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Are You Getting Enough Calcium?

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Does a glass of milk really do a body good? When it comes to the conversation about calcium, absolutely. While your body naturally produces the mineral calcium, it doesn’t produce enough on its own and therefore requires you to intake dietary calcium to make up the difference.

What exactly does calcium do?

Calcium plays an important role in many critical body functions including:

  • Reinforcing structure and density of bones and teeth
  • Helping nerve cells communicate and send signals back to the brain
  • Aiding muscle contraction
  • Supporting the flow of blood through the body’s blood vessels
  • Stimulating release of vital hormones and enzymes

When you are not intaking enough calcium, your body actually starts to pull it out of your bones resulting in loss of bone density, also known as osteoporosis. Overtime, serious calcium deficiency can result in increased risk for bone fractures, convulsions, abnormal heart rhythms, and numbness or tingling in the fingers.

A 2014 analysis  of U.S. Census and National Health and Nutrition Examination Survey data found that over 50% of the U.S. adult population over 50 years of age had osteoporosis and low bone mass. Postmenopausal women especially experience greater bone loss and less calcium absorption due to biochemical changes in their bodies, like a reduced production of estrogen, which is believed to help the body more readily absorb calcium.

What does this mean for older adults? Low bone mass increases risk for bone fracture, diminishes overall strength, and increases risk for experiencing a fall. Ultimately, potential for mobility issues, which require aids like wheelchairs, quad canes, or walkers, grows as older adults experience bone loss and crippling injuries like hip fractures.

It’s not just older adults who aren’t getting enough calcium either, but evidence suggests that on average, many kids and younger adults don’t intake the daily recommended amount of calcium.

What are the recommendations for calcium intake?

The Office of Dietary Supplements under the National Institutes of Health shares a helpful breakdown of recommended daily values of calcium in milligrams by age:

  • Children 4 to 8 years of age should intake 1,000mg of calcium a day
  • Children 9 to 18 years of age should intake 1,300mg of calcium a day
  • Adults 19 – 50 (and men 51 to 70 years of age) should intake 1,000mg a day
  • Adult women 51 to 70 years of age should intake 1,200mg a day
  • And all adults over 71 should intake 1,200 mg a day

For special cases like infants to 3 year olds, smaller doses of 200 to 260mg of calcium a day are recommended. And for pregnant and breastfeeding women, 1,000 to 1,300mg of calcium a day is recommended depending on age.

How much calcium are you consuming a day?

Dairy foods, like milk, yogurt, and cheese are a common go-to source for calcium, while additional non-dairy foods like kale, broccoli, collard greens and fish with soft bones, like sardines and salmon, provide appreciable amounts of calcium too.

You may notice in the grocery store how some foods are “fortified” with calcium as well, like orange juice, cereals, breads, even tofu. It’s important to look at nutritional labels when prioritizing your calcium consumption.

Many adults take calcium supplements which are comprised of calcium carbonate or citrate. Their effectiveness can vary depending on how much you consume at a time, your level of stomach acid, and whether you eat food with the supplement. Recent research has indicated possible adverse effects from taking calcium supplements however.

The Journal of the American Heart Association reported in October 2016 that taking calcium in the form of supplements may increase the risk of plaque buildup on artery walls, potentially harming the heart and vascular system. A growing body of research reinforces the association of taking calcium supplements and developing cardiovascular disease, however, further studies are needed to substantiate the exact links of why and how this is happening.

The bottom line is that incorporating more calcium into your diet is an absolute must. And don’t forget your Vitamin D! Vitamin D increase calcium absorption and ensures young people reach peak strength and bone density by the time they are 30. Exercise and resistance training at any age stimulates the body to produce calcium and build up bone density too, so stay active!

5 Things You Should Avoid to Prevent Back Pain

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Back pain can be uncomfortable, annoying, and downright debilitating at times, and yet, it seems to be an everyday part of life. That simply doesn’t have to be the case. Avoiding these 5 things could help you successfully prevent back pain for good:

Inactivity

Rest, taking it easy, putting your feet up, binging Netflix . . . all of these ideas seem obvious for taking it easy on your back, especially if you have stiff or sore muscles, right? Wrong. Back pain is only exacerbated by inactivity because it diminishes blood flow to key tissues – blood flow which aids healing and carries vital nutrients to muscles, bones, tendons,
and ligaments.

Inactivity also shortens muscle length and makes muscles and joints stiffer and less limber, so when you do finally get around to exercising, stretching, or taking part in some physical activity, they’re more likely to strain and feel sore later. The American College of Physicians actually lists exercise and physical activity as a remedy for lower back pain in their updated 2017 clinical guidelines

Bad Posture

In addition to inactivity, working on a computer all day also promotes bad posture, which can lead to back pain. Slumping, slouching, rounding the shoulders, craning the neck, and hunching the back – all these body positions place added stress on internal joints and the spine, making
muscles strain and work harder to stabilize your body.

Forward Head Syndrome, or the condition where your neck and head lean forward past your shoulders, is typically applied to people who spend hours and hours each day staring down at a computer screen or other mobile device. Studies have shown that for every inch your head cranes past your shoulders, you’re applying 10 extra pounds of force down on your body from the pull of gravity. This pull tugs directly on your neck and back muscles, leading to inflammation and chronic pain down the line.

Awkward Movements

No, we’re not talking embarrassing dance moves, but awkward movements which twist and turn your body in ways it really shouldn’t. A good example of this is trying to pick up an item you dropped behind your bedroom dresser. You stoop and swivel your shoulder, crane your neck and extend your arm farther than it should really stretch, grasping for a tiny object you can’t even see. You feel a yank, pop, or pull and all of a sudden your neck and back muscles are crying for help.

Awkward body movements and positions like this can lead to muscle spasming, inflammation, pinched nerves, and lasting achiness. Humans are so inclined to think the easiest route for something is over-extending themselves, when truly taking the time to use proper form or finding an assist with a tool or handy device could save much pain and trouble down the line.

Bad Lifting Technique

Lifting heavy loads with improper form and technique is the ultimate recipe for back pain, especially lower back pain. Millions of people see their doctor each year for complaints about some type of back pain, but those who work in physical labor jobs like airport baggage handlers, movers, warehouse workers, and even nurses who are required to lift and move patients, have it the hardest. Wearing a lower back brace can help provide compression, support, and stabilization for someone doing heavy lifting each day, but nothing beats proper form and technique.

The Occupational Health and Safety Administration (OSHA) shares proper
lifting techniques and guidelines for workplace lifting including using machines, tools, and
devices when possible to add leverage or to do the lifting for you. They also recommend companies implement good lifting environments like having workers lift from their ‘power zone’ (mid-thigh to mid-chest) area and not straight off of the ground.

Skipping Warm-ups & Stretching

Going from 0 to 60 might be fun in a fast-moving sports car, but when it comes to working out, launching into a full-on session without warming up can take its toll. Dynamic warm-ups are active movements that help your muscles warm up by boosting your heart rate, increasing blood circulation, and stretching and loosening stiff joints and connective tissues. A dynamic warm-up before a game, weight lifting circuit, or workout may include plyometric jump squats, a brisk walk, burpees, or jumping jacks.

Stretching after a workout or training session also plays an important role in preventing sore back muscles. Your muscles are most pliable after you complete physical activity. Engaging in static stretching helps re-lengthen muscles, boost blood flow to flush out toxins and lactic acid, and reorganize jumbled muscle fibers to aid with healing and tissue repair.

Preventing back pain is possible and has a lot to do with what you avoid doing as much as what you choose to do. Avoiding inactivity, bad posture, heavy lifting, and more will play a significant role in keeping you active and pain-free.

How to Ease Foot Pain in 5 Steps

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Is foot pain disrupting your day to day activity? Or even worse, preventing you from staying active and exercising? The danger of foot pain is that it often goes undiagnosed but can have the greatest impact on lifestyle, affecting mobility and activity levels. With your health potentially on the line, don’t leave your foot pain unchecked. Check out these help tips and ideas:

Common Causes of Foot Pain

If your foot pain doesn’t resolve itself with rest or ice and heat therapy, it may be time to see a doctor or podiatrist for an expert evaluation. Your foot pain may be caused by:

Plantar Fasciitis – when the plantar fascia band of tissue that runs along the bottom of the foot from the heel to the toes becomes inflamed or incurs tiny tears, it can cause pain when walking or standing.

Ingrown Toenail – typically afflicting the big toe, an ingrown toenail occurs when the sides of the toenail are curved inward and grown into the skin instead of away from it. Ingrown toenails can result in painful inflammation, tenderness, and even infection.

Bunion or Bone Spur – unwanted bone growth, usually on the outside of the
big toe or pinky toe, develops from wearing narrow shoes over a long period of time, from general overuse and stress of the inner and outer foot joints, or even from arthritis of the foot.

Hammer Toe – often found on the second, third, and fourth toes, hammer toe is simply the permanent bending of the toe at the top joint, leaving the end of the toe facing down. Sometimes it can rub on footwear and become irritated with blisters, corns, or calluses.

Steps to Ease Foot Pain

Foot pain relief does not necessarily need to include medicinal avenues or invasive treatments.

Check out these natural and accessible foot pain remedies:

1) Foot Care

This one might sound simple, but few actually care for their feet quite like they should. Washing and drying feet thoroughly each day (don’t forget in between the toes!) is vital to removing unwanted contaminants and bacteria. Moisturizing daily as well helps to nourish skin, prevent
calluses from developing, and keep skin from drying out and cracking.

Regular foot massages can help break up scar tissue and even aid muscle repair in the feet after a long day at work or after a workout.

2) Exercise

Long, limber foot muscles and ligaments are less likely to strain or become injured with movement. Routine stretching and exercise boosts blood flow to the feet, stretches important muscle groups in the feet and legs, and strengthens connective tissues – even the tiny tendons in your toes. This can prevent conditions like Achilles tendinitis, plantar fasciitis, and
hammertoe as well as soothe pain associated with inflamed joints, or arthritis.

3) Wear Good Shoes

Investing in a solid pair of shoes is critical to aiding and preventing future foot pain. For athletes, shoes which fit and support your arch type and stabilize your ankle motion play a critical role in promoting good body mechanics. For seniors, shoes which fit well, but aren’t too snug, and have a smooth bottom to allow for safe, easy mobility are a must. For women, ditch the high heels. When you can, avoid heels as they narrow the forefoot, throw off hip stability, and can cause painful foot conditions like bunions, bone spurs, and arch pain.

4) Brace and Splint

Existing foot problems can make walking and exercising difficult, but like with some injuries, bracing, wrapping, splinting or wearing orthotic insoles can help. For example, an arch support which slides over the foot like a sleeve and sits in the arch can provide arch support to someone with flat feet. A plantar fasciitis wrap can provide compression to an inflamed and painful foot, or the best bunion splints can stabilize the big toe joint and prevent the bony growth from rubbing against footwear.

5) Cross Training

For athletes and avid gym members who are pained to miss out on routine training because of foot pain, cross training may be a viable alternative. Largely referred to as the learning of an additional role or sport to enhance performance in the original, cross training can also be employed during recovery from a lower extremity injury. Runners suffering from painful plantar fasciitis or metatarsalgia may benefit from body weight exercises, walking on a treadmill, or riding stationary bicycles.

With one quarter of all your body’s bones in them, your feet make up some of the most important components of your body. Ignoring foot pain now can lead to much bigger health problems down the line. Consult a doctor and find routes for treatment and pain relief that are accessible, practical, and effective.

Ice Therapy – How Does It Work?

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You sprain your ankle or pull your back – what’s the most common
recommendation you’ll get from a friend or family remember? “Put some ice
on it,” right? You might be curious how ice therapy works exactly and if it
is really beneficial for treating acute injuries.

Part of the ‘RICE’ treatment – rest, ice, compression, and elevation – ice
therapy might include applying an ice pack or other cold compress,
receiving ice massage, or soaking an injured body part in an ice bath.

There are best practices when it comes to applying ice packs to avoid ice burn and further injury, but when administered correctly, ice can be a powerful tool to relieve acute pain and swelling.

How Does Ice Reduce Pain?

The cold sensation of an ice pack applied to the skin for 10 to 20 minutes actually has a somewhat analgesic effect. It slows the conductivity of sensitive nerve impulses around the injured area which are sending pain signals back to the brain, essentially providing a numbing effect and preventing nerve-spasming.

How Does Ice Reduce Swelling?

Ice therapy generates a cold shock to the area of application which makes the veins in the tissue constrict, reducing blood circulation and therefore inflammation of the injured area. This can also prevent tissue damage.

After the ice is removed, blood flows back in carrying oxygen and nutrients vital to tissue repair and wound healing.

How Should Ice Be Applied?

A handful of misconceptions about ice therapy may actually cause more harm than benefit when it comes to aiding a painful injury. Ice and ice packs should never be applied directly to skin, but rather some sort of barrier like clothing, a towel, or a soft cover over the ice pack should be used in conjunction with the cold therapy.

Ice packs should not be left on an injured area for more than 10 to 20 minutes at a time, and should be reapplied up to three times a day. Only after swelling has subsided 48 to 72 hours later should heat therapy be considered.

Ice massage may also be a cold therapy alternative that soothes sore back muscles and provides pain relief typically to the lumbar spine region. Ice massage involves taking an extra large ice cube and moving it around the lower back area in a circular motion for no more than 5 minutes at a time.

Because ice massage involves constantly moving the ice and only doing it
for a limited amount of minutes, you avoid ice burn even though you are
applying the ice directly to the skin. Your body can handle ice massage up
to five times a day.

Ice baths, or cold water immersion, are popular with athletes and runners after an exhausting performance because they cover more surface area of the body with cold thus restricting blood vessels, inflammation, and reducing metabolic activity on a greater number of muscle groups. When you exit an ice bath, the underlying tissues begin to warm up and blood flow back to the area increases quickly, flushing out metabolic debris and speeding up tissue repair. Experts recommend ice bathing in water between 50 and 59 degrees Fahrenheit and soaking for no more than 10 or 20 minutes at a time.

What Are Common Types of Ice Packs?

Most drug stores and big box stores carry ‘reusable’ ice packs which can be frozen, used, and refrozen. Typically comprised of a synthetic gel material in a flexible or hard plastic casing, reusable ice packs are inexpensive and effective. Alternately, one-time use, or disposable, ice packs may be room temperature to start and become cold through a chemical reaction of the compounds inside them when shaken or broken. Great for having on hand when playing sports, disposable ice packs are convenient, but considerably more expensive and not as eco-friendly.

Experiencing a leg injury and don’t have a reusable ice pack for knee or ankle pain handy? There are plenty of common household items you can use for ice therapy to treat a painful injury like an ankle sprain. Grab a bag of frozen vegetables out of the freezer, freeze a wet towel or sponge, or even fill a resealable baggy with dish detergent and freeze it to make your
own faux gel pack.

Ice therapy can be a beneficial instrument in the injury and post-athletic play toolkit. By following expert best practices and committing to routine treatment with ice packs, ice massage, or cold baths, speeding up your body’s healing capabilities may be just an ice cube away.

Brain ‘Wonder Drug’ May Save Dementia Patients

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Dementia Alzheimer's Disease

Mention Alzheimer’s disease, Parkinson’s disease, and prion disease and many experts will tell you that these are health conditions that have kept researchers scratching their heads in search of effective treatment without success.

About five years ago, there was excitement when a test drug proved that it could reverse brain cells degeneration in rats with prion disease.

Prion disease is characterized by many misfolded proteins and the disease affects humans in nearly the same way. While the drug proved helpful in the rats, it turned out to be toxic to humans with cases of toxicity to the pancreas being reported. Needless to say the clinical trials of the drug were stopped.

New excitement

There is renewed excitement after scientists in the UK announced that they have found drugs that can prevent or arrest Alzheimer’s and Parkinson’s disease among other neurodegenerative disorders such as prion disease and the dreaded ‘mad cow disease’ (CJD)

The news about this were published in the respected Brain – A Journal of Neurology of April 19 2017 (online version)

These drugs are not entirely new. They have been in use for the management of other medical conditions and the research results suggest that they could be repurposed to fight the brain disorders. The first drug trazodone hydrochloride has been in use as an antidepressant and anxiolytic medication. The other dibenzoylmethane (DBM) has been mainly been intended for use in cancer (prostate and bowel) treatment.

A recent report by the PubMed Health noted that the two drugs were effective in:

  • Memory restoration
  • Reducing neurodegeneration signs and symptoms. This includes brain shrinkage which is a typical feature in these conditions.
  • Reduced associated paralysis
  • Not showing toxicity effects in the doses used

According to this source, the trial of trazodone on human beings could start almost immediately because issues about its safety have already been settled in its use for the emotional disorders mentioned above. Probably the focus would now be on the effective and safe doses of the medication for the purpose of the neurodegenerative disorders.

Although there is optimism about trazodone, marketing it for neurodegenerative disorders might take a while. It will involve the many stages it needs to go through in human clinical trials before it is approved for that purpose. The fact that such clinical trials have not even began suggests that it take time before it hits the market. The reality is that, such trials may not even go beyond the initial steps depending on initial findings.

For dibenzoylmethane (DBM), the journey to the market as a drug for neurodegenerative disorder is much longer and uncertain since it is still under review as a cancer drug.

One of the leading authors of the study, Professor Giovanna Malluci urged that clinical trials should commence to find out whether the same results would be achieved on human trials. She however, cautioned the public and other stakeholders against rushing to use the drugs until the studies offer reliable findings (on human subjects)

Why are scientists and the medical fraternity excited about this?

Neurodegeneration disorders present a challenging medical and social situation. Consider these:

  • The disorders affect both aspects of the central nervous system – the brain and the spinal cord.
  • Neural tissue in these areas is gradually lost
  • The disorders insidiously destroys decision making ability and coordination
  • The damaged nervous tissue and cells cannot be regenerated easily and so the damage is usually irreversible.

The future

Many experts agree that the study was well-conducted and inspires hope. Dr. Doug Brown of the Alzheimer’s Society in the UK said that the results of the research had potential and the time between the release of the findings and the drug’s availability in pharmacies can be greatly reduced (for trazodone).

Dr. David Dexter (Parkinson’s UK) said that a replication of the findings in human beings would be a ‘major step forward’ in the treatment of the degenerative neurological disorders.
According to Professor Malluci, efforts should now be focused on finding out whether using trazodone can help in arresting or slowing down the progression of the brain and spinal cord cells disorders. Either of these outcomes would be a major step in making the disorders easier to live with.

References
Mark Halliday, Helois Radford, Karlijn A. M. Zents, Collin Molloy, Julie A. Moreno, Nicholas C. Verity, Ewan Smith, Catharine A. Ortori, David A. Barrett, Martin Bushell, Giovanna R. Mallucci; Repurposed drugs targeting eIF2α-P-mediated translational repression prevent neurodegeneration in mice. Brain 2017 awx074. doi: 10.1093/brain/awx074

Do Sciatica Exercises Work?

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Sciatica ExercisesSciatica is a condition that can grossly affect a person’s quality of life (QOL). Depending on what is causing the problem, almost 90% of cases will improve without the need for surgery. 50% of patients will recover within six weeks. Exercises play an important role in the efforts of alleviating pain without resorting to surgery.

Sciatica Exercises can be done at home or in a health institution. In both situations the guidelines of a physical therapist are a must so that you do them right and safely. Surgical intervention is the last resort when every other measure has failed. But do these exercises work? What types of sciatica exercises are employed?

Types of sciatica exercises

A physical therapist will most likely design an exercise program that fits an individual’s circumstances. Common sciatica exercises can include:

  • Knee to chest stretch
  • Sciatica mobilization stretch
  • Back extension
  • Pilates
  • Standing hamstring stretch
  • Aerobics
  • Lying deep gluteal stretch
  • Trigger point massage. Strictly speaking this is not a form of exercise but it involves pressure that helps to release piriformis muscle impinged sciatic nerve
  • Yoga. This may combine exercises and meditation

A physical therapist may also prescribe other types of exercises for general back health.

What research has established about sciatica exercises

One of the risk factors for sciatica is a sedentary lifestyle. This means back and other muscles in the body become weak and lax. Exercises are known to strengthen muscles and so when done correctly; they can strengthen the spine muscles which in turn reduce the risks of factors that promote chances of sciatica.

A combination of muscle strengthening exercises and high intensity exercise programs can help you to achieve this.

Yoga

Yoga involves ancient forms of exercises that strengthens specific muscles and improve balance and flexibility. According to the Yoga Journal, specific yoga exercises and poses can help you to loosen up tight muscles and reduce back pain (including sciatica pain).

This works well if the proper exercise sequence is followed. Working with a yoga instructor in the initial stages is important until the exercises, poses and sequence has been mastered. The journal further specifies that the lotus pose and reclining big toe pose are the best for sciatica management.

The International Journal of Yoga of January 2015 published a study that found that Iyengar yoga can be an effective practice that can help to reduce back pain. Study subjects who did these yoga exercises for sixteen weeks had a 64% improvement rate.

Pilates and sciatica

A study published in the Maturitas – The European Menopause Journal of December 2015 found that women aged over 65 who went through a six week program improved their chronic back pain among other balance related benefits. While this study may not have been specifically targeted at sciatica patients, it suggests that sciatica as a cause of back pain may also benefit from Pilates.

Tentative study results repeatedly indicate that exercises are beneficial for sciatica pain. However, there is a general consensus that there is need for more research involving many sciatica patients so that more conclusive results can be achieved.  While exercises are beneficial not only for the back and sciatica but the whole body and overall health, it is important to do them correctly to avoid more health problems including an exacerbation of sciatica pain.

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Understanding Sciatica

Understanding Sciatica – An Overview

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What is sciatica?

The word sciatica comes from sciatic which refers to the largest nerve in the body that runs from the lower back at the level of the lumbar vertebra 3. It is about 2cm wide. It starts from the lumbosacral plexus and goes down to exit the pelvis through the greater sciatic foramen.

The sciatic nerve branches into two to supply each of the limbs. Some of the areas the nerve offer motor functions include:

  • Posterior compartment of the thigh muscles that include biceps femoris
  • Calf muscles through the tibial nerve
  • Inner and outer sides of the leg through the fibular nerve

The sensory functions of the nerve are indirect through its end-point branches.

The area that the sciatic nerve supplies is where symptoms occur when the nerve has issues.

One of the commonest problems that can occur with this nerve is sciatica. This term is used in reference to a collection of symptoms that affect the leg and does not refer to a specific diagnosis.

A more technical name for sciatica is radiculopathy

In most cases, sciatica does not affect both branches running down the legs but only one side. The pain can be severe and activity limiting but in most cases it resolves on its own after a few weeks. When the symptoms are severe, medical or surgical intervention may be necessary.

Symptoms of sciatica

The symptoms relate to the path the nerve takes. Common ones include:

  • Lower back pains
  • Pain that radiates down the hip, buttock and down the leg
  • Tingling or numbness of the affected limb
  • Leg weakness and in severe cases, walking is difficult or impossible

The nature of the pain varies. For some people it feels like an electric shock while for others it can be mild and dull. Common actions that may exacerbate sciatica pain include:

  • Sitting for long
  • Standing for long
  • Coughing
  • Sneezing
  • Sleeping

Severe types of sciatica can cause disturbance in the bladder and bowel habits. This can either be retention or incontinence. When this happens, it is considered a surgical emergency that must be managed without any delay.

How do you differentiate sciatica from other types of back pain?

According to the American chiropractic association – ACA, at any one time, there are 31 million Americans suffering from some type of back pain. Obviously not all these people have sciatica.

The main difference that separate sciatica from other causes of back pain is the associated properties of the pain. The pain in sciatica runs down the leg to the foot while that of common back pain does not.

Sciatica also usually occurs suddenly without any apparent cause while with other types of back pain; there may be a history of straining or overextending the back.

What causes sciatica?

Sciatica symptoms may follow an injury to the spine, an infection or a malignant process. The commonest cause is a slipped disc which is also referred to as prolapsed or herniated disc. This condition occurs when for some reason the tough tissue between the vertebral bones is damaged and subsequently presses on the sciatic nerve. Sometimes, despite the most advanced investigations, no obvious cause of sciatica can be established.

Other causes of sciatica

  • The outlet of the nerve from the spine narrows. This is called spinal stenosis. This leads to the compression of the sciatic nerve
  • Injury. When this happens, either the nerve itself or the spine vertebral column is affected
  • infections
  • inflammation of the sacroiliac joint
  • Cancerous or benign growths within the spine. If due to cancer, the cause may be from the site or as a metastasis from another part of the body.
  • A rare condition called cauda equine syndrome. This serious disorder follows spinal cord nerve damage due to compression.
  • Vertebral slip from its normal position. This is not the same as slipped disc where the problem is within the strong rubber-like tissue that lies between the boney vertebrae. This condition is also called spondylolisthesis. Here, either due to an injury or other problems, the vertebra moves forwards or backwards from the normal anatomical place.
  • Metabolic disorders that can lead sciatica include complications of diabetes
  • Piriformis syndrome. This is a muscle that runs deep in the buttock and very close to the sciatic nerve. Should this muscle get problems or goes into spasms, it presses on the nerve which can give rise to sciatica symptoms due to irritation. A common cause of piriformis is the habit of putting a wallet in the back trouser pocket.
  • Any irritation from the adjacent structures can lead to sciatica. This includes bleeding

Risk factors for sciatica

Factors that increase the risk for sciatica include:

  • Pregnancy. The increased abdominal pressure and spine curvature are responsible for this.
  • Hormonal changes are also thought to contribute to this risk.
    Obesity. As in pregnancy, the spine is strained and the excess body weight makes this worse.
  • Sedentary lifestyle. This involves prolonged sitting or just lying around.
  • An active lifestyle can also increase the risk for sciatica. This includes people who run and walk regularly. The repeated muscle activity can cause irritation of the nerve and subsequent sciatica symptoms.
  • Age. Advancing age leads to changes in the spine and increases the risk for problems that include herniated discs and other spinal disorders
  • Diabetes. Nerve damage is possible when diabetes is long-standing and the blood sugar control is poor.
  • Arthritis
  • Spinal or pelvis injuries
  • Spine congenital disorders
  • Menopause
  • Occupation. Jobs that require prolonged sitting or moving heavy loads may increase sciatica risk.

How is sciatica diagnosed?

History of the illness

An accurate diagnosis of this condition starts with a detailed history of the illness where the doctor (a GP may be the first contact medic to see) delves into how the symptoms started and the progression. A good history details about the site of the pain, the duration, how it radiates, the nature and its intensity. The direction of where the pain radiates to and what makes it worse or offers relief are more of the questions the doctor will want to know the answers to.

Finally he will want to know whether there is any associated tingling, burning or numbness on any or both of the lower limbs.

Physical examination

What does a thorough physical examination involve? The doctor starts examining you from the moment you enter the door to his office. He will observe how you walk in (gait) and the posture you assume. He will also carry out a general examination before focusing his attention on the problem area. He will note how far you can move a limb and if there are any limitations and associated pain.

Your specialist will carry out localized examination of your spine and note if there is any spine curvature or evidence of muscle spasms. This will be followed by a detailed neurological examination. This involves muscle tone and strength as well as the response of certain reflexes and relevant nerve functions. Depending on the findings, your doctor will go to the next step of looking for an accurate diagnosis.

Imaging tests

This may involve a combination of the following radiological imaging tests.

  • Plain spinal x-ray. This may show any bone growths or misalignment
  • Computerized tomography (CT) scans. This shows greater details and pinpoints any pathology more accurately. A contrast media may be injected into the spinal canal and serial scans are taken. This is called computerized tomography myelogram.
  • Electromyography (EMG). Here your nerves’ integrity is tested and problems arising from disc herniation or spinal narrowing can be identified.
  • Magnetic resonance imaging (MRI). This test gives great details about the boney structure of the spine vertebrae and the surrounding tissues.

Laboratory investigations

Depending on what the doctor has identified through the history, physical examination and radiological tests, specific laboratory tests may be carried out. The aim here is to rule out infections and possible malignancies as possible causes of the sciatica.

Metabolic disorders such as diabetes that increase the risk of the condition should also be ruled out where necessary. Otherwise, where a specific disorder such as a herniated disc has been identified, then laboratory tests add no value to the patient’s management; unless there are comorbidities with the sciatica.

History, physical examination, imaging tests and laboratory investigations are all meant to confirm the exact cause of the symptoms since other spine-related symptoms may be confused with sciatica. This other conditions that may mimic this condition must be ruled out.

Treatment of sciatica

The treatment of sciatica is an individualized affair. It depends on the causative factor(s) and other considerations such as weight, age, pregnancy and other things that may have been identified during the diagnosis.

Prevention

Preventing sciatica is recommended when possible. It is also cheaper. Some of the steps you can take to achieve this include:

  • Leading a healthy lifestyle. This means avoiding risk factors such as smoking, obesity and a sedentary lifestyle.
  • Learn to assume a good posture all the time
  • Always have a warmup and cooldown session before and after exercising. This should involve stretching.
  • Make sure your mattress is neither too soft nor too hard. The heavy body parts such as the shoulders and the hips should be comfortable lying on it.
  • Learn how to lift things safely to avoid straining your back.

At home measures

Sciatica pain can resolve on its own. It can also persist so that you are forced to take certain measures to alleviate the pain and discomfort. The steps you can take at home include:

  • Taking over-the-counter analgesic medications
  • Remaining physically active
  • Using warm packs
  • Using ice packs
  • Massage liniments
  • Where possible, remove any risk factors associated with the pain.

These measures may offer gradual improvement and there may be no need to consider any other steps.

When the sciatica pain persists

If this happens, then it’s time to seek professional help. Common measures may include:

  • A physical exercise program by your physical therapist. Initially this may be at a health facility but once you have understood the program, then he may allow you to continue at home. Find out if sciatica exercises work
  • Massage therapy and spine manipulation techniques as carried out by physiotherapists and alternative and complementary medicine specialists such as osteopaths and chiropractic doctors. Acupuncture, acupressure and other related techniques can also be tried.
  • Use of stronger analgesics. Nonsteroidal anti-inflammatory drugs (NSADs) are commonly used.
  • For severe pain, narcotic analgesics may be used for a short period to avoid the risk of addiction.
  • Use of muscle relaxing medicines
  • Intra-thecal injections of analgesic and or anti-inflammatory drugs. Corticosteroids may be used for short periods of time.
  • Sciatica can be a source of depression. Psychological support is necessary for some patients and a few may even require antidepressant drugs. Antidepressant drugs such as amitriptyline have also been found to relief nerve pain and so they can be prescribed for that reason even where there is no depression.
  • Part of psychological support can include cognitive behavioral therapy (CBT). This helps a patient to have the right attitude towards the pain they are suffering from.
  • Gabapentin is a drug that is better known for use by epileptic patients. However, it has been found to possess a positive side-effect by reducing nerve pain. You may ask your doctor about ongoing clinical trials on sciatica. Volunteering for such trials may expose you to therapies that are not yet available to the mainstream medical practice.

Complications of sciatica

  • Chronic pain
  • Progressive neurological deficiencies on the lower foot
  • Bowel/bladder issues
  • Psychological problems

When is surgery necessary for sciatica?

Surgery is avoided as much as possible. However, there are situations where it is unavoidable. These include:

  • Where the sciatica has led to bladder and or bowel problems – retention or incontinence
  • Some cases of spinal stenosis
  • Severe neurological deficiencies of the lower limbs

The surgeon will decide on the exact surgical technique to use depending on the nature of sciatica problem.

Prognosis of sciatica

Majority, up to 90%, of sciatica patients will recover without surgery. About half of all cases recover completely within six weeks. A few of the remaining will need surgical intervention to relieve the pain.

Related Articles

Do sciatica exercises work

References
Tarulli AW, R. E. (2007). Lumbosacral radiculopathy. Neurologic Clinics, 387-405.

Koes, B. W., van Tulder, M. W., & Peul, W. C. (2007). Diagnosis and treatment of sciatica BMJ : British Medical Journal, 334(7607), 1313–1317.

Ocrevus Is The New Entrant In The Fight Against The Debilitating Multiple Sclerosis

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In March 2017, the authoritative U.S regulatory body, FDA, approved the first ever, medication used to specifically treat multiple sclerosis. Until then, this chronic and degenerative condition was managed with drugs that had not yet been approved for the condition.

Ocrevus (ocrelizumab is the new entrant in the fight against the debilitating multiple sclerosis. The drug, developed by the world giant pharmaceutical company, Roche, under its subsidiary Genentech has had both patients and doctors excited not to mention the dynamic world of pharma.

The mode of action of Ocrevus involves inhibiting specific types of a patient’s B cell lymphocytes that are associated with the development of the condition.

Multiple sclerosis is an immune-mediated disorder where the body’s immune system fights its own central nervous system tissues. The exact cause or the antigen responsible for this abnormal process is unknown. The main pathology involves the sheath that insulates the nerves (myelin). This sheath is destroyed which exposes the nerve. Scarring tissue then follows (sclerosis) and symptoms set-in.

With time multiple sclerosis progressively damage more nervous tissue and can lead to paralysis and cognition problems. The disorder can have periods of remission only to flare-up later and cause more damage. Every relapse leads to more irreversible nervous system damage. The disease strikes people between the ages of 20 and 40 with more females affected than males.

Studies on Ocrevus

Rebif® has been one of the main medications used for the management of multiple sclerosis. During the development of Ocrevus, studies were conducted to compare the two drugs’ action in the management of the common forms of multiple sclerosis. These are the primary progressive multiple scleroses (PPMS) where the disease progressively cause nervous system damage from the time it sets-in. The other is the relapsing multiple sclerosis (RMS) type.

According Roche two identical studies were carried out to find out the efficacy of Ocrevus versus Rebif®. These studies found that Ocrevus offered better outcome in these areas: reduced MS relapses per year, slowed down disability progression and markedly reduced MS related lesions as per MRI imaging. Treatment complications (adverse reactions and serious infections) incidence was the same.

Another study confirmed that Ocrevus was the only, and first medication to slow down the progression of disability and lowered signs of the disease in the brain. These studies were published in the January 19 2017 issue of The New England Journal of Medicine.

Who should avoid Ocrevus?

As promising as this medication is, some classes of patients should avoid it. These include patients with viral inflammation of the liver (hepatitis B) and those with a history of adverse reactions to Ocrevus infusion.

According to FDA, this drug can cause serious reactions. For this reason, a Patient Medication Guide must accompany every prescription with the details about the drug uses and potential risks. Symptoms of reactions include skin symptoms such as hives, itchiness, redness and flushing. More serious systemic reaction symptoms include congested throat, difficulty in breathing, low blood pressure and increased heartbeat rate.

FDA further warns that, Ocrevus can increase the risk of developing cancer and especially breast cancer. Patients suffering from an active infection should also not use the drug until the infection has cleared. Vaccination with live-attenuated vaccines is also contraindicated for patients on Ocrevus.

The studies found that both upper and lower respiratory infections and skin infections were the commonest side effects of Ocrevus on the study subjects.

The serious nature of multiple sclerosis is exemplified by the way FDA expedited its approval. Ocrevus application was granted breakthrough therapy designation, fast track designation and priority review. All these are given to drugs believed to play an important role in improving the quality of life of patients suffering specific conditions such as multiple sclerosis.

Should you switch from your current MS drugs to Ocrevus?

Switching to a new drug for a chronic condition such as multiple sclerosis creates both anxiety and excitement. Apart from the buzz about the drug, there are several things to consider. These include:

  • How is your response to the current medications that you are using?
  • What is the cost of the switch to Ocrevus
  • What is the opinion of your neurologist?
  • Are you prepared for the yet to be identified side effects of Ocrevus (considering that its duration of clinical use is relatively short)?
  • If you are tolerating your current medications fairly well, are you ready to risk the potentially serious side effects of Ocrevus?

What experts think about Ocrevus

Multiple sclerosis specialists are both enthusiastic and cautious about Ocrevus. Annette M. Langer-Gould, MD, PhD is a research scientist at Kaiser Permanente Research who feels that the excitement about Ocrevus should be tempered with the reality. According to her, the potential for this drug to cause tumors in patients on it is a major concern. According to her, another drug Rituximab from the same manufacturers of Ocrevus is not only safer but also cheaper although not approved by FDA for use in multiple sclerosis patients.

The International Multiple Sclerosis Management Practice in New York shares the same feelings with Annette M. Langer-Gould. They feel that patients on Rituximab should not be in a hurry to switch to Oclerizumab until they, the experts, are in a better position to offer informed advice about the facts of the new drug.

References
New England Journal of Medicine. (2017). 376(3): 209-234. Available at: http://www.nejm.org/toc/nejm/376/3.

Ketamine Treatment Potential For Depression?

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Ketamine has been used as a safe anesthetic for close to 50 years. 8 years after it was produced in 1962, it was approved for use on human beings. The safety margin of ketamine proved important when soldiers were allowed to administer it to their injured comrades during the Vietnam War.

This was done in the field by people who were not necessarily trained anesthetists or even medical professionals. Apart from its anesthetic effects, this drug has been abused as a recreation and club drug.

The use of ketamine as an anesthetic has gone down significantly in many developed countries after more effective anesthetic drugs have been developed. But now there is renewed interest in this drug after researchers found it to be effective in the treatment of depression that is not responding to convention anti-depressant medications.

The journey of ketamine as an antidepressant

The first study group of patients who used ketamine for depression was in the year 2000. The initial study involved only 7 patients. Another study 6 years later found that 71% of patients with treatment-resistant depression improved and reduced symptoms of depression by up to 50%.

These encouraging results occurred within 24 hour of giving a single dose of ketamine infusion. Now compare that with the almost 4 weeks that conventional antidepressant drugs take to start showing any significant improvement. For some patients, no improvement is observed at all with the conventional antidepressant.

What research on ketamine has so far revealed

Compliance

A single low-dose ketamine infusion is given in about 40 minutes. According to The Lancet – Psychiatry, severe depression signs and symptoms reduces for a few hours to up to 14 days after that single dose. Some severely depressed patients may not be very compliant in taking daily medications as is common with many anti-depressants. The Lancet compares this with the 3-4 weeks it would take for conventional antidepressants to offer the same effects.

Still, according to the Lancet, about a third of patients on these antidepressants do not respond to the treatment at all. In this regard, ketamine as an antidepressant is likely to be more convenient for some patients. The only challenge would probably be the need to visit a health facility for the infusion. But for patients whose ketamine antidepressant effects last for up to 14 days, this may not be an issue.

The fast and effective antidepressant effects of ketamine can also be a point in promoting patient’s compliance. This may create a window for counsellors to help the patient gain more insight and positive attitude to help them in the journey out of chronic depression.

Another point to note is that conventional treatment-resistant depression is managed by combining various medications and adjusting treatment regimen. This is likely to confuse the patient and the many different pills are more likely compromise the patient’s compliance to treatment.

Single drug treatments always offer superior compliance than multiple drug therapy.
One of the causes of major depression is chronic pain due to any of the longstanding health conditions. Ketamine has strong analgesic properties. The double effect of pain killing effects and antidepressant properties are further reasons for better patient compliance.
Safety

Ketamine is one of the drugs commonly abused for its dissociative and hallucinogenic effects. This non-medical use creates concern to authorities and for it to be used as an antidepressant calls for effective control measure. Other concerns include:

  • Risk of tolerance. However, unlike the recreational ketamine, preliminary study results indicate that this is not likely to happen with the therapeutic doses used for depression due to the dose and frequency of use. But research is on to consider other routes of administration or prolonged infusions that will ensure small doses are given over a long period of time in an effort to reduce possible undesirable effects on the liver
  • Daily users of ketamine are prone to cystitis. This painful condition can theoretically affect those using the drug for depression. This problem has however, not been seen with the therapeutic doses of ketamine used for pain management and the infrequent use in depression management.
  • Patients with psychosis appear to have their symptoms exacerbated and so should not be given ketamine.

Ketamine and suicidal tendency

A good number of people on the usual antidepressant drugs have a suicidal tendency but this disorder has not been observed with ketamine use.

Ketamine and ECT

The use of conventional antidepressant used in major depression is often combined with electroconvulsive therapy (ECT). The benefits of ketamine are achieved without this unpleasant mode of treatment that requires an anesthetic.

The future of ketamine as an anti-depression agent

There are ethical and social concerns about the use of ketamine. Effective controls have to be in place to minimize its potential for abuse. Currently, its use is largely off-label which means different clinicians use it differently and many recommendations are based on studies.

More research needs to be done and pharmaceutical companies should look into the possibility of promoting it as an antidepressant. There is no doubt that ketamine offers hope for eligible patients with treatment-resistant depression.

References
Radvansky, B. M., Shah, K., Parikh, A., Sifonios, A. N., Le, V., & Eloy, J. D. (2015). Role of Ketamine in Acute Postoperative Pain Management: A Narrative Review. BioMed Research International, 2015, 749837. http://doi.org/10.1155/2015/749837

Cetylev- A Promising New Alternative To An Old Classic

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Cetylev is the new effervescent oral medication recently approved by the FDA for the treatment of acute liver toxicity, following over dosage of the popular drug Acetaminophen (better known as Tylenol).

The drug contained in Cetylev; acetylcysteine, is not new by any means. In fact, it was approved since the 1960’s for use, albeit as injectable intravenous solution. It is also available as an inhalable solution which has to be prepared by the pharmacist prior to use.

The Future- Convenience

In cases of acute poisoning or over dosage of Acetaminophen, the first line or therapy could be at home, as is likely to become the case thanks to the convenience of Cetylev effervescent tablets. The principle behind effervescence is simple; the tablets need to be dissolved in a quantity of water, which liberates the drug into free form, which is flavoured in a lemon-mint vehicle.

The tablets are available in 500mg and 2.5g (2500mg) sizes, and must be dosed according to weight. An initial loading dose of 140mg/kg of bodyweight is advised, followed by 70mg/kg every subsequent 4 hours for a total of 17 oral doses.

At this time, however, the medication will only be available for in-hospital management of over dosage.

Pharmacodynamics (Drug Chemistry)

Following oral ingestion of Cetylev, the drug elicits maximal effect in two hours, with a half-life of 18 hours. Cetylev is extensively metabolized by the liver, where it forms cysteine and sulfide metabolites. Following its metabolism, it is excreted in urine.

In patients suffering from renal impairment, dialysis may be needed to promote clearance from blood.

Possible Adverse Effects

Vomiting frequently occurs in cases of Acetaminophen over dosage, which may be worsened by Cetylev. Gastric bleeding may also follow in predisposed individuals (history of gastric ulcers, gastric valve disorders), so the need for risk-benefit analysis is important.

Allergic Reactions have also been reported in patients receiving oral Acetylcysteine medications, in which event the use should be discontinued unless deemed absolutely necessary.

References:

http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/207916s000lbl.pdf