for sensitivity to occur.  The teeth become temporarily dehydrated which reduces their ability to insulate the nerve from changes in temperature. Sensitivity will disappear 12-36 hours after whitening. To prevent soft tissue irritation use gingival barrier.

Ankylosis spondylitis homeopathic treatment

Living with spondylosis can be tremendously painful. Our spine is made up of a number of bones known as vertebrae. Between two consecutive vertebrae, there is a cushion like substance called intervertebral disc. Spondylosis is a common degenerative condition of the intervertebral disc due to subsequent biochemical changes in the bones and soft tissues. This affects the normal spinal structure and function of the cervical (neck), thoracic (chest area), and lumbar (low back) spine.

We're going to refer to ankylosing spondylitis as word by word just once, you'll see that ankylosing means fusion.
So it describes the spine being fused together. Spondy, this first part of the word, refers to the spine. And then -itis anywhere is inflammation. So this is an inflammation of the spine and at the sacroiliac joint, actually,
And it leads to the fusion of the area.

There are some buzzwords surrounding it. So one of them would be that it is the poster child for a group of different diseases we can read in complication of ankylosis spondolysis HLA b27 synonym term. That are referred to collectively as the seronegative spondyloarthropathies.
Spondylo-, so again, that's the spine, and then arthro, which refers to joints in general,
And then pathologies or illnesses.

So what this means is that they are rheumatoid factor negative.
They do not have rheumatoid factor but immunological reaction due to hla b27.

As biochemical changes transpire, collagen - a crucial structural elements of the intervertebral disc is affected by the loss of water content which causes the discs to weaken and shrink in height escalating the risk for disc bulging and herniation. The cartilage covering joint surface erodes causing the spine's ligaments to thicken and lose strength. In an effort to repair itself, the body forms bone spurs (osteophytes) and the joints enlarge causing osteoarthritis or degenerative joint disease.

'if you wake up in the morning with a stiff back and feeling tired - indeed after moving about for some time, his back hurt less, just as his physician had said'
This is the typical picture of an ankylosing spondylitis patient - whose spine is gradually getting'rigid.

Hla b27 what does it means in ankylosis spondolysis-
It's hlab27. Again, it's part of the immune system. It's an antigen on the surface of the cell that can be recognized by t-cells, which can recruit things to attack it. So this is the autoimmune component of the disease. This hla-b27 association actually exists for the seronegative spondyloarthropathies in general, but here, in particular, for as you should remember that connection.

An abnormal result may be caused by:

• Ankylosing spondylitis
• Arthritis-related to Crohn's disease or ulcerative colitis
• Psoriatic arthritis (arthritis associated with psoriasis)
• Reactive arthritis or reiters syndrome
• Sacroiliitis (inflammation of the sacroiliac joint)
• Uveitis

And then, just a little background information on the group of people that tend to get this. Remember, nothing is absolute, but if we're looking for patterns, it's going to be males and relatively young ones, actually, really young ones, from 15 to 45 is going to be the mean or the biggest group of people who get as or that's when it's diagnosed the most.

Complications of ankylosing spondylitis-

• Anemia
• Osteoporosis
• Spinal fracture
• Quadriplegia
• Spondylodiscitis
• Spontaneous subluxation of the atlantoaxial joint
• Cauda equina syndrome
• Glomerulonephritis
• Acute iritis/ uveitis
• Conjunctivitis
• Depigmentation and scarring of iris
• Cardiomegaly
• Pericarditis
• Aortic incompetence
• Mitral incompetence
• Cardiac conduction defects
• Amyloidosis
• Apical pulmonary fibrosis with cavitation
• Prostatitis
•  Undefined

Causes of ankylosing spondylitis -
Interesting thing about ankylosing spondylitis is that the exact cause of this condition has not been clearly understood till date though it has been the subject of numerous studies!

Ankylosing spondylitis is considered to be a genetic disorder in which the HLA-b27 gene, in particular, has an important role to play.

The risk factors that predispose a person to ankylosing spondylitis include:

Testing positive for the HLA-b27 marker:- people with this particular gene have a significantly higher risk of developing ankylosing spondylitis. However, it must be noted that not every person who has the HLA-b27 gene develops this disorder. Thus there are some additional factors, probably environmental, that are involved in the development of this condition.
A family history of ankylosis- patients with a family history of ankylosing spondylitis stand a greater chance to develop it as compared to those with no family history.
In addition, gender affinity has been strongly noticed in this condition. Males are almost 2 to 3 times more prone to develop this condition as compared to females. Ankylosis spondolysis is more common in men but occurs in women as well.
As commonly occurs in younger people, between the ages of 17-45. So restrict the life style of these people. However, it can affect children and those who are much older.
Frequent gastrointestinal infections:- the initial inflammation that activates the immune system is thought to be triggered by a bacterial or microbial infection. At a later stage, the immune system is unable to turn off this response which continues to attack the body’s own tissues now, in this case, the joints leading to arthritis. This explains the auto-immune nature of the disease.
Undefined

Symptoms of ankylosing spondylitis-

• Backache and stiffness along the spine – usually worse in the mornings or after periods of inactivity
•  The joint pain (arthritis) experienced by the patient is often relieved by motion, applying local heat or taking a warm shower
•  Pain in the hips, buttock pain
•  Difficulty in bending down (inflexibility)
•  Stooping posture due to chronic back pain
•  Neck pain
•  Pain in heels
•  Affection of other joints leading to pain and stiffness – e. G. Knee pain, shoulder pain, ankle pain
•  Expansion of the chest during breathing is restricted
•  Fatigue
•  Loss of appetite
•  Weight loss
•  Inflammation of the eyes (iritis) where there is redness of eyes and pain while looking at bright lights
•  Lungs may be affected by ankylosing spondylitis leading to breathing difficulty
•  Pain and stiffness in the back of the heel (Achilles tendinitis)
•  Inflammation of the tissues of the bottom of the foot causing pain (plantar fasciitis)
•  Rarely the electrical system of the heart may be affected leading to a slow heart rate – patient experiences symptoms of dizziness, fainting, and shortness of breath in such cases
•  The kidney may also be affected leading to accumulation of the toxins in the body that causes nausea and chronic fatigue.

Diagnosis of ankylosis spondolysis-

1. History: Individuals typically complain of a gradual onset of low back pain and associated muscle spasms experienced over several months. The pain is usually described as worse in the morning and improving during the day. It may have followed a gradual ascending pattern from the tailbone (sacrum) to the lower back (lumbar spine) to the chest region (thoracic spine) and finally to the neck (cervical spine). Individuals may also report pain and stiffness of the rib cage and/or pain beginning in the larger peripheral joints (e. G, knees, hips, shoulders). Eye pain may be reported as well as a loss of appetite, weight loss, and fatigue. A family history of ankylosing spondylitis may also be reported on questioning.
2. Physical exam: The exam may reveal tenderness over the area where the sacrum and hipbones meet (sacroiliac joints) and lumbar range of motion may be decreased. Chest expansion may be decreased to well below the 2 inches (5 cm). Evidence of eye inflammation (iritis) may be observed. Peripheral joints will be evaluated for tenderness, swelling, and restricted motion. Limited motion in the lumbar spine means that when the patient bends forward motion occurs by hip flexion, and very little or no lumbar spinal flexion occurs.
3. Tests: Routine laboratory tests, including complete blood count (CBC) and blood chemistries, may reveal a low-grade anemia, an elevated erythrocyte sedimentation rate (ESR) indicative of active inflammation, and an elevated serum alkaline phosphatase indicating active bone remodeling. Tissue typing (HLA typing) may be done to determine presence of HLA-b27 since as is more likely if HLA-b27 is positive. X-rays of the pelvis may show characteristic fusion or inflammation of the sacroiliac joints (sacroiliitis). Lumbar x-rays may reveal fusion of the facet joints (anterior and lateral osteophytes bridge disc spaces and fuse motion segments into a" bamboo spine"). Mri will show evidence of inflammation in the sacroiliac joints.

Homeopathic treatment-
Homeopathic treatment can contribute to an effective and safe cure in the preliminary stage of spondylosis. In chronic cases of spondylosis, homeopathy can reduce overcrowding of the spine, compression of the nerves and also conclude the progressive degenerative changes. In very advanced cases of structural damage like a badly deformed spine, homeopathic remedies along with a correct posture can facilitate in living better without any complaints or pain. We can aim for near normal in all other cases. The outcome of homeopathy in managing spondylosis will be remarkable compared to another system of medicines or surgical interventions.

Homeopathy can provide good relief to the patients and control the progress of ankylosing spondylitis. We strive to give the patients of ankylosing spondylitis a better quality of life, free from the pain of arthritis - one that can be lived to the fullest.

 Homeopathic treatment is natural, safe, gentle and without side-effects. Another impressive thing about homeopathy is that people on multiple medications can safely take homeopathic medicines. Homeopathic drugs are non-habit forming and have no addictive characteristics. Homeopathy has an exceptional proven safety record with the FDA with 200 years of clinical effectiveness.

Since homeopathy treats in totality, it leads to a permanent long-lasting cure, rather than a temporary suppression of symptoms, and you will be able to enjoy all kinds of food to the fullest. So, food lovers, you won't have to think anymore before eating.

Self-care measure -

• Exercise in an integral part of any as management program. Regular daily exercises can help create better posture and flexibility as well as help lessen pain. Most people with as feel much better with exercise.
• Maintain good posture while sitting, standing and sleeping.
• Hot showers will help in relieving pain.
• Maintain a healthy weight - lose that extra weight, if any, to avoid worsening of the joint pain. Swimming, underwater exercises are good for people with ankylosing spondylitis
• Practicing good posture techniques will also help avoid some of the complications of as including stiffness and flexion deformities of the spine. While working, sit in a chair that has an upright firm back.
• Applying heat to stiff joints and tight muscles can help reduce pain and soreness. Applying cold to inflamed areas can help reduce swelling. Avoid violent massages.
• Eat a varied diet including plenty of calcium-rich foods (sesame seeds, green leafy vegetables, ragi), whole grains, fruit, and vegetables. Alcoholic beverages weaken bones. Consuming more than two alcoholic drinks per day increases a person's chances of developing weakened bones. Decrease your intake of saturated fats (dairy, red meat), salt and sugar
• Deep breathing exercises help improve as well as maintain the lung capacity.
• Avoid sports or any activities that involve the risk of falling.
• Sleep on a mattress that is firm (not hard). Avoid using thick pillows since they cause the neck to bend forward.
• A hot bath or shower in the morning may help reduce pain and stiffness.
• Stop smoking
• Bed rest when needed
• Do not be in one position for a long time.
• Avoid heavy lifting and activities that aggravate pain or other symptoms.
• Use seat belts in vehicles and keep headrests at proper heights.
• Try to keep your weight close to ideal.
• Stop smoking.
• Avoid cold exposures and cold bath
• Avoid citrus fruits since they can precipitate pain.

Hence, every individual suffering from spondylosis must consider homeopathy to provide relief and/or lifetime cure. Homeopathic treatment can change a person’s life from one of distress to one of health.

We believe in a strong patient-doctor relationship and our motto is'healthy people wealthy nation'

Homeopathic remedies for ankylosis spondolysis-
The following homeopathic medicine may prove beneficial: arsenic, calcare carb, cal. Phos, causticum, cimcifuga, guaicum, phosphorus, phosphoric acid, pulsatilla, silicea, sulphur, etc.

Arsenic album- Burning pain the lower back with stiffness, worse between 12- 2 am. Persons who are extremely tidy in their nature, want everything neat and clean, and in order. Ankylosing spondylitis with recurrent chest infections, respiration difficult, has to sit down to get relief.

Calcarea carb- Ankylosing spondylitis in fair, fatty and flabby persons who are easily tired on walking, with much sweeting, cold extremities and sour smell of body, having longing for eggs and undigestable things. Pain is relived by lying on the painful side i. E on the back.

Causticum- Ankylosing spondylitis in dark complexioned and rigid-fibred persons. Restlessness at night and faint like sinking of strength. Emaciation is marked due to diseases, worry and of long standing. Pains are worse in clear fine weather, dry cold wind, while coming from cold air into a warm room. Pains are better in damp wet weather, warm air and heat of bed.

Cimcifuga- Ankylosing spondylitis in chilly patients, easily affected by cold, sensitive to cold and relieved by warmth. Fear, restlessness, and anguish are well marked. Fear of death with great suspicion. Sensation as if a heavy, black cloud settled all over her and enveloped her head. There is an illusion of a mouse running under her chair. Bad effects of anxiety, fright, disappointed love, business failure, over-exertion. Severe pain in the uterine region, darting from side to side, sharp, lancinating, electric-like pain. Bearing down sensation with relaxation of the parts.

Guaicum- Ankylosing spondylitis with contraction of limbs, with stiffness of lower back with immobility. Stinging pains in the limbs with feeling of heat in the affected part. Parts affected sensitive to touch with intolerance of pressure, can’t bear heat.

Phosphorus- Suitable to persons who craves cold food and icy- cold drinks, refreshing, juicy things, ice-cream relives the gastric pain. Ankylosing spondylitis in children and young adults who grow rapidly. Pain and stiffness are worse in evening and before midnight, lying on left or painful side, during a thunderstorm, any change of weather. Ailments are better by lying on right side, from being rubbed or magnetized, from cold water and cold food and in darkness.
Phosphoric acid- Abashed, sad, despair of cure in person suffering from ankylosing spondylitis with debility and emaciation. Patient is listless, apathetic and indifferent to the affairs of his own life, prostrated and stupefied with grief.

Pulsatilla- Ankylosing spondylitis with drawing, tensive pain in thighs and legs, with restlessness, sleeplessness, and chilliness. Pain in limbs shifting rapidly, tensive pain, letting with a nap. Persons who are fair and beautiful-looking but inclined to be fleshy with fine hair and blue eyes, soft and lax muscles, anemic and chlorotic with pale face. Full of tears, slow and indecisive. It is almost impossible for them to tell their symptoms without weeping. The patient likes open air, feels suffocated in a closed, stuffy and heated room. Wants sympathy, thirstlessness is well marked.

Silicea- Soreness in feet from instep through to the sole in patients of ankylosing spondylitis, with cramps in calves and soles. Person is cold, chilly, hugs the fire, wants plenty of warm clothing, hates drafts, hands, and feet cold worse in winter. Great sensitiveness to taking cold. Intolerance of alcoholic stimulants. Offensive sweat on feet, hands, and axillae. The parts lay on go to sleep.

Sulphur- Ankylosing spondylitis in hot patients, who cannot walk erect, stoop-shouldered. Stiffness of back, sensation as if vertebrae glided over each other. Immobility. Pains are worse at rest when standing, warmth in bed, washing, bathing, in the morning, 11 am, night, from alcoholic stimulants. Pains are better in dry warm weather, lying on right side, from drawing up affected limbs

Gummy smile -

 Smiles that shows an excessive amount of gum greater than 3 mm under the upper lip while speaking and smiling is considered as a gummy smile 

An Esthetic Problem or Something More?

1.Abnormal dental eruption 

2.Hyperfunction of upper lip elevator muscle

3.The excessive vertical growth of maxillary bone 

4.Short upper lip

Treatment-

1. Botox injections have been successful, but the result last only for six months   the material is injected into the hyperactive muscle to reduce their activity 

2. Orthognathic surgery- bimaxillary  orthognathic surgery to reposition the maxilla upwards  and remove excess gum, this procedure require hospitalization

3.Orthodontics 

4. Surgical lip repositioning results in Shallow vestibule restricting the muscle pull thereby limiting gingival display during smiling

5.Crown lengthening and Crown placement