Monteggia Fracture Treatment Information

The Monteggia fracture is a fracture of the ulna, which affects the relationship with the department. Fracture Monteggia frequently associated with dislocation of the radial head. More common in children. Due to blow on the forearm. Monteggia fracture-dislocations are classified by the system Bado. Bado monteggia classified four types of injuries and said radial head broke up the angulation of the ulna. Type I is characterized by ulnar fracture with proximal anterior dislocation of the radial head. Mechanism of injury is described as a direct trauma to the posterior part ulna, or fall on an outstretched arm.

Another mechanism described is falling on an outstretched arm with the hyperextended elbow. This pattern is more common. Type II injuries are “reversed” Monteggia fracture-dislocation injuries. The fractured ulna tree is after the apex. This lesion is thought to be caused by a force rotation in supination or direct trauma of the forearm in supination position. This pattern is rare in children and is often a compound fracture. Type III monteggia lesion side or antero-lateral dislocation of the head with radial fracture of the ulnar metaphysis. This pattern is unusual, and all cases were reported among children.

The mechanism of injury can be a direct trauma on the inner aspect of the elbow with or without rotation force. This causes an adduction force moving radial head forward. Pronation and supination forces added lead-lateral posterior or anterior-lateral dislocation. Type IV monteggia lesions anterior dislocation of the head with a radial fracture of the proximal radius. The ulna has a pre-summit before the break. Treatment of a Monteggia fracture is with surgery to repair the ulna fracture. Intravenous antibiotics should be administered to patients with open fractures. Ketamine is a very useful drug for sedation.

Cast Away Your Fracture Coding Confusion

Fracture care is one of the most common procedures performed in the ED, yet many EDs barely break even treating these and other types of orthopedic injuries. To avoid denials and unnecessary fee reduction, coders must know whether the physician provided restorative or definitive care, or whether the patient was only stabilized and referred out.

Identify Fracture Type

The ED physician typically identifies the injury’s type and location. You can locate diagnosis codes for traumatic fractures in ICD-9’s injury and poisoning section, where they are classified according to body area. The ICD-9 code’s fourth digit signals whether the fracture was open or closed. Compound fractures or fractures that involve foreign bodies are usually open fractures, while greenstick or simple fractures are closed.

Occasionally, the chart fails to define a fracture as either open or closed, in which case you should code it as closed. That’s because an emergency physician usually provides closed treatment only, meaning the doctor doesn’t surgically open the injury site, even when caring for an open fracture.

When the chart lacks sufficient detail about multiple fractures, combination categories such as 817.x (Multiple fractures of hand bones) can be handy. However, if the chart includes detailed information about each fracture, then you should code each fracture separately using the fifth-digit subclassification, such as 816.02 (Fracture of one or more phalanges of hand; distal phalanx or phalanges).

In cases of multiple fractures, always list the most severe instance as the primary diagnosis. For fracture dislocations at the same anatomic site, report only the fracture code, because fractures are usually also dislocated as the result of the injury. Therefore, the ICD-9 manual lists dislocation as a nonessential modifier or one that is included in the fracture code.

Treatment Details Signal Billing Choices

Once you have identified the diagnosis to support medical necessity, the next crucial step to determining reimbursement is to pinpoint the type of treatment rendered. Coders must also establish what kind of care the physician provided was it restorative or definitive care? Or, was the patient simply stabilized in the ED and referred out to an orthopedic surgeon?

The most confusing aspect of fracture billing is who can bill for what” ” says Carol Dodd RHIT senior coding consultant for MedQuist Coding and Information Services in Gibbsboro N.J. The problem results from the fact that “fracture care is coded as a complete or bundled procedure that includes both pre- and post-op care.”

Note: The fracture and dislocation management codes are in the CPT manual’s musculoskeletal section and include fracture and/or dislocation codes grouped under body area. This section ends with listed procedures for application of casts and strapping.

Because few ED physicians provide definitive fracture care except for closed nondisplaced fractures an ED doctor will usually stabilize the fracture bill for an E/M and the splint and send the patient to an orthopedist for follow-up. The follow-up period could range from several weeks to several months of office visits which may include changes of casts or further treatment. According to Dodd if the emergency physician bills for only the E/M and the splint the orthopedist could bill the unmodified fracture code.

Use procedure codes for casting and strapping (29000-29799) when the application is an initial service performed without any restorative treatment or stabilization or when the service is a replacement procedure used during or after the follow-up care period.

For initial splint applications and replacement procedures “we code an E/M because the patient presented to the ED we took a history did a review and an exam ” says Tracie Christian CCSP CPC director of coding at ProCode in Dallas. “Then the splint would be an additional procedure code.” For instance a patient presenting with a simple break in the forearm would be splinted and 29125 (Application of short arm splint [forearm to hand]; static) would be used in addition to the proper E/M level. Be sure to append modifier -25 on the E/M service to show that it was a separately identifiable service from the splint application.

Initial Stabilization and Beyond

Such initial stabilization usually constitutes a temporary measure that allows for definitive or restorative care to be performed by an orthopedist later. Fracture and/or displacement codes have global periods which means they include a medical examination open or closed treatment of the fracture and normal uncomplicated follow-up care. Any subsequent cast application or supplies should be billed independently as should postoperative complications that require additional procedures.

“If the physician is merely splinting the fracture and referring the patient to an orthopedic surgeon then that is restorative stabilization and not definitive/restorative care ” Christian says. But “if we can document that the physician is providing restorative care such as manipulating a dislocation into line then we can bill for that.”

Consider an example of restorative stabilization: A patient presents with a displaced fracture of the distal radius. The ED physician documents that he has manipulated the fracture back into alignment applied a splint and referred the patient to his or her own primary physician or orthopedist in five to seven days for follow-up. Code the fractured distal radius (813.42) and the CPT fracture care code 25605-54 (Closed treatment of distal radial fracture; with manipulation; modifier -54 indicates Surgical care only).

Another example is a patient who presents with a dislocated shoulder and the ED physician documents that he has reduced the shoulder dislocation using manipulation and weights applied a sling and referred the patient to her primary physician or an orthopedist in five to seven days for follow-up. In this case code the dislocated shoulder 831.00 and the shoulder relocation code as 23650-54 (Closed treatment of shoulder dislocation with manipulation; without anesthesia; modifier -54 indicates Surgical care only).

Definitive or restorative care may also refer to splinting strapping and/or pain management. For example most rib-fracture cases include pain management as the definitive treatment and are rarely strapped or splinted. In contrast long-bone fractures almost always require casting or other definitive treatment by the orthopedist. Definitive care aims to repair rather than simply stabilize the injury.

Example: A patient presents with a rib fracture and the ED physician documents that he provides breathing instructions prescribes pain medication and refers the patient to his primary physician for follow-up. In this case Christian notes that she would code the rib fracture 807.0x and use the CPT fracture care code 21800-54 (Closed treatment of rib fracture uncomplicated each; modifier -54 indicates Surgical care only).

In another example a patient presents with a non-displaced nasal fracture and the ED physician provides the patient with an ice pack prescribes pain medication and refers him to his primary physician for follow-up. The nasal fracture would be coded as 802.0 and the correct CPT fracture care code would be 21310-54 (Closed treatment of nasal bone fracture without manipulation; modifier -54 indicates Surgical care only).

Splint Strap Wrap Cast

“We rely upon the physician’s documentation to indicate his or her application of splints straps wraps and casts ” Christian says. “When appropriately documented we can bill for these services. For example: A patient presents to the ED with a sprained ankle and the ER MD documents that he or she applied a splint to the ankle. We would code 845.00 for the ankle sprain and CPT code 29515 [Application of short leg splint (calf to foot)].”

If the patient broke the splint two days later and returned to the ED for a replacement Christian notes that she would code V54.8 (Other orthopedic aftercare change checking or removal of cast or splint) and 29515 with either modifier -76 (Repeat procedure by same physician) or -77 (Repeat procedure by another physician). If difficulty was encountered in reimbursing both claims the payer may request copies of the record to verify the necessity of repeating the application.

“Very few ED physicians do casting ” Christian says. “The fracture care in the ED is typically limited to splinting strapping the use of buddy tape and/or pain management.”

Fracture care codes include the application and removal of the first cast or traction device but subsequent replacement of a cast or traction device may require additional codes from CPT’s casting and strapping section. “Sometimes a patient presents not with a broken bone but with a cast that has been cracked or gotten wet and we can charge for a reapplication in that instance ” Christian says. “Typically if the patient was seen somewhere else and got a cast then they present to the ED we could bill for a cast reapplication because the service was supplied by a different physician.

“A worst-case scenario would be that the payer might wonder why we were submitting such a bill two times and they would want to see the medical records that would show it was necessary to reapply the cast ” Christian says. “I could see doing an initial splint application in the ED then the patient breaking the splint two days later. Then we would rebill for the service.”

Road Accidents and First Aid

Author – Dr.Jimmy.M.L.
1. Accident rate and ‘golden hour’
The major cause for death below fourty years of age in the world population is road traffic accidents. Hence it is called pandemic of twenty first century. The Indian R.T.A. rate is six percent of the total world rate, even though the total number of vehicles in Indian roads is one percent of the total world number. R.T.A. death rate in India is double that of the developed world.
The chart of deaths occurring after road traffic accidents can be grouped into three peaks. First peak of deaths occur immediately after the accidents. The major reason for death in this group is head injury. It is usually non preventable. The second peak of deaths occurs within first four hours after the accidents. This period is called `Golden hour’. The main cause of death in `Golden hour’ is blood loss. The third peak of deaths occurs three weeks after the accidents. This is due to multy organ failure. This has to be treated in the hospitals. If we can give correct first aid and shift the patient to the optimum hospital as early as possible; then we can reduce three fourths of R.T.A. deaths and can also improve the quality of life obtained after the treatment completion of accident victims.
2. ‘Control’ at the accident site
First of all, the care providers or volunteers should protect themselves from getting injured at the accident site. Then, off the `ignition’ of the involved vehicle. Abstain from carelessly throwing lighted cigarettes or other ignitable materials at the accidents site. Otherwise it may ignite the spilled fuel from the vehicle and produce major fire. The accident victims should be removed from the vehicle to a safer place by slowly removing the heavy objects fallen on their body instead of pulling them. If there are more volunteers at the accident site, then we should take their help also instead of doing everything by ourselves. We may send some volunteers to inform the police, ambulance, the hospital where we are going to carry the victims and relatives of the victims by phone.
3. ‘Triage’ and order of the first aid
When many persons are involved in an accident, they are sorted by an expert and are given different colour cods according to the order of priority in which they are to be shifted to the hospitals. This is called ‘triage’. The victims who are to be shifted immediately to the hospital are given red, second priority victims are given yellow and the persons who may be shifted at a later time are given green color codes. Dead persons are given white and the persons who are very serious but will not survive even after shifting them to the hospital are given pink colour code. The first aid provided to the accident victims are conducted in the order of A, B, C or airway, breathing, circulation, bandage, splintage, and transport.
4. First aid for `breathing’
First step in the R.T.A. first aid is examination of the airway. The breathing is checked by placing fingers in front of the nostrils. If breath air flow is absent, examine the mouth and nose to check for any obstructing objects such as loose artificial dentures, mud etc. If the bones of the face are broken, place the `airway’ that makes a passage for the air from outside to enter in to the lungs. If the air is not entering the lungs after the airway is kept, pierce the trachea with five or six large bore injection needles to let the air in.
Next examine the breathing, by observing the chest movements or by using Stethoscope. If the victim is not breathing; give artificial respiration by `mouth to mouth’ breathing. This is given by making the victim lie on the floor and then extend the head of the victim and open the mouth by holding on the jaw. Keep a towel in front of the mouth of the victim. The provider takes deep breath and then exhales to the mouth of the victim by placing his mouth over the towel. This is repeated twelve times in a minute.
5. First aid for `circulation’
Next examine the `circulation’ or the functioning of the heart and blood vessels. Usually the heart function is assessed by palpating the `pulse’. Usually `radial pulse’ is palpated to assess the heart function. This is palpated by placing three fingers just below the front of the wrist, on the side of the thumb of the victim and the volunteers thumb on the back. Feel for the repeated elevations of the three fingers. 2
If the radial pulse is not available; look for carotid pulse. This is felt by placing the fingers of the provider in the upper part of the neck, just below the corner of the jaw. If this is also impalpable; then it can be concluded that heart is not beating sufficiently.
If the heart is not functioning sufficiently, artificially squeeze the heart from outside for sending the blood to entire body and this is called `cardiac massage’. For this; make the victim lie on a firm place and place the heel of the palm one above another on the lower part of sternum. Keeping the elbow and wrist straight, press the chest by giving force from the shoulder so as to press down the chest to one and half inches. This is repeated seventy two times in a minute. In children use one hand so as to press down the chest to one inch and in infants use two fingers so as to press down the chest to half an inch. Cardiac massage is continued till the functioning of the heart returns or up to half an hour. Once the heart starts functioning; Place the patient in the side position or in the `recovery’ position. If both the heart beating and respiration are absent; give the ‘cardiac massage’ and ‘mouth to mouth breathing’ in the ratio of 30:2 which means 30 ‘cardiac massages’ followed by two ‘mouth to mouth breathings’.
Next, search the body to identify bleeders. If the bleeding is occurring from the limbs, keep them elevated to reduce the blood flow. After that, give `pressure bandage’ by using pads and tie them with pressure. ‘Tourniquet’ or tying the limbs with rope may produce further damage to the limbs and hence must be avoided.
6. Rapid examination and fluid `shock’
Examine the head, eyes, nose, ears, chest, abdomen, pelvis and limbs to detect wounds, contusions etc. Ask the victim to move the toes, fingers and the limbs to check their movements or function. With the help of two volunteers keep the victim on the side position, identify the wounds on the back and check the tenderness behind the centre of neck and vertebral column. These examinations are to be done with in two minutes.
Fractures in the pelvic bones may produce oozing of blood to the abdominal cavity. This may cause death. Hence such a victim has to be shifted immediately to the hospital. A condition called `shock’ develops; when more than forty percent of the whole body blood is lost due to multiple bone fractures, deep wounds or pelvic bone fractures. The feeble pulse, cold and pale skin, fast and shallow breathing and loss of
consciousness are the signs of the `shock’. In such a stage; the legs should be elevated to shift the blood to the vital body parts like brain. At the accident site; penetrating objects should not be removed from the body of the victim because it may cause death due to internal bleeding.
7. Bandage, splinting and transport
Cover the all the significant wounds by using pads and bandages. The abnormal movement in the chest and breathing difficulty due to fractures of many ribs can be reduced by strapping the chest with cloth. If the abdominal viscera went outside the abdomen due to wounds, relocate it to the abdominal cavity and cover the abdomen with clean cloths.
Use splints in the case of fractures to prevent further damage to the near by tissues, blood loss, pain and edema. The available materials like wooden bars, Umbrella etc. may be used as splints to immobilize the fractures by tying them around the fractured limbs. A square shaped cloth may be folded to form a `triangular sling’. This is used for immobilizing upper limb fractures. A fractured lower limb may be immobilized by tying it to the uninjured lower limb with the help of four cloths.
The possibilities for vertebral fractures are high, if there is tenderness behind the centre of the neck. If the neck moves in such a victim, spinal cord may be damaged by the fractured vertebral column to produce paralyses of the limbs. Hence in such persons, the neck should be immobilized using hard cervical collar. If there is tenderness on the back of the centre of chest or abdomen, the victim should be shifted to the ambulance by four persons like a `log of wood’ or without bending the victims body.
8. Matters related to the hospitals
The decision to shift to the respective hospital is made after considering the financial status of the victim and the type and seriousness of the injuries. If the treatment for the specific injuries of the victim are available, it is better to shift to the near by hospital. The head injuries patients are to be shifted to a hospital were C.T. Scan and Neurosurgeon is available. The amputated body parts should be placed in a clean plastic bag which is placed in another plastic bag containing ice cubes and the bag is tied safely. This should be carried within 6 hours to a hospital with micro
vascular surgical facility. Victims with severe muscle or soft tissue loss are to be shifted to hospitals where facilities for plastic surgery are available. Hand injury victims may have tendon cuts which require suturing and hence they are to be shifted to hospitals having orthopaedic or plastic surgery departments.
In order to undergo anesthesia for major surgery, the patient has to abstain from taking food and drinks for six hours. The seriously injured victims should not be given food or drinks after the accident because they may require major surgery. After transporting the victim from the accident site; instead of forsaking the victims in the hospitals, intimate their relatives, give the doctor necessary information to write the police intimation and also if necessary arrange for blood transfusion.
9. Causes and solutions
Driving after consuming alcohol must be avoided because even with minor quantities of alcohol; decision making capacity, co-ordination, muscle strength, vision and hearing may be impaired. Drunken driving, sleepy driving, over speed, non use of seat belts or helmets, use of mobile phones during driving, carelessness and disobeying of traffic rules may cause R.T.A.s or make the injuries more grievous and hence must be avoided.
Those who drive the vehicles must rectify their health problems by undergoing time to time health check ups and treatments. Those who are in diseases like fever which causes tiredness, those with recurrent heart pain, fits and dizziness etc. and those who have taken medications that causes tiredness like that for allergy, should not drive vehicles. In the circumstance of increasing R.T.A.s and treatment expenses, every one must take R.T.A. health insurance. Well equipped first aid box in the vehicles and first aid training to all vehicle drivers and travelers can cause reduction of R.T.A. deaths and improve the quality of life obtained after the treatment completion of the injuries.

Cerebral Palsy Therapy

There are many forms of physical Cerebral Palsy therapy that can help reduce the disabilities associated with this disorder.

Each person with Cerebral Palsy will often need a specialized kind of therapy.

The Maribelle exercise assist system, otherwise known as the MEAS is one option that people with Cerebral Palsy may be interested in and has had very beneficial results.

The MEAS is an exerciser that is suspended from the ceiling with a body support. This allows people that have little or no use of their legs to actually be put in an upright position (supported standing), or a sitting position where they can move or move with assistance. For example, swinging.

The benefits of this are many, including much enjoyment for the user just from being in an upright position, or from the swinging and other possible movements. Remarkably, the movements in the MEAS result in LESS spasticity! 3 to 5 minutes of gentle bouncing, followed by swinging, invariably will relax tight elbow joints and clenched hands will open up.

The Neurophysiological reasons for this change have been well documented in research studies about using rebounders.

Progressive treatment goals, which have been achieved in varying degrees by the regular use of the MEAS in an eight week or longer program include:

1. Eye contact, tracking, eye-hand coordination, focusing, dramatically improved vision.

2. Increased attention span, improved learning skills.

3. Social awareness, interaction with peers, self confidence

4. Vocalization, improved speech.

5. Independent purposeful movement, muscle development.

6. Head Control, trunk balance, independent righting.

7. Improved circulation, improved bowel function.

8. Reduction in flexon spasticity, relaxed open hands.

9. Reduction in extension spasticity, less startle reflex

10. Release of frustration, improved morale, enjoyment.

11. Easier to feed after exercise, better appetite

12. Self feeding, finger foods, spoon, fork.

13. Desensitization of skin areas, particularly the soles of the feet, starting by letting the user splash their feet in warm water, shaving foam etc.

14. Crawling, independent mobility, knee walking, running.

15. Reduction of Athetoid movements allowing the person to control their electric wheel chair independently after exercising in MEAS Therapists have reported that clients who were fearful when they were placed in a hammock are much less afraid of doing Sensory Integration and Vestibular Stimulation techniques using MEAS.

Meas is used for

Sensory integration
Vestibular stimulation
Gait training
Desensitizing soles of feet
Occupying a child while tube feeding to distract the child from yanking tubes
Encouraging weight bearing in hypertonic children
Allows wheelchair-bound adults to move in upright position.
Early recovery periods after injuries

Besides Cerebral Palsy, the Maribelle exercise assist system will also be of benefit for people with

Low muscle tone
Poor balance
Spastic cerebral palsy (CP)
Impaired vision/blindness
Fearfulness & insecurity
Sensory deprivation
Athetoid cerebral palsy (CP)
Congenital dislocated hips
Leg length discrepancy
Fetal alcohol syndrome (FAS)
Limited motor abilities
Failure to thrive
Poor head control
Hyposensitive vestibular systems
Cerebral cortical atrophy
Agenisis of corpus collosum
Developmental delay
Intractable seizure condition
CDH (congenital diaphragmatic hernia)

Questions about Erb’s Palsy

What Is Erb’s Palsy?

Erb’s palsy is a disability disorder caused by an injury to the brachial plexus during a baby’s birth. The brachial plexus is a “bundle” of nerves, originating from the spinal cord and located between the neck and shoulder. The result of damage to this nerve set can be as severe as paralysis in the arm, shoulder or hand.

Erb’s palsy, also known as brachial plexus paralysis, is considered a serious birth injury, just as cerebral palsy is considered a birth-related condition.

What Causes Erb’s Palsy?

Erb’s palsy is usually caused by a stretching of the brachial plexus nerve fibers as a baby’s head and shoulder are moved in opposing directions during delivery. Medical malpractice has been shown to play a role in the development of Erb’s palsy in some cases, including these types of situations:

  • Failure of doctor to accurately estimate the baby’s size before labor begins
  • Failure to schedule a C-section for mothers who have risk factors, such as a previous infant with a brachial plexus injury or a small mother with a large infant
  • Use of unnecessary or excessive force during delivery
  • Failure to recognize a breech-positioned baby prior to labor and delivery
  • Inappropriate use of forceps or vacuum extraction
  • Allowing a troubled delivery to go on for too long or delaying the decision to perform a C-section for too long

What Are the Symptoms of Erb’s Palsy?
A child with Erb’s palsy may exhibit some or all of the following signs:

  • Inability to move the shoulder, arm, wrist or hand (paralysis)
  • Numbness or no feeling at all in the hand, arm or shoulder
  • Decreased or lack of muscle control in the shoulder, arm, wrist or hand
  • Limpness in the hand, wrist or arm (baby appears “floppy” on one side)
  • Paralysis on one side of face
  • Inability to sit up or crawl without assistance (in an older infant)

What Are the Treatments Available for Erb’s Palsy?

Early diagnosis of Erb’s palsy is essential to give a baby the best prognosis for injury recovery and reduced disability later in life. Treatment options can include physical therapy, nerve grafting, and surgery on the nerves, tendons and muscles in the injured area.

What Should I Do If I Suspect My Child’s Erb’s Palsy Was Caused by Medical Malpractice?

Don’t wait any longer to contact an experienced medical malpractice attorney to discuss your case. (There are statutes of limitations involved in medical malpractice cases.) You may also find the online resources available from Salt Lake City, Utah’s Erb’s palsy lawyers at G. Eric Nielson & Associates, LLC.

Types of Abdominal Wall Hernias

Usually, the term hernia is used when we talk about hernias of the lower torso, but it can be used for bulges in other areas too. It is known that a hernia appears when the contents of a body cavity bulge out of the area where they are normally contained.
Although in most of the cases hernias are harmless, they still have a potential risk, because it appears the possibility to become strangulated and the blood supply to be cut off. This thing may need surgical attention.

There are different types of abdominal wall hernias. Inguinal hernia represents 75% of all abdominal wall hernias, it appears up to 25 times more often in men than in women, and is categorized in 2 types: direct inguinal hernia and indirect inguinal hernia. Both of the types can look like a bulge in the inguinal crease, and can be treated in the same way.
Indirect inguinal hernia descends from the abdomen into the scrotum, following the pathway that the testicles made during prebirth development.
There can appear the possibility that the hernial sac to protrude into the scrotum. Usually, this hernia may occur at any age, but it becomes more common as people are getting older.
The direct inguinal hernia appears in a place where the abdominal wall is naturally slightly thinner, slightly to the inside of the site of the indirect hernia, and it is known that this hernia will rarely protrude into the scrotum. The direct inguinal hernia usually appears in the middle-aged and elderly persons.

Another type of abdominal wall hernia is the femoral hernia. The femoral canal, which is a tight space and the way that the femoral artery, vein, and nerve leave the abdominal cavity to enter the thigh can sometimes become larger and allow abdominal contents into the canal. The femoral hernia produces a bulge below the inguinal crease in roughly the middle of the thigh. These hernias can develop the risk of becoming irreducible and strangulated

Caused when an opening in the abdominal wall doesn’t close completely, these hernias are usually noted at birth as a protrusion at the bellybutton. If it is small, this type of hernia closes gradually by the age of 2, but if it is bigger and does not close, surgery is needed. Umbilical hernias can appear later during life, even if the area is closed at birth. This type of hernia can appear later in middle-aged women who have had children and in elderly people.

Incisional hernia appears after abdominal surgeries,but in rare cases. The flaw in the abdominal wall, created by the abdominal surgery can determine the apparition of an area of weakness where a hernia may develop.

Occuring mostly in women, the obturator hernia protrudes from the pelvic cavity through an opening in the pelvic bone. It can often cause nausea and vomiting.

Other types of abdominal wall hernias are the sigelian hernia- this hernia occurs along the edge of the rectus abdominus muscle- and epigastric hernia, which occurs between the navel and the lower part of the rib cage in the midline of the abdomen, and are composed usually of fatty tissue and rarely contain intestine.

For more resources about hernia please visit these pages or

Mckenzie Exercises For Low Back Pain-Look Something New

About nine out of ten adults meet with back pain at some point in their life, and five out of ten working adults have back pain every year. Back pain (also known “dorsalgia”) is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine. One potential source of back pain is skeletal muscle of the back. Back pain is one of humanity’s most frequent complaints. In the U. S. New Mckenzie Exercises For Low Back Pain results.

No conclusions can be drawn about the work of cold for low-back pain” Prolonged bed pause or inactivity is actually counterproductive, as the resulting stiffness leads to more pain. In addition, spinal cord stimulation, where an electrical device is used to interrupt the pain signals being sent to the brain and has been studied for various underlying results in of back pain.

It may have a abrupt beginning or can be a chronic pain; it can be persistent or intermittent, stay in one place or radiate to other areas. Cold compression therapy is advocated for a strained back or chronic back pain and is postulated to shorten pain and inflammation, especially after strenuous working-out such as golf, gardening, or lifting. Back pain is regularly cited by national governments as having a major impact on productivity, through loss of workers on sick leave.

Back pain in individuals with medical conditions that put them at high risk for a spinal fracture, such as osteoporosis or multiple myeloma, also warrants prompt medical attention. Back pain does not usually require immediate medical involvement. Back pain in individuals with a history of cancer (especially cancers known to spread to the spine like breast, lung and prostate cancer) should be evaluated to rule out metastatic disease of the spine.

Biomechanical factors of pregnancy that are shown to be associated with low back pain of pregnancy include abdominal sagittal and transverse diameter and the depth of lumbar lordosis. Back pain in pregnancy may also be characterized by pain radiating into the thigh and buttocks, night-time pain severe enough to wake the patient, pain that is increased during the night-time, or pain that is increased during the day-time. Ordinary factors aggravating the back pain of pregnancy include standing, sitting, forward bending, lifting, and walking.

Organized exercise programs using these therapies have been developed. Ultrasound has been shown not to be beneficial and has fallen out of favor. Clinical Trials Some national governments, notably Australia and the United Kingdom, have launched campaigns of public health awareness to rescue combat the problem, for example the Health and Safety Executive’s Better Backs campaign.  Mckenzie Exercises For Low Back Pain. See also Failed back syndrome Low back pain Posterior Rami Syndrome Tension myositis syndrome Upper back pain Pregnancy related pelvic girdle pain Spinal stenosis Scoliosis References T. Patel, A. A. Ogle.

Geranium Oil For Nerve Pain

I absolutely love the smell of geranium oil.  But what I love more is all of the amazing excuses that I have to use it all of the time.  This wonderfully scented essential oil is an effective household remedy for so many women and childrens’ conditions from pain relief, to soothing anxiety and stress, reducing swelling and inflammation, and sedating the nervous, this stuff is a natural first aid.

Geranium is also renowned for healing burns, wounds, and skin ulcers and it’s even used to soothe the sore breasts of lactating mothers. You can even use it safely for all types of skin conditions including dry eczema, burns, shingles, ringworm, lice, acne and herpes. I actually had an opportunity to use it for my children’s lice and it worked beautifully (believe me, I checked their little heads extremely thoroughly each day after school!)  It sounds incredible for one simple essential oil, but even modern medicine has recently validated the efficacy of geranium for treating pain.

A recent study on 30 adults with post-herpetic neuralgia were assigned to receive one of five topical treatments (100% geranium oil, 50% geranium oil in mineral oil, 10% geranium oil in mineral oil, mineral oil only, or 0.025% capsaicin cream and measurements of spontaneous and evoked pain one a scale of 0 (no pain) to 100 (worst possible pain) were taken at 2, 10, 15, 20, 30, 45, and 60 minutes following application of the respective topical treatment.  Pain was found to be reduced in all participants receiving geranium oil and the degree of pain reduction was proportional to the amount of geranium oil in the topical mixture, so those using 100% geranium oil had greater pain relief than those using 10% geranium oil.

The researchers reported that topical peppermint oil (Mentha piperita) or licorice (Glycyrrhiza glabra) may also be useful for neuralgia.  Considering how well it worked for nerve pain, I’m definitely planning on enjoying the smell of geranium on a regular basis in my home, for whatever reason I can.

Exercises For Sciatica – Relieving Sciatica Nerve Pain

If the sciatic nerve happens to become squeezed or pinched it can cause pain, numbness or a tingling down the leg or even in the foot. The pain often comes from a nerve in the lower back being pinched by one of the spinal vertebrae.

Sometimes it can originate in the piriformis muscle since often the nerve runs directly through this tissue. It is best to consult with your doctor if you are experiencing pain due to a herniated disc or other back injury.

With lower back injuries causing nerve pain, strengthening and stretching the muscles often can relieve the pain but it is important to only do so in such a way as to not cause further injury.

Here are some good muscle stretches to help with sciatica nerve pain. They are based on yoga postures but are simplified.

This technique is a variation of the yoga pigeon position. Lie flat on your back and put both legs straight up in the air. Then put your right ankle onto your left leg, just above your knee so that it forms a figure of 4 shape.

Put your right hand through the space between your legs and hold your other hand that stretches round your left leg to meet it. Once you can comfortably hold your hands together start to bend your left leg so that you can feel the outside of your right hip start to stretch.

Don’t over do it and as soon as you feel the stretch hold it for about half a minute.

A second stretching exercise that can help with sciatica nerve pain is as follows.

Lying down on your back bring your left knee up and place your left foot flat on the floor. Bring your right let up as far as you comfortably can but try and keep your pelvis flat.

Hold your thigh and flex your foot to stretch the hamstring and calf. Once you feel some tension try to hold it for about 10 seconds, relax and repeat a few times.

Slowly let the leg down and then repeat using the other leg.

Be sure to take it easy with these and any other exercises for sciatica, especially if you haven’t been getting too much exercise in recent years. Gently is the key to avoid further injury. Your body may be stiff but will start to loosen and strengthen as you practice these on a daily basis.

Home Remedy For Sore Throat

The general things that cause a sore throat include viral infections which are flu’s, colds, and infections caused by the bacteria. Apart from the above listed ones, other things can also cause a sore throat. These are throat abuse for example shouting, food allergies, infected tonsils and singing, smoking, changing weather, mouth breathing, allergies, smoking such as singing, shouting, coughing, infected tonsils, and food allergies. Some of these causes can be avoided while others cannot.

Below are some of the home remedies that can be useful to get rid of a sore throat;

• Clearing nasal passages- This means not leaving your mouth open when sleeping, this is a very useful yoga practice that is very useful to curing the sore throat because leaving the mouth dry causes this problem.

• Gargling-it can be with salt water, raspberry tea or turmeric. This is one of the best and simplest method and most commonly used in homes.

• The belleric myrobalan – The pulp of its fruit is taken, mixed with salt, long pepper and honey.

• Ginger – It is a very effective remedy. It is also used for treatment of colds and flu’s which are also causes of sore throat. It can be taken in form of tea, made into a hot beverage with plain water and sugar. The juice of ginger can also be taken with honey to treat sore throats.

• Adding cumin seeds to boiling water and adding garlic in it then simmering it and allowing it to cool also helps in relieving sore throats.

• It is dangerous to consume cold foods and drinks when having a sore throat as it will make it so severe that even breathing will become difficult.

• Licorice- sucks some pieces of raw licorice which allows the juice to pass slowly through the throat to help in soothing the sore throat.

• An infusion of cardamom and cinnamon is also used as a gargle for treating sore throat as it also helps prevent and cure influenza.

• Mango bark chewing is also very effective when it comes to treating the sore throat.

• Adding two teaspoons of dry blossoms of chamomile to boiling water. Drinking this four times a day is a very effective method of treating sore throats.

• Prepare a decoction from the leaves of henna and use it for gargling and it will bring instant relief to the sore throat.

• Fill a cup with honey and add onion pieces. Swallow one teaspoon of honey each and every two hours as this can also relieve sore throat.

Sore throat is a temporary thing and goes away within a short time, hence the above mentioned remedies are some of the common ones mainly used at home, that are likely to assist in making the sore throat go in a short period of time. Incase one does not have ingredients for making a home made remedy for the sore throat they can always choose from the many options available as they are many. Also a good point to note is that keeping the body hydrated with hot drinks e.g soups lessens the severity of the infections.

Don’t Take Your Tonsils Out!

Do you have a sore throat that won’t go away? Do you find it difficult or painful to swallow? Are you suffering from headache, fever and chills at the same time?

If you said “yes” to the above questions, you probably have tonsilitis – a disease characterized by red, swollen tonsils.

The tonsils are collections of spongy tissues located on each side of the back of the throat. Doctors once believed they served no useful purpose and even tagged them as dangerous sources of infection. Due to this mistaken belief, the golden age of tonsillectomy flourished and many children went through this unnecessary operation.

Today, we know that tonsils filter out mild infections and are the guardians of the gateways to the digestive and respiratory passages. Since the tonsils are part of the body’s defense systems, removing them is like throwing away your sword and suit of armor while confronting a dragon.

In the course of their duties, however, the tonsils get sick and become inflamed. This is known as tonsilitis and is characterized by a sore throat, pain with swallowing, pus on the tonsils, fever, headache and nausea.

Tonsilitis may be caused by a viral or bacterial infection. The latter can be deadly, especially in children since strep bacteria are responsible for many serious diseases like rheumatic fever, heart and kidney damage. Fortunately, strep bacteria can easily be crushed with today’s antibiotics.

“When bacteria and viruses enter your body through your nose or mouth, your tonsils act as a filter – engulfing the offending organisms in white blood cells. This may cause a low-grade infection in your tonsils, which stimulates your immune system to form antibodies against future infections. But sometimes the tonsils are overwhelmed by a bacterial or viral infection. The result is tonsillitis,’ explained the Mayo Clinic.

You can limit your chances of contracting tonsilitis by staying away from an infected person. Frequent hand washing is another effective measure against tonsilitis.

“Other common-sense precautions apply, too. Cough or sneeze into your elbow or a tissue. Don’t share drinking glasses or eating utensils. Avoid close contact with anyone who’s sick. Look for a child care setting with sound hygiene practices and clear policies about keeping sick children at home,” said the Mayo Clinic.

When should tonsillectomy be considered? The late Dr. Morris Fishbein, the former editor of the Journal of the American Medical Association, says the time for surgery is ripe in the face of recurring ear infections or chronic enlargement of the tonsils that interfere with breathing.

Dr. Marshall Stone, senior otolaryngologist at the Children’s Hospital Medical Center in Boston, said surgery may be required if the enlarged tonsils make breathing difficult.

“Emergency surgery is necessary only rarely, when sudden blockage of the air to the lungs occurs or an abscess is not responding to medical management; otherwise, a tonsillectomy is an elective procedure that should occur only after careful evaluation of several issues,” he said.

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Hypothyroidism In The German Shorthaired Pointer

Many people are diagnosed as being “hypothyroid.” Although this disease is rare with the feline population, it can occur quite frequently with canines and the German Shorthaired Pointer is one of the breeds that can develop this metabolic disorder. The thyroid is an extremely important gland in the body which is double lobed and located on either side of the trachea (windpipe). The thyroid secretes a hormone that is responsible for regulating the body’s metabolic rate. If the thyroid isn’t producing enough thyroid hormone, the dog can become “hypothyroid” and this will slow the metabolic rate of the German Shorthaired Pointer. This is not a good thing to have happen to your dog.

The immune system of the dog is significantly involved with the development of hypothyroidism because this system doesn’t work properly and negatively affects the thyroid tissue and kills thyroid cells. At first, the German Shorthaired Pointer’s body retaliates by oversecreting thyroid hormone but the dog’s body will be unable to continue doing so and the lack of sufficient thyroid hormone results in the development of hypothyroidism. The scientific jury is still out on the exact reason for this particular autoimmune disorder, but believe in a genetic predisposition and possible contributory factors of allergies and possibly environmental pollutants.

Some of the symptoms that should result in a vet visit for your German Shorthaired Pointer include lethargy, little food consumption with weight gain. If you notice that your dog doesn’t seem to want to play, sleeps a lot, gets tired more easily when engaging in usual activities please see the vet for examination. If the GSP has hypothyroidism , the dog might also be prone to dry skin, bacterial skin infection, hair loss. The dog’s tolerance for temperature changes particularly colder temperatures may decrease. Some affected animals can end up with chronic ear infections and possibly negative behavior changes which will be easily observed by the astute owner.

When you take your GSP for examination, you will review the obvious symptoms and/or behavior and mood changes with your vet. The vet will draw blood for the test that can determine the level of thyroid hormone in your pet’s blood. If the results of the blood test indicate that your GSP is secreting a less than normal amount of thyroid hormone and is diagnosed with hypothyroidism, the vet will most likely prescribe a synthetic thyroid hormone which your dog will most likely need to continue for the rest of its life. This medication should resolve the problem and you should observe an increase in energy, and more positive mood and behavior changes.

Diabetics And Teen Pop Sensation Nick Jonas

Apart from his doctors, his fans are also very concerned about his health as he is affected by diabetes. And this has brought diabetes to the from page of pop culture. One of the famous brothers of Jonas brothers Nick Jonas was not definitely trying to become famous for type 1 diabetes. But unfortunately he became famous for that. He took the center stage of fame at an young age of 17.


Nick Jonas was the picture of health for almost his entire childhood. It wasn’t until the fall of 2005 that the youngest Jonas brother noticed symptoms. Weight loss, constant thirst, and a poor attitude became commonplace for him. He was quoted saying that this behavior “was totally odd for me because I’m actually a nice person. And it was hard.” When his weight loss became so dramatic, he took time off from a tour to see a doctor. He was shocked to discover the diagnosis: Type 1 diabetes. With his blood sugar over 700, he was admitted into the hospital immediately.

Controlling diabetes

Nick Jonas was devastated. He was thinking that he will ever perform on stage ever. But to everyone’s surprise he performed on stage the same day he got discharged from the hospital. On a regular basis he is injected with insulin and checked his blood glucose level for 12 times a day. Then he was introduced to Omnipod by insulet after an year. He describes that it is awesome and he says he is not adhering to any special diet, he just takes enough insulin for what he eats.

Saving Others

He waited until he managed his diabetes well and now he even injects insulin in public amid flashes from paparazzi’s. Ever since Nick Jonas was diagnosed with diabetes he wanted to reveal it to public. He thinks his popularity can bring immense awareness on diabetes and this will save many people.

He knows that diabetes “is a huge part of my life and I can’t just forget about it, obviously. I have to keep taking care of it and managing it, and learning more things about it. Hopefully one day they’ll come up with some type of cure, and I hope I’ll be one of the first to know about it.” While Nick has not publicly acknowledged his use of supplemental health care options, he has made one thing very clear – a positive attitude can go a long way. There is little doubt that the optimism- perhaps the most natural treatment of all – he demonstrates on stage and in his young life translates to better health.

People who are looking to alternative diabetes care there are many number of options available. There are many number natural health options online. Apart from this we will also release our detailed on how to control diabetes naturally.


How People Become Morbidly Obese

The definition of morbid obesity states that an individual’s weight is about 50 to 100% more than that of his or her ideal weight. The people whose weight is 100 pounds more than the correct weight are also called the morbidly obese people. Where the BMI value which is more than 30 for an adult is considered as obese, they are considered morbidly obese when it is more than 40. Morbid obesity is related to various other health problems and can lead to death. A survey states that about 9 million American people are suffering from morbid obesity.

Cause of Morbid Obesity

There are two types of reasons of morbid obesity. The genetic factor is often held responsible. This is also known as heredity which means that this disease has always been there in the family of an individual. But the family heredity cannot be solely responsible for a disease like this.

This is a very common thing that the members of the same family are used to with similar kind of life style and food habits. In fact the food habit and activity level has a great role to play in morbid obesity. The other cause of morbid obesity is the environmental factor.

When we talk about environment it can be the environment at school, at office, and home. The kind of food available in an individual’s environment, the quantity of food taken by him in a day and the exercise habits of that person add up to give rise morbid obesity.

Then the psychological factors are also there which can cause morbid obesity. Severe depression, anxiety, trauma etc are included in these psychological factors.

Health Risks Due to Morbid Obesity

Morbid obesity is labeled as the second most prominent reason of the death of people in United States. This is closely associated with the risk of other 30 diseases. First of all the morbidly obese people can loose their mobility and ability to accomplish the regular activities.

Apart from this they are often at the risk of coronary heart diseases which can lead to stroke. The blood pressure can become excessively high. The internal organs like liver get damaged with excess fat deposition. Osteoarthritis and grout are two problems related to the bones and joints which are caused by morbid obesity.

Then the gall bladder problems and diabetes is closely related to this. Respiratory trouble and sleep apnea can arise from this particular type of obesity. Women can suffer from gynecological disorder. Finally the patients can lead towards cancer.

The only treatment for morbid obesity is often surgery which is risky enough. So it is always advised to get conscious about the health before it leads to morbid obesity.

Rash – the Persistent Symptom of Scabies

Scabies rash is one of the first symptoms that occur in persons infested with scabies mites. Similar to all symptoms produced by scabies, rash occurs due to allergic reactions to the toxins produced by the parasitic mites. Scabies mites’ eggs, secretions and feces are the main agents that produce rash, irritation, severe itch, discomfort, scaling and blistering of the skin.

In most cases, scabies rash shares many similarities with the clinical manifestations of many different skin disorders, including eczema, dermatitis and chicken pox. In the absence of more relevant signs of mite infestation, scabies rash can point to other conditions rather than scabies, preventing doctors from deciding upon the accurate diagnosis and prescribing the right treatment. The unspecific character of the rash produced by scabies mites is the main reason for delayed medical intervention. In some cases, persons with scabies may have already developed complications (bacterial infections, scaling and crusting of the skin) by the time they are diagnosed with scabies and are prescribed the appropriate medications.

Most often, scabies rash affects the hands, fingers and wrists, toes, feet, ankles, knees, elbows, armpits, lower abdomen and chest, buttocks, the region of the nipples and the genitals. Scabies rash rarely occurs on the neck or face, as scabies mites avoid infesting more exposed regions of the skin that can’t provide a good hiding place. However, sometimes scabies rash may also involve the scalp (in the case of infants, old adults and persons with impaired immune system). In very young children and infants, scabies rash is generally more severe and is associated with pruritus and intense itch.

Scabies rash can be very persistent and is usually difficult to treat. It is often the first symptom to occur and the last to disappear, as scabies rash can persist for weeks after the mite infestation has been successfully eradicated. Scabies rash can be alleviated with medications such as hydrocortisone and antihistamine, which provide temporary relief but are often unable to heal the rash completely. Analgesic creams and gels can also be used to calm down severe scabies rash, while oral analgesics provide a longer-lasting effect. Many persons still use alcohol-based lotions and creams for treating scabies rash, unaware that such pharmaceutical products actually aggravate the rash, intensify the sensation of itch and facilitate the formation of crust, which further amplifies discomfort and soreness. In order to avoid an entire series of undesirable effects, it is best to avoid using alcohol-based products for treating scabies rash.

For more resources on different scabies related issues like scabies rash, causes of scabies, symptoms of scabies and many more visit .