At a fair it was eight hundred forty fall when people were using laugh guys as an entertainment form and one of the volunteers had an accident but he didnt feel any pain and luckily there was a doctor present who drew the right conclusions you confuse. Us for Pain Management and today in his teaser were using a lot of different products and what you can do to put patients to deep sleep without any pain through the surgery this is what im going to talk about this doctor here at the his clinic even if im getting it done and. If you need surgery. We take care of your three. Were here in the operating wing of this hospital with all those operating rooms for surgeons doing all kinds of different procedures and they all have something in common theres always an anesthesiologist taking care that the patient remains totally pain free during the procedure. For many people the sort of undergoing an operation is frightening many prefer to have even relatively simple procedures under general anesthesia but is that really the best method a growing number of clinics now offer an alternative spinal anesthesia also called a spinal block honestly train for glycation solution its kind of like the difference between snorkeling and scuba diving for when you think of snorkeling all you need is goggles very little equipment you breathe on your own for scuba diving though you need oxygen tanks or diving computer a lot of Precision Technology to them and the difference between spinal anesthesia and general anesthesia do similar for knuckles. So what are the major differences. First of all the cost. Of going completely under with general anesthesia requires a lot of technology and a lot of anesthetics and patients have to be artificially respirator because the muscles that control breathing are also and if the tiniest. Spinal anaesthesia is a completely different approach there are a small amount of anaesthetic is injected into the nerves of the spinal cord the patient remains awake and responsive throughout the procedure. The second difference involves the procedure itself during spinal anesthesia only the abdomen and legs are an isa time used so its suitable for operations on the hips legs bladder and you rethrow as well as other surgery in the groin Area Operations on the upper body will usually require general anesthesia. The third different time if an operation takes more than a couple of hours general anesthesia makes more sense than a spinal block. By all parts in operations where cardiovascular disorders are expected or ones involving major blood loss or very long operation periods when its probable that spinal anaesthesia is insufficient for the length of the procedure i would recommend general anesthesia and feel. The full skin situation is side effects following spinal anesthesia patients can temporarily experience headaches or bladder dysfunction after general anesthesia they can soften or damage to their teeth or vocal cords or postoperative impaired consciousness. And theres another side effect patients opting for a spinal block dont have to worry about. It departs in. Elderly patients in particular benefit when few mind altering anesthetics are used. Then there is no risk of the patient developing a brief transient delirium so. Remaining conscious yet not suffering any pain music can help distract the patient during the operation and afterwards they return to normal activities is faster with a spinal block than with general anesthesia. Im human i can because hell use clearly keep me from beating in berlin this is the operation and the induction so whats going to happen right now. Here we are checking the right. Kind of operation as well and if its scheduled for the right surgery and after that. Then we up again with the induction and so that probably when the pension is asleep. And thats the past we are ready to go and you know what. This is the must go you know as a. Player. Its almost. You who shoot you and also. Its true. So this is no anesthesia or gas heat this is fred oxygen hes not falling asleep from not got a gas. Injected the first medication strong pain medication and after wants the second medication this lets the patient fall asleep. When hes giving the pain medication first and after this the direct to sleep takes a little bit longer for the pain medication to take action and. Second course is that this may put a little bit down a little bit and if the patient has the pain medication its better for the patient so you just using this in medication here is an injection method for falling asleep you dont need to gasp right were performing a total intravenous anaesthesia and this is the medication which let the patient fall asleep so no not for the guest its comfortable for the patient. So this is a very nice method for falling asleep its a very common. Ancient time it was quite different peoples. Right before that we used other medications and the patient described it as a very. Strong falling asleep like a cold talk and you are unconscious now youre helping to grieve i can officially ventilation right now through the mask and its you know breathing all right. Right there are two medications which let the patient not breathing normally. So this is at first the strong pain medication this makes that the patient the breathing seasons and the second muscle response so. All muscles are blocked so the patient cannot breathe anymore. So you can see. The entrance in very you know. And shes putting the troop right into the truck so it was a very smooth integration. There are some patients who would say you wouldnt go forward. With some regional procedures into place if the patients have the circumstances which makes it difficult for the patient to be mechanically ventilated pretty nasty stuff like that so your patient is sound asleep and hes going into the just a minute and. Many patients for a rehabilitation to get on to the feet again but nowadays we doctors say there should be Something Like pretty habitation this will to get the patient into really good shape before an operation and exercise is a very good. Cardiovascular training lifting weights activating your muscles before an operation it may sound strange but thats exactly what a growing number of doctors now recommend resting before surgery is out. If you take all the factors into consideration and ensure the physical strain matches their ability even have critically ill patients exercise. The concept is called taishan. Four to five weeks before an operation the patient comes to work out twice a week the aim is not a major increase in muscle mass but rather to simply make demands on them. Even pain is no deterrent a surprise for many people who are undergoing an operation due to pain for instance patients with joint problems but if it is a seven its often the case that if you have us rightists you will soon have joint pain so you tend to rest more or less active and spend less Time Outdoors that in turn has an impact on muscle strength and coordination and thats what patients a building out here puts in the alfonse getting in shape for an operation its not just a good idea before orthopedic surgery matilda both is getting ready for a bladder lift a three hour procedure that requires a large abdominal incision she should also work out beforehand but first shes come to the German Sport University cologne there documenting her state of health before the operation which flu was crucial on trying to turn out im looking forward to a night im working out again something i havent done for almost thirty years. Im curious to see if it helps them understand i would kill. Him block is convinced that it does he compares the stress of an operation to the stress of running a marathon. With me in the four twentieths and then recall if you havent trained in the run up to it itll be almost impossible to finish but if youve trained you can manage it and thats also true of an operation in the world were doing in advance is stimulating things in the body in a small way in order to prepare it for the much greater stimulation thats coming to. Stimulating in a small way for both and that means circuit training twice a week on the cross trainer in exercycle four minutes of exercise followed by a one minute pause repeated for half an hour in all the sixty five year old is a little out of breath after a. While but she feels like the effort is doing her good. Just to make the sizes everything no legs hips waist oh. And blood samples show the exercise is having an effect her heart pumps harder forcing the blood through her circulatory system at a faster rate that makes demands on her blood vessels and her body rises to the challenge. The effects a workout has on the immune system are visible under the microscope Cancer Patients can profit as well even if the surgery has to take place quickly. Also that our study shows that even stimulating the body ones through exercise can help activate immune cells and if you do that within the right time frame for an operation then the patient basically goes into it with better defenses up the. A large scale Scientific Study has not yet been carried out on the positive effects of physical activity before surgery but evidence so far indicates that it has them. Spartan exercise is a great way of getting people on their feet off the surgery in no time but nothing is just giving them warm during the procedure was that. Right because if patients suffering from hypothermia and risk off on the. Bad wound healing or even on a take so it is of great importance to have to patient warm during the operation and this is what our machine does it inflates and this meant for us where the patient is lying on and as you can see the patient is what temperature. Off a lot of machines here supporting the patient during the surgery so what kind of machines do you have but we have this machine now this is providing the anesthesia. I dno steve just so this is a syringe. We have our monitoring of the vital signs you c. G. Oxygen and. Blood pressure arterial Blood Pressure and stuff like temperature and more c. G. Functions and this is on mechanic a ventilator where you can see c o two on top of all of them and stuff like that so the patient is very closely monitored during the procedure because youre taking over all the vital functions for you but this is what we have to do it and to provide the maximum safety we need this machines dont want to the patient goes and. Many of our viewers might know all this money tossed from medical shows. So what do those numbers actually mean. This is the frequency of the heart this is a fraction off the situation of oxygen in the blood and here this is the not a real Blood Pressure like you would measure on your arm but this is measured directly in the vessel and this is how the breathing is performed this is one concern of my patients going surgery that they weak up over the procedure and they can signal the surgeon that they were wide awake and this is one of those concerns of patricia nevius from brazil so how how how high is the risk actually breaking up over the surgery actually in the risk especially lower but it can be even lower if you will for example perform this in the g. Twenty touring or if you watch closely your numbers like the hot frequency or the Blood Pressure or even if you look at the patient and see the patient is sweating or stuff like that and then you just deepen the his teacher ride we deepen the honesty and the patient is at every phase of this surgery well asleep people are getting older older and. And are getting more and more preconditions so is it more difficult to do this team on a multimode patient giving an amnesty for a young and healthy patient is more or less easy and its more complex if patients are getting older and have maybe severe conditions and of course we need for example more morning touring or even complex monitoring suite which have to be a stay attached to the patient and what about changes is every anesthesiologist prepared to treat these designs children. If i were them i would go to a hospital where the surgeons and the and this is the largest are used to and small children because this is a critical situation things are going to go for answering all my questions and if youve got any questions you like me to ask our experts be sure to write me an email. And enough coming show well be taking a look at the acid reflux or heartburn its painful and sometimes dangerous if medication doesnt help surgery may be required if you have any questions about it write to us in good shape that d. W. Dot com please write heartburn in the subject line we look forward to hearing from you. If you let dixie zhorzh are well known to occur in kids adolescence but even adults can suffer from seizures one cause may be brain injuries that have never been detected before. A sudden hot flash nose ear cramps then comes the blackout that long describes her epileptic seizures she sometimes had several a day its changed her life. I once you lose everything. Thats putting it mildly. Its like when you think you have everything you wanted in life and then theres this bolt out of the blue and you have to start again from zero thats what its like. The forty five year old suffered her first seizure three years ago. In principle. You can differentiate between two forms of epilepsy theres the genetic one that people are born with where patients develop a condition in childhood. Then there is acquired epilepsy where an adult begins to have seizures due to lesions in the brain caused by a head injury or stroke sometimes it isnt clear whats causing the neurological changes. Epilepsy has been attributed to lesions in her temporal lobe but it isnt clear what caused them epilepsy is a chronic disease during seizure neurons in the brain fire excessively a picture of whats going on can be gained within e. G. It provides important hints about whats happening inside the patients brain seizures can manifest in very different ways losing consciousness convulsions a memory loss or just some of the symptoms if someone begins to have a serious seizure bystanders need to remain calm the british an eye for an epileptic seizures generally and all on their own within two to three minutes so we shouldnt try to restrain the person affected just move any potentially dangerous objects out of the way when the seizure has passed place the patient in the recovery position and call a doctor if necessary. To reduce the number of seizures she has sandra takes medication but it doesnt always work now shes going in for regular checks to optimize have therapy. There are a range of medications for treating epilepsy that suppress nerve activity you have to tailor dosages individually to the patient and if necessary prescribe different compounds. And there are other measures that are important in sun just treatment along with psychotherapy and patient therapy the painting she does english felt their appeal has helped her cope. This helps me a lot. Its relaxing and you feel liberated right away and. It helps you switch off the pressure just falls away it puts you in the good mood straight off. When you see the picture and you know that youve done something to mark this is youve succeeded at something that must be the only. C. I. Its exhausting for me. This is. True for me ill see i really have to concentrate while i do it its mostly a part and its very embarrassing to be quite honest. But i have to do it otherwise things will just get worse. It. Isnt giving up she hopes one day to be able to work again and feel like shes back in charge of her life. Have you ever felt afraid to embarrass yourself in front of other people patients with this social anxiety disorder do know this feeling but going to therapy and joining its health group might be a solution. Disfigurement effect i mean it started out that id get nervous just when the post man rang the bell. I didnt want to sign for a package anymore because i was so embarrassed about my hand shaking and. Sometimes i was even afraid to go shopping with it i mean i needed stuff but i just couldnt bring myself to go out to the store looking in log on to look at the phone rings and im not doing well i just ignore it. I didnt want to run into the neighbors i dont go out to the letterbox when no one was around and only empty the rubbish at night. Also going on but i thought i knew that it was totally absurd but i couldnt help it the greatest fear was that others would notice that i had this weakness i would embarrass myself and i didnt want that and always tried to hide it as much money as it doesnt matter. When i know i have to do something i start going through all of the possible scenarios in my mind but what if i get asked this what if i get asked that question and i try to prepare what i can say that really. Doesnt even toy but its a vicious circle the more you think about what could happen the more desperate you feel. In the end because of this condition you isolate yourself more and more and the kind i got to the point where i had no friends left i found myself alone and felt even more desperate and didnt know what to do. And effect my point comes when you start to have suicidal thoughts. Fortunately ive always been a very fearful kind of a guy so i dont think id ever do anything like that because id be too afraid to. Do get thoughts. But now i fear of. Just talking about it helps enormously ive learned not to think about things so much that i need to face up to my fears and not run away and if i fall over ten times i still need to get up and try again. Its been up and if im in a Selfhelp Group for people with social anxiety disorder the people there understand me because they struggle with similar problems on talk so you get to know people and can slowly build up a circle of friends again. Ive tried in the past to do a Vocational Training course each time it hasnt worked out because i was too afraid but then there are times when i pull myself together and have another go about that side kind of just right now i can pretty much cope with everything. So im hopeful that i can train for a job before its too late. So ive decided that ill definitely apply to train as a veterinary assistant. Now with me. Sometimes i think if i hadnt gone through all the things ive been through i would have become the person ive become. And when i think about my personality i like myself and. This experience has enriched me making me more empathetic i think and to mention i find it much easier to understand other people without prejudging that. Because i know there are reasons there are factors that make people the way they are but the mentions of the lets hope its the is. Thats it for today you can find more information about health and fitness on our Facebook Page and see you again next week and until then lets all try to stay in good shape. Im going. To. Be. More intrigued by International Talk show for journalists to discuss the topic of the week chancellor merkel answer back to the wall as