Cell nucleus: structure and function Nucleus: Think about your favorite superhero. Regular person by day, vigilante in spandex, and a cape by night. Saving the world isn’t an easy job, so most superheroes have support. Enter the guy behind the computer, the allknowing tech whiz that helps the hero succeed, hacking blueprints, giving directions during surveillance. The guy behind the computer does it all. And we can think of the cell nucleus like the guy behind the computer, making calls, sending directions, and overall being in charge of the superhero cell, despite always getting less credit than the superhero themselves. The nucleus is a multifunctional organelle that is found in eukaryotes. Generally, eukaryotes have only one nucleus, but this isn’t always the case. Certain eukaryotic cells, like red blood cells and prokaryotes, like bacteria and archaea, don’t have nuclei either. These are called enucleate cells. Other cells, like those of slime mold, have two or more nuclei and are called multinucleate cells. The nucleus, if there is one, makes up approximately 10% of the cell’s volume and has an incredibly important purpose in the cell. The cell nucleus functions as the information processing center of the cell, storing genetic material and organizing all of the cell’s activities, from cell division to synthesizing proteins. The nucleus is especially important for protein synthesis. Oh, yeah. It’s the site of transcription, where messenger rna, or mrna, is produced. The nucleus may appear to be one lone blob of an organelle, but in fact, it’s made of many different structures that contribute to the overall function of the nucleus. We’re talking about the nuclear membrane, the nucleoplasm, chromatin, and chromosomes, and the nucleolus. Now, let’s see what kind of programs the guy behind a computer nucleus runs in the superhero cell. The first important structure making up the nucleus is the nuclear envelope. The nuclear envelope is like your computer’s antivirus. It keeps everything where it should be and screens for everything before allowing it on your computer, or in this case, the nucleus. You can’t be a superhero sidekick with a virus on your computer, can you? The nuclear envelope consists of two phospholipid bilayers that act as a wall for the nucleus, keeping all of the contents in place. This protective envelope is actually composed of two membrane layers, an inner nuclear membrane, or INM, facing inside towards the inside of the nucleus, and an outer nuclear membrane, or ONM, facing away from the nucleus towards the cytoplasm of the cell. The ONM also connects directly to the rough endoplasmic reticulum and is covered in ribosomes. There is also a fluid filled space between the INM and the ONM called the perinuclear space separating the two membrane layers. Although the nuclear envelope acts as a wall to keep the nucleus in shape, it also has another important function, selectively allowing things into the nucleus. Small holes in the envelope, called nuclear pores, act as a safe passageway for different molecules, like proteins and rna. The pores are like a bodyguard. Unless you pass the check, you’re not allowed entry. And this keeps the nucleus safe and allows it to keep doing its job without issue. Next up, let’s talk Internet. The guy behind the computer can’t function without Internet, right? That magical, hidden network that can get you anywhere you need to go. Much like the nucleoplasm of the nucleus, the nucleoplasm, composed of water, salts, enzymes, and other organic molecules, helps the nucleus in a number of ways. First, it acts as a cushion for the nucleus, protecting all of the contents within the organelle, and also helps the nucleus keep its shape. But more importantly, the nucleoplasm acts as a transportation network for the nucleus, much like the Internet of the cell. Imagine you’re helping a superhero on a mission and search up bad guys near me, and you immediately get the perfect website back on your browser. Because of your super fast Internet. The nucleoplasm works in sort of the same way. Say the nucleus needs something like an enzyme, for example. The enzyme travels through the cell, right through the nuclear pores, into the nucleus. It’s like cellular level Internet, but cooler. Now, let’s think about how a computer actually works. If you’re a superhero’s right hand man, you have to have a top notch, state of the art computer, and you can’t run a computer without code. The code on your computer dictates how every single thing on it runs, so it’s really important. Chromosomes are like usb sticks for computers, but instead, they store the blueprint to our bodies. They store and share code in the form of DNA. Chromosomes have all our bodies information from howto manuals on cell growth to development and reproduction 101. Chromosomes live in the nucleus, but in a resting form when the cell is not in active reproduction stage, chromosomes exist in long, free floating strands of dna and protein called chromatin. And chromatin can be classified even further into heterochromatin, the inactive form of chromatin, and euchromatin, the looser, more delicate form of chromatin. Chromatin in all its forms, comes together during cell division to form chromosomes. The nucleolus is the final feature we’ll talk about, and it actually directly relates to chromosomes and chromatin. Think of the nucleolus like a temporary line of code that your guy behind the computer uses to save the day. It’s put on your computer to finish one job, and once it’s done, the code disappears until you need it again. The nucleolus is a membraneless feature that spends its time floating around in the nucleoplasm and also plays a big role in protein synthesis. The nucleolus, which stores proteins and rna inside, has features called nucleolar organizers that are integral for creating ribosomes during the process of protein synthesis. Ribosomes are formed during protein synthesis, and then when the cell is ready to divide, the nucleolus disappears. Talk about not taking

Cell membrane introduction Cell membrane: When you go swimming or showering, have you ever wondered, why don’t your cells in your body fill up with water? Or why don’t the substances in your cells leak into the pool? Well, the reason is because we actually have a very important structure that prevents this from happening. This is what we call the cell membrane. The cell membrane is what’s on the outside of a cell. So if we have a very basic picture of cell here with a little nucleus on the inside, this pink outside layer is what we call the cell membrane. The cell membrane can protect our cell from the outside environment, and it can determine what can enter and leave our cell. This is a property that we call semipermeability. It is somewhat permeable. Some things can enter while other things cannot. So since this is such an important part of our cell, in fact, it’s one of the reasons why we can actually survive in the world. So what actually makes up this structure? Well, the main building block of a cell membrane are what we call phospholipids. There are other substances that make up our cell membrane, but the most important building block are phospholipids. And so phospholipids have three major components. The first is a phosphate head group. The second is a glycerol backbone. And the third are two fatty acid tails. So the way we draw this is we give the phosphate head group, kind of like a head. It’s a circle, and two fatty acid tails hang down from it, kind of like strings on a balloon. So the way I kind of remember this is a phospholipid, looks like a balloon, but with two strings. Now, where’s our glycerol backbone? Well, our glycerol backbone is actually what it sounds like. It’s what holds the fatty acid tails to our phosphate head. It’s the backbone of this molecule. So it’s usually not drawn in the picture, but just remember that it’s there, and it holds our two fatty acid tails to our phosphate head group. So this structure actually has a very interesting property up here. This head group is actually hydrophilic, or polar. So hydrophilic means that it’s water loving. This phosphate head group will do whatever it can to get to water. It loves water, but these fatty acid tails, because they’re very, very long carbon chains, this is hydrophobic. I remember hydrophobic because a phobic or phobia is fearing. So hydro is water. So it’s water fury. These two fatty acids will do whatever it can to get away from water. A molecule that has both of these things together is what we call an amphipathic molecule. It means that the molecule has a hydrophobic section and a hydrophilic section. So in water, what would this do? So let’s say we put a ton of these molecules in water. Once in water, the hydrophobic heads want to be as close to water as possible, but the tails don’t. So what will happen is these phosphate groups are going to cluster together while the tails try to shield themselves away from water. But since this is a substance that’s in water, water is going to be down here, too. So this will actually form a really unique structure because the fatty acid tails are going to start grouping like this, and the phospholipids are going to be kind of upside down so that the phosphate head groups can be close to water, while this inside section can be hydrophobic and away from water. This is what we call a phospholipid bilayer. This is the basic structure of a cell membrane. And like we mentioned, this inside section is going to be hydrophobic. So now we have this structure that looks kind of like this. We call this our phospholipid bilayer or lipid bilayer for short. But doesn’t this section here also interact with water? How can this structure be like this if this section here still touches water? And we know that the fatty acid tails don’t want to touch water. Well, in a cell in real life, what actually happens is we end up with the structure that forms a circle like this. Now, this is a fairly crudely drawn picture. In a cell, this wall is actually pretty thin compared to the entire body. So you’ll notice that this water here doesn’t become a problem anymore, because in our actual cells, water can be on the outside and on the inside. And no matter where this cell membrane touches water, it’s always going to be the phosphate head groups that are hydrophilic, that are seeking out water. And inside the cell membrane, we actually have a hydrophobic section. So, moving on to a new picture, we mentioned before that the cell membrane is semipermeable, and we’re going to explore that a little bit more. So I’ve taken the liberty of pre drawing a very long picture of a cell membrane. So, as we mentioned, the cell membrane is actually a sphere that surrounds our cell. For the sake of this lesson, we’re going to draw it out in a straight line, and we’re going to say that this can be the outside environment or the extracellular, and this can be the inside or the intracellular. So you’ll notice that the cell membrane has these phospholipids packed really closely together. So usually small molecules are what can pass through the cell. Another property of the cell membrane that we’ve discussed is that this inside section right here is really hydrophobic. So generally, small nonpolar molecules can pass through our cell membrane. This is what we call passive diffusion. So what is a good example of a small nonpolar molecule? Well, the most common type of small nonpolar molecule tend to be gases, things like o two, for example, or co2. These are things that surround us every single

Cells Structure and Functions All living organisms are composed of cells. Cells are responsible for all anatomical and physiological features of all body systems. Different cell types can vary greatly in shape and size, but they all have a common structure and similar components. A typical cell cell is enclosed in a plasma membrane and contains a nucleus and a cytoplasm. The plasma membrane serves as the cell’s boundary, controlling the traffic of substances in and out of the cell. It is also the site of communication between the cell and its environment. The membrane consists mainly of two layers of phospholipids with their hydrophilic heads, the phosphate groups facing the aqueous environments inside and outside the cell, and their hydrophobic fatty acid tails facing in together. Other membrane lipids include cholesterol, which is essential to membrane structure and fluidity, and glycolipids, which maintain membrane stability and facilitate cell to cell interactions. The lipid membrane is dotted with membrane proteins, of which there are two types, integral or transmembrane proteins, which span across the membrane, some passing through multiple times. Some transmembrane proteins have a small carbohydrate chain on the outside of the cell and peripheral proteins, which attach to the membrane on the inside. A peripheral protein typically functions together with an integral protein. Membrane proteins fulfill a variety of functions. As receptors or receptorassociated proteins. They receive messages from outside the cell. For example, a nonsteroid hormone must bind to a membrane receptor and act via several other membrane proteins to activate a cellular response. Each receptor is specific to a certain molecule. As ion channels or transport proteins, they help move charged particles and large, uncharged polar molecules across the cell membrane. As adhesion molecules, they help cells adhere to each other and to the extracellular matrix. As enzymes, they catalyze reactions that are required outside the cell but in the vicinity of the cell membrane. Transmembrane glycoproteins also serve as surface antigens, determining the cell’s identity on top of the cell membrane. Some cells have surface extensions that carry out specialized functions. Examples include microvilli that increase the surface area in the small intestine cilia that move mucus in the respiratory tract, and flagella that are responsible for the movements of sperm cells. The nucleus contains genetic material, the DNA, and is where DNA replication and transcription, the major step of gene expression, take place. Most cells have one nucleus, with the exception of red blood cells, which have none, and some other cells that have multiple nuclei. The nuclear envelope surrounding the nucleus consists of two membranes, inner and outer, each of which is a phospholipid bilayer. The envelope is dotted with nuclear pores protein complexes that provide controlled passage between the nucleus and cytoplasm chromosomes are strands of DNA wrapped around proteins. Under a light microscope. Chromosomes are only visible during cell division when they are highly condensed. Instead, the most prominent feature of the nucleus is the nucleolus, the area around the clusters of ribosomal rna genes. This is where ribosomal rnas are made and where ribosomes are assembled. Ribosome then move to the cytoplasm to fulfill their function in protein synthesis. The cytoplasm includes a gel like liquid called cytosol, various organelles and cytoskeleton, the endoplasmic reticulum, ER, Golgi apparatus, and vesicles constitute the intracellular membrane system. The ER is a network of connected flattened sacs called cisterni. Its membrane is continuous with the outer nuclear membrane. Part of the ER appears rough, as it is covered with ribosomes. This is where the synthesis of secretary and transmembrane proteins take place. These proteins have a signal sequence within their amino terminus, which, as soon as it emerges from the ribosome, targets the rna ribosome complex to the ER membrane, where translation continues. The emergent polypeptide enters the ER membrane as it is being translated. Transmembrane proteins, identified by the presence of a hydrophobic stretch, stay in ER membranes while secretary proteins are released into the ER. Lumen, the smooth part of the ER, synthesizes lipids and lipid components of cell membranes. As lipids are produced, they are inserted into the ER membrane. Membrane proteins, lipids and secretary proteins are then packaged into vesicles to be transported to the Golgi, where proteins undergo post translational modifications. Vesicles pinch off from ER membranes, travel to golgi apparatus, fuse with golgi membranes, and release their content. The golgi is a stack of separated cisterni. Each contains a set of enzymes responsible for a certain step in protein maturation. Similar vesicles transport lipids and proteins from one cisterna to another and ultimately to their destinations. The plasma membrane lysosomes or storage vesicles the destination of a protein is typically determined by a signal sequence acting as an address tag within the protein. The ER is also a major site for metabolism and storage of calcium, whose release is a trigger for many cellular processes. Lysosomes are vesicles containing hydrolases that break down macromolecules into their building units, which can then be recycled. The enzymes are activated by the acidic environment within lysosomes. In white blood cells, lysosomes digest phagocytized bacteria and play a role in immune response. Mitochondria are best known as the cell’s powerhouses. This is where energy is extracted from food compounds and stored in energy rich molecules. A mitochondrion has two membranes. The inner membrane has multiple folds called christi. Two of the three main steps of cellular respiration occur in the mitochondria, citric acid cycle in the matrix and oxidative phosphorylation on the christi. Cytoskeleton is a network of protein filaments that fulfill a variety of functions. There are three types of filaments, microfilaments, intermediate filaments and microtubules. Microfilaments are made of the protein actin. They enable muscle contraction, provide support for microvilli, produce cell movements and play a role in cell division. Intermediate filaments are made of different proteins in different cells. Their roles are mostly supportive. Microtubules are large tubes of 13 protofilaments. Each is a long chain of

Tendinitis: Causes, Symptoms, and Proven Treatment Options Imagine getting a complete joint replacement without surgery. Believe it or not, this is the new reality for THOUSANDS of former arthritis sufferers… Triceps Tendinitis – Tendinopathy – Elbow Rehab Tendinitis a threeheaded muscle, hence the prefix tri that’s visible on the back of the arm. The medial and lateral heads originate on the humerus, while the long head actually attaches up at the shoulder blade. All three muscles insert on the electron of the ulna via a common tendon and act to extend or straighten the elbow. The long head also extends and stabilizes the shoulder due to its attachment up at the scapula. (Tendinitis) Although the diagnosis is often referred to as triceps tendonitis, triceps tendinopathy is a better descriptor for this condition because inflammation likely isn’t the primary driving factor. Instead, you can just think about it as an overload of the tendon, meaning that you probably just did a little bit more than what it could handle over a certain period of time. This is not to be confused with golfer’s elbow on the inside of the elbow, tennis elbow on the outside of the elbow, or anything to do with instability, trauma, significant swelling or numbness and tingling. (Tendinitis) I would expect fairly localized pain in the back of the elbow that worsens with increasing demands on the triceps. For example, I would expect a 40 pound dumbbell skull crusher to cause more issues than a 20 pound dumbbell skull crusher because it’s a greater load. Similarly, a very fast repetition would likely present more challenges than a very slow repetition because tendons are also affected by the rate or speed of loading, and triceps tendinopathy does not mean that you have to discontinue all training. (Tendinitis) Instead, you have to find a level of training that allows you to have tolerable symptoms somewhere around a three out of ten pain or less while making objective progress in your lifts. Symptoms for tendinopathies can often take three or more months to resolve, so the focus should be on improving function over the long term. The most important concept to understand for any teninopathy is load management. (Tendinitis) Essentially, you’re attempting to achieve a Goldilocks principal level of load, not too much where you’re exacerbating symptoms and prolonging recovery, but not too little where you’re deconditioning and not driving. Beneficial adaptations start with the big picture. (Tendinitis) Has your training changed significantly in the past three months? That may have contributed to symptoms? Did you alter frequency, volume, and or intensity? Analyze your current program to see if there’s any reasonable modifications that you can make based on any significant fluctuations in these variables that might have occurred over the past few weeks or months. (Tendinitis) The next things you’re going to look at are exercise selection, technique, and tempo as they relate to your compound multijoint exercises, assuming they’re part of your normal routine. The three main pushing movements that target the triceps include a vertical press where your arms end up overhead, a horizontal press where your arms end up straight out in front of you, and a dip where your arms end up down at your side. (Tendinitis) The easiest thing to start with here is finding exercise variations that are most comfortable for you. For example, an overhead press can be done with a barbell. Dumbbells, kettlebells, or unilaterally. Horizontal pressing can include any type of pushup, bench press, dumbbell press, machine press, or even incline options. Now, if your symptoms are exactly the same regardless of the movement, you can try to modify your technique to reduce the demand on your triceps. (Tendinitis) For example, a wider pushup or bench press will likely challenge the triceps less than a very narrow pushup or bench press. For an overhead press, you can shorten the range of motion. Bringing the bar all the way down where your elbows are maximally flexed will place more load on the triceps than if you limit the movement to about 90 degrees of elbow flexion. Finally, you can alter the tempo. A lot of tendinopathy protocols implement a three second eccentric, 1 second pause, and three second concentric. (Tendinitis) These aren’t inherently special numbers, but decreasing the speed of the movements can be helpful, as mentioned earlier. Also, it’ll force you to use a lighter load, and the consistent tempo can help with maintaining technique and tracking. Objective progress next up, examining single joint isolation exercises. There are four main types for the triceps elbow extension with the shoulder in maximal flexion, elbow extension with the shoulder flexed to 90 degrees, elbow extension with the shoulder in neutral, and elbow extension with the shoulder extended. (Tendinitis) While the multijoint exercises are optional, depending on your goals, picking one to two of the isolation exercises will be necessary to ensure appropriate loading of the triceps. Just like the compound exercises, though, you can try to find variations that work best for you. I’d try to implement a fairly strict, consistent technique with that same tempo initially for one to two exercises. For example, a dumbbell skull crusher can be done with shoulders maintained at 90 degrees of flexion, no shoulder, internal or external rotation, bringing the weight to 90 degrees of elbow flexion and then straightening the arms. A similar technique could be used for a standing triceps press down with a rope bar or band. I’d highly recommend executing these one arm at a time. These would be done for three to five sets of six to twelve repetitions, two to three times per week at a three out of ten pain or less at an intensity that is close to failure. I’ll give a sample routine at the end of the video. Lastly, accessory exercises. There’s no research to support this for tricep tendinopathy, but other elbow issues benefit from strengthening of the shoulder. (Tendinitis) Therefore, I would

Gout: Causes, Symptoms, and Effective Management Strategies What if it only took 10 seconds each morning to… Well that’s exactly what happened when researchers gave patients 1 tablespoon of this weird “gelatin.” Gout: Everything You Need to Know Have you ever woken up with sudden and intense pain in your big toe or another joint? If so, you may have experienced gout. Today, I will talk about one of the most common types of arthritis, which is gout. Gout is a painful condition that affects millions of people worldwide. In this video, I will review five signs of gout you need to know about, including some lesser known symptoms. Plus, we will dive deep in what can precipitate a gout attack. So let’s get started. Rheumatologist oncall.com I want to share with you a story of one of my patients. One morning, Mr. Colleen called my office for an urgent appointment. He told my assistant that he needed to be seen right away as he was in excruciating pain. He had swelling in his right foot and he could not walk. He could not even stand the sheets over his foot. When he came to my office, Mr. Colling hopped on 1ft. He had a red, swollen, red foot, and he could not even stand to be examined. A few days before he came to me, he attended a party where he drunk some alcohol and ate some shellfish. At this point, I was almost sure I knew what he was experiencing. But watch until the end to find out what happened to Mr. Choline. What is gout? Gout is a very common form of inflammatory arthritis, which is caused by the buildup of uric acid crystals in your joints. It will affect males earlier in lives, but after menopause, females are also affected. Gout is very rare in children. The uric acid crystals can cause inflammation, redness and pain in certain situations. While most patients experience gout in the big toe, some patients will get gout in the hands, in the knees, in the ankles, and even the lower back, like the sacroeliac joints. So not always gout starts in the big toe. You can have one joint affected, or you can have multiple joints at the same time. And you can also have migratory pain, meaning that one joint will hurt this week, and then a few days or weeks after, you will have another joint affected and in another few days, another joint affected. Now let’s talk about five signs of gout that you need to be aware of. Podagra. Podagra refers to the gout that involves a big toe. If you have gout in the big toes, you will experience redness, pain, swelling and intense pain. Most of my patients say that it’s the worst pain in their life, worse than giving birth. Most patients go to bed fine and they wake up in severe pain the following day. The pain may last for several days and can go away on its own, but it can also respond to antiinflammatory medication. Before seeing the doctor. Most patients will try something for pain, which is most often overthecounter antiinflammatory medication like naproxen and ibuprofen. Ankles, knees, elbows, wrist and fingers can all be involved. Most of the time, one joint at a time is affected. But as I mentioned, multiple joints at a time or a migratory type of pain can happen. The joints will be red, swollen and very painful. I cannot emphasize that patients can be tearful due to severe pain. Tofi tofi are small white and yellowish lumps that can develop under your skin. They are caused by the accumulation of these uric acid crystals in your joints, but it can also be a sign of advanced gout. When I have a patient with gout, I always examine the ears, the elbows and hands, as these are the common areas for tofi. Tofi do not hurt, but they can damage your joints. They can open up the skin in the areas where they are located, and they can increase the risk for infections. There are patients with huge TOFI that can cause severe destruction of the joints and can affect the mobility of those joints. Kidney stones. So kidney stones are caused by the buildup of the uric acid crystals in your kidneys. Once the kidney stones are big enough and they start to mobilize, they can cause severe pain on your side or on the back, together with nausea and vomiting. Kidney disease or chronic nephropathy. This is a way to call a kidney disease that is caused by uric acid deposits in the kidneys that will create inflammation and eventually will lead to kidney damage. You must know that gout is often linked to other medical conditions like obesity, high blood pressure and diabetes. Some medications like diuretics or water pills, low dose aspirin medications to decrease your blood pressure, and some chemotherapy drugs can also increase the uric acid and precipitate a gout attack. What happened to Mr. Colin? Mr. Colin was a gentleman that was slightly overweight, and he was often eating in restaurants while he was meeting with his clients. He preferred a beef, a hamburger, and he also had a whiskey every night before dinner. His father also had gout. He was familiar with this disease. After his episode of Gout, we decided to get some labs. And then I started him on treatment, first on steroids, then with a medication that will lower his uric acid. After a few days on steroids, he called back that his swelling is down, his foot was no longer red, and hot and he was able to put weight on that foot. He called me his angel for helping him with that awful pain. In conclusion, gout is a very painful type of arthritis that is caused by the buildup of uric acid crystals in your joints. The five signs

Guide to Ankylosing Spondylitis Management Thanks to Ivy League research that replaces old, tired, worn-out joints without even breaking the skin… Using this weird “jelly” discovered in a tiny remote Japanese village. What is Ankylosing Spondylitis? Causes, Symptoms, and Diagnosis Ankylosing spondylitis is an inflammatory condition that mainly affects the spine, that causes progressive stiffness and pain. It’s part of the seronegative spondyloarthropathy group of conditions that are related to the HLA B 27 gene. And other conditions in this group are things like reactive arthritis and psoriatic arthritis. The key joints that are affected in anklosing spondylitis are the sacro iliac joints and the joints of the vertebral column. And the inflammation causes pain and stiffness in these joints, and it can progress to fusion of the joints. So fusion of the spinal column and the sacraliac joints fusion of the spine leads to the classical finding on the x ray of a bamboo spine. And this is something that will often appear in your medical exams. There’s a strong link with the HLA B 27 gene, and around 90% of patients who have ankylosing spondylitis will have this HLAB 27 gene. However, only around 2% of people who have the gene will develop ankylosing spondylitis. This number goes up to around 20% if they have a first degree relative that’s affected. So if you have a first degree relative and the HlAB 27 gene, there’s around a 20% chance of developing the condition. So how do these patients present the typical presentation, especially in your exams, is a young adult male in their late teens, or affects males about three times more often than females, and symptoms usually develop gradually over more than three months. The main presenting features are low back pain and stiffness and sacroileac pain, which occurs in the buttock region. The pain and stiffness is worse with rest and it improves with movement. And the pain is worse at night and in the morning, and it may even wake them up from sleep in the early hours of the morning. And when you take a history, the patient will describe how it takes at least 30 minutes for the stiffness to improve in the morning, and then that stiffness seems to get progressively better throughout the day as they do more and more activities. The symptoms can fluctuate with periods of flares of worsening symptoms and other periods where the symptoms seem to improve. One of the key complications of anklosing spondylitis is vertebral fractures. So what associations are there between ankylosing spondylitis and other affected areas in the body? An ankylosing spondylitis doesn’t just affect the spine, it can affect other organ systems and cause things like systemic symptoms such as weight loss and fatigue. It can present with chest pain related to the costovertebral joints and the costosternal joints. Enthusitis is inflammation of the enthuses, and this is where the tendons or the ligaments insert into the bone. This can cause problems like plantar fasciitis and achilles tendonitis. Dactylitis is a condition where there’s inflammation of an entire finger or toe. It can cause anemia, anterior uvitis, aortitis, which is inflammation of the aorta or the large blood vessel coming out of the heart. It can cause heart block when there’s fibrosis of the heart’s conduction system. Restrictive lung disease can be caused by restricted movement in the chest wall, and ankylosing spondylitis can also be associated with pulmonary fibrosis, particularly at the upper lobes of the lungs, and this occurs in about 1% of patients. Another condition that’s also associated with ankylosing spondylitis is inflammatory bowel disease. There’s a test called Shoba’s test, which you’re expected to know about in medical school, and this is a test that’s used as part of a general examination of the spine to assess how much mobility there is, particularly in the lumbar spine. You might be asked to do this in your OSCi examinations. So how do you do it? Well, you have the patient stand straight. You find approximately where their l five vertebra is, and then you mark a point 10 cm above the l five vertebra and 5 cm below, so the points are 15 cm apart. Then you ask the patient to bend forward as far as they can, and you measure the distance between the two points. If the distance between them when they’re bending forwards is less than 20, indicates there’s a restriction in the lumbar movement, and it would help to support a diagnosis of ankylosing spondylitis. What investigations can you do? Well, you can start with some basic inflammatory markers like CRP and ESR. They might go up with increased disease activity. You can send off a genetic test to look for the hlab 27 gene. You can do x rays of the spine and the sacrum. And if the x rays are normal, an MRI of the spine can show early changes and this shows up as bone marrow edema in the vertebral bodies. And this is something that will appear before there’s any changes on the x ray. So what x ray changes do you get? Well, this bamboo spine is the typical exam description of the x ray appearance of the spine in later stages of anklosing spondylitis. And it’s worth remembering this term in case it appears in your MCQ exams. Xray images and anklosing spondylitis can show squaring of the vertebral bodies. Subcondrial sclerosis and subcondrial erosions. Syndesmophytes, which are areas of bone growth where the ligament normally inserts into the bone. And this occurs relating to the ligaments that support the intervertebral joints. So where the ligaments insert into the vertebra to hold the vertebra together, you can get these developments of bony growth called syndesmophytes. Ossification can occur in the ligaments, the discs and the joints, and this is where the structures like the ligaments starts to turn into bone like tissue. And you can get fusion of

Osteoporosis : Causes, Symptoms, and Effective Solutions New Harvard research shows adding 1 teaspoon of this to your water each morning can: It’s super effective and easy to do…And you can do it from the comfort of your own home. What is Osteoporosis and What You Need to Know Osteoporosis is a bone disease that causes more than 8.9 million broken bones worldwide, across men and women, every year, resulting in an osteoporotic bone break every 3 seconds. Osteoporosis is a medical condition that weakens bones and makes them more likely to break. They can become so fragile that in serious cases, a strong sneeze or minor bumps can cause them to break. Wondering why you haven’t heard more about osteoporosis? Well, one reason could be that it is known as a silent disease because you can’t see or feel bone loss, so it goes unnoticed until the first bone break occurs. Both men and women are at risk of osteoporosis. Postmenopausal women are at a higher risk after an initial fracture. These women are five times more likely to suffer another bone break within a year. The World Health Organization, who has considered osteoporosis to be of increasing importance, many women remain untreated within six months after an osteoporosis related fracture. It’s important to be aware of the risk factors associated with osteoporosis in order to understand if you could be affected. Here are a few to consider. Previous bone break as an adult advanced age low bone mineral density parental history of hip fracture low body weight smoking. You’ve likely heard that vitamin D, calcium, and weight bearing exercise can help keep bones healthy. It’s true. But for people with osteoporosis, it may not be enough to protect against a fracture. Osteoporosis and broken bones are not a normal part of aging. If you are a postmenopausal woman, you may be at risk for osteoporosis. It’s important to talk to your doctor about a bone health plan. What are the common risk factors and pathophysiology associated with osteoporosis? What is the common complications associated with osteoporosis? And then finally, very briefly, we’ll look at how is it diagnosed? How is it treated? So osteoporosis is a term, it’s a compound word where osteo refers to bone porosis, pores. Simply, it just means our bones become weakened. Let’s have a quick look at this particular diagram. It’s a typical bone, and with all bones, they have an outer covering. This outer covering is known as compact bone. This compact bone is very dense bone tissue, which means it’s strong, provides structural integrity, but most importantly, it stops compressive forces. Now, deeper to compact bone, which you can see in red, is spongy bone. This is less dense. It has almost these little holes all the way through it, which makes it look like a sponge. And this is why it’s called spongy bone. But this tissue also allows for flexibility and strength, but without the weight associated, or as we found with a compact bone. Now, when we look at bone, I kind of think of it like a brick house. We kind of think it’s made, it’s there, it’s providing the support. It doesn’t do much else, but in fact, it’s a very dynamic tissue, which means it’s constantly being turned over. This term is known as remodeling. And actually, this bone would probably remodel between four to ten years. So the whole thing is reabsorbed and added back between four to ten years. This is known as remodeling, which is a balancing act between taking bone away, which we call bone resorption, and adding new bone. Now, the cells that take bone away is they’re known as osteoclasts. Now, these are kind of like macrophages that take, that eat away and take bone or reabsorb bone, whereas bone cells that add new bone are known as osteoblasts. So it’s a balancing act between these two to keep this bone remodeling process going. Now, in our early ages of life, so child adolescence, the actual osteoblasts win. So we see more bone being formed, which actually leads to the bone mass or our bone mass being peaked. So we call this peak bone mass at the ages of about 20 to 29 years. So that means we have the strongest bones in this age. So after this age, peak bone max starts to drop off, and we actually see approximately zero, 7% drop in away each year. That means the osteoclasts become more active after the 29 years in comparison to the osteoblasts. So what kind of things in the early phases allow the osteoblast to be more active? Well, probably the most important one are hormones. So the hormones that we see that have the greatest effect on osteoblast activity would be oestrogens, more dominant in females, testosterone more so in males, and growth hormone for both. So these hormones, which are higher in these periods, would allow this cell to be more active in that phase. Other things is diet, specifically calcium. So calcium, high amounts of calcium will activate greater activity for the osteoblasts. And remember, vitamin D increases calcium. So those two kind of go hand in hand. So diet is also important for that peak bone mass. Other things that are important is physical activity, specifically loading physical activities, like putting your bones under stress, like resistance training. So this is an important physical activity to generate the osteoblast activity. Now, these things feed into the peak bone mass. So if we don’t have these things working or it’s slightly reduced, we actually see we have a lower peak bone mass, which then would predispose someone to osteoporosis. Now, with the peak bone mass, because of the hormonal difference, males will have slightly higher peak bone mass than females. So that’s important to know why females will be at higher risk of osteoporosis. It’s actually at five to one. So five females

Essential Guide to Osteomyelitis Folks are ending DECADES of agonizing joint pain after just a few days of trying it… Thanks to Ivy League research that replaces old, tired, worn-out joints without even breaking the skin… Using this weird “jelly” discovered in a tiny remote Japanese village. Think it could work for you? Test it out for yourself here: Osteomyelitis – Causes, Symptoms, Diagnosis & Treatment The word osteomyelitis can be broken down. Osteo refers to bones. Myel stands for myelo and relates to the bone marrow. And lastly, itis refers to inflammation. So osteomyelitis is an inflammation of the bone or bone marrow, and it typically results from an infection. Normally, if we look at a cross section of a bone, we can see that it has a hard external layer known as the cortical bone, and a softer internal layer of spongy bone that looks like honeycombs. There’s also another layer called the periosteum that covers the cortical bone like the lamination of a basketball card. And that’s where the muscles, tendons, and ligaments are attached. If we zoom into a cross section of cortical bone, we can see that it has many pipelike structures called osteons running through the length of the bone. Each pipe has an empty center called a herrsion canal, which contains the nerves and blood vessels that supply the osteon. At the outer border of the osteon is a ring of cells called osteoblasts, which synthesize bone. Along with these cells are osteoclasts that break down bone. In bones like the long femur, the tips are called the epiphysis, while the shaft is called the diaphysis. Between them, we have the metaphysis, which contains the growth plate, the part of the bone that grows during childhood. In osteomyelitis, microorganisms such as bacteria reach the bone to cause an infection in a few different ways. Bacteria particularly affect certain high risk individuals, like those with a weak immune system and those with poor blood circulation due to uncontrolled diabetes. In fact, a major way that bacteria reach the bone is through the bloodstream, and that’s called hematogenous spread. For example, this might happen in a person who uses contaminated needles to inject drugs or in individuals undergoing hemodialysis that may be contaminated by a bacteria or even through the dental extraction of an infected tooth. Through the bloodstream, the microorganisms may reach specific places in the body, and this mostly depends on the age of the person. In older adults, for example, the microorganisms may reach the vertebrae and cause vertebral osteomyelitis. This usually affects two adjacent vertebrae and the intervertebral disc between them. In children, the metaphysis of long bones like the femur is commonly affected. The second way that bacteria cause osteomyelitis is through trauma. For example, in an open fracture after an accident, the bone may get exposed to the outside environment and come into direct contact with bacteria. A third way is during surgery when there’s bacteria that’s introduced into the bone. A fourth way is when an infection spreads from one area like cellulitis, which is an infection of the dermis layer of the skin, to an adjacent area like the bone, and this is known as contiguous spread. There can also be combinations of these, for example, when a prosthetic joint becomes contaminated with bacteria during surgery, and then that bacteria contiguously spread to nearby bone. Another example is when people with diabetes mellitus develop a severe vascular compromise. A small trauma to the foot can lead to the formation of a foot ulcer, which then becomes infected and spreads to the nearby bone. Now, once the bacteria reach the bone by any of these roots, they start to proliferate. This alerts nearby immune cells, specifically dendritic cells and macrophages that try to fight off the infection. This represents the acute phase of the disease and occurs over a course of weeks. The immune cells release chemicals and enzymes that break down bone and cause local destruction. Usually, acute osteomyelitis comes to a resolution, meaning that the immune system eventually destroys all of the invading bacteria. If the lesion is not that extensive and there’s viable bone, the osteoblasts and the osteoclasts begin to repair the damage over a period of weeks. However, in some cases, the process turns into chronic osteomyelitis, lasting months to years. In that situation, the affected bone sometimes becomes necrotic and separates from the healthy part of the bone, and that’s called a sequesterum. At the same time, the osteoblasts that originate from the periosteum may form new bone that wraps the sequesterum in place. This is called an involve. Occasionally in both acute and chronic osteomyelitis, the inflammation may involve the periosteum. The periosteum is loosely attached to the compact bone, especially in children, so the two layers can separate and allow an abscess to form between them. That sort of an abscess tracks along the periosteum, lifting it up away from the compact bone. The infection can also spread further to involve a nearby joint, particularly the knee or hip joint, in young children, as well as overlaying muscle skin and even get into the blood vessels, causing thromboflabitis. Many microorganisms cause osteomyelitis, but the most common is Staphylococcus aureus, a grape looking bacteria that lives on the skin. It can invade the skin and spread contiguously to the bone, or it can reach the bone through the bloodstream. Another one is salmonella, a rod shaped bacteria that particularly affects individuals with sickle cell disease. Unfortunately, individuals with sickle cell disease are therefore at risk of getting both Staphylococcus aureus as well as Salmonella infections. Another pathogen is Pasteurella multicyda, a pill shaped bacteria. It usually spreads from the skin to the bone from a bite or scratch from a cat or dog. Now, acute osteomyelitis typically causes pain at the site of infection as well as fevers. Depending on the location, it may affect use of the bone. In

Osteoarthritis: Symptoms, Causes, and Remedies Understanding Osteoarthritis Osteoarthritis is often described as wear and tear in the joints. It’s not an inflammatory condition like rheumatoid arthritis, and it occurs in the synovial joints, and it’s a combination of genetic factors, overuse and injury to the joint. Risk factors for osteoarthritis include obesity, increased age, occupation, particularly occupations where there’s a high usage of particular joints, trauma to the joint being female, and also a family history of osteoarthritis, it’s thought to be the result of an imbalance between the cartilage being worn down and the chondrocytes repairing that cartilage, and this leads to structural issues within the joint that causes more wear and tear and pain. These abnormalities can be seen on an x ray, and the key mnemonic for remembering the four key x ray changes in osteoarthritis is loss loss. So l stands for loss of joint space. So the joint space in the joint becomes narrower and the bones come closer to each other. O is for osteophytes and osteophytes are little spurs of bone that come out of either end at the joint. The first s is for subarticular sclerosis, and this is increased density of the bone along the joint line where the bones come in contact with each other and the second s is for subcondrial cysts, and these are small fluid fill holes in the bone along the joint line. Xray changes do not necessarily correlate with the symptoms, so you might find significant xray changes. Incidentally, in someone who doesn’t have symptoms. Equally, someone with severe symptoms of osteoarthritis might only have mild x ray changes. So how does it present? Osteoarthritis presents with joint pain and stiffness. This pain and stiffness tends to be worsened by activity. In contrast to inflammatory arthritis, where activity tends to improve the symptoms, it leads to deformity of the joints, instability of the joints, and reduced function in the joints. So which joints are commonly affected? Well, the knees and the hips are key joints that often get affected with osteoarthritis. It can also affect the sacro iliac joints where the spinal column meets the pelvis. It typically affects the distal interphalangeal joints of the hands, the dips at the ends of the fingers, the carpometicarpal joint at the base of the thumb, or the CMC joint at the base of the thumb, the wrist, and then the cervical spine, which we often call cervical spondylosis. Let’s talk about some of the signs that you might see when you examine the hands of somebody who has osteoarthritis. The first is Haberdon’s nodes, and these occur in the dip joints or the distal interphalangeal joints of the hands at the end of the fingers. The next is Bouchard’s nodes, which are seen in the proximal interphalangeal joints of the fingers. So this is the second joint. From the end of the finger, you can see squaring at the base of the thumb, and this is at the carpometacarpal joint or the CMC joint. There might be a weak or reduced grip and also a reduced range of motion in the fingers. The carpometacarpal joint at the base of the thumb is a saddle joint with the metacarpal bone of the thumb sat on the trapezius bone, using it like a saddle, and it gets a lot of use from day to day activities. And this makes it very prone to wear and tear when it’s used for complex movements. And this is why the carpimetacarpal joint is a key joint that suffers with osteoarthritis in people that use their hands a lot. Let’s talk about diagnosis. Well, the nice guidelines from 2014 suggest that a diagnosis can be made without investigations if the patient’s over 45, if they have typical activity related pain, and they don’t have any morning stiffness or stiffness lasting less than 30 minutes. If they have stiffness in the morning that lasts more than 30 minutes, you need to think about more of an inflammatory cause. X rays can be helpful for checking the severity and confirming the diagnosis, but they’re not always necessary if the presentation is typical. Finally, let’s talk about management. It’s important to start with patient education about the condition and advise them on lifestyle changes like losing weight if they’re overweight, and this helps reduce the load on the joint. Physiotherapy to improve the strength and support of the joints. And also, occupational therapy can be helpful in terms of how to maximize the function of the remaining joint. And orthotics can be used to help support activities and function as well. We can use a stepwise approach to analgesia to help control the symptoms. The first line would be starting with oral paracetamol and a topical nonsteroidal antiinflammatory like topical ibuprofen or topical diclophenic. You can also use topical capsaicin, which is chili pepper extract that causes a warmth around the joint and helps to improve symptoms. The second step is to add oral nonsteroidal antiinflammatory medications like ibuprofen or naproxen. And also consider prescribing a proton pump inhibitor to protect their stomach, such as a meprazole, whilst they’re using the nsaids. It’s better to use nsaids intermittently rather than continuously because of the risk of affecting the stomach lining, affecting the kidneys and so on. Third line you may consider opiate medication like codeine and morphine. However, these should be used very cautiously as they have significant side effects and patients also develop dependence and withdrawal. They also don’t work for chronic pain because they’re useful for a couple of weeks and then they stop having an analgesic effect and the patient becomes dependent on them without actually getting any benefit. The two final things to talk about is intraarticular steroid injections, which can provide temporary reduction in inflammation and improve the symptoms, and the other is joint replacement which can be used in severe cases and the hips and the knees are the

Rheumatoid Arthritis: A Comprehensive Guide Rheumatoid Arthritis Pathophysiology – Signs and Symptoms At rheumatoid arthritis, which is a systemic rheumatological disorder affecting multiple joints. The clinical presentation of rheumatoid arthritis is arthritis, which is symmetrical. We have pain, swelling, as well as nodules around the area. Hand involvement is early in the disease and affects the metacarpophalangeal and proximal interfalangeal joints. In rheumatoid arthritis, there’s also extraarticular involvement, which we will look at later on. But first, let us look at the hand involvement in rheumatoid arthritis and see how it differs to osteoarthritis. So here is rheumatoid arthritis and osteoarthritis. So in osteoarthritis, the joints affected are the distal interflangeal joints, as well as approximal interflangeal joints, whereas in rheumatoid arthritis, it is approximal interflangeal joints and the metacarpophalangeal joints as well. You can have other joint involvements, such as the wrist. So these joints are affected early in the disease. In rheumatoid arthritis, but as the disease progresses, you can have other features occurring in the hands. These are swan neck, butonier, or z deformity of the thumb. So in Swannick, what you have is you have the distal interflangeal joints flexed, but the proximal interflangeal joints hyperextended. In boutonniere, it’s the opposite. You have the distal interflangeal joints hyperextended and the proximal interflangial joints flexed. The z deformity of the thumb is essentially the thumb looking like a z. It’s sort of bent, hyperextended in the hands. The hands can also deviate medially. This is referred to as ulna deviation. So they were the features of the hands in rheumatoid arthritis. Let us actually look at what happens inside the joints. So let us zoom into a finger here, and just to recap the anatomy, here we have the bone, the joint capsule, the synovial membrane, also known as a synovium. The synovial membrane, also known as a synovium, which produces the synovial fluid, which helps in lubrication as well as supplying nutrients to the area. Then we have the cartilage here in blue. In rheumatoid arthritis, you essentially have inflammation of the synovium of the synovial membrane. You have sinovitis, and this causes pain and swelling, which occurs in rheumatoid arthritis. This also leads to bone and cartilage erosion, breakdown. Another feature we can see in the joints of rheumatoid arthritic patients is angiogenesis. So that was the macroscopic view of the joint. Just an overview. Let’s look at it in a lot more detail at a cellular level. Let us zoom into this area and see what cells are involved. So just to show where we are, here we have the bone, the synovium. Here is the fluid. Here in yellow and blue is the cartilage. And again, I’m drawing the synovium really big because it is inflamed. Right. The synovial membrane. Now, the synovial membrane is made up of these cells, known as fibroblast like synoviocytes. And these guys are very important in the pathogenesis of rheumatoid arthritis. So, again, rheumatoid arthritis is where we have inflammation of the synovial membrane of the synovium. Now, the exact trigger of the inflammation of the disease is really not quite known. However, we are now looking at what cells we can find here and what cells are involved. So we have macrophages here, and they’re normally around here as well, but they essentially begin secreting cytokines, such as tnf alpha, interleukin one, and interleukin six, which, of course, leads to inflammation. These cytokines also stimulate the fibroblast like synoviocytes. When the fibroblast like synoviocytes are stimulated, they essentially become activated, and then they begin to proliferate. At the same time, they also begin assisting in rank l expression, stimulating the rank l expression, which, together with the cytokines here, will stimulate osteoclast activity, which will lead to bone erosion. What we find in rheumatoid arthritis, when the fibroblast like synoviocytes are stimulated and proliferate, they also begin secreting proteases. These proteases essentially cause the cartilage to break down, so we get cartilage degradation, and the cartilage also secrete proteases, and it’s sort of like a feedback loop. Another interesting feature of the fibroblast like synoviocytes is that when it’s stimulated, when it’s activated, these guys can actually migrate from joint to joint. So they can migrate from the hand joint on one side to the hand joint on the other. And this is why we get symmetrical arthritis. In rheumatoid arthritis, we also can find t cells in the area. In the synovium, t cells make up about 50% of the immune cells in this area. So they’re very important in the pathophysiology. T cells promote inflammation, essentially, and they can secrete interleukin 17, which will promote macrophage activity, as well as stimulate the fibroblast like synoviocytes. The T cells also help in the expression of rank l, which will stimulate osteoclast for bone erosion. We also find plasma cells in the area, and plasma cells only make up a small majority, about 5% of the immune cells, and they essentially assist in inflammation through cytokines as well as through antibodies. Now, in the fluid, in the synovial fluid, not in the synovial membrane. In the synovial fluid, we can find neutrophils and neutrophils. They essentially produce proteases and reactive oxygen species, which will essentially cause bone and cartilage degradation, erosion. So they contribute to inflammation. In the synovial fluid, we also find the immune complexes, which is a feature of rheumatoid arthritis. These immune complexes are essentially antibodies that bind to one another, and they essentially promote inflammation. So those are the cells that we can find in an inflamed joint in rheumatoid arthritis. Again, another feature around this area is that we see angiogenesis. Also the cytokines that are produced by all these cells. They help increase vascular permeability and the expression of adhesion molecules on the vasculature, allowing for these immune cells to migrate into the joints. But where do all these cells come from? Why do they migrate into these joints

Arthritis and joint pain Symptoms, treatment and prevention There are two broad categories of arthritis, inflammatory and osteoarthritis, and they all have individual sub features. So rheumatoid arthritis has particular features. It affects the small joints of the hands. For example, gout may affect peripheral joints, but it can have other distributions too. Annulene spondylitis may affect the back and some peripheral joints, and osteoarthritis tends to affect more the large joints, but also the small joints in the tips of the fingers. They can be interchangeable. So osteoarthritis can have inflammatory component and rheumatoid arthritis can go on to have osteoarthritis changes. Fortunately, there are very clearly defined ways of assessing patients, both clinically and in terms of different investigations, to determine the form and type of arthritis individual has. And we also have very many effective treatments which can be tailored to that individual to help reduce the symptoms or to get them into remission, and in some cases into drug free remission. Arthritis sometimes may have no symptoms and we have some clues in the blood test and other investigations that we might be doing. But often the cardinal symptoms are pain and swelling, stiffness and difficulty with movement or function and disability generally. There can also be systemic features, so not the joints, but other parts of the body might be affected, such as lungs or kidneys or muscles. The key features as far as the joints are concerned is pain and swelling. If there is any swelling, that’s a very high probability of inflammation or infection or something significant with the joint and the individual should be assessed. It really should be looked at as a medical emergency, because having any symptoms leads to loss of function, which then takes huge amount of effort to recover and to improve. So it’s best to prevent progression and get timely treatment. We’re going to be covering treatment later on, but if we delay treatment, the conditions are less responsive and may not be as effective. And so it’s really important that the treatment is carried out as early as possible with the appropriate drugs. Fortunately, there are several different treatment approaches in arthritis that have been proven to be effective. We can broadly categorize them into nondrug drug and surgical. The aim of treatment should be to eradicate symptoms and to restore function. And if we treat early and if we treat appropriately, we should be able to achieve that in majority of the cases. And in some cases we’re even able to achieve drug free remission. Drug free and symptom free, and restore the individual back to their former health. The range of options that we might have in broad category, there’s non drugs such as nutrition, exercise, physiotherapy of the drug treatment. There are a number of different agents and they can be administered in a range of different ways such as tablets, creams, infusions or injections into a given joint. And after surgical approaches it may be keyhole surgery or open joint surgery. All of these treatments used appropriately can help significantly or fully control symptoms and restore function and hopefully prevent progression of the condition. Our understanding of arthritis and the risk factors has improved significantly. There are a number of genetic factors that cannot be changed, but there are also some lifestyle factors that can be altered and the risk of developing arthritis reduced, such as smoking, alcohol, diet, exercise can have a role to play. But it’s important to bear in mind that if you do have any symptoms that to seek help early, even such a simple thing as a tennis alba or symptoms related to a given one joint can have an impact on the related structures, can lead to muscle wasting and lead to some loss of function disability and reduce your energy and your productivity. And treatment early is more effective than waiting for a period of time before you have treatment, before some degree of disability has set in. So we would advise you to seek help early, to be fully assessed and have adequate treatment to help reduce the symptoms and to prevent any progression and hopefully get to a point where you have where you’re symptom free and you don’t need any ongoing treatment. Osteoarthritis treatment Hello everyone. Today we will discuss about some home remedies for osteoarthritis. We have already made a video on recent medicines and surgeries available for osteoarthritis. You can watch the video by clicking the I button on the upper right corner of your screen. Home remedies aren’t meant to completely replace medical treatments. Instead, they may be able to help you manage osteoarthritis pain with fever side effects. You can turn on both medical treatments and home remedies to ease arthritic pain and joint stiffness. When it comes to pain, hot and cold compressors are very beneficial. The best thing is it is easily available and side effects free hot compresses are helpful for joint stiffness. It helps soothe stiff joints and relax muscles. Cold compresses are best for joint pain to numb sharp pain and reduce inflammation. Compresses can reduce muscle pain or spasm surrounding a joint, so making a compress can be as simple as using a warm or cold towel. Next is Epsom salt baths. Epsom salt baths can provide all over relief, especially for joint pain. Osteoarthritis Home Remedies The magnesium in epsom salt may help with inflammation and pain. You can buy epsom salt from a drugstore. According to Epsom Salt Council, these baths are safe enough to take as often as you would like for 30 minutes at a time. Use up to three cups of epsom salt in a bath of warm water. Now let’s discuss about some osteoarthritis friendly foods glucosamine and chondroitin are one of the most popular nutritional supplements. Different studies have different opinions on these nutritional supplements. A few have found benefits for people with osteoarthritis.

the Secrets of Human Bone and Joint Health Human Bone and Joint Health: Essential Insights for Optimal Well-being In understanding the intricacies of human bone and joint health, we embark on a journey through the remarkable framework that supports our bodies. Bones and joints are the unsung heroes of our mobility, providing structure, stability, and protection. From the moment we take our first steps to the activities that define our daily lives, our bones and joints silently bear the burden, often unnoticed until discomfort or injury arises. Bones, the sturdy pillars of our skeletal system, serve as the foundation upon which our bodies are built. Comprised of living tissues constantly undergoing remodeling, bones play a pivotal role in not only supporting our weight but also in housing vital organs and producing blood cells. From the dense cortical bone that forms the outer layer to the trabecular bone that provides internal support, each component contributes to the resilience and strength of our skeletal structure. Joints, on the other hand, are the dynamic connectors that facilitate movement and flexibility. Ranging from the hinge-like movement of the knee to the complex articulation of the shoulder, joints come in various forms, each adapted to its specific function. Encased within the protective embrace of cartilage and synovial fluid, joints undergo a delicate balance of stability and mobility, allowing us to perform a myriad of tasks with ease. However, despite their remarkable resilience, bones and joints are not invincible. Aging, injuries, and underlying medical conditions can all take their toll, leading to discomfort, pain, and impaired mobility. Conditions such as osteoarthritis, osteoporosis, and rheumatoid arthritis can significantly impact the health and functionality of our bones and joints, posing challenges to our overall well-being. Maintaining optimal bone and joint health is therefore paramount for a fulfilling and active lifestyle. A holistic approach encompassing nutrition, exercise, and preventive care can help safeguard against the ravages of time and disease. Adequate intake of calcium, vitamin D, and other essential nutrients lays the foundation for strong and resilient bones, while regular weight-bearing exercises promote bone density and muscle strength. Similarly, fostering joint health involves a combination of low-impact exercises, flexibility training, and proper ergonomics. Engaging in activities such as swimming, yoga, and tai chi can improve joint mobility and reduce the risk of stiffness and discomfort. Moreover, paying attention to posture, using ergonomic equipment, and avoiding repetitive stress can mitigate the strain on our joints and tissues. In addition to lifestyle modifications, seeking timely medical attention and adopting preventive measures are crucial steps in preserving bone and joint health. Routine screenings, diagnostic tests, and consultations with healthcare professionals can help identify risk factors and address underlying issues before they escalate. Moreover, adhering to prescribed treatments, medications, and therapies can mitigate symptoms and improve quality of life for individuals living with bone and joint conditions. In conclusion, the health of our bones and joints is a cornerstone of our overall well-being, influencing our mobility, independence, and quality of life. By understanding the intricate interplay of factors that contribute to bone and joint health, we empower ourselves to take proactive steps towards prevention and management. Through a combination of lifestyle modifications, preventive care, and medical intervention, we can nurture and safeguard these vital components of our musculoskeletal system, ensuring a lifetime of movement, vitality, and resilience. Understanding the Intricacies of Human Bone and Joint Health In the complex framework of the human body, bones and joints serve as the foundational pillars, supporting mobility, stability, and overall well-being. Our bones provide structure and protection, while joints facilitate movement, allowing us to perform everyday activities with ease. Delving deeper into the realm of bone and joint health unveils a fascinating interplay of anatomy, physiology, and various factors influencing their functionality. At the core of bone health lies the intricate process of bone remodeling, where old bone tissue is replaced by new bone tissue. This dynamic equilibrium is regulated by a delicate interplay between osteoblasts, responsible for bone formation, and osteoclasts, responsible for bone resorption. Proper nutrition, including sufficient intake of calcium, vitamin D, and other essential nutrients, plays a crucial role in maintaining optimal bone density and strength. However, the health of our bones is not solely determined by nutrition. Physical activity, particularly weight-bearing exercises, stimulates bone remodeling, enhancing bone density and reducing the risk of osteoporosis and fractures. Conversely, a sedentary lifestyle can lead to bone loss and compromised bone health. Therefore, incorporating regular exercise into our daily routine is paramount for preserving bone strength and integrity. While bones provide structural support, joints facilitate movement, enabling us to bend, flex, and rotate our limbs. Joints are comprised of various components, including cartilage, synovial fluid, ligaments, and tendons, all working in harmony to ensure smooth and pain-free motion. Cartilage, in particular, acts as a cushion between bones, preventing friction and absorbing shock during activities. Maintaining joint health is essential for preserving mobility and preventing conditions such as osteoarthritis, a degenerative joint disease characterized by the breakdown of cartilage. Strategies for promoting joint health include maintaining a healthy weight, avoiding repetitive stress on joints, and practicing proper posture and body mechanics. Additionally, incorporating foods rich in omega-3 fatty acids, such as fish and nuts, may help reduce inflammation and support joint function. Beyond lifestyle factors, genetics and age also play significant roles in bone and joint health. While we cannot alter our genetic makeup, adopting healthy habits early in life and engaging in preventive measures can mitigate the impact of genetic predispositions. Furthermore, as we age, our bones may become more susceptible to fractures and our joints may experience wear and tear. However, proactive measures such as regular exercise, balanced nutrition, and adequate hydration can help mitigate these age-related changes and preserve bone and joint health. In conclusion, understanding the intricacies of human bone and joint health is essential for maintaining mobility, functionality, and overall quality of life. By prioritizing proper nutrition, regular exercise, and preventive measures, we can optimize bone density, strength, and

Weight Loss Coach to Unlock Your Best Self-Success Embarking on a transformative weight loss journey requires personalized guidance and support, and that’s where a dedicated weight loss coach becomes your invaluable partner. A weight loss coach is not just a fitness expert but a motivator, educator, and confidant rolled into one. With a weight loss coach by your side, you gain access to tailored strategies, expert advice, and a customized roadmap to achieve your fitness goals. Say goodbye to one-size-fits-all approaches and welcome a personalized weight loss plan crafted specifically for you. Whether you’re seeking to shed pounds, boost your metabolism, or adopt a healthier lifestyle, a weight loss coach is your compass on this empowering voyage. Start your transformative journey today with the expertise of a weight loss coach, and unlock the secrets to sustainable, long-term success. Your healthier, happier self awaits – let your weight loss coach guide you to triumph! Certainly! providing information and tips to help you on your weight loss journey. However, please keep in mind that it’s important to consult with a healthcare professional or a certified nutritionist before making significant changes to your diet or exercise routine, as individual needs can vary. 1. Set Realistic Goals For weight loss coach: Liv Pure is very different from anything you have ever tried or experienced before in your life. This is the only product with our special Liver Purification and Liver Fat-Burning Complex. It has a mix of Mediterranean plants and nutrients to make your liver work better. In the quest for achieving sustainable weight loss, setting realistic goals is paramount, and the guidance of a seasoned professional, such as a weight loss coach, can make all the difference. Embarking on a transformative journey demands a holistic approach that goes beyond mere numbers on a scale. A proficient weight loss coach serves as a beacon of support, helping individuals navigate the labyrinth of dietary choices, exercise routines, and mindset shifts. One of the fundamental principles emphasized by a weight loss coach is the establishment of achievable milestones. Unrealistic goals often lead to frustration and setbacks, hindering progress. A knowledgeable coach tailors objectives to individual capabilities, considering factors like metabolism, lifestyle, and personal preferences. This personalized approach not only ensures attainability but also cultivates a sense of accomplishment, motivating individuals to persist in their efforts. A successful weight loss journey transcends quick fixes, embracing sustainable habits that promote long-term well-being. A skilled coach provides valuable insights into nutrition, devising meal plans that strike a balance between nourishment and enjoyment. By fostering a positive relationship with food, individuals can overcome challenges and maintain healthier eating habits over time. Exercise, another cornerstone of effective weight management, is integrated into the coaching process. A coach collaborates with clients to develop workout routines that are realistic and enjoyable, aligning with their fitness levels and preferences. This pragmatic approach minimizes the likelihood of burnout, ensuring that exercise becomes a sustainable and integral part of their lifestyle. Furthermore, a weight loss coach functions as a motivational ally, guiding individuals through the inevitable ups and downs of their journey. Cultivating a resilient mindset is crucial, and a coach instills confidence and self-compassion, helping clients overcome setbacks and stay focused on their ultimate objectives. In conclusion, setting realistic weight loss goals is an essential component of any successful wellness journey. With the expertise of a dedicated weight loss coach, individuals can navigate this path with confidence, ensuring that their objectives are not only achievable but also conducive to lasting health and vitality. By embracing a holistic approach that incorporates nutrition, exercise, and mindset, individuals can embark on a transformative journey towards sustainable weight loss, guided by the expertise and support of a seasoned weight loss coach. Embarking on a weight loss journey is a transformative endeavor that necessitates a well-defined roadmap, and a key player in this process is a knowledgeable weight loss coach. Setting achievable short-term and long-term goals is a cornerstone of success, and a seasoned coach plays a pivotal role in guiding individuals through this goal-setting process. Short-term goals act as stepping stones toward the larger objective of weight loss. A proficient weight loss coach collaborates with clients to establish realistic milestones that are attainable within a specific timeframe. These short-term goals may include incremental changes in dietary habits, incorporating regular exercise into daily routines, and cultivating a positive mindset. By breaking down the overarching goal into manageable steps, individuals can experience a sense of accomplishment, reinforcing their commitment to the weight loss journey. Equally important are long-term goals, which provide individuals with a vision of their desired outcome. A weight loss coach helps clients define sustainable objectives that go beyond mere numbers on a scale. These could involve achieving a certain level of fitness, adopting lifelong healthy eating habits, and cultivating a positive relationship with one’s body. Long-term goals serve as a compass, guiding individuals through the journey and ensuring that their efforts contribute to lasting well-being. The collaborative process between a weight loss coach and their clients extends to the customization of goals. Recognizing that each individual is unique, a skilled coach tailors short-term and long-term objectives to align with personal preferences, lifestyle, and health conditions. This personalized approach not only enhances the attainability of goals but also fosters a sense of ownership and empowerment, crucial elements in sustaining motivation throughout the weight loss journey. In conclusion, the establishment of achievable short-term and long-term goals is a fundamental aspect of any successful weight loss strategy. With the expert guidance of a dedicated weight loss coach, individuals can navigate this goal-setting process with precision and purpose. By breaking down the journey into manageable steps and envisioning long-term success, individuals can embark on a transformative path toward sustainable weight loss, supported by the expertise and encouragement of their trusted weight loss coach. Embarking on a weight loss journey can seem like a daunting task, especially when faced with larger goals. However, the key to sustained success lies in the art

Ultimate Guide to Meal Prepping for Weight Loss: Strategies, Recipes, and Tips Meal prepping for weight loss is a game-changer in achieving health goals. It involves planning and preparing meals in advance, offering numerous advantages for those aiming to shed pounds. By meticulously arranging nutritious meals ahead of time, individuals can take charge of their caloric intake, portion sizes, and nutrient balance. This method not only promotes healthier eating habits but also saves time and reduces the temptation to opt for unhealthy fast food choices. Effective meal prepping emphasizes variety, incorporating lean proteins, complex carbohydrates, and plenty of vegetables. It enables individuals to stay consistent with their dietary objectives, supporting weight loss efforts. With proper planning and dedication, meal prepping emerges as a sustainable approach, empowering individuals to make healthier food choices while managing their weight effectively. Start your meal prepping journey today to experience the transformative benefits it brings to your weight loss endeavour’s. I. Introduction to Meal Prepping for Weight Loss Meal prepping for weight loss is a strategic approach to manage your diet and achieve fitness goals efficiently. This practice involves planning, preparing, and portioning meals in advance to support healthier eating habits and aid in weight management. By dedicating a few hours a week to meal prepping, you can ensure access to nutritious, well-balanced meals throughout the week, eliminating the need for spontaneous and often less healthy food choices. It offers convenience, saves time, and empowers you to stay on track with your dietary goals. Whether you’re aiming to shed a few pounds or maintain a healthier lifestyle, meal prepping for weight loss provides a structured and practical way to enhance your nutrition and pave the way for successful weight management. Importance of meal prepping for weight loss Meal prepping for weight loss holds paramount significance in achieving and sustaining a healthier lifestyle. This strategic approach to nutrition involves preparing and organizing meals in advance, offering a multitude of benefits for individuals striving to shed excess weight. One of its primary advantages lies in fostering portion control and calorie management. By pre-planning meals, it becomes easier to regulate serving sizes, ensuring that each dish aligns with specific dietary goals, thus aiding in weight management. Moreover, meal prepping encourages the consumption of nutritious, balanced meals. Incorporating a variety of whole foods, lean proteins, complex carbohydrates, and a spectrum of colorful vegetables enables individuals to create well-rounded, healthful meals. This diverse array of nutrients not only supports weight loss but also contributes to overall well-being and sustained energy levels throughout the day. Another pivotal aspect is the time-saving attribute of meal prepping. By dedicating a few hours at the beginning of the week to prepare meals, individuals can streamline their daily routine, bypassing the need for frequent cooking or resorting to less healthy, convenience-based meal options. This convenience factor significantly reduces the likelihood of impulsive, unhealthy food choices, ultimately supporting weight loss efforts. Furthermore, meal prepping fosters consistency in dietary habits. Establishing a routine of planned, pre-made meals assists in steering clear of spontaneous, less nutritious options, thereby reinforcing adherence to a healthier eating pattern. This consistency is key to achieving sustainable weight loss goals over time. In essence, meal prepping serves as an instrumental tool in weight loss journeys, offering a structured, organized approach to nutrition that promotes portion control, dietary variety, time efficiency, and overall consistency in healthier eating habits. Embracing meal prepping can make a substantial difference in managing weight effectively while fostering a long-term commitment to improved health and well-being. How meal prepping aids in achieving weight loss goals. Meal prepping plays a pivotal role in effectively achieving weight loss objectives by revolutionizing dietary habits and providing a structured approach to nutrition. This strategic practice involves planning, preparing, and packaging meals in advance, offering several key advantages that significantly contribute to successful weight loss journeys. Firstly, meal prepping cultivates portion control and calorie management, two fundamental aspects crucial for weight loss. By preparing meals in predetermined serving sizes, individuals can better regulate their food intake, ensuring they consume the appropriate amount of calories aligned with their weight loss goals. This method installs discipline and awareness, ultimately aiding in creating a calorie deficit necessary for shedding excess weight. Moreover, meal prepping facilitates the consumption of nutritious, well-balanced meals. Crafting dishes rich in lean proteins, whole grains, ample fruits and vegetables, and healthy fats becomes more manageable when meals are planned in advance. This variety of nutrients not only supports weight loss efforts but also contributes to overall health and sustained energy levels. Additionally, meal prepping eliminates the reliance on fast food or processed meals. Having pre-prepared, wholesome meals readily available reduces the temptation to opt for less nutritious, convenience-based food choices. This not only prevents the consumption of excessive calories and unhealthy ingredients but also promotes healthier eating habits essential for weight loss success. Furthermore, meal prepping fosters consistency and adherence to dietary plans. By establishing a routine of pre-made meals, individuals are more likely to stick to their prescribed eating regimen, avoiding impulsive decisions that may hinder weight loss progress. This consistency plays a crucial role in maintaining a balanced, controlled diet conducive to achieving weight loss goals. In essence, meal prepping serves as a cornerstone in the journey towards weight loss success by promoting portion control, facilitating the consumption of nutritious meals, mitigating reliance on unhealthy food options, and fostering consistency in dietary habits. Embracing meal prepping not only aids in shedding unwanted pounds but also cultivates a sustainable and healthier approach to eating, supporting long-term well-being and weight management. II. Understanding Meal Prepping Understanding meal prepping for weight loss is about embracing a systematic and efficient approach to nutrition and healthy eating habits. It involves planning and preparing meals in advance, typically done over a dedicated time, to ensure a supply of balanced, portion-controlled dishes throughout the week. Meal prepping allows for customization, catering to specific dietary needs and weight loss objectives. By familiarizing yourself with this method, you gain control

How to Decode Food Labels for Informed Choices In our fast-paced world, making informed and health-conscious food choices is essential for maintaining overall well-being. One of the most powerful tools at your disposal for making these decisions is the unassuming yet critical food label. Food labels serve as a window into the nutritional content of packaged foods, providing vital information that empowers you to make better choices. In this comprehensive 5000-word article, we will delve deep into the world of food labels, deciphering the jargon and demystifying the numbers. By the end of this guide, you will be equipped with the knowledge and confidence needed to navigate the grocery store with a discerning eye and make healthier dietary decisions. Luckily, a rebel specialist from Japan has revealed a normal “belly fat Drāno” juice that flushes out this harmful greasy corrosive from your body. The Basics of Food Labels Understanding food labels is crucial for making informed choices about what we consume. These labels serve as a window into the nutritional content of the products we buy, offering vital information that helps us maintain a balanced diet and make healthier decisions. Whether you’re health-conscious, managing a specific dietary requirement, or simply curious about what’s in your food, comprehending the basics of food labels is key. Before diving into the details, let’s start with the fundamentals. Food labels are mandated by law on most packaged foods, providing a wealth of information to help you make informed choices. Here’s what you typically find on a food label: 1.The Significance of Food Labels Food labels are more than just a list of ingredients and nutritional facts—they’re a consumer’s compass, guiding them through the nutritional landscape. They provide insights into serving sizes, calorie counts, macronutrients (such as carbohydrates, proteins, and fats), vitamins, minerals, and the infamous “percent daily value” (%DV) that helps us gauge the contribution of a specific nutrient to our daily diet. 2.Decoding the Label The front of food packaging often showcases various claims—be it “organic,” “low-fat,” “sugar-free,” or “gluten-free.” These claims are regulated by specific guidelines. For instance, “organic” typically means the product was grown without synthetic pesticides or fertilizers, while “low-fat” implies reduced fat content compared to a reference product. Understanding these claims aids in making quick decisions but delving deeper into the label is necessary for a comprehensive understanding. 3.Nutritional Facts Panel The Nutrition Facts panel is the heart of the food label. It delineates serving sizes and the corresponding nutritional information. Observing the serving size is crucial, as all nutrient values listed are in reference to this portion. Calorie counts, macronutrients, cholesterol, sodium, vitamins, and minerals are meticulously detailed here. The %DV is especially valuable, as it indicates how much a nutrient in a serving of food contributes to a daily diet, based on a 2,000-calorie intake. 4.Ingredients List This section lists the ingredients in the food, with the primary ingredient first and others following in descending order by weight. The ingredients list reveals what components constitute the product. They’re listed in descending order by weight, allowing consumers to understand the primary constituents of what they’re consuming. This section helps in identifying allergens, additives, preservatives, and even hidden sugars or unhealthy fats, empowering individuals to make more informed choices. 5.Unraveling Misleading Labels While food labels are designed to inform and guide consumers, misleading tactics sometimes prevail. For instance, a product labeled “natural” doesn’t necessarily mean it’s healthier—it might still contain excessive sugar or unhealthy fats. Understanding the nuances of these terms and critically analyzing the label prevents falling prey to deceptive marketing strategies. 6.Tailoring Labels to Your Needs Each individual’s nutritional requirements differ. Some might focus on low sodium, while others prioritize high fiber content. Understanding how to tailor the information on food labels to suit your specific needs is empowering. For instance, someone managing diabetes may focus on the carbohydrate content and added sugars, while someone with heart issues might prioritize limiting saturated fats and sodium. In essence, comprehending food labels is an essential skill in today’s world. It’s a tool that empowers consumers to make conscious, well-informed choices about their diet and health. By unraveling the complexities of food labels, one can navigate the aisles of supermarkets with confidence, ensuring that what goes into their bodies aligns with their health and wellness goals. The more one understands food labels, the better equipped they are to make healthier, informed decisions. Nutrition Facts Panel: This is the heart of the label, containing information about serving size, calories, and the amounts of various nutrients in the food. It’s usually presented in a table format. Understanding the Nutrition Facts Panel on food labels is key to making informed dietary choices. This section of food packaging provides a comprehensive breakdown of essential nutritional information, enabling consumers to assess the contents and make healthier decisions. The Nutrition Facts Panel typically includes details on serving sizes, calories, macronutrients (such as fats, proteins, and carbohydrates), vitamins, minerals, and %DV (percent daily value) indicators. Delving into these details can aid in maintaining a balanced diet and meeting specific health goals. 1.What the Panel Offers The Nutrition Facts Panel is a treasure trove of vital information. It doesn’t just list the nutritional content but also delineates serving sizes, allowing consumers to grasp the actual intake per portion. This section also includes calorie counts, which are fundamental for those monitoring their energy intake. Moreover, the macronutrient breakdown—fats, proteins, and carbohydrates—helps in understanding the composition of the product, aiding in various dietary preferences or health concerns. 2.Unveiling Macronutrients Understanding the significance of fats, proteins, and carbohydrates is pivotal. Fats encompass various types—saturated, unsaturated, trans fats—each with its impact on health. Proteins are essential for building and repairing tissues, while carbohydrates serve as the primary energy source. Recognizing the quantities of these macronutrients in a product allows individuals to align their consumption with their nutritional needs. 3.Micronutrients and %DV Vitamins and minerals play a crucial role in our overall health. The Nutrition Facts Panel reveals the presence of essential