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Dr. .R.Sarwate

MBBS

Radiologist, Mumbai

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Dr. .R.Sarwate MBBS Radiologist, Mumbai
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My experience is coupled with genuine concern for my patients. All of my staff is dedicated to your comfort and prompt attention as well....more
My experience is coupled with genuine concern for my patients. All of my staff is dedicated to your comfort and prompt attention as well.
More about Dr. .R.Sarwate
Dr. .R.Sarwate is a trusted Radiologist in Ghatkopar East, Mumbai. Doctor is a MBBS . You can consult Dr. .R.Sarwate at Parikh Hospital in Ghatkopar East, Mumbai. Book an appointment online with Dr. .R.Sarwate and consult privately on Lybrate.com.

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Parikh Hospital

Near Railway Station, Khokhani Lane, Ghatkopar East. Landmark: Above Samarth Hotel, MumbaiMumbai Get Directions
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Parakh Hospital

1st Floor, Khokhani Lane, Saibaba Nagar, Pant Nagar Landmark: Opposite Ghatkopar Railway Station, Near Police Quarters, Next to Parekh HospitalMumbai Get Directions
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I am having neck pain radiating to my right thumb which started around oct'2014. I am working in it sector and prolonged hours I have to sit infront of computers. I took some treatment in ayurveda for almost one month. Then later shifted to idd therapy which showed hood results and I was able to get back into my job after 1-2 months treatment. There's a disc prolapse in c5 c6 region and that's the reason. So, now the pain again started to come back although not severe and I am afraid I have to quit my job and go for surgery. Can any body help me send a suggest a solution without surgery.?

DNB (Radiodiagnosis), DMRD, MBBS
Radiologist, Bangalore
Hi, thanks for writing in to us. Your mri scan shows disc problem at c 5 - c 6 level. This requires rest, physical therapy and pain relief as first line of treatment. Maxgalin er is a good medicine and will treat nerve related pain. The condition you have might be due to trauma or degeneration. It is unlikely to heal completely. You can try a rehabilitation and treatment with nerve pain reliever like maxgalin er. Please do not stress your neck for a long duration and avoid sudden neck movement. Go slow on your job. Non surgical pain relief options are best. They might be steroid shots or rf ablation. Regards,
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Uterine Prolapse: Risks, Symptoms and Diagnosis

fellow in Obstetric Medicine , MS - Obstetrics and Gynaecology, FMAS, DMAS, MBBS
Gynaecologist, Hyderabad
Uterine Prolapse: Risks, Symptoms and Diagnosis

The uterus or womb, is a muscular structure and is held in place by ligaments and pelvic muscles. If these muscles or tendons become weak, they cause prolapse and are no longer able to hold the uterus in its place.

Uterine prolapse happens when the uterus falls or slips from its ordinary position and into the vagina or birth waterway. It could be complete prolapse or even incomplete at times. A fragmented prolapse happens when the uterus is just hanging into the vagina. A complete prolapse depicts a circumstance in which the uterus falls so far down that some tissue rests outside of the vagina. Likewise, as a lady ages and with a loss of the hormone estrogen, her uterus can drop into the vaginal canal. This condition is known as a prolapsed uterus.

Risks: The risks of this condition are many and have been enumerated as follows:

  1. Complicated delivery during pregnancy
  2. Weak pelvic muscle
  3. Loss of tissue after menopause and loss of common estrogen
  4. Expanded weight in the stomach area, for example, endless cough, constipation, pelvic tumors or accumulation of liquid in the guts
  5. Being overweight
  6. Obesity causing extra strain on the muscles
  7. Real surgery in the pelvic zone
  8. Smoking

Symptoms: Some of the most common symptoms of prolapse involve:

  1. Feeling of sitting on a ball
  2. Abnormal vaginal bleeding
  3. Increase in discharge
  4. Problems while performing sexual intercourse
  5. Seeing the uterus coming out of the vagina
  6. A pulling or full feeling in the pelvis
  7. Constipation
  8. Bladder infections

Nonsurgical medications include:

  1. Losing weight and getting in shape to take stress off of pelvic structures
  2. Maintaining a distance from truly difficult work
  3. Doing Kegel workouts, which are pelvic floor practices that strengthen the vaginal muscles. This can be done at any time, even while sitting down at a desk.
  4. Taking estrogen treatment especially during menopause
  5. Wearing a pessary, which is a gadget embedded into the vagina that fits under the cervix and pushes up to settle the uterus and cervix
  6. Indulging in normal physical activity

Some specialists use the following methods to diagnose the problem:

  1. The specialist will examine you in standing position keeping in mind you are resting and request that you to cough or strain to build the weight in your abdomen.
  2. Particular conditions, for example, ureteral block because of complete prolapse, may require an intravenous pyelogram (IVP) or renal sonography. Color is infused into your vein, and an X-ray is used to view the flow of color through your urinary bladder.
  3. An ultrasound might be utilised to rule out any other existing pelvic issues. In this test, a wand is used on your stomach area or embedded into your vagina to create images of the internal organ with sound waves.
2548 people found this helpful

I am a student and suffering from lumbar disc herniation since last two years or more treatments are being done but there have been no proper result but severe development in sciatic pain, numbness and feeling some effect on other leg also. And please suggest me some solution for this herniation.

MBBS, MD, DNB, FIPM, FIPP
Pain Management Specialist, Chennai
Hi lybrate-user, disc herniation is causing your nerves to get pinched when they get out of the spine. This may cause pain, tingling, numbness, etc radiating down the legs. If conservative management is not helping, you may consider a nerve root or epidural injection with a pain physician. They are effective and safe. In severe cases, you may require spine surgery. Good luck.
1 person found this helpful
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My MRI INDICATE 1. Lumbosacral transitional Vertebra with complete socialization of L5 2. Disc desiccation with diffuse disc bulge and broad based posterior central disc protrusion at L4-L5 level causing ventral thecal sac indentation and significant compromise of bilateral neural forminal (right>left). Mild ligamentum flavum thickening is also seen at this level with maintained spinal canal dimensions. 3. Cervical spondylitis changes with disc osteophyte complexes at C4-C5 and C5-C6 levels. Broad based left paracentral disc protrusion at C4-C5 level causing ventral thecal sac indentation and moderate compromise of left sided neural forminal. 4. Mild disc bulge at d5-d6 (screening of rest of spine revealed) I am confused. Dr. Said physio will fix it. I read too many damages. Please guide and suggest sustainable solutions. I am willing to take prolonged treatment. What does this report mean?

Radiologist, Delhi
Hello Mr. lybrate-user. The report says that there is significant compression of nerves at L4-5, C4-5 and C5-6 vertebral levels. You need to wear lumbar hot belt on regular basis, have to take medicines, you have to undergo physiotherapy and take precautions like no forward bending, no lifting weight, using ortho matress to keep spine straight. I would advise you to meet an orthopedician and discuss your symptoms in detail. Clinical examination and some further tests are required before prescribing medicines.
3 people found this helpful
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I want to know about exercises being done in case of diffuse disc bulge at l1-l2 level indenting anterior the cal sac mildly with bilateral mild neural foraminal narrowing.

Diploma in Radio-Diagnosis
Radiologist, Shimla
If pain is there no exercise indicated, after relief mild passive exercises, lumber exercise, lumbo-sacral exercise, mild lumber extension exercise; click on private quastion in my name for any clarification.
1 person found this helpful
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Treatment of Cerebral Ischaemia and Cerebral Congestion With Homeopathy

BHMS
Homeopath, Gurgaon
Treatment of Cerebral Ischaemia and Cerebral Congestion With Homeopathy

Cerebral ischaemia or brain ischemia is a medical condition that restricts the flow of blood to the brain, resulting in an unmet metabolic demand. This leads to limited oxygen supply in the brain, which could result in death of brain tissues, cerebral infarction or an ischemic stroke. Thus, a cardiorespiratory arrest, a stroke, and irreversible brain damage are few possible consequences of cerebral ischaemia.

People with compressed blood vessels, low blood pressure, congenital heart defects or sickle cell anaemia have a high risk of developing cerebral ischaemia, since compressed blood vessels or very low pressure can lead to restricted blood flow. Also, sickle-shaped cells have a greater tendency to clot, causing obstructed blood flow.

Patients with cerebral ischaemia experience a host of symptoms, such as weakness in the body, problems in coordination and movement, vision and speech impairment and unconsciousness.

Cerebral congestion, on the other hand, refers to excessive quantity of blood in the brain vessels, causing pressure on the cerebral substance. Cerebral congestion is of two types. It is termed as active when there is too much arterial blood flow and passive when there is undue quantity of venous blood in the veins of the brain. Both conditions cause symptoms, such as severe headache, insomnia, irritability and unconsciousness. The patient gets little sleep and is disturbed, often followed by dreams. When awake, the patient’s mental activity in the brain is very high.

Homeopathy is now a well-established school of medicine backed with years of research and practice. Gone are the days when homeopathy was considered no more than an extension of herbal home remedies. Homeopathic laboratories around the world produce large number of medicines covering almost all ailments. The benefits of homeopathic treatment are now well established due to its holistic approach and minimal side effects. Homeopathy is undoubtedly a ray of hope for patients with cerebral ischaemia and cerebral congestion, as it delivers a comprehensive treatment plan designed to target the signs and symptoms of the disease and address its non-occurrence.

The medications deal with mild to severe symptoms, including inflammation of the brain, headache, vomiting, insomnia, stroke/convulsions and seizures. The stramonium drug, for example, deals with seizures. Belladonna is an effective remedy for sharp shooting headaches, a common symptom of cerebral congestion. Ferrum is believed to be a valuable remedy for brain ischaemia. Few drugs deal with the symptoms of both ischaemia and congestion—nux is a suitable drug for the treatment of ischaemia as well as for passive cerebral congestion. Similarly, phosphorus can be used to treat brain ischaemia and congestion. Zincum metallicum is a highly recommended drug for chronic cases of ischaemia.

The treatment is comprehensive and long term and shows substantive results. Regular follow-ups and consultation with a homeopath specialist is the key to an effective treatment.

4598 people found this helpful

Sir I have a problem of slipped disc in cervical spine. I am a dance choreographer so I should do my profession or I should stop it.

Fellowship in Shoulder and Upper Limb, Fellowship in Joint Replacement, MS - Orthopaedics, MBBS
Orthopedist, Mumbai
If the problem is recent and correctly diagnosed you should take rest for a couple of weeks and then start gradually with neck physio. Once your neck muscles are strong then you can gradually restart your dance activity.
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Know All About Gynae Laparoscopy Surgery

Panchkula & Delhi
Mother and Child Care, Panchkula
Know All About Gynae Laparoscopy Surgery

Q1. What exactly is Laparoscopy?

Laparoscopy is an alternative to 'Open' surgery wherein the abdomen is opened by tiny 'key hole' incisions and surgery is done. 'Scopy' means the use of an endoscope or telescope to see inside the abdomen. This is attached to a camera and a light source and the inside of the abdomen is projected on to a monitor. The surgeon performs surgery looking at this screen. The surgeon makes a total of 2-4 small cuts on the abdomen ranging from half to 1 cm through which the telescope and other thin surgical instruments are passed into the abdomen. When the uterus is removed , known as hysterectomy, there is also a cut at the top of the vagina where the uterus is attached.

Q2. What kind of gynaecological surgeries can be performed by Laparoscopy?

Most surgeries done in gynaecology can now be performed by Laparoscopy and do not require the large incision as for open surgery. Laparoscopy can be done sometimes only for diagnosis and is called Diagnostic Laparoscopy, as in checking whether the tubes are open or not and to look for any causes of infertility or pain outside the uterus. In women who are unable to conceive, Diagnostic Laparoscopy is often combined with Hysteroscopy (endoscope inside the uterus, inserted from below, via the vagina). When laparoscopy is done to perform some surgical procedure inside the abdomen it is called Operative Laparoscopy. This may be for simple procedures like sterilization, minor adhesions, drilling ovaries; or for intermediate or major reasons like fibroids, endometriosis, removal of ovaries or tubes or both or removal of uterus, for staging of cancers or radical surgeries for cancer. However, about 5% of all surgeries including those for cancer or very large tumours may benefit from open surgery.

Q3. Why does an expert surgeon recommend Laparoscopy over Open Surgery?

Laparoscopic surgery has many advantages above open surgery: the incisions are much smaller (open surgery incisions are 8-10 cms long), therefore pain is much less; requirement for pain killers (which can have side-effects like sleepiness, impaired judgement) is lesser; hospital stay is shorter; complications fewer; requirement for blood transfusions infrequent; recovery in terms of physical, emotional and mental state is much better and quicker; return to work is faster with consequent lesser loss of working and earning days. Surgery with laparoscope is more precise because it is magnified view. Further vision is much better because it's like having your eye behind the structure because you can see with the telescope at places where the surgeon's eye cannot reach.

Q4. If the cuts on the abdomen are so small in Laparoscopic surgery, how do you remove the uterus or a large tumour from inside the abdomen?

Quite often if the tumour is not malignant and contains fluid, it is punctured to collapse it into a smaller size. If it is solid, it can be cut into smaller pieces inside the abdomen using a special instrument. The collapsed or cut structures can be removed gently through the 1 cm cut on the abdomen which may be increased a bit if required. After hysterectomy, the uterus can be removed easily from below, through the vagina.

Q5. Will there be much pain or discomfort after Laparoscopic Surgery?

There may be some pain and discomfort in lower abdomen for one day to few days after Laparoscopic surgery but this is much less as compared to open surgery because the incisions on the abdomen are much smaller and there is much less tissue handling inside the abdomen by fine instruments instead of rough, big, gloved hands which can cause tissue injury in open surgery. There may be some pain in the shoulder following laparoscopy. This is not serious and is due to the gas used in the surgery to make space for instruments.

Q6. When can I be discharged from hospital?

Following Diagnostic Laparoscopy or with simple Operative Laparoscopy you can expect to be discharged from hospital latest by the morning after surgery. In most other cases of intermediate or even major surgery, discharge is generally 1-2 days following the surgery unless there is some health issues prior to the surgery or any complication during the surgery. The complication rates for Laparoscopic surgery are not more than for open surgery and depend upon patient factors like anaemia, diabetes, obesity and skill of the surgeon.

Q7. When can I perform routine household activities or return to work after Laparoscopic Surgery?

Recovery after surgery depends upon many factors: presence of health problems before surgery; why the surgery is required; what surgery is being done; problems or complications of surgery, anaesthesia or blood transfusions. If all is well, one can perform routine household activities by 1 week, provided one doesn't feel tired. Although there may not be any harm, it may be unwise to be normally active within 48 hours of procedure. Following Diagnostic Laparoscopy or Operative Laparoscopy for simple procedures, one can return to work in 1 week. For other procedures, a 2-3 week off from work is reasonable. It depends on the type of work you are returning to. Avoid too rapid return to work if it is manually hard or requires standing for long durations of time. Sometimes a surgical procedure brings on a well needed rest and break from a lifetime of work. Mostly, when you return to work depends upon your own body and its signals of tiredness. You need to listen to those signals.

4326 people found this helpful

Back Injury

BPTh/BPT
Physiotherapist, Delhi
Back Injury
Herniated disks or bone spurts in the vertebrae of the neck may become the reason behind severe neck pan. They sometimes take too much space and compress the nerves branching out from the spinal cord.
225 people found this helpful

Breast Cancer - 6 Ways You Can Prevent it

MBBS, DGO, MD - Obstetrics & Gynaecology
Gynaecologist, Mumbai
Breast Cancer - 6 Ways You Can Prevent it

Breast cancer begins when the cells that are present in the breast start to go out of control. These cells generally form a tumor which can be seen on mammogram or one can feel it as a lump. The tumor is threatening if the cells can grow into the tissues that surround it or spread to other areas of the body. Breast cancer happens mostly in ladies. Here are a few methods with which you can prevent breast cancer-

  1. Keep your weight in check: Maintaining a healthy weight is important for everyone although, it is easy to tune it out since it is said so often. Being overweight can expand the danger of a wide range of cancers, including breast cancer, particularly after menopause.
  2. Be physically active: Women who are physically active for almost or at least 30 minutes a day have a lower danger of breast cancer. Normal activity is additionally one of the ideal approaches to keep weight under control.
  3. Eat Your Fruits and Vegetables and Avoid Too Much Alcohol: A balanced and healthy diet can bring down the danger of breast cancer. Attempt to eat a considerable measure of fruits and vegetables and keep liquor at moderate levels or lower. While moderate drinking can be useful for the heart in most grown-ups, even low levels of intake can build the danger of breast cancer. If you do not drink, don't feel you have to begin. In case you drink modestly, there is less risk.
  4. Try not to Smoke: Smokers and non-smokers alike know how undesirable smoking is. It brings down a person’s quality of life and expands the danger of heart and lung diseases, stroke, and no less than 15 types of cancer, including breast cancer. It additionally causes bad breath, awful teeth, and wrinkles.
  5. Breastfeed, If Possible: Breastfeeding for almost one year or more brings down the danger of breast cancer. It additionally has extraordinary medical advantages for the baby as well, especially in terms of immunity.
  6. Keep away from Birth Control Pills: Contraceptive pills have both dangers and advantages. In many cases, the more young a lady is, the lower the danger is. While ladies are taking birth control pills, they have more chances of falling prey to breast cancer as per various medical studies. This danger leaves rapidly in the wake of stopping the pill. The danger of stroke and heart attack is increased while on the pill, especially if the woman smokes. Long term use can likewise have essential advantages, such as bringing down the danger of ovarian cancer, colon tumor and uterine cancer and undesirable pregnancy. In case you are exceptionally worried about breast cancer, staying away from birth control pills is also an alternative to lower the risk. If you wish to discuss about any specific problem, you can consult an oncologist and ask a free question.
3959 people found this helpful

I am 19 years old and I am having lower back pain (disc herniation l4-l5. I suffer pain everyday. What shall I do?

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Kindly show me a photograph of the affected part. Rule out diabetes & vit. D deficiency or any other metabolic disorder. Sleep on a hard bed with soft bedding on it. Spring beds, folding beds or thick matress are harmful use no pillow under the head. Do hot fomantation. Paracetamol 250mg od & sos x 5days. Caldikind plus 1tab od x10. Do neck, back & general exercises. It may have to be further investigated. You will need other supportive medicines also. Make sure you are not allergic to any of the medicines you are going to take. If it does not give relief in 4-5days, contact me again. Do not ignore. It could be beginning of a serious problem.
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I have back pain L4. L5 problem fast in 5 years. I want to reduce pain with out operation is possible. Please Inform

M.Ch, DNB (Orthopedics), MBBS
Orthopedist, Mohali
You should do a proper regime of medicaton and Exercises for 3 months. the kind of exercises depend on your x-ray and mri reports. Only of this fails completely then we think of other measures like injections to the spine, surgery etc. the basic principle of spine therapy is minimal intervention.
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Hi doctor. I have a severe backache as per Dr. Advice I have done mri. My mri report is as under kindly advise in matter degenerative lumber spondylitis are seen in the form of marginal osteophytes and multilevel disc dessication. 1. D12-l1 & l1-l2 discs show mild bulge, indenting anterior thecal sac without significant never root compression 2. L2-l3 disc reveals right paracentral disc extrusion, indenting anterior thecal sac and causing right lateral recess narrowing, impinging on right traversing l3 nerve root. 3. L3-l4 disc shows mild diffuse disc protrusion, indenting anterior thecal sac and causing bilateral mild neural foraminal narrowing, minimally abutting bilateraltraversing l4 nerve roots. 4. L4-l5 disc reveals mild diffuse disc protrusion, indenting anterior thecal sac and causing bilateral mild neural foraminal narrowing, minimally abutting right existing l4 nerve root-bilateral traversing l5 nerve roots. Nerve roots. Cord is seen ending at d11 vertebral level. Distal cord and conus appear normal. Both hip and si joints are normal. No pre / paravertebral, epidural soft tissue or haematoma is seen. Bilateral psoas and posterior paraspinous muscles are normal. Please advise for home exercise / medicine.?

Bachelor of Physiotherapist
Physiotherapist, Noida
Sir you should back strengthening and stretching exercise. It will relax and strengthen or back muscles. If you personally want to consult me Please consult privately.
1 person found this helpful
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I have slip disc l4, l5 Should I avoid carrying weights. More over what are the exercise I must follow?

MBBS, MS, DNB, FNB (SPINE SURGERY)
Orthopedist, Chennai
Hi. You should avoid forward bending activities, especially while lifting weights. Learn spinal and core strengthening exercises from a physiotherapist and do them regularly. You should also learn about proper posture and follow it during daily routine activities.
1 person found this helpful

Please tell me what can I do in slip disk problem please explain preventive & treatment methods without using drugs because I need not anymore drugs because I already taken lots of drugs.

Fellowship of the Royal College of Surgeons (FRCS), Membership of the Royal College of Surgeons (MRCS)
Orthopedist, Trichy
you have to avoid lifting heavy weight and doing strenuous activities. Core muscle strengthening exercises helps. weight reduction is necessary.
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An Overview Of Bone Cancer

MD - Oncology
Oncologist, Hubli-Dharwad
An Overview Of Bone Cancer

Bone cancer is a cancerous tumour in the bone, destroying the normal bone tissues. Tumours on bone tissues are not always cancerous or malignant, they are mostly benign. Primary bone cancer is when the malignant tumour begins to form in the tissues of the bones, but when these cancerous cells spread to other body parts like breasts, prostate or lungs, it is called metastatic cancer. Primary bone cancer is less common than metastatic cancer.

Bone cancer can be of three different types:

  1. Osteosarcoma: In this case, the malignant tumour arises from the osteoid bone tissue. This occurs mainly in the upper arm and knee areas.

  2. Chondrosarcoma: In this case the cancerous cells form in the cartilaginous tissues, causing a lot of pain. This occurs mostly in the pelvic area.

  3. The Ewing sarcoma generally arises in the bone but it can also form in the soft tissues. Other kinds of soft tissues affecting cancerous cells are known as soft tissue sarcomas.

Causes-

There aren’t many clear defined causes; however, several factors have been identified by researchers.

  1. Osteosarcoma is seen to occur more frequently in people who have been through a high external radiation therapy dose.

  2. In people who have frequently been treated with anticancer medications, children tend to be most affected.

  3. Heredity may be an adding cause, although the percentage of hereditary transfer of cancer cells is very low.

  4. People with hereditary bone defects or implants have a higher chance of acquiring bone cancer.

Symptoms-

The most common and saddening symptom of bone cancer is painful, although not all bone cancers cause pain. Unusual or persistent swelling or pain around a bone maybe a red flag for bone cancer. In case of a situation like this, immediate doctor’s opinion is required.

Diagnosis-

Usually, diagnosis of a bone cancer can be made using X-rays; for example, a bone scan, a computed tomography scan, a magnetic imaging procedure—positron emission tomography, and an angiogram. Biopsy and blood tests are also helpful in bone cancer diagnosis.

Treatment-

The size, location and stage of cancer, age, and health of the person decide the kind of treatment that should be given to the patient. Various treatment options include chemotherapy, radiation therapy and cryosurgery.

Survival-

The combined survival rate of all sorts of bone cancers is 70%. This percentage may vary with the type of bone cancer and also its stage.

14 people found this helpful

This is my Mri report impression. Disc degeneration and disc bulge is seen at L5/S 1 level indenting the thecal Sac without any nerve root compression. Annulus tear is noted. 2 this r my x ray report impression. Pid L5. S 1.

FRHS, Ph.D Neuro , MPT - Neurology Physiotherapy, D.Sp.Med, DPHM (Health Management ), BPTh/BPT
Physiotherapist, Chennai
Do Take Physiotherapy treatment of IFT and vacuum Therapy Physiotherapy treatment for pain relief for 12 days followed by strengthening exercise from physiotherapist Best wishes.
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I have back pain before 3 years. I have checked MRI test in hospital that result show the mild disc dics bulge noted at L4 and L5 level intending the thecal sac without neurological compression. Doctor has given pain relief tablets but no get relaxation. Please give me solution.

DNB (Orthopedics), MS - Orthopaedics, MBBS
Orthopedist, Bhopal
Your mri is normal as mild disc bulge is inconsequential. You better start some lower back muscle strengthening exercise (available on internet or visit a physio)
1 person found this helpful
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Herniated disk l3-14 mm L4-11 mm L5-10 mm S1-8 mm My age 23 /M Dr. suggest for surgery but I didn't want that any chances for normal.

MBBS, MD (Anaesthesiology)
Pain Management Specialist, Varanasi
It seems that you are having multiple disc herniation. I cannot comment unless I see you MRI but definitely you having at least two slipped disc at L4/5 & L5/S1. These days non surgical treatment are available like TFSI, Disc Fix and Percutaneous Endoscopic Lumbar Discectomy (PLED) done under Local anaesthesia, no blood loss, no stich required, patient walks within next few days. We will provide you detailed information if you wish or you may see on website. I may need your blood inv. Like TLC/DLC/ESR/CRP/HLA B-27 before giving further opinion.
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