Straighten spine (Flatback syndrome)

       Straighten spine (Flatback syndrome)

   The flatback syndrome is an abnormal condition where the spine loses its natural low back curve to become flat. It is a type of sagittal imbalance or front to back imbalance in the spine. 

    Normally the spine has several gentle fronts to back curves. The Lumbar (Lower) spine has a lordosis or inward curve. The thoracic (Middle) spine has kyphosis or outward curve, and the cervical spine (neck) has a lordosis. These curves usually work in harmony to keep the body's center of gravity aligned over the hips and pelvis. If the lumbar lordosis is lost the center of gravity can be put too far forward. This is the case in flatback syndrome. 

  The human spine has natural curvatures. When you look at a back from behind, the spine should be straight and centered over the pelvis. However, when you look at the spine from the side, the curves are designed to maintain balance as the spine is behind organs in the chest and abdomen. The spine has two alternating curves to create an "S" like shape. 

  In the neck and low back, there is normally an inward curvature or sway back known as lordosis. I the thoracic spine and sacrum there is an outward curvature known as Kyphosis or hunchback. These curves normally balance out each other so that when the patient stands they are well balanced with their head straight above their hips when viewed from the side. Standing in this position minimizes the effect of gravity and allows the patient to stand with the best posture and use the least energy when moving or walking.

 The flatback syndrome is an abnormal condition where the spine loses its natural low back curve to become flat. The spine becomes imbalanced and the patient leans forward. Patients with flat back syndrome typically notice troubles standing upright or have ongoing back or leg pain. Symptoms usually worsen as the day goes on and the patient feels they lean further and further forward the longer they tey to stand upright. The severity of the symptoms usually depends on the amount of curvature present and difficulties with standing erect.  

 In patients with the flat back syndrome, a loss of normal lumbar curvature causes an imbalance of the spine. The patient's head begins to lean forward, away from the body and they may have trouble standing upright. This imbalance can cause muscle fatigue and pain. 

 The flatback syndrome was first noted in patients who received a specific type of spinal instrumentation for scoliosis treatment. Early types of scoliosis implants, called Harrington rods, allowed the surgeon to straighten the back curvature but also decreased the spine's normal side curvature. 

Causes:
  
  Term flat back syndrome has been broadened to include any patient with a decrease in lumbar lordosis causing symptoms. As such, flat back syndrome can occur as a result of any condition that shortens the front portion of the spine, causing the patient to lean forward. 

   The flatback syndrome may develop as the result of the following causes: Degenerative Disc Disease, Lumbar post Laminectomy syndrome, compression fractures, Ankylosing spondylitis. 

Degenerative Disc Disease:
  
  The progressive degeneration of the intervertebral disc or the shock absorbers of the spine may lead to a loss of height in the front part of the spine. As discs degenerate the spine begins to lean forward and lumbar lordosis decreases. The patient may develop pain as a result of the degenerative disc disease or a result of the spinal imbalance. 

Lumbar post Laminectomy syndrome:

 The lumbar flat back syndrome may develop in patients previously treated with a laminectomy or other lumbar surgery to decompress the spinal nerves to treat stenosis. These procedures can lead to a decrease in lumbar lordosis and in some cases spinal instability. 

Vertebral compression fractures:

  Compression fractures are often the result of weak spinal bones due to Osteoporosis. A fracture can lead to loss of height of the bone in the thoracic and lumbar spine. This may occur in one bone or in multiple bones throughout the spine, resulting in flatback syndrome. 

Ankylosing spondylitis:

 Ankylosing spondylitis is a chronic inflammatory disease that causes stiffness and arthritis throughout the entire spine. Some patients with AS notice an increasing forward posture of the spine, including an increase in thoracic kyphosis or a decrease in lumbar lordosis.  

Symptoms:

  The flatback syndrome can cause difficulty standing upright, chronic pain, and difficulty with daily tasks. In order to stand upright, a person with flatback syndrome must contract the back muscles, and possibly flex at the hips and knees. These maneuvers may temporarily help a person stand upright, but over time, they may result in severe pain. 

Diagnosis:

 To determine the degree of the flatback syndrome, the doctor may order an X-ray test that produces images of the spine and other bones and tissues using invisible electromagnetic rays. This may be a long cassette upright scan that shows the entire spine in a single image. The doctor may also order additional diagnostic procedures to obtain a more detailed image of the spine:

- Magnetic resonance (MR) imaging scan- uses a magnet and radio waves to provide detailed images of the spinal cord, can help identify whether the spinal cord (the bundle of nerves connecting brain and body) has been affected by the spinal curvature. 

- Computed tomography (CT) scan- uses x-rays and a computer to produce detailed images of the body. CT scans are more detailed than general X-rays. 

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Alcoholism

                                                        Alcoholism

Alcoholism is the inability to control drinking due to both a 

physical and emotional dependence on alcohol. 


Symptoms include repeated alcohol consumption despite

related legal and health issues.

  Those with alcoholism may begin each day with a drink, feel guilty about their drinking and have the desire to cut down on the amount of drinking. 

 Treatment involves counseling by a healthcare professional. A detoxification program in a hospital or medical facility is an option for those who need additional assistance. Medications are available that reduce the desire to drink. 

Usually self- diagnosable:

 Symptoms include repeated alcohol consumption despite related legal and health issues. Those with alcoholism may begin each day with a drink, feel guilty about their drinking and have the desire to cut down on the amount of drinking. 

People experience:

whole body: blackout, dizziness, shakiness, craving, or sweating

Behavioral: aggression, agitation, compulsive behavior, self- destructive behavior, or lack of restraint 

mood: anxiety, euphoria, general discontent, guilt, or loneliness

gastrointestinal: nausea or vomiting

psychological: delirium of fear

also common: physical substance dependence, problems with coordination, slurred speech, or tremor. 

Symptoms of alcohol abuse:

  If left untreated, alcohol abuse can spiral out of control quickly. When alcohol abuse begins to negatively impact a person's life and causes harm, it is diagnosed as an alcohol use disorder (AUD). Recognizing the warning signs of alcohol abuse and getting proper treatment can make a significant difference in someone's recovery process. While there is no exact formula for determining whether or not someone is an alcoholic, symptoms often co-occur. One symptom may snowball into another, fueling additional problems down the road. 

- Experiencing temporary blackouts or short-term memory loss

- Exhibiting signs of irritability and extreme mood swings

- Making excuses for drinking such as to relax, deal with stress or feel normal

- Choosing to drink over other responsibilities and obligations

- Becoming isolated and distant from friends and family members. 

- Drinking alone or in secrecy

- Feeling hungover when not drinking

- Changing appearance and group of acquaintances you hang out with

Stages of alcoholism

1- Occasional abuse and binge drinking

 The first stage of alcoholism is a general experimentation with alcohol. These drinkers may be new to different forms of alcohol and likely to test their limits. This experimental stage is commonly seen in young adults. These experimental drinkers also frequently in binge drinking. Many binge drinkers exceed this amount. 

2- Increased drinking 

Drinkers leave the experimental stage when their alcohol consumption becomes more frequent. Instead of just drinking at parties once in a while, you may find yourself drinking every weekend. Increased alcohol consumption can also lead to drinking for these reasons
- as an excuse to get together with friends
- to alleviate stress
- out of boredom
- to combat sadness or loneliness

Regular alcohol use is different from moderate drinking. 

3- Problem drinking

 Frequent, uncontrolled alcohol abuse eventually leads to problem drinking. While any form of alcohol abuse is problematic, the term problem drinking refers to someone who starts experiencing the impacts of their habit. 
- relationship issues 
- decreased social activity because of erratic behavior
- sudden change in friends 
- Difficulty conversing with strangers 

4- Alcohol dependence 

Alcoholism has two facets: dependence and addiction. It's possible for a person to be dependent on alcohol, but not yet addicted. Dependence forms after the problem drinking stage. Another characteristic of dependence is withdrawal. As you sober up, you may feel undesirable symptoms such as:
- nausea that is unrelated to a hangover
- body tremors
- sweating
- severe irritability
- a racing heart
- trouble sleeping

5- Addiction and alcoholism:

 The final stage of alcoholism is an addiction. At this stage, you no longer want to drink just for pleasure. Alcohol addiction is characterized by a physical and psychological need to drink. 

 People with alcohol addiction physically crave the substance and are often inconsolable until they start drinking again. They may be addicted to other drugs as well. Compulsive behaviors are prominent in addiction, and people with alcohol addiction often drink whenever and wherever they desire. 

Diseases associated with alcoholism:

 There are several scientific reasons for the prohibition of consumption of intoxicants i.r. alcohol. The maximum number of deaths in the world related to any one particular cause is due to the consumption of alcohol. Millions of people die every year only because of the intake of alcohol. 
List of few alcohol-related illnesses

- Cirrhosis of the liver is the most well-known alcohol-associated disease

- Other are cancer of the esophagus, cancer of head and neck, cancer of the liver (Hepatoma), cancer of the bowel, etc

- Oesophagitis, gastritis, pancreatitis, and hepatitis are linked with alcohol consumption. 

- Cardiomyopathy, Hypertension, coronary atherosclerosis, angina and heart attacks are linked with heavy alcohol intakes. 

- Stroke, Apoplexy, Fits and different types of paralysis are linked with alcohol intake. 

- Peripheral neuropathy. cortical atrophy, cerebellar atrophy is well- known syndromes caused by alcohol consumption. 

- Wernicke- Korsakoff syndrome with amnesia of recent events, confabulations and retainment of memory to old events with different types of paralysis are mainly due to thiamine deficiency due to excessive alcohol intake. 

- Beriberi and other deficiencies are not uncommon among alcoholics. Even pellagra occurs in alcoholics. 

- Delerium Tremens is a serious complication that may occur during recurrent infection of alcoholics or postoperatively. It occurs during abstentions as a sign of withdrawal effect. It is quite serious and may cause death even if treated in well-equipped centers. 

- Numerous endocrine disorders have associated with alcoholism ranging from Myxodema to Hyperthyroidism and florid Cushing syndrome. 

- Hematological ill effects are long and variable, Folic acid deficiency, however, is the most common manifestation of alcoholic abuse resulting in Macrocytic anemia. Zieve's syndrome is a triad of hemolytic anemia, jaundice, and hyperlipidemia that follows alcoholic binges. 

- Thrombocytopenia and other platelet abnormalities are not rare in alcoholics. 

- The commonly used tablet metronidazole interacts badly with alcohol. 

 - Recurrent infection is very common among chronic alcoholics. The resistance to disease and the immunological defense system are compromised by alcohol intake. 

- Chest infection is notorious in alcoholics. Pneumonia, lung abscess, Emphysema and pulmonary, tuberculosis are all common in alcoholics. 

- During acute alcoholic intoxication, the drunk person usually vomits, the cough reflexes which are protective are paralyzed. The vomitus thus easily passes to the lung causing Pneumonia or lung abscess. Occasionally it may even cause suffocation and death.

- The ill-effects of alcohol consumption on women deserves special women. Females are more vulnerable to alcohol-related cirrhosis than men. During pregnancy alcohol consumption has a severely detrimental effect on the fetus. Fetal alcohol syndrome is being recognized more and more in the medical profession.   

- Skin diseases are also related to alcohol indulgence. 

- Eczema, alopecia, nail dystrophy, paronychia, and angular stomatitis are common diseases among alcoholics. 

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