Back pain

Back pain is a common symptom in which a patient can feel the pain in the back of the body and the origin of the pain can be from any of the spine portions such as the neck, upper and/or lower back or in the coccyx or the tail bone of the terminal spine. Back pain  is medically termed as Dorsalgia and it is very common worldwide. In the United States, one in five people complain back pain during their hospital/Physician visit. Most of the symptoms of back pain are acute and in some cases such as lumbar compression, cancer, herniated or protruded discs, the symptoms may persist for a longer duration and these problems need medical interventions.

Causes of back pain

Some of the factors that can contribute to back pain are cervical or lumbar or sacral bone compression, lumbar herniation, discprolapse, malnutrition, poor stature and posture in work environment and walking and/or standing, degenerative changes or calcification in the discs, multiple myeloma, Hodgkin’s lymphoma and some of the psychological factors. Also, previous medical history of traumatic injury can also cause back pain.

Symptoms of back pain

• Pain starts gradually and becomes intense
• Pain or discomfort while sitting
• Pain upon bending or standing in the same position for sometime
• Onset of back pain while driving a car
• Numbness in the lower extremities
• Stiffness-like sensation in the affected area that may spread to other parts.
• Intense pain while waking up in the morning.

Diagnosis of back pain

Back pain needs to be differentially diagnosed from other medical conditions with similar symptoms. But in some cases such as non-discogenic problems, these radiological examinations are not useful and disease-specific diagnosis should be done to identify the exact cause and origin of the disease. Some of the common diagnostic tests for back pain are:

• X-ray of the lumbar or cervical spine to diagnose the degenerative changes
• CT or MRI of the affected Spinal bone(s)

Treatment options for back pain

The drugs to treat back pain are NSAIDS and analgesics such as acetaminophen, centrally acting opioids, pain killers and muscle relaxants. Other non-pharmacological approaches such as hot water pack application, water bath and yoga-like exercise, ayurvedic massage, good posture and general exercise are reported to be useful in patients with back pain. 

Prognosis

In most of the cases, back pain can be managed well and most of the symptoms will subside by medications, maintaining good posture, exercise, physical therapy and lifestyle alterations. If the underlying cause of the back pain is cancer or disc protrusion, a surgical and other medical procedure may be required. Usually, most of the patients with back pain can be treated effectively with simple analgesic and anti-spasmodic medications.

Prevention

The incidence of back pain can be prevented by maintaining good posture in day-to-day tasks such as walking, avoiding heavy object lifting and climbing on the stairs, avoiding sitting directly in the opposite side of the air condition, avoiding wearing footwear with high-heels, instead of abrupt bending trying to sit down slowly and taking the objects on the floor. By these simple ways, you can avoid Back Pain up to 90%.

When to see a doctor

If you experience abnormal and persistent pain in the neck, lower or upper back or if you cannot do the daily tasks including standing in the same position for a while, bending, pain in the back while driving a vehicle or if your symptoms persist or worsen even after you took your medications, you should get medical attention immediately.

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Alzheimer's disease

Alzheimer’s disease is a progressive, biochemical, degenerative disorder of the brain and it is the most common form of Dementia. The patient with Alzheimer’s disease experiences frequent loss of memory, cognitive functions, inability to understand other’s language, etc. Alzheimer’s disease is common in the older age group and it is incurable, and due to the inability to perform daily activities, the patient may need caregivers and palliative care in the advanced stages. Currently, there is no effective medical treatment for Alzheimer’s disease; but medical management can delay the development of Alzheimer’s disease. Many patients develop the disease in the age group of 50–62 years.

Causes of Alzheimer’s disease

The reason for the development of Alzheimer’s disease is overproduction and decreased elimination of a biochemical called Beta Amyloid protein. The biochemical pathology of Alzheimer’s disease is the protein mis-folding that leads to accumulation of the beta amyloid protein without the respective degrading enzymes. This can damage the brain nerve cells that results in the initiation of the disease. However, other factors such as advanced age, genetic factors and family’s medical history of Alzheimer’s disease, decreased blood supply and oxygen supply to the brain due to blood pressure, stroke and other carotid circulatory failures can contribute to the development of Alzheimer’s disease.

Symptoms

• Acute and short-term memory loss
• Cognitive inability, poor judgments, mood swings.
• Changes in sleep patterns and difficulty in reading and speaking
• Behavioral changes and sudden social withdrawal
• Confusion, delirium, loss of initiative and aggression.

Diagnosis

There is no disease-specific laboratory or radiological diagnosis for Alzheimer’s disease. But some of the co-existing disorders that can contribute to Alzheimer’s disease can be diagnosed, and it can be clinically correlated with the existing symptoms. These include decrease in blood circulation to the brain, stroke-like medical conditions, encephalitis, Parkinson’s disease and other neurological problems of the brain.

Treatment Options

The available medications can treat the symptoms temporarily but the medicines cannot cure or delay the development of Alzheimer’s disease. Some of the medicines prescribed for Alzheimer’s disease are cholinesterase inhibitor and partial glutamate blockers. The cholinesterase blockers such as Galantamine, Rivastigmine, Taccrine and Donepezil are useful to mask the symptoms of Alzheimer’s disease. The Partial glutamate antagonist such as Memantine can be useful. Other medicines such as anti-anxiolytic drugs, sedatives, stimulants and mood stabilizers can be useful for the symptomatic treatment. Some of the alternative therapies such as Yoga, music therapy and brain function stimulation such as cognitive rehabilitation are reported to be useful; but there is no scientific evidence for the beneficial effects of these therapies.

Prognosis

The prognosis of Alzheimer’s disease is usually progressive and it invariably results in a decrease in the brain functions and neurological synaptic transmission that result in permanent disability. Most of the patients in the initial stages can manage to do their daily activities but in the advanced stages they need a caregiver for medical, palliative care assistance and to alleviate the psychological stress.

Prevention Strategies

There is no effective prevention method for Alzheimer’s disease but some of the modifiable risk factors of the disease can be prevented, which can decrease the incidence of Alzheimer’s disease. These include prevention of blood clotting by using Aspirin-like drugs under medical supervision, monitoring the cardiovascular and stroke biomarkers to prevent the incidence of Alzheimer’s disease, refraining from smoking and alcohol with low carbohydrate and oil-free diets and intake of foods rich in antioxidants can be helpful to some extent in prevention of Alzheimer's disease.

When to see a doctor

If you feel something abnormal in your daily activities, frequent memory loss, inability to tell the words or word-finding difficulties, cognitive disabilities including poor judgment, abnormal psychological behaviors such as aggression, confusion, disability to do a particular or daily activity, you may need to seek medical advice immediately.

Amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis, also called as Lou Gehrig’s disease, is a neurological disorder that can affect the voluntary activities, which are controlled by the brain and the spinal cord. In amyotrophic lateral sclerosis, due to the neuronal damage, the nerve cannot function properly and also the muscular functions associated with that nerve are impaired. According to a medical survey report, Amyotrophic Lateral Sclerosis affects 1 in 100000 people worldwide. It mainly affects the young people and the incidence of Amyotrophic Lateral Sclerosis after the age of 60 years is uncommon.

Causes of Amyotrophic Lateral Sclerosis

The exact cause for amyotrophic lateral sclerosis is still unknown to the medical community and some of the genetic causes are considered to be inheritable causes of Amyotrophic lateral sclerosis. 

Symptoms

• Difficulty in breathing
• Difficulty in swallowing
• Choking
• Paralytic attacks
• Profuse muscular weakness
• Changes in vocal cord and voice patterns
• Weight loss

Diagnosis

• Genetic diagnosis
• Electromyogram (EMG)
• Nerve Conduction studies
• Swallow tests and breathing tests
• Laboratory and radiological examinations to rule out other medical problems

Treatment Options

As of now, there is no cure for amyotrophic lateral sclerosis and the available medicines can delay the progression of amyotrophic lateral sclerosis or mask the symptoms. Some of the medicines prescribed for amyotrophic lateral sclerosis are Riluzole, amitriptyline and other anti-spasmodic drugs. Other options such as physical therapy and rehabilitation of the amyotrophic lateral sclerosis patients can be helpful to cope with the disease symptoms. Some of the other supportive therapies such as occupational therapies are useful to swallow the food as it is impossible to take liquid diet all the time. Amyotrophic lateral sclerosis can cause intense weight loss and a nutrition specialist’s advice is required to take food and the recommended dietary allowance of amyotrophic lateral sclerosis patients is also more than the normal individuals’ to equalize the weight loss.

Prognosis

The prognosis of amyotrophic lateral sclerosis is usually poor even after the proper diagnosis and treatment procedures. Most of the amyotrophic lateral sclerosis patients will survive till 4–6 years after the diagnosis and in this period, the patient tends to lose all the abilities and body functions.

Prevention

As of now, there are no prevention procedures available and we can diagnose the asymptomatic amyotrophic lateral sclerosis by genetic diagnosis and counseling to prevent the genetic diseases in our babies.

When to see a doctor

If you experience respiratory arrest, irregularities in breathing, abnormal weight loss, ARDS-like symptoms or difficulty in breathing and/or swallowing food with muscular cramps or if you are a known amyotrophic lateral sclerosis patient experiencing similar symptoms even after you took the medicines or if you feel your symptoms are worsened, you need to visit a Physician immediately.