A lady had developed three carcinogenic tumors on the right side of her neck which was as hard as a stone. Doctors had asked her to undergo chemotherapy. She belonged to a poor family which could not afford it.
She approached me. I taped out a 20-minute suggestion.
She was asked to put on the taped suggestion while lying on bed and perceive what the sound suggested and try to feel the same to be happening in her body. She was expected to do this thrice a day. After doing this for a month, the lumps became soft. Two months later, their sizes decreased and by the end the 5th month they had completely vanished !

Acute coronary syndrome or ACS is an umbrella term used for any condition characterized by symptoms of acute myocardial ischemia caused by an abrupt reduction in blood flow to the heart. Three related but distinct clinical entities fall under the category of ACS; Unstable Angina (UA), Non ST segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI)
Unsable Angina; This occurs when a thrombus partially or intermittently blocks blood flow through a coronary artery. It is characterized by the development of chest pain that may or may not radiate. The chest pain may be associated with additional symptoms such as dyspnea, diaphoresis, nausea, lightheadedness, elevated heart rate, hypo or hypertension, and arrhythmias. Chest pain occurs with rest or exertion: the pain and associated symptoms are severe enough to limit the patients activity. A 12 lead ECG will show transient / temporary ST- segment depression or T-wave inversion. Cardiac biomarkers are not elevated. Chest pain that occurs with minimal exertion or requires an increasing dose of sublngual nitroglycerine to obtain relief is defined as UA. It also includes prolonged episodes of chest pain at rest, any chest pain that increases in severity, or any chest pain that is very severe upon first presentation.
NSTEMI; Also occurs when a thrombus partially or intermittently blocks blood flow through a coronary artery. On initial presentation, it may be difficult to differentiate between UA and NSTEMI. Like unstable angina, it is characterized by chest pain that may or may not radiate to the arm, neck, back or epigastric region. The chest pain may be accompanied by additional symptoms such as dyspnea, diaphoresis, nausea, lightheadedness, tachycardia, hypo or hypertension, arrhythmia and a drop in oxygen saturation. Pain may occur at rest or with activity. Compared with UA chest pain in NSTEMI lasts longer and is more severe. A 12 lead ECG may show signs indicative of myocardial ischemia.; ST segment depression or T wave inversion. Diagnosis of NSTEMI is made on the basis of elevated cardiac biomarkers.
STEMI; Occurs when a thrombus fully occludes a coronary artery resulting in necrosis of part of the myocardium. Development of an acute MI is characterized by a central necrotic area surrounded by zone of injury. Tissue in the zone of injury can recover if blood flow is restored quickly enough; if it is not, the area of injury will become necrotic. The zone of injury in turn, is surrounded by outer zone of reversible ischemia. Like other forms of ACS, STEMI is characterized by chest pain that may or may not radiate to the arm, neck, back, or epigastric region. Accompanying symptoms may include dyspnea, diaphoresis, nausea, lightheadedness, tachycardia, tachypnea, hypo or hypertension, a drop in oxygen saturation and arrhythmias. Also like UA and NSTEMI, this pain may occur at rest or with exertion and is severe enough to limit the person's activity. Quantitatively, pain is longer in duration and more severe than chest pain in UA. Definitive diagnosis of STEMI is made on the basis of 12 lead ECG changes indicative of MI. Serum biomarkers are elevated.
Adherence to evidence based guidelines for the management of ACS has been associated with better patient outcomes and decreased risk for subsequent cardiac events such as recurrent ischemia/ infarct.

Shivering is a normal physiological response of an individual's sensed temperature and the thermostatic-like response of their threshold zone. Incoming signals of "cold" from the periphery provides the input information to the central control mechanism (hypothalamus) and initiates thermoregulatory responses. When hypothermia develops either accidentally or intentionally induced, the body will immediately try to counteract this disturbance to decrease heat loss by vasoconstriction and piloerection (gooseflesh) followed by shivering, a thermoregulatory mechanism.Febrile shivering is the shaking chill experienced during fever. The observed increase in skeletal muscle activity results in increased heat production until the body temperature reaches the new thermostatic set point.
Temperature reduction therapies have been proven to provide substantial protection against ischemic brain injury and also to slow and prevent brain injury. Induced moderate hypothermia which purposely lowers the body temperature below normal has seen to improve neurological outcome in survivors of cardiac arrest. Traumatic brain injury guidelines recommend mild to moderate hypothermia or normothermia for neuroprotection. But shivering, one of the common side effects seen with therapuetic cooling remains a serious limitation to this therapuetic modality and must be controlled in order to avoid serious physiologic consequences.
A growing body of evidence shows that vigorous shivering can increase metabolic heat production upto 600% above basal level, even in febrile patients. Shivering is not only uncomfortable, it also increases intracranial pressure and has undesirable effect in patients with primary neurological and post hypoxic brain injury. Shivering can double or even triple the oxygen consumption causing hypoxemia, myocardial ischemia in high risk patients because of increased myocardial demand. This has a particularly negative impact on post cardiac arrest patients whose heart has just been resuscitated. Therefore, avoidance of shivering is strongly recommended during hypothermia induction, normothermia or rewarming periods.
Shivering is most likely to occur when the core temperature is 34-36 deg celcius.The ideal goal in shivering management is prevention. Protection of cold sensitive cutaneous receptors from direct cold contact and avoiding skin exposure and contact with cold surfaces and use of warm packs should be the first step to minimize the risk of shivering. In current clinical practice, several sedatives, anaesthetics and opiate drugs and neuromuscular blocking agents are utilized to suppress shivering activities. (in neuro ICU) Many of these agents can compromise airway defense and respiration and they are used for intubated and mechanically ventilated patients only.
Neuroscience nurses often encounter a multitude of challenges managing fevers in their patient population. The efficiency of the cooling modality is critically important since the therapuetic window to implement neuroprotection is very narrow, and " time is brain" The neuro ICU nurse's bedside practice focusses on ease of initiating cooling therapy, the speed of fever reduction, and maintaining tight temperature control. Traditional cooling blankets and even the newer skin surface cooling methods have limited impact on core cooling and also induces shivering which is seen to be detrimental. For patients who need cooling measures specially with neuronal injuries intravascular cooling technology has been shown to be more effective and superior in reduction of visible and subclinical shivering compared to several methods of skin surface cooling and use of antipyretics .It is effective in transferring or removing heat directly within the core thermal compartment via a central venous catheter. This also means less usage of sedatives, neuromuscular blocking agents, opiates etc to prevent shivering thereby promoting better ventilation.
Therefore while considering methods to induce hypothermia and fever control to optimize neurological outcomes, shivering should be anticipated as a normal thermoregulatory response and as far as possible it must be prevented and controlled.

Dr. Neeraj Jain. M.D.
Senior Consultant Interventional Pain Specialist.
Spine & Pain Clinic, Pitampura, New Delhi-110088.
Head, Department of Pain Medicine, Sri Balaji Action Medical Institute, Delhi.
Incharge Pain Clinic, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi.
9810033800(M),

Pain is a major symptom of cancer and occurs at all stages of the disease. In addition, pain is usually a hallmark of progression or metastatic spread, and 65 to 85 percent of people with cancer have pain when they develop advanced disease. In 10 to 20 percent of cancer cases, pain is difficult to treat, frustrating, and poorly controlled. Currently, opioid pharmacotherapy is the principal weapon in the fight against cancer pain; but when less invasive treatments are unsuccessful, invasive interventions should be added to optimize pain relief. Interventional pain procedures target neural and non-neural pain generators and neural blockade techniques provide excellent pain relief for neuropathic, sympathetic, nociceptive somatic, or visceral pain. Neural blockade techniques are broadly categorized into non-neurolytic and neurolytic blocks.



Non-Neurolytic Blocks
Local anesthetic and corticosteriod blocks are used to treat a variety of pain syndromes. They can also predict how a patient will respond to neurolytic blocks. A good response to non-neurolytic interventions usually means the patient will benefit from neurolytic procedures as well. Fluoroscopic guidance improves the accuracy of these blocks and minimizes complications. Somatic, sympathetic, and neuropathic pain respond to local anesthetic injections or the continuous administration of anesthetic drugs through a catheter. Intercostal nerve blocks or interpleural analgesia are indicated in post-thoracotomy chest wall pain/intercostal neuralgia, and radiculopathy requires selective nerve root blocks or transforaminal epidural injections when non-invasive treatments fail. Sympathetic blocks and other regional anesthetic techniques are employed in sympathetically maintained pain states, ischemic pain, postherpetic neuralgia, and radiation plexopathy

Neurolytic Blocks
Alcohol and phenol are the preferred agents for neurolytic procedures because they cause axonal degeneration within minutes and effectively interrupt the central transmission of pain impulses. Chemical neurolysis can result in immediate and total pain relief in selected patients with localized or regional pain. Opioid requirements decrease sharply, and patients on high doses of opioids will require careful tapering to avoid respiratory
depression. Other indications for neurolysis are costopleural syndrome and sympathetically maintained pain in Pancoast’s syndrome. Unfortunately, potentially unacceptable side effects limit the utility of neurolytic blocks; but neurolytic blocks are still preferred over standard opioid analgesia to control intractable abdominal, pelvic, and perineal pain. The following four criteria must be met before a nerve block is considered appropriate: --Limited lifespan of three to six months --A favorable risk to benefit ratio (i.e., the block will not impair bladder or bowel function or cause limb paralysis) -- A poor response to primary antitumor treatment, which has not been able to reduce the tumor burden -- A good analgesic response and acceptable side effects with prognostic blocks.
Advantages: The neurolytic blocks have the following advantages in home care by relatives of patients particularly in rural area of India: 1). Neurolytic blocks provide longer duration of pain relief. 2).Drugs and inexpensive equipment required are readily available.Elaborate equipment is not mandatory. 3). Long-term indoor ward treatment is avoided, repeated visits to the urban pain center are not required. 4). Patient can remain at home pain free even in rural areas where medical help is scarce.

Table 1. AUTONOMIC NERVE BLOCKS
Neurolytic Block Site/Condition Treated
Stellate ganglion Head Neck or arm pain
Gasserian ganglion Trigeminal neuralgia and facial pain
Interpleural (thoracic sympathetic chain) Upper—head, arms
Middle—thorax, heart, lung
Lower— abdominal organs, uterus, bladder
Celiac plexus (splanchnic nerves) Pancreatitis, Hepatobiliary Cancer pain, visceral/GIT cancer pain upto trans. Colon.
Lumbar sympathetic Lower limb pain, retroperitoneal pain
Hypogastric plexus Pelvic, Perineal, urogenital pain
Sacrococcygeal ganglion (impar, Walther) Rectal, uretheral, perineal, vaginal pain

Neurolytic Celiac Plexus Blocks (NCPB) And Splanchnic Nerve Blocks (SNB) are routinely performed (and are preferred over standard analgesic therapies) for patients with intractable pain from pancreatic and upper gastrointestinal cancer. NCPBs provide immediate and substantial pain relief in 70 to 90 percent of cases, improve the patient’s quality of life, and significantly reduce opioid intake. The procedure can be repeated in three to six months if the effect of the initial block wears off. NCPBs are performed percutaneously or intraoperatively. Under radiologic guidance, 50 to 100 percent alcohol is instilled anterior to the aorta at the level of the L1 vertebral body. Injection site pain, diarrhea, and temporary hypotension are transient adverse effects. A low complication rate is observed, since the risk of the neurolytic agent spreading to the somatic nerves supplying the lower limbs, bladder, and bowel is minimal
Superior Hypogastric Plexus Blocks (SHPB) are indicated for unrelenting pain from cancer of the pelvic viscera. This plexus lies in front of the L5 and S1 vertebrae in the prevertebral space. A spinal needle is placed percutaneously in this space from the back under radiologic guidance. Excellent analgesia is reported by 70 percent of patients after a SHPB. Reductions in pain scores and opioid consumption are reported to be significant, even in patients with advanced disease. No major complications have been reported following SHPBs, although a potential risk exists for the spread of neurolytic agents to the nerve fibers controlling micturition, bowel motility, and sexual function. The SHPB block can be repeated if pain recurs. Patients who fail two consecutive attempts are candidates for intraspinal opioid analgesia.

Ganglion Impar Neurolytic Blocks relieve perineal pain from cancer of the cervix, endometrium, bladder, and rectum. The ganglion is a single, midline structure ventral to the sacrococcygeal junction and can be accessed by a midline trans-sacral approach.
Painful input from somatic and visceral structures can produce sympathetically maintained pain (SMP) that may be visceral or neuropathic in nature. Sympathetic Ganglion Neurolysis relieves SMP and improves blood flow and is used to treat pain from radiation plexopathy, phantom pain, herpes zoster, vascular insufficiency secondary to malignancy, and complex regional pain syndromes (reflex sympathetic dystrophy and causalgia), with little risk of motor or sensory loss or deafferentation pain.
The trigeminal nerve receives sensory input from the skin of the face, anterior two-thirds of the tongue, and oronasal mucosa. Anesthetic Blockade Or Chemical Rhizolysis of the trigeminal ganglion or its individual branches is indicated in orofacial malignancies with intractable head and face pain.

Neurolytic Spinal Blockade can produce profound segmental analgesia. Nociceptive input is interrupted by selectively destroying the dorsal roots and rootlets between the spinal cord and the dorsal root ganglia. The procedure is reserved for terminally ill patients with cancer who have a short life expectancy and unilateral somatic pain localized to a few adjacent dermatomes, ideally in the trunk and distant from sphincter or limb innervation. Combined with a unilateral cordotomy, subarachnoid phenol blocks effectively control pain in costopleural syndrome, which is caused by invasion of the pleural cavity and thoracic wall. Adverse effects include PDPH, meningitis (rarely), persistent numbness and paresthesia, loss of motor function due to the unintended neurolysis of ventral rootlets, and sphincter and limb weakness.

Trans-sphenoid Pituitary Neuroablation: Chemical Hypophysectomy
Very useful simple intervention with 70-80% success rate in diffuse cancers of advanced stage with multiple bony & spinal metastasis especially hormone dependent cancers not responding to all other measures.
3) Intraspinal Opioid Therapy
continued administration of opioids intrathecally or epidurally with or without dilute concentration of local anesthetic& adjuvant drugs is an important option for patients with thoracic, abdominal or pelvic cancer pain that is refractory to conventional pharmacologic management. Advantages include profound analgesia, often at a much lower opioid dose without the motor, sensory, or sympathetic block. However combinations of low-dose opioids given epidurally with a local anesthetic act synergistically to produce effective analgesia while decreasing the side effects. Administration can be carried out using a variety of drug-delivery systems ranging from a temporary percutaneous epidural catheter to a totally implanted system. The effectiveness of preimplantation procedure and reversibility of effect makes this an attractive treatment option.



Conclusion
The management of patients with cancer pain can be a challenging task, even for physicians trained in cancer pain management Effectively relieving pain in cancer patients requires a range of treatment alternatives, including neural blockade when the patient’s pain no longer responds to opioid analgesia. The type of neural block selected is determined by the location and mechanism of the pain, the physical status of the patient, the extent of tumor spread, and the technical skill and experience of the person performing the intervention. Non-neurolytic blocks can provide safe and effective analgesia for the less serious conditions indicated above. Neurolytic blocks, with their potential for complications, are reserved for select patients who are unresponsive to standard analgesic pharmacotherapy and/or are at a more advanced stage of disease. However, few would question that aggressive intervention is often appropriate. Neurolytic nerve blocks offer an excellent option for the physician in the fight to control cancer pain. Such blocks can be easily utilized to help provide cancer pain relief in most of patients at the utmost needed times.

Does my subject Sounds rickity?
It must be as we all have been nurtured under a similar commercialised health world. We are not aware of the inner powers of ourselves and specially the power of Sub- Conscious Mind. Lets make it a bit easy. Take for example, you are suffeing from fever. I tell you that I have a special medicine imported from America which costs Rs. 5000/- and will cure in 2 hours. I give you that medicine. What will happen? If you know the answer its good. But if you dont, then try it out on somebody. Your mind will accept my challenge and presentation and will regulate your Sub- Conscious mind and then there will be a lot of Chemical and Hormonal fundas in your body and you will cure sharp within 2 hours.

That's the power of Sub- Conscious mind.

Similarly, in Swine flu, we can enhance our Immnization and prevent it from effecting us and cure it if we are effected. It will take no more than 3 days for you as a starter, to learn the technique and art of self curing and healing. Swine Flu like other diseases, induces some alienated subjects like Virus, Bacteria, Fungi etc in our body and from that perticular moment, our body starts reacting to it. Its a trigger situated in our Sub-Conscious Mind which starts the reaction of Body prevention from all diseases. If the efficiency of Sub- Conscious Mind is enhanced, it would work in a much better way and a proper tuning of this part of brain through Meditation, will obviously make our immune system as unscratchble.
You all can do it. You just need to learn it.

Courtsey: Cosmic Healing Foundation
"www.cosmichealingfoundation.com"