Articles on prosecutorial immunity

Spice It Up to Boost Your Immunity

Ms. Mitalee Doshi, Dietitian/Nutritionist
Is there a viral infection going around cause of which you are dreading to send your child to school? Most of your colleagues seem to be sneezing is making you fearful of going to office? Now, you can grow past those worries. Here comes a list of herbs that will strengthen your body’s defense forces so can you be your kicking self all the time. Eating these wonder foods everyday will keep the doctor away.Our immune system does a great job of keeping us healthy and preventing infections. However, we need to support it with the right foods so it works better and in turn helps us in the process.Garlic – this grandmother’s ally has immense infection fighting ability. Being a natural detoxicant, unlike antibiotics there are no side effects. It protects our body against bacterial and viral infections. The three powerful compounds (allicin, ajoene and thiosulfinates) contained in it helps the body prevent and fight infections. In the mornings or as an after office snack you could toast up a slice of bread. Spread butter on it and sprinkle raw minced garlic over it. Relish a super garlic toast. Have you ever tried making some sauce by combining this herb with an egg yolk and some oil? Doesn’t it sound yum? If you can eat a clove of raw garlic in the morning, pick up that habit.Ginger – spicing up your meals with ginger is a great way for boosting your immune system naturally. It helps to cleanse the lymphatic system and prevent the accumulation of toxins in our body organs. The quickest way to incorporate ginger in your diet it to add finely chopped ginger to boiled water, let it steep for 2-3 minutes. Strain out ginger and sip good health. Sprinkle dried ginger into any salad dressing or add finely chopped pieces to soups.Turmeric – If there’s a healer sitting on your kitchen shelf it is this yellow herb. Curcumin, the active ingredient present in turmeric, is anti-viral and anti-fungal. Whenever you use turmeric, add black pepper also to the recipe. This will increase your body’s absorption of turmeric significantly. Eggs can be scrambled using butter and turmeric can be sprinkled over it. Don’t forget to add the pepper while you add salt. If you are a rice lover, adding turmeric to rice also adds good flavor. Curries and soups with a pinch of turmeric in them is the best way to include this root in daily diet.Basil (Tulsi) – Worshiped in most Indian homes eating the leaves of this herb every morning is a sure shot way to keep diseases at bay. It contains a wide range of essential oils rich in phenolic compounds that gives it the immune boosting properties. It stimulates liver cells to increase the appetite. Also, gives relief from cirrhosis and other infections of the liver. Whether adding it to pasta or to soups or while making pesto sauce it complements every food. Dried basil can be easily added to any dish including the chicken recipes.Oregano (dried ajwain) – doesn’t that pizza or garlic bread always taste better when this Italian herb is sprinkled over them? At least, I love it that way! Rosmarinic acid, which is a strong antioxidant found in oregano supports immune system health. It also has compounds that inhibits inflammation. Studies have shown it to be beneficial for conditions including osteoporosis and arteriosclerosis. You can garnish your omelettes with oregano. Oregano also goes great with sautéed mushrooms and onions too.Barley – loaded with beta-glucan which is a special fiber compound that has powerful antioxidant properties, you must consume this regularly. Barley water is known to be good for kidneys and also to treat arthritis and rheumatic diseases. It speeds wound healing and is thought to make antibiotics more effective. Boil barley until soft, strain the extract; add lemon or orange flavor and little bit of sugar if needed. You can refrigerate it and drink a glass daily.Rebuild your immune system by adding these natural superfoods daily in rotation. Adding these disease-fighting punch is the secret to a healthy family. And, healthy families are happy families. Aren’t they?

7 Things to Improve Immunity Level

Dr. Ratnesh Chavan, Ayurveda
1) Eat HealthyThere is no alternative to eating healthy food. All those diet colas and french fries are definitely not contributing to better immunity. Include lots of fruits and vegetables in your diet with regular intake of protein (source can be both animal and plant).2) ExerciseWe all have excuses when it comes to exercise. However, doing some form of physical activity is one of the best ways to build immunity. Pick any activity of your choice (jogging, swimming, yoga, aerobics) and do it at least 5 times a week.3) Sleep wellDo not compromise your sleep time. Poor sleeping hours decrease your immunity level. Studies show that people who sleep for more than 8 hours a day have better immune system than compared to those who sleep poorly.4) Reduce stressStress is bad. Over 70% of health problems today happen because of increased levels of stress. Needless to say that it hampers immune system too. Acute levels of stress can cause cold, body pain and allergies too.5) Get that sunlightVitamin D is good for immunity. And sunlight is one of the most easily available sources for it. Exposing yourself for atleast 15 to 20 min everyday in the sunlight is highly beneficial. It will boost your immunity - naturally!6) Home remediesYour kitchen is the storehouse of health. Don’t always grab a medicine if problem can be solved with a simple home remedy. Like in case of a simple cold, you can opt for ‘Tulsi’ tea (a herb with immense medicinal properties) instead of a tablet from the nearest pharmaceutical shop.7) VaccinationsVaccinations are not limited to childhood. In fact, as we grow old, it becomes even more important to get vaccinated. Keep yourself updated with the latest vaccines (ask your doctor) and make sure you follow the routine.Follow these simple steps and you will see that your immunity has improved by many folds.Stay happy and have positive thinking. Mental well being is extremely important for you to have a healthy life!

I'm Immune!

Ms. Tehzeeb, Dietitian/Nutritionist
Achuu!!! Why do I always get this cold? Is my immunity weak? We have heard this and pondered over this more times than we would like to admit now. So what exactly it is to be immune and what is immunity all about?Let’s not get into the technicals. Long story short-our immune system does a wonderful job of defending us against disease causing micro-organisms. But sometimes, it fails and the germs invade our body and make us sick. So what must we do to build a strong immunity? Read on:Don’t smoke. It’s LITERALLY damaging the cells of your bodyModerate alcohol consumption. Sorry to be a buzz kill but don’t stop reading yet because you’ll love the next oneGet adequate sleep. If someone asks why, tell them it’s for your immunity!Take active steps to avoid catching an infection-wash your hands frequently and cook meats thoroughlyHello fresh fruits, vegetables and whole grains. They have antioxidants and anti-inflammatory properties which boost immunityGo glug glug on water. It helps remove toxins from the bodyWhen it comes to expedited immunity, there is nothing like the good ol’ exercise! Exercise has been shown to increase the production of macrophages, which are cells that attack the kinds of bacteria that can trigger diseases. More recent studies show that there are actually physiological changes in the immune system that happen when a person exercises. Cells that promote immunity circulate through the system more rapidly, and they’re capable of killing both viruses and bacteria. Now before you think of killing us, we will end the technical jargon. This will be the last of it, we promiseNow as an elaboration or an extra bonus if you will, some vitamins and minerals to be included in your daily diet to fight against infections and to build immunity:i) Vitamin CWhat does it do? It protects our cells from free-radical damage and has antiviral, anti-bacterial and anti-allergic activity. We recommend this vitamin especially to smokers and to those exercising consistentlyFood sources:Oranges, lemons, amla, spinach, bell peppers, papaya, strawberries, leafy green vegetables, guavas.ii) ProbioticsWhat does it do?Beneficial bacteria have a lifelong, powerful effect on your gut’s immune system and your overall immune system as well. They aid in the production of antibodies which help fight off infectionsFood sources: Fermented foods like yoghurt (homemade is the best), dosas, idlis, dhoklas, paneer are all good optionsiii) ZincWhat does it do?Zinc is the underdog when it comes to minerals. It is required for the production of white blood cells which protect us against colds and infectionFood sources:Dairy, rotis, nuts, beansiv) Vitamin EWhat does it do? When it comes to antioxidant, Vitamin E is the first that comes to mind owing to its excellent ability to fight off infections. It also accelerates the healing process while stimulating the production of new cellsFood sources:Almonds, peanuts, hazelnuts, spinach, broccoliv) Vitamin B6 (pyridoxine)What does it do?Also known as ‘The immune booster,’ it supports the production of red blood cells in the body (this stuff is extremely important for immunity). Along with this pyridoxine is also important for producing hormones and the cells of the immune systemFood sources:Daal, banana, cabbage, chicken, egg yolk (yes darling, leave it on!), milk, baked potatoes, chickpeas (bring on the hummus!)Stop the sneezing and start the healing!Love and health,Scale Beyond Scale

10 Easy Tips to Boost Immunity

Ms. Silky Mahajan, Dietitian/Nutritionist
Overall your immune system does a very good job of keeping you healthy and well, but you’ve got to do your bit to keep it at it’s A game. It could never hurt to take some care of your immunity! You could eat well, go for regular checkups and always eat your vitamins..But is that bare minimum enough to keep it on track? Diet, age, exercise, lifestyle as well as environmental factors play a huge role in the working of your immunity system. So here are 10 easy tips which will help you help yourself! And your immunity, of course.1. Sleep in – As per research, your immunity system only produces half the amount of antibodies than it usually would when you haven’t got enough sleep. That will ultimately increase your susceptibility to any illness. The easiest and most relaxed way to boost your immunity is to get 7-9 hours of sleep every night. 2. Stress is never good – Everyones got problems in life – home, family, financial, but they should be avoided as much as possible. When you stress, your body produces ‘stress hormones’ which suppress the working of your immunity system. Join a meditation class but don’t let the stress get to your body.3. Kale is the new spinach – Vegetables like broccoli, kale and cabbage support the livers ability to flush out toxins while also directly boosting your immune system. Go vegetarians!4. Don’t be a couch potato – Exercising, which could also be a 20 minute walk, will really stimulate the lymphatic system, increase oxygenation and increase the production of leukocytes – a cell which helps fight infection. You’re going to be living healthy and helping your immunity! Win-win situation.5. Mushrooms are good – Eat mushrooms! Medicinal and Japanese mushrooms are filled with antioxidants and immunity boosters. There’s a wide variety so try a new one every time!6. Avoid sweeteners and sugar – Consuming 75 grams of sugar will reduce the ability of the WBC’s to overpower and destroy the bacteria. Opt for fresh fruits and flavored tea’s to complete your sugar cravings.7. BMI matters – Shape and size really doesn’t matter, but having the right weight for your height and age really does. Higher numbers of fat cells tend to trigger a series of events which eventually lead to a diminishing immunity system.8. Eat your vitamins – Sounds like such a cliche but they’re really important. Each vitamin has a different property to boost ones immunity.9. Say bye to cigarettes and alcohol – Well that title would certainly ruin a Friday night for most people. But apart from what these items do to your body, they majorly undermine your immunity system. It’s almost like causing intentional bacteria in your body!10. Live,love,laugh – Well the key word here is laugh. By laughing, you’re automatically distressing while also unintentionally allowing your body to produce more WBC’s. Watch a good comedy and let the magic begin.In case of any query or to book an appointment with Dt. Silky Mahajan please send us a mail at

9 Foods to Boost Your Immunity Naturally

Dr. Dt. Shreni Lalpurwala, Dietitian/Nutritionist
BOOST YOUR IMMUNITY, PREVENT DISEASESFood is one of the most powerful tools we have to help prevent disease and a healthy body begins with a healthy immune system. Over 70% of your immune system is in your gut and what you eat forms the foundation of your health. Make sure you are getting daily dose of fresh fruits, vegetables and quality protein every day so that your body can repair quickly.Boost your immunity naturally by including following foods:1) Citrus foods: Citrus like oranges, grapefruit, lemons and limes are an excellent source of vitamin C which helps maintain the body’s defence against bacterial infections.2) Turmeric: Turmeric is anti-inflammatory, anti-oxidant, anti-bacterial, detoxifying and amazing for digestive health.3) Papaya: Papaya is beneficial for those with digestive problems.4) Ginger: Ginger has potent antioxidant, anti-inflammatory andantimicrobial properties. It helps to boost immune function and combat cellular damage.5) Garlic:Garlic is also an immune system warrior,protecting the body from infections and illness6) Pineapple: Pineapple helps in protein digestion which allows your body to utilize immune boosting amino acids effectively.7) Proteins: Protein nourish your immune system, repair the bodyand assist recovery.8) Wheat grass:Wheat grass Juice help support liver and immune function by boosting the liver’s ability to flush out toxins.9) Berries: Berries help promote healthy tissues and organs. So by including the above foods in your daily diet you startgetting improvement in your health.Eat healthy, Stay healthy!

5 Foods That Boost Immunity

Ms. Swati Kapoor, Dietitian/Nutritionist
Citrus fruitsVitamin C contributes in increasing the production of white blood cells. The key cells to fighting infectionsBecause your body doesn't produce or store it, daily intake of vitamin C is essential for consistent good healthFruits rich in vitamin C are oranges, lemon, amla, strawberries, kiwis, papayaYogurtWhen selecting yogurt, look for ones that have "live and active cultures" printed on the label. According to the American Journal of Clinical Nutrition, these cultures can stimulate your immune system to help fight diseases.GarlicGarlic is found in almost every cuisine around the world. It adds a little zing to the food and it's a must-have for good health. Studies by the National Institute of Food Science and Technology have shown that garlic helps to lower cholesterol and may prevent hardening of arteries. Garlic’s immune-boosting properties seem to come from a heavy concentration of sulfur-containing compounds, such as allicin.AlmondsVitamin E is the key to a healthy immune system. Vitamin E is a fat-soluble vitamin, meaning, it requires the presence of fat to be absorbed properly. Nuts (especially almonds) are packed with vitamin E. A half-cup serving provides nearly 100 percent of the recommended daily amount.TurmericA key ingredient in many curries, this bright-yellow, bitter spice has been used for years as an anti-inflammatory in treating both osteoarthritis and rheumatoid arthritis. A recent study published in the Journal of Ethnopharmacology demonstrates that high concentrations of curcumin, which gives turmeric its distinctive color, helps to reduce inflammation and fever.Green teaGreen tea really has high levels of epigallocatechin gallate, or EGCG, another powerful antioxidant. The fermentation process black tea goes through destroys a lot of the EGCG. Green tea, on the other hand, is steamed and not fermented, preserving EGCG. If that wasn't enough, it's also a good source of the amino acid L-theanine. L-theanine aids in the production of germ-fighting compounds in your T-cells.

The Scope of Homeopathy in Various Auto Immune Diseases

Dr. Rangadhar Satapathy, Homeopath
The environment where we live is packed with various harmful agents like bacteria, virus, allergy inducing particles (antigens), chemicals, dusts, pollutants etc. Every moment they are entering inside our body either through the air that we breathe or foods or drinks that we take or through skin by contact with. Inside our body there is a defence unity called body immune system that consist of various immune cells.Those immune cells of our immune system acts like well trained shoulders at the situation whenever any foreign particles like virus, bacteria or harmful substance enter inside our body they fight with them to kill and protect our body and cells from their attack. So every moment our immune cells are engaged in searching and fighting with the foreign substances to keep our body safe and healthy.BUT, sometimes our immune system get confuse to recognize between our own cell and outer foreign particles and start attacking our own cells thinking of foreign particle by which some health issues are developed. This is called auto immune disease. There are as many as 80 types of autoimmune diseases. Some common auto immune diseases areRheumatoid arthritis - inflammation of joints and surrounding tissuesleucoderma (vitiligo) - white patches on the skinPsoriasis - a skin condition that causes redness and irritation as well as thick, flaky,silver-white patchesSLE - affects skin, joints, kidneys, brain, and other organsCeliac sprue - a reaction to gluten (found in wheat, rye, and barley) that causes damage to the lining of the small intestineInflammatory bowel disease - a group of inflammatory diseases of the colon and small intestineType 1 diabetes - destruction of insulin producing cells in the pancreasSjögren’s syndrome - destroys the glands that produce tears and saliva Pernicious anemia- decrease in red blood cells caused by inability to absorb vitamin B-12WHY THE AUTO IMMUNE DISEASES OCCURIn medical science it does not have any specific cause why it occurs. But there certain factors that may responsible for developing auto immune diseases.Many clinical surveys say that the environmental factor plays a major role in developing various auto immune diseases. Now a days our environment has changed a lot. Everywhere there is pollution. The airs, water, foods all are polluted. 50 years ago there were not so many types of auto immune diseases. The atmosphere was not so polluted like present age. During those period peoples were taking healthy foods not so  much adulterated foods. The air was clean not so much polluted like present day. So as the science and technology develops side by side brings lots of negative things. The pollution level rises. The ozone level is gradually decreasing in the air. The water level is gradually decreasing. There has been a lot of changes in the atmosphere in compare to the past few decades years back. Not only in the external world the changes is marked inside us. Our stress level has increased a lot. Our though process has changed a lot. Our work style has changed a lot. Our mind setup has changes a lot. Our perception towards a subject has been changed a lot. The positiveness and positive attitude has been decreased a lot. Our anxiety, fear, stress, level has increased in compare to past age. The attitude of a person has changed. Anger, irritability, greedy, intolerance attitude has been increased. Physical activities have reduced a lot. In fact the whole things have been changed from external world to our internal world drastically in the course of time. But our body, our organs, our cells are same as millions year back, working the same function like before. The changing of environment, the changing of emotional level, the changing of psychological level putting tremendous negative impact on our body, in our cells specifically in our immune endocrine system. So our innocent simple reacting immune system has been disturbed and acting abnormally as a result so many auto immune diseases are creating and destroying the human society. This is the real threat now in the medical science to cure the auto immune disease as because there is no treatment has been discovered to cure a auto immune disease except managing the symptoms for temporarily basis.Scope of Homeopathy Treatment- In this regards homeopathy has a prospective role of treatment in the auto immune disease as because homeopathy treatment is not only based on the disease symptoms alone but the person’s psychological and emotional symptoms also taken care which are otherwise known as the root trigger factors for the development of the disease. Every individual has its own trigger factors either in his psychological level or emotional level or physical level or genetic level. Homeopathy treatment finds the thread of root cause of the triggers factors and treat accordingly, thus helps to bring back the equilibrium of the body’s immune system in a natural way to normal state thus may help to cure the auto immune diseases. For example a person of having psychological trauma in past life like death of any of his/her nearest or dearest one and that makes him/her to a depressive state and in the course of time develops irritability and after a few years develops psoriasis. So a homeopath takes the detail symptoms not only about the psoriasis symptoms of the person but his/her past life event of any psychological trauma and his/her present irritability nature and basing on all those symptoms the medicine is choose and if given can able to cure the disease. So there are not same set of medicines for a particular disease which can be repeated for every patient. But at the same time the general management therapy whatever is required for the patient should be kept continued along with homeopathy treatment.

Health Tips for Kids to Beat the Heat This Summer and Build Immunity

Vanikala Venugopal
During summer, our body becomes hotter, muscle enzymes speed up and burn glycogen more rapidly, depleting stores of the sugar that your muscles use for fuel. Hence it is necessary to make the child drink plenty of fluids that would help hydrate the muscle and skin adequately in order to maintain internal cooling down.Safety tips for children:Hydrate their body: Make them drink at least 8-10 glasses of water/ day. Parents should provide fresh juices, coconut water, butter milk or lemon juice as refreshments to their kids as they replenish the fluids that are lost in sweat.Keep kids out of midday sun: try to keep your kids out of direct sunlight especially during peak hours from 12-4 pm and instead engage them in indoor activities during that time of the day. Evenings are best for recreational activities,especially for kids playing outdoor games.Dress children in light coloured cotton fabricsNo junk food please! Avoid making your children eat a lot of spicy junkies like pizza, pasta and burgers. Instead go for fresh fruits like water melon, muskmelons, chikku and kiwis as they have antioxidant properties and water content which helps in preventing dehydration.Let them eat light and small frequent meals.Every mother wants to help her child stay healthy and fight off infections, especially during winter and flu season. A strong immune system is very important for children to stay healthy as it protects their developing body from diseases. We need to boost up their immunity so that they do not get infected with germs easily. Feeding children a balanced and healthy diet is very important for having a strong immune system. Food rich in antioxidants should be fed to children. Eating yoghurt everyday is good for health. It strengthens and stabilizes the immune system. Apart from these, parents should also take other steps to ensure that children stay healthy also during later winter months where infection prevalence is high. Beneficial action is to be taken to strengthen their Immunity. So in case your child is particularly susceptible to allergic attacks, then plan a few sessions of SALTROOM THERAPY which is a drugless treatment to increase immunity in a natural way. This therapy can be taken even when the child is not necessarily under the allergy attack at that particular point in time. Vacation can be the best times to future protect your child.

Does Backache in the Morning Mean More Than Just Normal Pain?

Dr. Tanoy Bose, Internal Medicine
Must Read Basics:When the cells and chemicals who are responsible for the security [immunity] of the body from external virus, bacteria and other micro-organisms misdirect their target and start attacking our own normal and healthy tissues considering them to be external to the body, a phenomenon is created which is called AUTO IMMUNITY. This process goes uncontrolled as the cellular security mechanism fail to realise that the tissue under attack are of their own and the very same body and the civil war continues causing damage to healthy tissue and its adjoining structures. In a healthy human body this destruction is characterised by five unique symptoms known as:1. Pain [Lat: Dolour]2. Redness of the affected area [Lat: Rubor]3. Swelling of the local site [Lat: Tumour]4. Rise in local temperature [Lat: Calor] 5. Loss of function [Lat: Functio Lussa]These 5 symptoms and signs together comprise a pathological entity called INFLAMMATION.From now onwards these two terms AUTO IMMUNITY and INFLAMMATION will be quite frequently used in explanation of different Rheumatological disorders. It is worth mentioning that the intensity of INFLAMMATION can roughly be quantified by checking few blood investigation parameters e.g. CRP [C - reactive protein] and ESR [Erythrocyte Sedimentation Rate]. The above explanation was necessary to discuss Ankylosing Spondylosis as the disease is an AUTO IMMUNE INFLAMMATORY disorder where the affected tissue or area is the Sacro-Iliac Joints and Lumbo-Sacral Joints of young healthy individuals where boys are more affected than girls. The diagram underneath points out the area of involvement.COMMON SYMPTOMS:Having back pain is a common finding among most of the individuals and almost 90% of these back pains are caused due to mechanical problem i.e. due to excess weight bearing, trauma, poor posturing, excess body weight etc. There is no mechanical component in back pain of Ankylosing Spondylosis. The pain is purely caused due to an Autoimmune Inflammation of previously healthy uninjured normal Sacro-iliac joints. Hence the back pain of Ankylosing Spondylosis is often termed as INFLAMMATORY BACK PAIN which has the following characteristics:1. Pain & Stiffness most severe in early morning 2. Pain can disturb sleep especially during the latter half of the entire sleeping duration3. Pain improves with walking or activity but recurs after prolonged state of inactivity4. Pain may radiate to either of the buttocks and may have alternate buttock pain5. Response to Pain killers is excellent6. Often there is a family history of similar pain in young age7. Often there is a family history of a skin disease called Psoriasis, Inflammatory Bowel Disease, Uveitis [An eye problem caused by redness and pain of eyes].Apart from INFLAMMATORY LOW BACK PAIN, there may be involvement of one or two large joints e.g. ankle, knee or wrist in asymmetrical manner. This component of the disease is called PERIPHERAL ARTHRITIS. Apart from joint involvement there may be symptoms of organ involvement other than joints e.g. Redness and Pain of eyes [due to UVEITIS], Skin disease [Psoriasis] and Gastro intestinal problems [Inflammatory Bowel Disease characterised by Painful passage of Stool which is often mixed with Blood and Pus and sometimes along with fever] and Lung Disease [Interstitial Lung Disease characterised by progressive shortness of breath, chest tightness and loss of elasticity of the lungs]These group of disorders are often coined together as EXTRA-ARTICULAR SYMPTOMS.Ankylosing Spondylosis usually affects the age group of 18 to 30 years and Boys or Men are more affected than Females. The presentation is very typical of a Low back Pain which is severe in early morning after waking up from bed and gradually improves on walking or activity and again comes back during prolonged period of rest of on the second half of the sleep. Often there is radiation of the pain into buttocks [Hips] causing alternate buttock pain. In peripheral arthritis one or more large joints of the body is affected causing pain and swelling along with early morning stiffness. Usually ankles and knees are affected but it is not uncommon for elbows and wrists to be affected.IN UNTREATED DISEASE:If the disease is not addressed early and chronic therapy is not started then this disease can cause severe debilitation, deformity, tremendous deterioration of quality of life and ultimately death. Progressive Inflammation of the Sacro Iliac joints may cause ultimately fusion of the Sacrum with Ileum and this phenomenon of obliteration of joint space causing fusion of the two bones over a joint is called ANKYLOSIS. This process of bony fusion gradually proceeds upwards involving each segment of the Spinal Column or the Vertebra causing impaired movement of the lumbar region of the spine [Reduced and painful movement of back leading to complete loss of any movement of low back]. The patient takes a complete erect posture and sometime hyper- erect posture. The process of bony ankylosis gradually proceeds upwards towards the thoracic spine and up to cervical spine [Upper mid back to Back of Neck] causing a straight and rigid body posture with complete loss of neck movement. Often the X Ray of Spine taken at this time looks like a BAMBOO SPINE. Patients are dependent on manual support or walker to move around. There may be difficulty in breathing due to poor movement of the rib cage and may cause severe oxygen shortage of lungs, pneumonias and ultimately death.MANAGEMENT:One should seek consultation from Experienced Rheumatologist at the earliest as the treatment of Ankylosing Spondylosis is getting updated every 3 to 4 years and new treatment guidelines are coming. Recently the researchers have separated Ankylosing Spondylosis from Peripheral Arthritis and Self Limiting Inflammatory Low back pain that resolves automatically without any damage. However, the treatment remains the same.To diagnose the disease classical symptoms as discussed above are strong enough to create a high index of suspicion. A genetic marker called HLA B27 is often asked for and almost 90% of patients of Ankylosing Spondylosis have this test as POSITIVE. If the results are positive along with the symptoms then an MRI of Sacro-Iliac Joints is often asked for. MRI can identify changes in the joint much ahead of X Rays as it can visualise the cartilage, the soft tissue within the joint and even the bone marrow of the adjoining bones. Bone Marrow edema of the adjoining joints is the earliest sign of Sacro-Ilitis and helps the rheumatologists to catch the disease early in the course and start management. MRI can grade the intensity of Sacro-ilitis which is necessary to follow up the treatment response. Plain X Rays of the Sacro Iliac Joints cannot detect any changes in early disease but any bony changes can readily be detectable. A normal X Ray is not necessary to be repeated within next 2 years for confirmation of the same diagnosis.Blood Parameters such as CRP [C – Reactive Protein] and ESR [Erythrocyte Sedimentation Rate] are frequently measured as these parameters give an idea of the amount of inflammatory activity persisting in the body. The treatment is directed towards relief of symptoms, arrest of disease activity and achieving minimal inflammatory state of the body [or the joints]1. PHYSICAL THERAPY or PHYSIOTHERAPYAll patients of Ankylosing Spondylosis should be physically active all throughout the day. The disease demands more activity in the person than his peers. A normal sacro-iliac joint hardly permits any movement in human body as these joints are formed by apposition of two flat bony surfaces. Hence, the inflammatory chemicals easily get stagnant inside the joint space in highly concentrated amount and can cause easy joint damage. Excessive activity in form of dynamic exercises and games such as contact games [Football, volleyball, kho kho, kabaddi, hockey, basketball, tennis etc] causes jerky movement of body and results in small amount of movement of the sacro-iliac joints. This movement of the sacro-iliac joints results in gradual movement of the inflammatory chemicals out of the joint into blood and fresh joint fluid which is low in inflammatory chemical concentration pours into the joint cavity and thus the intensity of the joint damage is reduced. However, if the disease has progressed a bit it is advisable to avoid jerky movements of the body and start dedicated and guided physical therapy instead.2. PAINKILLERSWe use ETORICOXIB tablets to control the pain. The dose ranges from 60 to 120 mg per day. It has got its own battery of side effects such as gastritis, gastric ulcers, kidney injury and worsening of cardiac pre-existing cardiac problem. But, kindly note that this is the only medicine that can reduce the intensity of inflammation in the sacro-iliac joint and arrest or reverse erosion. Hence for a person suffering only from inflammatory back pain without involvement of any other peripheral joint, this is the medicine of choice. We prescribe concomitant antacids for gastric protection and execute caution in persons who are suffering from Cardiac and Renal Ailments.Other pain killers like ACECLOFENAC, DICLOFENAC, TRAMADOL, PIROXICAM, MELOXICAM and PARACETAMOL are prescribed to control breakthrough pain or when ETORICOXIB is not available but it is ETORICOXIB that scores beyond others as it is the only group of drug that can reverse the process of joint destruction3. PARACETAMOLPARACETAMOL is not a pain killer per se. It is an antipyretic or a drug that reduces fever. But at a dose of 1000mg four times a day, it can address painful conditions. PARACETAMOL has got no role in reversal of the disease process. It is prescribed when ETORICOXIB is not available or is contraindicated as in patients with Kidney disorder or Cardiac Problems.4. SULFASALAZINESULFASALZINE is actually an antibiotic and at a dose of 2 to 3 Gms per day in divided doses it has shown promise in addressing peripheral joint involvement. Researchers have failed to show any benefit with the use of SULFASALAZINE in only axial disease or in only back pain conditions. The common side effects of SULFASALAZINE is gastritis, nausea, heart burn, hypersensitivity, photo dermatitis, rashes, bone marrow suppression, liver problems and sometimes haemolytic anaemia [in patients who are deficient with a specific enzyme called Glucose 6 Phophatase (G6PD)]. Following precautions should be taken while taking SULFASALAZINE:a.Take the medicine in empty stomach. It is well absorbedb.Gradually increase the dose from 500mg once daily up to 2gms to 3gms per dayc.Check for Glucose 6 Phosphatase levels before starting the drugd.Avoid the medicine who are known to be allergic to SULFURe.Periodically monitor Blood Counts and Liver function to look for any adverse effectsf.Any kind of allergic phenomenon of rash should immediately be reported.5. METHOTREXATE:METHOTREXATE was first discovered for its efficacy against different cancers. Currently it is used in treatment of quite a few cancerous conditions. It has got excellent role in management of RHEUMATOID and PSORIATIC ARTHRITIS but unfortunately researchers have failed to show any benefit of its use in ANKYLOSING SPONDYLOSIS. Hence, use of METHOTREAXATE is not recommended in this disease6. BIOLOGICS:Biologics are highly specific molecules which have come into the picture in last decade. The mechanism of action of the biologics is by directly blocking the action of the pro inflammatory chemicals that cause damage to the joint and its structures directly. Due its highly specific action, these dugs are costly. Commonly prescribed biologics in Ankylosing Spondylosis are:1. ETANERCEPT 2. INFLIXIMAB3. ABATACEPT4. TOCILIZUMAB5. ADALIMUMABThese medicines can reverse the process of joint damage and arrest the progression of the disease. They are administered in once a week to once a month dosing basis and have a common class of side effects. Due to their targeted action against the chemicals that mediate inflammatory damage, their use may be associated with opportunistic infection of the other organs of the body. This is because of the blockade of inflammatory chemicals that are also responsible for normal human defence mechanism against external bacteria or virus.The common infections that can occur are Tuberculosis, Hepatitis, fungal and other bacterial infections. Hence, it is always recommended to screen for Latent Tuberculosis Infection and Hepatitis and HIV infection in the body.7. SUPPORTIVE THERAPY:The bones near the area of inflammation and as well as the entire human skeleton undergoes a process of accelerated osteoporosis. Hence we often provide CALCIUM supplementation and anti bone resorptive treatment with BISPHOSPHONATES. These are group of medicines which is used to treat OSTEOPENIA and OSTEOPOROSIS8. COUNSELLING:ANKYLSOING SPONDYLOSIS is a non curable disease. The current medical and physical treatment is directed towards slowing down of the joint damage, improve mobility of the spine, reduce morbidity and improve the quality of life. Since it affects the young age group, proper guidance, education and counselling is necessary for coping up with the disease and its complications.