Ortho Problems, patient questions asked and answers given

Please find some of the questions asked regarding the problems affecting the bones and joints [Ortho Problems]

 I will share few questions in each blog and i will be pleased to answer any if you have queries.

Disclaimer: This sharing is only to educate the public and not taken as an advice to your or someone else's present problem

Question # 1

Sir,

My sister’s daughter met with right leg thigh bone fracture. She is 1 year 8 months old. She tried to climb  over 25 inch TV which is kept at approx. . 2 ft height. TV fell down and top edge of TV heavily hit her thigh. Immediately she was rescued , but moment we don’t what impact on her ( no blood injury) suddenly when we touched her thigh she started  reacting. Rushed to hospital and did POP in OT. After one month last week we took Xray . X ray shows similar position of Broked bone . Doctor told that will join in due course . Some more extracts from report:

 X-Ray right femur fracture mid shaft of right femur with mala lignment of fragnents .Opinion :  acceptable position It is ok please clarify.

Answer:

Fracture Femur in this age is usually treated in plaster. The position of the fragments does not matter much at this age. This is due to the fact that the bone will remodel with growth. Be guided by the Ortho Surgeon by discussing your concerns and do not worry by just looking at the x ray.

Question # 2

Dear Sir,

                    I have a heals  problem when I am going home after Office work it start pain and when I get up in morning again it pain. Pl’s give some remedy

Thanks & Regards

Answer:

This is called Plantar Fascitis and in lay man’s term Policeman’s heel. Please refer to this web site for better understanding and the exercises you need to do.

http://www.stockport-pct.nhs.uk/Patient%20information%20sheets/Plantar%20Faciitis_Arc.pdf

Wear MCR Cheppals or normal slippers at home. Apply ointment such as one which contains diclofenac. Make sure you do these exercises in the morning before starting walking

Question # 3

Dear Sir,

My queries are regarding orthopedics...

I got operated in my left forearm in November 2009 because I had an accident. Now everything is good with my hand but there are some queries regarding the issue. In winter and monsoon the bone in forearm and scaphoid bone start paining slowly and pain lasts for 5 to 6 days. At this time I keep my hand in salted hot water for some time and pain decreases in 5-6 days. What should I do so that this pain don’t come in winter and monsoon.

1.       During operation a plate was inserted in my forearm to properly align the broken bones. The plate is still in the hand.  Is the plate can be the reason for any pain after 30-40 years? Should I get operated again and get this plate out or I should continue with this plate for whole life? Please suggest.

2.        There is a scar of 4’’ In my forearm. How can I make this mark very-very light? Please suggest some homemade solution.

3.       What are the precautions I should take in my normal day to day life to keep my hand free from any type of pain?

Answer:

1. Aching pain after plate insertion in winter is fairly common problem. If it bothers you significantly, you can consult the Ortho Surgeon who may advise you to have the plate and screws removed. In other words, you do not have to put up with the discomfort, though in most patients I advise the plate and screws to be left alone.

2. The scar if prominent can be revised by a plastic surgeon to give you a neat scar, I am not aware of any home made solution.

3. Most patients with the plate and screws after the fracture healing will not have any discomfort or pain

Question # 4

Dear Sir

I, aged around 30 years, used to be very active physically2-3 years ago. I used to play cricket / table tennis / jogging on regular basis then. After 2-3 years gap, I have started again these type of physical activities. But now it creates problems to me in terms of joint pain in my hand / legs / feets. Even after 2-3 weeks of regular play, the problem not diminished. Though, now pain is lesser.

Pls suggest

Regards

Answer:

Generally the joints and the muscles become tighter as we grow older with out exercises. Hence follow some flexibility exercises for a week before returning to sports. But please do those exercises every time prior to sports.

The link for the flexibility exercises is

http://orthoinfo.aaos.org/topic.cfm?topic=a00310

Question # 5

Dear Sir,

My Mother, 44 years old, has been diagnosed with Spondylitis on her neck. The doctor said that its in the early initial stage. Can you advise me what needs to be done so that it can be cured in the initial stage itself?

Regards,

 Answer:

Spondylitis is a condition of the joints of the spine. It occurs in the neck or the lower back. To prevent the condition progress, she needs to keep the joints as flexible as possible by following the simple neck exercises.

http://www.thephysiotherapysite.co.uk/physiotherapy/exercise/simple-neck-exercises

3-2, for the man to mosquito, part 2

If you have followed my previous blog on mosquito and the battle i had with them in the balcony, you would have agreed that the mosquitoes had won with the score 2 - 0 .

I had vowed that humans would come back with some tactics to win and do did I. I did try to get them out of my house with various methods such as good knight, sprays and so on.

The sprays such as Hit were super only to have time related effect and they smell not so nice. We had to go to the drawing board, and do a bit of research.

The sprays outdoor to control the breeding and the grown ups seem to be a good way but it is not under our control and we see the corporation already doing their bit. And one has to realize the spraying outdoors has to be repeated so often.

I had a chat with one of the sellers of these outdoor spraying machines and he mentioned that these are selling hot cakes and may be we would see change later.

But what about now!!!!!

I resorted to the time tested physical barrier and the mosquito netting of all the open access areas such as windows and the doors including those to the balcony.

Oh, boy, what a difference it made to our lives. At last  and at least for now, we can control the open entry of these deadly living things to our bedroom. Yes now and then one snoops in. it then becomes a decent battle i.e one to one as opposed to one to many.

It then hurts harder when one manages to bite us outdoors, such as when i was roaming with Shorts in a theme park.

I was thus brought to reality and then quickly put on jeans in the nice weather cursing the mosquitoes.

Yes you the mosquitoes win outdoors, a bit unfair but indoors in my house where the battle is fair and square, i am leading 3-2 score. though it means i have put another layer where i live behind bars so as to speak!!!!



Hope you enjoyed

Take care

Chockalingam

God, Vishwaroopam, Avatar and the Pristine Road

God for those who believe His Existence does not show himself to his devotees all the time and does appear briefly. This appearance can be incarnations, or Avatar. For incarnations, one should have lived during this period of time and physically present where He or She lived or visited.

Vishwaroopam is when the Lord shows @"Himself as God" to some special person such as Arjuna in Mahabharatha. The important thing about Vishwaroopam is that the  Lord only shows this form for a very brief period of time. In Fact during the Avatar of Lord as Krishna, he apparently showed himself as the God [ Vishwaroopam] only six times during this Avatar.

The common theme for both the incarnation namely the avatar and Vishwaroopam is the brevity of time or absence of permanence.

Now let us turn to driving and the road when it is pristine. You do really enjoy driving when the road is good, the motor is responsive and the landscape is exquisite. You can choose the area where the landscape is good, buy and drive the best motor with the money we have, but hey! what about the road condition.

This obviously depends on where you live, the authorities on how they lay down the road and maintain, the nature such as rain does not spoil the laid road and so on.

What would you say when the road is pristine only for a short period of time and then when the road surface is so bad that you wish you are not there!. You start praying that the road gets re laid to a better condition and you do not know when that would be.

You keep praying since you cannot do anything else and it is not under your control even though it should be?

And then one day the road is relaid and it is pristine, and you rejoice at the best road surface you are able to drive and start enjoying the ride!!

You worship the God in this case the pristine road, which has made an avatar when you are able to Darshan it. Sometimes you feel the road is soooooo goooooood that you forget to worship the Avatar only to realise that the next time you drive, what you had the time before was indeed a Vishwaroopam!!!!!

I hope you got it and sorry for the sarcastic part of it and learn to laugh with me

and say Deivame [Oh, The Lord/ God] and worship the Pristine Road next time you drive on one!!!!!

Warm Regards and Best Wishes

Chockalingam

Hunter being Hunted: The ground reality in the life of a patient and doctor.

The human race we would like to believe is superior to others. However you are taught humility when other species can over power you. Simply you observe as you are defeated.

You do watch National Geographic Channel,don't you where the animal caught by the cheetah or the lion simply lies helpless when eaten alive.

It is not uncommon in human illness when the doctors feel as helpless if not more when the patient succumbs to some infective illness.

i was speaking to a Physician colleague of mine other day, when he commented Dengue to be one such illness, when he knows that the patient is not going to make it.
 
We may think ourselves to be the hunters and not the hunted but hey, at some stage we may be the hunted!

"Mortals we are"  is something we get to understand when faced with it, like someone who we know is not making it or did not.  This may happen once in few years!

However the doctors who treat patients face this reality more often than a common man. Sometimes he or she may have dealt with few deaths even in one day!

It does take a toll on the doctor, even though he may look bold enough to take it.

So next time you meet your doctor, be nice to him as much as he is to you, since he may have taken too much toll already from the mortals he had to deal with!

Warm regards and sorry for the long time for the blog

Best Wishes

Chockalingam

A walk through India which you may not want to!

There is an interesting Web site called Walk through India, similar to my incredible India. It is indeed heartening to see India which is growing, bright and beautiful with such a vast area of natural and man made beauty. A Walk through India may sound appealing and inviting to you and it did for me as well until........

Basic rights of a citizen are widely listed for every country and i am not sure if walking peacefully or you might call a stroll in the morning or evening could be considered one. But my brother who is a doctor as well advises me not to go on the open and outdoors after 5 PM as me or my family may get bitten by one of those mosquitoes.........

These mosquitoes may be one of those which transmits Dengue, which is increasingly seen and diagnosed in the part of Tamil Nadu where I live, let us dwell in a bit more.

It is an endemic disease in some parts of the world. now when does this endemic become an epidemic, one can discuss separately. But it is even more worrying to know that there is no definite treatment for this condition.

http://www.who.int/mediacentre/factsheets/fs117/en/index.html

The above link gives the salient facts about this condition and WHO feels that 40% of World population is prone to this deadly disease.

I hope WHO does not object to me posting their advice on prevention of this disease and let us all spread this and increase the awareness.

As Quoted by WHO in their web site

• "preventing mosquitoes from accessing egg-laying habitats by environmental management and modification;
• disposing of solid waste properly and removing artificial man-made habitats;
• covering, emptying and cleaning of domestic water storage containers on a weekly basis;
• applying appropriate insecticides to water storage outdoor containers;
• using of personal household protection such as window screens, long-sleeved clothes, insecticide treated materials, coils and vaporizers;
• improving community participation and mobilsation for sustained vector control;
• applying insecticides as space spraying during outbreaks as one of the emergency vector control measures;
• active monitoring and surveillance of vectors should be carried out to determine effectiveness of control interventions."

We do need more community participation on this disease and let us all spread the importance of prevention and if you find clean water collection as storage which is not covered. remember to call the authorities.

Please alert your corporation or Panchayat to take these preventive measures in their power and let us all do what we can

Warm Regards

Chockalingam

My Battle with the mosquitoes which I lost!, read on!!

I decided to go to the balcony to dry some clothes. I took the basket with the wet clothes and started hanging them. One mosquito bit me and i disregarded it as the work was more important. It irritated me when the second mosquito took the liberty of taking my blood!



Enough, I said. I left the work i was doing of hanging the wet clothes and decided that i would murder these two before returning to the job in hand. I managed to kill one of the two, but hey!, there were few more attacking me.

I got wild and decided to do the killing act on these who attacked me and do you know what happened another few appeared. I got hold of one of the wet towels and wield the towel like a sword and try to scare them off.

But they liked this game and decided to play head on with more joining the fun, of course their fun but my misery. I knew at this time, the game is lost and i have to retreat and oh boy, how i did it!

I ran into the house leaving all the wet clothes behind and closed the balcony door quickly and very quickly. few mosquitoes did not call it quits and followed me into the house before i could shut the door.

They are intelligent, aren't these mosquitoes.



Now this is how intelligent they are. I am returning from work and i get into the lift. As i go up in the elevator, few mosquitoes travel with me. When i leave the escalator they come out with me to my door. They wait for me to open the door and enter the house.

I am not exaggerating this, but do watch the behaviour of this insect and they know how to reach us, even if you live in the fourth floor as in my case.

This is the quote from wikipedia

"Some authorities argue accordingly that mosquitoes are the most dangerous animals on Earth.^[2] 

^ http://www.mimosq.org/mosquitoes.htm (accessed 2011/12/13)" 

^{Indeed when you know that people and often children die of dengue which is a viral fever transmitted by the mosquitoes, you do develop a dislike for them as much as you do when they attack you.}

What is commonly practised in killing the mosquitoes ourselves. however can it work, does not look like if you read the following quote

This is another quote from the literature

"A paper published in the Proceedings of the National Academy of Sciences says the mosquito branched off the same evolutionary tree as the house fly around 220 million years ago."

Meaning that they have been in this universe for more time than we the humans who apparently can be traced back to only 2.3 million years ago.



 <sup>It is interesting to note that the natural predators of mosquitoes are dragon flies which can be introduced into the ponds according to the literature out there!



The area which we live in is riverside and frankly may sound attractive but it is not. since this river which often stagnates is a breeding ground for the mosquitoes.

Here they multiply happily that more and more multiple floored flat complexes are built with more people to suck blood from than before

and most important is that these flat complexes come with lifts which saves their effort visiting all the floors effortlessly!

and are they not intelligent!!!!!!!!!!!

Hey i may have lost the battle, but as a human will do, i have retreated to fight again with the right weapon, may be with few dragonflies!!, but not necessarily to eradicate them, but to make my life better!

Hope you enjoyed

and warm regards

Chockalingam</sup>

 

Quality of life, Knee arthritis and Total knee replacement part 1

A 55 year old lady is having pain in her knee. this does not sound surprising, is it? Quite common you would say. But do we understand that she is suffering. Suffering! did you say? it is not cancer, is it, one might wonder.

Yes i did say suffering. This lady is literally house bound, cannot walk outdoors due to this pain. She is not able to go out to do her own shopping. How does this matter, She has a family who can take her outdoors in a car or a two wheeler and she does not need to do her own shopping, one might say.

She cannot go to a temple or to a church or do her prayer. So what one might say, many persons do not go out to to place of worship now a days you might say.

She cannot climb a flight of stairs or sit with her friends on the floor and have a friendly chat. So what, most people now do not sit cross legged on the floor nor need the use of stairs. one might argue.

I am telling you that she is not able to sit in an Indian Toilet to do her normal activity in the morning. One argues that if she uses the Western Closet, it should be fine.

But the fact that "this person should be able to do all the activities without pain" is what i am getting to! It does make more sense, that half of the population of Indians do not have access to Toilet facilities let alone have a Western Toilet in their own household! See my earlier blog for reference.

It does really matter when she says to you that she is not able to sleep without pain, one would agree that she is suffering. Even there, there are patients who keep taking tablets for over an year to be relieved of this suffering albeit to a short term benefit.

Can one actually quantify this suffering to make a case for intervening and help these people.

Yes is the answer.

please wait for my next blog for the answer and so more facts and thoughts!

Warm Regards

Chockalingam

Young's Modulus and some Physics and how We apply in Orthopaedics. Medical Students' Stuff!

Orthopaedics is a branch of medicine and surgery where the bones, joints and their ailments are diagnosed and treated. Correction of Deformity in Children is the literal meaning of the word "Ortho Paedics".



To correct the deformities due to fractures and other diseases and subsequently to prevent deformities primarily in fractures. we have to use materials other than the bone and the natural tissues.

One of the common materials used in this area are metals. There are various metals used namely Stainless Steel, Titanium, Cobalt Chrome, Plastics, Ceramics, Naturally available Gypsum and so on.

To understand how we choose different material and metal in this instance, one needs to be familiar with some physics.

This is where Young's Modulus of Elasticity which is what in Physics in Schools come to use.




If you pull any material with sufficient force, the material will elongate. This is easily understandable in a material like Elastic Rubber Band. The material will revert back to its normal length when the force is removed.

This property is true to a structure like Stainless Steel, Titanium, Cobalt Chrome etc. It is true to the bone as well.

We then to use a material which will have high strength but elasticity close to the bone. The measurement of elasticity is calculated by Young's Modulus. The high strength is denoted in the graph as the point where it is indicated "the material breaks"

This is where titanium scores over Stainless Steel in fracture fixation or joint replacements. Its modulus of elasticity is closer to bone than stainless steel, though stainless steel is very good indeed and the most commonly used metal in fracture fixation. Cobalt Chrome is commonly used in joint replacements as the wear is better.

Now what is Wear? here we are talking about the surface wear or the wear of the material's surface.

Wear is the damage by friction, shear or compressive force. you can scratch the stainless steel or plastic more easily than cobalt chrome. Hence you need a substance such as cobalt chrome for joint replacements where there is movement between two surfaces.

What is even better in joint replacement? considering the wear

we all have ceramic ware in our kitchen and dining room and we are often proud that it is there with us for a long time and not lose its shine. Yes we do use ceramic in joint replacements due to its surface hardness and resistance to wear. They are expensive like our domestic products compared to stainless steel.

Like our domestic ceramic cup, they were prone for breaking, however improvement in the manufacturing of these ceramic materials has made it unbreakable in joint replacments.

Now we do have these technologies available in a country like India and for use in a city like Trichy and the technology is helping us to provide a better care though at a price!

Now next time please do take time to talk to the Orthopaedic Surgeon treating you or someone known to you about the technology which goes behind.

Please watch the space as i would take time to more articles on the science in Medicine as the practice of medicine is considered to have Art and Science Component.


May be we can dwell into the art component which makes it human sometime in the future. Otherwise you wont have humans as doctors, rather you would be going to a robot doctor. May be we will and may not have a choice either in 2050 perhaps!!!!!!!!!!!!1



Warm Regards

Chockalingam

Total Knee Replacement at Trichy, Information for patients and relatives.

Please find the information prepared by us for the benefit of patients and relatives who wish to know about Total Knee Replacement. Please read, copy or print and use 

INTRODUCTION

The knee joint is among the strongest, largest and most complex joints of the body. Whenever

You walk , sit, squat, turn around, drive or perform many other seemingly simple movements,

You are depending on the knee for support and mobility. When your knee is healthy, you may

Take it for granted, not giving a thought about the job it does for you. But once it starts to

Become painful, stiff, and you are forced to restrict certain activities, you may come to realize

How much freedom of movement means to you.

Fortunately, today’s advanced medical technology makes it possible to replace the knee joint

With an artificial one that reduces pain, allows you to strengthen your legs, and improves your

quality of life.

Knee replacement is a procedure commonly performed throughout the world, and one that

offers an  outstanding rate of success.

In this brief, we will discuss how your knee works, how arthritis causes your pain, and the

Knee replacement surgery you will have. We will also help you can expect every step of the way.

HOW YOUR KNEE JOINT FUNCTIONS.

The Healthy Knee. The healthy knee joint is a remarkable mechanism. It is formed by the Bottom end of the femur (thigh bone), the top end of the tibia(shin bone) and the patella

(knee cap) . A healthy knee joint has cartilage between the bones that acts as padding. This

Padding helps assure a gliding movement of the knee that is both effortless and smooth.

The healthy knee joint also has a joint capsule which houses the synovial membrane. This

Membrane produces lubricating fluid which contributes to the smooth movement of the

Knee.

The human knee is designed to withstand a lifetime of stressful activity. However,

Sometimes arthritis intrudes, interfering with the knee’s ability to cushion the body from stress,

and eventually causing the pain that dramatically  erodes your quality of life.

WHAT IS ARTHRITIS?

Arthritis is not a symptom of “just getting old”. It is a degenerative or inflammatory disease

Of the joints that is not necessarily part of the normal aging process. Indeed, some patients

With arthritis present symptoms in their 20s and 30s.

Although there are several types of arthritis, one of the most common is called osteoarthritis.

If effects million of people in the world today.

Arthritis causes permanent deterioration of the cartilage layers that shield the joint from

Impact. Because cartilage cannot repair or replenish itself, it begins to crack, wear away and

Eventually disappear. The cushion your knee requires to absorb stress is gone, resulting

In bone-on-bone contact. The bones in advanced cases may be so rough and pitted from

Grinding against each other that they form bone spurs, which often cause stiffness.

In the first stages if osteoarthritis, your knee may feel stiff and  swollen. Later, you may feel

Pain and may be notice that one leg seems shorter or more crooked than the other.

Eventually, your mobility may become limited and you may need to alter your lifestyle to

Accommodate your sore, arthritic knee. If you are overweight or have a malalignment, the

Extra stress on your knee can accelerate the damage.

Regardless of your type of arthritis, you may have already had to curb or quit the activities

You enjoy. This is partly why arthritis can make people “feel” old, eventhough they are

still in the prime of life. But there is hope-you have options.

HOW TO KNOW WHEN YOU ARE READY FOR TOTAL KNEE REPLACEMENT SURGERY?

Total knee replacement surgery is an elective procedure. Along with your doctor, you will

Decide when the time is right for this surgery. Your doctor has more than likely treated your

Condition with plain medications, anti-inflammatory drugs or perhaps even minor surgery.

But now the pain has become severe. Even staying off your feet doesn’t help. You cannot

Sleep at night because of the discomfort. You are probably the best judge of when you

Will finally need total knee replacement surgery. When the pain becomes so chronic

That even medication does not seem to help, you are probably ready to consider surgery.

GEETING INTO SHAPE MENTALLY AND PHYSICALLY

Take the four essential steps that will help you get into shape before knee replacement surgery.

1.     Commit to the success of your surgery. Working as a team, you, your physician and

Your family must adopt a positive attitude toward the success of your surgery.

Together, you will gain a clear understanding of the commons goals and expectations

of the procedure.

2.     Loss excess weight. Because excess weight causes strain to be placed on already –

Damaged  joints, losing weight is one of the best ways to improve the condition

Of your knee and optimize surgical results. Remember to seek your doctor’s

advice before beginning your weight loss program.

      3.   Start a physician approved, low-impact exercise plan. After a comprehensive

           assessment of your condition, your physician or physical therapist may recommend

           a low-impact exercise plan that will strengthen your knee without creating further

           damage. Do not attempt an exercise program without consulting your physician!

       4.  Stop smoking. If you have not already done so, it is suggested that you stop smoking

            This will be good for you during and after your surgery.

ALL ABOUT TOTAL KNEE REPLACEMENT SURGERY

Surgeons and manufacturers have made remarkable advances in joint replacement technology

Over the last few years. The materials are long lasting and durable. The surgical methods have

Been fine tuned and standardized. As a result, the chances for a successful outcome are

Excellent.

THE COMPONENTS OF YOUR NEW JOINT. 

In total knee replacement (also known as total knee arthroplasty, or TKA), the joint’s bone-

End surfaces are resurfaced with man-made materials. In total knee arthroplasty, the implant

(prosthesis) design may vary according to your needs, but the most common implant consists

Of three component parts. The patella, or knee cap, is made of high- density polyethylene and

May be supported by a metal tray.

BENEFITS OF KNEE JOINT REPLACEMENT.

Once your new joint has completely healed, you will reap the benefits of the surgery.

These include:

·       Reduced joint pain (maybe no pain!)

·       Increased movement and mobility

·       Correction  of deformity

·       Increased led strength (if you exercise)

·       Improved quality of life ability to return to normal activities and pastimes

Most likely, running, jumping, or other high – impact activities will be discouraged.

RISKS OF KNEE JOINT REPLACEMENT SURGERY.

As with any major surgery, there are potential risks involved. It is important that you are

Informed of these risks before the surgery takes place.

Infection.  Because a bacterial infection from your mouth could infect your new joint, you

Will be asked to complete all dental work before surgery. Consult your physician before

Scheduling any post – Operative dental work.

Blood clots. You could develop blood clots. Many TKA surgeons prescribe anticoagulation

Medications after surgery. You may also need to wear elastic stockings for several weeks

To minimize the risk of blood clots forming and to prevent emboli.

Pneumonia. Pneumonia can sometimes develop in patients who are lying in bed right after

Surgery. Getting out of bed soon after surgery is encouraged.

MAKING PREPARATIONS FOR SURGERY

MEDICAL EVALUATIONS

Before surgery, your doctors needs to understand your overall health status. You will be

Evaluated in several ways.

Complete medical evaluation  Your doctor will take your health history, an inventory of

Medications you now take, and will adminster  a total physical. X-ray images will be taken of

Your knee that help the surgeon plan your surgery. Some patients will also need chest X-rays,

ECGs and other tests to ensure they are strong enough for surgery and recovery.

Preliminary lab work. As part of your pre admission process, you will need to undergo routine

Lab work. Your physician’s nurse can explain what each test is and why you need it.

Donate your own blood. You may be asked to donate some blood to have on hand in case

You need it during surgery. Some patients cannot donate their own blood. In these cases,

Using pre-screened blood bank blood is recommended.

GETTING YOUR HOME READY.

To make your life easier post-operatively, it pays to think ahead about how to adapt your

home environment for safety and greater efficiency. Here are some tips that can help:

Arrange for help now. You won’t be able to drive immediately after surgery. This means

You will need the assistance of someone who can drive you to your follow up doctor’s

Appointments, as well as help you with shopping and errands. Try to line up this person’s

Assistance now.

Reorganize your home.

Bending, kneeling and squatting will be impossible immediately following your surgery.

Also remember, you will be on crutches or a walker for a while. Place everyday essentials

In top drawers or easy-access places. Remove electrical cords and clutter that pose a hazard.

Don’t wax floors.

Obtain assistance items .  It makes sense to have certain assistance items ready when you

Return home. Some suggested items might be a cordless phone,large apron with pockets,

Reaching aids and bathing aids. Check with your surgeon and hospital to identify which items

Will be provided to you at discharge.

PACKING FOR  THE HOSPITAL

When packing your hospital bag, bring your list of medications and the telephone numbers

Of your relatives or designated “help” person. Bring walking shoes, loose, comfortable clothes,

Underwear, books, personal care items and cash for sundries. Please don’t bring jewelry, large

Amounts of cash, credit cards or other valuable items to the hospital with you.

A NOTE ABOUT MEDICATIONS.

It is very important to tell your doctor about every single medication you are taking, even

Aspirin or ibuprofen. Some medications are not compatible with anesthetic, and others

Could increase bleeding or cause other problems. Your physician will determine which

Medications you can continue up until your surgery, and which ones you must discontinue.

WHAT TO EXPECT THE DAY OF SURGERY

When you are admitted to the hospital you will change into a hospital gown. Your vital

Signs are taken by a nurse. An intravenous line containing medications and fluids will be

inserted comfortably into a vein on your arm or neck. At this point, your anaesthetist

will  arrive to begin administration of your anesthetic for surgery. Once you are transferred to t

the  operating table where the surgery will take place. This is often the last thing you remember

before  waking up in the recovery room. You may have general anesthesia or spinal anesthesia

With sedation.

WHAT TO EXPECT RIGHT AFTER SURGERY

In the recovery room, you will recover from surgery until you are awake and alert. You could

Experience chills or nausea-these are normal side effects of anesthesia. You may notice:

Driange tubes  and catheters.

Catheter may be in place.

Pain Medications. To manage the pain you may feel right after surgery, you will be given

Medication.

Elastic stockings.

You may be fitted with elastic surgical stockings that help prevent blood clots and improve

Circulation. You may wear there stockings every day for six to eight weeks following surgery.

CPM Machine. Your operated leg may be connected to a CPM (continous passive motion)

Machine, which slowly bends it up and down to improve range of motion.

You are returned to your regular hospital room once you are completely awake. Your family

Members may then visit you in you room.

TWO DAYS AFTER SURGERY.

IV tubes and lines are usually removed within the first few days following surgery. If a

Drain was placed in your knee, then it will probably be removed a day or two after surgery.

The start of physical therapy.

Physical therapy usually begins for most patients within the first few days following surgery.

The therapist focuses on helping to increase the knee’s range of motion with bending

Exercises. You will also be building strength in the knee and muscles of the leg. Often

The CPM machine is continued at a higher degree of bend.

Walking.

It is imperative that you get up and begin moving as soon as possible. This ambulatory

Activity helps prevent clots and speed your recovery. With the help of the therapist and

Nurses, you should be able to get from the bed to a chair(transfer) at least once or twice a

Day. You will eventually be able to transfer with  your crutches or walker.

THREE TO FOUR DAYS AFTER SURGERY

Your physical therapy will continue, except you will practice becoming more independent

In your exercises, transfers from bed to chair, stair climbing and other activities your

Therapist has designed for you. Your dressings will be changed, as well as your blood

Tested for coagulation.

Before you are discharged from the hospital, your physician and physical therapist will

Review instructions for your continuing care and exercises at home. You will be given

Prescriptions for medication you need.

LONG – TERM CARE OF YOUR KNEE.

Your knee replacement should give you years of service. You can protect it by taking

A few simple steps:

Watch for and prevent infection.

Because your new knee is sensitive to infections, you must be diligent about preventing

Them. You may need to take antibiotics before seeing the dentist. If you suspect a bacterial

Infection of any kind, notify your physician right away.

Follow-up care. When you leave the hospital,you will be given a schedule of follow-up visits.

These visits will ensure the long-term success of your operation. Your physician may want to

Check you several times during the first year and annually thereafter. Often,follow-up

X-rays will confirm proper placement and alignment of the implant.

Weight control.  Keeping your weight under control will reduce the amount of pressure

And stress on your new knee. Avoid high-impact sports and  participate regularly in low

-impact activities such as walking, swimming, golfing, or cycling. These are excellent

Ways to strengthen your new knee and get the exercise you need to stay fit.

I hope the information was useful and pass it on to your friends and people who need it

Warm Regards

Chockalingam

Rich but poor, Upper class citizens be ware! the Sunshine Vitamin

Rich but poor can be a theme, but i shall limit in this blog to one aspect.

Vitamins as we know are food nutrients which are needed in small quantity but are important in functions of the key organs of our body. Vitamins are named by English Alphabets such as A, B, C and so on.



Among these vitamins, Vitamin D is unique in that it is synthesized in the body and effects the function of organs and technically a hormone.

The synthesis is done in the skin when exposed to sunlight and hence the condition of the skin, exposure of enough of our skin to sunlight for adequate amount of time is essential. Otherwise we rely on the food sources.

When we move up in our class of society, we tend to believe that the food would be rich in all these vitamins and hence we would not need supplements.

However moving up in the class of society also entails living in air conditioned houses, leaving for work in Cars, and not getting enough sunlight.

Surprisingly, Vitmain D testing among this class of middle and upper class citizens reveal that the deficiency is rife and needs attention.

We also found that some of the patients have toxic levels of Vitamin D as they are consuming the so called health foods in abundance.

All you need is enough sunshine in our life!



Many singers have written and sung on sunshine in our life

Dont let the sun go down on me as George Michael and Elton John!

There is enough sunshine outside in India but let it shine on us at least half an hour a day.

I am told that the darker you are, more sun needs to shine for our Vitamin D

Remember Vitamin D is called SunShine Vitamin as there are sunshine States in US and Australia



Warm Regards

Chockalingam