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00:00:02
hello dear friends today we
00:00:05
will talk to you about las ponchos logins and
00:00:08
doors algia we will talk about the pathogenesis of
00:00:11
diagnosis and approaches to treatment
00:00:13
you will most likely remember that in the past we were
00:00:18
dressed in the lumbar we talked about
00:00:20
he affairs on those we talked already managed
00:00:24
gene dorsal gays as in the form I remembered
00:00:28
sweating, which means I’m reminding you, I’ll translate it into
00:00:33
Russian, I remembered the loss,
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these are all diseases that are in one way or
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another connected with the spine, this
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includes infections and hernias and protrusions, you are warm
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roses with the power of chondrosis,
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I understood all about you, and the benefits of the
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camp door lie, I’m a subspecies
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I remembered sweating, why we will
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talk about it in detail and once again not
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stop in order to understand the
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mechanism on the road, why it occurs,
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we have already spoken a few words about this,
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now we will go deeper so that you understand
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how it works, how pain arises in
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principle in our in the body, including
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in the spine, the issue is more
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acute and because about 80 percent of
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people on our planet have, in one way or another,
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ever experienced pain, and for
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some of them, 5 to 10 percent, these pains are
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constant, and so I remembered the gene
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from -behind the spine dorsal gia back pain we
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remember with you that back pain
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can be not only due to the spine
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but due to disruption of the
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internal organs,
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for example the heart, heart pain,
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pancreatic pain, pancreatic
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pain can radiate to the back and so
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in lie the problem is interdisciplinary
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because what we have already said, back pain
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can be the result of a disorder of the
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nervous system
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orthopedics rheumatology which includes
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rheumatic lesions motor
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arthritis which can affect discs
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including somatic diseases and
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diseases of internal organs and we
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said that the prevalence of
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chronic pain, that is, constant
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pain syndromes 13.8 percent belly
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and to
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go 10 6.7 that is, every second pain in the
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back and neck thirty-four cases per
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100 people surveyed and so
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we talked about this let by origin
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distinguish leisure and vertebrogenic that
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which is associated with pathology of the
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spine here one forces osteochondrosis
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hernia of angels rope spondylosis
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specific processes of infection
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oncology non-vertebrogenic something that is not
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associated with the bone apparatus is ligaments
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is muscles somatic diseases
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mental illnesses the cause of
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development 95 percent are
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benign in nature I
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asked arthrosis or osteochondrosis about
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these concepts we talked about at the last
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lecture with you in In 10 percent of cases, it is
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not possible to accurately establish the cause; in
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this case, we are talking about an
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idiopathic nature, that is, it
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is the cause is unknown, unknown,
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either in general or to a specific doctor;
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Among
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the news of chondros,
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there are mechanisms for the development of doors of algia, or
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rather stages of the
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stage, because all these mechanisms
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complement each other about these mechanisms,
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we talked about these mechanisms last time
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as an introduction, now we’ll talk in
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more detail and so peripheral
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sensitization what does this mean this means
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that our peripheral nerves, the
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receptors that are located in the
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place where inflammation occurs, are
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constantly irritated, this is called
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and the reputation with two rr3 ations is constantly
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and damage to these nerves leads to the fact
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that it does not become sensitive to
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this irritant and the pain
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threshold decreases, there are four mechanisms of
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peripheral sensitization,
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this is dice fixation of the vertebrae when the
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vertebrae are poorly fixed
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relative to each other,
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this compression of the nerves is a dice genetic
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component, we remember with you how the
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vessels miss the calls at the disc and to the vertebral
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bodies, including in the case of, for
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example, hernias or some kind of
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developmental anomalies, these vessels are compressed and not then the
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nutrition
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from here dice is a chemical component of
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blood supply disturbance and, of course,
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inflammation, all these four mechanisms
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that we have listed lead to the
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fact that its
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substances or
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alga genes doors begin to be released alga I am Albus this is pain
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Olga genes algu genes these are the substances
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that cause this pain
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they are tissue,
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this is histamine, this is serotonin, these are
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leukotrienes and they are plasma, which
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include brody,
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we have all this in the picture, drawn in the
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form of abbreviations, all this affects the
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peripheral component of the nervous system,
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constantly irritates it and pay
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attention to the letter and this is the first activation, that
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is, compression of these substances has occurred
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stand out, irritate these nerve
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endings and thus
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sanitisation occurs, this nerve
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ending becomes sensitive to
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this component of sensitization, I passed it,
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go to the picture, now there is no
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compression, but as soon as some kind of
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imbalance of ions occurs, as in the left part we
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are looking at this this part,
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for example, destruction of mast cells most
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villages destruction of mast cells
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leads to the release of histamine and here 5
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eat as a result of damage to platelets,
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irritation of this nerve occurs and
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thus pain, provided that there
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was no compression either, this is
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called peripheral sanitation
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according to this The same mechanism works, for example,
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our allergies work, and once upon a time, a long
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time ago, you and I ate strawberries,
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our body didn’t like them,
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the same thing happened, and then upon repeated
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contact, it’s still the same strawberry, no matter
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where the shampoo cream, re-
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activation occurred and already an allergy,
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that is, the body hyper you will be
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excited and hyper response to this
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irritation on the day
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rhetorical sensitization has become more or
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less clear non-erogenous inflammation
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we move with you further returning to the
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first picture before peripheral
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sensitization I that is, on city ation of
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nerves on the outskirts of our body to in the
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spine leads to that the neurons,
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in principle, in this entire system
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will stop hyperexcitable, especially the
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neurons that are responsible for pain, but tsetse
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ptara
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and this entire system, but cc bti clearly,
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which is indicated here in a circle, yes, all these
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systems that we have
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listed and leukotrienes, prostaglandins,
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had to ferment histamine and
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hydrogen protons all of this is released and
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injures neurons, injures nerves and
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there is such a concept as abnormal inflammation,
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that is, the body is so hyper
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excited
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that it responds to any impact with
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this inflammatory soup, everything that is
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drawn here is released when it acts on the
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affected area,
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this will also include such a
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component as substance p is the alga gene of
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all gogen and a substance that causes
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more directly in the nervous system
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and then when this inflammation becomes
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chronic and constant,
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central sensitization begins to occur;
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central sanitation is the
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formation of a model of such pain
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when the number of paths that
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transmit these pain impulses increases
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and then when these pathways become
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intact, that is, they no longer work,
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0 stimulus that this person will have is
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cold, on the contrary, heat, touches,
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turns, the effects of some
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medications, some
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unattractive view from the window,
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all this will cause pain, that is,
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such a stereotype is added
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pathological in a given patient, in
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some it will be associated with mental
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characteristics, in some it is not, in
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some it is exclusively such a
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pathological component as a degenerative
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disease, here we will
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include osteoporosis as a phenomenon when
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calcium leaves the bones, the
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bones lose their mineral component,
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how the body protects itself from the loss of this
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calcium To a greater extent, of course,
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estrogens exist in the male
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body, by the way,
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and there they perform the same functions,
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that is, they block the activation of
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osteoclasts, what are
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osteoclasts, these are cells that wash
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calcium from the bones,
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collect calcium for some other
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needs, estrogens block that is, about the
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class reduces the sensitivity of bone
00:12:01
tissue to the resorption of vitamin D;
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resorption means destruction because
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some metabolites of vitamin D can
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take calcium from the bones;
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very fashionable and such a
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movement,
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dairy products are good; consumption of cottage
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cheese is good, but in children, for example,
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yes, dairy products are well absorbed,
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and calcium from there is well absorbed
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because the body grows and washing is
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necessary; in adults, tiny amounts of
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calcium are cooked from dairy
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products,
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therefore, in case of presence For any
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signs of osteoporosis, it is necessary not to
00:13:03
drink more milk, but to resort to
00:13:05
active supplements such as calcium D3,
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because vitamin D and calcium are
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absorbed together, so in this country they do not
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enhance the absorption of calcium and
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reduce the catabolic effect of thyroxine,
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thyroxine is a thyroid hormone
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that also can activate
00:13:23
osteoclasts and take calcium from bones,
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risk factors during menopause, one of the
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most interesting problems, yes, in
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menopausal women, these are endocrine risk factors,
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which includes diabetes mellitus, for example,
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diseases of the gastrointestinal tract,
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why, gentlemen, is
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calcium absorbed in the intestines if there are
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any problems with the intestines my with
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the intestines, the
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rings will not be absorbed, so it is
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necessary to treat liver disease because
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calcium carrier proteins are synthesized there,
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estrogens are metabolized there,
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vitamin D is metabolized there,
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all these components are necessary for the
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correct delivery of calcium to the site
00:14:15
rheumatic diseases and vascular lesions
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again dice chemical companies before
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we remember swarm flows without
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occurrence more
00:14:26
means what syndromes can develop
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during the decline of the camp dav lie
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1 reflex syndromes or and
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ritative which arise as a result of
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irritation of the nerve roots
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this is more all these syndromes that you and I
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know this and eat with and brothers all
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brilliant beams and and so on and so
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on, compression syndromes as a
00:14:53
result of compression of the roots, loss of
00:14:58
sensitivity, movement disorder and
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spinal cord compression syndrome, that is,
00:15:05
nice party,
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these syndromes, by the way, they can
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transfer, that is, for example,
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the same sciatica, it can
00:15:13
be both a reflex syndrome or
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tation and compression syndrome
00:15:19
as a result of transferring the phenomenon and as a
00:15:22
result, myelopathy, that is, both the
00:15:25
same syndromes can
00:15:27
occur in different numbers, here it
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depends on what, on the pathogenesis, what
00:15:34
led to this syndrome,
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from here we will use it in one
00:15:38
form or another, for example, if it is an
00:15:41
imitation of inflammation, for example in
00:15:44
tuberculosis, then this there will be a
00:15:46
sha as a result of ritative syndrome
00:15:48
number 1
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if it is a hernia it will be
00:15:51
compression syndrome number 2
00:15:57
back pain we recalled with you the last lecture
00:16:00
on the lumbar region
00:16:03
before I remember the symptoms of danger
00:16:05
here the algorithm is exactly the same as in
00:16:09
previous lectures therefore in great
00:16:11
detail on we will not stop here, we will not
00:16:13
remember, and this slide is here so
00:16:16
that all parts of the spine
00:16:19
are diagnosed in the same way;
00:16:21
we should never
00:16:23
ignore the symptoms of danger; let us remember with you the
00:16:28
symptoms of danger; we will check the survival rate; know how many symptoms of danger you can
00:16:31
remember; be
00:16:32
sure to check and if suddenly
00:16:36
more arise in an older person 50 years
00:16:39
for the first time
00:16:40
and that means something is wrong there, it means you need to
00:16:43
look carefully at this patient, be
00:16:45
sure to invite additional
00:16:47
specialists because doctors,
00:16:52
many doctors have a very good
00:16:56
habit of asking for advice because there are doctors who
00:17:00
look quite 1 on
00:17:04
the sides there are doctors who, unfortunately,
00:17:06
simply don’t looks, therefore, if you see
00:17:10
that your doctor is asking for advice or
00:17:14
referring you to another specialist,
00:17:16
this does not mean that he is
00:17:18
a fool, it means that this doctor understands
00:17:21
that he may not have examined something from you
00:17:24
and this does not mean he lacks the
00:17:27
competence, on the contrary, of a doctor who
00:17:29
asks for advice from another doctor, you need to
00:17:31
respect it and if there are no danger symptoms,
00:17:37
before we definitely do an MRI,
00:17:38
we look at the condition of the affected part,
00:17:42
differential diagnosis, there
00:17:45
must be questions about pain
00:17:48
and about their nature, whether it is related to movement
00:17:50
or not, and so on and so on, that is,
00:17:54
you understand how complex this
00:17:55
problem is and you need to be able to
00:17:58
understand it, it is
00:18:02
important
00:18:03
to note that I already said on the last
00:18:07
slide it is definitely a matter for March and why
00:18:09
because up to 50 percent of hernias can
00:18:13
be symptoms, that is, they are there, but there are
00:18:16
no symptoms and it seems that the
00:18:19
person has suffered some -
00:18:21
some area has lost sensitivity,
00:18:23
it has stopped responding to touch for
00:18:27
tingling,
00:18:28
you need to do an MRI to see what’s in it
00:18:35
with you, we see an x-ray
00:18:36
and in this ring of years of minutes it’s not very
00:18:40
visible, of course, but we see that
00:18:42
the intervals have become a little more transparent,
00:18:50
which means that the mineral component there has decreased
00:18:52
and most likely we
00:18:55
will wait for some kind of roof there or about
00:18:59
something else, depending on the symptoms, what are the
00:19:03
symptoms of the
00:19:04
cervical spine in the same way, pay
00:19:07
attention from above to the height of the disc and
00:19:11
pay attention from below to the height of the disc,
00:19:15
they have become smaller, which means this is compression and
00:19:19
such a person will complain of pain in the
00:19:22
neck or may complain of pain in the head.
00:19:27
Here we see the presence of such
00:19:32
transparent
00:19:36
x-ray negative glimpses, and such
00:19:42
glimpses, these glimpses indicate
00:19:44
that most likely some pathological component has also crept up there,
00:19:48
which can be seen and
00:19:50
pay attention to the
00:19:53
lumbosacral region between r5 and s1,
00:19:57
how uneven the edge is, the
00:20:01
arrow is not marked, but we will
00:20:04
look at this and we see that there are
00:20:07
marginal growths, this is not very
00:20:11
good, the picture is unfavorable, how the
00:20:16
dorsal gia is treated, treatment with oils has already been said about
00:20:19
treatment dorsal gay means firstly, of
00:20:21
course, a reduced pain syndrome, that
00:20:24
is, if it is more related to the fact that a
00:20:25
person is vacuuming, but leave
00:20:28
him alone, let him not vacuum, or
00:20:30
buy a robot vacuum cleaner
00:20:32
or help, or a vacuum cleaner that
00:20:37
will reduce the load, but such and such a part of
00:20:39
the spine is medicated the treatment is already
00:20:42
very familiar to you and non-steroidal
00:20:45
anti-inflammatory drugs
00:20:47
analgesics muscle relaxants here we also
00:20:50
include drugs that
00:20:53
will reduce inflammation drugs
00:20:56
that will reduce the sensitization
00:20:59
that we talked about these are
00:21:01
tranquilizers anticonvulsants
00:21:04
antidepressants chondroprotectors
00:21:06
improvement of microcirculation to the Omsk
00:21:09
company low-level reduction of
00:21:12
venous stagnation and drugs with a
00:21:14
metabolic effect such as
00:21:17
Mexidol,
00:21:19
for example, which will improve
00:21:21
microcirculation, remove this disk, a
00:21:24
chemical component,
00:21:25
that is, treatment is always aimed
00:21:28
at mechanisms
00:21:29
or symptoms, I will give symptomatic
00:21:33
pathogenetic, that’s why we
00:21:36
discussed pathogenesis so that
00:21:37
you understand what pathogenetic therapy is,
00:21:43
for example if we go into
00:21:46
detail now we will open with you
00:21:50
this pathogenesis and here it is peripheral
00:21:54
sensitization I will give anti-inflammatory
00:21:59
drugs we use to which will
00:22:01
reduce pain and they will be
00:22:04
symptomatic but they are also
00:22:07
anti-inflammatory they will
00:22:08
interfere with the synthesis of
00:22:11
these inflammatory agents these
00:22:16
inflammatory agents thereby reduce
00:22:18
inflammation this will already be their
00:22:22
pathogenetic effect, then we move on
00:22:25
non-erogenous inflammation again
00:22:27
non-steroidal anti-inflammatory
00:22:28
drugs here it is prostaglandin they will
00:22:32
remove it here it is histamine and since
00:22:35
histamine we have wonderful
00:22:37
antihistamines all this will
00:22:40
influence the pathogenesis and finally the
00:22:44
antidepressant anticalc usan can
00:22:47
mulsanne you this drugs that remove
00:22:49
central sensitization, stopping
00:22:52
the development of these additional
00:22:55
pain pathways and, accordingly, remove the review of
00:22:58
lies, so the treatment should be, you
00:23:00
see, complex symptomatic and
00:23:04
pathogenetic in the metabolic
00:23:06
effect, we have already said it will
00:23:08
improve microcirculation and remove the disk
00:23:11
chemical effect disks facial
00:23:17
mechanism drug blockades blockades
00:23:20
help us with you reduce pain,
00:23:23
for example novocaine blockade, there are
00:23:25
anesthetics that make the end of
00:23:29
nervous days sensitive to the
00:23:32
inflammatory agent physiotherapy
00:23:36
reflexology manual therapy all
00:23:38
this improves blood supply in the lesion
00:23:42
yoga therapy psychotherapy
00:23:44
of course an obligatory component for
00:23:47
these diseases the most important thing gentlemen
00:23:50
treatment should begin as
00:23:53
early as possible saw heard about felt pain
00:23:59
one of your friends has an
00:24:02
urgent MRI from their clients,
00:24:07
and sometimes even patients come
00:24:12
to the doctor Samart, this naturally speeds up
00:24:15
treatment because you don’t waste time going
00:24:21
to the doctor, he prescribes an MRI, you do a
00:24:24
household MRI, the doctor has this have already lost at
00:24:27
least a week, especially if it’s a good
00:24:30
specialty for which the registration is a month in advance, and
00:24:34
here, accordingly, much
00:24:38
more time is lost; in a month,
00:24:41
everything will be
00:24:42
healed, and we need to
00:24:44
start this as early as possible during treatment and therefore
00:24:47
to our health and the health of our
00:24:49
relatives or the health clients need to be
00:24:53
treated very carefully for this, we are
00:24:55
here with you at lectures and meet so that
00:24:57
I reveal to you the little secrets of
00:24:59
pathogenesis as much as possible on my
00:25:02
part in simple words so that they
00:25:05
understand how this process occurs,
00:25:07
understand how you can influence it and
00:25:10
why we see these diseases
00:25:13
so often keep the cumin there too because
00:25:16
you see that there are
00:25:18
a lot of components to inflammation and few of us
00:25:22
of course like it when the doctor prescribes 6
00:25:25
to 8 drugs, but unfortunately now you
00:25:28
see that there are a lot of components to inflammation
00:25:30
and we don’t have to act on them all
00:25:32
universal tablets, therefore, you need to treat
00:25:36
your treatment and the healing of the people who
00:25:38
surround you
00:25:39
with the utmost
00:25:41
responsibility; of course, I encourage you
00:25:45
and have encouraged you constantly, or I will continue to
00:25:48
encourage you, see you
00:25:49
at the next lectures

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