These days we can see the level of competition is too high that it becomes very hard for the children to handle it in the right way. Do not forget their studies and extra curriculum that needs to go the parallel way. Parents too are demanding when it comes to child�s escalated success. We often see parents comparing their children with other�s children, which itself it the root cause of depression. Reality shows, publicity, fame and other kind of competitions coming in our sphere children are soft target for depression. Children don�t play well nor do they get sleep well. They are over loaded with all kind of stuff. The childhood phase in them is been wiped out at a very early stage in life. Unlike adults, children don�t exhibit sadness or express like adults do, so it becomes difficult to recognize whether a child is depressed or not. They hold back their feelings and that in turn leads to stress and depression.


Here are some symptoms that could help you identify juvenile depression.


� Being very irritable or angry or start to respond negatively on anything and everything.
� Becoming unenergetic and not responding to things where it could be fun for them.
� Feeling of not wanted or detected. (This happens usually when compared.)
� Not being able to concentrate and as a result fairing miserably at studies.
� Growth considered improper ie. Gaining and losing weight at a fast pace.
� Obesity in children.
� Crying without reason or anything and everything making them cry.
� Frequent illness.
� Feeling of �I can�t� in life.
� Mood swings. (Suicidal thoughts: take them to a qualified psychotherapist right away)


Tips to overcome juvenile depression.
� Talk to your child and make him/her understand that everyone faces depression.
� Allow the child to express.(If he/she wants to cry; let him/her cry but be with them to support their feelings with encouraging words and action).
� Make the child face the truth. We often try to cover their painful/hurtful feelings. (esp. getting the
child a prize from the shop and gifting when failing to get a prize in the competition).
� Develop confidence of the child in you. This helps them to open-up everything to you.
� Do not over empathize with the child, rather empathize to lead the child back to recovery.
� Make the child understand various other options to excel and be better.
� Schedule time for the child to eat, play and sleep. Do not encourage the child to be obese.
� Develop a hobby of child�s interest.
� Seek opinions from them for decisions at home. This is helpful in implanting a feeling of being
wanted and/or getting them mature to situations.
In spite of trying out all these if the child do not respond take him/her to a qualified psychotherapist who could assist your effort in leading the child out of situational depression.
Every child is unique and let him/her be what he/she is and excel in their field of interest. Bring the smile back on the child�s face.


Dr. Kurien S. Thomas
Executive Director
Effective Living Inc


Dr.Kurien S. Thomas is a writer, columnist, corporate trainer, psychotherapist, yoga therapist & counsellor; Founder & Executive Director of Effective Living Inc., a global counselling, k yoga & stress management clinic, which has a unique approach to psychotherapy, counselling, yoga therapy & wellness therapy. He also conducts seminars and workshops for corporate, schools, colleges and various organisations.


His personal / online counselling on family issues, teenagers, parenting, health issues, obesity, slimming, alcoholism and other issues has been a boon to many with 100 % confidentiality assured.


For more details and appointments write to him here or call at: +91-0-9969105310 or +91-0-9987223811. Website: www.effectivelivingonline.com

A Case: by
Dr. Nilesh Jitendra Shah
Bhakti Homoeopathy Dispensary, Pune � 37.
Mobile: +91 98223 93060

CASE OF CALC CARB IN ACUTE EPIDIDYMI-ORCHITIS {A Post-Op Complication After Trans-Urethral Resection Of Prostate.}

Patients Initial: S M P Age: 58 years Sex: Male
Date of Case taking: 10th Nov�08
Treating Physician: Dr. Nilesh J Shah M D (Hom)
Probable Clinical Diagnosis: Acute Epididymo-orchitis following T U R P done one & half month back (25/09/08) Clinically diagnosed with swelling redness pain etc and Routine Urine report showing abundant Pus cells within ten days of T U R P
O D P: Patient said that he was admitted for the same (Acute Epididymo-orchitis) again and was given allopathic mode of treatment and was advised by his Surgeon to take Homoeopathic medicine as he did not have relief either in pain, nor in his urine c/o, i.e. pain while urination and also Urine routine report always showed abundant Pus cells.
Patient when came on 10th Nov 08 narrated the above history and said that it all has taken very long as he is in Govt. service & about to retire, he is more worried that all the leave that he has to take now is L W P (Leave without pay) and the Surgeon has again asked him to get admitted after getting fresh Urine Culture and Sensitive report so that they can start him on fresh course of Antibiotics. He is worried and says �itna paisa kaha se lane ka� and said �ab aap hi dekho kya karma chahiye�. He was so curious about his c/o that this time he got his Urine routine report and Culture and Sensitive report done at two different place of same Urine sample as he was doubtful about the reporting that he had got earlier.

Presently on visiting he c /o
Location: Scrotum, right side
Sensation: Pain throbbing, sore
Modality: worse from Touch, Rubbing,
better byRest, Lying still

Final Prescription: CALC CARB

Potency: Calc Carb 200 single dose on 10 / 11 / 08
S L 4 pills TDS
Patient was having good susceptibility and the disease was of Acute nature.
Remedy Repetition: Single dose was prescribed
Follow up after Two days
Follow up Analysis
12 / 11 / 08
Pain less by 50 %
Anxiety while talking relieved
Did not utter about his leave
Infact asked to give him Medical certificate so that he can join his job
Confirmed doubtfulness by getting fresh Urine routine report done at three different places
Seeing the curiosity to join his job and on noticing the above fact CALC CARB 1m single dose was prescribed followed by SL
Urine report was shown on 13/11/08 Pus cells 25 � 30 / hpf which earlier was abundant
17/011/08 C / o >>> was kept on SL
22/11/08 C / o >> Patient said �tichki marlya sarkhe wat te�
Had got his Urine report done at one place only which showed Pus cells 15 � 16 / hpf
So was still kept on SL
Learning from the experience of this case
Homoeopathy works FASTEST

DO HOMEOPATHIC DRUGS CONTAIN STEROIDS ?

The answer is a definite '�NO'�.
When appropriate Homeopathic medicines act fast & help acute conditions, people often ask or feel that the physicians are using steroids in the garb of Homoeopathy for quick results.
First of all, can steroid cure all the conditions? No, it will give only a palliative relief for the time being. Also, if you take steroids for a long time, it would induce puffiness of face �moon face�, excessive body hair, osteoporosis, weight increase etc. You can�t find in a single patient using Homeopathic drugs any of the above symptoms of steroid drugs. We don�t use any steroidal drugs since it is against the law of Homeopathy. i.e. steroid suppresses the immune mechanism where as Homeopathy stimulates the immune mechanism for expelling the disease.
The commonly performed test to find out steroids is the "Colorimetric Method test" which gives a false positive result for any reducing sugar & aldehyde. As you know, most homoeopaths use lactose as a base for holding the pills, containing the homeopathic remedy, together in the powders. The pills themselves are made of cane sugar, a reducing sugar. Moreover, almost all Homeopathic remedies have alcohol as a diluting agent. One can see how Homeopathic remedies, either as pills, powders or in alcohol, are likely to give a false positive test for steroids if this method is used. The best test to find out if the medicine contains steroids is the "Liberman Buchard" test, Thin Layer Chromatography Method & a UV Absorption Method. This method helps in differentiating & finding out if the substance indeed contains steroids.
Thus it is clear that before accepting a claim that the tested medicine does contain a steroid, one must find out what testing procedures were used to eliminate the possibility of a misleading result. Unsubstantiated allegations against any doctor or system of medicine are most unfair and damaging to his professional integrity and indeed to the profession.
Homeopathic medicines are completely safe and non-addictive. They can be used without any anxiety by anyone, including small babies, children, pregnant women, breast-feeding mothers, the elderly, and the chronically ill.

Gastro Esophageal Reflux Disease (GERD ) is a very common digestive disorder. Medical therapy , involving acid suppression and promotility agents are very effective for a majority of these patients but a small number of these patients do not get complete relief. Laparoscopic fundoplication is a procedure performed for patients with symptomatic GERD refractory to medical management and that which is associated with hiatal hernia .The problem lies at the junction of the esophagus and stomach where a muscular valve should prevent acid from backing upwards. If this sphincter mechanism fails, acid is free to reflux up into the food pipe and cause damage. The surgery basically augments this sphincter by wrapping a portion of the stomach known as the fundus around the lower esophageal sphincter.Before the laparoscopic approach was developed, this surgery required a large incision and the hospital stay was long. Laparoscopic fundoplication is a safe procedure, and provides less post operative morbidity in experienced hands.The fundus of the stomach which is on the left of the esophagus is wrapped around the back of the esophagus until it is once again in front of this structure.The portion of the fundus that is now on the right side of the esophagus is sutured to the portion on the left side to keep the wrap in place.The fundoplication resembles a buttoned shirt collar. The collar is the fundus wrap, and the neck represents the esophagus imbricated into the wrap.This has the effect of creating a one way valve in the esophagus to allow food to pass into the stomach, and prevent reflux of gastric acid.

DR. NEERAJ JAIN M.D., FIPP (USA)
SENIOR CONSULTANT INTERVENTIONAL PAIN SPECIALIST
SPINE & PAIN CLINIC, RU23 PITAMPURA, NEW DELHI. &
SRI BALAJI ACTION MEDICAL INSTITUTE
(M)09810033800

Ozone Discectomy is the injection of Ozone inside the intervertebral disc in trouble. This is done as an outpatient under local anaesthesia with strict real time radiological control, which ensures the proper placement of Ozone in the center of the disc making it shrink.
LOW BACK PAIN, SCIATICA & PIVD:
Among working age people, as many as 20 percent experience back symptoms at least
every year. spinal diseases are the most common cause of disability in persons under the age of 45. Spine care results in expenditures two to three time greater than cardiac services for many health plans. While there is no specific data related to India, spine surgeons estimate that roughly 5% of the general population is affected by serious disc problems.

Some of the main causes of back pain include facet arthropathy, sciatica, muscle strain, sacroilitis, bulging or herniated discs and degenerative disc disease. Prolapsed intervertebral discs (PIVD) are the most common cause of low back pain associated with a defined structural Abnormality.

Patients who are not helped by weeks of conservative therapy are often referred for
surgery on the premise that further non-operative care is unlikely to help. Ideally, a patient with low back pain that has persisted beyond a four-week period should be referred to a multidisciplinary pain centre.

Different Non Surgical Interventions Employed Successfully:
. Epidural Steroid Inj.
. Epidurogram & Epidurolysis.
. Nerve root sleeve/ transforaminal Inj.
. Intra-discal steroid inj.
. Nucleoplasty- Laser, Thermal & Mechanical
. Ozone Discolysis

Conventional treatment methods for back pain comprise lamminectomy/ discectomy microsurgery, endoscopic disectomy and percutaneous arthoscopic disectomy, among others. These are invasive methods and their goal is to remove or contain the protruding disc. However, these methods have occasionally demonstrated a discrete incidence of failure and/or recurrence. Outcome studies of lumber disc surgeries documents, a success rate between 49% to 95% and re-operation after lumber disc surgeries ranging from 4% to 15%, have been noted. "In case of surgery, the chance of recurrence of pain is nearly 15 per cent as against less than three percent in Ozone treatment.
Reasons for the failures of conventional surgeries are:
1. Dural fibrosis
2. Arachnoidal adhesions
3. Muscels and fascial fibrosis
4. Mechanical instability resulting from the partial removal of boney & ligamentous structures required for surgical exposure & decompression
5. Presence of Neuropathy.
6. Multifactorial etiologies of back & leg pain , some left unaddressed surgically.
THE NEED FOR NEOTECHNOLOGY:
. The various treatment options has confused clinicians and investigators due to high failure rate and complications associated with different kinds of surgeries and interventions. There has been surge of interest in search of safer alternative method of decompressing the nerve roots maintaining the structural stability.
. Another safe least invasive alternative therapy that has been receiving exposure in Europe is the use of medical Ozone (02/03 mixture) in the treatment of PIVD. Epidural steroid injection, transforaminal epidural decompressions has a high success rate (up to 85%), but chances of recurrences are there specially if these interventions are done at later stage. Chemonucleolysis using chymopapain has also high success rate (80%) with low recurrences but not popular owing to the chances of anaphylaxis following intradiscal chymopapain injection. Injection of Ozone for discogenic radiculopathy (low back pain with radiation to legs) has developed as revolutionary alternative to chemonucleolysis and disc surgery .

THE OZONE REVOLUTION IN DISC DISEASES:
Muto suggested intradiscal injection of Ozone for disc hernia in 1998 under CT guidance. Leonardi popularized fluoroscopy guided Ozone injection into the intervertebral disc. After that successful outcome has been reported from various European centers. It is very important to note from those reports that complications are remarkably few. Not a serious single life threatening complication was found even after 120,000 cases of Ozone nucleolysis, which stresses the safety of these procedures.

The most critical portion of performing any of the minimally invasive procedures is accurate and safe positioning of the needle (or terminal device) in the centre of the disc space. The risk in ozonucleolysis is particularly minimised, with the use of a very thin 22/25-gauge needle. It may take anywhere from 5 to 30 minutes to position a needle in the centre of the disc space under radiological guidance. Once the needle is safely placed in position, ozonucleolysis is completed in only another 2 to 3 minutes.

HOW DOES OZONE WORK ?
There are four main biochemical actions on the intervertebral disc and its surrounding tissues. The various proposed mechanisms of action are:


. BY �MUMMIFICATION� OF THE DISC.
. Intra/intermolecular Bonds and collapse of the threedimensional Structure of the disc.
The plausible mechanism of action is the direct effect of the ozone on the Herniation. It is well established that the nucleus pulposus (the actual part of the disc that herniates through annulus) is 70-90% water contained within the domain of proteoglycans. The water binding capacity of the proteoglycan molecule is partially a property of its size and physical shape, but the main force that holds water to the molecule stems from the ionic, carboxyl (COOH) and sulphate (SO4) radicals of the glycosaminoglycan chains. The ozone can have a direct effect on these carboxyl and sulphate groups, breaking down some of these glycosaminoglycan chains which make up the proteoglycans. The destruction of these cross-linked structures reduces their ability to hold water therefore diminishing the size of the herniation by dehydration of the fibrillary matrix of the nucleus pulposus, revealing collagen fibers and signs of regression (vacuole formation and fragmentation)- a sort of disk �mummification.�

. BY INHIBITING INFLAMMATORY NOCICEPTORS.
. Synthesis of Prostaglandines & Secretion of Proteinases
. Liberation of Bradykinines and Pain Inducing Products
. Several studies suggest disc inflammation as a mechanism of sciatica due to disc herniation. Ozone has been shown to have an effect on the inflammatory cascade by inhibiting synthesis of proinflammatory prostaglandins or release of bradykinin or release of algogenic compounds; increased release of antagonists or soluble receptors able to neutralize proinflammatory cytokines like interleukin (IL)-1, IL-2, IL-8, IL-12, IL-15, interferon, and tumor necrosis factor. Therefore, by reducing the inflammatory components there is a corresponding reduction in pain.

. BY STIMULATING FIBROBLASTS & IMMUNOSUPPRESSOR CYTOKINES
. Local production of Antioxidant Enzymes
. Release of immunosuppressor cytokines like transforming growth factor, and IL-10
. Another action which may prove to be one of the most important is the stimulation of
fibroblastic activity by ozone. Fibroblasts initiate the repair process by stimulating the
deposition of collagen. Although yet to be validated, this mode of action could
explain the resolution of PIVD on CT scans and the small percentage of patients who
have relapses after the completion of treatment plan.
. �Ozone may have a reflex therapy effect called �chemical acupuncture�, breaking the chain of chronic pain stimulating anti-nociceptor analgesic mechanism. As pain is multi-factorial, ozone may also have a multi-factorial pharmacological effect alleviating disc compression by shrinkage of the herniated disc.�

. BY IMPROVING MICROCIRCULATION & OXYGENATION.
. The direct effect is the oxygen directly diffusing into the area.
. The indirect action is the Ozone causing an increase in 2,3-DPG (diphosphoglycerate) which has a direct effect in the release of O2 from hemoglobin.. The end result is an increase in the amount of oxygen and a reduction in anoxia.
. Disk shrinkage may also help to reduce venous stasis caused by disk compression of vessels, thereby improving local microcirculation and increasing the supply of oxygen.
This effect has a positive effect on pain as the nerve roots are sensitive to hypoxia.

RESULTS & SAFETY:
In a multi-centre, retrospective 3 year follow-up study of lumber disc herniation treated with European Neurosurgical Institute protocol of ozone therapy in 917 patients showed 78.9% good & excellent results with only one case of disc infection which healed with antibiotic.
In fact, over 120,000 patients have been treated successfully worldwide using injection of medical ozone with a success rate of 80-90% and with a near nil rate of procedure-related complications. �The procedure is a safe and effective alternative to open surgical procedure. Patients get the advantage of going home after a short recovery on the same day. They generally go to work within a week and are spared prolonged absence from work and disability,� The treatment relieves pain substantially and, after two sittings, people "can go back to work under medical guidance".

COMPARISON: SPINAL SURGERY OZONE DISCOLYSIS
1 .More Hospital One day/Day Care.
2 Complications of prolonged surgery& anaesthesia GA is not required
3 �failed back surgery syndrome� No �failed back
surgery syndrome�
4 HighCost Total cost is 1/5th to 1/10th
5 Failure rate 10-51% Comparable 10-21%
6 Safety profile comparatively not so high. Very
high safety prorofile
7 Repeat surgeries are more complicated. May be safely repeated many times
8 Cervical PIVD poses a surgical challenge Ideal procedure in cervical PIVD
9 Highly invasive very demanding surgery Least invasive much easier procedure
10 High postoperative morbidity
Negligible morbidity
11 In-patient major surgery Mostly OPD procedure


CONCLUSION:
Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a day care setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. Total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no post operative discomfort or morbidity and low cost.

DR. NEERAJ JAIN
09810033800