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Ankylosing spondylitis (AS) is a chronic, systemic, inflammatory form of arthritis that preferentially affects the spine leading to limitation of spine movement. The cause of AS is not fully known, but there is a strong genetic predisposition associated with a genetic marker called the human leukocyte antigen (HLA)-B27.

AS usually begins with back pain and stiffness in the late teen years and early adulthood due to inflammation of the sacroiliac joints (the joints that join the spine to the pelvis) and the spine. AS also has a tendency for affecting sites where ligaments attach to bone. When inflammation affects these areas, the condition is called “enthesitis.”

The most common joints outside of the spine and sacroiliac joints to be affected are the hip and shoulder joints. Other joints such as the knee, wrist, ankle, and elbow can also be involved. Some patients may develop eye inflammation termed “acute anterior uveitis”.

Involvement of the heart and lungs, while rare, can be a complication. There may also be an association with psoriasis or inflammatory bowel disease.

Males are affected twice as often as females. Onset of symptoms after age 45 is unusual. Roughly, 15% of patients have disease onset during childhood.

The earliest symptom can be a dull pain in the buttock region. This occurs as a result of sacroiliac joint involvement. Some patients may have radiation of pain down the upper part of the back of the thigh and be misdiagnosed as having sciatica.

The pain at first may be one-sided and intermittent. It may also alternate, first in one buttock and then the other, but the pain, over time, becomes persistent and involves both sides.

The low back area becomes stiff and painful. This may be accompanied by tenderness along the spine and in the sacroiliac joints.

The back symptoms tend to worsen after prolonged periods of rest so that a patient will say their worst times are late at night and early in the morning. The symptoms improve with physical activity or exercise and worsen with rest.

The back symptoms also worsen with exposure to cold or dampness. Some patients have fleeting aches and pains or tender spots that can lead to a misdiagnosis early on of fibromyalgia.

Sometimes, the first symptom can be pain and stiffness in the middle part of the spine (thoracic region) or even the neck. Sometimes chest pain may be more of a symptom than low back pain.

Eye inflammation in the form of anterior uveitis is the most common non-joint feature of AS. This complication occurs in 25%-40% of patients at some time during their disease.

Clinical examination may or may not be helpful in the early course of the disease. The physician should examine the sacroiliac joints and the entire spine, including the neck. Chest expansion (the ability to move the chest with a deep breath) along with range of motion of the hip and shoulder joints should be measured. A search for signs of enthesitis can be helpful in making an early diagnosis of AS. The areas to search for enthesitis include the spinous ligaments, pelvis, front chest wall, bottom of the heels, back of the heels (Achilles tendon), outside of the hips, and the front of the knees just below the kneecap. This area is called the tibial tubercle.

The muscles along the spine may also be tender.

As the disease progresses, the spine becomes stiffer leading to loss of mobility in all directions. Chest movement also becomes more restricted.

Spinal deformities slowly progress and make the spine more rigid. Some patients may develop osteoporosis. If osteoporosis accompanies the rigidity, then a particularly dangerous situation develops because this rigid osteoporotic spine is very susceptible to fracture even after minor trauma.

The diagnosis of AS is based on physical exam and confirmed by imaging procedures. Symptoms, family history, and the joint exam are the most important tools early on.

X-ray evidence of AS may not be evident early in the course of the disease. Patients may need to undergo magnetic resonance imaging (MRI). MRI can detect subtle inflammatory changes in the sacroiliac joints and other areas of enthesitis early on HLA-B27 typing can be helpful in cases where AS is suspected but the diagnosis remains uncertain.

In cases where AS suspected, the HLA-B27 test may allow the presumptive diagnosis of AS to be made.

However, the presence of HLA-B27 should not be used to diagnose AS in the absence of other supporting history and physical exam evidence.

Dr. Muhammad Khan, the world’s foremost expert in AS, has flatly stated that, “HLA-B27 testing is inappropriate in patients with back pain or arthritis in whom neither the history nor the physical examination suggests the presence of AS. A positive result in this clinical situation would still not permit the diagnosis of AS to be made because up to 8% of the general population possesses this gene.”

Laboratory tests measuring inflammation are of limited value. Elevation of erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) occurs in about 70% of patients with active AS. The problem is that there is not a good correlation between the elevation in these blood tests and disease activity.

It may be that the increases in ESR and CRP reflect the presence of active arthritis in joints outside of the spine. Normal ESR or CRP does not exclude the presence of clinically active AS.

Successful treatment of AS requires a combination of non-drug as well as appropriate drug therapies.

Patient education is important and should include a life-long program of regular stretching and range-of-motion exercise. Smokers should be encouraged to stop smoking.

Use of non-steroidal anti-inflammatory drugs (NSAIDs) is often helpful. Traditional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, leflunomide (Arava), and sulfasalazine (Azulfidine), are not useful for the treatment of disease restricted to the spine. They may be helpful in patients where peripheral joint arthritis or enthesitis is present.

Tumor necrosis factor (TNF) inhibiting agents, etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade) are very effective in treating AS patients.

MRI studies have shown that TNF-inhibitors are capable of resolving severe inflammation in the spine as well as in peripheral joints. Whether these drugs can prevent structural damage remains to be seen.

As with all forms of arthritis that require immunosuppressive therapy, close supervision of the patient is mandatory.

Surgery may be required for cases of AS that don’t respond to medical therapy. Joint replacement, in the case of peripheral involvement, and corrective spinal surgery may be needed.

Fortunately, today, quicker diagnosis and more aggressive medical intervention have reduced the need for surgical solutions.

One other note of caution… In patients with significant neck involvement and rigidity, intubation for general anesthesia is extremely difficult and dangerous. These patients should notify the anesthesiologist in cases of elective surgery. They should also wear an ID bracelet advising of their condition.

The art of massage has been around since time immemorial, widely practiced since hundreds of years by the Chinese, Indians and the Greeks. Though massage started off as a pain-relieving technique, medial practitioners now recognize that it also improves blood circulation by stimulating the lymphatic response; it is also well known that massage helps the body in throwing out accumulated toxins.

Massage is an ancient “bodywork” technique that is used to iron out muscle stress and also to provide relief from pain by applying pressure at sensitive points of the body.

Massage is beneficial for the many variables present in the body. It can strengthen the skin, relieve muscular and joint pains, and can also help in adding that element of robustness in ligaments, tendons and connective tissues. It also has the propensity to fortify the gastrointestinal system and the reproductive organs.

Only a professional massage therapist who has received adequate training can deliver a beneficial massage treatment. Though traditional massage involves administering pressure using hands and feet, nowadays the massage market is swamped with many mechanical aids that help in providing more depth and variety to the practice of massage.

One interesting device is the Massage Chair that comes equipped with all kinds of bells and whistles such as a motor and various mechanical protrusions that imitate the actions of a massage therapist. These massage chairs are computerized and can be adjusted according to the weight, height and the back contours of the person. These massage chairs give an all-round massage covering the back, neck, shoulders, hips, thighs, legs and even the feet.

All types of medical practitioners ranging from the common physician to the highly specialized sports trainer nowadays prescribe massage for pain/stress relief and recovery. Massage is helpful not only in providing physical relief, it also works on the mind, freeing it from routine problems such as depression, stress and mental fatigue.

Apart from mental and physical relief, massage is also used as a sense-stimulator during the course of making love. Massage connects with both the body and the mind, and rejuvenates the entire being while calming the senses at the same time. As such, just about everyone and anyone benefits from massage - right from someone who is suffering from unbearable arthritic pains to the robust rugby player who is plagued by injuries, to someone who wants to get a sense of extraordinary stimulation during lovemaking.

Massage is always received in a professional setting, wherein the client has to remove his clothing and cover his body with sheets or towels. The massage therapist needs the massage receiver to be unclothed in order to get easy access to the body parts that need massage. The sheets and towel that drape the body provide the necessary warmth, comfort, and, of course, the privacy.

The client has to lie down on a table that may be warmed or sheeted so that it is comfortable to the body. A typical massage setting will also have other elements that soothe the senses such as enchanting music, aromatic candles and the like. It is important that the client is fully relaxed before the massage begins in order to receive the key benefits of massage therapy.

The massage session typically begins with the massage receiver lying face upward, a position also known as the “supine” position. During the second half of the massage, the receiver has to roll over - this position is referred to as the “prone” position.

If the massage has to be effective, then communication between the therapist and the client has to be excellent. The client must keep communicating to the therapist if he feels the pressure being applied is too much or too less. Such feedback can help the therapist take corrective action. The client must always discuss his medical history and his current ailments with the massage therapist before partaking the massage.

Some of the well-known and prominent massage techniques are: The very popular Swedish Massage, Ayurvedic Abhyanga, Barefoot Deep Tissue Massage, Chair Massage, Chinese Tui Na, Chinese Zhi Ya, CranioSacral, Deep Muscle & Deep Tissue Massage, Effleurage, The Hawaiian Lomilomi, Roman Massage and Reiki.

As a side note, massage therapy rocks as a career choice. Great money, flexible hours and a growing interest and marketability help make this profession a hightly sought after massage therapy career choice.

Once… as recently as 20 years ago, it was not uncommon for patients with arthritis to rapidly become crippled or to die from the devastating effects of arthritis.

Today, many patients are able to experience remission from their arthritis. To get to this point has taken the work of many hard-working researchers as well as the dedication of thousands of patient volunteers.

The goal of arthritis clinical research is to safely translate promising basic laboratory discoveries into safe and effective medical practice.

All clinical research conducted in the United States is guided by the Nuremberg code. These guiding principles were established to protect human subjects from unethical conduct, such as what took place under the Nazis during World War II.

The eight fundamental standards that guide clinical research are:

Women with large heavy breast may experience several health concerns related to this problem including, back and neck pain, breast pain and rashes under the breast. The added weight of large breasts may exacerbate the symptoms for women with arthritis or spinal problems. Some women are bothered by the psychological embarrassment of large breast, finding it uncomfortable to engage in physical activity or experiencing difficulty in finding clothes that fit. In the long term, large breasts can lead to increased sagging (ptosis) and as a result of this many women present with a combination of large breasts and ptosis. Women, who are very self-conscious of the if large breasts, tend to develop a slouch in their posture, droop in their shoulders and chronic backache. Bra straps tend to dig into their shoulders causing deep indentation. Breast reduction surgery removes excess fat, glandular tissue and skin to achieve a breast in proportion to your body and reduce the discomfort associated with large breasts. It will not only correct the functional symptoms but also result in better-proportioned breasts, enhancing a woman’s body image and self-confidence. It is recognised world wide that women who have had breast reduction are some of the most satisfied and grateful patients.

How will my plastic surgeon evaluate a patient for breast reduction surgery?

Plastic surgeon will examine the patient’s breasts, taking measurements and perhaps photographs for your medical record. The size and shape of the breasts, the quality of your skin, and the placement of the nipples and areolas will be carefully evaluated.

Patient should come to the consultation prepared to discuss his medical history. This will include information about any medical conditions, drug allergies, medical treatments patient has received, previous surgeries including breast biopsies, and medications that you currently take. Patient should tell her plastic surgeon if she plans to lose a significant amount of weight, particularly if patient have noticed that her breasts become smaller with weight loss.

Type of Anesthesia required for Breast Reduction Surgery:

Breast reduction is nearly always performed under general anesthesia. Patient will be asleep through the entire operation.

The Surgery for Breast Reduction:

Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He or she then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.

In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the vertical part of the scar. And occasionally, when only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars.

Does insurance help cover the cost of breast reduction surgery?

Insurance coverage is sometimes available for breast reduction surgery. Many factors determine the eligibility of the patient, including the specific terms of your insurance policy and the amount of breast tissue to be removed. The insurance company prior to surgery may require a letter of predetermination.

Results of Breast Reduction Surgery:

Breast reduction surgery will make your breasts smaller and firmer. Without the excessive weight of large breast. The incisions from your breast reduction surgery will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible, more so in some individuals than others. Fortunately, the incisions for clothing in locations easily conceals breast reduction, even low-cut necklines.Breast reduction often makes a dramatic change in your appearance. For this reason, it may take some time for the patient to adjust to her new body image. Most women, however, eventually become comfortable with their smaller breasts and feel very pleased with the results of surgery. In fact, the level of patient satisfaction resulting from breast reduction is among the highest of any plastic surgery procedure.

Savings from Breast Reduction Surgery In India:

Americans spend billions on cosmetic surgery procedures Cosmetic surgery procedures have been gaining popularity throughout the US over the years. You can now save enormously by getting breast reduction surgery in India It’s true, you can get savings of up to 75% on breast reduction surgery costs and the savings can fund a free Holiday, When you have them done in India. You also get world-class treatment comparable with any available in the US or Europe. If you have never thought of combining breast reduction with seeing the Taj Mahal, or visiting the beautiful beaches of Goa well now you can. Western hospitals cannot compete on price. Why pay inflated prices in the US Or Europe when you can have breast reduction surgery costs dramatically reduced and get a free holiday as well? The answer is its as good as anywhere else in the world yet, its far cheaper in India due to the lower infrastructure costs. The facilities they work in provide the most modern and advanced equipment and procedures available. Millions of tourists are now undertaking their surgery in India, getting lower cosmetic surgery costs and also getting a free holiday as well. Costs are so low, that it makes sense to combine surgery with a holiday and enjoy a relaxing break as well.

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Bactrim is a widely used and effective antibiotic medication used to treat and prevent bacterial infections.

Treating Infections with Bactrim

Some infections most commonly treated with Bactrim include:

• Bronchitis (when long-lasting or increased in severity)

• Urinary tract infections

• Middle ear infections

• Traveler’s diarrhea

• Intestinal inflammation

In most cases, adults being treated with Bactrim for bacterial infections will be prescribed one Bactrim DS (double strength) or two regular strength bactrim tablets. Children are normally prescribed one teaspoonful for every 22 pounds of body weight; dosing is usually twice daily for a period of five to fourteen days. The type and location of infection dictates the dosage amount and length.

Preventing Infections with Bactrim

The Bactrim antibiotic may also be used to prevent bacterial infections in persons with weakened or compromised immune systems. Bactrim is a common defense used in transplant patients and patients with AIDS against Pneumocystis Carinii Pneumonia (PCP). Likewise, Bactrim may be used to treat PCP.

Normal dosing for the prevention of PCP in adults is one tablet daily for a period of 6-12 months. In children the dosage is determined by total body surface area, and the prescribed dose is taken twice daily for three consecutive days (not to exceed 320 milligrams trimethoprim and 1600 milligrams sulfamethoxazole daily).

While Taking a Bactrim Antibiotic

It is recommended that the Bactrim antibiotic be taken with eight ounces of water, and that water is drunk periodically throughout the rest of the day to prevent uncomfortable side-effects. As with all antibiotics, the full course of the Bactrim prescription should be taken to completely clear the infection (or continue preventative protection). Bactrim works best when adequate levels of the drug are maintained, therefore, it is important to take a Bactrim antibiotic at prescribed intervals, and make every effort not to miss a dose; if a dose is missed, it should be taken when remembered, but double doses should never be taken as overdoses of bactrim antibiotics can be very serious.

Bactrim can interact unfavorably with some drugs, and can decrease the effectiveness of others, so it is important that doctors are made aware of all other medications being taken by the patient. Additionally, people with additional medical conditions, pregnant and/or breast-feeding women need to discuss the safety of Bactrim antibiotics with their doctor.

Bactrim antibiotics can cause skin and sun sensitivity. Precautions should be taken to avoid the sun when possible and protect the skin while in the sun when taking a Bactrim antibiotic.