Surgery for Low Back Pain?

Every one of us who never had backache must consider themselves very lucky as it has been reported that LBP affects as much as 70-90% of the adult population at some point of time.
The good news is that only one fourth get recurrence or progression to longstanding LBP. The person who has been suffering from LBP for a long time seeks solace at any cost even if it means undergoing a major operative procedure. But nowhere the role of operative treatment of any disease has been as controversial as in low back pain.
What I am trying to tell you is not a substitute to the opinion of a well informed doctor but it may help you to arrive at a correct decision pertaining to your individual condition.
There is insignificant correlation between back pain and the findings on different imaging studies. An overdependence on the diagnosis of disc herniation occurred with early use of MRI that show disc herniations in 20% to 36% of normal volunteers. This incidence increased to 76% of asymptomatic controls when they were matched to a population at risk for work-related lumbar pain complaints.
Severe nerve compression demonstrated by MRI or CT correlates with symptoms of distal leg pain; however, mild to moderate nerve compression disc degeneration or bulging, and central stenosis do not significantly correlate with specific pain patterns.
Lumbar MRI scans of 67 asymptomatic patients and found that 20% of those younger than 60 years of age had herniated disc, which were also present in 36% of those over the age of 60 years. Asymptomatic abnormalities were found in 57% of those 60 years of age or older. Lumbar disc degeneration was found in 35% of those from 20 to 39 years of age and in 100% of those over 50 years of age.

If you have been considering surgery for LBP here are certain things to consider before making a decision.
If the pain is mainly in your back with no or minimal radiation with no other abnormality other than a disc bulge reconsidering surgery would be better.
Appropriate treatment for what can be at times excruciating pain generally should begin with evaluation for significant spinal pathology. This being absent, a brief (1 to 3 days) period of bed rest with institution of painkillers and rapid progression to an active exercise regimen with an anticipated return to full activity should be expected and encouraged. Generally, patients treated in this manner improve significantly in 4 to 8 weeks. Diagnostic studies, including roentgenograms, often are unnecessary because they add little information.
Structural abnormalities do not always cause pain and diagnostic injections can help to correlate abnormalities seen on imaging studies with associated pain complaints. In addition, epidural injections can provide pain relief during the recovery of disc or nerve root injuries and allow patients to increase their level of physical activity. Because severe pain from an acute disc injury with or without radiculopathy often is time-limited, therapeutic injections help to manage pain and may alleviate or decrease the need for oral analgesics.
Surgical treatment can benefit a patient if it corrects a deformity, corrects instability, or relieves neural compression, or treats a combination of these problems.
There have been various studies comparing the long term results of operations for LBP ranging from microscopic discectomy to circumferential fusion.
Both the surgeon and the patient must realize that disc surgery is not a cure but may provide symptomatic relief. It neither stops the pathological processes that allowed the disc prolapse to occur nor restores the back to a normal state. If you have a prolapsed disc on the much coveted MRI examination, to conclude that a removal of disc will bring total relief from pain may not be true for everyone.
Disc surgery with fusion of the affected spinal segments definitely provides relief from pain arising from instability but may also increase the motion strain on adjoining segments thereby increasing the chances of degeneration at these levels.
The patient must practice good posture and body mechanics after surgery. Activities involving repetitive bending, twisting, and lifting with the spine in flexion may have to be curtailed or eliminated. If prolonged relief is to be expected, then some permanent modification in the patient's lifestyle may be necessary.
This does not mean that chronic LBP patients are doomed to suffer. The most important aspect in treatment of such patients lies in education of the patient pertaining to his problem and to mutually manage the condition with medicines, life style modifications, structured exercise programs with constant supervision and surgical intervention in cases that would definitely be benefited.
The question that �Is surgery for LBP a solution to a problem or itself a problem� still remains unanswered not only in the minds of patients but also the people responsible for treating Low Back Pain.
Dr Sameer Agarwal can be reached at International Medical Center.

AYUR SCAN : Ayurvedic Whole Body Scan

ELECTRO - TRIDOSHA - GRAPH / GRAM (E.T.G.)

The Ultimate Ayurvedic Diagnosis Solution

Invented and Developed by: -

Dr. Desh Bandhu Bajpai

KUNMUN ELECTRO-TRIDOSHA-GRAM RESEARCH INSTITUTE

67/70, Bhusatoli Road, KANPUR-208001. Uttar Pradesh,

INDIA

Phone no: 0512-2367773




ABSTRACT; AYURVED, the Indian System of Medicine, is 5000 (five thousands) years old medical science. The whole Ayurveda is based on the Tridosha, Dhatu, Mal, Agni, and Oaj Theory, which are factually known as Maulik Siddhant. Diagnosis of Tridosha-agni-dhatu-mal-oaj etc. and diagnosis of diseases or disease conditions are based solely on the radial pulse examination conventionally and the treatment and management of the sick individual is totally dependent on the Radial pulse reading conceived by the Ayurvedic practitioners. To quantify TRIDOSHA, only radial pulse examination is conventional to assess the status of Tridosha in human body, depending upon the knowledge of the Ayurvedic practitioners he. How Vaidya /Ayurvedic clinician quantifies and conceives Tridosha himself and unto what extent? This is not explanatory by any means in physical proofs, as EVIDENCE-BASED-MEDICINE term, like examples of X-ray, Imaging pictures, Ultra-sound, MRI, Pathological investigations etc.

For the first time, Electro-Tridosha-Gram/Graph technology is invented with the help of Electro-Cardio-Graph Machine, making some changes. It is believed that this technology will improve the scientistic approach in MAULIK SIDDHANT of Ayurveda, the INDIAN SYSTEM OF MEDICINE, more accurate, more logical in its philosophy, examination, evaluation of drugs/remedy/medicine, monitoring and treatment. Today the Tridosha, the EachTridosha�s five kinds, the Sapta Dhatu, the Mal, Mootra and the Sved, Agni, Oaj and Total Oaj and other AYURVEDIC MAULIK SIDDHANT can be quantified with their presence in human body in their respective intensity on paper, which is showing physical existence of these theory before eyes in form of paper report, say �EVIDENCE BASED MEDICINE� by ELECTRO-TRIDOSHA-GRAPH/GRAM technology. Now Ayurveda have a scientific tool and technology at present time, which is capable and effective to prove scientifically the Tridosha and Sapta Dhatu (Dosha-Dooshya), Malam-moolam philosophy and other Maulik Siddhant. Today, it is believed that with the help of ETG technology, Ayurveda will enter into new era of research, which has innumerable possibilities to explore the truth of Ayurveda in evidence form, earlier said by the sages since five thousands years ago, in philosophy, in logic, in Siddhant etc. This technology will change the concept of Tridosha etc in diagnosis and treatment more accurate, more logical and most scientific. The technology will open new doors for research in Ayurveda, which have been never explored earlier.


SUMMERY OF THE RESEARCH WORK


1 - BACKGROUND:

How the idea was incepted and why the need for such a device has been felt?

IDEA INCEPTION

For the first time, the idea of ELECTRO-TRIDOSH-GRAM/GRAPH was that conceived by me, when few years back, one day, I was recording Electro-Cardio-Gram of my one patient by my Single channel BPL Cardiart 108T-MK-VI, ELECTRO-CARDIOGRAPH machine, which I am using since few years as a routine check of cardiac patients. My attention went to the movement of the ECG machine�s �stylus�, which is actually a heated needle, moves up and down according to signal received from the sick person�s body for tracing record on heat sensitive paper. Actually this is basically a type of Galvanometer. The movement of the stylus nature was throbbing and pulsating, just like Radial Pulse is throbbing and pulsating, when touches and slightly presses by the fingertips. The Radial Pulse examination is known as NARI PARIKSHAN in AYURVED, the Indian System of Medicine. Thus NARI PARIKSHAN done by the practitioners of Ayurvedic science, status of TRIDOSH, which are VATA, PITTA, KAPHA, in single and in combinations, are quantified in human body. Tridosha is an important and essential part of the basic root and foundation of Ayurveda, on which whole Ayurvedic science, its philosophy and concept is built. Without Tridosha, Ayurveda-science is nowhere stands.

Suddenly at a time, an imagination cropped-up in mind, that what is be good, if a sensor is made and fitted with the needle, so that it recorded the throbbing and pulsation and presented the recording on paper, so that radial pulse examination will be more scientific and authentic in compare to finger touch radial pulsation, observed mentally, but not physically existed, by the Vaidya, the Ayurvedic practitioners.

In fact I was in search of a mechanical means for Radial Pulse recording. Nari-examination is directed in many classical books of Ayurveda. It is directed that both hands� radial pulse should be examined. I have seen many patients that they have only one hand or in some cases both hands are absent or amputees. In these instances, radial pulse reading is impossible to assess the Tridosha intensities; therefore treatment based on Tridosha is difficult in these cases.

Ayurvedic practice is going on in my family as a traditional job from generation to generation. My forefathers were practicing Ayurveda. As for as concerned to myself, I belong to fifth generation of my traditional family profession. When I was teen-ager, my father gives me training to observe Radial pulse examination. My father narrates the pulsating and throbbing nature of radial pulse. How Vata, Pitta and Kaphha are observed in a sick, he describes all very lucidly.

One day I thought, could ECG machine be helpful in TRIDOSHA quantification? I tried on this thought, worked practically for weeks, without any result, but I never left any hope. The practical efforts on TRIDOSHA findings were continue. I never took any other persons� help. I discussed my idea to other Vaidyas, but nobody was in position to help me. I took help from classical textbooks of Ayurveda and Modern western medicines regularly. Books have always guided me at every crucial points and matters. One day I was studying a book on cardiology about the lead-arrangement system of Electro-Cardiograph machine {ECG machine}. I tried deeply to understand the lead arrangements of an ECG machine and gone thoroughly with some chapters on cardiology in textbooks. At last, I decided that Chest-lead could solve the problem.

The other problem was where to locate the site of body from where tracings could be recorded. Several experiments were done on different locations of body, but all was fruitless and nothing could be obtained. I was hopeful that I would hit the target. Studies, ideas, imaginations and real experiments were continued.


Another day I thought, Tridosha are living inside the human body, and first of all I should find out and locate the exact places of Vata, Pitta, and Kaphha existence. I started to find out this idea and gone through the great Ayurvedic classical like Charak Samhita, Sushrut Samhita, Ashtang Hridaya, Bhav-Prakash and many others. Lastly I got clearly in Bhav-Prakash, where these Vatadi doshas are present in human body with their locations. After that I decided the points, from where tracings can be recorded, for Tridosha status quantification. Patient�s case history, past and present complaints were the guide for establishing the points and waves pattern.


2- DESCRIPTION:

Technical details including mechanism of the innovation.

Since last over six years, Electro-cardio-graph machine is used to quantify and evaluate Tridosha and other �Maulik principles� by me in my clinic for studying, evaluating, measuring and establishing Tridosha etc. intensity from my outdoor patients. For Maulik Siddhant study a part of ECG machine is selected, with some changes. The selection of the sectors / site for placement of sucking electrode for obtaining tracings from Right Vata, Left Vata, Right Pitta, Left Pitta, Right Kaphha and Left Kaphha and sites for other leads are established accordingly.

Basic Principles

This is a known fact that when the heart contracts, electric currents are produced and distributed throughout the body to the skin, just like the spreading waves of a pool of water into which a stone has been dropped. Two electrodes can be applied to any parts of the body to lead the heart current to a recording galvanometer. The obtained trace record on heat sensitive paper is called an Electro-tridosha-gram.

Basic Electrophysiology

The changes in the electrical potential with each heart beat can be understood by considering the electrical behavior of a single cell. The surface of the resting cell will be electrically positive compared with the interior of the cell which is electrically negative. A cell in this condition is said to be in the polarized state and the exterior and interior of the cell can be compared to the two poles of a battery. When the cell is stimulated, the difference in the electrical state between the negative interior and positive exterior of the cell is temporarily abolished and the cell is said to be �depolarized�. When the effect of excitation has passed off and the cell has returned to its former resting state, the positive charge outside and negative charge inside are restored, the cell is �repolarised�.

When an excitatory [depolarization] process flows towards a unipolar electrode, the galvanometer will record a positive or upward deflection and when it flows away from the electrode, a negative or downward deflection.

Normal resting muscles:

No difference in electrical potential exists, therefore if the two ends are connected to a galvanometer no current will flow- no deflection

Depolarization

If one end of the muscles stripe is stimulated, the surface of the muscles is no longer positive whereas the surface of the cell at the resting portion is still positive, an electric current will therefore flow from the resting to the stimulated part causing the needle of the galvanometer to deflect.

When the excitation has activated the whole strip, all cells are in the excited or depolarized state. Consequently there is no difference in electrical potential between any points on the surface of the stripe. No current will therefore flow through the external circuit and the galvanometer needle will return to the zero position.

Repolarization

When the effect of stimulation has subsided, the strip returns to its resting state, recovery starting at the point which was first stimulated. At this movement the cells of the recovered portion are again in the polarized state and their surface is electrically positive in relation to the surface of the still excited cells. The differences in the electrical potential are therefore of the opposite direction from those during the spread of excitation. The current will therefore flow from the already recovered to the still excited portion of the muscle strip.

When subsequently the whole strip has recovered all the cells are again in the resting [polarized] state. The electrical potential at all points being the same, no current will flow and the needle will return to zero.

Thus the excitation and subsequent recovery of the muscles stripe have given rise to two electrical currents or deflections of opposite directions. The current of the Repolarization [during recovery] are weaker and extend over a longer period of the time than those of the depolarization [during excitation]. Applying this to the electrical changes produced by the heart beats the same fundamental principle holds but with some modifications. This is because the hearty consists of a multitude of intercommunicating muscle fibers and had four chambers which are activated in sequence more complicated than the simple spread of excitation through a muscles strip.

Physiological Basis

The important characteristics of human heart include excitability, rhythmicity, conductivity, contractibility and distensibility. Excitability and contractility are the inherent properties of each cardiac cell. The excitation wave passes from cell to cell once stimulated at any point and the whole mass of cardiac cells behave as a syncitium. This is due to ionic flux of Potassium across the cell membrane maintained by Sodium+ Potassium+ ATPase whereby intracellular potassium is 30 times more than the exterior. Following excitation, the depolarization wave starts. If a microelectrode is placed inside a muscle fiber, it records an extreme rapid phase of depolarization lasting 1-2- msec and then becomes positive in comparison to exterior by 15-30 mV over a period of 6-15 msec. Thereafter there is a plateau of 100 msec followed by a Repolarization period. Upstroke of this action potential coincides with R wave of ECG, the plateau period with R-T segment and the Repolarization with T wave. Changes in concentration of Potassium and calcium and to less extent sodium have profound effect on excitability and contractility of heart. Magnesium and Strontium have some effect only when calcium concentration is low.

Depolarization wave in myocardial cells and cells of Purkinjee system is brought about by fast inward movement of sodium whereas in pacemaker cells of SA node and in proximal region of A-V node it is brought about by slow inward movement of calcium. Only under abnormal conditions, the fast inward current by sodium channel is often inhibited and depolarization is brought about by calcium channel.

Electrophysiology

Electrophysiology is the study of the electrical properties of biological cells and tissues. It involves measurement of the voltages changes or electric current flow on a wide variety of scales from single ion channel proteins to whole tissues like the heart. In neuroscience, it includes measurements of the electrical activity of neurons, and particularly action potential activity.



Action potential

An action potential is a wave of electrical discharges that travels along the membrane of a cell. Action potential carries fast internal massages between the tissues, and is an essential feature of animal life. They can be created by many types of body cells, but are used most extensively by the nervous system to send massages between nerve cells and from nerve cells to other body tissues such as muscles and glands.

Action potential is an essential carrier of the neural code. Their properties may constrain the sizes of evolving anatomies and enable centralized control and coordination of organs and tissues.

Signal transduction

In biology, signal transduction is any process by which a cell converts one kind of signal or stimulus into another. Process referred to as signal transduction often involve a sequence of biochemical reactions inside the cells, which are carried out by enzymes and linked through second messengers. Such processes take place in as little time as a millisecond or as long as a few seconds. Slower processes are rarely referred to as signal transduction.

In many transduction processes, an increasing number of enzymes and other molecules become engaged in the events that proceed from the initial stimulus. In such cases the chain of steps is referred to as a �signaling cascade� or a �second messenger pathway� and often results in a small stimulus eliciting a large response.

Membrane potential

Membrane potential [or transmembrane potential or transmembrane potential difference or transmembrane potential gradient] , is the electrical potential difference [voltage] across a cell�s plasma membrane. In membrane biophysics it is sometime used interchangeably with cell potential, but is applicable to any lipid bilayer or membrane. Hence every organelle and every membranous compartment [such as a synthetic vesicle] has a transmembrane potential [although the size of this potential may be zero].

Electrolyte

An electrolyte is a substance that dissociate into free ions when dissolved [or molten], to produce an electrically conductive medium. Because they generally consist of ions in solution, electrolytes are also known as ionic solutions. They are sometimes referred to in abbreviated jargon or lytes.

Electrolytes generally exist as acids, bases or salts. Furthermore, some gases may act as electrolytes under conditions of high temperature or low pressure. An electrolyte may be described as concentrated if it has a high concentration of ions or dilute a low concentration of ions. If a high proportion of the dissolved solute dissociates to form free ions, the solution is strong; if most of the dissolved solute dose not dissociate, the solution is weak. The properties of electrolytes may be exploited via electrolysis to extract constituent elements ad compounds contained within the solution.


NOVEL ELEMENT:

Unique features of the innovation

1. Ayurvedic physician observes Tridosha by touching Radial pulse. It is solely depend upon the knowledge, experience and mental capability of Physician, to which level and unto what extent, the physician estimate the status of the Tridosha level of a sick person. It is very difficult for another Ayurvedic physician to know and experience similar and equal estimation of Tridosha, Dhatu, Mal, Agni, Oaj etc. observed by the earlier Ayurvedic physician. By using ETG technology, Dosha-Dhatu-Mal-Agni-Oaj is recorded on heat sensitive white paper strip. Earlier the recording was performed on the ECG papers. But due to graphical print on the paper tracings minute details can not be well observed. Therefore white sensitive paper is used for recording. Now Tridosha etc Quantification is possible by any Ayurvedic Physician, who has knowledge of interpreting ETG.

2. Ayurvedic physician can estimate and measure the level of Tridosha i.e. Vata, Pitta and Kaphha or its combination, Sapta Dhatu and Tridosha affected Sapta Dhatu etc. in sick person and can conclude, which Dosha-Dhatu-Mal-Agni etc is normal, below normal or above normal. By this the physician can choose Branghan or Shaman treatment accordingly to Dosha etc

.
3. Apart from Tridosha, ETG can help in diagnosis of various human body disorders and disease conditions, which no other modern diagnosis gadgets could detects. By this technology physician can observe which part of body is damaging, the tendency of disease.
4. When patient recovers health, significant changes are observed in ETG after treatment. Ayurvedic physician can monitor patient health improvement and progress time to time and evaluate his treatment�s effects.

5. ETG is differed to ECG. ECG is for the diagnosis of cardiac problems only, while ETG is for diagnosis of Tridosha, Sapta-Dhatus, Mal and whole body scanning etc. The lead system, heat sensitive paper is totally changed and only a part of the ECG machine is used.

6. Treatment can be ascertained after analysis of Vata five kinds, Pitta five kinds, Kaphha five kinds, because ETG analysis gives which Dosha is Normal, Less normal, Minimum or above normal or maximum. The intensity of Dosha, Dosha kinds, Sapta Dhatus and Mal etc thus shown, helps the clinician to make a plane for treatment.


7. Most of the Tridosha-kinds have no proper medication for particular area i.e. for Kaphha kinds Shleshman, Tarpan, Kledan, Snehan, Avalamban have no particular medicine for the treatment purposes specifically. No special medicine has been developed for the specific Tridosha, Sapta Dhatu and Mal disorders. With this technology medicine can be sorted and categorized for the particular and special nature of diseases or ailments.

8. Effects of medicine, herbs, minerals, animal products, prepared medicine which have been characterized with their specific uses, narrated classically in Ayurveda Ethics can be examined and evaluated by this technology successfully.














9. The scope of ELECTRO-TRIDOSHA-GRAM Technology is very brilliant at present and in Future. No-other technology is in existence to quantify the TRIDOSHA status on paper. This is for the first time, the Tridosha status in human body is quantified by this technology. Apart from Tridosha as a whole, each five kinds of Tridosha humors, Sapta Dhatu, Agni, Mal and Oaj are quantified according to their intensities persisting in human body. The intensities of the Doshas can be shown in their presence, percentages and in graphical forms. Dosha-Dhatu-Agni-Mal-Oaj etc are shown and produced in report form.


10. This technology will open a new gateway of the evaluation of the Ayurveda Tridosha, Dhatus, Mal and the Ayurvedic Drugs, Herbs, Mineral and other medicines. The effects of the medicine in human body can be assessed by this HI-TECH technology.


11. The diagnosis of several disease conditions, which are by no other ways possible to detect, is now possible by this technology, because it scans electrically whole body organs. After scanning by this technique, the sick parts can be observed or the sectors, where normal or abnormal tracings are found, detect the sick areas.


12. Ayurvedic graduates can do their Post-graduate in this subject and they can open their investigation center to help the clinician by obtaining reports on Tridosha etc. Before start of Ayurvedic treatment , During treatment , before PANCHAKARMA and after panchakarma the ETG report will show the progress of the treatment


13. During research work on this technology, I have founded many unusual, peculiar, uncommon, rare, strange waves in the recorded tracings, which are yet to be analyzed. Very importantly, it is suggested that electrical behavior of the Astronauts should be observed in Space shuttle and in Space station during their stay in Space.


14. The technology is equally useful for all Doctors and Physicians belongs to any method of clinical practices i.e. Modern western medicines, Unani, Siddha, Homoeopathy, Nature-cure, Yoga, Acupuncture, Acupressure, Physiotherapy, Magnet therapy, Aromatherapy, Tibetan medicine, Chines Medicine, Herbal Treatment, Korean medicine etc.

15. Those who will adopt this technology, they will find more ways of its use, which are unseen in future. But this is a prime fact that Ayurveda science will be benefitted much more.

16- The quality of heat sensitive paper is very perishable in nature. Paper can not be retained safe and preserve for a very long period. It is observed that within six to one-year time, the paper destroyed/ fade its tracings and color. Recorded tracings cannot be saved well after this period. Therefore a computerized data collection and storage system should be developed and provided for saving and collection of the acquired data for future reference purposes and to make a library of data/tracings for academic and future uses.

17- ELECTRO-TRIDOSHA-GRAM/graph is taken with the help of Electro-cardiograph machine. Obviously and mentally it looks bad that ECG machine is used for some other purposes. Therefore a separate indigenous machine especially for the ELECTRO-TRIDOSHA-GRAM/GRAPH recording purpose, should be designed, fabricated and developed to register twenty-one sectors excluding SOS sectors. SOS sectors are those sectors where patient located his main complaints.

18- The construction of the ETG machine should be done in the way of complete computerization. The machine should be facilitating to record all twenty-one tracings simultaneously excluding SOS sectors. After recording the data, analysis and final report should be produced with the results automatically in printed and graphical forms etc. The machine should have capacity to store atleast 50 case histories with data and tracing records.

19- For establishing more scientific and accurate results from ETG tracings, research and development of this technology will be a continuous feature. For the same, a well-equipped laboratory is must, where Pathological investigations, Ultrasound, X-ray, EEG, Oximeter and other scanning facilities should be available for counter checking of the ETG findings.

20- Doctors and student of Ayurveda should brought forward to study the technique, to experience the concept, to develop technology and to do research in MAULIK SIDDHANT, HERBAL-MINERAL-ANIMAL DRAVYA GUN, TESTING OF AYURVEDIC MEDICINES AND REMEDIES, EFFECTS OF PANCHAKARMA etc in human body.

Dentinal Hypersensitivity

Tooth sensitivity or pain after eating cold, hot food, liquids or even breathing cold air is termed as dentinal hypersensitivity. The person may have a thought that the tooth needs to be extracted. or requires filling .However the problem of hypersensitivity can be treated very easily.

Etiology of Dentinal hypersensitivity

� Attrition
� Recession of gums
� Fractured tooth
� Post operative
� Dental caries
� Erosion of tooth surface

Person with hypersensitivity usually avoids brushing, because of pain, thus neglecting oral hygiene leading to serious problems, such as tooth decay and gum diseases. The reason why the teeth becomes hypersensitive in certain people is, when the tooth�s protective covering is absent, dentin is exposed. Dentinal tubules are open at the surface of the dentin allowing a direct channel to the nerve pulp. The dentin is normally covered by enamel or cementum. When ever the enamel or cementum is absent due to many factors like erosion, abrasion, brushing habits or a tooth defect, dentin is exposed. This exposed dentin leads to hypersensitivity.

Cause of dentinal hypersensitivity

Age
The regression of the gums as the person gets older.
Brushing habits.
Tooth enamel abrasion which may be caused by wrong brushing, by using very hard toothbrush.
Diet
Habitual ingestion of acidic food causes erosion of enamel or dentin leading to opening of dentinal tubules. The citric acid in citrus fruits dissolves enamel leading to hypersensitivity.
Tobacco
Users of tobacco regularly experience dentinal hypersensitivity. The tobacco placed between teeth and gum is known to cause gingival recession. As gingival receeds, soft gingival cementum is exposed. Continuous brushing erodes the cementum and opening the dentinal tubules.
Diseases
There is a risk of dentinal hypersensitivity in those affected with gastro esophageal reflex disease leading to increased intra oral acidity. Subsequently causing enamel erosion, leading to dental hypersensitivity.
Prevention
Following the correct brushing technique and brushing gently.
Flossing is crucial to reach tooth surfaces where brushing cannot reach.
Maintain proper oral hygiene. This will reduce gum recession and periodontal diseases
Treatment
Sensitivity tooth paste,
Fluoride mouth washes.
Filling up of hypersensitive areas.
Avoiding highly acidic food.

Breathing Techniques: How to Practice


Throughout all practice, remember these points:
1. There is no required breathing strategy for each
phase of labor.
2. Slow-paced breathing is best for mother and baby.
Return to it whenever possible.
3. Use relaxation skills with all breathing techniques.



Phase I--Developing Breathing Awareness

� During relaxation practice, feel your breath in your
nose, mouth, throat' then shoulders, chest, abdomen,
and back.
� Note rise and fall of chest.
� Feel the pressure of your body against a chair, bed,
pillows, and other contact areas.
� Listen to the sounds made by your breath.
� Notice changes in your breathing as you vary
positions and activities.



Phase II--Mastering Slow-Paced Breathing

� Practice with the strategy most comfortable for you.
For example, "In, 2,3,4,5, out 2,3,4,5" or listen to your
breath go in and out.
� Mentally link the ideas "release tension" and "focus"
with the initial cleansing breath.
� Practice slow-paced breathing in different positions.

Note the different sensations as you vary your position.


Phase III--Developing Strategies for Slow-Paced Breathing;

Mastering Modified-Pace Breathing
Practice slow-paced breathing by yourself using different strategies. Examples:
� Visualize breathing in a continuous circle.
� Picture energy entering your body as you breathe in
and tension leaving as you breathe out.
� As you inhale and exhale, say phrases such as "I
can give birth," "energy in, pain out," "My breath is
calm."
� Rock or walk in rhythm to your breathing.
Practice slow-paced breathing with your partner's help. Examples:
� Imagine breathing into the parts of your body where
your partner places his hands.
� Have your partner stroke down your arms or legs as
you exhale.
� Begin to practice modified-paced breathing as taught
in class, using a strategy most comfortable for you.
Vary positions and note differences in sensations.


Phase IV--Developing Strategies for Modified-Paced Breathing
Experiment with one or two strategies using modified-paced breathing. Examples:
� Breathe quietly, listen to your breath move in and out.
� Say words in rhythm, like "health-y ba-by," "be calm,"
"in, 2,3, out, 2,3."
� Use music our counting while you breathe.
� Practice patterned-paced variation as learned in
class.
� Practice with your partner, using gentle pressure
contractions rather than verbal cues.



Phase V--Mastering All Techniques
� Practice switching from one paced breathing
technique to another within the same pretend
contraction.
� Vary the length and intensity of practice
contractions.
� Practice for an early urge to push. Use a series of
light blows or a pattern of one breathe, one blow.

Introduction

Primary infertility is the term used to describe a couple that has never been able to conceive a pregnancy, after at least 1 year of unprotected intercourse.
We present a case study in which PCOS (diagnosed by USG) and unovulation were thought to be the cause of primary infertility. After taking the conventional treatment for about 1 � year the patient was unable to conceive. The conventional treatment was discontinued and ayurvedic treatment was given. The patient conceived in 7 months and delivered a healthy child.
The Case Report

Mrs. V. N, a 24 year old women, software engineer, married for 3 � years, approached for the treatment of primary infertility. Since their marriage Mrs. V. N and her husband were staying together and were sharing a healthy sexual relationship. After one year of normal married life, as Mrs. V. N was unable to conceive, she consulted a gynecologist for advice.

The gynecologist advised routine investigations and sonography of the abdomen and ovulation study. On sonography, the ovaries were found to be polycystic and a diagnosis of PCOS was made. On ovulation study, it was observed that the ovarian follicles were not maturing, resulting into un-ovulatory cycle.

She was advised a course of Human Chorionic Gonadotrophin (HCG) 5000 i.u., i.m. in mid cycle, which she took for 12 cycles. However, even after a year of treatment, she was unable to conceive.

The gynecologist then advised her to undergo exploratory laparoscopy, which she was unwilling to undergo. At this stage she thought of �trying� ayurvedic treatment.

Complaints of: Inability to conceive after 2 � years of marriage

On examination: G.C - fair, Temp / Pulse / Respiration / Blood Pressure - Normal. R.S, C.V.S - Normal, Weight 51 Kg.

No history of consuming oral contraceptives or the use of any IUCD.

Menstrual history- Regular, moderate, painless

Menarche- at age 12 years

Past history of illness- Insignificant
Family history- Insignificant
No menstrual complaints of mother and elder sister

Investigations:
CBC, Blood sugar- Normal
Hystero salpingography - Normal, both tubes patent
Husband�s Semen - Normal

Treatment:

The following medicines were advised:
1.Syrup Dashmularishta1 20 ml two times a day before meals
2.Tablet Rajapravartini vati2 500 mg twice a day before lunch and dinner from day 1 to day 13 of the cycle.
3.Phala ghruta3 10 gm twice a day after breakfast and after dinner from day 14 till the next cycle.
4.Tab. Garbhapal Rasa4 250 mg twice a day after breakfast and after dinner from day 14 till the next cycle. (And throughout pregnancy)
5.Tablet Laghumalini Vasanta rasa5 250 mg twice a day after breakfast and after dinner from day 14 till the next cycle. (And throughout pregnancy)

The same treatment was continued for 7 months. No other modern medicines were given.

Result:
After about 7 months of treatment, Mrs. V.N. conceived. During the treatment period her menstrual cycles were normal. There were no other complaints. She delivered a healthy male child, weighing 2.5 kg,

Discussion:

According to ayurved, akin to the germination of a plant seed, the four most important factors for conception are 1) Rutu (season), 2) Kshetra (the field- uterus), 3) Ambu (water - nourishment) and 4) Beeja6 (seed - ovum and sperm).The probability of conception increases if all these factors are in perfect condition and in harmony with each other.

�Rutu�, in this context, refers to the most fertile days of the menstrual cycle and the fertile age of women. �Kshetra� refers to the cyclical conditioning of the uterus for making the uterine cavity most suitable for implantation of the fertilized ovum. As both these factors are associated with rhythmicity / periodicity, it is under the control of vata dosha. Also, the process of ovulation, maintaining the pregnancy till its full term and parturition are controlled by �apana vayu�7. Diminution of vata dosha also results in unovulation7b. Therefore, procedures (ahyanga, basti) and medicines beneficial in balancing of vata dosha, would be useful in ovulation, maintenance of pregnancy and in normal childbirth.

Nourishment of the fetus is carried out by �rasa�. Rasa dhatu in a pregnant women is split into three parts one nourishes the mother herself, second part is utilized to nourish the fetus and the third to produce milk8. Therefore, the medicines acting on rasa dhatu would benefit the nutrition of the fetus.

�Beeja� refers to both ovum and sperm. Both need to be in perfect condition for conception. The ovum is �agneya�9 (�agni mahabhoota� predominant) and shukra is �soumya� (jala mahabhoota predominant). Therefore the �rasayana� medicines predominant in agni mahabhoota and jala mahabhoota are beneficial for producing best quality of �beeja� - ovum and sperm.

During the follicular and ovulatory phase of menstrual cycle, Rajapravartani vati, which contains �hinga� (asafetida) as one of its ingredient was given to induce ovulation. As hing is �ati ushna veerya� (very hot in potency, it helps the maturation and release of ovum, which is also �agneya� (hot) in nature.