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Sunday, January 27, 2013

Ortho Questions Part 3: Patients queries answered


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 # 11:


Can a low back ache person (L3~L5) practice swimming. If yes, what are the pre‐cautions to be taken?

Yes is the answer, avoid breast stroke if in acute pain. Otherwise need not worry.


Question # 12:
I was a regular runner and sports person right from my school days, was active till my college days. Later I continued
exercising in gym and run in almost all terrain surfaces ( Uphill, ground, beach, and tread mill) I had even participated in
Marathon running until 2010, later I developed pain in my knees which use to be acute with little swelling in between
knee bones. Without running or exercise the swelling and pain gets reduced and aggravates slowly when I continue. And
now without any treatment I haven’t got any pain for last few months. Kindly requesting clarity on what would have
been the cause for above said symptoms and any best way to deal with it to continue my running.

Answer: 
You have not mentioned your age. Osteo arthritis of knee is very common as one grows old; typically pain comes after
prolonged activity or rest. Consult an Ortho Surgeon who would be able to assess and give you an answer.
Question # 13:
My Sister, aged 30yrs. Is having Extra bone Growth at Feet (Heel). Doctors saying there is no cure. She is suffering from
severe pain. What is the Cure?
Please refer to the answer to question 2. Injection to the heel by a trained Ortho Surgeon can be considered if in severe
pain after following the treatment methods mentioned in the answer to question 2

Question # 14:

Attached herewith please find my Hinduja Hospital scanned copy Reports wherein I have done my Vitamin D & BMD
Tests. My Ortho Doctor  has prescribed the following medicines to be consumed:‐
1. Gemfos‐35, once a week, daily after breakfast for 4 weeks.
2. Bio‐D3 Mox to be taken once daily after breakfast for 10 days.
Kindly advise me the extent of Calcium level in my body & what treatment. Should I take for my calcium level to be
normal in my body/bones?

Answer:
Calcium is controlled strictly by vitamin D and hormones. Measurement of calcium is done in blood and will be normal in
most situations. However Calcium in the bone can be deficient due to vitamin D deficiency and you are already on
treatment for the same.
Table 2: Selected Food Sources of Calcium [2]
Food
Milligrams (mg)
per serving Percent DV*
Yogurt, plain, low fat, 8 ounces 415 42
Mozzarella, part skim, 1.5 ounces 333 33
Sardines, canned in oil, with bones, 3 ounces 325 33
Yogurt, fruit, low fat, 8 ounces 313–384 31–38
Cheddar cheese, 1.5 ounces 307 31
Milk, nonfat, 8 ounces** 299 30
Soymilk, calcium‐fortified, 8 ounces 299 30
Milk, reduced‐fat (2% milk fat), 8 ounces 293 29
Milk, buttermilk, low‐fat, 8 ounces 284 28
Milk, whole (3.25% milk fat), 8 ounces 276 28
Orange juice, calcium‐fortified, 6 ounces 261 26
Tofu, firm, made with calcium sulfate, ½ cup*** 253 25
Salmon, pink, canned, solids with bone, 3 ounces 181 18
Cottage cheese, 1% milk fat, 1 cup 138 14
Tofu, soft, made with calcium sulfate, ½ cup*** 138 14
Ready‐to‐eat cereal, calcium‐fortified, 1 cup 100–1,000 10–100
Frozen yogurt, vanilla, soft serve, ½ cup 103 10
Turnip greens, fresh, boiled, ½ cup 99 10
Kale, raw, chopped, 1 cup 100 10
Kale, fresh, cooked, 1 cup 94 9
Ice cream, vanilla, ½ cup 84 8
Chinese cabbage, bok choi, raw, shredded, 1 cup 74 7
Bread, white, 1 slice 73 7
Pudding, chocolate, ready to eat, refrigerated, 4 ounces 55 6
Tortilla, corn, ready‐to‐bake/fry, one 6" diameter 46 5
Tortilla, flour, ready‐to‐bake/fry, one 6" diameter 32 3
Sour cream, reduced fat, cultured, 2 tablespoons 31 3
Bread, whole‐wheat, 1 slice 30 3
Broccoli, raw, ½ cup 21 2
Cheese, cream, regular, 1 tablespoon 14 1
* DV = Daily Value.

Question # 15:
My father was suffering from knee pain since 2 years. 6 months back it was diagnosed that there was pus inside the
knee. Finally pus was removed by the doctor. But till this time he is not able to walk without support. He is diabetic.
What precaution he must take? Is it required, the knee replacement or there are any other ways for healing.
My mother is also suffering from the similar problem but she complains the stinging pain mostly in her legs and back. I
have consulted several doctors for my mother but they end up giving pain killers. The root cause of the problem is
not diagnosed. Please give me some idea what could be the real cause of the problem and what tests to make in order
to diagnose the problem.

Answer: 

Your father having pus in the joint is fairly uncommon. Pseudo gout with wear and tear of the knee can mimic pus in the

joint. If he indeed had infection in the knee joint, then total knee replacement is contraindicated. Hence please confirm
with the surgeon who treats your father on the exact diagnosis. Your mother, please consult a neurologist for the
shooting pain down the back and the legs. It may be sciatica and some medicines and some physiotherapy would help. If
the symptoms do not resolve, then further investigations such as MRI of the back may be indicated, then you need to
consult an ortho surgeon or a neurosurgeon who deals with spine.