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A pacemaker for the spinal cord?

The Kashmir Monitor

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By Dr Amithabh Gupta

Spinal cord has pathways (called tracts) that carry pain signals from any part of the body (neck and below) and a relatively new and exciting technology opens up possibilities of controlling pain that may be impossible to control with other means. Uncontrolled pain drastically impairs the quality of life, and this technology offers a ray of hope to the worst affected people.

Among the common pain syndromes that can be effectively treated using this technology, is pain arising from Brachial plexus injury, which common results from road traffic accidents wherein one of the arms stops working due to a severe stretch injury to the nerves as they pass into the arm. Sadly, this condition involves young people, and although specialized nerve surgery may alleviate the loss of movement, severe unremitting pain can devastate the quality of life.

 

Good news for the people suffering untreatable back pain. Sometimes medications may not be fruitful in relieving the spinal pain be it injections, topical or oral pain medications. In extreme cases a neurosurgeon has to decide to take up for surgery after which, in 5-10% cases a chronic back and leg pain persists post surgery and the patient may not get permanent relief from pain, sometimes even after multiple surgeries.

This is called as “failed back syndrome” or “Post-laminectomy syndrome” and commonly results from either excessive inflammation or scar tissue around the nerves, despite adequate surgery. Other pain syndromes, such as complex regional pain syndromes are also good indications for this procedure.

Fortunately, there is a ‘New technology’ developed that can override back pain-‘Pacemaker for the spinal cord’. When a patient has exhausted all the therapies, medications or surgeries, this device reduces the chronic back pain by manipulating the nerve pathways.

What is a pacemaker for spinal cord?

Just as a pacemaker can regulate the contraction of the heart muscle and provides a mechanism for a normal rhythm, a pacemaker for spine can be the last resort for those who suffer from back pains that can disrupt their daily functioning.

The device is implanted under the skin, and when the electrode is put over the spinal cord, electrical impulses are generated that neutralize the pain impulses, thus overriding the pain. This mechanism works over the principle known as ‘Gate control theory of pain.’

Mechanism – Gate Control Theory

This theory says that the non-painful impulses close the gates to the painful input that prevent the painful sensation to travel from periphery to the central nervous system (from spinal cord to the brain) that can suppress the pain. When a tissue is injured or damaged, it is not that easy for the pain signals to reach the brain.

These signals have to pass through ‘gates’ at the spinal cord level known as the ‘Neurological gates’ which decides whether or not to allow these signals to the brain. The nerve fibres can be classified into 3 categories namely- A, B, and C fibres. The A types are further classified into A-alpha, A-beta, A-gamma, and A-delta.

Out of which A-delta and C fibers carry the pain signals to the spinal cord. In the back of the spinal cord, in the Dorsal horn, a specialized area called the Substantia Gelatinosa where these nerves communicate and carry the impulses to the spinal cord. These impulses can be reduced by other interneurons by the release of Morphine-like chemical called ‘Enkephalins’.

How does ‘new tech’ feel?

Based on this principle, an electronic device is implanted under the skin and electrodes are placed in the spinal cord space called as the ‘epidural space. Electrical impulses are generated with high frequency with a few milliamperes current that blocks the pain signals from travelling through the spinal cord to the brain.

The implantation doesn’t require any major surgery, except a sterile room for operating. And usually it is done in two steps: (i) trial implant, (ii) permanent implant. It is important to know how well the patient reacts to the stimulation before getting it permanent. A temporary implantation is done which is connected to an external stimulator and are programmed to cover the painful areas and to find out the following:

Helps the patient decide whether this therapy is effective for the level, type, location and the severity of pain.

As it has various stimulation settings and programs, the effectiveness with patient body is also checked.

Depending on the type and level of relief- immediate or with time, the type of system to be implanted like the conventional, or the rechargeable can be decided.

If this process is pain relieving, the second step is followed, with the permanent implantation. One or more leads are inserted depending upon the pain in the exact location using a small needle or an incision. It can be implanted in any comfort zone of your choice but commonly and preferably embedded in the lower abdomen on one side.

(Writer is HOD, Neurosurgery, Batra Hospital, New Delhi)

Dr Amithabh Gupta


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Health

Hepatitis A Causes and Symptoms

The Kashmir Monitor

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Generally speaking, hepatitis A is more common in parts of the planet that are developing. It’s for the fact that sanitation and food handling practices are by and large poor. However, medical experts say that living in developed countries can also put you at risk of having hepatitis A, but it’s really a rare occurrence.

Just like what’s mentioned earlier, hepatitis A is caused by the hepatitis A virus or HAV. It can be spread around by someone who has hepatitis A because he or she is a carrier of the virus behind it. It is said that a person with hepatitis A is most infectious about 2 weeks before he or she begins to experience signs and symptoms.

Here are some of the ways that hepatitis A is spread around:

 

Consumption of food that is prepared by a person who has hepatitis A. This is most especially true if he or she has not properly washed his or her hands.

Drinking of water that is contaminated with the hepatitis A virus.

Intake of raw or undercooked seafood obtained from contaminated water.

Close contact with someone who has hepatitis A. This includes having sexual intercourse with an infected person, especially when the rectal or anal area has been touched with the fingers, mouth or tongue.

Using illegal drugs, especially when paraphernalia contaminated with the hepatitis A virus are used.

Symptoms

Medical experts say that it may take a while before the various signs and symptoms associated with hepatitis A show up. They say that someone may experience them about 4 weeks after getting infected. It’s even possible for someone with hepatitis A to not experience any sign and symptom at all.

Some of the initial signs and symptoms of hepatitis A include:

Tiredness and malaise
Achy muscles and joints
Pain in the upper right section of the abdomen
Loss of appetite
Mild fever
Headaches
Sore throat
Diarrhea or constipation
Hives or raised rash that’s itchy

These initial signs and symptoms associated with hepatitis A can last anywhere from a few days only to a couple of weeks. Afterwards, as the infection of the liver progresses, the following may be experienced by the individual:

Jaundice, which is the yellowing of the skin as well as the whites of the eyes (sclera)

Pale colored stools
Dark colored urine
Skin itching

Tenderness and swelling of the upper right section of the abdomen

Although it rarely happens, hepatitis A can cause liver failure. When such develops, the person who is infected may experience severe vomiting, frequent bruising, bleeding of the nose and gums, drowsiness and confusion.

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Health

Busting myths around blood donation

The Kashmir Monitor

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As per the World Health Organisation (WHO) norms, ideally, one per cent of the total population should regularly donate blood to meet the requirements, which is anywhere between 1% and 3% of country’s population that would require blood in a year.

Contrary to the myth about blood donations making a person weak or anaemic, the body replenishes the lost blood in a matter of a few days, say experts.

“A healthy bone marrow makes a constant supply of red cells, plasma and platelets, so there is no question of becoming weak, much less anaemic. It is a myth and should not deter people from donating blood,” says Dr RK Singal, chairman, internal medicine department, BLK super-speciality Hospital.

 

The donors can give either whole blood or specific blood components, as there is sophisticated equipment available these days that extract relevant components from blood and the rest of the blood can be transfused back to the donor.

As per the World Health Organisation (WHO) norms, ideally, one per cent of the total population should regularly donate blood to meet the requirements, which is anywhere between 1% and 3% of country’s population that would require blood in a year.

About 65% of India’s population is young and if this section donates blood regularly, chances of the country facing blood shortage will be remote. Hence, there is all the more reason for people, especially youngsters, to come forward and be regular blood donors.

How to prepare

Have enough fruit juice and water in the night and morning before you donate

Have a full meal 3 hours before donation; never on an empty stomach

Have some rest for about 10-15 minutes after donation

Have some snacks or a juice with high sugar content after donation

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Health

Erectile dysfunction’s connection with lifestyle

The Kashmir Monitor

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By Dr Anjani Kumar Agrawal

healthy-lifestyle-can-reverse-effects-of-hypertensionAll over the world, but perhaps more so in India, men are embarrassed to admit that they may have a problem getting or keeping an erection — a condition known as erectile dysfunction (ED).

All over the world, but perhaps more so in India, men are embarrassed to admit that they may have a problem getting or keeping an erection — a condition known as erectile dysfunction (ED). From my research, I have found a strong link between ED and stress. Other major causes include smoking, drinking, diabetes, hypertension or high blood pressure and cholesterol levels. My advice to these patients is — do not get even more stressed over this situation. Instead, focus on taking the right medication and making some changes to your lifestyle, so you can once again enjoy a satisfactory sexual life.

 

DIAGNOSIS OF ED

We normally diagnose ED and its underlying causes by asking the patient a few questions about his medical and sexual history. This is sometimes done by sharing a questionnaire with the patient. The questions that we ask are designed to help us understand the cause of ED in the particular patient.

We also do a physical exam, ask for certain blood tests to rule out other medical conditions responsible for erectile dysfunction, and recommend imaging tests (if required) to determine whether the person is physically able to have an erection or not.

SHORT-TERM SOLUTION, LONG-TERM CURE

Underlying medical conditions such as diabetes, hypertension and hypercholesterolaemia (high cholesterol levels) can cause ED. In these cases, ED can be reversed once the patient starts treatment.

In my experience, many men suffer from ED because of work stress, family pressure and anxiety. So, changes in lifestyle with regular exercise, yoga, abstaining from alcohol and smoking, and proper counselling help in treating ED. Along with this, medicines for ED are usually prescribed for about 3 to 6 months by which time lifestyle changes start to take effect and the patient is physically and mentally healthier, which helps resolve the problem.

An estimated 16% to 25% of men experience ED at some point in their lives. I would urge them not to be embarrassed about it. Seek medical help from a urologist or andrologist; get the necessary advice/medication; and go on to enjoy a healthy, fulfilling sexual life.

The author of this article is Dr Anjani Kumar Agrawal, head, andrology, department of urology sciences, Max Smart Super Speciality Hospital, Saket

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