[Disease Science] Intermittent catheterization in patients with neurogenic bladder

   The frequency of intermittent catheterization is very important to the patient’s therapeutic effect. Too few catheterizations may cause bacteriuria to stay in the bladder for a long time, and also make the bladder often in a state of high pressure, which increases the burden on the bladder. In severe cases, it may affect the upper urinary tract. Frequent catheterization, although the pressure on the bladder is reduced, it may increase the chance of urethral injury and increase the inconvenience of children and parents.   The risk of urinary tract infections caused by catheterization 3 times a day is 5 times that of 6 catheterizations. The frequency of catheterization plays an important role in preventing urinary tract infections. Therefore, appropriate catheterization frequency plays an important role in the successful implementation of intermittent catheterization. Ask patients to record a catheterization diary and instruct them how to accurately record various data, such as the amount of water consumed (including intake of various fluids) and the number of intakes, the time and interval of each catheterization, the amount of urine exported each time and whether urine leaks Wait. Children should drink more water evenly to maintain a certain amount of urine to prevent urinary tract infections; the amount of drinking water can be adjusted reasonably according to the amount of urine to avoid ingesting a large amount of liquid in a short time; try not to ingest liquid after dinner to prevent a large amount of urine at night.   Associate Professor Li Xudong introduced: Intermittent catheterization is generally believed to be once every 4-6 hours at the beginning, no more than 6 times a day, and then adjust the number of catheterizations according to the amount of residual urine in the bladder. When the residual urine volume is less than 100ml or the bladder volume is only 10% to 20%, the bladder function is considered to be balanced and the catheterization can be stopped.  Complications and precautions  In order to prevent urinary tract injury, urinary tract infection, high intravesical pressure and retrograde infection during intermittent urinary catheterization, which may affect kidney function. During the implementation of intermittent catheterization, attention should be paid:    (1) Strictly implement the principle of aseptic operation.   (2) Regular catheterization, the amount of urine exported should not exceed 500ml each time, to prevent excessive catheterization from causing collapse of the patient.   (3) The method of squeezing the bladder should be correct. The applied force is light and then heavy, and continuous pressure is applied to a depth of about 3-4cm.  (4) The catheter material used should be soft and fully lubricated with sterile lubricant. The catheterization is gentle. Communicate more with patients during catheterization to achieve better cooperation.   (5) Urinary catheterization strives to exhaust the urine without leaving residual urine.  (6) Routine urine examinations and mid-section urine cultures are performed every 1 to 2 weeks.  (7) During the intermittent catheterization, the patient’s water intake and discharge was recorded in detail.

What are the symptoms of lumbar spondylolisthesis?

Common symptoms: Clinical symptoms caused by lumbosacral pain, sciatic nerve involvement, intermittent claudication and lumbar spondylolisthesis have great variability. Not all spondylolisthesis have clinical symptoms, and different patients may have different clinical symptoms and severity. One. This is not only related to the compensatory ability of the structures around the spine, but also depends on the degree of secondary damage, such as articular process hyperplasia, spinal stenosis, cauda equina and nerve root compression. The main symptoms of    include the following aspects:    1. Lumbosacral pain: mostly dull pain, a very small number of patients may have severe tailbone pain. Pain can appear after exertion or persist after a sprain. It is aggravated when standing and bending down, and is reduced or disappeared after bed rest.  2. Sciatic nerve involvement: manifested as radiating pain and numbness in the lower limbs. This is because the fibrous connective tissue or hyperplastic callus at the isthmus break can compress the nerve roots, and the nerve roots are stretched during spondylolisthesis. The straight leg elevation test is mostly positive.   3. Intermittent claudication: If the nerve is compressed or combined with lumbar spinal stenosis, intermittent claudication often occurs.  4. Symptoms of traction or compression of the cauda equina nerve: When the spondylolisthesis is severe, the cauda equina nerve may be affected and may cause symptoms such as weakness of the lower limbs, numbness in the sellar area, and dysfunction of urine and urine.   5. Lumbar lordosis increased, buttocks kyphosis. Patients with heavier spondylolisthesis may have a sunken waist, a lordotic abdomen, and even shorten their trunks and wobble when walking.   6. Palpation slippage, the previous spinous process moves forward, the back of the waist has steps, and the spinous process is tender.

In the treatment of trigeminal neuralgia, a clear diagnosis is the key

Trigeminal neuralgia can be divided into two categories: primary (symptomatic) trigeminal neuralgia and secondary trigeminal neuralgia, of which primary trigeminal neuralgia is more common. Primary trigeminal neuralgia refers to trigeminal neuralgia for which no exact cause can be found. Secondary trigeminal neuralgia refers to trigeminal neuralgia caused by tumor compression, inflammation, and vascular malformations. This type is different from the primary characteristics, the pain is often persistent, and signs of pathological changes in adjacent structures of the trigeminal nerve can be detected. The etiology and pathogenesis of primary trigeminal neuralgia are unclear, but most of them believe that the pathology is around the trigeminal nerve, that is, in the semilunar sensory root of the trigeminal nerve. According to microsurgery and electron microscopy observations, it may be related to factors such as small blood vessel malformations and bone malformations in petrous bones, which may cause pain attacks. It is generally believed that the diagnosis of trigeminal neuralgia should have the following characteristics: 1. Gender and age: most of them are over 40 years old, mostly middle-aged and elderly. More women than men, about 3:2; 2. Pain: the right side is more than the left side, the pain starts from a certain point of the face, mouth or jaw and spreads to one or more branches of the trigeminal nerve, with the second branch, The third branch is the most common, but the first branch is rare. The pain range does not exceed the midline of the face, nor does it exceed the distribution area of ​​the trigeminal nerve. Occasionally have bilateral trigeminal neuralgia, accounting for 3%; 3. The nature of the pain: severe and unbearable pain such as undercutting, acupuncture, tearing, burning, or electric shock, even painful; 4. Pain pattern: trigeminal neuralgia The onset of pain is often without warning, and the onset of pain is generally regular. The duration of each pain episode ranges from only a few seconds to 1 to 2 minutes and stops suddenly. At the initial onset, the number of attacks is small, and the intermittent period is also long, ranging from several minutes to several hours. As the disease progresses, the attacks become more frequent, the intermittent period gradually shortens, and the pain gradually increases and becomes severe. Pain episodes decreased at night. No discomfort during the intermittent period; 5. Precipitating factors: talking, eating, washing, shaving, brushing teeth, and wind blowing can induce pain episodes, so that the patient is sluggish, acting cautiously, and even dare not wash face, brush teeth, eat, or talk Also be careful, lest it cause an attack; 6. Trigger point: The trigger point is also known as the “trigger point”, often located on the upper lip, nose, gums, corners of the mouth, tongue, eyebrows, etc. Touching or stimulating the trigger point can trigger a painful attack; 7. Expression and facial changes: When the attack occurs, you often stop talking, eating and other activities suddenly, and the painful side may show cramps, that is, “pain cramps”, frowning, clenching teeth, and covering your eyes. Or rub the face with the palm of your hand vigorously to cause local skin roughness, thickening, loss of eyebrows, conjunctival hyperemia, tearing and salivation. The expression was in a state of nervousness and anxiety; 8. Nervous system examination: no abnormal signs, and a few had decreased facial sensation. Such patients should ask for further medical history, especially if they have a history of hypertension, and perform a comprehensive neurological examination, including lumbar puncture, skull base and internal auditory canal photography, brain CT, MRI, etc., to help Identification of secondary trigeminal neuralgia.

What are the training methods for bladder urination in patients with neurogenic bladder?

Bladder retraining is based on learning theory and conditioned reflex principles, through the patient’s subjective conscious activity or functional exercise to improve the bladder’s urine storage and urination function, so as to achieve partial recovery of lower urinary tract function and reduce lower urinary tract dysfunction to the body damage. Mainly include: behavioral skills, reflex voiding training, compensatory voiding training (Valsalva breath holding method and Crede maneuver), anal stretch training and pelvic floor muscle training.  Bladder urination training method  ①Search for reflex bladder trigger point: Stretching, tapping on the suprapubic bone, inner thigh, squeezing, and anal stimulation to induce urination. The sitting and standing positions are more advantageous for urination. This method is suitable for most patients with spinal cord injury and cooperates with intermittent catheterization to establish a reflex bladder. It is also what most people call “trigger point” or “urination switch.”  ② Breath-holding method (Valsava method): Breath-holding can increase abdominal pressure by more than 50cmH2O. The increased abdominal pressure compresses the bladder to urinate. It is also effective in sitting and standing positions. This method is generally used after intermittent urinary catheterization and bladder function training. When urine is discharged every time the sensitive area of ​​the bladder is stimulated, it can be changed to this compensatory urination method as appropriate, which is beneficial to the reduction of residual urine output. ③Crede manipulation treatment: Use your fist to squeeze deeply from the umbilicus, and slowly move towards the pubic bone. It cannot reach the pubic bone. The bladder is compressed to promote urine discharge. The key point of this technique is to slowly apply pressure to the pubic bone to avoid adding pressure to the pubic bone. Pressure of urine reflux causes hydronephrosis. This method is also a compensatory urination method. It is generally used after intermittent catheterization and bladder function training. When urine is discharged every time the sensitive area of ​​the bladder is stimulated, it can be changed to this type of urination method as appropriate to reduce residual urine volume. .  ④Drinking water control: regular and quantitative drinking water control, first set the patient’s daily fluid intake according to the specific situation, control it at about 2000ml, and then drink regularly and quantitatively to avoid irregular drinking.   Specific operation method: Drink 500ml of water for each meal in the morning, lunch and evening, including food and drinking water. You can drink 200ml separately between meals, and try not to drink again after dinner. Temporary thirsty can drink 1-2 tablespoons of water as appropriate. According to the above drinking water control requirements, the bladder can be filled regularly, which facilitates the arrangement of the time and frequency of intermittent catheterization. ⑤ Knock on the pubic symphysis: It should be light and fast to avoid heavy buckling, the frequency is about 100 times/min, and the time is 15-20 minutes. At present, the bladder function training method commonly used in the rehabilitation department is suitable for most patients with spinal cord injury. The urinary catheterization method cooperates with each other to establish a reflex bladder, which is also what most people call the “trigger point” or “urination switch.” ⑥Intermittent catheterization: Determine the time and frequency of intermittent catheterization according to the specific conditions of the patient. Usually, intermittent catheterization is required every 6 hours. The total amount of urine exported each time should not exceed 400-500ml, and the pressure in the bladder should not exceed 40cmH2O, when the residual urine volume is about 300ml, catheterization once every 8 hours; when the residual urine volume is about 200ml, catheterization twice a day; when the residual urine volume is about 150ml, catheterization once a day; when the residual urine volume is about 150ml When the amount is about less than or equal to 100ml, catheterization can be suspended according to the specific situation.  ⑦Extend urination interval training: Before each occurrence of urinary incontinence or start urination, perform bladder function training such as levator anus and abdomen, extend the urination interval by 1 minute, and extend by 1 minute every day to improve urinary incontinence. It is suitable for neurogenic bladder patients whose residual urine volume is basically normal and the bladder volume is reduced. The specific application of the above-mentioned urination method is subject to the doctor’s instructions. It does not need to be applied at the same time. It also requires different rehabilitation techniques and equipment. So please follow the doctor’s guidance to avoid blind imitation and cause urine reflux. , Hydronephrosis and other irreversible consequences.

What should patients with neurogenic bladder pay attention to during intermittent catheterization?

   Neurogenic bladder is a common comorbidity of spinal cord injury. There are about 50,000 new cases in my country each year. Mainly manifested as urinary retention, urinary incontinence, increased residual urine volume, etc. If not handled properly, it may cause vesicoureteral reflux, hydronephrosis, urinary system infection, and renal function decline or failure.   Intermittent urinary catheterization means that the catheter is not left in the bladder, but inserted into the bladder only when needed, and then removed after emptying. It can make the bladder expand intermittently, help maintain the capacity of the bladder and restore the contraction function of the bladder, and prevent overfilling the bladder from causing damage to the bladder and kidney function. Intermittent catheterization is recommended by the International Continence Association as the first choice for the treatment of neurogenic bladder dysfunction. Therefore, intermittent catheterization plays an important role in neurogenic bladder management.   The risk of urinary tract infections caused by catheterization 3 times a day is 5 times that of 6 catheterizations. The frequency of catheterization plays an important role in preventing urinary tract infections. Therefore, proper catheterization frequency plays an important role in the successful implementation of intermittent catheterization. Ask patients to record a catheterization diary, and instruct them how to accurately record various data, such as the amount of water consumed (including intake of various fluids) and the number of intakes, the time and interval of each catheterization, the amount of urine exported each time, and whether urine leaks Wait. Children should drink more water evenly to maintain a certain amount of urine to prevent urinary tract infection; the amount of water can be adjusted reasonably according to the amount of urine to avoid ingesting a large amount of liquid in a short time; try not to ingest liquid after dinner to prevent a large amount of urine at night.   Associate Professor Li Xudong introduced: Intermittent catheterization is generally believed to be once every 4-6 hours at the beginning, no more than 6 times a day, and then adjust the number of catheterizations according to the amount of residual urine in the bladder. When the residual urine volume is less than 100ml or the bladder volume is only 10% to 20%, the bladder function is considered to be balanced and the catheterization can be stopped.  In order to prevent urinary tract injury, urinary tract infection, and excessive bladder pressure during intermittent catheterization, which may cause retrograde infection and affect kidney function. During the implementation of intermittent catheterization, attention should be paid:    (1) Strictly implement the principle of aseptic operation.   (2) Regular catheterization, the amount of urine exported should not exceed 500ml each time, to prevent excessive catheterization from causing collapse of the patient.   (3) The method of squeezing the bladder should be correct. The applied force is light and then heavier, and continuous pressure is applied to a depth of about 3-4cm.  (4) The catheter material used should be soft and fully lubricated with sterile lubricant. The catheterization is gentle. Communicate more with patients during the catheterization process to achieve better cooperation.   (5) Urinary catheterization strives to exhaust the urine without leaving residual urine.   (6) Routine urine examinations and mid-section urine cultures are done every 1 to 2 weeks.  (7) During the intermittent catheterization, the patient’s water intake and discharge was recorded in detail.

Intermittent fasting can lose weight, please pay attention to these 3 points when trying

Speaking of losing weight every day, you have to keep your mouth open and open your legs. Many friends have headaches and feel that this day-to-day persistence is too hard. Can you eat as you like under certain rules? There really are such eating patterns, such as intermittent fasting. Studies have found that intermittent fasting can really help you lose weight. In addition to helping you lose weight, it can also improve insulin sensitivity, help control blood sugar; regulate blood lipids, reduce vascular inflammation, and help improve cardiovascular disease; Survival rate of specific cancers, etc. [1] 1. Intermittent fasting is mainly divided into three types. Intermittent fasting is actually called light fasting. As the name implies, it is intermittent stop eating. At present, there are mainly three kinds of intermittent fasting programs that are most widely studied in humans. 1. Time-limited eating every day refers to eating for 6-8 consecutive hours, and not eating for the remaining 16-18 hours. Only drink water, tea, black coffee and other beverages that do not affect blood sugar fluctuations. If you still have to eat three regular meals a day, you have to eat breakfast at 9 am, and you have to eat dinner at 5 pm. Freelancers or partners who work late in the morning and leave early in the afternoon are still able to do so. We ordinary office workers want to try, we can only cancel dinner, and eat more during afternoon tea. 2. Fasting every other day means eating today-fasting tomorrow-eating the day after tomorrow-fasting the day after tomorrow. This cycle is carried out. Do not eat on fasting days or consume 500-600 kcal of food. If you work a day and take a day off, there are basically no gatherings on the rest day, and there is little activity. In short, it is very casual and relaxed, and you have the conditions to try. Like our little friends who work five days a week, they may be hungry on the day of fasting so that their chests will stick to their backs. It is really difficult to think about not affecting work. 3, 5+2 fasting means that there are 5 days of normal eating in a week, two days of fasting, and two days of fasting are not continuous, such as normal eating on Tuesday/Wednesday/Thursday/Friday, and two days of fasting on Saturday and Monday. The energy intake on fasting days is about 1/4 of the usual, about 600 kcal/day for men and 500 kcal/day for women. If you take a non-consecutive rest ≥ 2 days in a week, the rest day is also very relaxing and it will be easier to implement. Like ordinary office workers, we still have to fast for one day during the working day. If you can do it, you can try. Two and four types of people are not suitable for fasting. The research on the health benefits of intermittent fasting mainly focuses on overweight young and middle-aged people. These health benefits and safety cannot be extended to other age groups. For example: children and adolescents in the growth and development period of the elderly during pregnancy and lactation. In addition, if you have physical diseases such as diabetes, anorexia nervosa and eating disorders (not limited to these two), do not try it yourself. It is necessary to consult a doctor whether it is suitable and how to perform it. If a diabetic patient tries it by himself, it is likely to cause hypoglycemia. Third, try fasting. It is recommended that you do this. If you try 5+2 light fasting, 4 points are recommended. 1. The principle of how to match 500 kcal food is balanced nutrition. The formula for reference is: cereals (90 kcal) + vegetables (90 kcal) + fruits (90 kcal) + milk (135 kcal) + Meat egg beans (90 kcal). The specific mix is ​​as follows: 1. Cereals (choose one of the following) 1 slice of whole wheat sugar-free bread (about 35 grams) 25 grams of pure oatmeal 65 grams of multi-grain rice (about 0.5 fist) 60-75 grams of cooked noodles 2. Fruit watermelon , Peaches, pears and other about 1.5 fists 3, vegetables, leafy vegetables and melons and eggplant vegetables, cooked about 5 fists 4, milk 1 box of whole milk (250 ml) or 200 ml of unsweetened yogurt 5. Meat eggs (below) Choose one) Egg 1 3-4 rolls Shabu-shabu pure beef rolls 8 ordinary shrimps, a slice of fish of the palm size and thickness, 2 small wings, 1 fist tofu/tofu silk/tofu skin and above five types of food can be flexibly matched There are N 500 kcal recipes that are not too heavy. You can mix them flexibly according to your favorite foods. As for the time to eat, you can spread it out, or you can focus on a meal, such as eating at lunch. Just pay attention to two points: (1) Cereals and fruits are best eaten in two periods, which will help stabilize blood sugar; (2) The amount of vegetables is large and it is not easy to eat at one meal. It is better to eat separately. 2. Decrease energy step by step and slowly enter fasting mode. If you take 5+2 light fasting, you will consume 500 kilocalories at the beginning of the fasting day. You may be too hungry and persist for only one day. So at the beginning of the fasting day you can be better than usual

[Case] ​​6 years of tingling cheeks, pain disappeared after microvascular decompression

   57-year-old Mr. Liu suffered intermittent tingling in the right cheek and a slight toothache in the right temporomandibular joint six years ago. In order to relieve the pain, he received gamma knife treatment in 2016, but it was ineffective. In 2017, the pain worsened. I had another gamma knife and took carbamazepine at the same time. The pain control was somewhat effective. After the effect was maintained for one year, the pain became worse. Before the operation, I took carbamazepine, half a tablet once, twice a day. In order to completely get rid of trigeminal neuralgia, Mr. Liu approached Professor Jiang Haitao of Neurosurgery, First Affiliated Hospital of Xi’an Jiaotong University. Professor Jiang Haitao introduced: A typical trigeminal neuralgia is generally divided into three areas. There are trigger points in the areas where the sensory peripherals are concentrated (such as the upper and lower lips, corners of the mouth, gums, tongue, and wings of the nose). Experts conducted consultations, and performed maxillofacial CT + MRI, combined with the results of cranial nerve imaging, which showed that Mr. Liu was suitable for microvascular decompression surgery. His postoperative pain disappeared and there was no facial function problem. Experts remind: the identification of typical trigeminal neuralgia is the prerequisite for MVD surgical treatment. Typical trigeminal neuralgia is paroxysmal and short-term pain episodes. The duration of each episode ranges from a few seconds to a few minutes. The pain is severe, unbearable, and painful. It presents electrocautery, acupuncture, knife cutting, tearing, etc. The attack may be accompanied by facial muscle twitching, and the mouth angle is tilted to one side. Pain mostly occurs on one side, and there are often trigger points (trigger points) along the trigeminal nerve distribution area, such as upper and lower lips, corners of mouth, gums, tongue, wings of nose, etc. It can be induced by washing face, brushing teeth, drinking water, talking, and shaving. Affect the daily life of patients. The intermittent period of pain episodes is the same as that of ordinary people. The intermittent period is longer in the early onset and gradually shortened later. In severe cases, it will occur once in a few minutes, and even develop into continuous pain. Pain cannot be relieved naturally without treatment. Nervous system examinations often have no positive signs. The diagnosis of trigeminal neuralgia mainly depends on clinical manifestations, and imaging examinations such as CT and MRI are mainly used to rule out secondary trigeminal neuralgia.  Trigeminal neuralgia is usually divided into two types: typical and atypical, and can also be divided into two types: primary and secondary. At present, the former classification method is closely related to the choice of treatment options and surgical efficacy. Therefore, here are the diagnostic criteria for typical and atypical trigeminal neuralgia. Diagnostic criteria for typical trigeminal neuralgia (1) Paroxysmal pain in the distribution area of ​​the trigeminal nerve;    (2) The pain is paroxysmal, each episode lasts from several seconds to several minutes, and the intermittent period is completely normal;    (3) pain It is lightning-like, electric shock-like, and intense and unbearable. It can be induced by washing your face, brushing your teeth, drinking water, talking, or even wind blowing;    (4) In areas where the sensory peripherals are concentrated (such as upper and lower lips, mouth corners, gums, tongue, etc.) Nose, etc.) There is a trigger point phenomenon;   (5) In the early stage of the disease, carbamazepine is effective in treatment;   (6) Neurological examinations often have no positive signs. Diagnosis criteria for atypical trigeminal neuralgia:   (1) severe pain in the distribution area of ​​the trigeminal nerve;   (2) frequent episodes of pain, intermittent pain, and even continuous pain;   (3) the nature of pain is diverse, and patients are very It is difficult to describe, but it can induce pain aggravation when washing face, brushing teeth, drinking water and speaking;   (4) Most patients do not have trigger point phenomenon;   (5) Facial numbness, rough skin and hypoesthesia;   (6) Neurological examination can be There is a decrease in the superficial sensation of the affected skin. Clinically, the diagnosis of typical trigeminal neuralgia is not difficult, but the diagnosis of atypical trigeminal neuralgia needs to be differentiated from a variety of diseases, such as toothache, temporomandibular joint pain, migraine, glossopharyngeal neuralgia, pterygopalatine neuralgia, Intermediate neuralgia, etc.

What are the methods for neurogenic bladder urination after spinal cord injury?

  Many patients with spinal cord injury have bladder dysfunction, especially those with conus injury or cauda equina injury. Second, the difficulty of control seriously affects their daily life self-care ability and quality of life. Some urination methods currently used internationally have different indications and contraindications, especially when combined with intermittent catheterization techniques, they adapt to different patient conditions. The detailed introduction is now as follows:   ①Search for the reflex bladder trigger point: by pulling Zhang and percussion on the suprapubic bone and inner thigh, squeeze the penis, and stimulate the anus to induce urination. The sitting and standing positions are more advantageous for urination. This method is suitable for most patients with spinal cord injury and cooperates with intermittent catheterization to establish a reflex bladder. It is also what most people call “trigger point” or “urination switch.”  ② Breath-holding method (Valsava method): Breath-holding can increase abdominal pressure by more than 50cmH2O. The increased abdominal pressure compresses the bladder to urinate. It is also effective in sitting and standing positions. This method is generally used after intermittent urinary catheterization and bladder function training. When urine is discharged every time the sensitive area of ​​the bladder is stimulated, it can be changed to this compensatory urination method as appropriate to reduce residual urine output. ③Crede manipulation treatment: Use your fist to squeeze deeply from the umbilicus and slowly move towards the pubic bone. It cannot reach the pubic bone. The bladder is compressed and urine is discharged. The key point of this technique is to slowly apply pressure to the pubic bone to avoid adding pressure to the pubic bone. Pressure of urine reflux causes hydronephrosis. This method is also a compensatory urination method. It is generally used after intermittent catheterization and bladder function training. When urine is discharged every time the sensitive area of ​​the bladder is stimulated, it can be changed to this type of urination method as appropriate to reduce residual urine volume .  ④Drinking water control: regular and quantitative drinking water control, first set the patient’s daily fluid intake according to the specific situation, control it at about 2000ml, and then drink regularly and quantitatively to avoid irregular drinking. Specific operation method: Drink 500ml of water for each meal in the morning, lunch and evening, including food and drinking water. You can drink 200ml separately between meals, and try not to drink again after dinner. Temporary thirsty can drink 1-2 tablespoons of water as appropriate. According to the above drinking water control requirements, the bladder can be filled regularly, which facilitates the arrangement of the time and frequency of intermittent catheterization. ⑤ Knock on the pubic symphysis: It should be light and fast to avoid heavy buckling, the frequency is about 100 times/min, and the time is 15-20 minutes. At present, the bladder function training method commonly used in the rehabilitation department is suitable for most patients with spinal cord injury. The urinary catheterization method cooperates with each other to establish a reflex bladder, which is also what most people call the “trigger point” or “urination switch.” ⑥Intermittent catheterization technology: The time and frequency of intermittent catheterization is determined according to the specific conditions of the patient. Usually, intermittent catheterization is required every 6 hours. The total amount of urine exported each time should not exceed 400-500ml, and the pressure in the bladder should not be allowed. When the residual urine volume exceeds 40cmH2O and the residual urine volume is about 300ml, catheterization is performed every 8 hours; when the residual urine volume is approximately 200ml, catheterization is performed twice a day; when the residual urine volume is about 150ml, catheterization is performed once a day; When the urine volume is about less than or equal to 100ml, the catheterization can be suspended according to the specific situation.  ⑦Extend urination interval training: Before each occurrence of urinary incontinence or start urination, perform bladder function training such as levator anus and abdomen, extend the urination interval by 1 minute, and extend it by 1 minute every day to improve urinary incontinence. It is suitable for neurogenic bladder patients whose residual urine volume is basically normal and the bladder volume is reduced. The specific application of the above urination method is subject to the doctor’s instructions. It does not need to be applied at the same time. It also requires different rehabilitation techniques and equipment. So please follow the doctor’s guidance to avoid blind imitation leading to urine reflux. , Hydronephrosis and other irreversible consequences.

Will intermittent epilepsy be inherited?

 Can intermittent epilepsy be inherited? Epilepsy has now become a very serious chronic disease. Due to its stubbornness and complexity, it has greatly increased the difficulty of treatment. Epilepsy has caused serious harm to patients. The incidence of adolescents in the population is very high. Epilepsy is also called claw wind. The claw wind has caused a lot of harm to humans. He not only affects the patients themselves, but also affects the relatives of the patients. Therefore, the treatment of claw wind is a problem that many people are considering. Before treatment, we will first study the common symptoms of claw wind. Will intermittent epilepsy be inherited? Can epilepsy patients eat seafood? Will intermittent epilepsy be inherited? Sudden and excessive repetitive firing of neurons with high excitability in the brain leads to sudden and temporary disturbances in brain function. Clinical manifestations are transient sensory disturbances. Where to see epilepsy, limb convulsions, loss of consciousness, behavioral disorders or plants Abnormal nerve function, called seizures. Can be divided into major attacks, small attacks, localized attacks and psychomotor attacks, etc., with the common characteristics of intermittent, short-term and stereotyped. Epilepsy is a disease in which abnormal motor, sensory, conscious, mental, and autonomic nerve functions are caused by paroxysmal abnormal discharge of brain neurons. Commonly known as amniotic wind or sheep epilepsy. Can intermittent epilepsy be inherited? 1. Patients with epilepsy should properly bind carbohydrate intake. The heat energy and protein required by epilepsy patients are the same as those of normal people, and carbohydrates do not need too much. It is advisable not to cross 300 grams per day. The amount of fat added properly should account for about 60% of the total calories. Moisture, do not exceed 1000 ml per day. Salt does not exceed 3 grams per day. Adequate supply of vitamins and minerals to see epilepsy, especially iron, calcium and other elements. Obstruction of eating sugary foods and irritating foods is epilepsy One of the patients’ diet. Will intermittent epilepsy be inherited? 2. Patients with epilepsy should avoid eating foods that induce epilepsy. The diet of people with epilepsy includes lamb, dog meat, rooster, duck, carp, etc. “Hair” should not be eaten more. Spirits, strong tea, coffee should be hindered. Pepper, chili, mustard, green onion, garlic and other spicy condiments It should also be properly quantified. Will intermittent epilepsy be inherited? 3. Eating schedules in patients with epilepsy, severe or repeated epilepsy, will increase nerve excitability, simple alkalosis or blood calcium decline to epilepsy, so should make up for zinc and calcium rich food, calcium can Calms the central nervous system and suppresses the excitability of nerve cells. Calcium-rich foods include celery, potherb mustard, rape, and small white tea. Will intermittent epilepsy be inherited? Fourth, the dietary schedule of epilepsy patients during the treatment period, and the recipes for the treatment of epilepsy patients can be found in the general diet organization. On the basis of the diet of epilepsy patients, we should reduce carbohydrates to see epilepsy, travel fat, and bind water. Available foods are: millet, sesame, wheat, jujube, etc.

Lumbar spinal stenosis can be disabled! Don’t take it seriously anymore

     was a soldier who had been a soldier for ten years when he was young, and exercised his temperament of “not afraid of heaven, not afraid of earth”, especially strong and determined. A few years ago, his wife passed away because of illness, he had been living alone, the only daughter married to the field, only one or two months to come back to see him once, told him to live together unwillingly. I usually have a cold and fever, and have pain in the waist and legs. I never go to the hospital and go to the pharmacy to dispense some medicine. It passed by quite a bit, making my daughter very sad.  Walked limping, actually hiding waist diseases  Last year of the Spring Festival, the daughter’s family came back for the New Year, which made Uncle Yu very happy. It happened that the weather was good during this period, and the family happily went to climb the mountain. A few kilometers away, the uncle Yu, who was in his 60s, was struggling. The daughter found that his father was limping and asked if he had twisted his feet, but the father said that he was old and did not hinder him.  Old problems? It seems that the father’s symptoms often occur, and the daughter is not at ease, so that he can be taken to the hospital for a check, and the result is diagnosed as: lumbar spinal stenosis. Although I have never heard of this disease, Uncle Yu still didn’t care about it: “Isn’t it just chronic waist disease? The elderly don’t have it, it doesn’t matter…”    doctor warned him if he neglected the treatment of lumbar spinal stenosis , It is easy to cause the compression of the cauda equina nerve in the spinal canal, and the symptoms and signs of the perineum appear, which are manifested as hypoesthesia and sphincter dysfunction. In severe cases, there may be obstacles to stool and sex life, causing sciatic nerve pain, cervical pain, thoracic spine Pain, lumbar pain, etc., may even be paralyzed and crippled!   After listening to the doctor’s description, Uncle Yu was a little scared for the first time, and quickly asked the doctor to arrange surgery for himself. But the doctor said that Uncle Yu’s symptoms are not serious, and he does not have surgical indications. He can be treated conservatively. After returning, take Yaotongning capsules and other medicines to strengthen rest, avoid sitting for a long time, bending over, and weight-bearing. Muscle exercise will receive good results. Why is the typical symptom of lumbar spinal stenosis? Why is intermittent claudication?    is also a little puzzled by my uncle: Why is there intermittent claudication when his illness is clearly in the waist, and it is also a typical symptom of lumbar spinal stenosis?   Explain that when the patient stands or walks for a period of time, the legs will feel pain, numbness, heaviness, fatigue, etc., but when you rest, the discomfort will be relieved… This is called intermittent claudication. This is because the patient’s spinal stenosis, nerve blood oxygen supply is limited during walking, and nerves are compressed, causing symptoms. When sitting down, crouching or flexing forward, the spinal canal space is relatively enlarged, and the nerves are temporarily liberated, so you can continue walking. When walking again, the above symptoms reappeared, then rested, and the symptoms were relieved again, so repeated and alternated, forming intermittent claudication. Therefore, once this symptom occurs, it is necessary to check whether it is lumbar spinal stenosis, especially the prone to middle-aged and elderly people.

What’s going on after a short walk? Such leg pain is likely to be lumbar spinal stenosis!

Leg pain is a “old problem” often mentioned by the elderly. Some elderly people will feel leg pain after walking for a long time, and the symptoms will be relieved after a rest. They often think that this is normal because they are “old”. In fact, this is probably caused by lumbar spinal stenosis! What’s going on after a short walk? This situation will take a break after walking for a while. Specifically, there are almost no symptoms at rest and it feels good. After walking for a while, there will be distress, soreness, numbness, weakness, and bloating in the lower limbs. Some performance like this. For example, some people walk hundreds of meters or even tens of meters. If they walk a few kilometers, the above symptoms may appear. He sat down or squatted down. After five or ten minutes, the symptoms eased, and then they got up again. The symptoms appeared again when I walked tens of meters and hundreds of meters. We call it this situation-intermittent lameness. Intermittent claudication is a typical symptom of lumbar spinal stenosis, which is of great significance for the diagnosis of this disease and is more common in the elderly. (Of course, some patients have intermittent claudication related to other diseases, but lumbar spinal stenosis is more common.) Why does lumbar spinal stenosis cause this condition? Let’s first understand what is the spinal canal! We know that the lumbar spine of the human body is composed of vertebrae stacked like blocks, shaped like “pillars”, and every two vertebrae are connected by a cushion (intervertebral disc), and each vertebrae has a hole in the center of the back, all The “holes” are stacked together to form a pipe, which is also called the “vertebral canal”. What is in the spinal canal? It contains the spinal cord, spinal cord capsule, spinal nerve roots, blood vessels and a small amount of connective tissue. Generally, as the age increases, the structure surrounding the spinal canal appears aging, hyperplasia, and even vertebral spondylolisthesis, and “dislocation”, resulting in different degrees of spinal canal stenosis. Root, vertebral artery and sympathetic nerve plexus, causing a series of symptoms such as corresponding neurological dysfunction. The volume of the spinal canal is larger when it is bent, and the waist is straight when walking, so the nerve compression is relieved when bending, and the symptoms of waist and leg pain are reduced or even disappeared, and the diameter of the spinal canal becomes smaller when walking straight , The nerves are easily compressed, and the symptoms of low back and leg pain are aggravated, resulting in difficulty walking. This is also why many patients report that it is fine to bend over and ride a bicycle, but walking is impossible. How to determine if your condition is lumbar spinal stenosis? Of course, after the “intermittent claudication”, the first thing you should do is to go to the neurosurgery of the regular hospital in time. One characteristic of lumbar spinal stenosis is “heavy symptoms and light physical examination.” Many patients describe symptoms that are more serious, but there are fewer signs that can be induced during physical examination, but in general the diagnosis method is relatively mature. Combined with the patient’s symptoms, physical examination, CT, magnetic resonance and other imaging results, the diagnosis of lumbar spinal stenosis can generally be confirmed. In addition to intermittent claudication, what other symptoms should be paid attention to? 1. Low back and leg pain. Low back pain is more common in patients with developmental lumbar spinal stenosis, mainly manifested as low back pain and groin and thigh pain. 2. Low back pain. Low back pain in patients with lumbar spinal stenosis is mainly manifested by increased pain when the waist is extended. 3. Obstruction and defecation. Clinically, patients with lumbar spinal stenosis with defecating disorders are rare, mainly due to compression of the cauda equina nerve. 4. Signs of nerve compression. The nerve signs of patients with lumbar spinal stenosis are mainly due to spinal stenosis resulting in nerve compression. How to treat lumbar spinal stenosis with intermittent claudication? In general, the conservative treatment effect of patients is limited. Most patients who have been found to have obvious intermittent claudication will eventually have to choose surgery. The earlier the operation, the simpler it is, and the lower the risk of surgery. Of course, it does not mean that surgery is necessary, but it still needs to be based on the specific condition of each person.

Will intermittent epilepsy be inherited?

Will intermittent epilepsy be inherited? Epilepsy has now become a very serious chronic disease. Due to its stubbornness and complexity, it has greatly increased the difficulty of treatment. Epilepsy has caused serious harm to patients. The incidence of adolescents in the population is very high. Epilepsy is also called claw wind. The claw wind has caused a lot of harm to humans. He not only affects the patients themselves, but also affects the relatives of the patients. Therefore, the treatment of claw wind is a problem that many people are considering. Before treatment, we will first study the common symptoms of claw wind. The following are some relevant knowledge explained by experts. Is intermittent epilepsy inherited? Can epilepsy patients eat seafood? Is intermittent epilepsy inherited? Sudden and excessive repetitive discharge of neurons with high excitability in the brain, leading to sudden and temporary disturbances in brain function, clinical manifestations of transient sensory disturbance Abnormal nerve function, called seizures. It can be divided into major seizures, minor seizures, localized seizures, and psychomotor seizures. It has the common characteristics of intermittent, short-term, and stereotyped. Epilepsy is a disease in which abnormal motor, sensory, conscious, mental, and autonomic nerve functions are caused by paroxysmal abnormal discharge of brain neurons. Commonly known as sheep epilepsy or sheep epilepsy. Is intermittent epilepsy inherited? 1. Patients with epilepsy should properly bind carbohydrate intake. Epilepsy patients require the same amount of heat and protein as normal people, and carbohydrates do not need too much. It is advisable not to cross 300 grams per day. The amount of fat added properly should account for about 60% of the total calories. Moisture, do not exceed 1000 ml per day. Salt does not exceed 3 grams per day. Adequate supply of vitamins and minerals to see epilepsy, especially iron, calcium and other elements. Obstruction of eating sugary foods and irritating foods is epilepsy One of the patients’ diet. Is intermittent epilepsy inherited? 2. Patients with epilepsy should avoid eating foods that induce epilepsy. The diet of people with epilepsy contains lamb, dog meat, rooster, duck, carp, etc. “Hair” should not be eaten more. Spirits, strong tea, coffee should be hindered. Pepper, pepper, mustard, green onion, garlic and other spicy condiments It should also be properly quantified. Is intermittent epilepsy inherited? 3. Eating schedules in patients with epilepsy, severe epilepsy or repeated episodes will increase nerve excitability, alkalosis or blood calcium decline will occur. Epilepsy should be compensated for, so zinc-calcium-rich food should be made up. Calms the central nervous system and suppresses the excitability of nerve cells. Calcium-rich foods include celery, potherb mustard, rape, and small white tea. Is intermittent epilepsy inherited? Fourth, the dietary schedule of epilepsy patients during the treatment period, and the recipes for the treatment of epilepsy patients can be found in the general diet organization. On the basis of the diet of epilepsy patients, we should reduce carbohydrates to see epilepsy, travel fat, and bind water. Available foods are: millet, sesame, wheat, jujube, etc.

I haven’t eaten any food, and the fat cells won’t let me go?

We all know that obesity not only affects body shape, but also increases the risk of various cardiovascular and cerebrovascular diseases, diabetes and even cancer. But weight loss is easier said than done, and it seems easier to control your mouth than to open your legs. As a result, hunger strikes and intermittent fasting have become the new darling of the slimming world. Intermittent fasting is usually divided into two categories: one is daily limited time eating, which shortens the eating period to 6 to 8 hours; the other is the so-called “5: 2 intermittent fasting”, which is 7 per week There are only two meals in the middle of the day. & nbsp. Previous studies have shown that intermittent fasting can improve insulin sensitivity, improve blood sugar stability, improve exercise metabolic efficiency, increase alertness, extend life expectancy, lower blood pressure and heart rate, reduce inflammation and protect nerves. benefit. & nbsp. However, recently, an article published in the journal “Nutrients” “Intermittent Fasting for Twelve Weeks Leads to Increases in Fat Mass and Hyperinsulinemia in Young Female WistarRats” (intermittent fasting for 12 weeks leads to increased fat and hyperinsulinemia in female rats) believes that intermittent fasting can effectively reduce weight in the short term But its long-term security is doubtful.

What’s the matter of taking a break after walking for a while? Such a leg pain is probably a lumbar spinal stenosis!

Leg pain is a “old problem” often mentioned by the elderly. Some elderly people will feel leg pain after walking for a long time, and the symptoms will be relieved after a rest. They often think that this is normal because they are “old”. In fact, this is probably caused by lumbar spinal stenosis! Why is it going to take a break for a while? Was to take a break for a while. The specific manifestation is that there are almost no symptoms at rest, and it feels good After walking for a period of time, there will be some symptoms such as sleepiness, soreness, numbness, weakness, and bloating in the lower limbs. For example, some people walk hundreds of meters or even tens of meters. If they walk a few kilometers, the above symptoms may appear. He sat down or squatted down. After five or ten minutes, the symptoms will be relieved, and then get up again. The symptoms appeared again when I walked tens of meters and hundreds of meters. We call it this situation-intermittent lameness. Intermittent claudication is a typical symptom of lumbar spinal stenosis, which is of great significance for the diagnosis of this disease and is more common in the elderly. (Of course, there are also some patients with intermittent claudication related to other diseases, but lumbar spinal stenosis is more common.) Why does lumbar spinal stenosis cause this? Let ’s first understand what is the spinal canal! We know that the human body The lumbar spine is composed of vertebrae stacked like a stack of blocks, shaped like a “pillar”, and each two vertebrae are connected by a cushion (intervertebral disc), and each vertebra has a hole in the center of the back, and all the “holes” are stacked Together, they form a pipeline, which is also called the “vertebral canal”. What is in the spinal canal? It contains the spinal cord, spinal cord capsule, spinal nerve roots, blood vessels and a small amount of connective tissue. Generally, as the age increases, the structure surrounding the spinal canal appears aging, hyperplasia, and even vertebral spondylolisthesis, and “dislocation”, resulting in different degrees of spinal stenosis. When it is severe to a certain extent, it will compress the spinal cord and spinal nerves. Root, vertebral artery and sympathetic nerve plexus, causing a series of symptoms such as corresponding neurological dysfunction. The volume of the spinal canal is larger when it is bent, and the waist is straight when walking, so the nerve compression is relieved when bending, and the symptoms of waist and leg pain are reduced or even disappeared, and the diameter of the spinal canal becomes smaller when walking straight. , The nerves are easily compressed, and the symptoms of low back and leg pain are aggravated, resulting in difficulty walking. This is also why many patients report that it is fine to bend over and ride a bicycle, but walking is impossible. How do you know that your condition is lumbar spinal stenosis? Of course, after the “intermittent claudication”, the first thing you have to do is go to the neurosurgery of the regular hospital in time. One characteristic of lumbar spinal stenosis is “heavy symptoms and light physical examination.” Many patients describe symptoms that are more serious, but there are fewer signs that can be induced during physical examination, but in general the diagnosis method is relatively mature. Combined with the patient’s symptoms, physical examination, CT, magnetic resonance and other imaging results, the diagnosis of lumbar spinal stenosis can generally be confirmed. In addition to intermittent claudication, what other symptoms of lumbar spinal stenosis should be paid attention to? 1. Low back and leg pain. Low back and leg pain is more common in patients with developmental lumbar spinal stenosis, mainly manifested as low back pain and groin and thigh pain. 2. Low back pain. Low back pain in patients with lumbar spinal stenosis is mainly manifested by increased pain when the waist is extended. 3. Urinary and urinary disorders. Clinically, patients with lumbar spinal stenosis with defecating disorders are rare, mainly due to compression of the cauda equina nerve. 4. Signs of nerve compression. The nerve signs of patients with lumbar spinal stenosis are mainly due to spinal stenosis resulting in nerve compression. How to treat lumbar spinal stenosis with intermittent claudication? Generally, in this case, the patient’s conservative treatment effect is limited. Most patients who have been found to have obvious intermittent claudication will eventually have to choose surgery. The earlier the operation, the simpler it is, and the lower the risk of surgery. Of course, it does not mean that surgery is necessary, but it still needs to be based on the specific condition of each person.

[Question answer] How do patients with neurogenic bladder conduct intermittent catheterization?

Intermittent catheterization refers to not leaving the catheter in the bladder, only inserting it into the bladder when needed, and pulling it out after emptying. It can intermittently expand the bladder, which is beneficial to maintain the bladder capacity and restore the bladder’s contractile function, avoiding overfilling the bladder and causing damage to bladder and kidney functions. Intermittent catheterization is recommended by the International Association of Urinary Control as the preferred method of treatment for neurogenic bladder dysfunction. Therefore, intermittent catheterization plays an important role in the management of neurogenic bladder. The frequency of urinary tract infection 3 times a day is 5 times that of 6 times catheterization. The frequency of catheterization plays an important role in preventing urinary tract infection. Therefore, the proper frequency of catheterization is important for the successful implementation of intermittent catheterization. Ask patients to record a catheterization diary and guide them how to accurately record various data, such as the amount of drinking water (including the intake of various fluids) and the number of intakes, the time and interval of each catheterization, each time the urine volume is exported and whether there is urine leakage Wait. Children should drink more water evenly to maintain a certain amount of urine to prevent urinary tract infections; the amount of drinking water can be adjusted according to the amount of urine to avoid ingesting a large amount of liquid in a short period of time; try not to ingest liquid after dinner to prevent a large amount of urine at night. Associate Professor Li Xudong introduced: Intermittent catheterization is generally believed to start once every 4-6 hours, no more than 6 times a day, and then adjust the frequency of catheterization according to the amount of residual urine in the bladder. When the residual urine volume is less than 100ml or only the bladder capacity is 10% to 20%, it is considered that the bladder function has reached balance, and catheterization can be stopped. In order to prevent the occurrence of urethral injury, urinary tract infection, and excessive intravesical pressure caused by retrograde infection during intermittent catheterization, affecting renal function. Attention should be paid to the implementation of intermittent catheterization: (1) strictly implement the principle of aseptic operation. (2) Timed catheterization, the amount of urine discharged every time should not exceed 500ml. (3) The method of squeezing the bladder should be correct. The applied force is light first and then heavy, and continuous pressure is applied, the depth is about 3-4cm. (4) The urinary catheter used should be soft and fully lubricated with sterile lubricant. The catheterization is gentle. Communicate with patients during urinary catheterization and get better cooperation. (5) Urinary catheterization strives to drain urine without leaving residual urine. (6) Perform routine urine examination every 1 to 2 weeks and do mid-stage urine culture. (7) During intermittent catheterization, record the patient’s water in and out in detail.