Rabu, 31 Agustus 2016

Qutenza Capsaicin


(...Treatments 2)

Given that this blog is dedicated to searching for facts, in as much as that is ever possible, this is the second treatment to come under the spotlight. There have been earlier posts concerning capsaicin but the more research you do, the more you come to the conclusion that this is one of the few treatments that has been proven to work for HIV patients with severe neuropathy.
Make no mistake about it, the Qutenza patches are strong and have to be applied with medical supervision and/or the greatest care but the statistics are promising.
It seems strange that science has come to the conclusion that two of the most efficient treatments for neuropathic pain are marijuana-based or chilli pepper-based but there you go, if it works don't knock it!
This is once again, a technical report but sometimes we need to learn to read these things in order to learn more about what's being prescribed for us
.


AAPM: Capsaicin Patch Eases HIV Neuropathy Pain

By Ed Susman, Contributing Writer, MedPage Today
Published: March 26, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco


WASHINGTON -- Difficult-to-treat HIV-associated neuropathic pain appears to be eased for at least three months with a one-time, 30-minute application of an 8% capsaicin patch (NGX-4010, Qutenza), researchers said here.

Patients reported a mean decrease of 27% in their Numeric Pain Rating Scale if they were treated with 8% capsaicin compared with a mean 15.7% decrease with the use of 0.04% capsaicin, an active control agent, said Stephen J. Brown, MD, of the AIDS Research Alliance in Los Angeles.

That difference translated to a significant reduction in pain scores (P=0.0026), he reported at the annual meeting of the American Academy of Pain Medicine.

"More than half of people with HIV-infection develop neuropathy, and about 30% to 40% of them have painful neuropathy," Brown told MedPage Today at his poster presentation. "To date, medications used to treat neuropathic pain have yielded disappointing results in large randomized controlled studies among HIV-associated neuropathy."
The only substances that have shown any impact on the pain appears to be the 8% capsaicin patch, smoked cannabis, and recombinant human nerve growth factor -- but none of these treatments has yet been approved by the FDA for that use, Brown noted.

Brown pooled data from two randomized, controlled studies in which 239 patients were treated with 8% capsaicin and were compared with 99 patients who received the active control -- a capsaicin treatment that is stronger than over-the-counter capsaicin, a drug derived from hot chili peppers.

The patients were assessed after three months following application of the capsaicin patch.

Both studies were sponsored by NeurogesX of San Mateo, Calif. The company is seeking an indication for treatment of HIV-associated neuropathy with the patch, which is approved for other neuropathy indications.

Patients were treated with 4% lidocaine for 60 minutes before the application of the patch. "This treatment can be painful," said David Walk, MD, of the University of Minnesota in Minneapolis. Walk has worked on other studies of the 8% capsaicin patch, but was not involved in Brown's HIV study.

"Even with the lidocaine that is delivered before the patch is applied, patients report some pain associated with the patch for as long as a week afterwards, so we usually send them home with analgesia to cover that period, Walk told MedPage Today.

He said that he prefers that that application be performed in the office setting, to assure that the patches are positioned and applied correctly and to treat any acute pain that might occur.

In Brown's study with HIV patients, about 36% of them also reported a reduction of 30% or more in the Numeric Pain Reporting Scale compared with 22% of those patients on the active control agent (P=0.0051).

About 37% of the patients on the 8% capsaicin patch reported a greater than two-point reduction in the pain scores compared with 24% of those on the active control agent (P=0.0284).

On the Patient Global Impression of Pain, about 36% of those taking the 8% capsaicin patch reported that their pain was either much improved or very much improved compared with 22% of the patients on the active control (P=0.0162), Brown reported.

"These integrated analyses show that a single 30-minute NGX-4010 application can reduce neuropathic pain due to HIV-associated neuropathy for 12 weeks," Brown said.

Brown said that 98% of the patients were able to tolerate at least 90% of the intended duration of patch application.

The most common side effects were application site pain and erythema. These mild-to-moderate adverse events were transient and resolved spontaneously within a week, Brown reported.

"I think this patch has promise in HIV-associated neuropathy," Erik Shaw, DO, of Shepherd Pain Institute in Atlanta, told MedPage Today. "This is one application and it appears to be effective for at least three months. I think we are going to see more use of this patch in other neuropathy conditions."

Brown's study was sponsored by NeurogesX.

Walk has disclosed financial relationships with Eli Lilly and Company, Pfizer, Aldoc Pharmaceuticals, AstraZeneca, Johnson & Johnson, and NeurogesX.

Shaw disclosed financial relationships with Azur, NeurogesX, Boston Scientific, and Forest Laboratories.

Primary source: American Academy of Pain Medicine
Source reference:
Vanhove G, et al "Efficacy of NGX-4010 (Qutenza), a capsaicin 8% patch, applied for 30 minutes in patients with HIV-associated neuropathy: Results of integrated analyses" AAPM 2011; Abstract 139.











Medicine Trees








Willow draping stories like waterfalls through the air

Chestnuts throwing daggers

Dripping perfume sap and resin

Broken limbs and torn ligaments

Ripped shoulders across the forest

Open, wounded, left

Littered medicine on neighbors lawns

Left for mulch and compost

Never taken for flu, tea, fire, scars

I scoop the drips from the branch

and dot it carefully on my daughter's incision

she says "thank you"

and I say "thank you"

to all the trees with giant scars

and take home the abandon medicine

for my chest.




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Longing to create more meaningful nature practices? Called into the Forest to learn the Medicine of the Tree Nation?
Tree of the Month Membership: Druantia Clan
~~~~~~~~~
Struggling to put into practice all those notions of Self-Care? Need real tools to help you put YOU first? Longing for a woman's voice to remind you how beautiful and powerful you are?
Woman's Decadent Herbal Self-Care Membership: Lady's Slipper Ring

Selasa, 30 Agustus 2016

Impotency



Impotency

MALE DISORDERS – Impotency - Erectile dysfunction
There are lots and lots of opinions on sex. For some, it is nothing; for some, it is something; for some others, it is everything. So, everything depends on the interest.
 For powerful sexual activities, people often use bunny rabbit or horse as a symbolic representation. These symbols have been used for a long time since bunny rabbit is a symbol for Playboy in sex, due to its brisk, funny, jumping activities and its indulgence in sex, and the horse is an indicator of power, for gaining vim and vigour. Some others may show a masculine body to denote power. In olden days, men had multiple wives and they were also able to satisfy all of them with their physique, healthy food and good, hard work. But this era of white collar jobs with hurried and tensed lifestyle which does not allow for it
In our culture, man is often challenged for his manliness or maleness in all aspects a childless man
is suspected to be an impotent. Actually, sex is somewhat different from fertility. It is a mutually pleasurable activity and nothing more than that. Infertility is the failure in producing an offspring. Impotency is the failure in performing sex. Impotency is a very sensitive topic since the person never wishes to discuss about it with his friends or family or even family doctor.
Any man will be ashamed of himself if his performance in sexual activity is not satisfactory to himself or his partner. In order to conceal his impotency, some men will keep away their wife and pose as if they are not enamoured of her beauty or her activities. The wives are also not so courageous to reveal this to the world due to their shyness. Men take this advantage and blame the women for everything. They also suffer silently, without going for any proper treatment.
Erectile dysfunction (impotency) is the leader of all the complaints which are often left untreated or maltreated. The worst nature is fear and lack of confidence. No excuses should be given in this world of science, as everything can be treated or managed well.
Sexology has become a money-minting zone for quacks who cheat and ruin the life of the patients. Even though there is no complaint at all, taking advantage of the fear and shyness of the patient, they do some costly treatments and recommend multiple drug cocktails, which initially boost the sexual activity but later on often hinder the sex health of the patient.
Generally, lots of impotency drugs are coming into market with attractive advertisement for increasing size, time and act. Are these attractive boosters really useful for the sufferers? No. Since they do not deal with the cause of the complaint or never drive the sufferer to a doctor for analysis or investigating the problem, but it makes them purchase the drugs directly from drug stores.
Many young chaps, with lots of fear and lack of understanding, go for testing their maleness before marriage. They often go to a sexologist, sometimes they even go to prostitutes to rule out their fear and test their efficacy. There they get trapped and exploited with more fear and lot of investigations. Media advertisement is the major trap for youngsters to enter into the unwanted drug world.
Also, most of the young chaps turn up for treatment or drugs only after seeing erotic blue films. They try the same in their life. Sometimes, they could not meet the same in size, time and act, since the film must have been shot in many ways and it was a result of several days of shooting. Don’t try to imitate anything or anyone, maintain your own originality. Also most of them admit or assume they have become impotent and lack confidence to regain their potency. To get rid of all the problems, everyone should know what sex is, how it occurs, what is behind it, what could cause problems, and how to rectify it, etc.
Sexology is the study of act of sex or sexual relationship. Sexual activity is a pleasure or treasure. The attitude and behaviour pertaining to sexual activity differ from person to person. The time and satisfaction also varies, depending upon the person or individual. While indulging in sex activity for the first time, fear of performance or tremor or shiver will be very common for everyone. With great fear or excitement, no one can do anything just right or perfect.
All about sex:
Sex is mainly influenced or driven by sex hormones androgen and oestrogen

Sex is one of the strongest and basic instincts which makes one crave for more
Sex is one of the recreations which can relax the mind and body
Sex appetite is common for everyone but its control varies
Sexual activity and interest can decline with age
Sex keeps everyone young in mind and thoughts
Sex is a pleasurable sportive act or exercise
Sex is really good for health
Sex can bring offspring
Impotency – The most common male sexual dysfunction is impotence. Impotency or erectile dysfunction (ED) is means inability to perform the sexual activity. Almost all men experience this at some or the other time due to overindulgence or due to a lot of time gap. Even though there are many roots for impotency, the main stem is psychology. Even in a good mood, with desire and environment, impotency can occur if the person is stressed out or has problems in life. It can reflect in getting erection. Also, usually, older men need more time to attain firm erection, more time to ejaculate and much more time or days between two erections. Likewise, they will find difficulty in maintaining erection for more a long time. They have to accept Nature’s laws. They could be able to perform better if they adapt to this.
Impotency can pose in different forms depending on the types of origin
  • Difficulty in getting erection (varies from occasional or partial or complete, etc.)
  • Difficulty in sustaining erection (varies from short span to zero time)
  • Difficulty in performing the sexual activity
  • Difficulty in ejaculation or early ejaculation
  • Sex without satisfaction in size, time and act.
Incidence – Impotence affects 15-20 per cent of males. Its occurrence is more common in depressed and psychologically upset persons than others of the same age groups. It is more common in smokers, alcoholics, drug addicts or persons suffering from diabetes or hypertension. Also its incidence increases with age, overindulgence in sex or craving for more. Now impotency is more common than ever before due to early pollution of the mind through the media or modern culture. Now teens get mature very early. This criterion also clinches a major cause for the increased incidences of impotency.
Before discussing the cause of impotency and its treatments, everyone should know about the organs involved in sexual activity in the right way.
Male reproductive organs
Testis – The two male gonads are small oval-shaped glands which hang in a scrotal sac of the inguinal region. They produce sperms. The testis originates in the abdomen and gets descended from the third month of uterine life to the scrotal sac. The ectopic or undescended testis may end in failure. The testis is mostly covered with convoluted seminiferous tubules. The secretions of seminal vesicles and bulbar glands add for the bulk or volume of semen. It is the responsible organ for manliness or maleness with its male hormones.
Sperm – is the spermatozoa of men. It is dispersed through semen. Semen is a mix of sperms and secretions which get ejaculated at the end of sexual act from the penis.
Prostate gland is located just below a male’s bladder and surrounds the top portion of the urethra contributing to the sexual function with its secretions. It adds for the volume of the semen and it neutralises the acid suspension of the sperm and makes the sperm more capable of motion and increases the likelihood of fertilisation. Its secretion is continuous and more during the sexual act.
The benign tumour of the prostate in old age will cause increased desire, priapism (persistent erection of the penis in night) and spermatorrhoea.
Penis
 is a muscular & vascular organ which appears as a long slender shaft in a male. The penis is mainly composed of erectile tissues which are made of sponge-like work that can be filled with blood. The penis is capped with glans penis which is partially covered with prepuce. The glans penis has most sensitive receptors for stimulation of erection and ejaculation. The penis consists of two long columns of the corpus cavernosum and one column of corpus spongiosum. The corpus cavernosa has much arterial supply and blood vessels which usually get filled during erection and account for size enlargement. The centre of corpus spongiosum is pierced with urethra, the tube through which urine or semen get emerged. During sexual excitement, the penis gets engorged with blood and lubricating mucous gets poured into the urethra. Finally erected penis propels the semen deep into the vagina in a series of spurts followed by flaccidity of the penis.
The size and strength of the organ varies from person to person and races. Many males normally crave for long thick penis to satisfy their partner and go for unnecessary treatment. Even though science has proved that the size of the organ is not at all important in activity, as the vaginal canal of the female is sensitive for the initial 4-5cms only, males have a constant craving for it. But in extreme cases of small penis, surgery could help.
The tip or end of the penis has urethral opening. It is the common pathway or outlet for passing urine as well as semen, but never both at a time. If there is a leak of semen in urine, it is called spermatorrhoea which should be treated to avoid weakness.
Erection of penis Penis erection during sexual activity is important for penetrating the vagina. Also a firm erection is absolutely needed to lodge the semen deep in the vagina. The erection of the penis due to the filling up of the erectile tissue with blood makes it rigid and elevated. It depends upon the mental or physical make-up of the person. It gets varied depending upon the partner, places, stimulation and moods. The erected condition of the penis closes the opening of the bladder end and opens the opening of vas end. Normally, a male will have 2-3 erections in sleep (in REM type during dreams which occurs mostly in the early morning).
Mechanism of getting erection – Penile erection is mostly controlled by the autonomic nervous system, i.e. sympathetic and parasympathetic nerves. The stimulation can be from psychogenic or genital touch. On getting stimulation, from brain or genitals,
  • Penis blood supply is increased in many ways
  • Venous return of the penis is blocked for holding all incoming blood in the penis itself
  • The blood filled penis gets elevated and becomes firm
If anything goes wrong, the penis will be flaccid and not enable sexual activity.
Ejaculation – is the sudden forcible expulsion or throw or spurt of semen into the vaginal canal from the penis to reach the uterus. The erected penis will throw semen deep into the vagina. Or, otherwise, it oozes out. It is a reflex phenomenon which intensely makes it a pleasurable sensation for men. The stimulation of ejaculation arises from the glans penis which finally pours the sperm into the vagina with the contraction of the smooth muscles of various glands and ducts. Early ejaculation may occur prior to penetration, or before getting orgasm.
Nowadays, you can see advertisements from money-minting people who promise extra long time for ejaculation. Sometimes, this extra long time may cause failure in getting ejaculation and satisfaction.

Libido
 – is the psychological feeling for moods of sex. It drives and keeps us in sex.

Orgasm
 – is the height or apex in the sexual excitement. The violent muscular contractions and movement of the body including the changes in heart beat, respiration and blood pressure with excitement accounts for the orgasm which is followed by a pleasant fatigue.
Female reproductive organs

Vagina
 is the sheath-like structure forming vaginal canal of nearly three inches from vulva to cervix. It accepts penis during sexual activity. Inflammation may cause pain, loss of libido and white discharges. Itching and urinary tract infection can also spread infection inside the vagina and reflect in sex. Dryness of vagina will cause difficulty in sexual activity and painful sex.
Uterus is the hollow muscular pouch or organ which usually gets prepared during every period for providing lodging facility for the fertilised ovum (if any). It takes care for the accommodation, nourishment and development of the fertilised ovum. If fertilisation of egg doesn’t occur, then it sheds its layers as menstrual bleeding.
Ovaries – are a pair of almond-sized organs which is kept loosely by the side of the uterus by a fold of peritoneum. They manufacture eggs for fertilisation and it is the organ responsible for the sexual moods and femininity of the female.
Fallopian tube – is a tube which leads the ovum from the ovaries to the uterus. Usually fertilization occurs in the middle of the fallopian tube. In case of blocked tubes, the egg or sperm will not be able to reach each other, for fertilisation which may result in infertility.
Ova or ovum – the egg of the female, which after getting fertilised have the ability to become an offspring.
In the female reproductive organs, except the vagina, nothing else is involved in the sexual activity. Ovaries may account for moods.
Causes for impotency may be
Psychological – fear of sex, unfavourable circumstances which affect privacy, inferiority complex, thoughts of previous failures, anxiety, stress, depression, drowsiness, scheduled sex in couples who are planning to have a child, lack of drive for sex, etc., can lead to impotency. Even though the psychological causes are several, in most of the cases the main spark is first time failure which leads to psychological fear and r secondaryso on.
Physical – can be classified as primary
  • Primary – from the very beginning, the person would suffer from the complaint due to physical complaints, i.e. testicular failure caused by congenital deformities like undescended testis (Cryptorchidism), torsion testis, hypogonadism, chromosomal abnormality, hypospadias (urethral opening in the under surface of penis), Hormonal disorders, metabolic disorders, etc.
  • Secondary – is due to effects of diseases or other causes

    Nervous system – Multiple sclerosis, Parkinson’s disease and spinal cord injuries
    Vascular diseases – Hardening of the arteries caused by arteriosclerosis caused by hypertension, diabetes, increased level of cholesterol and metabolic disorders like kidney failure or liver failure, etc., can damage nerves or blood vessels that are engaged in erection of the penis. Stenosis of the arteries or obstructed or clogged arteries can also cause the same effect.
    Infection – Orchitis, untreated mumps can cause swelling of testis and impotency
Drugs – Anti-hypertensive drugs (betablockers), hormonal tablets, anti-depressants, chemotherapy and other drugs used in treating paralysis can cause impotency.

Habits or activities


Food habits – a cholesterol-rich diet, which causes deposition of plaque, obstructs the blood flow producing impotency.

Smoking, alcoholism and other stimulants can cause impotency

Overindulgence in sex can cause weakness and impotency

Occasional sexual contact

Planned or scheduled sex

Symptoms of impotency
Psychological
  • Lack of libido (mood and interest) and confidence
  • No orgasm
  • Dejected life
Physical – may be in different forms
  • No erection at all during sexual activity.
  • Unable to perform due to erection that is less firm
  • Unable to complete the sexual activity due to early erection failure
  • Early ejaculation which causes flaccid penis before getting into the act
  • No satisfaction due to ejaculation failure
Puny penis size
Effects of impotency
 Sleeplessness


Depression


Fear of life

Keep roaming to avoid coming home

Family disintegration or divorce


Suicidal mania

Present way of diagnosis
There is no need for diagnosis and investigations if erection failure occurs once in a while or so. But if it occurs repeatedly without any notable weakness or emotional stress, it should be properly investigated in the early days itself, to treat it or otherwise the more the time delay, the more the problems arises in mind, body and family.
The routine tests are
Hormone tests for testosterone and follicle stimulating hormone (FSH)
Testicular failure is often indicated by
* Decreased testosterone level (normal testosterone level – 300- 1100ng/dl)
* Increased FSH (normal FSH level – 2-17 ml IU/ml)
Penile Doppler scans to check arterial obstruction or stenosis and venous leak

Rigi scan – for two consecutive night (in sleep laboratory) to check the occurrence of rigidity or erection in night for diagnosing the cause – whether physical or psychological. If there is no erection at all at night, then mostly the problem will be physical i.e., due to artery stenosis or obstruction or venous leak or others
Semen analysis
Ultra sound scan for prostate problems
Routine blood tests including electrolytes to rule out any metabolic disorders
Advice to sufferer to enjoy sex again as a pleasure 

Caring or precaution or prevention

In general, keep good health with regular good habits and good exercises.

Do’s
  • Try sexual activity in early morning if there is problem in getting erection, since erection will be more rigid during or after deep sleep and in a cool climate. The success will trigger your mind and body to become normal.
  • Don’t give much gap between two sexual activities (not more than a week) which may lead to premature ejaculation or erectile dysfunction or dissatisfaction. For this, normal condition can be revived by tuning the frequency of sex itself.
Avoid
  • Stress and strain
  • Loneliness and deep thoughts
  • Pre-occupied notion or thoughts of poor experience while indulging in sex
  • Stimulants like alcohol, drugs, coffee and tea
  • Drug cocktails
  • Smoking (since it will promote arteriosclerosis and obstruct arterial blood flow)
  • Fatty diet
Take
  • Natural foods, vegetables, fruits, nuts, seeds, honey, milk, meat, egg, etc.
  • Recent research shows that drumstick seeds have some aphrodisiac (sex boosting) effect. Also from good old days, garlic, onion, asparagus, cashew, pista, dates are believed to have medicinal effect for impotency.
  • But usually people run behind quacks who sell costly, rare ‘medicines’ which is supposed to have an aphrodisiac effect i.e., rhino horn, moschus musk, horn of deer, vivera civetta (a rare variety of cat), peacock feather, mutilla occidentalis, fat oil from shark, etc. Also some recommend cannabis sativa for boosting effects. People usually think that the thing which cannot be achieved easily or which is high in demand has highest value. But nothing have been proved so far about their efficacy.
Finally for better sex – Spice your spouse or spouse should spice you.
Advice for the sufferer
  • Be open hearted to your better half and doctor
  • Hope for success and hope to succeed
  • Greed never wins and he greedy never get satisfied.
  • Haste goes waste
Advice to partner
  • Your satisfaction keeps your partner more energetic
  • Foreplay is important in getting full erection
  • Never do intercourse until full erection is attained or otherwise it may lead to failure
  • Keep in mind, if the partner is cheering and cooperative, drugs are just litter
  • Don’t tease about failure
False ideas
  • All childless men are impotent.
  • Aged persons cannot perform sex
Masculine and a well-exercised body is more potent
General treatment – First of all, everyone should understand that for getting treatment, age is no bar. Lack of treatment or getting treatment late makes oneself and one’s partner suffer psychologically. Impotence is the commonest problem of men which is often corrected easily with treatment and reassurance.
Present way of treatment
Psychological – even before analysing the cause, everyone should be psychologically reassured for complete recovery. Psychological counselling can help
Hormonal – Sometimes hormonal supplementation will be given when there is a disturbance in hormones. But beware that testosterone therapy can cause cancerous testis or prostate
Early ejaculation – Anti depressive drugs are often used for this type of complaints. This may create dependency or drowsiness or lack of concentration
Physical complaints like artery stenosis and venous leak may need surgical correction
For systemic illness like diabetes and hypertension – the blood glucose and blood pressure should be maintained in a perfectly normal level or otherwise there will be permanent damage in getting erection
For aged – Aged persons generally need more local stimulation or physical arousal since the brain gets atrophied during the ageing process. So getting the mood through psychological arousal gets weakened. But this is normal. No medications are required if they accept nature and life. The word “as before” is often used by these patients during consultation. One thing should be clearly understood: yesterday will not come today and today will not come tomorrow. We must satisfy ourselves with the present situation. They can surely perform sex pleasantly and pleasurably, but not vigorously as before.
Drugs for vim and vigour – These drugs mostly encourage men to use it for recreational use. They have side-effects like headache, flushing, allergic problems and diarrhoea. Even though the market is full of new arrivals, Viagra and Levitra lead the race. They reward sexual life for the time being, by flooding the penis to have a prolonged erection.
Injections – Papaverine is injected into carpora cavernosa to get firm erection for the time being. The common complication of using this injection is priapism.

Organ development
 – In extreme cases, surgical corrections can be done by inserting two silicon rods into corpus cavernosum to increase the size of the organ and better sex. But this procedure will cause persistent erection all the time. There are many companies and doctors who cheat people by lengthening the size of the penis by selling oils, jellies, tablets, tonics and even some instruments. Unless otherwise the person is in a growing age, it is not possible to increase the size. They have so much confidence that people will not come back or expose them about giving them false hopes or the failure in treatment. Regular erection in a good mood act as an exercise for developing the organ size.

Homeopathic approach – As the main message of this article, don’t be depressed or fearful or feel hopeless. A hopeful heart always keeps you happy. Be optimistic. Be cheerful.
Further, there is no need for magic prescription when you keep yourself on the right track, i.e., providing the right treatment for your problem. To recapture your youthful vigour, don’t go in for booster drugs. They last only for a few minutes. You will need it again the next day and you will not be able to have sex without those tablets – it will create dependency. Homeopathy never acts as a booster. But it works to make a person normal or revive the active normal state. So Homeopathy drugs can’t be used just for recreational purpose or just to boost erection or get the right mood for the time being, like other drugs.
In Homeopathy, erectile dysfunction can be corrected without any dependency or side-effects. It will blend perfection, pleasure and happiness in your life. Homeopathy also cures the most 
distressing symptoms of the impotency like early ejaculation and flaccid penis. Happiness
usually continues after a single success.
Homeopathy treats the patient and not the disease. It gives importance to the feelings of the patient. It cares for each individual and every symptoms of the disease or patient. Individualization is the specialty of Homeopathy.
There are many wonderful drugs for sexual weakness or relaxation of the parts. The Homeopathic medicines commonly used in cases of impotency are Acid phos, Agnus castus, Arg nit, Caladium, Cantharis, Conium, Damiana, Gelsemium, Lycopodium, Moschus, Nuphar luteum, Onosmodium, Pulsatilla, Sabal serrulata, Selenium, Sepia, Staphysagria, Titanium, Yohimbinum, etc. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)
Laxmi Homeo Clinic
24 E. New Mahalipatti Road
Madurai, TN 625 001
India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)
Fax: +91-452-233-0196
E-mail:  drcheena@yahoo.com
www.drcheena.com / www.drcheena.in





(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)


Senin, 29 Agustus 2016

Anal abscess and fistula



Anal abscess and fistula

Infection and abscess mostly arise in glands or hair roots of the skin. The infected spot initially erupts and then forms an abscess. The abscess gets opened and discharges its contents (pus) and then heals. Depending upon the load of infection, septic conditions like fever and toxic symptoms can result in the course of anabscess. Abscess will be usually red hot with throbbing pain. The abscess, after getting fully blown up with pus, usually opens near the surface and lets out the pus naturally. To save time and live comfortably without pain, abscess is now dealt with surgically with incision and drainage (I&D). If it is deep, persistent, not properly drained or becomes chronic in nature, then it gets reformed as a small cavity or sinus with a single opening. Sometimes, it opens at both sides/ends and thus becomes a tunnel or tract – namely fistula.
Anus, the exit route of faeces and it surroundings are more vulnerable to bacterial or fungal infection due to moisture and folded skins. Germs/micro organisms will also be more concentrated in that area in spite of cleanliness. Usually, infection occurs and causes boils or abscess due to lack of hygienic condition, but sometimes the causes remain unknown.
Anal abscess – Abscess is a mere collection of pus which is supposed to drain either inside or outside where the points are weak and easily prone for an outlet. Anal abscess mostly presents itself as a tender swelling in or around the anus with throbbing pain. Even though perianal abscesses are more common after piles, fissure and gland infection, ischiorectal abscess and submucous abscess can also be seen. Common bacterias which usually cause infections are staphy, E.coli, strepto and proteus. Sometimes abscess arises spontaneously without any cause. Mostly abscess opens externally and drains to cure. But sometimes it can lead to a tract of deep location to open in and out, giving rise to fistula. Either way i.e. natural drain or surgical drainage, if it lacks care in healing, the chances of fistula formations are there.
Fistula – Fistula in general, means abnormal passage/tunnel/tract which connects gland and skin or mucous membrane and skin. It occurs as a complication while the abscess gets resolved. It is either lined with mucosal membrane or may be lined with granulation epithelial tissue. There are different types of fistula, i.e. anal, umbilical, urethral, perineal, thyroglossal, salivary, arterio-venous, etc. Usually, the fistula opening will be indrawn and covered with the crescentic fold of skin.
Anal fistula – Among fistula, anal fistula is the commonest and most bothersome. Most commonly it arises from perianal abscess. This anal fistula mostly connects anus / rectum to the outer skin. Sometimes, it may connect anus and vagina or anus and urethra. The fistula usually traces the drainage pathway of the abscess. It may have a single or multiple opening(s) in inner/outer aspect, depending upon the position and direction of the drainage of the abscess. The fistula having multiple opening should be seriously investigated for tuberculosis or Crohn’s disease.
Incidence – Males have higher incidences than females. It usually follows in at least 40-50 per cent of anal abscess cases. Unhygienic conditions also favour higher incidences.
Pathophysiology – Usually, every abscess opens one day or the other and lets out the pus. Sometimes it needs surgical intervention to drain, especially when it is deep. In any case, if it doesn’t heal up properly or if it is not properly drained after letting out the pus then it will usually remain as infecting foci and suppurates. Also this will constantly or intermittently discharge pus or fluid through the outlet/tract. In due course, this tract gets lined with granulation tissue which resists healing (joining the other surface). Fistula’s length and openings (internal and external) usually vary in size and number according to the location of the abscess and care taken over it. Usually, the fistula tract will be a curved one. Untreated fistula or clogged outlet of fistula (due to infection or draining debris obstruction) will usually promote multiple internal/external openings with recurrent anal abscess and re-formation of tract or tunnel.
Causes – Ill-treated or maltreated infection and abscess are the main causes for fistula formation, the other causes include negligence/lack in treatment of piles, anal fissures, Crohn’s disease, cancer, constipation, etc. Fistula formation is mainly due to improper and inadequate drainage of pus from abscess with narrow opening or block or high opening or presence of infective foci or foreign bodies or unhygienic conditions. Another important cause to be ruled out is nylon underwear which does not absorb moisture. The major aggravating factor is pressure exerted by physical strain while passing stool since it will propel the faecal matter into the fistula tract.
Symptoms – Anal fistula is mostly present with the following symptoms, when there is infection or strain or block.
Feeling of lump near the anus with stabbing/throbbing pain
  • Pain will shut off immediately after letting out the pus
  • Continuous or intermittent (on and off) leakage of foul pus/mucous/faecal matter from the fistula’s external opening, soiling the inner garments
  • Discomfort and skin infections due to constant wetness caused by leaked fluids
  • Constipation or diarrhoea
  • If fistula gets blocked, again there will be abscess formation with the symptoms of swelling, fever, malaise and septicaemia.
Diagnosis – Anal fistula can be diagnosed easily by physical examination of the anus and its surroundings. Rectal examination, sigmoidoscopy and fistulography give more details about the abscess, its tracts and openings.
Management
  • Take plenty of water and fruit juices to avoid constipation
  • Follow hygienic measures in cleaning and caring
  • Pass stool twice a day to avoid strain to rectum and anus
  • Don’t strain while defecating. It is better to have semisolid stool for easy defecation
  • Sitz bath – After passing stool, sit in a shallow bath tub filled with antiseptic lotions or warm salted water for 10 minutes, to make the condition hygienic
  • Hot compress can help anal abscess by enhancing blood circulation for diluting the infective toxins over there and healing faster with supply of nutrients
General treatment Fistula is usually very difficult to cure with medicines. So, allopaths mostly opt for surgical excision of fistula namely Fistulectomy. But, even after surgery, the chances of recurrence are more, which may be due to leftovers of fistula tract or abscess residuals or suppuration after surgery. Caution should be exercised during post-operative care for otherwise the tendency to form abscess will post another innings with a new tract formation. Other than delayed healing, abscess formation and recurrence of fistula, surgical removal can also cause incontinence of anus related to urge. These make the sufferers dejected and shameful.
Preventive measures
  • Follow regular bowel habits without any strain
  • Follow hygeinic measures to keep anal area clean and dry
  • Treat any infections or boils immediately
  • Avoid nylon underwear and use cotton ones
Homeopathic approach to fistula – Homeopathy can help avoid fistula formation, when anal abscess is properly treated with Homeopathic medicines. Treatment for fistula should be started at the earliest, to heal it before gets granulations in the tract so that it can heal completely without giving any residual gaps or chances of recurrences.
Homeopathy usually cares fistula by controlling infection and helping the wound to heal. It aids natural cure. Patients need patience while getting treated for fistula since the fistula opening looks like it has healed but opens suddenly on strain or with a new anal abscess. Everyone can keep hygienic condition externally, but not internally. Since faecal matter is full of microorganisms, no one can avoid getting infection unless they have gained resistance to infection. Homeopathy can provide this. Also, for complete healing, fistula should get healed or closed from within first. Otherwise, the outer opening can reopen anytime or open a new tract to a new place.
Homeopathy can abort the tendency to abscess formation and suppuration by increasing resistance. So it can thus avoid the hindrances to cure by helping the healing process to continue naturally without interference. Also, to heal the fistula, first of all, the flow of fluid must get stopped since the draining fluid itself acts as a layer of separation to resist healing. For that, the tendency to fluid collection and suppuration must be stopped. Homeopathy provides this without any surgical measure. If the flow gets stopped, the pathway dries up naturally and shrinks to get close approximation for better healing.
Homeopathic medicines commonly used in cases of fistula are – Acid Nit, Apis mel, Bacilinum, Calc Flour, Calc Phos, Calc Sulf, Calendula Q, Capsicum, Carboveg, Causticum, Collinsonia, Graphites, Hamemelis, Hepasulf, Hydrastis, Hypericum, Lachesis, Lycopodium, Mag Phos, Mer cor, Merc sol, Muriatic acid, Silicea, Sulphur, Thuja, etc.. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)
Laxmi Homeo Clinic
24 E. New Mahalipatti Road
Madurai, TN 625 001
India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)
Fax: +91-452-233-0196
E-mail:  drcheena@yahoo.com
www.drcheena.com / www.drcheena.in



(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)