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| Sunday, 2 February 2003 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius Low back pain Low backache can strike anyone at anytime. It is one of the commonest ailments especially among people between 30-50 years. Sampath Nanayakkara its causes and management. Low Back Pain (LBP) can affect anybody, no matter what their occupation is. Most sufferers of LBP have not injured their back suddenly, but due to repeated stress on their spine over many years. Some impacts may resolve even without pain. Repeated injuries ultimately add up causing degeneration of the parts of the spine. Most of the LBPs are work-related. Manual workers are more prone to it than the white collar workers. Agriculture, construction work, mining and transport are a few examples. Causes Very severe sudden onset of back pain may occur by strain of the spine and surrounding tissues by lifting of a heavy object, a fall, a violent jerk (sudden braking of a car), fall of a heavy object on the spine. Not so severe slow onset back pains may occur in: (a) Wrong posture - This is one of the commonest causes. e.g. Watching TV slumped in the couch, long hours of sitting on chairs in the wrong posture. (b) Age - Obviously wear and tear will cause degenerative changes in the discs between two vertebral bones of the spine and arthritis-type changes in the surrounding joints. (c) Slipped disc - A vertebral bone slips forwards on the lower one. (d) Osteoporosis - Decrease amount of bone material causing loss of bone strength particularly in postmenopausal women. (e) Stress and mental tension - Also could present as backache in a few. Treatment Treatment of LBP ranges from simple reassurance to surgery. Treatment should be individualized to meet the circumstances. Some of the methods include - exercise, drugs, physical therapy. i.e. Heat, Cold-wave therapy. The treatment always has two goals: (1) To relieve the immediate problem (2) To reduce the risk of reinjuring in the future. Most of the cases of LBP can be effectively treated. A brief period of rest of the back may be helpful, but absolute bed rest may reduce the speed of the heating process. Therefore light activity with support is recommended. Low Back Pain can strike at anytime. Therefore be prepared to manage it. How to ease backache . Sleep on a firm mattress. . Adjust your working table and chair to a comfortable height. . Bend the knees, not the back when lifting. . Sit on an upright chair and use a rolled towel as a back support. Re-position the buttocks frequently from time to time. . When you have to keep on standing for a long period (i.e. kitchen work), do so with one leg raised on a box. . Some activities can be helpful in maintaining the tone of your muscles while reducing the possibility of further injury. Swimming and walking are recommended. Some activity can cause problems if done before symptoms are gone, i.e. tennis, golf, bowling, diving and high impact aerobics. Common causes Vertebral misalignment can be present at birth, occur acutely following a impact or other trauma to the back, or develop gradually with advancing arthritics. Compression of the neural route is the usual cause of pain. Characteristics manifestations: Lower back pain, Sciatica. A) Compression of nerve. Disc disorders Degeneration, herniation, prolapse, rupture Spinal disc, made of cartilage, serve as cushion between the spinal vertebrae. Any breakdown of these disc can cause them to bulge or 'slip'. Pain results when the disc bulges backward, compressing a nerve route or the spinal cord. Damage can be caused by arthritides, infection or trauma. Characteristic manifestations: Lower back pain, spondylosis, sciatica, progressive muscle weakness in the legs and feet. A) Herniated disc, B) Nucleus pulposusa, C) Annulus fibrosus, D) Compression of nerve. Vertebral disorders Abnormal bone growth, degenerations, fracture, inflammation, osteophyte growth The bony vertebrae are vulnerable to any number of conditions that can cause pain. Abnormal tissue growth and bony bulges called osteophytes can protrude into the spinal canal, compressing a nerve route of the spinal code. The canal can also be narrowed by abnormal bone growth, as occur in Paget's disease. Arthritic conditions, both inflammatory (ankylosing spondylitis) and degenerative (osteoarthritis) can cause destructive changes in the bone and cartilage of the spine. Spinal fractures can be caused by trauma or as an effect of the long-term reduction in bonemass caused by osteoporosis. Characteristics manifestations: Chronic lower back pain, spinal stenosis, spondylitis, spondylosis, sciatica, progressive muscle weakness, loss of height. A) Osteophyte, B) Loss of bone, C) Fracture, D) Disc degeneration, E) Articular cartilage degeneration, F) Compression of nerve, G) Osteoarthritic changes of joint. Soft tissue injury Back sprain and back strain Stress to the muscle (Strain) or to ligaments (Sprain) is the most common cause of short-term back pain. The stress can be cause by any number of factors, including exercise repetitive activities of daily living, sudden movement or trauma. Characteristics manifestations: Acute lower back pain, localised muscle weakness. A) Vertebral body, B) Intervertebraldisc, C) Supraspinal ligament, D) Anterior longitudinal ligament, E) Interspinal ligament, F) Muscle. ################# Keeping AIDS at bay AIDS is on the increase in Sri Lanka. Since the transmission of AIDS is connected to the lifestyle and living habits of people. AIDS can be prevented in the following ways, says Dr. W. W. S. W. C. Fernando. 1. Have only one sexual partner. Note: Those conducting these campaigns should guarantee confidentiality, provide counselling and support, and discourage stigma against infected people. They should also provide rehabilitation services to patients with HIV/AIDS. ################# Periodontal diseases by Dr. (Mrs) I. Ratnayaka Dental Surgeon Epidemiologial investigation of periodontal disease started in 1912 and is still continuing. The following article discusses the causes and effects of this gum disease that affects 80 per cent of the population in Sri Lanka. The periodontal membrane surrounds the root of the tooth and keeps the root and tooth bound to the bone surrounding the root. It forms the important anchorage to the surrounding tissues of the root and therefore the tooth. Destruction of the periodontal membrane, whatever the cause, will therefore result in loose teeth and its sequelae. The periodontal membrane is made up of minute fibres with a blood circulation and nerve supply. The fibres of this membrane at the neck (where the root meets the crown) of the tooth are attached to the gingiva (gum). When this gingival attachment is affected it breaks down, resulting in a gap between the root and bone immediately near the crown (that part of the tooth seen inside the mouth). This gap or pocket is a breeding ground for bacteria which then invade the periodontal membrane resulting in inflammation of the membrane (periodontitis) and further destruction. The tooth soon looses its anchorage. The products of periodontal membrane destruction results in an abscess leading to greater mobility and extensive forms of treatment. Gingivitis (inflammation of the gum) is often the cause of periodontal disease. In this condition the gums become reddish in colour and may cause itching or discomfort. The gingiva may be inflamed (swollen) and tender, and there may even be an exudate (fluid). The mucous membrane (lining) may become oedematous (swollen) and petichae (pin point bleeding) may be evident. Gingivitis results most commonly from neglected oral hygiene. Food debris clings round the teeth and plaque/calculus (hard deposit with time) results with bacteria multiplying in these areas. The consequent irritation on the gums as a result of the bacterial toxins and the calculus/ plaque, causes the onset of gingivitis. Soft pappy food cling on to the teeth more easily. Irregular or unopposed teeth, poorly contoured tooth surfaces, abnormal occlusion, mouth breathing, systemic conditions such as blood dyscrasias, diabetes, nephritis, certain medications and hormonal changes contribute to gingivitis and periodontitis. Puberty, pregnancy and menopause are associated with gingivitis. In pregnancy the gingivitis passes off a few months after childbirth. Bleeding of the gums is a common complaint associated with periodontal disease. Bleeding is often associated with brushing, interdental cleaning, taste of blood in the mouth, or on biting hard food. The tooth may seem raised during contact with opposing teeth. Deep or unattended dental caries in a tooth results in periodontitis. Here the bacterial toxins and products of the carious process seep into the periodontal membrane through a breach caused either in the crown or root of the tooth. Periodontitis due to dental caries is far more common in this country than that caused by gingivitis and its sequelae. Studies have shown that a bacteremia (bacteria in blood) is present in 10 per cent of patients with chronic gingival and periodontal infection and after tooth extraction in these cases, there is a transient (temporary) bacteremia in 75 per cent of the cases. The organism being mainly streptococcus viridans, which has a predilection (preference) for heart valves. Depending on the causative factor, peroidontitis can be treated successfully. Periodontal disease is known to contribute to myocardial diseases. At the last annual sessions of the American Heart Association in New Orleans in November 2000, E.N. Deliargris and co-workers from the University of North Carolina, Chapel Hill has reported that there is reason to suspect a higher occurance of coronary heart disease among people with periodontal disease compared with those free from periodontal disease. According to William H. Welirmacher (M.D., F.A.C.P., F.A.C.C.) treatment of periodontal disease may become a novel strategy for secondary prevention among patients with coronary artery disease or surviving a acute myocardial infraction. ################# 'Beating heart surgery' - the safer option for heart patients Bypass heart surgery is relatively new to Sri Lanka. So are the techniques used for this type of surgery. The Sunday Observer last week interviewed Indian Cardiac Surgeon Dr A.G. Jayakrishna on 'Beating Heart Surgery' which was performed for the first time by him in 1999 at the Nawaloka Hospital. Dr Jayakrishna is presently a consultant cardiac surgeon at the Nawaloka Hospital. Q: Could you explain what "Beating Heat surgery" is? A: It is surgery on the heart done with the help of a stabilising device known as the 'Octopus', instead of the conventional heart lung Machine. Q: What does this device look like? And how does it operate? A: It is a small plastic suction tube with tentacles. It operates the same way an octopus does with tentacles. The tentacles of this plastic tube clings onto the surface of the heart during a bypass operation, allowing the blood to flow to the heart as well as the rest of the body during the operation. Q: What are the advantages of using this device for a bypass, instead of the convention heart lung machine ? A: There are several advantages for a heart patient. Firstly, there is no reason to stop the heart function while operating as one does in the case of the heart lung machine. Secondly, there is much less blood loss and subsequent replacement of such blood. Thirdly, the patient's recovery is much faster and he can thus leave hospital in a much shorter time. Q: Does that mean there are fewer post operative complications? A: Yes. There are hardly any after effects in this kind of surgery. Furthermore, any cerebral brain complications caused by stopping the heart when using the heart lung machine, are also significantly less. Faction. Furthermore, this procedure allows for bypassing any number of blocks unlike 'keyhole surgery' which is also now being used for bypass operations, to minimise complications. Q: Is it widely used in India? A: It was introduced in Holland about five years ago and no sooner we heard about it, a team of Indian doctors including myself was sent to Paris to be trained in its usage. I was the first to introduce it to Kerala where I work. Now almost 98 percent of my patients have their bypass using the 'Octopus' device. Q: Has the 'Octopus' begun replacing the conventional heart lung machine elsewhere in India as well? A: To some extent yes. Some doctors however still continue to use the conventional heart lung machine. Q: Why? A: Probably because using it requires special training and skill . However, 'Beating Heart Surgery' can easily be mastered by any cardiac surgeon who is already skilled in the conventional procedure. Q: You say the first 'Beating Heart Surgery' was performed at the Nawaloka in 1999. Since then, how many patients have you operated at this hospital using this technique? A: Around 300 I think. Q: Are they all doing well? A: Yes. Even the oldest who was 83 when I first operated on him and is now 86, is still going strong! I am so confident of this new procedure that we are now operating on high risk patients who have been refused surgery by doctors in other hospitals. Q: And their survival rates are...? A: Excellent, so far. Q: So your mission is.... A: To create more awareness among the Sri Lankan public about the Beating Heart procedure and to encourage more of your doctors to follow this procedure. Although it is already being done by some doctors, I would like to see more cardiac surgeons in this country following their example. Q: Have you a message for patients undergoing bypass surgery? A: Only to tell them that they need not have any fear about this procedure, because it is safer than the heart lung operation. I also want to reiterate the fact that while a bypass involves major surgery, the risks of undergoing such an operation have come down significantly because of recent technical and medical advances. I also wish to emphasise that bypass gives long lasting relief to a heart patient when compared to other forms of surgery like angio-plasty and stenting. It is also cost effective in the long run. - Carol Aloysius Needy patients who require a bypass can now write to the Nawaloka Hospital directly . The Hospital performs one free operation for a needy child once a month. Patients should be registered at this hospital and will be operated on a priority basis, says Mr P. Withanage, Manager, marketing division of the Nawaloka Hospital. ################# The truth about steroids The use of steroids by athletes as well as other persons is on the rise. But how many users know the risks that they carry or are aware of their real benefits. This article discusses... Steroids are our internal hormones viz terterterone, nandrolone, Dihydrotestesterone, thyroids insulin, growth hormone, IDF Seratanin, aldosterone and so forth. Athletes use steroids made in labs. These are synthetically made ones. So the real name for them is pseudo anabolic steroids. Anabolic, means muscles building Catabolic means the opposite Upto now there have been only a few registered incidents reported in the world with regard to deaths associated with the use of anabolic steroids. Most doctors however are not aware of the risks and benefits of steroids. Side effects In fact steroids cause a rise in blood proteins (haemoglobin) so it leads to a rapid flow of blood sometimes causing heart attacks or cardiovascular differences. But these things are reversible if the steroids is stopped or drugs used for the cure of hyperblood pressure. Steroids also cause baldness, (alopecia) acne, aggression water retention, fat retention, shrinkage of testicles (not the penis) and some other minor side effects depending on the athlete. But the above mentioned side-effects are all reversible. Baldness is due to the conversion of testesterone (Tes) to dihydrotestesterone (DHT). So once we use a drug to stop the conversion of tes to DHT baldness is stoppable. Males have testosterone, and that makes them bald with the conversion mentioned above. Females have a little amount of testosterone and that makes them far less vulnerable to baldness. Most steroids are made to cure maladies like impotence, sexual disfunctions, obeisity, low/high blood pressure, restrict blood glucose and many more. Taking steroids does not mean that you are going to have a muscular body. Being muscular depends largely on one's genes. Steroids are not addictive. They do not stimulate the sympathetic nervous system which controls one's addiction through brain and nerves. But when one loses some muscles owing to stopage of steroids then one may become addictive and continue to use them for the sake of physique. Steroids Nandrolone stays active in the body in adipose (fatty) tissues for many months. But it is harmless. The following are a sample of steroids (pseudo) in high use, with scientific (chemical) names. Insulin Insulin related drugs - metformin (glucophage) phenformin, Rezulin, prandin. Thyroid drugs for fat loss - Fat loss drugs - Cleubuterol, ephedrine, yohitube, salbutermol, cimeterol. Growth Hormones - H.G. Hormone, Catapresz, GH-RH, Insulin Growth factor. - Kelum Perera |
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