Tuesday, 24 October 2017

Some important facts related to myeloma (plasma cell Myeloma)

Pathology

v Type - Cancer

v Cause(s) - Unknown

v Symptoms - Bone pain, widespread infection, kidney failure, anaemia, neurological symptoms.

v Mortality Rate - Inevitably fatal if untreated. Even if treated, 50% mortality rate after five years.

v Treatments - Chemotherapy, thalidomide, steroids, stem cell transplant

What is multiple myeloma?

Multiple myeloma, also known as plasma cell myeloma, is a cancer of plasma cells, a type of white blood cell normally responsible for producing antibodies. Often, no symptoms are noticed initially. When advanced, bone pain, bleeding, frequent infections, and anemia may occur. Complications may include amyloidosis.

You may not require treatment until symptoms develop, and most people respond well to treatments that include:

• Chemotherapy

• Radiation

• Blood treatment called plasmapheresis.

In some cases, a bone marrow or stem cell transplant is an option.

Multiple myeloma is not considered “curable,” but symptoms wax and wane. There can be a long period of dormancy that could last several years. However, this cancer usually recurs.

There are several types of myeloma, but multiple myeloma accounts for 90 percent of cases, according to the Leukemia and Lymphoma Society. The Surveillance, Epidemiology, and End Results Program (SEER) list myeloma as the 14th most common type of cancer.

The cause is generally unknown. Risk factors include drinking alcohol and obesity. The underlying mechanism involves abnormal plasma cells producing abnormal antibodies which can cause kidney problems and overly thick blood. The plasma cells can also form a mass in the bone marrow or soft tissue. When only one mass is present, it is known as a plasmacytomawhile more than one is known as multiple myeloma. Multiple myeloma is diagnosed based on blood or urine tests finding abnormal antibodies, bone marrow biopsy finding cancerous plasma cells, and medical imaging finding bone lesions. Another common finding is high blood calcium levels.

Multiple myeloma is considered treatable, but generally incurable. Remissions may be brought about with steroids, chemotherapy, thalidomide or lenalidomide, and stem cell transplant. Bisphosphonates and radiation therapy are sometimes used to reduce pain from bone lesions.

Globally, multiple myeloma affected 488,000 people and resulted in 101,100 deaths in 2015. In the United States, it develops in 6.5 per 100,000 people per year and 0.7% of people are affected at some point in their lives. It usually occurs around the age of 61 and is more common in men than women. Without treatment, typical survival is seven months. With current treatments, survival is usually 4–5 years. This gives a five-year survival rate around 49%.The word myeloma is from the Greek myelo- meaning "marrow" and -oma meaning "tumour

Signs and symptoms.-

Because many organs can be affected by myeloma, the symptoms and signs vary greatly. A mnemonic sometimes used to remember some of the common symptoms of multiple myeloma are CRAB:

C = calcium (elevated),

R = renal failure,

A = anaemia

B = bone lesions.

Myeloma has many other possible symptoms, including opportunistic infections (e.g., pneumonia) and weight loss. CRAB symptoms and proliferation of monoclonal plasma cells in the bone marrow are part of the diagnostic criteria of multiple myeloma.

Treatment

Treatment for multiple myeloma is focused on therapies that decrease the clonal plasma cell population and consequently decrease the signs and symptoms of disease. If the disease is completely asymptomatic (i.e. there is a paraprotein and an abnormal bone marrow population but no end-organ damage), as in asymptomatic ("smoldering") myeloma, treatment is typically deferred, or restricted to clinical trials.

In addition to direct treatment of the plasma cell proliferation, bisphosphonates (e.g., pamidronate or zoledronic acid) are routinely administered to prevent fractures; they have also been observed to have a direct anti-tumor effect even in patients without known skeletal disease. If needed, red blood cell transfusions or erythropoietin can be used for management of Anaemia.

Prognosis-

Durie-Salmon staging system

First published in 1975, the Durie-Salmon staging system is still in use. However, one of the limitations of the Durie-Salmon staging system is the subjectivity in determining the extent of bone disease.

• Stage I: all of

• Hb > 10g/dL

• normal calcium

• Skeletal survey: normal or single plasmacytoma or osteoporosis

• Serum paraprotein level < 5 g/dL if IgG, < 3 g/dL if IgA

• Urinary light chain excretion < 4 g/24h

• Stage II: fulfilling the criteria of neither I nor III

• Stage III: one or more of

• Hb < 8.5g/dL

• high calcium > 12 mg/dL

• Skeletal survey: Three or more lytic bone lesions

• Serum paraprotein > 7g/dL if IgG, > 5 g/dL if IgA

• Urinary light chain excretion > 12g/24h

Stages I, II, and III of the Durie-Salmon staging system can be divided into A or B depending on serum creatinine:

• A: serum creatinine < 2 mg/dL (< 177 μmol/L)

• B: serum creatinine > 2 mg/dL (> 177 μmol/L)

Prevention

The risk of multiple myeloma can be reduced by maintaining a normal body weight

Diagnosis

Myeloma

There are two main systems used to stage multiple myeloma:

• International Staging System (ISS)

• Durie-Salmon system

Stage 1

In this stage you have a relatively small number of myeloma cells in your blood and urine. Your hemoglobin levels are only slightly below normal, and bone X-rays may look normal or show only one affected area.

Stage 2

In this stage a moderate number of myeloma cells are present. Hemoglobin levels are usually much lower than normal. Monoclonal immunoglobulin may be increased, and blood calcium levels may also be high. X-rays may show several areas of bone damage.

Stage 3

In the final stage of multiple myeloma, a high number of myeloma cells are found. Your hemoglobin level is also usually below 8.5 grams per deciliter, and calcium blood levels are high. And there are multiple areas of bone destruction caused by the cancer.

Survival rates

Survival rates are based on comparing people with myeloma to their peers who don’t have cancer. According to the American Cancer Society (ACS), these are the average survival rates by stage:

Stage 1: 62 months

Stage 2: 44 months

Stage 3: 29 months

It’s important to note that survival rates are calculated from the time treatment begins, and the average is the median survival rate. This means that half of the people with multiple myeloma lived longer than the average length for each stage.

Monday, 16 October 2017

Pain Management through Ayurveda

Pain is a more terrible lord of mankind than himself even death.

Albert schweitzh.

What is Pain

v Pain is an uncomfortable feeling that tells you something may be wrong. It can be steady, throbbing, stabbing, aching, pinching, or described in many other ways. Sometimes, it’s just a nuisance, like a mild headache. Other times it can be debilitating.

v Pain can bring about other physical symptoms, like nausea, dizziness, weakness or drowsiness. It can cause emotional effects like anger, depression, mood swings or irritability. Perhaps most significantly, it can change your lifestyle and impact your job, relationships and independence.

v Pain is classified as either acute or chronic. Acute pain is usually severe and short-lived, and is often a signal that your body has been injured. Chronic pain can range from mild to severe, is present for long periods of time, and is often the result of a disease that may require ongoing treatment.

v Currently, the best way to treat the pain is to manage the symptoms. If the source of your pain can’t be treated, or isn’t known, our pain medicine specialists can offer options for pain control.

v Examples of pain conditions which can be treated by Ayurveda

1-Sciatica

2-Sprains

3-Accute fissure

4-Perianal abscess

5-Cellulitis

6-Gout (vata Rakta)

7-Amavata (R.A.)

8-Planter fasciitis or calcanial spur

9-fracture

10-Osteoarthritis

11-Vrana sopha

12-Cevical spondilitis

13 -Strain

14-External piles

15-Varicose vein

16-Appendicitis

17-Renal stone & uretric stone

18-Soph18-frozen shoulder

19-corn

20-prolaps of intervertibral disc

21-Back pain

22- Dislocation of joint

23-Migrane

24-Glucoma

25-Burn

26-sinusitis

27-fistula

28-epididymitis

29-bursitis

30-DVT

31-conjunctivitis

32-Inflammed externointernal piles

Other pain full conditions.

v Low back pain

v Spinal stenosis

v Vertebral Compression Fractures

v Cervical and lumbar facet joint disease

v Sciatica/Radiculopathy

v Sacroiliac joint disease

v Neuropathic (Nerve) pain

v Head pain / Occipital neuralgia (Scalp/head pain)

v Intercostals neuralgia (Rib pain)

v Peripheral neuropathy (Diabetic nerve pain)

v Complex regional pain syndrome (Reflex Sympathetic Dystrophy - RSD)

v Neck pain

v Shoulder and knee arthritic pain (osteoarthritis)

v Myofascial (Muscular) pain

v Post surgical pain

v Cancer pain (pancreatic, colorectal, lung, breast, bone)

v Pain from peripheral vascular disease

v Anginal pain (chest pains)

v Post-herpetic neuralgia (shingles pain)

v Nerve entrapment syndromes

v Spastisticy related syndromes/ pain

v Spinal Cord Injury (central pain)

v Pelvic pain

v There are different types of pain. Acute pain is a type of pain that typically lasts less than 3 to 6 months, or pain that is directly related to soft tissue damage such as a sprained ankle or a paper cut.

v Acute pain is of short duration but it gradually resolves as the injured tissues heal. Acute pain is distinct from chronic pain and is relatively more sharp and severe

v Chronic pain is any pain that lasts for more than three months. The pain can become progressively worse and reoccur intermittently, outlasting the usual healing process.

v After injured tissue heals, pain is expected to stop once the underlying cause is treated, according to conventional ideas of pain. However, chronic pain can persist after injuries heal for no apparent biological cause.

v The most common sources of chronic pain include low back pain, headache and arthritic pain. Chronic pain can cause significant psychological and emotional trauma and often limits an individual’s ability to fully function.

Ayurveda’s Approach to Pain Relief-

Ayurveda suggests a different approach to pain relief. It begins by viewing pain as a mind-body experience that's highly subjective. Pain is approached through a phenomenon called "self-efficacy." The brain contains many pain-relieving chemicals, and these can be triggered mentally, which is why taking a placebo leads to pain relief in a significant proportion of people.

Subjects unknowingly self-regulate their pain. This isn’t just the mind fooling us. Brain scans show that a placebo, when effective, changes the brain in the same way as do active pills, and these changes can be found in the spinal cord, not just the brain. The implications are strong for chronic pain over an extended period, too. Studies in arthritis patients have shown that the placebo effect can last more than two years. In fact, self-efficacy is more powerful and more long-lasting than is generally realized, even among physicians. Ayurveda recognizes this power of the mind to relieve pain, and strengthens.

v Lifestyle’s Role in Pain Management

The lifestyle components of Ayurveda—such as positive relationships, nurturing emotions, massage balanced activity, rest, and diet—are some of the means to rebalance, strengthen, and purify the mind/body variables that lower our pain sensitivity. Love and human touch are other potent pain relievers. Studies have shown that a 20-second hug can relieve pain and stress by acting on nerve cells to release pain-relieving brain chemicals such as oxytocin and reduce the release of the stress hormone cortisol.

1. Local analgesics:

Local analgesics are topically applied to a particular part of the body, and often include paste preparations (known as Belladonna);

2. Central analgesics:

Central analgesics (known as Dhatura) are more powerful than local analgesics, and are sometimes combined with strict dietetic restrictions;

3. body-ache medications:

Body-ache medicines are used to fight stress and fatigue (which we have generally known as Balam and Patala).There are more than 100 plants in ayurveda that are recognized to have pain-relieving properties, but some are really excellent.

v The application of this plant and herbs are equivalent as used in muscle pain and other pain, relaxants in ayurveda is alike as that of the modern symptomatic treatment like use of drugs that act as sedative, tranquilizers and anti spasmodic.

v There are specific terms in ayurveda Vednasthapak (which refer as painkiller) Shulaghan (high degree painkiller) adyavatahara (medications for anti convulsion and related complications), and the oil preparation used for massage are the categories of muscle relaxants and other pain used in ayurveda.

v Apart from this, all the remedies that are used for treatment the stroke, tetanus and different disturbance due to physiological and pathological factors are also having the effects of muscle relaxants and other pain.

1. Garlic for Earache Cure

2. Clove for Toothache Pain Relief

3. Honey for Mouth Ulcers

4. Ginger Root for Muscle Pain

5. Vinegar for Heartburn and Acid Reflux

6. Epsom Salt Bath for Leg Pain.

7. Cherries for Pain Relief.

8. Diabetic Pain Treatment with Turmeric

9. Fish Oil for Stomach Problems.

10. Buttermilk for Pre-Menopause.

v Ayurveda advises buttermilk for pre and post menopausal syndromes and menstrual pains. You can possess natural buttermilk two to three times; it’s truly efficient in curing vaginal infections and itching. Buttermilk is also highly effective in curing yeast infection.

v Try to have a plain glass of buttermilk together with cumin seeds; this may truly help in your condition. Researchers conducted have shown the favourable results of buttermilk in treating gynaecological problems. The calcium in buttermilk dispassionate the physical and psychological irritability led to during PMS.

v Pain management by Ayurveda

1-siravedha

2-leech therapy

3-shnehana

4-swedna

5-pradeha

6-lepa

7-Agnikarma

8-Acupressor

9-Aqupuncture

10-Awgaha sweda

12-Basti Chikitsha

13-Tarpan

14-Sarvang sweda

15-virechna

16-Deep yantra

17-Sirovirechna

v Ayurvedic Medicines for pain

1-Guggulu

2-Tail

3-Upanaha

4-Dashmool kwatha

5-Rashnadi kwatha

6-Yastimadhu tail

7-Yashtimadhu Ghrita

8-Colchicine

9-Nashya

10-Triphla Guggulu

11-Sirovasti

12-bednasthapak mahakashaya

13-sool prashmana mahakshaya

14-Ahiphena

15-sura (alcohol)

16-yoga

17-swarn yogaraj guggulu

18-pidan chikitsha

19-Aswashan

Thursday, 12 October 2017

ANALGESIC AND ANTI-INFLAMMATORY EFFECT OF LEECH THERAPY (JALAUKAVCHARAN) IN THE PATIENTS OF OSTEOARTHRITIS (SANDHIGATA VATA)

Osteoarthritis (degenerative joint disease) is the most common joint disorder. It mostly affects cartilage. The top layer of cartilage breaks down and wears away. Osteoarthritis is of two types, primary (idiopathic) and secondary. In idiopathic osteoarthritis, the most common form of the disease, no predisposing factor is apparent. Secondary OA is pathologically indistinguishable from idiopathic OA but is attributable to an underlying cause. In Ayurveda the disease Sandhivata resembles with osteoarthritis which is described under Vatavyadhi. The NSAID’s are the main drugs of choice in modern medicine which have lots of side effects and therefore are not safe for long-term therapy. Raktamokshan, i.e., blood letting is one of the ancient and important parasurgical procedures described in Ayurveda for treatment of various diseases. Of them, Jalaukavacharana or leech therapy has gained greater attention globally, because of its medicinal values. The saliva of leech contains numerous biologically active substances, which have anti-inflammatory, analgesic as well as anesthetic properties. Encouraging results were seen with application of the leech therapy.

OTHER SUPPORTIVE AYURVEDIC TREATMENT FOR OSTEOARTHRITIS

1-MATRA BASTI

2-PANCHTIKT GRITA KSHEER BASTI

3-JANU BASTI FOR JANU SANDHI

4-PANCHTIKT GHRITA GUGGULU

5-AABHA GUGGULU

6-MAHAYOGRAJ GUGGULU

7-RASHNADI KWATHA

8-RASHAYNA

9-MAHANARYAN AND MAHAMASH TAIL

10-LEECH THERAPY

11-DASANG LEPA

12-GUDUCHYADI KWTHA

13- SHNEHANA AND SWEDNA

14-LAKCHADI GUGGULU

Tuesday, 3 October 2017

SCRUB TYPHUS FEVER- CAUSES, DIAGNOSIS AND TREATMENT

Introduction

Scrub typhus or bush typhus is a form of typhus caused by the intracellular parasite Orientia tsutsugamushi, a Gram-negative α-proteobacterium of family Rickettsiaceae first isolated and identified in 1930 in Japan.
Scrub typhus is transmitted by some species of trombiculid mites ("chiggers", particularly Leptotrombidium deliense), which are found in areas of heavy scrub vegetation. The bite of this mite leaves a characteristic black eschar that is useful to the doctor for making the diagnosis.
Scrub typhus is endemic to a part of the world known as the tsutsugamushi triangle (after O. tsutsugamushi) This extends from northern Japan and far-eastern Russia in the north, to the territories around the Solomon Sea into northern Australia in the south, and to Pakistan and Afghanistan in the west. It may also be endemic in parts of South America, too.
It affects females more than males in Korea, but not in Japan, and which may be because sex-differentiated cultural roles have women tending garden plots more often, thus being exposed to vegetation inhabited by chiggers. The incidence is increasing in the southern part of the Indian subcontinent and in northern areas around Darjeeling.

Symptoms and Signs

Incubation period of 6 to 21 days (mean 10 to 12 days).
fever, chills, headache, and generalized lymphadenopathy start suddenely.
Muscle pain, cough, and gastrointestinal symptoms.
Morbilliform rash, eschar, splenomegaly, and lymphadenopathies are typical signs.
At onset of fever, an Escher often develops at the site of the chigger bite.
The typical lesion of scrub typhus, common in whites but rare in Asians, begins as a red, indurated lesion about 1 cm in diameter; it eventually vesiculates, ruptures, and becomes covered with a black scab.
Regional lymph nodes enlarge
Fever rises during the 1st wk, often to 40 to 40.5° C. Headache is severe and common, as is conjunctival injection. A macular rash develops on the trunk during the 5th to 8th day of fever, often extending to the arms and legs.
It may disappear rapidly or become maculopapular and intensely collared. Cough is present during the 1st wk of fever, and pneumonitis may develop during the 2nd wk.
In severe cases, pulse rate increases; BP drops; and delirium, stupor, and muscular twitching develop. Splenomegaly may be present, and interstitial myocarditis is more common than in other rickettsial diseases. In untreated patients, high fever may persist ≥ 2 wk, then falls gradually over several days. With therapy, defervescence usually begins within 36 h. Recovery is prompt and uneventful.