Botox and Incontinence Treatment

It really is a novel treatment for patients who suffer from overactive bladder for whatever reason and mostly due to spinal injury and multiple sclerosis.

This condition, which is involuntary bladder contraction, results in urinary incontinence . It is a very frustrating situation for patients and hugely affects the quality of life. Most of them confine themselves and do not socialize only because of urge incontinence.

Botox injection in bladder muscles reduces its contraction and increases bladder capacity, therefore patients need to urinate less frequently and have more control. Moreover It is a durable treatment and usually lasts 12 months and patients can repeat injections after that period. Also this is a non-invasive and reversible procedure.

Patients who are interested to take part in the study for this treatment can get more information from following link. http://www.bcm.edu/urology/?pmid=4997

Parkinson Disease, Botox Injection & Deep Brain Stimulation (DBS)

Parkinson disease or PD usually does not affect patients' life expectancy but it has a huge impact on patients' quality of life. Therefore controlling symptoms will translate to an acceptable normal daily life for patients.

Recently Botox injection has turned out to another possibility for patients not responding reasonably to mainstream drug treatments.
Botox injection relieves symptoms related to dystonia. Dystonia is involuntary muscle spasm which can cause uncontrollable twisting, repetitive movement, abnormal posture and can affect any part of body even eyelid and vocal cord. It could be very debilitating and affect vision and speech, walking, writing and any kind of movement.
Botox injections block the communication between nerve and muscle and reduce abnormal movements. It is a local injection and a non-invasive procedure.The injection location can be face, eyelid, arm, leg, etc. and it depends on the affected muscles. The results usually last 4-6 months.


Deep Brain Stimulation (DBS) is a surgical procedure to treat PD disabling neurological symptoms such as tremor, stiffness, rigidity, slowed movement and walking problems.
During this procedure surgeon implant a battery operated wire-size neurostimulator in deep brain (Thalamus or surrounded area ). This device stimulated the targeted area and blocks abnormal nerve signals which cause debilitating symptoms.

Before the procedure surgeon uses MRI, CT or microelctrode recording to identify the precise brain target to implant the device. The procedure does not damage other healthy brain tissue and is adjustable and reversible.

This method reduces patients' symptoms and improves his quality of life considerably. Most of the patients after surgery can reduce their medications. For some patients it works like a miracle.
There are ongoing clinical trials accepting patients for DBS and also there are very professional clinics performing this procedure.

Obesity & Non Surgical Treatments

As I mentioned before the only effective and proven treatment for morbid obesity is surgery. Since so many patients consider surgical treatment as the very last option, I am going to cite two other non –surgical available options.

The first one is Balloon weight loss procedure or Bioentrics Intragastric Balloon (BIB). Through the mouth a silicon expandable balloon is introduce into the stomach and is filled with sterile saline. The balloon is too large to move freely in the stomach or goes to the intestine. It increases your fullness feeling and should be accompanied with a supervised diet and behavioral adjustment. This technique needs a mild sedative and takes 15 to 20 minutes. Depends on the result the balloon will be removed or replaced after 6 months.

The next and newer technique is inserting an endobarrier into the stomach and 2 feet of intestine. Food goes into the barrier and without mixing with digestive enzyme passes into the intestine. This method works like gastric bypass surgery and by reducing food absorption helps patients to shed pounds. The average weight loss is about 25 pounds in 3 months period. This non surgical method can be done through an endoscopic instrument and usually takes 30 minutes.

Morbid obesity: surgical and non-surgicel treatment

Morbid Obesity is a serious disease that is usually overlooked. Morbid obesity has a huge impact on all aspects of health condition.

Cardiovascular diseases, endocrine disorders and psychiatric problems are general expressions of complications associated with morbid obesity. In detail endocrine disorders alone cause a complete hormonal imbalance which result in diabetes, osteoporosis, infertility, feminine character in men and much more.

While patients are struggling to do their daily simple tasks they are offended by lack of respect. Most people around them don’t even think that is a disease. Doctors don’t spend enough time to consult them for appropriate treatment.

The only really effective treatment is bariatric surgery, which improves patient’s health and quality of life enormously. Due to lack of consultation most of patients are hesitant about surgery and they are afraid of surgical complications which compared to the complications of morbid obesity is nothing.

There are two options for surgery; the first one is gastric bypass or Roux –en – Y method. This procedure can be done either conventionally or by laparoscopy. This technique provides a small pouch stomach for early satiety and shorter intestine for less absorption.

The newer technique is Lap- band adjustable or adjustable gastric banding and usually is done laparoscopic which is less invasive. A silicon adjustable band splits stomach to a small pouch reservoir. Lap – Band has less complication because does not affect absorption and also is an adjustable and reversible procedure.

And bottom line for those patients who are scared of surgery: there is exciting news about a very new non surgical procedure. In this procedure an endobarrier is placed in stomach and upper intestine through an endoscopic instrument. This procedure takes half an hour and works like gastric bypass. Link

Is hormone replacement therapy for you?

For women who are in menopause or about to experience this period of their life, hormone replacement therapy (HRT), estrogen with or without progesterone, could be a big question mark.

They usually opt for HRT to relieve menopause symptoms. However, many other health related consideration are also included in decision making.

One should know that hormone replacement therapy is not for everyone. Just for your information, it is better to be aware of some conditions that prohibit using hormone replacement therapy.

You should NOT even think about hormone replacement therapy if you have any of these conditions:

• Acute liver disease
• Undiagnosed vaginal bleeding
• Known or suspected uterine/breast cancer
• Acute vascular thrombosis or history of severe thrombophlebitis of thromboembolic diseases

If you have any of the following condition you should be extra cautious and most probably choose any of alternative to hormone replacement therapy:

• Uncontrolled hypertension
• Uterine fibroids or endometriosis
• Familial hyperlipidemia
• Migraine headache
• Family history of estrogen-dependent cancer
• Chronic thrombophlebitis
• Diabetes mellitus
• Gallbladder diseases
• Impaired liver function
• Fibrocystic disease of the breast

The take home message is that hormone replacement therapy is not a simple answer to a simple condition. Menopuase should be dealt with very carefully and delicately. Always consult your doctor and let your doctor know about any change in your condition/health as soon as it happens.

Mental status examination

Physicians usually take note of what they observer when they visit a patient. It is no different when they interview a patient with suspected psychological problem. They write down their observations and impressions. These notes are not only for keeping record for future reference but also an important diagnostic tools in psychiatry.

These areas are normally covered in such a note:

General description

Mood and affect

Speech

Perceptual disturbance

Thought

Sensorium and cognition

Impulse control

Judgment and insight

Reliability