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Dry Needling Technique to Recover Fast From Running Injuries- by Dr. Darshita Fatnani

Are Running injuries interfering with your performance? Dry needling will help you to recover fast. Achilles tendonitis is the second most common injury experienced by habitual runners. Achilles tendonitis is inflammation of the Achilles tendon as a result of repeated injury (usually tearing). The main symptom is pain often described as burning or aching in the Achilles tendon 1-4 inches above the heel. The pain is usually worse in the morning and aggravated with prolonged activity. There are 3 reasons: 1. Tight/Weak Calves: The calf is comprised of two large muscles, the gastrocnemius and the soleus, which combine to point the foot downward. This motion is an essential part of walking/running, and the calf should supply a large amount of the force necessary for a proper push off. However, when a muscle is weak or tight, the muscle is in a state of restriction. Because of restriction tension will accumulate in the muscle & tendon. Continued stress will break down the tendon, and it will be subject to repetitive tearing and thus a chronic inflammatory process. 2. Abnormal Foot Structure: The thing is, there is no such thing as a “perfect” foot. They all come in different shapes and sizes. There are definitely structural characteristics of some feet that will make them susceptible to developing pathological hypomobility. The foot is the first line of shock absorption of the kinetic chain. There are 33 articulations in the foot alone, each one important for proper force distribution when load is being placed through the lower extremity. The less mobile these joints are, the more force will be translated up the kinetic chain. Sometimes that excessive force will accumulate as stress and tension in a muscle or joint, such as the Achilles tendon. 3. Weak Glutes/Hips: Weak glutes and hips can lead to a myriad of musculoskeletal conditions, including Achilles tendonitis. The weaker the glutes and less stable the hips are, the more distal muscles will be called upon to compensate. This can sometimes lead to overutilization of the calves to promote hip extension with walking/running. As we can imagine, this is multiplied especially for an activity like running as it involves repetitive eccentric loading of the lower extremities for prolonged periods. When muscles are overused, they will be in a state of increased tightness and restriction, thus leading to accumulation of stress and irritation to the musculotendinous junction, the Achilles tendon. To relax the tight muscle dry needling will help. Dry needling involves having a needle plunged into your skin so that it touches your muscles on key points. The technique is often called trigger-point needling and it’s meant to help release tight muscles. Dry needling is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments. It is a technique used to treat dysfunctions in skeletal muscle, fascia, and connective tissue, and to diminish persistent peripheral nociceptive input, and reduce or restore impairments in body structure and function, leading to improved activity and participation.

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How to Choose a Mouthwash by Dr. Pramanik Namrata

Though it may seem that all mouthwashes are the same, they are not! There are 2 major categories of mouthwashes-cosmetic and therapeutic. a cosmetic mouth rinse acts as a temporary breath freshner. It contains no agents that help protect teeth against cavities or prevent gingivitis. On the other hand, the therapeutic mouth rinses help prevent cavities and gum disease. If you are prone to cavities you need to choose a mouthwash that contains fluoride, this mineral helps protect your teeth by strengthening the enamel and making it more difficult for acids that cause cavities to affect the teeth. In persons suffering from gum disease, increased tartar build up allows gum disease causing bacteria to spread and inflame the gums. In such cases, mouth washes designed to control tartar and gum disease must be used. Unfortunately, certain fluoride containing mouth washes can contribute to gum disease as fluoride is another mineral that can nurture accumulation on tartar on your teeth as tartar is nothing but mineralized plaque. Thus most mouthwashes cannot address the 2 conditions simultaneously.

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What is leptospira? by – Dr.Anand Tiwari

 What is leptospira?                                 It is a bacterial disease, caused by bacteria leptospira, spread through the urine of infected animals Most commonly spread through rodents like rats, mice Most common in warm climates In developing country like India-most commonly affects farmers Transmitted by water /soil contaminated by urine of infected animals coming in contact with  breaks in skin, eyes, mouth, nose   What are the presenting symptoms? Incubation period i.e  the time from infection to symptom onset   is: 7-12 days some infected people may have no symptoms disease may occur in 2 phases wide range of symptoms from mild to severe high fever,headache,chills,muscle aches,vomiting,jaundice,abdominal pain,diarrhea, rash after the first phase of above mentioned symptoms –the  patient may recover for a time and become ill again if second phase occurs-it is more severe, may cause –kidney failure, liver failure or meningitits, and lung hemorrhages   How can one get infected? Rats, mice, and moles are important primary hosts A wide range of other mammals including dogs, deer, rabbits, hedgehogs, cows, sheep, swine, raccoons, and certain marine mammals carry and transmit the disease as secondary hosts Transmitted through contact with water, food, or soil that contains urine from infected animals Through  swallowing of contaminated food or water Can also get transmitted through the skin, mucosal contact What are the various tests that can be done? For the first 7 days, bacteria is detected in Blood & CSF After 7-10 days of bacteria detected in Urine Diagnosis is confirmed with tests such as enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) MAT (microscopic agglutination test) is considered the gold standard in diagnosing leptospirosis kidney function tests and liver function tests may also be deranged What conditions can mimic leptospirosis? dengue fever and other hemorrhagic fevers hepatitis of various causes viral meningitis malaria typhoid fever mild forms should be distinguished from influenza and other related viral diseases What are the preventive measures? Effective rat control Avoidance of urine contaminated water sources During outbreaks in endemic regions-prophylaxis with Doxycycline once a week, with  doctors advise is used to minimize the risk of infection What are available medical therapy? Effective antibiotics include doxycycline or penicillin For more severe cases: cefotaxime or ceftriaxone are preferred antibiotics In cases with kidney damage-dialysis may be required corticosteroids in gradually reduced doses is recommended by some specialists in cases of severe hemorrhagic effects. Administration of organ-specific care and treatment are essential in cases of kidney, liver, or heart involvement. other supportive symptomatic  treatment  is given as required          

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Angiography Procedure

About cardiac catheterisation and cardiac angiography  Non-invasive tests can provide a lot of valuable information about the heart. However, sometimes it is not possible to make important decisions about a patient’s treatment unless a test called cardiac catheterisation is performed. Cardiac catheterisation, also known as coronary angiography gives vital information about the blood pressure inside your heart, and how well the pumping chambers and valves are working. Most importantly, it shows whether there are any narrowing in the coronary arteries and demonstrates their position and severity. This information can be used to help plan further treatment. Intended benefits  To provide valuable information about how your heart is functioning which then helps us to plan further treatment. Who will perform my procedure? This procedure will be performed by a consultant cardiologist or cardiology specialist registrar. Before your procedure  Most patients attend a pre-admission clinic, where you will meet a member of the nursing staff. At this clinic, we will ask for details of your medical history and carry out any necessary clinical examinations and investigations. The procedure will be explained to you. Please ask us any questions about the procedure, and feel free to discuss any concerns you might have at any time. We will ask if you take any tablets or use any other types of medication either prescribed by a doctor or bought over the counter in a pharmacy. Please bring any packaging with you. This procedure involves the use of local anaesthesia. We explain this at the end of this leaflet. Most people have the test as a day case. You should not eat or drink anything for at least three hours before the test. However, on the morning of the procedure please take the medication as advised by staff. When you arrive, you will meet your nurses who will prepare you for the procedure. Please inform medical or nursing staff if there is any possibility that you may be pregnant. You will be taken to the X-ray room (catheter lab) for the test. You may be asked to shave the groin or wrist area prior to your procedure, however this can be done by nursing staff on the day.   During the procedure The test usually takes between 20 minutes and an hour. You will change into a gown before your procedure and a nurse will prepare you by going through a check list. When it is your turn for the procedure you will be transferred to the cath-lab where the staff will check your name, personal details and confirm the procedure you are expecting. Once that is complete, the nursing staff will make you comfortable on the X-ray table. Monitoring devices may be attached to you, such as a heart monitor (ECG) and a monitor to check your oxygen levels (a pulse oximeter). A catheter is a long, flexible, hollow plastic tube, about 2mm in diameter. It is passed into a vein or artery either in the groin or, sometimes, the arm. You will be given a local anaesthetic by the person carrying out the procedure, using a small needle to numb the area where the catheter is put in. A local anaesthetic is a drug which numbs a specific area of the body for an operation. It stings for a few seconds when injected and then the area becomes progressively more numb. You will be fully awake during the procedure although you should feel no pain. The numbness usually fades after a few hours but occasionally it may last longer. Following the injection of local anaesthetic, a small incision will be made over the groin or wrist, and a fine sheath will be inserted. The operator will then pass a series of catheters through the blood vessels and into the correct position in the heart. You will not feel the catheter moving around inside your chest, but you may be aware of the occasional missed heartbeat or extra beat. You can watch the procedure on the video screen if you want to. Feel free to ask questions about what is going on. While you are having the test, you will be linked to an ECG recorder which records your heart rate and rhythm. This will be checked continuously. The blood pressure at the tip of the catheter will also be monitored. X-ray pictures of your coronary arteries are taken by injecting a special fluid (contrast) through the catheter into the coronary arteries. A further picture of the left ventricle of your heart may be taken by rapidly injecting contrast. The contrast sometimes causes a hot, flushing sensation which lasts a few seconds. This sensation may pass to your groin and give you the impression that you have wet yourself, even though you have not. You will be warned when to expect this. People occasionally feel a short-lived, mild chest pain during the test. This does not necessarily mean anything is going wrong, but you should tell the doctor about the pain   After the procedure  You will be brought to the Recovery area of the Cardiac Catheterization Lab on your stretcher bed. Depending on the type of procedure that was performed, your sheath (the catheter that was put in your blood vessel through your skin) will be managed with one of these options: Removed right after the procedure with a closure device put in. There are different types of closure devices. They are a seal or plug for the tiny hole in your artery. Removed right after the procedure and a special band/brace will be put around your wrist. Removed after you are transferred back to the Cath Recovery area In place for a few hours In place overnight If you have a sheath in your groin, the nurses will place a special clamp over your groin to stop the bleeding after they remove it (unless you have had a closure device). This clamp will apply pressure for about 20 – 45 minutes. The nurses will check your pulse, blood pressure, pulses in your

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Angioplasty Procedure

WHAT IS ANGIOPLASTY?  Angioplasty is a type of Percutaneous Intervention but the two terms are often used to talk about the same procedure. Angioplasty is much like an angiogram procedure. It is also done in the catheterization lab or “cath lab”. It is a procedure used to widen the narrowing in the arteries of your heart without open surgery. In an angioplasty, a catheter with a small inflatable balloon attached is positioned within the narrowed section of the artery. When the balloon is inflated it pushes outward against the narrowing and the walls of the artery. This opens up the artery so that your blood flows freely through the artery. The balloon is then deflated and removed from the artery. In some patients, a stent is placed within the artery once it is opened. A stent is a small metal mesh tube that is put inside your blood vessel on a balloon catheter. When the balloon is inflated, the stent opens up against the wall of your blood vessel. After the balloon catheter is taken out, the stent stays in place permanently, holding the walls of the vessel open for better blood flow. Stents lower the risk of this area narrowing again. There are several types of stents available. Your physician will select the best type of stent for your medical condition. In some cases, an angioplasty may be performed on you at the same time or during the same day as your angiogram. You might also be asked to return for a second time to have your angioplasty performed. This decision is made by your doctor. Angioplasty is not a cure for coronary artery disease. It needs lifelong management. You can control your condition with a healthy lifestyle.   ADVANTAGES OF ANGIOPLASTY  Over 90% of angioplasties are successful immediately. Blood flow through the artery returns to normal or near normal and patients get complete relief from angina. People with severe coronary artery disease may not have complete relief but their symptoms are improved, allowing them to be more active and comfortable. Unlike surgery, you do not need stitches and you are not put to sleep (general anaesthesia). People recover more quickly from angioplasty than from heart surgery. Most people are up walking on the same day. Some people go home the next morning.   DISADVANTAGES OF ANGIOPLASTY  Angioplasty is not for everyone. It does not work well when there are many narrowings in many arteries or in certain locations. Your doctor will decide if angioplasty is suitable for you. An artery may become narrow again after angioplasty. This is called restenosis. If the artery narrows enough you may feel angina again. The use of stents has reduced the restenosis rate to 0-15% of cases. Restenosis is usually treated with a second angioplasty but occasionally bypass surgery is needed or medical therapy is used.   Who will perform the procedure? This procedure will be performed by a consultant cardiologist or cardiology specialist registrar.   Talking with your doctor about benefits, risks, and alternatives  The below lists the most common potential benefits, risks, and alternatives for this procedure. Other benefits and risks may apply in your unique medical situation. The conversation you have with your healthcare provider is the most important part of learning about these risks and benefits. Don’t be afraid to ask questions. It’s important to have all your questions answered before you agree to a recommended procedure.   Potential benefits Relief of symptoms, such as chest discomfort or shortness of breath. Restoration of blood supply to the heart muscle. This can prevent a heart attack or stop heart damage if you’ve had a heart attack. Faster recovery than with surgery. The procedure doesn’t require a major cut or general anesthesia. Lower risk and cost when compared to surgery.   RISKS DURING CATHETERIZATION AND/OR ANGIOPLASTY  What could possibly happen? Leg numbness or weakness for a few hours after (rare) Bruising and bleeding at the site of arterial puncture due to blood thinning medication. Haematoma – if there is bleeding from the areas where the catheter was placed, you may have a patch where blood collects under the skin, called ahaematoma. This usually clears up on its own. False aneurysm – Rarely, a pulsating lump develops in the groin at the site of the puncture. This is because bleeding occurred when the catheter was removed. The clot produced a small sac on the side of the artery via the hole made in the artery. This sac is called a false aneurysm and can be treated with a small injection into the sac to block the hole to the artery. Infection – There is a risk of the puncture wound becoming infected. This can be treated with antibiotics Allergy/reaction to the dye used in the procedure, leaking of the contrast dye into tissues (rare and temporary) Radiation exposure from the X-rays, which can slightly increase your lifetime cancer risk (for more information, see Intermountains Guide to Understanding Radiation) Reduced kidney function (kidney failure in rare cases) – tell your doctor or the imaging technician if you have kidney disease or diabetes Need for surgical repair of the artery that held the sheath Dislodged plaques and clots from your coronary artery – causing stroke, paralysis, heart attack, permanent kidney failure, the need for urgent Dialysis, death After Angioplasty, the artery becomes blocked again in the days to weeks after the procedure. After Angioplasty, scarring of the artery happens and the procedure needs to be repeated Damage to the artery or heart muscle (extremely rare) Heart attack or stroke (extremely rare, and not typically caused by the procedure itself) In rare angioplasty cases, the artery collapses or is damaged by the wire or balloon. A stent(s) can often fix this, but sometimes patients need emergency coronary artery bypass surgery. If you need bypass surgery, you will be flown immediately to the Operation Theatre. Talk to your doctor about your risks and the benefits of this procedure for you. Restenosis or renarrowing at

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