How is bone formed?

It is formed in three stages.

1) Osteoid formation

2) Mineralization Of Osteoid

3) Modeling till puberty & later on remodeling

Osteoid formation-  Bone is composed of tough organic matrix,which consists of 90 to 95% collagen fibers with gelatinous ground substance. Collagen fibers extend primarily along the line of tensions force.Ground substance is composed of extracellular fluid plus proteoglycans namely chondroitin sulphate & hyluronic acid.They help in deposition of calcium salts.These are formed by osteoblast cells of bone.As Osteoid is formed some of the osteoblasts are trapped in it which are called osteocytes.

Mineralization Of Osteoid- ocurres within a few days of Osteoid formation, by deposition of calcium & phosphate on the surface of collagen fibers which grow over a period of days & weeks to form the finished product  called hydroxyapatite.Other ions present in bone are magnesium,sodium,potassium & carbonate.Collagen fibers offer great tensile strength & calcium salts offer great compressive strength to bone.

Modeling & remodeling – The skeleton increases in size by linear growth & by apposition of new bone tissue on the outer surface of cortex. This apposition process is the phenomenon of modeling which also allows the adaptation in shape to respond to stressplaced upon them.Once the peak skeletal mass is attained,the process of remodeling becomes the principle metabolic activity of skeleton.This has three primary functions.

1) Repair microdamage in the bone

2) To maintain bone strength

3) To supply calcium from skeleton to maintain serum calcium level.

Process Of remodeling occur by actions of osteoblast cells  to form the bone & osteoclast cells to absorb the bone. This is regulated by estrogen,androgens,Vitamin D & Parathyroid hormone. Osteoclast cells are large,multinucleted,phagocytic cells.They are under influence of Parathyroid hormone.The net result of remodeling is mass of the bone remaining constant by balance of osteoblast & osteoclast cells activity.

Pathophysiology of Osteoporosis – 

1) After the age of 30 to 45 the resorption & formation process becomes imbalanced. The resorption exceeds formation.It May begin at different age & vary at different skeletal sites.

2) Nutrition – Sufficient  protein intake is necessary for Osteoid formation.Inadequate calcium & or Vitamin D will lead to secondary hyperparathyroidism leading to increased osteoclastic activity.Hence adequate calcium & Vitamin D is essential to maintain normal bone mass.

3) Physical activity – helps to maintain bone mass by stimulating osteoblast activity.Athletes & rural people have more bone mass due to physical activity

4) Menopause – Estrogen deficiency causes bone loss by reduced osteoblast activity.This leads to imbalance of bone formation & resorption. ( remodeling imbalance) Remodeling is initiated at surface of bone.Trabecular bone has larger surface area than cortical bone,hence get affected more commonly.Bones which have more trabecular component e.g. vertebrae face fractures more commonly.

5) Chronic Diseases – Of different types may lead to excessive bone loss by poor nutrition,less physical activity & factors affecting remodeling rates. e.g. Cushing’s syndrome,Rheumatoid arthritis

6) Medications – Glucocorticoids,anticonvulsants,immunosuppressants are found to lead to bone loss.

7) Cigarette consumption – for a long period may lead to bone loss by toxic effect on osteoblast cells

Measurement of bone mass

DXA  ( DEXA scan ) is highly accurate X ray technique to measure bone mass ( density) T score of -1 is normal Less upto – 2.5 is suggestive of Osteopenia Less than – 2.5 is considered as Osteoporosis.It is tested in Lumbar vertebrae & neck of femur.

Ultrasound is used for screening for osteoporosis.It detects bone mass by calculating the attenuation of signal as it passes through the bone.

Treatment

Physical activity

Calcium,Vitamin D,Protein supplementation

Bisphophonates – reduce osteoclstic  activity

Calcitonin nasal spray – reduces the osteoclasic activity

Teriparatide injection given subcutaneously for three months, which is a synthetic form of Parathyroid Hormone.Its intermittent use stimulates osteoblast to deposit bone to increase bone mass.

Yoga as a controlled Physical activity- Carefully selected  Yogic Postures offer a safe & easy form of physical activity involving many bones,joints & muscles.

The post Osteoporosis & Yoga – 1 appeared first on Gnosis Medical Yoga - Blog.

The modern version of Hippocratic oath says ,I will remember that there is art to Medicine as well as science & that warmth, sympathy & understanding may outweigh the surgeon’s knife or the chemist’s drugs.So as to follow this principle in our clinical practice we need to understand the patient as a whole individual & not by its part or organ which is diseased.More than that the surrounding conditions in which he or she is living should also be considered.

This approach has a lead to the branch of Mind Body Medicine.As we all know emotions affect body structure & function & vice a versa,we need to learn management of emotions & thought process as early as possible in our life.

Science of  Ashtanga Yoga, our ancient wisdom provides us a methodical pathway to avoid the sufferings of future as described by Mahamuni Patanjali,”Heyam Dukhham Anagatam”Homeostasis is the final aim of all our systems to live well,so is Samatva the aim of Yogic science,both being complimentary to each other.So to say that Samatva helps Homeostasis.

Improper lifestyle & psychological stress are the major contributors to the diseases of modern civilisation.Ashtanga Yoga provides a new way of looking at life,so everything remaining the same the person starts feeling better.A method based not on changing the circumstances but on changing our attitude to circumstances is potentially infallible.

Psychoneuroimmunology has provided a solid scientific foundation for mind – body relationship.While stress,anger and hostility or relaxation,peace,love & intimacy may be difficult to measure their effects on cytokines levels or NK cell activity can be quantified.So PNI has acted as a bridge between ancient wisdom & modern science.

Ashtanga Yoga as the name suggests guides us at eight limbs to be remembered & followed for 365 days,24  by 7 hours.First & second are called Yama & Niyama being social & personal disciplinary code which helps at our healthy behaviour.Third is Asana popularly known as Yogic postures which disciplines us at skeletal level but slowly reaching our mind. Fourth limb is Pranayam which teaches us the place,duration,number,depth & subtleness Of our breathing.It constantly reminds us to control our emotions & energy metabolism.It offers us a pathway to reach autonomic responses of our body.Fifth is called Pratyahar which  takes the discipline at sensory inputs.Every sensory input reaches the respective area in cerebral cortex with information relayed to limbic  system.Parts Of limbic system generate emotions which have an impact on our body functions.Pratyahar practice constantly maintains our awareness to optimise our sensory inputs & to observe their effects.This changes our perspective  & attitude to face the circumstances.Sixth limb is Dharana ,called as concentration meditation.This is the practice we observe when we are doing something with keen interest,passion & dedication.This enhances our ability in performance.Seventh is Dhyana,the Meditation state which is to be experienced by an individual with practice.The EEG in meditation shows unaltered alpha rhythm in spite of stimulations by vibration,sound or heat/cold. Eighth is Samadhi state which enlightens us for our existence at energy level.

Ashtanga Yoga offers a potent instrument to deal with commonly observed ailments in life.To name a few….1)  degenerative disorders like Osteoarthritis of knee joint,Spondylosis can be best prevented & palliated with restoration to near normalcy. 2) Acid peptic disorder , habitual constipation & irritable bowel syndrome has good prognosis.3) Anxiety – depression states can have a support for long term care 4)Type II Diabetes mellitus receives a good support by Yogic Postures ,breathing techniques & Pratyahar for glycemic control,5) HPO axis controlling the female life is helped by Yogic approach from perimenarchal to post menopausal phases.5) Coronary artery disease does have an emotional aspect to its presentation which can be attended by Yogic approach.

How much role Ashtanga Yoga has in health and disease depends on what one understands by Yoga and what one expects.If Yoga is viewed comprehensively as a foundation  of peace & joy,it has extensive & potentially all pervasive application S in medicine ranging from primary prevention to care of terminally ill.

The post Yoga & Modern Medicine appeared first on Gnosis Medical Yoga - Blog.

Zero Point

Now to reach Lachung – 8738 ft. the next day. This is once again a stopover to reach Yumthang valley at 12,000 ft. But excitation is further….that is to travel further to reach Zero point- 15,300 ft.  the last civilian reach. Here you view a large panorama of Himalayan Mountains with soft snow everywhere to cater hundreds of tourists!!

Then of course back to Lachung to different destinations in Sikkim or back to Gangtok.

What I experienced is the 5 to 6 hours of daily car travel (all mountain travel……round & round), at times even 10 hours requires lots of patience. But expert, polite drivers, Xylo cars, perfect stops for waterfalls & healthy food ( momos, noodles, rice……piping hot!) make you forget everything.

The walking, climbing is not much! But sufficient strength in your muscles habit of stretching selective muscles, deep breathing techniques taught in Yogic practices surely multiply the pleasure.

Kala Pathar      

Above all the Art Of relaxation, enjoyment but being careful is well taught by Yoga.

GAURI…..Thanks once again!!

Dr Vineeta Ketkar

Visit website- www.gnosismedicalyoga.com

The post North Sikkim Tour & Yoga For Senior citizens appeared first on Gnosis Medical Yoga - Blog.