Miss Eilnaz Momenzadeh, PA, MSPAS

Episodes may be a mixture of both manic and depressive symptoms. In such an episode, individuals with bipolar disorder may feel sad, empty, and hopeless but have a high level of energy at the same time. Sometimes, changes in mood are less dramatic. For example, individuals may feel happy and think everything is fine, but people around them may notice their mood changes. Episodes like this are called hypomania. If an individual is hypomanic and does not receive proper treatment, their condition will likely worsen.

Generally considered a lifetime illness, the disorder begins in the late teen or early adult years. Bipolar disorder has no known cause, but research has shown that it tends to run in families. To diagnose it, a psychiatrist carefully assesses an individual's moods and behavior patterns. They may also be asked to keep a daily record of their moods and other factors that can help with diagnosis and determining the right course of therapy. Counseling is a typical form of treatment, as is a group of medications that can control symptoms, called antipsychotics.

Both injection and aspiration are techniques that involve inserting a needle connected to a syringe directly into the joint. Aspiration involves the removal of excess fluid, and injection is the placement of medication directly into the joint space via the needle. Both procedures may be performed at the same time. In both cases a local anesthetic may be used, the skin will be cleaned and disinfected, and then the needle will be inserted. In some cases, especially if the injection or aspiration is in a large and deep joint such as the hip or spine, ultrasound may be used to guide the needle to the exact location desired.

In some cases, irritation to the joint can cause fluid to build up so significantly that the joint hurts and can no longer move well. Aspiration removes some of the excess fluid and relieves the pressure. In addition, aspiration can be used to provide a sample of joint fluid if it needs to be examined microscopically for the presence of white blood cells, bacteria, or crystal formations.

Certain injuries and diseases that affect joints are inflammatory in nature, such as rheumatoid arthritis, tendonitis or gout. These diseases may be helped by the local injection of anti-inflammatory medications directly into the affected joint. In this case, corticosteroids such as methylprednisone are usually used. Relief from the pain may be felt right away and may last for weeks or even months.

In some cases, such as with osteoarthritis, the cartilage buffer between the two bones wears down and pain comes from bones rubbing against each other. In this case, injection of a lubricating agent such as hyaluronic acid may be beneficial. It provides a slippery cushion between the bones to relieve pain that can last for months.

There are several different types of spinal fusion surgery available, mostly depending on where a patient's pain is located and whether his or her surgeon will perform the procedure through the back, front, or side. In general, a fusion is performed by packing the vertebrae to be fused with grafted bone. This bone may be taken from the patient's hip, may be donated from a cadaver, or it may be a manufactured synthetic material. The bone is placed along the vertebrae, and sometimes, the disc that lies in between the vertebrae is removed and replaced with grafted bone. The bone material will grow and cement the two vertebrae together. After the bone graft is placed, the vertebrae are sometimes held in place with rods, screws, plates, or cages, depending on the weakness of the spine and needs of the graft.

Spinal fusion is a significant surgery and can take three to four hours or more. Recovery is typically two to four days in the hospital. After surgery, it is important to remember that the fusion takes time to grow from the bone graft. So, the actual fusion is not complete for several months. Patients will probably feel somewhat better right away, but it may take a while to feel the full effects of the fusion as the bone grows into place. In the meantime, doctors might have patients wear a brace to protect their spine and keep it properly aligned.

Spinal fusion is not used for all kinds of back pain. Changing the way the spine moves can lead to strain on the other joints in the back, and fusion is only performed when the benefits outweigh the risks. Some spine disorders that are treated with fusion include:

• Curvature disorders, such as scoliosis and kyphosis
• Degenerative disc disease
• Spondylolisthesis, a disorder that causes vertebrae to slip over each other
• Significant spinal fractures that cause instability
• Weakened spine due to infection or tumor
• Some cases of spinal stenosis, a narrowing of the spinal column
• Chronic lower back pain (although the use of fusion to treat this is controversial)

Regardless of the diagnosis, there is always a possibility of 'failure' with spinal fusion, or of the surgery not fully solving the pain. This is more likely when fusion is used primarily to treat pain instead of structural problems. Patients can improve their chances of a successful outcome by stopping smoking, maintaining a healthy weight, moving their body every day, and following their doctor's instructions for any physical therapy that they are prescribed.