How I Beat Onychomycosis

How I beat Onychomycosis

I was doing my pre university college (PUC) near Mangalore in 1983. This place really pours in rainy season. And it is really cold and damp in rainy season. You do not see sun for many days. In my second year of PUC I my left thumb nail was getting yellow and thick. Over time it really got thicker and filled with a kind of powdery nail below the nail. Nobody knew what the hell it was. And doctor there also did not know what to do with it.

The next year I joined medicine (MBBS). And my nail was really sick and ugly. I could not show anybody as it really looked very bad and I always covered it with my index finger.

Six months to one year down the line in my first year medicine, I went along my senior friend to dermatology department. The skin specialist saw that nail and told us that it was Onychomycosis the fungal infection of the nail. Then he sent me to microbiology department for scrapings to be sampled for tests. Of course it was fungal infection of the nail. Yeah,  What can I do? The place where I got this, even our clothes used to get fungal infection in the form of black dots.

Then I went to the doctor again for which he asked me why I was I bothered, as I was not getting married. Then he told me I may have to take Tab Griseofulvin for six months to one year.

Over time I went on forgetting it and continuing. Again in my second year medicine when I got in to clinicals, I started reading about it again and again. But treatment was same. I was really tired of this. There was nothing much I could do about it. Every time I used to start tablets and stop it after few months as there was no change. I used to scrape that nail regularly hoping it will go till the nail bed bled. But nothing happened. I tried topical cream also for few months and stopped.

The nail by itself never bothered me. It was only the cosmetic purpose it bothered me.   Again I went to the doctor who had the same answer and no new medical miracle had happened to solve my nail. At that point of life that was the only thing I was praying for other than the routine. And you know the jokes with that kind of nail.

Onychomycosis is the fungal infection involving the nail bed. Not the nail. As the nail is made of keratin which is dead by itself it cannot get infected. But the nail bed infection where the nail is formed causes the nail to be transformed in to a dirty and thick nail. So applying antifungals on the nail does not work. The nail bed is very vascular (rich blood supply). Since the nail bed itself is infected it has to be treated systemically, that means you need to take the drug and it has to go through the blood stream in to the nail bed and over time it has to kill those fungi. This is a long process as the fungi who are involving the nail bed take time to be treated. After fungi have been cleared the newer nail can grow. Nail takes long time to grow. Whatever is infected and has grown has to grow further and get out making way for the treated and fresh nail. That is a long process.

Having read about it and thought about it for at least four years and having approached everybody and I could not solve it. I was waiting to finish my medicine and get in to my internship. Once I got in to internship, I planned a treatment for myself. I thought I will approach this in multimodal way. So I started Tablet Griseofulvin, which was the treatment of choice at that time which 1991.  After taking this tablet for two to three months, I went to my surgery post graduate and asked him to take off my nail surgically.

Though reluctant initially he agreed to knock it off when I insisted. I got my nail surgically removed. Few days later I removed the dressing, I started to apply antifungal cream. I continued the drug and cream till the new nail came. Over two months my nail came back and it was new and normal. I had achieved my dream of a normal nail after almost seven years.

Whoever is trying treatment of this has to meet a doctor and go according to the recent times. Newer Antifungal drugs have come in to practice. I only did this as I was a qualified doctor.

RSI – Repetitive Stress Injury – What you need to know.

In response to my previous blog, I got a mail from my senior and old friend asking me why I did not contact his Department, which he heads now in Bangalore, as I had worked along with him.

 I had mentioned that there is no specialty that deals with muscles in medicine. I was wrong, as there is a department which deals with this. It is Department of Physical Medicine and Rehabilitation (PMR). The specialists are called Physiatrists. We have MD and DNB courses in this subject. I have hardly seen any medical professional knowing about the existence of this department. St John’s Medical College in Bangalore and Christian medical college in Vellore have these departments. They deal with kinesiology which is about muscles. Very few departments exist in the country. And most of the practising doctors do not know about this.

RSI is increasing in number. Some are having full blown condition and have left their jobs; many are in different stages of this condition and are in the process of going in for serious trouble. I have seen many who are suffering yet not willing accept the reality. I have spent hours explaining so many people, though it was none of my business to lecture them to get help.

       I did mention about Recoup which came out with this new treatment. The problem in that centre is the attrition of therapists and insufficient knowledge of the newer therapists. There is lack of comprehensive treatment with non involvement of Doctors with therapists. Most of the therapists treat blindly without understanding the real problem. So they can only treat the earlier stages completely. You all know about how some centers work in our country which, I won’t talk about. Most of the therapists themselves develop RSI treating continuously. As it is manual work most are not willing do the job.

 RSI patients have multiple trigger points. The trigger points were first described by Janet travell almost fifty years back. Still this has not found its way into medical textbooks. It was later popularised by Claire Davies a piano business man who wrote a self help book. Other day I found an article in journal of rheumatology about the relation of latent (non active) trigger points with depression. That is to say everybody have trigger points, some are latent and do not cause pain. Active trigger points cause pain and contractile state of a muscle.  

        Whenever a muscle is strained, it goes in to a contractile state by formation of a nodule which is called a trigger point. This trigger point has been studied by electron microscope and contents have been found. Trigger points hold the muscles in contractile state as a defence mechanism. In this process they shorten. These points are extremely painful and can be released by massage or needling them. If they are not released and continued abuse of the muscle causes trigger points in the assisting muscles which are called satellite trigger points. Over time if proper treatment is not done, most of the muscles develop trigger points. They involve the muscles who get in to action to correct posture and so on.

I have come to realise that there are two types in neck pain.  First is with People working with neck bent posture and developing TrP (Trigger points).

Second type is with people working with outstretched hand. First type develops trigger points in specific muscles which can be treated easily by TrP therapy. The second type is the one which is causing havoc. Continuous outstretched hand without rest seen in computer users, causes lot of strain on the shoulder muscles. The primary shoulder muscles are Rotator cuff muscles which involve four muscles which develop TrP’s when are strained. If continued working the supporting muscles get in to action and tire easily only to develop TrPs themselves. Later the muscles which attach from neck to shoulder try to assist and they also bite the dust. Because of this the posture changes and constant correction to keep straight causes the opposite side muscles get in to action and join the rest of the crowd to bite the dust. So we have all these poor guys with TrP’s causing contractile state and shortening pulling on bones causing osteophytes which are bony projections termed as degenerative changes.  

Then there is muscle pull between the head and shoulder causing compression of the spine causing discs to rupture and herniate just like when multiple cream biscuits are compressed cream comes out.

      

       If there is a disc herniation and nerve root compression it is a clear case for surgery. Others end up with physiotherapy, which happened to me initially, where I was given Isometric exercises aggressively. I had to put my head against wall and push it on all sides. Next was cervical traction. This has been followed from years by our medical community.  These are the worst things to do for a strained neck. If muscles with TrP and contractile state are abused further by contraction and stretching only makes it contract further. There by causing more shortening and discs to rupture. Any muscle with a TrP should not be exercised or stretched.

My junior colleague was the first to develop RSI more than 3 years back. He was put on one month of cervical traction and ended with disc herniation.  

By now I hope you understand the logic of neck pain. The approach to treating neck is difficult in the second type of neck pain if it has progressed. The problem with people treating neck pain is that they have not understood the logic of neck pain. I have seen them working on only neck and treating the ones pointed by the patients which is symptomatic. The moment they are off the table they get their TrP’s back with this type of treatment. That is the reason the RSI has been elusive. I have read many articles written by therapists who are also not giving a proper picture to approach.

  Whereas the logic of treating stubborn TrP s lies in solving other muscles which are pulling them and causing TrPs more than the work or posture.

       Finally it is the ignorance of comprehensive treatment and not understanding the real problem which has led this increasing number of RSI. The prevention of RSI lies in understanding it. I would suggest people who work with computers keep their shoulders, back and neck fit. People who have developed RSI, can only hope they get a therapist who understands this. Otherwise you are wasting time, instead you should learn about this yourself by reading about it. At present I am in the process of treating people myself. I have almost come to a state where I can help those who have not been solved by others from years. I have injected myself on many trigger points and have solved them. It is a tedious process. 

Take care and please do forward this to as many, because RSI can hit anybody anytime as long as the computers are there. And please comment so that I can put forward some more points.

Neck Pain – RSI, The Repetitive stress injury, What your Doctors do not tell you.

Neck Pain – RSI, The Repetitive stress injury, What your Doctors do not tell you.

            I am a Radiologist by profession which involves working on computers all the time. Whether I report X rays, CT or MRI scan everything is over a monitor. Since all the computers are same with a keypad and mouse it does not differ from anybody who works continuously on computers.  I also do Ultrasound scans, where I have to hold a probe which I rub over patient’s body which is manual work with lot of pressure over hand and shoulders.   I will be bending my neck and extending my arms to do this job repetitively whole day, which I am doing for the past 13 years. And now I am paying for it.       

            Around three years back I developed severe neck pain, which I neglected initially and went on working, as there was nobody to do my work.  Over time when it got really bad I went for physiotherapy and it did not subside, I continued with physiotherapy like traction, TENS and some more with an advise of exercises. I exercised regularly, some time very hard, but my neck was getting worse. Working was difficult but I continued. When I used to wake up in the morning I just could not move my neck. It took me couple of hours to get to acceptable pain. Washing face was difficult as I could not turn or bend my head. I used to get shooting pain over my upper back. Both arms used to have needles and pins with severe pain in the fingers.

            Then my friend suggested me a new therapy which involved some ayurvedic oil and manipulation. I tried and within  a few days I knew this was nonsense and took off. Then another friend put me on to another Ayurvedic therapy, in ten days I took off again. Swimming was the next suggestion from the person who had gotten rid of his neck pain and there I was swimming paying nine thousand bucks. I swam for six months, neck pain did not go, except that I learnt the better style of swimming. By this time I was trying everything suggested by every tom dick and harry. My neck never got better and along with neck pain I had shoulder pain now.

        Finally I accepted I have a problem and took an X ray and found a bad cervical spine. Next was MRI scan of my cervical spine which showed multiple disc and vertebral degenerations.  Finally after months of denial I had to accept that I had problems. I consulted some surgeons who were ready to operate but could not guarantee pain less post-operative state. Again I was lost. I was living with this pain and still working. One day I mentioned this to my friend in his party. He is a Radiologist and a former colleague of mine told me that he had the same problem and how he just escaped surgery. This happened when his colleague told him not to have surgery as she also had just escaped from carpal tunnel syndrome surgery, accidentally finding out the solution.  Finally I had the diagnosis, RSI - Repetitive stress injury.

He told me so many things at that time, the problem was by then I was drinking with him, I just did not take that seriously as it was unheard in medical circle. I moved on and was back to work.

My neck pain was getting more and more nagging and painful. Every act was painful and there was pain continuously all the time. Every second there was pain and mind was only occupied with this pain.  Overtime my life was changing. After a couple of drinks, pain was not perceived and started getting dependent on a drink. It was simpler to drink and forget. It was  getting so common and I was drinking whenever possible at cost of fights and neglect at home. 

            I was doing aggressive isometric exercises, one day I really felt a sudden pain in my left neck while exercising and I thought I tore a muscle. It was so painful and there was nothing I could do. There was nobody I could tell, either a sympathetic ear or a doctor who could solve. At the same time my life was going crazy with lot of personal and professional problems. This stress  was adding on to my problems. Mentally I was unstable along with neck pain and I could not sleep.  I could get sleep only at 3 or 4 AM minimum when I was sober. I still had to wake up to be at work by 9 AM, which I did as I was always very punctual in life.  By now things were getting ugly; I was drinking and smoking more.  Finally one day I decided I have to do something for this. I called my friend and asked him about this. He told me enough of holding on to your job, forget it, your damn neck is more important, get out of your job and solve it.

Finally I took an appointment with a Doctor in Bangalore in his centre called Recoup. I took off for a week which I never did in life and I had a new diagnosis. Thoracic outlet syndrome and I was put on myotherapy. I did this for a week and I had to come back to Mysore.  Just before leaving the physiotherapists told me about their senior opening a clinic in Mysore. I got his number. Doctor asked whether I had any other problems for which I told him about my burning feet for more than a year.

            I had this burning feet for so long and I did not know what it was. I consulted all the specialties, including endocrinologist, dermatologist and Psychiatrist. They put me on so many vitamins and minerals which I promptly consumed. It never left me; I could not see any connection between my neck pain and burning feet at that time. 

            I was back to work; my pain had reduced mildly with reduced stiffness. They had advised me at least one month of therapy which I could not do.  I found this therapist in my place and started on twice a day myotherapy. The problem was chronic and complicated.  By now I knew about this problem and referred him many patients who also referred him some more.  I did this therapy for almost two years, yet my neck pain did not resolve. He was frustrated about my pain more than me. It is little irritating if your patient keeps coming back to you for years.  My problem was bigger, he was always reading new and I was also reading, but we still could not solve me.

            I started Yoga which went on well for some time and I got a little better but the pain was there. Six months of yoga with stopping smoking for six months. One day I burnt my leg in my bike and I never went back to yoga. By now personally I had so many problems. Now it was pouring problems as if there was nobody else. I had problems everywhere. I had problem with everything, because neck pain is such an irritant every moment of life, everything turns in to a problem. Pain used to get better after  treatment only to reappear with work.

        By now I had bought exercise ball, multigym, dumbbells, theraband and many others. I bought a powerball for around 3.5k which had life time warranty. It broke down after three months.  I was doing all kinds of exercises. I was exercising everywhere all the time. With all this I got fitter and slimmer. Looking at me nobody could believe internally how I go through. Life was living hell. Finally I went to one quack to break my neck; which he did not succeed.  My neck pain increased after his manipulation. I had to use neck collar to work. I have six of them.

        By now I had changed in life. My life perception had changed. I started viewing life in a different perspective. I had lost interest in life. The happiness of life was not there, nothing brought me joy. Only thing I was doing was drink and smoke. I did not want to mingle with people as I could not listen to anybody. I could not talk to people standing. I could only talk after getting drunk. Talking over the phone was difficult, within 20 seconds I used to get irritated. Over time people stopped calling me. Within 2 minutes of sitting on a computer I used to get severe pain.

        I am writing this to educate many of you about the real problem which can come to anybody. I thought of writing this when I read an article How I overcame RSI written by James  http://www.howiovercamersi.co.uk/

The problem of overuse syndrome has caused loss of so many jobs of people around the world. Medical professionals are unaware of this. In medicine these problems usually go to neurologists, neurosurgeons and orthopedicians. If these guys do not solve, you may end up with psychiatrists. Most of the pain in back and neck are caused by muscles. We have all specialties in medicine, except muscles. Nobody has understood the physiology of muscles. We also have never read or heard something called trigger point which happens in muscles.

There are few people who have researched about this. RSI cannot be solved by anybody other than the people who know about this. If you have RSI and it is not solved anybody within six months by people around you, that means they cannot at all.  

        RSI is simple. The muscles which are put to continuous use in one posture get tired. Over time they get in to spasm and develop a trigger point. If you continue working with this, other muscles start to work and get tired earlier and develop a trigger point. Over time without releasing trigger point if you continue working secondary trigger points develop as other muscles are affected due to altered posture and biomechanics.  If you continue working it only gets worse, and most of the muscles are connected across the head, neck, upper back and shoulder. They contract and compress causing degenerative changes. Finally discs start to degenerate or burst out. If seen by a surgeon you may end up with discectomy and may not be relieved of pain later except the pain caused by the disc itself.

       

If you are working with computers, over time your muscles of the shoulder get tired and weaken. Continuing work may cause other muscles to come in to action and over time neck muscles also come in to action. Along with this constant bending towards the monitor will add to the problem. There are so many muscles around neck, upper back and shoulder which all play in cycle of events.

Only way to treat this RSI is, first accept you have problem. And take this seriously as the medical professionals do not know about this at present. Read about it extensively. Everything is online. You need to find the people who know about this to treat this. If nobody is solving, you may have to think of trying all your best to treat yourself. There are so many people who have overcome and written about it. Google them and read. You have to read it seriously. And learn all the things he talks about and practice. Then you have to read about strengthening each muscle properly. 

The Trigger therapy workbook by Claire Davies, is an excellent self treatment guide. You have to buy this.



Along with that you have to buy a theracane or body back buddy to treat yourself. 

        I have not overcome RSI as yet. I have more to talk about this. I can't go on as you will get bored. I went through hell; I have educated hundreds of people and got them treated by directing to right place.  If you are developing this, run to the professionals who know about this. If you are in denial or neglect can ruin you.  I am just trying to help those who need help. I am in the process. Read my next blog

( Updating now in July 2019, I am planning on starting a practice to solve RSI
I can help those of you who have not been solved. 
I will help how to solve and guide. 
You will have to visit me.  )




PS: All the pictures are copied from the Google search and are used for illustrations only.
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The great Indian gold standard

The Great Indian gold standard

          Gold is the most sought after metal in the world which has been in demand for hundreds of years all over the world. Nations and communities have fought wars for the same. Over years there is less demand of Gold in the developed country than the developing country. Gold has been used for monetary exchange and nation’s wealth. 

          India is the highest consumer and importer of gold. Almost double the amount of gold consumed by China which stands second.

Indians have highest amount of gold in the house. Indians value everything in gold and you can see this obnoxious amount of gold used by the Indian brides.  How does this metal give so much pleasure more than anything else?  How do they feel wearing this and does it make a person happy? Gold by itself doesn’t give anything. It is the after effects when somebody wears it.

         

          Jewelry has been an essential part of women beautification since ages in all cultures of the human race. The basic idea was to beautify a woman and it could have been anything from a flower to pearls. Over years they have found variety of items to be worn as jewelry all over the world. However Gold has been the long lasting metal to maintain its Gold standard as the ultimate winner. Now it is a precious metal with its own status and a standard. Women beautification is the ultimate to win the heart of the opposite sex which is same as the animal kingdom. All the enhancements and artificial works on women’s body have the same benefit.

Over years as the human population evolved, matured ones got over the age old theories and style of attraction changed. The pseudo attraction by jewelry is replaced by standard of living, life style and dressing. The developed world has gotten over the desire for gold as their lifestyle has changed and importance of a person is not by the artificial jewelry. Now it is minimalist, where lesser is more attractive, whether it is jewelry or anything else on the body including clothes. 
 

Indians are crazy after gold and wear so much gold; I wonder how they do not have neck pain. Because of the demand gold prices are shooting up and every corner has a jeweler. Because of the appreciation of price, gold is bought as an investment. Gold comes in use for difficult times for loan and can be sold for an appreciative price. Every poor man wants to have gold also. In turn they are concentrating on buying gold more than the life style they are supposed to enhance. In turn they have problems marrying or marital problems with dowry attached to it.

          Most of the educated do not wear so much gold, except the few neo rich ones or the orthodox. If you look at the poor and rich you will see more jewels worn by the poor. 4 to 5 ear rings in each are worn by the poorer class than the educated middle class. We do have exception in all. We use gold to show our status. We assume more gold you wear higher your value. I mean they are trying to elevate their standard which they are really lacking by wearing gold and expecting others to give their status which are they looking for. This happens with the neo rich like the ones who have sold their land for city expansion or industry and real estate men. They wear thick dog chains all over their body and rings in all the fingers. What these people are communicating to the rest of the world is that they are rich and they have to be accepted by the elite. Whereas world has its own standards. People tend to choose standards by different measure. People still can’t figure out how to attain that standard to be accepted by others and they use the only way out that is dump gold on their body.

          Most of the Indian women spend so much time in choosing jewelry, nobody appreciate them, as the jewellery is covered most of the time. Only time they get the happiness is when they show it off to other women in some corner. Most of the gold is always locked up. The amount of time spent by the jeweler in bringing out that shape is not appreciated at all. Most of the women’s gold has not been seen by their husbands and many are disinterested in appreciating them. Men’s interests are different. They do get attracted by gold, unless he is looking for wealth. 

          Time has come to discourage gold in public by the government. Gold is causing lot of problems to the poor. People who cannot afford but still have to buy for the society and ending up getting cheated by the ever hungry cheating jewelers. They are the ones who are benefited looting with making and breaking charges . Gold has to be taxed in such way that it loses its gold standard. And we have to educate the masses or else this is going to cause lot of problems to the people in the future.

PS: All the photos are for illustrations only, and they have been taken from google search.

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