AGONY MEDIC

Dr. Lutful Aziz FCPS, PHD Counsultant "analgesia", Pain relief centre

Pain in the neck
The neck, termed as 'cervix', means a constricted part of body or organ. Long necks are believed to be beautiful. The neck has its own worth in having the cervical spine, spinal nerves, blood vessels, thyroid gland, food tube (oesophagus), wind tube (trachea), voice box (vocal cord) and muscles to move the head. In this golden age, the neck is often rewarded with a chain or necklace for beauty. Acupuncture and reflexology finds health points in favour of having a chain around the neck, like a ring on the finger.

The neck is one of the most important parts of the body, since:
It holds the head which has the brain.
It is the condensed pathway of the nerves which emerge from the brain, to supply the parts of the body and blood vessels from the heart to supply the brain.

As age advances, everything in constant use will have natural degeneration, or wear-and-tear phenomenon due to friction or movement. The neck is no exception. In childhood, this wear and tear mechanism is ruled out due to deposition of calcium and growth of the bones, whereas in the case of adults or aged persons, it is worsened by osteoporosis or osteoarthritis, or improper depositions of calcium. We see people carry heavy weights (porters) or a big pot full of water on their head (village ladies). But even a cap or helmet or flower cannot be tolerated by cervical spondylitis patients.

Even though many things in the neck could cause neck pain, the thing which often goes wrong is the spine due to overuse, misuse or non-use. The spine is built for stability and mobility. It is made of supportive small bones which help us to stay erect. The cervical column is the starting point of the spinal column or spines. The degree of rotation of the spines varies with length and the type of facet joints of the vertebras.

Cervical spondylitis is a wear-and-tear ageing process involving cervical vertebras as age advances, or due to overuse. This type of arthritis is most commonly seen in middle age or elderly persons, but can also be seen in youth. It can involve one or more vertebrae. A severe form of spondylitis is Ankylosing spondylosis, where the inflammatory condition leads to sharp acute pain and new bone formation by calcium deposition to fuse of joint. The patients are advised active exercises to avoid fusion.

Cervical spondylosis is a secondary degenerative disease condition where damaged inter-vertebral discs and vertebra in course of time get ossified at the edges, forming an extra bone called osteophytes. This compensatory, undue formation of a new bone occurs on the edges which often hinge on the spinal nerves and cause pain. It also causes structural impairment. It can also involve one or more vertebrae. Here patients are advised not to do active exercises since pain, fracture, losing normal curvature of spine and distorted appearances can occur.

Pathology The vertebrae are neatly arranged, one after another, and transmit spinal nerves through the central opening and blood vessels through the lateral opening or canal. In total, there are 33 vertebrae. They are separated from one another by inter-vertebral discs, which act as shock absorbers or cushions while walking or moving. Cervical or neck vertebras are 7 in number, namely C1, C2, C3, C4, C5, C6 & C7. They are held in proper position with facet joints, ligaments, capsule and muscles of the neck. The cervical spine usually curves in front. The problems of vertebrae or discs are referred to as cervical spondylitis or spondylosis depending upon the causes. Any problem in the spine can reflect in the nerves emerging from them. C5, C6 & C7 are more vulnerable to degeneration.

To be continued

Interpreter Of Maladies

Dr. Nighat Ara, Psychiatrist

Dear Dr.
I have an 11-year-old daughter. Since the age of 3, she started having inner ear infection. Now she has to wear a hearing aid in one of her ears. She has been experiencing serious problems since she started wearing it a year back. Her classmates are taunting her regularly. They tease her saying that she is deaf. You can understand the fate of a deaf girl in our society. Although my daughter is not completely deaf she is already going through some of the aggravations. Even our relatives are saying things about her behind our back. They are wondering who will marry a deaf girl? All these things are upsetting my poor daughter. She is gradually becoming an introvert. I don't hear the laughter any more that used to echo through my home. My heart breaks seeing her like this. I don't want to go to any consular, as it will label my daughter further in a negative way. Hope you can help. Can you suggest how I can help her gain back her lost self-esteem? How I can cheer her up? And how I can make my relatives understand the situation that it is not her fault? Please help.

Ans: Your daughter has hearing impairment and it seems that you are becoming apprehensive about her future life. It is surely a big challenge for any parent to deal with this kind of situation.

It also appears to me that the classmates are bullying your daughter and school authorities are doing nothing to stop it. We wait for some rescuer who would come to fix our problems though unfortunately, most of the time, nothing happens unless we take action to fix it. Blaming or whining can hardly cure this social injustice unless well-planned, well-organized actions are taken to build a tolerant society, which allows everybody to live with equal dignity. It can start in a very humble way with whatever resource one has and by mobilizing like-minded people to voice their concerns over this human right issue. Your emotional commitment in this matter can be the driving force to work for a greater purpose of life.

Your relatives are talking behind your back. What are they saying? How dumb are they if they don't understand it is not her fault? People who are devoid of basic humanity and empathy are a real burden for any society. Your daughter's partial loss of hearing is insignificant compared to the loss of human qualities that those people suffer from. You may choose to spend your valuable time on trying to correct them; those "hearing perfect" people may still not be able to hear you specially if they are not doing anything to recover from their moral and spiritual bankruptcy. Advice, suggestions, or counselling etc. does not work on a person who is not ready to look at his or her own mistakes. Change in individuals often cannot be imposed from outside; it has to start from inside first. Trying to establish an effective communication could be the first step to deal with your relatives.

General ignorance about this sensitive issue and lack of social skills are major contributory factors in this kind of miscommunication. Public awareness, knowledge base, specialized skills and experience are important tools in developing a culturally, linguistically and personally affirmative environment for hard of hearing people. Someone has to start working towards that social goal (parents, ENT specialists, social workers, psychologists can play an important role to start the ball rolling!).

Hearing impairment can lead one to withdraw into an inner world as they are less distracted by outside auditory stimulations. Deafness cuts people off from other people. Even best friends find it difficult to keep up the friendship. Some experts say "deafness is a lesser problem of hearing than a problem of communicating and connecting with others". Hearing impairment is a very common form of disability now a day and it causes a form of cultural difference from hearing people. People who develop deafness after learning a spoken language eventually find it very difficult to speak the language that they don't hear anymore. To boost your daughter's self esteem, give her positive strokes, focus on positives rather than on negatives, reinforce her strengths and accept her the way she is. Hearing biases of hearing people leads them to exercise authority over deaf people and make them feel incompetent and inadequate. Consider getting help from an ENT specialist about psychological support (weigh the cost and benefit of avoiding counselling) and inquire about latest hearing aids, which are very tiny, hardly noticeable and very efficient devices.

Correcting eyebrow mistakes

Tweezing is still the most efficient method for removing eyebrow hair. To shape up your eyebrows perfectly with tweezers, you must have a steady hand. Yet no matter how steady your hand is, mistakes are bound to happen. Don't panic if you find yourself with some empty spaces or bald patches. Just fill in your eyebrows with an eye pencil or eye shadow that closely resembles the colour of your eyebrow hair. By grooming your brows and blending in the colour, they will look more natural.

By Iffat Nawaz

Connected

I had walked into many of them. Those cold uncomfortable rooms with slow net connections and the horrific sound of the air conditioning. Too many computers for show with only a few of them working. The cyber Cafes of Dhaka, all with jazzy names .net or .com with the word café or cyber in common… some of them even requiring you to take your shoes off, you might not only get to check your email but also catch a few germs from the mossy carpet and humid feet…pleasant!

But what can a Bengali with a net need to do when they don't have connection at home? The only resort -- these cyber holes, rescuing us from disconnected worlds, the worlds of junk mail and web blogs. How can we live without it?

So I had my share of cyber cafes, a few that I visited more frequently than others for their faster speed or for the convenient locations. Some I ignored after the first experience of their certain shoe-taking-off requirements, or that particular smell that requires you to take an instant shower after using them. There were of course certain "elite" places offering such services for literally ten times more the price. So I used the ones I wanted to, paid my twenty taka or fifty and walked away with pieces of words extracted from random emails inside my mind.

I had forgotten about them. I mean what's there to remember about using Dhaka Cyber café, until recently when I started getting random emails from a particular email address…one, two, then a few more. They were the generic "Want to be your friend, I man 20, studying engineering, like chatting and I am a lot of fun, please reply" types…so I paid no attention. These were like junk mails that most of us get from avid chat freaks who collect email addresses from random places. So I kept deleting them. Until one day this certain email address became a person who claimed to know me. Well not really know me but someone who saw me in person.

The email went "Hi…you don't know me, I saw you in Dhaka at a cyber café; you came to check emails, wore a red sari the first day, amar apnake bhalo legeche…keno jani na…
so I hacked your ID, please reply, I want to be your friend." Should I have been flattered? Alarmed? Shocked? I am not sure…but it was truly amazing how Bengalis can try to find romance or a romantic connection from the least desired spots.

I fought with my curiosity and stopped myself from writing back. I wanted to know more, ask him questions like, if this is a side hobby of his, sitting at cyber cafes in Dhaka collecting email addresses of random girls and then emailing them. If he has found any "friends" this way, how many like him are out there, and if this is a good way of meeting girls, and finally how much harder it is to just walk up to a person and talk to them, then hacking their id…
Our culture has set up these standards for men and women, where the woman will forever act naïve and unapproachable and the men will forever woo in ways taken out of innovative Hindi movies, or good old Sarat Chandro novels. A responsive woman (negative or positive) is never proper…making it harder for both the men and herself to play the whole game of charade. Where do these games take us anyway? Just another first time for the 50th time? The "I love yous" that come pre-maturely just like the next "first time" walk ins…
I resisted myself from having a "first time" experience with my cyber café buddy, but I didn't delete his email. I kept it as an example of desperate-yet-weak-woos, the unneeded net connections for an undeserving me.