Prof Dr S R AMEERKHAN BABU M.D.(Hom) MBA: 2013

Wednesday, September 25, 2013

CONQUER ANGER BEFORE IT CONQUERS YOU – AN APPROACH TO INTERMITTENT EXPLOSIVE DISORDER

CONQUER ANGER BEFORE IT CONQUERS YOU – AN APPROACH TO INTERMITTENT EXPLOSIVE DISORDER

Dr. S. R. Ameerkhan Babu., M.D.(Hom)

Anger is a complex emotion experienced by all people to some degree throughout their lives. While it is a natural and typical feeling in the majority of cases, some people may have difficulty controlling the emotion or preventing it from becoming a factor in their daily lives. Health issues linked to unresolved anger include high blood pressure, heart attack, depression, anxiety, colds, flu and problems with digestion.

Anger disorder, more properly known as Intermittent Explosive Disorder (IED) is a psychological condition characterized by sporadic episodes of aggression, violence, and destructive behavior. People who suffer from anger disorder are unable to control themselves, exploding with rage in a way which is often out of proportion to the event which triggered the anger. People with intermittent explosive disorder may attack others and their possessions, causing bodily injury and property damage. They may also injure themselves during an outburst. Later, people with intermittent explosive disorder may feel remorse, regret or embarrassment.

Causes

The exact cause of intermittent explosive disorder is unknown, but the disorder is probably caused by a number of environmental and biological factors.

· Environment. Most people with this disorder grew up in families where explosive behavior and verbal and physical abuse were common. Being exposed to this type of violence at an early age makes it more likely these children will exhibit these same traits as they mature.

· Genetics. There may be a genetic component, causing the disorder to be passed down from parents to children.

· Brain chemistry. There may be differences in the way serotonin, an important chemical messenger in the brain, works in people with intermittent explosive disorder.

People with other mental illnesses such as mood, anxiety or personality disorders or certain medical conditions such as Parkinson's disease or traumatic brain injury may display aggressive behaviors. However, they would not be diagnosed as having intermittent explosive disorder because the cause is from another condition.

A number of factors increase risk of developing intermittent explosive disorder:

· History of substance abuse. People who abuse drugs or alcohol have an increased risk of intermittent explosive disorder.

· History of physical abuse. People who were abused as children or experienced multiple traumatic events have an increased risk of intermittent explosive disorder.

· Age. The start of intermittent explosive disorder most commonly occurs in people in their teens and 20s.

· Being male. Men are more likely to have intermittent explosive disorder than women

Symptoms

Explosive eruptions, usually lasting less than 30 minutes, often result in verbal assaults, injuries and the deliberate destruction of property. These episodes may occur in clusters or be separated by weeks or months of nonaggression. In between explosive outbursts, the person may be irritable, impulsive, aggressive or angry.

Aggressive episodes may be preceded or accompanied by: Irritability, Increased energy, Rage, Racing thoughts, Tingling, Tremors, Palpitations, Chest tightness, Feeling of pressure in the head

Depression, fatigue or relief may occur after the episode.

People with intermittent explosive disorder have an increased risk of:

· Self-harm. They don't always direct their anger at others. They're at significantly increased risk of harming themselves, either with intentional injuries or suicide attempts. Those who are also addicted to drugs or have another serious mental disorder, such as depression, are at greatest risk of harming themselves.

· Impaired interpersonal relationships. They're often perceived by others as always being angry. This can lead to relationship problems, divorce and family stress.

· Trouble at work, home or school. Other complications of intermittent explosive disorder may include job loss, school suspension, auto accidents, financial problems or trouble with the law.

Diagnosis

Diagnosis is made using a psychiatric interview to affective and behavioral symptoms to the criteria listed in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders). This manual is used by mental health providers to diagnose mental conditions to reimburse for treatment.

DSM criteria include:

· Multiple incidents of failure to resist aggressive impulses that resulted in deliberate destruction of property or assault of another person

· A degree of aggressiveness during incidents that's completely out of proportion to the event that triggered the behavior

· Aggressive episodes that aren't accounted for by another mental disorder and aren't due to the effects of a drug or a medical condition.

· Other conditions that must be ruled out before making a diagnosis of intermittent explosive disorder include other mental disorders or substance use problems.

Management:

Psychotherapy
Individual or group therapy sessions can be helpful. A commonly used type of therapy, cognitive behavioral therapy, helps people with intermittent explosive disorder identify which situations or behaviors may trigger an aggressive response. And, more importantly, this type of therapy teaches people how to manage anger and control inappropriate responses using techniques such as relaxation training, thinking differently about situations (cognitive restructuring) and learning coping skills.

Tips for Taming Your Anger

· Take better care of yourself. Often it’s possible to curb anger simply by cutting back on stimulants like caffeine and nicotine, which can shorten your emotional fuse. Getting more sleep can also help.

· Talk over your feelings. Having a heart-to-heart with a friend or family member can help you understand and overcome your anger. “Hearing honest feedback from others can be a great way to understand and change our emotional responses,

· Practice delay and distraction. Counting to 10 really works for some people, as does wearing a rubber band on your wrist and snapping it each time you feel angry. Mindfulness meditation can help, as can humming a favorite tune or saying a prayer

· Practice relaxation techniques. Regular use of deep breathing, relaxing imagery or yoga may help you stay calm. Physical activity can potentially be an effective way of expressing anger.

· Develop new ways of thinking (cognitive restructuring). Changing the way you think about a frustrating situation by using rational thoughts, reasonable expectations and logic may improve how you view and react to an event.

· Change your environment. When possible, leave or avoid situations that upset you. Also, scheduling personal time may enable you to better handle an upcoming stressful or frustrating situation.

Homoeopathic Management

Homoeopathy considers the person as a whole, and takes account of the physical and psychological characteristics of the patient. It involves a detailed case history, which serves as ray of hope to both the patient- i.e., the one who is abused, as well as the offender. The patient has an opportunity to be heard and understood from her own perspective .After careful case taking and analyzing the case, the homeopathic physician decides on the remedy which suits the patient’s needs. Other therapies like yoga, meditation, music therapy, dance therapy, hypnotherapy, anger management, and family therapy are available as adjuncts. The remedy is chosen depending upon the patient’s characteristic traits and symptoms. This list of remedies is meant for use with the guidance of a qualified homoeopath.

Aconite Napellus - This is one of the common medicines that are used for the treatment of fear. This medicine is basically for people who are always anxious, fearful, and in a state of anguish.

Nux Vomica - This person is very ambitious, intelligent and capable, with a strong sense of duty. He is very irritable and wants everything around him to be perfect and in order. He is disturbed by others around him, is impatient and cannot stand disorder or objection. He is ready to quarrel at any time for these reasons. At first he tries to suppress his anger and not to quarrel, then with next unimportant matter he bursts out shouting, cursing even throwing or tearing things. He loses his self control. They weep from irritability (Plat.).The second stage is characterised by destructiveness. Here the wife can hit her husband or have the impulse to throw the child into the fire or kill it, (Sulph., Thea.). In the deeper stages this impulse becomes a fear and is followed by weakness and depression.

Anacardium - suited to individuals who are irritable, irresolute, easily angered, lack confidence. Suspicious, irresistible desire to swear and curse; malicious, destructive, offended easily. Laughs at serious matters and become serious about laughable matters. Aversion to work. Forgetful- forgets names of near ones. The characteristics seen in this remedy are- shrieking and cursing when in rage, violent anger, abusive behavior towards partner and children, revengeful.

Belladonna - This remedy is characterized by great intensity and vividness in the patient and in the disease process. In anger they explode, they burst out, they become violent. They pull, they bite, they strike, they knock their head. Their face becomes frightful and red. The rage is strong, but without passion and malice (like in Stram.) and stops suddenly. They feel pulsation of the arteries during rage.

Staphysagria - Sensitive to scolding, insults. Suppression of anger, emotions; become speechless in arguments; sympathetic. Suited to individuals who do not allow themselves to express their emotions. His body may tremble in anger. Especially indicated when physical complaints appear after suppression of emotions and suppressed anger.

Magnesium Muriaticum- This remedy can be indicated after the loss of a care giver where one feels abandoned and forsaken, left on her own, not able to fend for herself. This may be accompanied by digestive ailments.

Natrum Muriaticum - This remedy is often indicated in a “romantic loss” in very introverted people. They feel the loss as a breaking in half of their own identity. They will cry horribly while alone looking at pictures and listening to music, yet dread to show their feeling in public. This homeopathic remedy is especially indicated in cases where long term illness progressed from the loss.

Ignatia- This is the first remedy a homeopath thinks of when someone has suffered the “loss of a loved one”. This remedy often applies when there are symptoms of a lump in the throat, spasms in the body, feelings of disappointment in one’s life dreams.

References

1. Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association. 2000.

2. Ray DiGiuseppe, Anger-related disorders: a practitioner's guide to comparative treatments.

3. Raymond DiGiuseppe, Raymond Chip Tafrate, Understanding Anger Disorders

4. International Handbook of Anger

5. www.mayoclinic.com

6. http://www.wisegeek.org.

7. http://www.webmd.com/mental-health/

8. http://hpathy.com/homeopathy-papers

9. Homeopathic Materia Medica by Boericke

10. http://www.knowhomeopathy.com/01_anger.php

11. http://en.wikipedia.org/wiki/

12. Lilienthal S., Homoeopathic Therapeutics

13. Dewey W. A., Practical Homeopathic Therapeutics

Dr. S. R. AMEERKHAN BABU., M.D. (Hom) (Pract. of Med), MBA

Reader, Dept. of Practice of Medicine

Vinayaka Mission’s Homoeopathic Medical College & Hospital, Salem, Tamilnadu.

GALL STONE - AVOID RECURRENCE AND SURGERY WITH HOMOEOPATHY – NON SURGICAL MANAGEMENT OF GALL STONE

AVOID RECURRENCE AND SURGERY WITH HOMOEOPATHY

– NON SURGICAL MANAGEMENT OF GALL STONE

Dr. S. R. Ameerkhan Babu., M.D. (Hom)

The gallbladder is a small little pouch that is shaped like a pear, and it is located behind the liver. Its primary duty is to save the cholesterol-rich bile that’s secreted from the liver. Bile helps the body digest fatty foods. Therefore, when that bit of fatty steak reaches the intestines, they deliver a note to send down some bile from the gallbladder. After this the fatty food becomes easier to digest and readily makes its way through the remainder of the digestive procedure.

Gallstones (also known as cholelithiasis) are pieces of solid material that form in the gallbladder. These stones develop because cholesterol and pigments in bile sometimes form hard particles. Gallstones usually form in the gallbladder; however, they also may form anywhere there is bile; in the intrahepatic, hepatic, common bile, and cystic ducts. A gallstone is a crystalline concretion formed within the gallbladder by accretion of bile components. These calculi are formed in the gallbladder but may distally pass into other parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or the ampulla of Vater.

Rarely, in cases of severe inflammation, gallstones may erode through the gallbladder into adherent bowel potentially causing an obstruction termed gallstone ileus. If gallstones migrate into the ducts of the biliary tract, the condition is referred to as choledocholithiasis. Choledocholithiasis is frequently associated with obstruction of the biliary tree, which in turn can lead to acute ascending cholangitis, a serious infection of the bile ducts. Gallstones within the ampulla of Vater can obstruct the exocrine system of the pancreas, which in turn can result in pancreatitis.

Types

On the basis of their composition, gallstones can be divided into the following types:

Cholesterol stones vary from light yellow to dark green or brown and are oval, between 2 and 3 cm long, each often having a tiny, dark, central spot. To be classified as such, they must be at least 80% cholesterol by weight (or 70%, according to the Japanese- classification system)

Pigment stones are small and dark and comprise bilirubin and calcium salts that are found in bile. They contain less than 20% of cholesterol (or 30%, according to the Japanese-classification system).

Mixed gallstones typically contain 20–80% cholesterol (or 30–70%, according to the Japanese- classification system).^[6] Other common constituents are calcium carbonate, palmitate phosphate, bilirubin, and other bile pigments. Because of their calcium content, they are often radiographically visible.

Causes

Gallstone risk increases for females (especially before menopause) and for people near or above 40 years. Several factors may come together to create gallstones, including: Genetics, Body weight, Decreased motility (movement) of the gallbladder, Diet.

Gallstones can form when there is an imbalance in the substances that make up bile. For instance, cholesterol stones may develop as a result of too much cholesterol in the bile. Another cause may be the inability of the gallbladder to empty properly.

Pigment stones are more common in people with certain medical conditions, such as cirrhosis (a liver disease in which scar tissue replaces healthy liver tissue) or blood diseases such as sickle cell anemia.

Risk factors for getting gallstones include:

Genetics. If other people in your family have had gallstones, you are at increased risk of developing gallstones.
Obesity. This is one of the biggest risk factors. Obesity can cause a rise in cholesterol and can also keep the gallbladder from emptying completely.
Estrogen. Estrogen can increase cholesterol and reduce gallbladder motility. Women who are pregnant or who take birth control pills or hormone replacement therapy have higher levels of estrogen and may be more likely to develop gallstones.
Ethnic background. Certain ethnic groups, including Native Americans and Mexican-Americans, are more likely to develop gallstones.
Gender and age. Gallstones are more common among women and older people.
Cholesterol drugs. Some cholesterol-lowering drugs increase the amount of cholesterol in bile, which may increase the chances of developing cholesterol stones.
Diabetes. People with diabetes tend to have higher levels of triglycerides (a type of blood fat), which is a risk factor for gallstones.
Rapid weight loss. If a person loses weight too quickly, his or her liver secretes extra cholesterol, which may lead to gallstones. Also, fasting may cause the gallbladder to contract less.

Diet causing Gallstones

The role of diet in the formation of gallstones is not clear. We do know that anything that increases the level of cholesterol in the blood increases the risk of gallstones. It is reasonable to assume that a diet with large amounts of cholesterol and other fats increases the risk of gallstones, but it is also important to remember that the amount of cholesterol in our bile has no relationship to our blood cholesterol. Loosing weight rapidly seems to increase the risk of gallstones and so does skipping meals. Obesity is a risk factor for gallstones. Eating a fatty or greasy meal can precipitate the symptoms of gallstones.

Clinical features

Most people with gallstones have no symptoms called "silent gallstones". In fact, they are usually unaware that they have gallstones unless symptoms occur.

Symptoms usually occur as complications develop. The most common symptom is pain in the right upper part of the abdomen. Because the pain comes in episodes, it is often referred to as an "attack."

– Attacks may occur every few days, weeks, or months; they may even be separated by years.

– The pain usually starts within 30 minutes after a fatty or greasy meal. The pain is usually severe, dull, and constant, and can last from one to five hours. It may radiate to the right shoulder or back.It occurs frequently at night and may awaken the person from sleep.

– The pain may make the person want to move around to seek relief, but many patients prefer to lay still and wait for the attack to subside.

– Other common symptoms of gallstones include nausea and vomiting, fever, indigestion, belching, bloating, intolerance for fatty or greasy foods, and jaundice (yellowing of the skin or the whites of the eyes).

– Warning signs of a serious problem are fever, jaundice, and persistent pain.

Diagnosis

There is no blood test that can identify gallstones.Ultrasound is the best test to examine the gallbladder for stones. Ultrasound is usually the first choice because it is completely noninvasive and involves no exposure to radiation.

An alternative to ultrasound is an oral cholecystogram (OCG). An X-ray is taken of the gallbladder after the patient swallow pills containing a safe, temporary dye. The dye helps the gallbladder and gallstones show up better on the X-ray.

Other tests are better choices if gallstones have left the gallbladder and moved into the ducts like Cholescintigraphy (HIDA scan), CT scan, Endoscopic retrograde cholangiopancreatography (ERCP)

Management

Natural treatment

· Lemon Juice - Drink freshly squeezed lemons each day on an empty stomach.It can help to remove the gallstones. The elimination of the gallstones gets easier when you drink lots of water.

· Mix the juice of beets, carrots and cucumbers and drink it twice daily for 2 weeks.

· Pour honey in 1 teaspoon of turmeric and have it everyday until the gallstones go away.

· Drink one teaspoon of apple cider vinegar. Gallstone pain is relieved by this very quickly. Mix it with apple juice if you can’t stand the taste.

· Soluble fiber helps to control metabolic rate and supports the elimination of cholesterol from our bodies. Eat cereals and other grains that are high in fiber.

· Obtaining lots of vitamin C to have in your daily diet will assist you with the prevention of gallstones

· There is a study that is discovering that omega-3 fatty acids, found in fish like salmon, can help in the prevention of gallstones.

· Consuming vegetables is a great way to keep gallstones away.

· Having 1/2 a glass of wine each day can help to keep gallstone attacks away. Researchers found that consuming 1/2 a glass of wine can reduce the amount of gallstone attacks

Surgical treatment

Gallstones are usually treated with surgery to take out the gallbladder. The traditional operation is called an open cholecystectomy. A newer procedure, called laparoscopic cholecystectomy, is less invasive, has fewer complications, and is used more often.

Laparscopiccholecystectomy. During this procedure, instruments, a light, and a camera are passed through several small incisions in the abdomen. The surgeon views the inside of the body by looking at a video monitor. This procedure is used in approximately 80% of gallbladder removals. After the surgery, the patient spends the night in the hospital.
Open cholecystectomy. This is a more invasive procedure in which the surgeon makes incisions in the abdomen to remove the gallbladder. The patient stays in the hospital for a few days after the surgery.

HOMOEOPATHIC MANAGEMENT

A constitutional remedy chosen by an experienced Homoeopathic prescriber is the most appropriate way to treat deep-seated, serious, or chronic conditions. Homoeopathic treatment involves detail history taking by concentrating on general physical make up of person, diet, life style, sedentary habits, physical build up, food eating habits, appetite, stool, perspiration, body weight, present signs & symptoms, any treatment history or drug history, bowel habits, disordered from particular foods, sleep and temperament. Also his miasmatic background taken into consideration. Remedies below have been helpful to some people with gallstones. Homoeopathy helps in the disease by dissolving the stone through proper remedies. With homoeopathic treatment one can successfully control the pain as well as the swelling of gall bladder. It also arrests further development of the gall bladder stones. To avoid recurrence of gall stone Constitutional line of treatment must be given.

Chelidonium: It relieves Gall-stones colic in a few minutes when there are shooting, stabbing pains extending to the back and marked jaundice. It is indicated medicine for bilious complications during gestation. It is useful for Gall stones, enlarged liver. There is constant pain under inferior angle of right scapula. There is yellow complexion worse on nose and cheek. Constipation with hard, round balls like sheep’s dung, alternation of diarrhoea and constipation.

Cardus Marians: It is a very important medicine for Gallstone disease with enlarged liver. There is Ailments from abuse of alcoholic beverages, especially beer. There is pain in region of liver extending to left shoulder, when lying on left side. There is pain under the right scapula near edge of the spine. Left lobe of Liver is very sensitive. It acts better in tincture should be given 10 drops of , Jaundice & Diabetes Mellitus. There is aching in umbilical region, griping. Patient feels as if a string were tied in a "slip-knot" around intestines which was suddenly drawn tight and then gradually loosened. Region of Liver is sore, tender, enlarged liver with jaundice and constipation. Stools are clay-colored, soft, yellow and pasty. Tongue heavily coated. Urine is of high specific gravity, bile and sugar in urine. Skin is yellow, marked moisture of skin.

Calcarea Carb: It is useful medicine for Gall stones colic with great chilliness. There is profuse sweat, abdominal spasms, bend double, clench hands, write with agony. Dr. Farrington says “It has often stopped pain as by magic and has also cured permanently”.

Podophyllum : It is useful medicine for Gall stones with jaundice. There is pain from stomach towards gall bladder. With excessive nausea, alternate constipation and diarrhea. Also useful in Chronic hepatitis with constipation and jaundice. Patient constantly rubs the liver region with hands.

Natrum Sulph : It is useful medicine for Liver and Gall Bladder problems like Gall stones. There is sharp, stitching pain in region of liver worse by touch, jar, lying on left side, tight clothes and better by lying right side with legs curdled up (Mag-m). There is indigestion and flatulence from farinaceous food worse before breakfast.

Veratrum Album : It is useful medicine for Gall bladder affection. There is pain in abdomen preceding stool, cramps, knotting abdomen and legs. There is sinking and empty feeling in abdomenStools are large, with much straining until exhausted, with cold sweat. Diarrhoea in Veratrum is very painful, watery, copious, and forcibly evacuated, followed by great prostration.

Berberis Vulgaris : It is important medicine for Gall Bladder Stone. There are stitches in region of gall-bladder worse by pressure, extending to stomach. It is useful for catarrh of the gall-bladder with constipation and yellow complexion. < by motion, standing.

Dioscoria : It is useful medicine for Gall Stone & Gall stone Colic. There are wandering type of pain which suddenly shifts to different parts as back, chest, arms, fingers and toes. All symptoms are worse by doubling up (Opposite of Colosynth).

> stretching out, bending back, Standing erect.

Lycopodium : It is useful medicine for Gall stone, Gall bladder, Liver affection. Lycopodium is right sided remedy symptoms go from right to left side. There is pain in right hypchondrium extending to back (Chelidonium) worse by eating to satiety. Abdomen is full, bloated, distended in epigastrium after meal. Lycopodium desires sweets and hot drinks. Symptoms are worse from 4-8 pm, after eating, suffer from anticipation.

Mother Tincture for Gall Stone Colic

Cardus Marians Q. : When liver is prominently affected with torpidity, constipation etc. To check formation of stone Cardus M Q. 5 drops in an ounce of cool water twice daily.

Chionanthus Q.: When symptoms are associated with pain under right shoulder. It gives instant relief and insures radical cure in gall stone colic. Give Chinanthus Q. 10 drops in an ounce of water every hour and oftener during paroxysms of pain. To check the formation of gall stones and recurrence of pain give chionanthus Q. 5 drops thrice daily in an ounce of cool water.

Dioscoria Q. : When pain ameliorated by bending backward. Give Dioscoria Q. 5 drops every 10 to 15 minutes in biliary colic.

Cholestrinum 1 x : It is specific remedy to be used independently.

Stigmata madagus Q.: It relieves at once the violent pain if given during paroxysm. DR Hausen says “It is very beneficial medicine for intolerable pain during passing of gall-stones if given in Q. 20 drops every 10-15 minutes. “

Cactus Q.: Gall stones or renal colic with constriction and cardiac affection.

Biochemic Materia Medica:

Calcarea Phos: To prevent the re-formation of new stones.

Magnesia phos: Spasms from gall-stones.

Natrum Sulph: Cannot bear tight clothing around waist.

References

1. Love & Bailey, Text book of Surgery

2. S.Das, Text book of Surgery

3. http://en.wikipedia.org/wiki/

4. http://www.emedicinehealth.com

5. www.mayoclinic.com

6. Tylers book on Homoeopathic Therapeutics

7. www.MedicineNet.com

8. http://www.webmd.com/

9. http://www.modernhomoeopathy.com

10. The Twelve Tissue Remedies of Schussler by Boericke & Dewey

11. http://www.naturalalternativeremedy.com/

12. Homeopathic Materia Medica by Boericke

13. Synoptic Key by Dr. Boger

14. A Dictionary of Practical Materia Medica by Dr. J.H. Clark

15. Lilienthal S., Homoeopathic Therapeutics

16. Dewey W. A., Practical Homeopathic Therapeutics

Dr. S. R. AMEERKHAN BABU., M.D. (Hom) (Pract. of Med), MBA

Reader, Dept. of Practice of Medicine

Vinayaka Mission’s Homoeopathic Medical College & Hospital, Salem, Tamilnadu.

NEARING OLD AGE? BE EARLY TO EXAMINE FOR BPH HOMOEOPATHY FOR PROSTATIC ENLARGEMENT – NON SURGICAL MANAGEMENT

NEARING OLD AGE? BE EARLY TO EXAMINE FOR BPH HOMOEOPATHY FOR PROSTATIC ENLARGEMENT – NON SURGICAL MANAGEMENT

Dr. S. R. Ameerkhan Babu., M.D. (Hom)

Benign prostatic hyperplasia (BPH), also called benign enlargement of the prostate (BEP), adenofibromyomatous hyperplasia and benign prostatic hypertrophy, prostate gland enlargement can cause bothersome urinary symptoms. Prostate problems are common in men 50 and older. Benign prostatic hyperplasia is nonmalignant (noncancerous) enlargement of the prostate gland. Untreated prostate gland enlargement can block the flow of urine out of the bladder and can cause bladder, urinary tract or kidney problems.

The prostate is a small organ about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). The prostate makes a fluid that helps to nourish sperm as part of the semen (ejaculatory fluid).

Causes and Risk Factors of BPH

· Aging - Prostate gland enlargement rarely causes signs and symptoms in men younger than 40. By 55, about 1 in 4 men have some signs and symptoms. By 75, about half of men report some symptoms.

· Family history. Having a blood relative such as a father or brother with prostate problems means more likely to have problems as well

· Excessive DHT: DHT (dihydrotestosterone), a substance that is the result of a conversion of testosterone by an enzyme called 5-alpha reductase. BPH is an “androgen-dependent disease,” which means it is influenced by the male hormone (androgen) testosterone. The prostate will not grow unless it is “directed” to do so by testosterone, which is made mainly by the testes

· Elevated estradiol: It’s natural for men to have some of the female hormone estrogen (in the form of estradiol). When estradiol levels are too high, however, and the ratio is out of balance, men can experience fatigue, increased body fat, loss of libido and an enlarged prostate. An imbalance between estrogen and testosterone increases DHT activity, and thus encourages prostate cells to grow.

· Overweight/Obesity: Being overweight, especially around the midsection, raises the risk of excessive prostate growth. The link between obesity and BPH may be related to the reduced testosterone levels seen in the obese. Also, a drop in testosterone means there’s an accompanying rise in estrogen levels, which can increase the activity of DHT and thus prostate growth.

· Diabetes mellitus : Having diabetes increases the risk of developing BPH, perhaps significantly. The diabetes-BPH link may also be related to the damage that diabetes does to blood vessels. If the vessels that service the prostate are damaged, an enlarged prostate may be the result.

· High “Bad” Cholesterol : Those who had higher levels of the notorious “bad” cholesterol, low-density lipoprotein (LDL), were more likely to develop BPH than men who had normal LDL levels. (Parsons 2008) When the researchers divided the men into three groups (high, medium, low), those with “high” LDL levels were four times more likely to have BPH than those in the “low” group.

· High blood pressure: Although no one is exactly sure how high blood pressure may trigger or worsen BPH, researchers have found a link between hypertension and BPH.

· Sedentary lifestyle: A lack of exercise may increase your chances of developing BPH, possibly because exercise helps fight obesity, type 2 diabetes, insulin resistance, and other risk factors associated with BPH.

Clinical Features:

Symptoms are classified as storage or voiding

· Storage symptoms include urinary frequency, urgency, urgency incontinence, and voiding at night (nocturia).

· Voiding symptoms include urinary stream hesitancy (needing to wait for the stream to begin), intermittency (when the stream starts and stops intermittently), straining to void, and dribbling. Pain and dysuria are usually not present.

· Urinary frequency - The need to urinate frequently during the day or night (nocturia), usually voiding only small amounts of urine with each episode

· Urinary urgency - The sudden, urgent need to urinate, owing to the sensation of imminent loss of urine without control

· Hesitancy - Difficulty initiating the urinary stream; interrupted, weak stream

· Incomplete bladder emptying - The feeling of persistent residual urine, regardless of the frequency of urination

· Straining - The need strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully evacuate the bladder

· Decreased force of stream - The subjective loss of force of the urinary stream over time

· Dribbling - The loss of small amounts of urine due to a poor urinary stream

· Physical examination over the suprapubic area for signs of bladder distention and a neurological examination for sensory and motor deficits.

· The digital rectal examination (DRE) is an integral part of the evaluation in men with presumed BPH. During this portion of the examination, prostate size and contour can be assessed, nodules can be evaluated, and areas suggestive of malignancy can be detected. Findings suggestive of Benign Prostatic Hyperplasia are Symmetric prostatic enlargement, Smooth and Firm but elastic

Lab Tests Used to Diagnose BPH

Several tests help the physician identify the problem and decide treatment to be needed. The tests vary from patient to patient, but the following are the most commonly used tests to diagnose BPH and other problems in the urinary tract:

· Digital rectal exam

· Prostate specific antigen test (PSA test):- PSA stands for Prostate Specific Antigen and is a protein enzyme made in your prostate gland

· Rectal ultrasound

· Urine flow study

· Cystoscopy.

Risk Analysis and PSA Range - Normal: 0-4 ng/ml, Slightly Elevated: 4-10 ng/ml, Moderately Elevated: 10-20 ng/ml, Highly Elevated: 20+ ng/ml.

Complications

Complications related to bladder outlet obstruction secondary to BPH include the following: Urinary retention, Renal insufficiency, Recurrent urinary tract infections, Gross hematuria, Bladder calculi, Renal failure or uremia (rare).

Management:

Lifestyle changes and Natural remedies

Making some lifestyle changes can often help control the symptoms of an enlarged prostate and prevent your condition from worsening. Try these measures:

· Limit beverages in the evening. Don't drink anything for an hour or two before bedtime to help you avoid wake-up trips to the bathroom at night.

· Don't drink too much caffeine or alcohol. These can increase urine production, irritate your bladder and worsen your symptoms.

· Limit decongestants or antihistamines. These drugs tighten the band of muscles around your urethra that control urine flow, which makes it harder to urinate.

· Go when you feel the urge. Try to urinate when you first feel the urge. Waiting too long to urinate may overstretch the bladder muscle and cause damage.

· Schedule bathroom visits. Try to urinate at regular times to "retrain" the bladder. This can be done every four to six hours during the day and can be especially useful if you have severe frequency and urgency.

· Stay active. Inactivity causes you to retain urine. Even a small amount of exercise can help reduce urinary problems caused by an enlarged prostate.

· Urinate — and then urinate again a few moments later. This is known as double voiding.

· Keep warm. Colder temperatures can cause urine retention and increase your urgency to urinate.

· Increase intake of fruits, vegetables and whole grains, soy, and green tea, foods rich in omega 3 oils (cold-water fish – salmon, sardines, mackerel) and in zinc (raw pumpkin seeds for omega-3 and zinc)

· reduce foods high in fat and cholesterol (butter and margarine, beef and
whole milk), sweet foods, and refined carbohydrates (white bread and white-flour pasta)

Some of the herbal treatments that have been suggested as helpful for reducing enlarged prostate symptoms include:

· Saw palmetto extract, made from the ripe berries of the saw palmetto shrub

· Beta-sitosterol extracts, made from several plants, such as certain grasses and trees

· Pygeum, an oil made from the bark of an African prune tree

· Ryegrass extract, made from ryegrass pollen

· Stinging nettle extract, made from the root of the stinging nettle plant

Homoeopathic Management

Homoeopathy considers the person as a whole, and takes account of the physical and psychological characteristics of the patient. It involves a detailed case history, which serves as ray of hope to both the patient- i.e., the one who is abused, as well as the offender. The patient has an opportunity to be heard and understood from her own perspective .After careful case taking and analyzing the case, the homeopathic physician decides on the remedy which suits the patient’s needs. The remedy is chosen depending upon the patient’s characteristic traits and symptoms. This list of remedies is meant for use with the guidance of a qualified homoeopath.

An clinical trail has been conducted in 220 men’s (aged 30-90 years) suffering from BPH in odisha india. This study compared homeopathic treatment strategies using constitutional medicines (CM) or organopathic medicines(OM) alone or in combination(BCOM) in patients suffering from BPH. The study result shows treatment response was highest with BCOM (38.24%) compared to OM (31.62%) and CM (30.15%).

Apis mellifica: Stinging pain during urination that is worse when the final drops are passing is a strong indication for this remedy. Discomfort may also involve the bladder. The prostate area is swollen and very sensitive to touch. The person may feel worse from heat and from being in warm rooms, with improvement from being out in open air or from cool bathing.

Causticum: Urine loss when the person coughs or sneezes often indicates a need for this remedy. Once urine has started passing, the person may feel pressure or pulsation extending from the prostate to the bladder. Causticum is also indicated when sexual pleasure during orgasm is absent or diminished.

Chimaphilla umbellata: This remedy is often helpful when the prostate is enlarged, with urine retention and frequent urging. The person may have the feeling that a ball is lodged in the pelvic floor, or experience pressure, swelling, and soreness that are worse when sitting down.

Clematis: This remedy is often indicated when swelling of the prostate seems to have narrowed or tightened the urinary passage. Urine usually emerges slowly, in drops instead of a stream, with dribbling afterward.

Conium :

This remedy is useful in chronic hypertrophy of the prostate with difficulty in voiding urine, it stops and starts and there is an accompanying catarrh of the bladder. The suitability of conium to the complaints of the aged should be considered. Depressed, timid with weak memory.

Lycopodium: This remedy may be helpful if urine is slow to emerge, with pressure felt in the prostate both during and after urination. The prostate is enlarged, and impotence may also be a problem. People who need this remedy often suffer from digestive problems with gas and bloating, and have an energy slump in the late afternoon.

Pulsatilla: Prostate problems with discomfort after urination and pains that extend to the pelvis or into the bladder (often worse when the man is lying on his back) suggest a need for this remedy. There may also be a bland, thick, yellow discharge from the penis. Pulsatilla is usually suited to emotional individuals who want a lot of affection and feel best in open air.

Sabal serrulata: A frequent urge to urinate at night, with difficulty passing urine, and a feeling of coldness in the sexual organs, suggest a need for this remedy. It is sometimes also used in lower potencies for urinary incontinence in older men. This remedy is made from saw palmetto which is also used as an herbal extract for similar prostate problems.

Staphysagria: This remedy may be indicated if a man feels burning pain in his urinary passage even when urine is not flowing, and urine retention is troublesome. Men who are likely to respond to Staphysagria are often sentimental and romantic, and may also have problems with impotence (most often caused by shyness).

Thuja: When the prostate is enlarged, and the person has a frequent urge to urinate, with cutting or burning pain felt near the bladder neck, this remedy may bring relief. After urine passes, a dribbling sensation may be felt. A forked or divided urine stream is sometimes seen when this remedy is needed.

References

1. Love & Bailey, Text book of Surgery

2. S.Das, Text book of Surgery

3. http://en.wikipedia.org/wiki/

4. http://www.emedicinehealth.com

5. www.mayoclinic.com

6. Tylers book on Homoeopathic Therapeutics

7. www.MedicineNet.com

8. http://www.webmd.com/

9. http://www.ncbi.nlm.nih.gov/pubmed/23089217

10. http://www.olivehomeopathy.in/

11. http://naturalremediesexplorer.com