Dr. Jayesh Jain

You know that feeling after a long day when your feet are so sore or swollen that you can’t bear the thought of standing on them for any longer? once you take off your shoes and sit down, or even soak them in a warm bath, it’s still an unpleasant experience. Luckily, I’ve collected 10 natural remedies for such an occasion and I want to share them with you.
 
Important: regular swelling vs potential health risks
When experiencing swelling in the feet and legs, apply pressure to the area with a finger. If the dimple created by the finger remains for more than a couple of seconds, it may indicate oedema, which can be the result of heart, liver, or kidney problems. When this occurs, see a doctor at the first possible opportunity.
If you experience swelling in one leg but not the other, you should also see a doctor as this may be an indication of deep venous thrombosis (a blood clot blocking the blood vessels).
If the swelling is accompanied by shortness of breath, fever, bluish skin, and chest pains, get immediate medical attention.
 
10 natural remedies:

1. Soak your feet in epsom salts
Pour 250g of epsom salt into a hot bath, and take a nice long soak. You can also add essential oils to the mix for enhanced relaxation. Your feet will thank you, your body will thank you, and you’ll emerge from that bath a happier person.
2. Massage the area
Massaging the painful area increases blood flow and moves the fluids that accumulate and cause the swelling. If you want to indulge, get someone to massage your feet for you, preferably with hot essential oils.
3. Stop smoking
If you smoke tobacco (cigarettes, cigars, etc.), you should know that one of the many negative effects of nicotine is constriction of blood vessels, which can lead to sore feet.
4. Stay hydrated
When the caffeine and sodium we consume accumulate in the body, they can cause swelling and pain in the limbs. The best way to dilute them and flush them out is by drinking water. If you want to maximize the efficiency of hydration, squeeze a lemon or lime into the glass of water for a boost of vitamins and antioxidants.

5. Eat healthy, avoid excess salt
While we need salt for our body to function well, when we overdo it, it can have adverse effects. Reduce the amount of salt you consume every day, and consider cutting down on caffeine as well.
6. Elevate the legs
If you’re suffering from chronically sore legs/feet, try keep your legs elevated for 30 minutes, three times a day. You will notice a difference within a couple of days. Also, when you’re in bed, use a couple of pillows to prop up your feet. Elevating the legs helps to drain the excess fluids that causes the swelling and pain.
7. Avoid sitting for prolonged periods
Whether you’re flying, taking the bus, or just sitting in an office all day, keeping your legs stationary can lead to pain and swelling. If you know you’re going to sit for a long period of time, make sure to stand up, stretch, and walk around every 20 minutes or so.
8. Use compression socks when traveling
If you’re going to fly overseas, another excellent solution is to use compression socks. These socks apply pressure to your feet, preventing fluid from building up – the main cause of swelling and pain in the feet.
 9. Exercise
Exercise will help boost your cardiovascular system, which in turn will reduce the possibility of swelling in the limbs. Exercise increases blood-flow in the body and reduces weight. 
10. Take magnesium supplements
Magnesium is essential for our body’s function. That said, many people suffer from a magnesium deficiency. By adding magnesium to your system, you will improve your overall health, reduce hangover symptoms and suffer less pain in your extremities

The symptoms caused due to herniated disc can be very severe and can also cause a bit of disability. The disc of the spine is like a cushion and separates the set of bones on the backside. The discs are shock absorbers of the spine and are mainly composed of 2 parts, a soft jelly centre called the nucleus and a tough outer covering called the annulus.

Effects of Herniated Disk
A herniated or cracked disc is a severe condition and it seems to happen most commonly in the lower back.  It happens when a fraction of the soft centre gets pushed through the destabilized area due to degeneration, trauma or by putting pressure on the spinal cord. 

Nerves are located precisely at the back of every disc and are responsible for controlling everything in our body. While a disc gets herniated, the external covering of the disc tears and creates a bulge. The soft jelly gets shifted from the centre of the disk to the region where the damage has occurred on the disc. Most commonly, the bulge occurs in areas where the nerve is located and it causes strain on the affected nerve. It has been observed that individuals do not feel any painful sensations even if their disc gets damaged.

When is Surgery Recommended for Herniated Disc?
Surgery for herniated disc is recommended only after options like steroid injections, pain relievers, exercise and non-steroid anti-inflammatory drugs do not work. If the pain persists even after these options, then it becomes important to go for surgery. There are certain risks involved in this surgery like infection, bleeding or nerve damage. 

There are chances that the disc may get ruptured again if it is not removed. If you are a patient suffering from degenerative disc disease, then there are chances that problem occurs in other discs. It is very important that a patient maintains healthy weight to prevent any further complications.

The main factor that increases the risk of herniated disc is excess body weight, which causes a lot of stress on the lower back. A few people become heir to a tendency of developing this condition. Even individuals with physically demanding jobs are prone to this condition. 

Activities like bending sideways, pushing, twisting, repetitive lifting can increase the risk of a herniated disk. At times, emergency surgery is also required to avoid paralysis in a patient. In case you have a concern or query you can always consult an expert & get answers to your questions!

Breast cancer is a form of cancer which develops from the breast tissue. Breast cancer is indicated by signs such as a lump in the breast, changes in breast shape, fluid flowing from the nipple, dimpling of skin, or the development of red scaly patches. Breast cancer is a fatal form of cancer in women and immediate diagnosis is required on observing the symptoms.

Diagnosis of breast cancer
Other than the regular breast screening, the diagnosis of breast cancer involves the following steps and methods:

1. Seeing your general practitioner (GP): It is very important to visit your GP soon after noticing the symptoms of breast cancer. Your GP will examine you properly and in case your symptoms need more assessment, he/she will refer you to a breast cancer clinic.
2. Mammogram and breast ultrasound: You will be required to have a mammogram, as recommended by a specialist breast unit. This is an X-ray of the breasts. An ultrasound scan may also be required. Breast ultrasound should be undertaken only if you are less than 35 years of age. This is because, young women have denser breasts and a mammogram is not as effective as ultrasound in the diagnosis of breast cancer. In ultrasound, high frequency sound waves are used for obtaining an image of your breasts. It is observed to notice any abnormality or lumps. A breast ultrasound is also important for determining whether a lump is solid or contains liquid.
3. Biopsy: In this diagnosis process, a sample of the tissue cells is taken from the breasts and tested under a microscope to find out if it is cancerous. A scan and needle test for the lymph nodes present in your armpit is also done to check whether they have also been affected. A biopsy is undertaken in several ways, depending upon the condition and severity. A needle aspiration biopsy is used for testing a sample of your breast cells without the removal of the tissues. This is the most common form of biopsy and it is also used for draining a small fluid-filled lump or benign cyst. During the process, you will be given a local anesthetic. Usually, a needle biopsy is carried out guided by an X-ray, ultrasound and an MRI scan as well. This helps in distinguishing it from non-invasive changes such as ductal carcinoma in situ.

Another form of biopsy used for the diagnosis of breast cancer is called vacuum assisted biopsy or mammotome biopsy. In this process, a needle gets attached to a suction tube, which helps in obtaining the sample and for clearing the bleeding. If you wish to discuss about any specific problem, you can consult a general-surgeon.

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 

1. PVP is generally safe with low risk.
2. Ectopic cement leak is frequent but generally inconsequential.

Outcome 

1. PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
2. 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.
3. PVP does augment height of VB but ideal would be kyphoplasty.
4. Patient is either off medicine or on reduced doses.
5. Patient feels so well that he almost forgets if he had VB

In case you have a concern or query you can always consult an expert & get answers to your questions!

Breast cancer is the most common forms of cancer in females, affecting one in every eight women in the US. There are huge awareness campaigns, which revolve around ways to recognize if you are prone for it and how to identify the disease in its early stages. Knowing the symptoms can help in early diagnosis and thereby early intervention and better prognosis.

How and why of breast cancer?
The breasts produce milk through the glands, which also contain connective tissue including fat, fibrous tissue, nerves, blood vessels, etc. The milk reaches the exterior through a fine network of ducts. Most cancers develop as small calcifications in these ducts, which continues to grow and spread to distant organs.

Warning signs and symptoms: Given the high incidence of breast cancer, knowing the symptoms helps in early identification. Read on to know more, especially if there is a family history.

1. Any change in the size, shape, or contour of the breasts
2. Appearance of a lump in the breasts or the armpits
3. Presence of a clear or bloody discharge from the breast
4. The breast or the nipple turning red
5. Sudden thickening of breast tissue or skin that continues for a while
6. Change in the feel or look of the skin (dimpling, puckering, scaliness, reddishness, warmth, etc.)
7. Hardening of the tissue under the breast skin
8. Difference in appearance or feel of one area in comparison with other areas

The presence of any of these or a combination of these symptoms should be an indication for a detailed checkup. As mentioned, early diagnosis helps in reducing complications and improving prognosis. It is also good to know risk factors, which also indicate if you need to watch for symptoms.

• Family history: Breast cancer runs in families, and if you have a first-degree relative with breast cancer, watch out for symptoms.
  • Tested positive for BRCA1 and BRCA2
  • Family history of other cancers
• Age: Women over the age of 50 are at an increased risk of developing breast cancer.
• Race: Caucasian women carry greater risk than African-American women.
• Hormones: Increased use of estrogen increases the chances of developing breast cancer. Therefore, women who have used birth control for long time or are on hormone replacement are at greater risk.
• Abnormal gynecologic milestones: Women who have abnormal menstrual milestones are more predisposed to developing breast cancer. For instance, girls who attain menarche before age of 12, get pregnant after 30, and reach menopause after 55. Women with menstrual irregularities including cycles earlier than 26 days and later than 29 days are also likely to have hormonal issues and are, therefore, at higher risk of breast cancer.
• Other factors: Smoking, alcohol abuse, and obesity also increase the chances of a woman developing breast cancer. If you wish to discuss about any specific problem, you can consult an Oncologist.