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| Sunday, 23 May 2004 |
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Features |  |
| News Business Features Editorial
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Holistic healing
Q. I understand that you have introduced a new technique to treat patients with aches and pains in different parts of the body. Could you tell us what this therapy involves? A. Orthopaedic Manual Treatment or IMT is a gentle treatment of the vertebrae to which most pain related problems in the body are connected . Q.How did it originate? A.It was originally called the DO Q. As a manual therapy, some people seem to think it is like Chiropractic. Is this so? A. No. It is different because my treatment is very gentle. there are no sudden jerks and harsh movements of the limbs, and no "crack" associated with chiropractice. Q. Does it involve drugs or medication that may have side effects? A. No. It is completely natural and free of any side effects. Q. What role does the vertebrae of the spine play in this kind of treatment?
Q. So what does this treatment involve? A. OMT involves first checking the alignment of all the vertebrae of the spine and other joints. When a patient comes to us, we first check to see if there is any difference in his leg lengths. Usually one leg is bound to be longer than the other in an adult, even though your legs are of equal lengths when you are born. Q.Why? A. Constant driving, sitting with your legs crossed and bad posture. This condition is called subluxation in the hip joint which give rise to various related pain such as for example, sciatica. Q. How can your treatment relieve such pain? A. By very simple exercises which a patient can do at home for a period of six months. These exercises take only about two minutes to do each day. Q. Why are these exercises so important? A. Because the ligaments are still loose and it is only by constant exercise that they will get back to their normal alignment. Q. Tell us what a patient has to undergo if he comes to you say, with a neck pain or back pain? A. First of all I have a thorough consultation with him/her. I ask the patient where he works and most importantly under what conditions he works e.g. does he work in an air conditioned room? Or under a fan? Is his chair too short for him? If he or she is at a computer or type writer, how does he/she sit? I need correct answers to these questions to trace the root cause. It is often related to the nerves. Q. How? A. It can be a referred pain caused by a nerve trap between the vertebrae. Nerves can give problems either from two strong muscles pressing on the nerves. A body builder who complains of a referred pain in his arms or legs can have not only vertebrae problems but muscles problems as well. So adjustment of the vertebrae can help remove these problems. Q. What's the next line of treatment? A. Consultation is followed by manual checking to see if there is any difference in leg lengths, and palpation of the whole spine for any subluxations. When and where necessary. I adjust these problems with very gentle therapy. Sometimes ultra sound and /or soft tissue massage is included in the treatment. Q. Is this safe? A. It is more safe than any other kind of manipulative therapy due to its gentle approach. Q. For what kind of problem can it be used ? A. For back and neck problems like a stiff neck (torticullis), cervical spondiolosis, headaches, lumbago, sciatica, referred pains in the arms of legs, shoulder pain, "frozen shoulder", a feeling of numbness in the fingers, sporting injuries, knee pain and other muscular related problems. Q. You said that these exercises can be done at home. Mention one. A. Lie on the bed and start with the longer leg after the doctor has checked you out. Lift the leg up slightly near the hip joint and pull it up towards the shoulder slowly lowering it down to the bed again. Repeat this four times every day. You can use a hand towel to help you. Q. What happens when you do this exercise? A. What actually happens is that we are putting the joint back into its original place by pulling it up towards the shoulder. Q. Are there any complications as a result of doing these exercises? A. Contraindications are minimal. If necessary I get an X-ray of the `pain' spot, before and after treatment. Q. Can patients with osteoporosis benefit from this therapy? A. If the patient has advanced osteoporosis I don't try to treat him. But if it is not an advanced case, I use Soft Manual Treatment. I must emphasise that this treatment will not make the condition go away, but will relieve any referred pain in the back, neck or leg. The same applies for cervical spondiolosis. With a slight adjustment we can make neck movement easier. Q. What about scoliosis? A. If it is a growing child, we may be able to cure him of this condition with slight manipulation. However, if there is no improvement after 2-3 treatments I ask his parents to switch to another treatment. Q. do you give the same advice to all your patients? A. Yes. Many of my patients come to me after having undergone various treatments before. But I tell them, if they do not improve after a couple of treatments , they should try some other method. I don't believe in giving prolonged treatment if it is not effective. It would be a waste of time and money for the patient. Q. What has been your success rate so far? A. Very good. This is a holistic approach and so most patients go away satisfied with the results ************ Beware! Your pet can bring you death Rabies is a viral infection of the central nervous system, transmitted usually by contamination of a wound with saliva from a rabid animal. It is a worldwide public health problem and because of its virtually 100 per cent mortality, a source of considerable terror for both exposed patients and their physicians. Reader Upul Priyantha Ratnayaka, a nursing officer discusses how the infection is caused and steps to prevent fatal consequences.
Scratches by the claws of rabid animals are dangerous because animals lick their claws. the dog is the most important vector of rabies for people throughout the world. Transmission How the rabies virus travels from the wound to the brain is only partially understood. Since the virus attaches to and penetrates cells rapidly in vitro, it is inconceivable that is a remains dormant in the wound for long period and time. Although the virus has been shown to ascend axons from the periphery to the spinal cord and prompt nerve section does save an animal from rabies, the speed of spread (3 millimeter/hour) is far too rapid to explain the long incubation period of the disease. Once rabies virus enters the brain the clinical symptoms of rabies appear. The basic lesion of the brain in rabies is neuronal destruction in the brain stem and medulla. The cerebral cortex is usually normal in the absence of prolonged anoxia before death. The hippocampus, thalamus and basal ganglia often show neuronal destruction and glair infiltrates. the most severe pathology is in the pons and the floor of the 4th ventricle in brain. A proposed explanation for the inspiratory muscle spasms that result in the striking symptom of hydrophobia is that the virus destroys brain stem neurons inhibitory to the neurons of the nucleus ambigus which control inspiration. Transmission of rabies virus spreads down nerves from the brain. It multiplies in many organs but those important to transmission are the salivary glands. Not all rabid animals have virus in the saliva and even when present the quantity is variable. The variability of virus in saliva explains the fact that only about half of bites by proven rabid animals will result in rabies even if untreated. The incubation period of rabies is extremely variable. Exceptionally long incubation period of two years have been seen. On the other hand, an incubation period of only 7-9 days has followed severe exposure. The great majority of cases have an incubation period of 20 to 180 days. The length is related to the site of the bite shortest for bites on the head, longest for bites on the leg. Symptoms There is usually a prodromal phase of rabies lasting 2 to 10 days. Common nonspecific symptoms include fever, malaise, headache, anorexia and vomiting. The patient may be troubled by ill-defined anxiety. The illness then enters an acute neurologic phase either of the furious or paralytic variety. In the former hydrophobia is a pathognomonic sign. Attempts to swallow liquids, including saliva, result in spasms of the pharynx and larynx and aspiration in to the trachea. Eventually a psychologic component exacerbates the spasms and even the sight of water evokes terror. Aerophobia (excitation to air flow) may be present. Aerophobia is elicited by fanning a current of air across the face, which causes violent spasms of the pharyngeal and neck muscles. Also hyper activity, disorientation, abnormal behaviours and horrifying aspects of rabies can be seen patient may also complain of pharyngeal pain, difficult in swallowing and hoarseness seizures (Fits) are common. at the acute stage, he or she slips into coma and dies of sheer exhaustion and dehydration. Invariably death is due to extensive paralysis of the body together with respiratory failure. The prognosis of rabies in very poor. The mortality percentage is 100 per cent. Medical Research Institute of Sri Lanka is the only place laboratory testing for the detection and confirmation of rabies virus infection. In the dog, symptoms may be considered under two general types although it is not possible to separate them completely. The "Furious" type result from increased excitation of the central nervous system with fever hyperthesia and lack of appetite. In the final stage if the dog is freed, it will run for miles, snapping at or biting all living things in its path until it falls paralyzed to the ground. The dog's owners rarely recognize the "dumb" or paralytic type, despite its frequency primarily because no agitation or excitement is seen. the course is far more rapid, paralysis occurring in any group of muscles, but particularly in the lower jaw and in the muscles of deglutition. In such cases the tongue hangs out of the mouth, continuously dripping saliva, suspecting a foreign body in the dog's throat may expose their hands to the infective saliva in an effort to relieve the dog. Prevention of rabies is the most important part of this disease. Pre exposure prophylaxis of rabies is the 1st line of prevention. Vaccination of domestic dogs and elimination of strays has resulted in eradication of terrestrial rabies from many areas. those who are expected to be at risk such as veterinarians and laboratory workers, dog catchers and employees in animal quarantine premises or zoo etc.... can be preimmunized with anti rabies vaccine given on 0, 7, 28 days by intramuscularly or deep subcutaneous injection. It is necessary to check serum antibodies after the last dose. A liter of 0.3 IU has been accepted as protective, although some observation suggests the need for a higher titer for them. The saliva of all animals carry tetanus germ, hence after a bite it is mandatory to immunize all bite victims against Tetanus with tetanus toxin. The post exposure prophylaxis depend on 3 complementary procedures as local treatments, passive antibody administration and active immunization. The chief requirement of local treatment is that it be prompt and thorough. Simple mechanical removal by soap and water should be the first step using copious amount of solution. Wounds should be washed in running water from a wound allowing tap or bucket loads of water poured to the wound allowing the wound to bleed freely along with the water. Puncture wounds should be irrigated well by syringe or catheter. The mechanical removal of virus should be followed by application of virucidal solution such as 1 percent povidone iodine or 70 percent alcohol. (Victims exposed to Rabies have been saved by this simple procedure alone) Passive antibody is available in Sri Lanka as Equine Rabies Immunoglobulin (ARS) this anti rabies serum should be infiltrated subcutaneous at the site of bite; the remainder is injected intramuscularly in to thigh or buttocks at our government hospital with trained staff. Active immunization vaccines (ARV) used since 1950. Normally its schedule which has been used in Sri Lanka consist of 6 doses (lml intramuscularly) at 0, 3, 7, 14, 30, 90 days. Other schedules of active immunization can be given intradermally (under the skin) as 2 site schedule on 30th and 90th day or 8 site schedule on day 0(1st day) with 4 site schedule on 7th day with one site schedule on 30th and 90th day according to risk and exposed amount of bites. These vaccines reaction rates have been low (about 0.1 percent). Therefore no neurological reaction have been noted. At present tissue culture vaccines are imported for post exposure prophylaxis of rabies. It is safe and effective but very expensive. In year 2001 Sri Lanka government expenditure was Rs 126 million for ARV and Rs 45 million for equine rabies immunoglobulin therapy. Therefore year 2002 Sri Lanka rabies control committee suggests the following guidelines for prevention and control of rabies in Sri Lanka. They suggested that fish, reptiles, amphibians and home rat bite, scratch without a skin break by claws of a dog or cat, consumption of boiled milk or curd from an animal with or suspected of having rabies, licks on intact skin by a rabid animal or an animal(pet) which has received at least two injections of rabies vaccine etc. were not necessary for post exposure treatment. According to that suggestion they categorized the exposure as follows: Severe exposures(eg.one or more bites on head, face or neck, front, back of chest, hands, finger tips of toes or genitalia, licks on the mucous membrane, single deep bites and multiple bites more than 2 tooth mark) Minor exposures (eg.single superficial bites or scratches on leg, arm, trunk, nibbling without break in skin and drinking of raw milk from a rabid cow or goat) High-risk group (eg.Jackals, bandicoots mongoose, polecats, monkeys, rock squirrels and civet cats or animals which cannot be identified or observed (stray dogs), non immune animals and animal whose behaviour pattern has changed in the previous two weeks who die within the following 2 weeks) Low risk group (eg.Domestic vaccinated non immune animals bites due to provocation of a vaccinated animal known fierce animal etc.) As such, they suggested severe and minor exposure groups as well as high and low risk groups for treating rabies. According to that severe exposed, high risk category animal bites need specific rabies immunoglobulin and anti rabies vaccine after first aid wound care and tetanus prophylaxis. As well as severe exposure, low risk category animal bites also need that schedule. But treatment can be discontinued if the animal healthy 14 days after the bite. Minor exposed high-risk (with out wild animal bite) category animal bites can only given anti rabies vaccine. For minor expose low risk category animal bites no specific treatment is immediately required when observing the animal for 14 days or animal head diagnosed from medical research institute for rabies. Rabies once established is variably fatal. Apart from 4 cases worldwide there are no cases of any patients who have survived after clinical features appear. Some people in Sri Lanka believe that ayurvedha could prevent and cure rabies. This is a fallacy. Ayurvedha provides no cure what so ever for rabies. The rabies is 100 percent fatal and the tragedy is, the patient is fully conscious almost to the last stages where mercifully coma sets in. A rabies death in a hospital is a tragedy. Doctors, nurses and all the other allied health staff watch helplessly a young adult or a child dies of rabies. All they can do is to give symptomatic relief like painkillers and anti convulsions. Therefore health authorities should make use of the radio, TV and print media and regularly stress the fact that rabies has no cure but only resorting to western medicine promptly could prevent it. ************ Methods of healing Complementary treatments are rapidly gaining popularity among people long accustomed to traditional medicine. following are some complementary treatments for Anxiety. Anxiety is and emotional state ranging from mild unease to intense fear. Normal in certain situations, it can become so intense as to interfere with daily life. Symptoms include irritability, sleeplessness, lack of concentration, fatigue and depression. Conventional treatments:Drugs, psychotherapy, counselling exercise. Complementary treatments: Massage. To relieve muscle tension and reduce stress. Aromatherapy. Calming aromas are thought to relieve anxiety. Therapeutic touch. Studies have shown this modern laying on of hands reduces anxiety in hospital patients. Naturopathy. Diet will be checked to stabilise blood sugar levels low levels are associated with panic attacks and depression. Homeopathy. Standard remedies include gelsemium, arsenium album and phosphorus. Hypnotherapy. Thought to be effective against hyperventilation and nausea. Meditation. Studies have shown it can reduce anxiety. Relaxation and breathing. May release muscle tension. |
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| Editorial | Security Produced by Lake House |
DR HANS MATER , A Dutch orthopaedic Manual Therapist at the Apollo
Hospital Colombo, talks to CAROL ALOYSIUS about a new method of treating
pain related problems.
RN therapy named after Dieter
Dorn from Germany, who developed it thirty five years ago.Thereafter
several doctors from Austria and Germany changed the treatment slightly. I
myself have modified the treatment and changed the name to Orthopaedic
Manual Therapy while lecturing at the International College of Natural
Medicine in Spain.
A. It is usually when one or more vertebrae of the spine are
"subluxated" meaning "out of alignment", that it can
causes aches and pains in different parts of the body. Hence alignment of
the vertebrae plays an important role in my treatment.
Rabies is a widespread infection of warm blooded animals. the principal
vectors for humans are skunk, foxes, raccoons, dogs, cats, bats and other
rabid wild animals. In Sri Lanka there are four animals that primarily
cause rabies. They are: 1. Dogs (97% of the cases), 2. Cats (2% of the
cases), 3. Mongoose, 4. The Jackal. Eighty per cent of infecting dogs are
stray dogs.
