An Introduction to Cryoanalgesia

Morton's Neuroma Anatomy

By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 833, Public Domain, https://commons.wikimedia.org/w/index.php?curid=541692

The recipient of a doctor of podiatric medicine from the Scholl College of Podiatric Medicine at Rosalind Franklin University in Illinois, Dr. Deo Rampertab is a former clinical assistant professor at Arizona College of Podiatric Medicine. Dr. Deo Rampertab has successfully developed and perfected ultrasound-guided cryoanalgesia (UltraCryo) as a minimally invasive treatment procedure for chronic and acute pain.

Also known as cryoneuroablation or cryoneurolysis, cryoanalgesia is a pain-relieving procedure that makes use of cold temperatures in treating nerve pain. While it is currently a medical procedure used in health care facilities, the principle behind cryoanalgesia has been around for centuries. In the past, people made use of snow to numb nerves and quell related pain. The more complex cryoanalgesia procedure practiced today involves the use of a tiny needle-like probe to deliver a very cold sensation through the use of cold compounds like liquid nitrogen to targeted nerves, thereby depriving the nerves of their capacity to send pain signals.

During modern cryoanalgesia procedures, doctors target the specific nerves to numb with high precision by using fluoroscopy, ultrasound, or a nerve stimulator. During the process, care must be taken to prevent lesions in areas close to large blood vessels.

Because it can be used to target a wide category of nerves, including many peripheral nerves, cryoanalgesia is used in treating certain types of headaches, back pain, pain due to scarring, and post-surgical pain.

Three Underrated Cuisines from Around the World

Steak with broccoli

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Podiatrist Dr. Deo Rampertab has been involved in the medical industry since graduating from the Scholl College of Podiatric Medicine at Rosalind Franklin University over 20 years ago. A reputable guest lecturer and podiatric surgery consultant in Washington, Dr. Deo Rampertab enjoys traveling in his free time, and enjoying different cuisines.

Despite the fact that there are hundreds of countries around the world, most people are unfamiliar with dishes outside of the more popular Italian and Mexican cuisines. But there are several delicious, underrated cuisines from around the world that are worth trying:

Ethiopian
One of the healthiest and more flavorful cuisines in the world is Ethiopian food. Many typical Ethiopian dishes involve dipping teff, a healthy flatbread, into a stew consisting of meat, broth, and plenty of spices. Injera, a sourdough bread, is also a staple in this type of cuisine, and is often paired with different meat, lentil, and vegetable dishes.

Filipino
While the Philippines is well-known for having scenic coastlines, its cuisine continues to fly under the radar for many. Taking inspiration from American, Spanish, Malay, and native Austronesian cultures, Filipino cuisine is extremely varied and includes everything from thin slices of meat to fried eggs and fried rice.

Nepali
Nestled between Tibet and India, Nepali cuisine borrows features from both countries. This is perhaps most notable in momos, a unique dumpling that originated in Tibet. When cooked in a Nepali style, these dumplings adopt an interested flavor derived from the use of spices such as ginger, coriander, and cumin. Lentils, rice, meat, and curried vegetables are also common in Nepali dishes.

Importance of Training for Long Distance Hiking Excursions

Sunset hiking
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Providing podiatric sports care, Dr. Deo Rampertab cares for patients with a wide range of foot and ankle issues. Passionate about climbing and running, Dr. Deo Rampertab also goes on long distance hiking excursions when he has the opportunity. 

Hiking long distances can be a uniquely grueling discipline that requires a high level of fitness, particularly as an injured hiker may be several hours or even days removed from help. One way of training for a lengthy hiking expedition is to regularly undertake aerobic exercises.

This can involve taking to nearby trails carrying the same pack you will be taking into the backcountry. This physically prepares the body for the load that will be carried, and also helps identify potential areas of strain and chafing. It also makes sense to wear the boots or shoes that will be taken on the local trail. Particularly with a new pair, getting used to the feel of the shoes and breaking them in can help avoid extremely painful sores and blisters.

In addition to aerobic activities, it's recommended to add resistance training to the mix as a way of building muscle strength and endurance. This will ensure that the body is in optimal fitness from the outset and avoid situations of intense fatigue on the trail that come from exerting underused muscle groups and increase the risk of injury.

VA Office of the Inspector General - Investigating Fraud

Investigation
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As the associate director of the Veterans Affairs (VA) Office of the Inspector General (OIG), Dr. Deo Rampertab conducted veterans’ healthcare quality oversight. Dr. Deo Rampertab's experience also includes a position as a staff podiatric surgeon with a VA provider in Fresno, California. 

Working to stop people from stealing resources intended for legitimate veterans affairs initiatives, the VA OIG carries out investigations into fraud that lead to serious federal charges and large settlements. In March 2019, a man who stole nearly $300,000 in federal benefits intended for his mother, who died in 1981, was sentenced to six months in prison.

Another recent VA OIG investigation discovered that a man had feigned blindness for years to defraud the VA of more than $1.2 million. After pleading guilty in April 2019, the Colorado resident was sentenced to 12 months in prison and ordered to pay more than $1 million in restitution. 

For more information about the VA OIG and its anti-fraud work, visit www.va.gov/oig.

Signs of Altitude Sickness When Hiking High Mountains

With a background as a podiatric surgeon, Dr. Deo Rampertab has performed surgeries for a wide range of foot and ankle issues. With a passion for long distance hiking and climbing, Dr. Deo Rampertab has climbed several US mountains higher than 14,000 feet. 

High altitude hiking carries with it a number of risks that it pays to be aware of, including high altitude cerebral edema (HACE), high altitude pulmonary edema (HAPE), and acute mountain sickness (AMS). 

The latter is the mildest type of altitude sickness and is not dissimilar to a hangover with its symptoms of nausea, headache, and general exhaustion. Unfortunately, AMS can be a gateway to more serious issues if steps such as drinking more liquids and eating high carb and sugary snacks on the trail are not taken. 

HAPE involves liquids seeping into the lungs and a sense of having had the wind knocked out. With one symptom involving coughing up a frothy substance, HAPE provides a clear message to descend down to a lower altitude. Even more serious, HACE has symptoms of disorientation and slurred speech, and is an indication that an immediate descent needs to be effected. 

In addition to training through hikes at the highest possible altitude locally before an extended trek in the mountains, it makes sense to bring along medications such as Diamox and ibuprofen, as well as cough drops in case altitude sickness symptoms should appear.

Washington's Mount Rainier National Park

A member of the International Foot & Ankle Foundation for Education and Research, Dr. Deo Rampertab possesses more than 20 years of experience as a sports medicine podiatric physician. Based in Washington State, Dr. Deo Rampertab is a fitness enthusiast who enjoys hiking and mountain climbing in his free time. 

Considered one of the premier "big mountain" climbing experiences in the United States, Mount Rainier in Washington was originally named Tahoma, which roughly translates to "Great Snowy Peak," by the Yakima Indians. The mountain was given its current name in 1792 by Captain George Vancouver, who renamed it in honor of Admiral Peter Rainier. 

President William McKinley authorized the establishment of Mount Rainier National Park in 1899 to provide protection to more than 235,000 acres of natural land, including over 35 square miles of glaciers. 

The mountain boasts three separate summits, with Columbia Crest recognized by the National Park Service as the highest peak at 14,411.05 feet. More than 10,000 people try to scale Mount Rainier each year, but visitors who want a less strenuous hiking experience can choose one of the 35 trails of varying lengths that wind along the mountain.