What is a Herniated Disc

[Extracted from ABOUT.COM]

Many patients with back pain, leg pain, or weakness of the lower extremity muscles are diagnosed with a herniated disc. When a disc herniation occurs, the cushion that sits between the spinal vertebra is pushed outside its normal position. A herniated disc would not be a problem if it weren't for the spinal nerves that are very close to the edge of these spinal discs.

What is the spinal disc ?

The spinal disc is a soft cushion that sits between each vertabrae of the spine. This spinal disc becomes more rigid with age. In a young individual, the disc is soft and elastic, but like so many other structures in the body, the disc gradually looses its elasticity and is more vulnerable to injury. In fact, even in individuals as young as 30, MRIs show evidence of disc deterioration in about 30% of people.

What happens with a 'herniated disc' ?

As the spinal disc becomes less elastic, it can rupture. When the disc ruptures, a portion of the spinal disc pushes outside its normal boundary--this is called a herniated disc. When a herniated disc bulges out from between the vertebrae, the spinal nerves and spinal cord can become pinched. There is normally a little extra space around the spinal cord and spinal nerves, but if enough of the herniated disc is pushed out of place, then these structures may be compressed.



What causes symptoms of a herniated disc ?

When the herniated disc ruptures and pushes out, the nerves may become pinched. A herniated disc may occur suddenly in an event such as a fall or an accident, or may occur gradually with repetitive straining of the spine. Often people who experience a herniated disc already have spinal stenosis, a problem that causes narrowing of the space around the spinal cord and spinal nerves. When a herniated disc occurs, the space for the nerves is further diminished, and irritation of the nerve results.

What are the symptoms of a herniated disc ?

When the spinal cord or spinal nerves become compressed, they don't work properly. This means that abnormal signals may get passed from the compressed nerves, or signals may not get passed at all. Common symptoms of a herniated disc include :


a) Electric Shock Pain
Pressure on the nerve can cause abnormal sensations, commonly experienced as electric shock pains. When the compression occurs in the cervical (neck) region, the shocks go down your arms, when the compression is in the lumbar (low back) region, the shocks go down your legs.

b) Tingling & Numbness
Patients often have abnormal sensations such as tingling, numbness, or pins and needles. These symptoms may be experienced in the same region as painful electric shock sensations.

c) Muscle Weakness
Because of the nerve irritation, signals from the brain may be interrupted causing muscle weakness. Nerve irritation can also be tested by examining reflexes.

d) Bowel or Bladder Problems
These symptoms are important because it may be a sign of cauda equina syndrome, a possible condition resulting from a herniated disc. This is a medical emergency, and your should see your doctor immediately if you have problems urinating, having bowel movements, or if you have numbness around your genitals.

All of these symptoms are due to the irritation of the nerve from the herniated disc. By interfering with the pathway by which signals are sent from your brain out to your extremities and back to the brain, all of these symptoms can be caused by a herniated disc pressing against the nerves.

How is the diagnosis of a herniated disc made ?

Most often, your physician can make the diagnosis of a herniated disc by physical examination. By testing sensation, muscle strength, and reflexes, your physician can often establish the diagnosis of a herniated disc.

An MRI is commonly used to aid in making the diagnosis of a herniated disc. It is very important that patients understand that the MRI is only useful when used in conjunction with examination findings. It is normal for a MRI of the lumbar spine to have abnormalities, especially as people age. Patients in their 20s may begin to have signs of disc wear, and this type of wear would be expected on MRIs of patients in their 40s and 50s. This is the reason that your physician may not be concerned with some MRI findings noted by the radiologist.

Making the diagnosis of a herniated disc, and coming up with a treatment plan depends on the symptoms experienced by the patient, the physical examination findings, and the x-ray and MRI results. Only once this information is put together can a reasonable treatment plan be considered.

Treatment of a herniated disc depends on a number of factors including :

* Symptoms experienced by the patient
* Age of the patient
* Activity level of the patient
* Presence of worsening symptoms

Most often, treatments of a herniated disc begin conservatively, and become more aggressive if the symptoms persist. After diagnosing a herniated disc, treatment usually begins with :

1) Rest & Activity Modification
The first treatment is to rest and avoid activities that aggravate your symptoms. Many disc herniations will resolve is given time. In these cases, it is important to avoid activities that aggravate your symptoms.

2) Ice & Heat Applications
Ice and heat application can be extremely helpful in relieving the painful symptoms of a disc herniation. By helping to relax the muscles of the back, ice and heat applications can relieve muscle spasm and provide significant pain relief.

3) Physical Therapy
Physical therapy and lumbar stabilization exercises do not directly affect the herniated disc, but they can stabilize the lumbar spine muscles. This has an effect of decreasing the load experienced by the disc and vertebrae. Stronger, well balanced muscles help control the lumbar spine and minimize the risk or injury to the nerves and the disc.

4) Anti-Inflammatory Medications
Nonsteroidal anti-inflammatory medications (NSAIDs) are commonly prescribed, and often help relieve the pain associated with a disc herniation. By reducing inflammation, these medications can relieve some pressure on the compressed nerves. NSAIDs should be used under your doctor's supervision.

5) Oral Steroid Medications
Oral steroid medications can be very helpful in episodes of an acute (sudden) disc herniation. Medications used include Prednisone and Medrol. Like NSAIDs, these powerful anti-inflammatory medications reduce inflammation around the compressed nerves, thereby relieving symptoms.

6) Other Medications
Other medications often used include narcotic pain medications and muscle relaxers. Narcotic pain medications are useful for severe, short-term pain management. Unfortunately, these medication can make you drowsy and can be addictive. It is important to use these for only brief periods of time. Muscle relaxers are used to treat spasm of spinal muscles often seen with disc herniations. Often the muscle spasm is worse than the pain from the disc pressing on the nerves.

7) Epidural Steroid Injections
Injections of cortisone can be administered directly in the area of nerve compression. Like oral anti-inflammatory medications, the idea is to relieve the compression on the nerves. When the injection is used, the medication is delivered to the area of the disc herniation, rather than being taken orally and travelling throughout your body.

Is surgery necessary in the treatment of a disc herniation ?
As mentioned, treatment of a disc herniation usually begins with the steps listed above. However, surgical treatment of a herniated disc may be recommended soon after the injury if there is a significant neurological deficit to your problem. Symptoms on pain and sensory abnormalities usually do not require immediate intervention, but patients who have significant weakness, any evidence of cauda equina syndrome, or a rapidly progressing problem may require more prompt surgical treatment.

Most often surgery is recommended if more conservative measures do not relieve your symptoms. Surgery is performed to remove the herniated disc, and free up space around the compressed nerve. Depending on the size and location of the herniated disc, and associated problems (such as spinal stenosis, arthritis, etc.), the surgery can be done by several techniques. In very straightforward cases, endoscopic or microscopic excision of the herniated disc may be possible. However, this is not always recommended, and in some cases, a more significant surgery may need to be performed.

Lumbar Discectomy

A discectomy is a surgery done to remove a herniated disc from the spinal canal. When a disc herniation occurs, a fragment of the normal spinal disc is dislodged. This fragment may press against the spinal cord or the nerves that surround the spinal cord. This pressure causes the symptoms that are characteristic of herniated discs.

The surgical treatment of a herniated disc is to remove the fragment of spinal disc that is causing the pressure on the nerve. This procedure is called a discectomy. The traditional surgery is called an open discectomy. An open discectomy is a procedure where the surgeon uses a small incision and looks at the actual herniated disc in order to remove the disc and relieve the pressure on the nerve.

How is a discectomy performed ?

A discectomy is performed under general anesthesia. The procedure takes about an hour, depending on the extent of the disc herniation, the size of the patient, and other factors. A discectomy is done with the patient lying face down, and the back pointing upwards.

In order to remove the fragment of herniated disc, your surgeon will make an incision over the center of your back. The incision is usually about 3 centimeters in length. Your surgeon then carefully dissects the muscles away from the bone of your spine. Using special instruments, your surgeon removes a small amount of bone and ligament from the back of the spine. This part of the procedure is called a laminotomy.

Once this bone and ligament is removed, your surgeon can see, and protect, the spinal nerves. Once the disc herniation is found, the herniated disc fragment is removed. Depending on the appearance and the condition of the remaining disc, more disc fragments may be removed in hopes of avoiding another fragment of disc from herniating in the future. Once the disc has been cleaned out from the area around the nerves, the incision is closed and a bandage is applied.

What is the recovery from a discectomy ?

Patients often awaken from surgery with complete resolution of their leg pain; however, it is not unusual for these symptoms to take several weeks to slowly dissipate. Pain around the incision is common, but usually well controlled with oral pain medications. Patients often spend one night in the hospital, but are usually then discharged the following day. A lumbar corset brace may help with some symptoms of pain, but is not necessary in all cases.

Gentle activities are encouraged after surgery, such as sitting upright and walking. Patients must avoid lifting heavy objects, and should try not to bend or twist the back excessively. Patients should avoid strenuous activity or exercise until cleared by their doctor.

What are the potential complications of a discectomy ?

The most common problem of a discectomy is that there is a chance that another fragment of disc will herniate and cause similar symptoms down the road. This is a so-called recurrent disc herniation, and the risk of this occurring is about 10-15%.

Most patients find relief of much, if not all, of their symptoms from a discectomy. However, the success of the procedure is about 85-90%, meaning that 10% of patients who undergo a discectomy will still have persistent symptoms. Patients who have symptoms for long periods of time, or severe neurologic deficits (such as significant weakness) are at higher risk of incomplete recovery.

Other risks of surgery include spinal fluid leaks, bleeding, and infection. All of these can usually be treated, but may require a longer hospitalization or additional surgery.

What is endoscopic microdiscectomy ?

Newer techniques may allow your surgeon to perform a procedure called an endoscopic discectomy. In an endoscopic discectomy your surgeon uses special instruments and a camera to remove the herniated disc through very small incisions.

The endoscopic microdiscectomy is a procedure that accomplishes the same goal as a traditional open discectomy, removing the herniated disc, but uses a smaller incision. Instead of actually looking at the herniated disc fragment and removing it, your surgeon uses a small camera to find the fragment and special instruments to remove it. The procedure may not require general anesthesia, and is done through a smaller incision with less tissue dissection. Your surgeon uses x-ray and the camera to "see" where the disc herniation is, and special instruments to remove the fragment.

Endoscopic microdiscectomy is appropriate in some specific situations, but not in all. Many patients are better served with a traditional open discectomy. While the idea of a faster recovery is nice, it is more important that the surgery is properly performed. Therefore, if open discectomy is more appropriate in your situation, then the endoscopic procedure should not be done. Discuss with your doctor if endoscopic microdiscectomy may be appropriate for you.

How Much Stretch is Enough

by Baxter

Reclined Leg Stretch

Last week I looked at the concept of “compression” both as a perceivable event in your body and as a potential problem for your body when doing asana (see Tension Versus Compression). After that post, one of our readers requested information about the other sensation producer, muscle tension, and the usually desirable event that occurs when we do asana, stretching in the muscle.

In the vast majority of our yoga classes in the US, we are continually asked to notice the sensations arising from the various yoga asana as we perform them. We are encouraged to find our “edge,” a place or perception of muscle stretch before which we don’t feel much, and beyond which we feel too much or begin to encounter pain. We are led to believe that stretching our tight muscles is highly desirable, but often are not clearly told where the “finish line” of this process might be. So how much stretch is the right amount? How much is too much? And how can we tell the difference? I have an opinion on all of these questions, but I took a look around to see if there was any objective evidence that might give more credence to my opinions.

The first interesting article I came across was How Necessary is Stretching? a New York Times article from 2009. Here Gretchen Reynolds reported on at some new information about stretching that had just been discovered. One study looked at a group of runners at a university in Nebraska. Researchers measured the runners' hamstring flexibility, then compared hamstring flexibility to a measure of their success as runners (known as “running economy”). They found that runners with tighter hamstrings were actually faster and stronger runners. Reynolds noted that, “In fact, the latest science suggests that extremely loose muscles and tendons are generally unnecessary (unless you aspire to join a gymnastics squad), may be undesirable and are, for the most part, unachievable, anyway.” She went on to quote a sports medicine expert:

“To a large degree, flexibility is genetic,” says Dr. Malachy McHugh, the director of research for the Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in New York and an expert on flexibility. You’re born stretchy or not. “Some small portion” of each person’s flexibility “is adaptable,” McHugh adds, “but it takes a long time and a lot of work to get even that small adaptation…””

This made me consider what purpose my yoga “stretching” was for. I tend to think that stretching is going to give me more success and less discomfort in performing my asana. The above article did mention one benefit of a regular stretching of the muscles. If done regularly, even if the length of your muscle does not change much, your perception of the intensity of the stretch sensation diminishes. In other words, you don’t feel so tight anymore. So stretching regularly will make your asana more comfortable, and if you are practicing asana to prepare for seated meditation or pranayama, you will also find it easier to sit comfortably on the floor.

For healthy aging, stretching is important for maintaining flexibility as you age. Without regular stretching, your muscles will become stiffer, potentially interfering with your ability to go about the normal activities of daily life, including dressing yourself, driving, walking unassisted and even getting in and out of a chair (see Transferring and Yoga), and can impact your ability to balance. For all these reasons, stretching is very beneficial for you whether or not your muscles actually become more flexible.

Before I go much further with that train of thought, let’s look at what else I found. When a muscle is stretched, it not just the muscle cells themselves that do the elongating, but also the connective tissue or fascia that surrounds and penetrates each muscle of the body. Where the muscle has pretty amazing ability to elongate and contract and change size dramatically, the ability of the fascia is more limited, even when it contains some elastic cells. And when the connective tissue is over-stretched, it can lose its supportive properties for the muscles and lead to increased chance of the muscle itself getting micro-tears that heal more slowly. In addition to the fascia, the other connective tissues, such as the tendons that attach the muscle to bone, are more vulnerable to injury as well.

So, I think common sense regarding stretching muscles is to work up to a point discomfort, but not into frank pain. Try to get the sense of stretch in the center of a long muscle and try to avoid sensation closer to its bony attachment at (or near) the joint.  On occasion, you will know you have overdone it by the sudden quality of pain that accompanies your stretch, but often you won’t know until the next day, when inflammation sets in and the pain is there more persistently. Shoot for taking your stretches slowly and mindfully, keeping your personal goals in mind as you work in your poses.

And as Paul Ingraham points out in The Unstretchables: Eleven Major Muscles You Can’t Stretch, No Matter How Hard You Try, some muscles aren’t actually stretchable the way muscles like the hamstrings—which are quite literally made for stretching—are. I know there are a lot of thoughts on this topic out there, so feel free to add your insights here. I believe in our collective wisdom!

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What is Progeria Premature Aging

After watching a short video presentation by Jeremy Kyle (a famous British Talk Show), I was indeed sadly moved after knowing the real situation, faced by 02 special patients, who are suffering from this extraordinary rare sickness.

It was known that there are only 02 such patients (unfortunately, they were both girls) in the United Kingdom and only around 45 of them, in the whole entire world.

Jeremy was kind enough to bring the 02 patients together for the 01st time and I can imagine how the 02 parents felt when they had such rare opportunity to meet with each other and undoubtedly, I can also see the teary eyes of all the audience too.

In this extreme rare, severe and genetic condition, it is said that all the internal organs of such a person, will age 08 years in advance within a year. When the 02 girls appeared in this show, they were just 05 years old, BUT their bodies are already 40 years old. So far, record shows that such victims will only live up to around 13 years of their own age. Their death is often due to Heart Attack, or Stroke.

It is hoped that a 'cure' can be made possible one day, by the Medical Field.

What is meant by a Ruptured Spleen

[Extracted from MayoClinic.Com]

A ruptured spleen is a serious condition that can occur when your spleen experiences a trauma. Without emergency treatment, a ruptured spleen can cause life-threatening bleeding.

Your spleen is located just under your rib cage on your left side, a prime spot for injury. With enough force, a blow to your abdomen — during a sporting mishap, a fist fight or a car accident, for example — might lead to a ruptured spleen.

In the past, ruptured spleens usually were removed in emergency surgery. These days, however, it's common for people with ruptured spleens to be treated instead with several days of hospital care to help the spleen heal.

The spleen helps your body fight infection and filter unwanted material, such as old or damaged blood cells. The spleen also produces red blood cells and certain types of white blood cells. A ruptured spleen may pour a large amount of blood into your abdominal cavity.

Abdominal pain and tenderness are the classic symptoms of a ruptured spleen. If internal bleeding causes your blood pressure to drop, you may become lightheaded or confused. Blurred vision and fainting are possible as well.



When to see a doctor ?

A ruptured spleen is a medical emergency. If you have pain in the left upper abdomen or signs and symptoms of low blood pressure — such as lightheadedness, confusion, blurred vision or fainting — following an injury, seek emergency medical care.
A ruptured spleen is typically caused by a blow to the left upper abdomen or the left lower chest. Sporting mishaps, fist fights and car accidents are common triggers. An injured spleen may rupture soon after the abdominal trauma or, in some cases, days or even weeks after the injury.

An enlarged spleen — which may be caused by various underlying problems, from mononucleosis and other infections to liver disease and blood cancers — may sometimes rupture with trauma to the abdomen. In fact, a ruptured spleen is the most significant complication of mononucleosis.

A ruptured spleen can cause life-threatening bleeding into your abdominal cavity.

In a critical situation, a physical exam may be the only diagnostic test before emergency surgery. In other cases, a sample of fluid from your abdomen may be tested for the presence of blood. If time allows, your doctor may use CT scans or other imaging tests to identify or rule out other possible causes of your symptoms.

Many small and many moderate-sized injuries to the spleen can heal without surgery. You're likely to stay in the hospital for up to a week while doctors observe your condition and provide nonsurgical care, such as blood transfusions, if necessary. If your injury is severe, your spleen may need to be surgically repaired or, in some cases, removed. Surgery to remove your spleen is called splenectomy.

Many splenectomies are done with a small incision and a slender tube equipped with a camera lens and light (laparoscope), but emergency surgery may require an open procedure. If you've lost a large amount of blood, you may need transfusions to improve your circulation.

Life without a spleen

You can live an active life without a spleen, but you're more likely to contract serious or even life-threatening infections. If your spleen is removed, your doctor may recommend a pneumonia vaccine, as well as yearly flu vaccines. In some cases, preventive antibiotics may be recommended as well — especially if you have any other conditions that increase your risk of serious infections.

After a splenectomy, notify your doctor at the first sign of an infection. Make sure anyone caring for you knows that you've had your spleen removed.