By Marvin Cervantes
 Experienced clinicians begin the process of making a diagnosis upon first laying eyes on a patient, and probability is one of the main tools they use in this process. A glimpse "behind the scenes" from the point of view of a diagnosing physician might help to explain an otherwise mysterious process.
The diagnostic process can begin even before laying eyes on the patient. As an exercise (and to prove a point) I ask medical students who are with me in the office to diagnose the patient we haven't seen yet who is still in the waiting room. Of course, they look at me like I'm crazy. But I tell them that we already know a lot about the patient and can make some educated guesses. For example, we might already know that the patient is a 34-year-old woman referred by a family doctor because of headaches.
So what have other women in their thirties referred to me for headaches ended up having as their diagnosis? In my neurology practice, as well as in those of most other headache specialists, about a third (33%)
have migraine, another third have medication-overuse headaches (in which the treatment has become the problem instead of its solution), and the remaining third fall into an "everything else" category that includes tension-type headaches, arthritis of the neck or jaw-joints, sinus disease, tumors, etc. So before seeing the patient I'm already able to identify the two most likely diagnoses and assign an initial probability for each.
These starting-point likelihoods are called "anchor" probabilities. During the subsequent history, examination and supplemental testing (if necessary) the anchor probabilities will undergo a series of upward and downward adjustments according to what the patient has to say and what does or does not turn up on her physical examination and testing. The physician individualizes the questions asked and items examined so that the outcome of each query forces one diagnosis to be more likely and another to be less likely. Thus, diagnosis is a dynamic and sequential process.
We invite the woman into the examining room and listen to her story. In the headache example given, one key piece of data is how many days per month she takes an as-needed medication - for example, aspirin, acetaminophen or a prescription drug. If she takes as-needed medicine more days than not and has been doing so for a matter of months, then the initial 33% anchor probability of medication-overuse headaches gets adjusted upward and the initial anchor probability of uncomplicated migraine moves downward. This, of course, is just a single distinguishing feature, and cannot be relied upon to tell the whole story. The physician gathers many such data points to refine the diagnosis.
The physical examination provides another source of facts to distinguish among still-viable possibilities. If my patient has migraine or medication-overuse headaches, she might have tender muscles in her scalp and neck but should not have a blind spot in her visual fields, slurring of her speech or clumsiness on just one side of her body. These findings, if present, would cause the probabilities of migraine and medication overuse headaches to be revised downward. By contrast, the probability of a brain disease - like a tumor, for example - that started with a low anchor probability would get revised upwards.
If a blood test or a scan is ordered, it is again with the idea that the test has been individualized to discriminate between competing diagnoses and re-adjust their relative probabilities.
There is an important principal in medical diagnosis called Bayes' theorem. In a nutshell, Bayes' theorem states that the probability of a diagnosis after a new fact is added depends on what its probability was before the new fact was added. Another way of saying this is that the same "yes" answer on history-gathering, reflex result on physical exam or dark spot on an MRI scan has different implications in different people. The meaning of each depends on its context. Yet another implication of Bayes' theorem is that one can't skip past the history and examination by ordering a test in isolation and expect it to make an accurate diagnosis. A test is an answer to a question. If there was no question, how could the test be an answer?
Let's say that at a particular point in time we have completed the diagnostic process for a patient. Then what? By the end of the diagnostic process the doctor might have a diagnosis that is nearly 100% likely, but in other cases, the working diagnosis (number one choice) might still be just 70% or 80% probable, with a number two choice less likely, but still on the radar screen. It might make some patients uncomfortable to realize that the diagnostic process does not lead to 100% certainty in every case, but a doctor wouldn't be doing a patient any favors by pushing the analysis past the outcome that the available information leads to.
When a diagnosis is not 100% likely at the time of initial evaluation, the patient's course of symptoms over time provides yet another form of data that can lead to revision of diagnostic probabilities. Fortunately, in cases involving uncertainty, even just narrowing down the list of diagnoses to a small number of concrete alternatives allows the doctor and patient to discuss reasonable options and make sensible choices.
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Human Body Is The Back
By Marvin Cervantes
 One of the most important parts of the human body is the back. When your back starts to give out on you - either through various ailments or through sheer old age - it's time to get some serious help because once your back goes dead, you're only a little bit better than a doorknob.
One particular back-related problem is Scoliosis, a condition that involves complex lateral and rotational curvature and deformity of the spine. It occurs relatively frequently in the general population, the gravity depending on the magnitude of the curve of their spine. It is typically classified as being congenital (since birth) or idiopathic (developed through an unknown cause), or as having been developed secondary to another condition.
Scoliosis due to bone abnormalities present at birth involving either failure of formation of a vertebra or separation of adjacent vertebrae. It is the abnormal development of the spine resulting in a missing portion, partial formation, or lack of separation of the vertebra that originated since birth. It is detectable only if an x-ray was taken of the child upon birth or his body is evidently crooked. The most common birth defect that causes congenital scoliosis is called hemivertebra, where half of one side of a vertebra forms while the other side doesn't. Another defect is called the unilateral bar, a condition where you will find three to four vertebrae stuck or fused together on one side. Up to this time, the origin of these defects.
Scoliosis may be brought about as a secondary effect to current or previous illness. Conditions such as cerebral palsy (CP), spina bifida, muscular dystrophy may cause the spine to bend out of the norm. Cerebral refers to the affected area of the brain, the cerebrum; and palsy refers to disorder of movement. CP is caused by damage to the motor control centers of the young developing brain and can occur during pregnancy, during childbirth or after birth up to about age three. Spina bifida, which literally translate as split spine in Latin, is a developmental birth defect involving the neural tube: incomplete closure of the embryonic neural tube results in an incompletely formed spinal cord. In addition, the bones of the spine (vertebrae) overlying the open portion of the spinal cord do not fully form and remain unfused and open. Muscular dystrophy refers to a group of genetic, hereditary muscle diseases that cause progressive muscle weakness, it is characterized by progressive skeletal muscle weakness which may lead to scoliosis.
By far the most common form of scoliosis is the idiopathic scoliosis. This most often develops in adolescents and typically progresses during the adolescent growth spurt. Because it most often occurs during adolescence, this condition is sometimes called adolescent scoliosis. It occurs to some degree in approximately half a million adolescents in the US. There is no known cause of idiopathic scoliosis although it does tend to occur in families. It is categorized to 3 groups: from birth to three years old - called infantile scoliosis; from three to nine years old - called juvenile scoliosis; from ten to eighteen years old - called adolescent scoliosis. 80% of idiopathic scoliosis cases belong to the 10 to 18 years old category.
There are generally two kinds of treatment for scoliosis: surgical and non-surgical. Non-surgical treatment may require a period of observation to catch small, low-risk curves. For spinal curves of about 25 to 40 degrees and are still growing, doctors recommend wearing back braces to keep the curve of the spine from getting worse as the sufferer grows. Alternative treatments, such as electrical muscle stimulation, exercise programs, nutritional supplements, physical therapy techniques, and manipulation, have not proven to be effective treatment options for scoliosis. Even if exercise and proper diet can improve the overall health of the patient, no evidence exists to prove that the above mentioned alternative options stop or correct curve progression. Surgery is an option used primarily for severe cases of scoliosis (curves greater than 45 degrees) or for curves that do not respond to bracing. There are two primary goals for surgery: to stop a curve from progressing during adult life and to diminish spinal deformity. The most frequently done spinal surgery is the posterior spinal fusion which aims to strengthen and limit motion of the spinal column; and bone grafting, wherein bone harvested from one location in a person is placed in another's, or in a different location in the same individual.
Scoliosis is not something that's easy to live with. Sometimes, you're born with it or its hereditary; or you may get it from taking your back for granted. Be glad you're able to stand straight, people with scoliosis would like to be able to. Don't forget to maintain a balanced diet, exercise, and always watch your back.
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Healing The Pain With Exercises
By Marvin Cervantes
 The sensation of pain is said to be one of the primary indicators of a problem or unlikely change within a person's system. Pain when analyzed physiologically is very complicated and involves various complex processes. However, pain is perceived basically as an unpleasant sensation with different intensities and areas affected. Pain usually signals a certain concern within a person's system that should be given attention, and it is always given the appropriate care since pain is especially bothersome to the entire functioning of an individual.
Pain, when analyzed physiologically, involves numerous and complicated processes. However, the perception of pain is basically characterized by differences in severity and areas affected. Some forms of pain are tolerable while others are simply too much to bear on one's own. This is the reason why throughout the history of mankind, as well as the rapid development in science and technology, man has continuously searched for better ways to prevent and treat pain. It is a special concern that is given attention main because of the continuous search for finding ways of avoiding it.
During the early times, the treatments used for various illnesses or diseases are taken from resources that are naturally found in the environment. Nowadays, certain synthetic chemicals have already been developed by chemists or scientists. The previously used form of treatment is still available, however. These treatments are usually used by people who are afraid of experiencing side effects from medicine drugs or by those who wish not to spend so much on medical treatment. As expected, there are also natural forms of pain relievers. Shown below are some examples.
Salicin of the white willow bark - The extract taken from the bark of the white willow is widely known in China to be a good cure for relieving body pain as well as for lowering fevers. The active ingredient contained in the extract of the white willow is salicin which is converted within the body into salicylic acid. This kind of acid is said to decrease the levels of prostaglandin which are substances known to cause pain and inflammation. For this reason, the white willow has been known to treat acute and chronic types of pain such as those that characterize headaches, backaches, and menstrual cramps. The white willow has also been acknowledged to have good anti-inflammatory properties, thus, making it a good treatment for arthritis.
Lobelin of the herb lobelia - The extract of lobelia is actually more widely-known as muscle relaxant. However, its active ingredient lobelin is also recognized to cause an effective reduction in inflammation and pain. Being a native in North America, it is said that the earlier settlers used to chew and smoke lobelia possibly as a preventive measure.
Boswellic acid of boswelia - The purified extract of the resin of boswelia is widely-known in India for its anti-inflammatory and pain relieving properties. Boswellic acid prevents certain chemical reactions from occuring within the body that would lead to inflammations. This is actually used by Indian healers as treatment for body pains as well as inflammations. In other parts of the world, this same substance is used as cure for osteoarthritis and rheumatoid arthritis.
Ginger - The extract of ginger contains a certain active ingredient called gingerols that is highly similar to capsaicin. Capsaicin is a known component of chili peppers and capsicum which are known pain relievers. Like capsaicin, gingerols have the same effect on pain and is currently being considered as an alternative for capsaicin in relieving pain for certain conditions.
Aside from utilizing natural resources as treatment alternatives, certain activities may also be undertaken to relieve pain without having to use medicinal drugs. These activities can either be mental or physical tasks, or it can even be both. Listed below are some examples suggested by medical experts.
Exercise - It is often heard from doctors that exercising is good for the health because of various reasons. One of those reasons is probably due to the release of endorphins upon engaging in this activity. Endorphins are chemicals that are the body's natural pain relievers. They prevent the pain signals from reaching the brain to be analyzed. Through this, the pain is also not felt by the person and the intensity is lessened.
Bake and eat cookies - According to some research conducted previously, exposing one's senses to sweet or pleasant stimuli lessens or prevents the sensation of pain.
Stretch - For certain types of pain associated with muscle areas such as those of low back pains, stretching can actually prevent these conditions from occurring.
Get outdoors - According to a previous study, getting enough Vitamin D can help lessen the impact or perception of pain. Vitamin D also helps in the absorption of calcium which may help those that need bone repair and growth to eliminate the pain. Sun exposure of about 15 minutes early in the morning can already provide the needed daily amount of vitamin D. This is the reason why it is also important to get outdoors and get some sunshine.
Sleep - Getting the appropriate amount of sleep everyday is important to the restoration of the system as well as the healing process through and after the pain.
Imagine - Thinking of pleasant imageries can help relax a person's whole system. A relaxed state can help lessen the intensity of pain or prevent it from happening or being felt by a person.
Change The State of Mind - According to some experts, the human body has an infinite capacity for healing and sometimes all that is needed is a change in a person's point of view. Seeing pain with healing in another way can possibly lessen the effect of the painful sensation.
Meditate - A lot of modern healers and some medical experts attest to the healing capacity of meditating. It can lessen the overall intensity of pain to a minimal point, it can make a person feel stronger, and lastly, it can refresh and reinvigorate the whole system.
When this entire natural alternative for treatment will still not work for alleviating or preventing pain, then probably it is about time to consider using medicinal drugs such as Butalbital or Fioricet. Despite having side effects, the effectiveness of these drugs is of a larger percentage compared to the natural approaches. It is simply important to remember that a consultation with a doctor should be done first prior to the use of prescription, or even over-the-counter, drugs. This is necessary to prevent possible complications or further worsening of the health condition.
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