Sky, Wind, Water ,Earth,and Sun.Are they Really Gods?. The trekking trip which teaches Spiritualism.

Man controls most things on the planet. Yes. He can tame an elephant, hunt a tiger [of course not now], Get a lion to a circus [ of course not now], put the snake into a park say the snake park in Chennai.

He does control other human beings, either as a business man, politician, sales man, a doctor and so on and so forth. He beats his fellow humans in sports and in war and even kill them.

He can build buildings as tall as he can at present and keeps beating the other like a game.He builds computers which are powerful and controls them to what they can do and what they should not [ of course for the time being]

He can fly [ of course in an aeroplane], swim and so on.

What is he cannot control something. They must be Gods.

When we did this 7km trekking up the hill near Thuraiyur to an altitude of one Km, you see the awe of the sun, wind, earth, the water and the sky and you really start wondering what i had titled this blog

Are they really Gods?

You may not want to name them Gods, but certainly something you can say that they have something which we cannot achieve or control or tame as you do for an elephant perhaps

Spritualistic, you may say. but does that not make you think. If you are not convinced, then take up a challenge to trek high[ of course you cannot do the same to the bottom of the ocean]

I will post some photos soon

With Regards

Chockalingam

Excellence is merely a habit. Accountability is the key however for this to be true.

Excellence is merely a habit. Surprised!.

suppose you need to clean the floor in the work place regularly and that is your job. Then you have the knowledge that a clean floor is beneficial to all of us and reduces problems with the health of all us. you also know which agents you use to clean and the materials you need to use to do the job well.

You have acquired the skill to clean the floor well.

the third attribute would be the right attitude. in other words if you do not feel the conscience that doing your job regularly and well is essential, then having the knowledge and the skill to do do not matter at all.

We need to add repetition of this work day and night consistently, then you are excellent. In other words doing a job once and well does not, i repeat does not denote excellence. Only if you repeat the work consistently to high standards, then excellence comes.


If one does a work consistently well everytime he does, then excellence is merely a habit, agreed!!!


But remember we need to add the responsibility that this job is our own is the key to consistency.Only when you assign responsibility to a person, one can expect consistency. However if one does not accept responsibility, then he does not take ownership.

If one does not want to take the ownership of a job or the work to be done, then it is difficult to get the consistency. In other words, if ownership is not assigned, then the responsibility is not transparent to the individual at work.

Then one cannot be made accountable for the excellence or the absence of it in that work.

Accountability has been the central theme to improvement at any work place. To be accountable, one need to do do the job well but also keep a record of this.

now how do we apply to our day to day life, you might ask

You do see that most rest rooms as they call it now a days, are cleaned regularly many times in a day and also a display is done to show that they are indeed cleaned with the name of the person who has done so with the signature. This is what is called accountability.

If a toilet cleaning is made accountable, imagine all things and works which should be made accountable!!!!

Keep in Touch

With Regards

Chockalingam

Why people do not follow rules, the psychology of anti social behaviour and its impact to a common man Part 2

We are in the process of treating a young man who was run over by a lorry. We had to amputate his leg to save his life. His leg was crushed and with in few hours, he as gone to renal failure. We had three patients in short succession of time with road traffic accidents with similar mechanism of injury. The pillion driver of the two wheeler is run over by a lorry.

When you drive in a car, you often do not give due consideration to a two wheeler on the same road. The same applies if you are a lorry driver, you do not worry about the car and so on and so forth. You would think then that the pedestrian or the person on the smaller vehicle will be very careful so that he/she does not get hurt

But the opposite is often the case. Here the person on the smaller vehicle or the pedestrian feels that he has the right of the way. Often he/she does not obey the traffic rules and still feels that what he has done is right.

Now coming back to the person on the two wheeler who got hit by the bus from the last blog. He was behind a smaller vehicle and gave due consideration to the traffic light and stopped when it was red.

The bus behind did not think it was necessary to stop at the red light and decided to drive on, but in the process hit our patient who stopped.

It does now begin to puzzle you to understand the psychology of what is right in a given situation. Should you follow rules, but might get hit in the process. Or should you follow the herd and live like a Roman in Rome.

Now what can be termed anti social. Like stopping at red light and get hit by the bus behind. it could be still within law but may be anti social. Or one might break the law like crossing a traffic light when it is red for example, but within the social norms of the day and the place you are living

Interesting

Going back to the run over incidents in India, the crush is so severe that people lose limbs. Be Very Careful if you drive a two wheeler in India, as you would not know whether the person behind the other vehicle would behave. Anti social, within the law, break the law but within the social norms of driving in India!!!!1

Hope you got the gist of it

Regards

Chockalingam

Why people do not follow rules, the psychology of anti social behaviour and its impact to a common man

Imagine you travelling at night driving a car, you come across a red light at traffic junction. You are the only vehicle at this junction and you are tempted to stop due to the fact that it is red. You look well across all directions. Definitely there is no other vehicle. You then are tempted to go past the red light. If you know that there can be traffic cameras and you might receive a letter with fine and points on your license, then you suppress the temptation of crossing the red light, as you know it is only few seconds before it goes green.

The scenario i have given is a common sense approach. Even though the common sense tells you to override the red signal as there are no traffic, the regulatory fear of traffic camera stops you doing so.

If you had read my previous blog of hazard, risk and incident, then you understand that another moving vehicle or pedestrian is the hazard for you in the car. The risk is very low as it is middle of the night and you reduce the risk by looking well all around. you think the chance of an incident of an accident is so low that you want to take the chance and you are tempted to cross at the red signal.

As the society does not want you to take even that chance, the traffic camera makes you decide to stop.

But then this logic does not seem to work in India while you are driving. One of my patient i am treating at the moment is a handicapped polio patient who was driving a two wheeler. he came to a traffic signal where the signal was red. he duly followed the above logic and decided to stop.
He then landed at our hospital with a fracture of the leg and shoulder.

Why? Why and Why ! these are the questions he asked me and you are probably asking as well

Wait for my blog and i am sure if you are driving in India you already know why

Regards

Chockalingam

Risk, Hazard and Incident, apply to your work place wherever you are!! part 2

Hazards are everywhere. A knife is a hazard. A needle in a hospital is a hazard. A gun is a hazard. Everyone of what i have given as examples are necessary in some walk of life.

In Other Words, We cannot have a hospital without a knife or a needle as they are needed to treat a patient. A Gun is an essential tool for someone working in the army or high security police for example.

However if the hazard is in a persons hand's or at a time or in an situation where it is not expected to be, then the hazard can cause an incident. For example a kitchen knife in a child's hand, a gun in the hands of anti social, or water on a mosaic or marble floor.

However not every time the hazard is in this situation will cause an incident. There you have to calculate the risk of such an incident. For example not every time you travel in a road, one is involved in an accident. you have to view every object in the line of your travel such as a bus, lorry or even a dog on the road as hazard.

When travelling, you take a risk by crossing these hazards to reach your destination. You minimise the risk by driving slowly, taking extra care at nights, not drinking alcohol before you drive and so forth.

However you do not want to take any risks in some areas such as not giving a knife to a child as the risk though may be small, is too much to take.

Back to wherever you work, you start looking at things with a note of

1. Are there hazards
2. What is the exposure
3 What is the risk
4 Should i take the risk or not
5. Can i reduce the risk or avoid the risk altogether by avoiding the exposure altogether

Hope it makes sense

It would certainly make sense if you start applying.

You then ask the cleaner to put a notice that the floor is wet when he is cleaning to warn the people walking by that there is a small risk of falling and they have to walk more carefully.

All of us would put our waste in a bin and dispose appropriately to reduce the breeding of bugs which then would cause infection and so on and so forth

Regards

Chockalingam

Risk, Hazard and Incident, apply to your work place wherever you are!!

Incident is an event or occurance. We talk of incidents as unplanned or unexpected events in a hospital set up. We record them diligently and analyse them to ensure such events do not recur for improvement of patient care.

Patients in India always ask me one thing when i suggest a treatment say for example surgery. It is this " risk onnum illiye" meaning "there is no risk in this, is there?". Once i had explained infection as one of the risks in treating a fracture to one of the wife of a patient who had treatment under me.

At two weeks when the sutures were being removed, the wife asked me with real worry "there is no infection, is there?". One has to remember that this wife was one of the staff member of my hospital itself. Now the point of matter is no one wants to take a risk in undergoing a treatment.

Yet treatment has risks. If someone tells you that there is no risk, what they are really doing is to reassure you as an worried patient or relative. They cannot really mean it. Yes this is true.

It is true in real life in all walks of life and in all situations. If you look at travelling in a road in India, you carry huge risk of having an accident. Does this mean that you do not travel and stay in the house all the time. No you do travel and you take risks.

But what then is the issue. It is in knowing the risk analysis of a situation. In other words, if somehow you know how much risk you are taking, then you may decide, yes it is worth it or not.

Is quantification alone enough?. What would you accept for example, one percent, five percent or less? Because the reason you are taking the risk may push you to take a larger than five percent risk as opposed to taking less

Say for Example, one has cancer and the surgeon says, have surgery. The surgery carries risk, but then not having surgery carries far greater risk. Hence one goes with the option of having surgery.

But what can everyone do in a place wherever they are. You control the risk by being aware of the hazards and avoid the exposure. If you cannot avoid then control the dose of exposure

Stay with me and
I will post in my next blog

Regards

Chockalingam

" Process over Outcome". the importance in life in general and campaign for it

Recently We went to a temple in Tamil Nadu. This experience made me think about the above subject. Going to temple is one of the main events in India. The process though is for pilgrimage to see their favorite God, can also be seen as a break from work combined with visit to offer your prayers. . Hence apart from the holistic aspect, the trip should be relaxing and comfortable with safe travel and good food.

However if you have been at the site of such pilgrimage, the converse is often true. Unless you know someone who can get you to the front of the Deity by bypassing the queues, it is taxing and tiring. The stay and surroundings of a pilgrimage are not hygienic by any standards. In other words, such a trip can rarely be pleasing to your mind or body apart from the time you spend in front of the Deity of course.

Today, everyone is interested in the outcome.Like seeing your favorite God and praying in front of the Deity. You can see this importance given in day to day life. You go to the personal improvement section in libraries and book stalls, there is so much emphasis on achieving the best in life or something!

Are we then forgetting that Life is there to live as much as achieving something. The process you go through to achieve what you want should also be considered. I feel that the generations of today are concentrating on the achievement of money, fame and lose life on the way. I often say that a generation which do not see the sun light is what we are seeing today. Like spending time in front of the computers all the time!

Is this the reason why everyone is rushing day and day out. I see people speeding in India may be partly due to this attitude. They are always in a rush running somewhere, but never enjoying the process. In doing so, they miss the process which gives importance to comfort, hygeine and sanitation and safety at large.

Hence we should campaign for The Process as opposed to just the Outcome whatever we are doing. Now if you have read my previous blog on the AC mechanic who came to fit my AC did not have the right tools to fit it, then you realise that he can fit an AC and complete the job. However he never concentrated on the process and hence does not concentrate on what he needs to do the job.

or the man in one of my previous blogs who lost the leg by travelling in an already fully loaded auto and rolled over!

Process over the Outcome should be your personal campaign and if everyone does so, the world would be a better place to live.

as "Dolly Parton sings in her song"

I can elaborate more in the future as this blog can be confusing and i am editing to make this more clear.

Regards

Chockalingam

Seat Belts in Coaches[ buses], campaign for this in India and safety for our future generation.

I treated a patient with an elbow injury. he was one of the survivors of a bus which fell off a bridge and rolled over. there were few who died in the accident. you have to remember the death is often due to the passengers rolling inside the bus like the object inside the rattle

the object inside is the passenger and the cage is the bus. you can also see this video in youtube

watch this video

http://www.youtube.com/watch?v=UthhJLekANU

now this is the time for us to campaign for seat belt to be worn in the cars but more importantly to campaign for the new buses manufactured for long distance travel to be fitted with seat belts.

UK had made it mandatory for all new buses and coaches manufactured after 2001 to be fitted with seat belts. In India we are crying for all the need for more buses, good roads and we are getting both. But we are forgetting that safety has to be considered when more buses are on the good roads speeding to more destinations.

you will know what i am talking of if you travel at night on the national highways. the number of omni buses are so many and it takes one accident for all of us to realise this.

Oops, this has already happened. a reputed coach service was involved in this and then you really wonder that the time has already come for us to campaign for safer buses and public transport.

http://www.thehindu.com/news/national/article2087173.ece

Many would go for public transport for comfort and safety other than their own cars.

Hence let us lobby for coaches with seat belt and restrainers. We are already ten years behind UK in this issue


Chockalingam

Drive and be alive in India: follow the two second rule

In India, everyone seems to be rushing. The people are rushing while walking, driving a two wheeler, or three or a four wheeler or an eight wheeler. They must be going to do something very urgent, may be save someone from dying perhaps!!. But they do not know that they themselves need saving with the way they are going on public path and roads.

Yesterday we had a passenger in an auto which overturned with four passengers on board just because the driver was crazy. the injured passenger had the auto landed on his leg and as a result we took off the dead leg, amputated. no fault of his own but the driver who thought he can negotiate a corner without slowing the vehicle and forgetting that it has only three wheels!

Not many educated people know about the safe distance they have to follow when driving. The best and practical tip is to follow the two second rule. It is described well and you can eve do three second rule when driving in wet and rainy times.

go to this site to get general idea

http://en.wikipedia.org/wiki/Two-second_rule

for pictorial description

http://www.rulesoftheroad.ie/rules-for-driving/speed-limits/speed-limits_2-second-rule.html


If you can maintain two seconds from the vehicle in front and let all the drivers who are behind you and too close to pass by, the chances of being alive at the end of your driving is good, but not guaranteed.

let us ensure more of our friends and families follow the rule and one day eventually Driving in India would be safe! one can only hope, but not without trying, eh!!!


With best regards

Chockalingam

"You are what you eat": importance of diet, how to relate money and savings to diet

I say to my patients, to understand weight loss and methods, simply do opposite to what you do when you save money in banking. I hope this article puts this in perspective.

The phrase "You are what you eat" is a decent way of saying "you are what you put in your mouth". The latter phrase can make people who are obese or overweight cry but it does make sense. One of my friend and colleagues in UK used to say this latter phrase when advising on the risk factors of overweight.

When you want quick access to your money, you leave some funds in the current account. . You put your salary or income in this account. you keep only enough money to keep you afloat in the current account. You keep a reserve account, called savings account where you save a larger amount which you can transfer quickly to the current account when necessary.

Where you think you have surplus money for the time being, you look for investments, assets and shares. The money you save in these methods, will not be available for you straight away. you need to mobilise them to realise the money to the savings or the current account. In other words, it will take time.

Now compare this scenario in banking to how your food is sorted once we consume.

Blood glucose is the current account
Liver, muscles acts as the savings account[ glycogen]
Fat acts as the investment account equivalent.[fat]

Weight gain and loss is exactly the same process of banking when you think of carbohydrate we consume. The carbohydrate we consume, namely the rice and wheat first goes to the current account. There is surplus of glucose, to what is needed for the brain, the kidneys and the muscle and all the nerves in the form of ATP. Some amount of blood glucose is put in the savings account, namely the liver and muscle as glycogen.

When there is lot more food consumed in the form of glucose, they are converted to fat and stored in various sites like our belly. Rightly or wrongly they can be termed as our asset or the investment.

But in fact we should plan our glucose consumption completely the opposite way to how we do banking as i had compared.

We need to earn less
so that we only have money for the current account and savings account
In turn we can mobilise our fat reserves in our assets and investment account to empty them.

Sounds Drastic in banking terms, does it not!. But this is true for our glucose metabolism.

Consume less glucose
so that we have only reserves in liver, muscles
In turn we can mobilise our fat reserves in our bellies and other parts of our body to empty them

The above picture shows how we can plan this. remember the base of the pyramid is still the glucose base of our diet. Hence do not starve to reduce weight, instead have more servings but less in amount

please go to this link if you want to learn more

http://www.medbio.info/Horn/Time%201-2/carbohydrate_metabolism.htm

or even better

http://www.health.gov/dietaryguidelines/dga2000/document/contents.htm

as the authors of the above link say

"Aim....Build....Choose for Good Health"
Regards

Chockalingam

Road Traffic Accident Prevention, A common Man's Hippocratic Oath

I am sorry about the pictures and unfortunately this is the reality in India

These are the rules one can try to follow in India

Let us make an Oath

I will always wear a seat belt when I travel in a car

I will always wear a helmet when riding a bike

I will always walk on the opposite side of traffic so that the on coming vehicles can clearly see me

I will never cross the road in front of a moving vehicle,because

I will never trust the driver on the road

I remember using a vehicle is for comfort of travel and not to reach quickly

I will not travel at night unless it is an emergency

I will never drive in the opposite lane of a road

I will always use public transport where it is practical and not use my vehicle

I will never drive close to the vehicle ahead, equally

I will make sure the vehicle behind is not too close to me, because

I will always leave racing drivers to overtake me [get away from danger]

I will reduce the speed when there is traffic and vice versa.

More rules to follow

I will go through the traffic signs and teach more people and friends and families

please go to this web site which teaches more traffic signs for Indian Driving Conditions

http://www.indiandrivingschools.com/road-traffic-signs-signals.html

Regards

Chockalingam

Arthroscopic Surgery at our KMC Speciality Hospital, Trichy, India: Key hole surgery

This is the article published in KMC News 2010

Arthroscopic surgery [Key hole Surgery] at our KMC Specialty hospital
Dr S Chockalingam FRCS, FRCS [Trauma and Ortho]

Joint replacements have now become the standard of care for advanced arthritis. These joint replacement surgeries for arthritis of knee, hip and shoulder have become common at our hospitals. The less known treatment method for joint pain in younger individuals will be discussed in this article.

This less known treatment method namely arthroscopic treatment for joint pain is now increasingly used in our city as in the Western world. An arthroscope is a telescope,[ type of endoscope] the size of a pen when introduced into the joint, helps us to evaluate the joint and introduce instruments to repair or remove the injured structures

Professor Kenji Takagi in Tokyo used a cystoscope back in 1919 to look inside the joint. Eugen Bircher a Swiss Politician/Army Physician is considered as the father of arthroscope where he used a thoracolaparascope to view the joint. Japanese surgeon Masaki Watanabe gets the credit for using arthroscopes for interventional procedures rather than for merely diagnosing the problems.

Advances in the fiber optics in the 1970s and 1980s have now helped to the current design of these arthroscopes which come in various small sizes for various joints. We now have this facility to treat joint problems and I have shown the use of this surgical technique in managing joint problems at KMC Speciality hospital

The following conditions are some of the patients who have been treated at KMC Speciality hospital with our state of the art instruments using this technique.
1. Diagnosis of unexplained knee pain where Tuberculous synovitis, synovial chondromatosis and other conditions and treatment of septic arthritis of all joints.
2. Meniscal tears:This is one of the commonest indication for this procedure. Even though sports injury is a common mechanism of these meniscal tears, it is fairly common in middle aged women and men in India.
3. Cruciate ligament tears. Ligament reconstruction of the anterior cruciate ligament done through this minimally invasive technique has perfected this reconstruction
4. Shoulder pathologies. The shoulder is only second to the knee in the numbers where this technique is being used here at our hospital. Decompression of the subacromial space and Shoulders that dislocate repeatedly are common indications
5. Ankle and other joint pathologies. So far we have treated variety of pathologies with this minimally invasive technique at KMC


Regards

Chockalingam

Bikes, Nature and Relaxation and health

I recently became a member of a group which enjoys trekking. Though i have not done a trekking expedition with the group so far, i did a bike ride. The ride was in the lower most fragmented Eastern Ghats called Pachai Malai hills. Nature beats you to anything we can build!

The nature included hills, valleys, trees, falls. It is astonishing to see the nature close to it on foot and closest to reach there is the bike. there are areas in this stretch where car is not the best way to see and by foot it would take a long time.

Time is something we find difficult to get hold of, and bikes make it easier to save some of this precious item. I got hold of Yamaha RX 100 which reminded me of post MBBS days when one of my dear friends had this bike.

I liked this bike more than the Hero Honda which we had ourselves. The Yamaha give you the thrill of acceleration though it did not have the power of the newer bikes trying to negotiate the hills with a pillion rider.

Negotiating the hills gave the pleasure partly due to the bike itself and mostly it was relaxing. we would have stopped in few places where the sceneries were breathtaking. Whereas in other areas simply we stopped since it was idyllic or should i say serene!

Relaxation is one of the areas to give the mind and the brain a chance to recuperate.

answers.google.com/answers/threadview?id=513495



The above link mentions that we have 7 thoughts per second and it certainly taxing if you are on the job where decisions are made such as my profession of being a doctor. The decisions are often involve well being of others and you take the responsibility.

Mental health is a prerequisite to physical health. A relaxed mind is a prerequisite to mental health. If a bike ride in the hills close to the nature is what it takes, go on make it!

I have done already!

if u want to know more of bikes in India go and visit

www.myindiaguide.com/bikes/bajaj/bajaj-avenger-220.html


and this is my favourite bike

Warm Regards

Chockalingam

Arthroscopy surgery at Trichy to cure joint problems of knee, shoulder and other joints

Sports Injury Service and Advanced Arthorscopic Surgery Service At KMC Speciality Hospital

Sports is becoming more of a passion as much as a hobby in our Country. Winning World level events has attracted more of our young boys and girls to partake in sports and even take this as their profession. As each profession carries its risks, sports poses us the biggest risk to these young generation in the form of injuries.

Injuries in sports mostly affect the musculoskeletal system. The muscles, tendons, bones and the joints are the components of this system. The joints are complex structures having cartilage, ligaments attached to the bone through soft tissues.

Most sports injuries are managed initially with the following fundamental principles. Remember the mnemonic RICE whenever one gets injured. Rest the injured part, apply Ice, apply Compression and Elevate the injured part. The practice of applying warmth in the form of hot water pack/bottle to the injured part is not recommended.

Physiotherapists either at the sports arena or at the hospital can treat majority of minor injuries to the muscles and tendons. The spasm associated with the muscle and tendon injuries can be treated with stretching and local treatment as described above. Some of these injuries especially the minor ligament injuries need rehabilitation by attending a dedicated physiotherapy department.

KMC Speciality Hospital has a dedicated Physiotherapy department to treat these injuries. The devices available in the department cover all areas of the body. They are designed to treat with mobilisation, stabilisation and retraining.
Though the initial pain and suffering improve with these simple measures and physiotherapy treatment, the long term recovery depends on detection and treatment of major injuries. These major injuries often feel like minor injuries after rehabilitation. However the key to return to sports and normality relies on recognising these as needing further treatment.

Hence we need experts who can diagnose and be able to treat them with the modern treatment methods. At KMC Speciality Hospital, we have surgeons trained and practiced abroad in treating these injuries. Treating them with modern treatment methods practiced in western countries is the key for getting back to normality.

Modern methods of treatment of the sports injuries often involve keyhole surgery to the joints. This is called Arthroscopic Surgery. Arthroscopy started as far as back in 1910s, though the treatment with this technique was possible after 1970s in Japan.

The Advanced Ortho Care at KMC Speciality Hospital has a dedicated state of the art High Definition Arthroscope with HD monitor for excellent visualisation and treatment of the injured part. The supportive power instruments, electronically controlled pump system and Radiofrequency Ablation techniques are at par with the most advanced hospitals in the world.

The problems, which can be treated with these Arthroscopic techniques, are many and can only be listed as a guide as follows.
1. Cartilage injuries of the knee: Meniscus Injuries in the knee and Wrist cartilage injuries
2. Ligament Injuries: Anterior and Posterior Cruciate Ligament Injuries in the knee
3. Tendon injuries of the muscles in the shoulder: Rotator Cuff Injuries and SLAP lesions
4. Recurrent Dislocations: Dislocations of the shoulder and kneecap, which often recur in young sports people
5. Recurrent and persistent pain in joints: Impingement of the joints, which affect mostly shoulders, ankles and elbow
6. Post trauma stiffness of the joints
7. Instabilities of the joints: shoulders and ankles
8. Infections of joints
9. Arthroscopic fusions of joints especially ankle


Some of the other Advanced Ortho treatment Methods provided at KMC Speciality Hospital are as follows
1. Joint Replacements of Knee, Hip, Shoulder, Elbow and Ankle using imported implants with international standards [Swedish, UK and Australian Standard]
2. Partial joint replacements with implants originating from Oxford,UK.
3. World Class treatment methods of simple and major Trauma using principles of international Swiss [AO] and American Standards [ATLS]
4. Treatment of deformities in Children with Ponseti Method [Canada]
5. Treatment of complex trauma and deformities using Russian Technique [Ilizarov technique]
6. Treatment of Fractures in Children using French Technique [Nancy]

Doctors Day India: Modern Technology of Arthroscopic Surgery for joint problems in Trichy

Pain Relief with Modern Technology at our doorstep: Key hole surgery to the Joints [Arthroscopy]
Dr S Chockalingam
Pain is highly unpleasant physical sensation caused by illness or injury, according to Oxford Dictionary. Joint pain not only causes this unpleasant sensation, but also disables a patient. Inability to do walk, sit, squat or wash ourselves without pain is quite common among us; often we do not like to talk about them.
We attribute lot of these inabilities to our age, illness such as diabetes or arthritis. Yet most of these problems are mechanical problems of our joints and the surrounding tissues. Tendonitis, ligament injuries and cartilage problems which affect so much of our sports stars, do not leave the rest of us from causing pain and disability.
These mechanical problems causing disabilities to our knees and shoulders are very common. Technology comes to our rescue in recognizing and correctly solving these problems. Arthroscopy of the joints help us to bring the benefits of key hole treatment like laparoscopy.
Arthroscopy is the key hole surgery to most joints in our body to provide treatment with advanced equipment. This treatment reduces discomfort to the patients, increases the accuracy of surgical technique and hence often relieves a patient’s disability to return them to normality.
The technical expertise in providing such a specialized treatment is more important than the equipment itself

. The message I would like to leave on this Doctors’ Day is to “commend the efforts by the doctors who strive to provide the best to our patients by bringing the modern technology right to our doorsteps to alleviate our pain and disability”.

Chest Injuries in trauma: The major killer in India after road traffic accidents: Seat belt should be worn in cars and buses

Breathing and Chest Trauma

Dr S Chockalingam

One of the major killer injuries is Chest Trauma. In fact the chest trauma is the commonest killer for a driver behind a steering wheel especially when not wearing a seat belt. Chest trauma is one of the injuries, which is treatable in a patient who can reach a hospital alive. Appropriate treatment can save many lives if recognised promptly. This appropriate treatment is often a simple intervention as opposed to a thoracotomy. Any doctor irrespective of their specialist interest should safely perform these simple interventions.

The following content focuses briefly on the essential anatomy, physiology of the chest. The main focus is then on recognising these injuries and acting swiftly to save one’s life. Early recognition of these injuries will also help in preventing late deaths.


Essential Anatomy:

The Chest is comprised of the lungs and pleural cavity, heart and pericardium, mediastinum and its contents, chest wall with the ribs and the muscles, diaphragm.

Essential Physiology:

The function of the chest is mainly two fold, gas exchange chamber and a safe haven for the heart and major vessels.

1.The lungs with the bronchial tree and alveoli function as gas exchange chamber. Oxygen gets in to the circulation and CO2 is excreted. The Chest Wall with the pleural cavity and the diaphragm acts as the motor behind to facilitate the gas exchange.

2. A safe place to keep the important organ, the heart and the main blood vessels.

Recognition and treatment of the chest injuries:

In our Medical School, we are taught the art of clinical Medicine. These would be taking a detailed history, thorough examination and ordering appropriate investigations before instituting treatment. The management of trauma is a clear exception to this approach. Hence we have to recognise the injuries and treatment the life threatening injuries before proceeding to the next step. This is most appropriate in chest trauma.



Recognition of Chest Injuries:


A patient who had trauma should always have the primary survey starting with

Ensuring a patent Airway with Cervical Spine Protection before moving on to the chest injuries. The injuries to the airway presents with similar features to the chest injuries. Airway obstruction with
1. Strider
2. Inability to talk
3. Broken tooth
4. Secretions in the pharynx
5. Gross swelling of the neck

Should be managed before moving on to the chest injuries.

The recognition of the chest injuries is essentially two fold.

1. Assess the breathing
2. Assess the cardiac function

These are done by

1. Look
2. Feel
3. Percuss
4. Auscultate
5. Use adjuncts

Look:

1. Equal chest wall movements
2. Engorged veins in the neck
3. For open wounds
4. Abnormal chest wall movements

Feel:

1. Tenderness
2. Crepitus
3. For equal chest wall movements
4. Pulse rate
5. Tracheal position, midline or deviated



Percuss:

1. Hyper resonance
2. Dull note on percussion

Auscultate:

1. Air entry on both sides
2. Heart sounds
3. Abnormal sounds suggesting obstruction
4. Blood pressure

Adjuncts:

1. Pulse oximetry, Pulse, Blood Pressure assessments
2. Chest X ray
3. ECG

Serious Injuries to be recognised promptly:

1. Conditions which affect mainly breathing
a. Massive air collection around the lungs: massive pneumothorax
b. Massive blood collection around the lungs: massive hemothorax
c. Chest wall injuries leading to flail chest
d. Open chest wound with pneumothorax

2. Conditions which affect the heart and circulation

a. Massive blood collection around the heart: Cardiac Tamponade
b. Massive blood collection around the lungs: massive hemothorax


Treatment as you recognise these serious injuries

1. Needle decompression and chest drain for massive pneumothorax
2. Cover open wounds with air tight dressings immediately
3. Resuscitate with oxygen and blood prior to
4. Chest Drain for massive hemothorax
5. Ventilate with oxygen, ambo bag for flail chest before intubation
6. Needle decompression of pericardium in rare instances

The rest of the chest injuries can wait until we complete the primary survey and management of other major injuries.
Other Injuries, which will become life threatening in due course and hence should be recognised and treatment started. These are

1. Pneumothorax which is not massive
2. Hemothorax which is not massive
3. Major airway injury of tracheobronchial tree
4. Blunt injury to the heart
5. Major vessel injury such as aorta
6. Mediastinal often open injury
7. Injury to the diaphragm
8. Multiple rib fractures

Please remember the power cable for chest wall function is “the intercostals nerves and the phrenic nerve and the brain” ultimately. Hence any injury to the spinal cord, brain and the phrenic nerve will affect breathing even when the chest wall is not injured.

Summary

We have to be familiar with understanding of the following features associated with major chest injuries

When observing the patient

1. Chest pain and air hunger
2. Distress in breathing
3. Sucking open, but often-small wounds in the chest wall.
4. Flail chest

When eliciting the signs

5. Absent breath sounds
6. Engorged neck veins
7. Subcutaneous emphysema
8. Tachycardia and Hypotension
9. Deviated trachea
10. Muffled heart sounds
11. Cyanosis

When assessing with
12. Abnormal saturation with Pulse oximetry
13. Chest x ray abnormalities in trauma
14. ECG changes of blunt cardiac injury

The key message of this review on Chest Trauma is never underestimate these injuries as often these injuries kill a patient within few hours of injury and if not will adversely affect the outcome in the first few days of admission to the hospital

Innovation in Orthopaedics and at KMC Speciality Hospitals: 1. Epsom to Trichy: Chockalingam

This is a custom spica table for applying hip spicas in children. There are so many different methods to attach a support for the child when applying hip spicas. The best one i have used is one introduced by my predecessor and former Colleague Mr[Dr] Philip Cheong Leen. We worked at Epsom General Hospital,Epsom, Surrey, UK. This was simply a miniature iron board made of metal.

So the concept was not mine but to bring to my hospital, i felt it was necessary. I have done hip spicas for femoral fractures, DDH and so on. I gave the measurements and idea to our Theatre senior ODP Mr Jayaraj and he executed very well. What you then see is what the output of the carpenter at our hospital and painting was done aptly in a pink colour.

Regards


Chockalingam

Academic Input from chockalingam

This is the work output of nearly five years of working on knee replacements at Royal London Hospital, London on Freeman Samuelson Knees. I always treasure the time I spent with Mike Freeman and Gareth Scott

This is the work output of my association with Mike Bell, Senior Consultant Paediatric Orthopaedics at Sheffield. I will always cherish the training given by him in this area along with other consultants in UK

This is the work output of a case report on skin burns in Orthopaedics

5th June 2011: Sports Injuries and Advanced Arthroscopy Awareness meet Trichy

Since 2009 January, We have done more than 150 thereupatic Arthroscopic Surgeries. These include Knee Meniscal Surgery, meniscal repairs, Anterior and Posterior Cruciate Ligament Surgery, Shoulder Decompressions, Rotator Cuff repair and Stabilisation, Ankle , elbow and wrist thereupatic arthroscopies. the indications even included rare conditions such as arthroscopic treatment of intra articular hemangioma and removal of bomb shrapnels arthroscopically.

When such work is being done in a hospital in a city like Trichy, you feel for the people who are not aware of the facilities being available and hence this year we took Arthroscopic Surgery , in other words the key hole surgery to joints for awareness program.

Sports being increasingly taken up by the younger generation and road traffic accidents constantly presenting with joint injuries, we decided that this would be the time for us to promote the awareness.

Please go through the picture attached with the details of the awareness program and i will post few pictures as well

Regards

Chockalingam

Part 2:Doing a job vs completing a job: concept of professionalism and sincerity and how money clouds both.

When I went to pay the Electricity Bill in Trichy, there were four queues. I joined the first outer queue without giving any thought. Then I noticed the queue on the inner two queues moved swiftly and the outer queues did not move as fast as one would expect. The obvious inference anyone would make is that the persons at the desk serving the public are efficient in some counters and may be we joined the wrong queue.

But why should only the outer queues move slowly whereas the inner queues were otherwise. Chances! May be and they were not in this instance. The outer queues had constant disturbances with people getting in front by pushing themselves in. And also many people would simply give their cards and money to someone in the queue already to pay for them. Hence the person at the counter was doing as fast as the other counters but had too many transactions per person to handle.

Why I am elaborating this story so much? This is part two of my previous blog and completing a job. You can complete this job of paying the EB bill in many ways.

1. By properly standing in the queue: Be Sincere

2. You can squeeze in and pay the bill and be efficient in comparison to the one who is following the option 1. : Be Efficient

3. You can find ways to avoid the queue altogether, for example pay someone to pay for you and stand for you or log on to your account online and pay without a sweat, Be Professional.

Be efficient sounds good in option 2 but it is not acceptable to someone who stands in the queue sincerely. But be Professional sounds the best option since you find better way to do a job and acceptable and sounds right as well.

This brings me to the concept of Professionalism and Sincerity.

Though Sincerity sounds right in any thing you do, it may not be the efficient approach in competing a job. That is why Professionalism is much needed to combine sincerity and efficiency. This is why professionals score more and earn more for a given job. But you have to find professionals who show professionalism as opposed to efficiency by short cuts just like our example.

It can be difficult for anyone to differentiate the people who can complete the job efficiently as opposed to completing professionally. The latter approach may sometimes appear to take longer and costlier. I see more people who can complete a job without professionalism but efficently. In fact lots of jobs completed are done efficiently.

The efficient methods of following shortcuts are good if the outcome is for one off use or has a definite end point. For example paying an EB bill as above. But where it really hurts if the outcome has long term use. For example a building or a bridge. Here Efficiency has to give way for Professionalism. Because if you do not follow professionalism, then the lack of quality would show in the long run.

But you have to remember that everyone of us is a professional in what we do if we show professionalism.


Regards Chockalingam

Our Trichy: Status of Sanitation and Hygeine, the Conundrum of Free Lunch and one that is paid for.

State Welfare Schemes and Government Welfare schemes are addressed to take off some of the inequalities in the population of the state or the nation. This to my understanding is that taking off some of the inequalities would give the underprivileged a head start in the race to achieving a reasonable or good standard of living.

If the population themselves are expected to achieve these comforts or essentials, it might take a very long time and that person may never see the benefit in his life time. This is why the State or the Government Free Benefits should continue.

Then the state or the Government has to decide which are the essentials and in what priority they should be given. Throughout the World , the countries have been doing this free benefits in different models. We will take Health Care for Example.

In UK, the Government vows to provide good health care for its population by beefing up the government hospitals with facilities, technical expertise and so on. Hence if you have an emergency then you feel safer in a Government Hospital even if you are the Prime Minister of that Country. You can walk in to any Government Hospital in UK expecting a good standard of health care for free funded by the Government.

Whereas in USA, the private providers take up the majority of health care provision just like our country. However the Government does not want the underprivileged to be left with a bad deal. They provide health insurance for those who cannot afford themselves. So you can walk in to any hospital who accepts Government health insurance to get your health care for free, funded by the government.

When the Government decides to give health Insurance for people who cannot afford themselves, or cannot buy health insurance for themselves and their loved ones, then it is commendable act. When it decides to give more free benefits like an item like a Television or a Fan or a Grinder which they can use in day to day life, one starts questioning them.

But I feel the issue is not the free item which is given at present. Because to me and you who is reading the blog, a fan may be a comfort which we can acquire easily but not to everyone. What is more important however is "what is not given which is more urgent to the needy".

I had the opportunity to see Trichy from a different point of view. Point of View is quite true in its meaning in that i observed Trichy by foot as opposed to going in a AC car.

Working in a hospital in India, I was alarmed in the number of Gram negative infections in my patients. These are not just wound infections after surgery for example, but in chest infections where these organisms are found.

Where do these bugs come from? From the community outside and the air we breathe in. If the sanitation is so bad outside and you are going to get infected with these bugs, then what is the benefit of all the comforts you acquire either by earning for it or by the State Benefits.

What is the point of having a toilet built for public use and charging for the same. If I am one of those underprivileged, I would rather go and do my duties outside for free and avoid paying to do so in a public toilet.

If you do not get my point by now, then this is it. There is an urgent need for addressing the Sanitation and the Hygeine for the environment as a whole to improve the quality of everyone's life. If the Government decides to build free and many public toilets for example, then it could be the best initiative ever.

Then I am told this had been done before and not used in the villages nor in the towns commonly. But having walked for nearly three hours in Trichy where the so called underprivileged live, i noticed only on public toilet.

What the Government should do is

1.to ensure that there are these facilities everywhere and make them free.

2. There should be clear directions in every part of the city and the villages.

3. These facilities should be brought under the vigilance of the Health Department. The contractors who are maintaining these can be independent, but their annual quota of money allocated can be linked to the health department vigilance report on their status.

4. The Government should then advertise the facilities so heavily that anyone not using such a free facility will be frowned upon.

If you then find a member of public not using these free facilities, available everywhere,maintained to high standard but funded by the government, then one can start fining the public to ensure that the sanitation standards do not fall.

You cannot blame the common man for passing urine outside in India yet until the above facilities are in place. Until then the India which we know lives as two halves.

One where people can afford and pay for it and maintain good standards and enjoy comforts they want. The second would be the one where people not only do not have the essentials and do not have a choice in spoiling the environment for the first half as well as themselves.

This is exactly the reason why the first half should worry about the second half and not just walk over them. The second half do not need the pity but essentials in life to be provided to them until they can move up in the social ladder.

The most essential of all is the Sanitation and Hygeine and the so called underprivileged people will find ways to earn the rest. So back to Health care Provision for free, I hope to go to any city or village and able to do our essential morning duties for free, funded by our Government.

or will it be a John Lennon Song Imagine Scenario! Time only can tell us, Oh No, We do not have time, Remember time gone is already time lost. Read my previous blog on time and money.

Regards

Chockalingam

Doing a job vs completing a job: concept of professionalism and sincerity and how money clouds both.

Doing a job is standard practice in almost all our life. Not doing a job is not uncommon in some employed areas. In other words, we do see some people who get paid but actually not doing the job they are meant to do. It can be upsetting to people who do work well and get paid the same money or salary.

But the above scenario is not as frustrating as when someone does not do the job to completeness. It is like trying to fix a broken hinge by a repair man. We do across some scenarios where someone comes to the job but finds that he does not have the necessary tools. he leaves the site without completing the job at hand saying that he would come another day to complete the job.

The above scenario happened at our house when we recently fitted a new air conditioner unit. When the unit was delivered and the installation team came to our house, the installation team asked me to get the electrical wiring sorted out and they will complete the job in one hour after the wiring is sorted. They had inspected the site of the fitting and marked where the holes had to be drilled.

We duly called our trusted electrician who finished the wiring straightaway and no sweats!. We called the AC team back again. They started making the hole, they realised that a more powerful drill is needed as the wall is too thick. We asked them to sort it out. Oops!! there is a problem. they do not know how to get a more powerful drill.

We asked them to contact their office. Oops they do not know either. Then we spent next two days making phone calls to our carpenter and other friends who have done AC installation in their house. At the end we called our electrician back again, he did the hole straightaway and no sweats!

But the AC installation team have wasted our time for good two days. Remember the time is our precious commodity if you have read my previous blog.

Now you begin to understand that doing a job is different to completing a job. But wait, not completing a job is not the worst thing and wastage of our time.

Because completing a job can be achieved with different methods.

Take the above domestic scenario for example. The electrician who helped us for the AC installation not only had to complete the hole which was started by the AC team, but also had to correct the errors the AC team had made when they attempted the job. Now we bring the concept of Professionalism and sincerity.

Please wait for my next blog when it all makes sense.

"Time is our best gift to someone", use it in your life or lose it!!! . "Money and Time the Conundrum"

You work and spend your time to get money. One gets money to get the essentials in life and the comforts one can get. We also need money to gift someone you love. This can be in the form of food, clothes, education, assets as the gift to the someone you love. this can be your parent, child, wife and so on. But you spend time to get the money to gift that someone in any form as i detailed.

Then the time of yours is the gift to them and not the actual gift. The time is then the most precious part of all. Just like the time you invest in health as i explained in my previous blogs, you also invest in time to get the money which in turn is used for your loved ones. Then what you are actually giving your loved ones as the gift is your time.

Now if time of yours is the gift to someone, then even if that time does not yield in material benefits (with money and the associated gifts), it is still the gift. for example, you spend time with your loved ones, then it is your gift to them. in fact the loved ones with which you are spending the time are also gifting their time to you

This is something you can use in your work life as well. If you are able to give time at work to someone or something important then you are gifting your time. This is something you have to remember in a job you love doing where you are happy to gift your time for that job.

More importantly you should not be wasting your time in jobs you do not like or enjoy. When the people who do not do their job properly for example, are wasting their precious time in a job where they do not enjoy or like.

You also have to remember if someone is incompetent, or complascent in what they should be doing, then they are not only wasting their precious time of life but also your precious time of life if you are involved in the outcome of their job.

Which brings me to the concept of finite gift concept in everyone's life. Finite means that there is definite end point and it is measurable. Our life has a finite end point though we ourselves cannot measure it.

In other words, our life and the time you spend has a finite end point and that is all the gift we can give to anyone and ourselves. Hence one should choose how we would like to gift that precious time we have and not waste it.

Remember our time is finite and hence the gift of time we can give is precious. Remember the person who is receiving that gift should also be able to appreciate this and make them understand so.

I hope that you have got what i wanted to convey as Time is My Best Gift to you and not the actual gift. Now if someone moans that they did not get what they wanted from someone they love, make them understand this point. The time that individual spent to get that particular item is the gift
.

This is especially important if one is not well off to give an expensive gift but labours his time to get that gift

Back to the second part of title of the blog, "Use it or lose it". This is written for the good use of the time we have got and if we do not use it well, sorry it is too late, we have already lost it.

Now go on and use your time well and i shall try to do as well

Regards

Chockalingam

Invest your health For the sake of your loved ones!!!!!!!!!!!!

I spoke of health, money and the importance of time in our life in the earlier blogs. I also wrote on investing Health for your loved ones. If you invest on your health, it would be not only for yourselves but also for your loved ones.

I spoke mainly of exercises in the context of investing in health for your loved ones. This means that you exercise and the amount of exercise can be quantified and counted as your investment for your loved ones. Just like saving account you do for your child for example.

You can also extrapolate the same on your diet for example. If you make sure you eat healthy diet with vegetables and fruits, then you can count towards the same. If you did not eat healthily today, then you have not saved for health on diet.

Now imagine if you are the main person who cooks for the household or someone who serves food, you have then the responsibility of getting the right food on the table. If you do not, then you are not investing on your loved ones health.

In India, often you are asked to eat more than you can chew in the name of love or Virunthombal. This would then negatively affect your health and the person who insists on eating may be then drawing on your health savings account. You just have to make sure they understand that!


Happiness and rest and sleep or also important for your health. Hence if you take adequate rests, sleep well, then you are investing on your health. If you acaquire happiness by being with your friends and families, you would like to be with or go on holidays you wanted, then indirectly you do invest in your health and for your loved ones.

Now the calculation of how much investment you have for your health becomes interesting. if you have regular exercise, eat good food, be happy and take adequate rest and sleep well, your investment account of health is going to be looking good.

But what if you start off now with obesity or overweight. Then you have to start your health savings account now. Think of your body weight as an account and this is your credit card account.

I say this to my patients. Your body weight is opposite to that of a savings account. In a savings account you want to save more by putting in more money and taking less out. But in your body weight credit card account, you put less in and take more out if you want ot lose weight.

How to put this all into a measurable method. We thought of one method of really putting money when you exercise ,and you can do so if you have healthy food and sleep well and take adequate rest and so on.

I will let you know of a formula in my next blog.

My patient is ready they say and i have to go now

Regards

Chockalingam

How Sports Should Develop in India. learn from Wimbledon Lawn Tennis Association. Sports Medicine in Trichy including arthroscopy.

I had a discussion on sports with Sports Officer. It is true that identifying talent, nurturing them to appropriate sports, getting them appropriate gears and facilities, supporting them through injuries and getting them back on track are all issues which need lots of effort and money.

A country which is cricket mad, gets lots of money on advertising and TV rigths alone with an appropriate sports body, should be able to streamline money and resources to cities. these should not only be first tier cities like chennai, but also cities like Trichy.

Wimbledon as far as i understand does this very well supporting so many Lawn Tennis Association across UK by not only giving tickets but also supporting them as i mentioned in my first Paragraph of this blog.

What happens to the millions and crores of money which come through sports and affilitiations and advertisements and tv rights. Is the information available through Freedom of Information one wonders!

More and More people are taking up fitness routines at slighly later age and i see lot of ladies take up gym and yoga and get injured which probably will not come under sports injuries. but as an orthopaedic surgeon practising in Trichy, i see more of these over use and sudden stretching and strengthening exercise programs in older people.

I detect more and more meniscal injuries and Anterior Cruciate Ligament ACL injuries in sports and Road Traffic Accidents in particular in India. These knee injuries need surgery and extensive rehabilitation and we are proud to have one of the best facitlities in physiotherapy in Trichy and we are able to provide arthroscopic treatment methods to the international standards.

I am also proud to have conceputalised the design and i thank the KMC Specialtiy managment for implementing the design.

Back to the title of this blog however, lots of money and efforts should be channeled from the central sports bodies of the country to places like trichy to prevent injuries in the first place by providing the expertise and facilities. Then we at KMC speciality are ready to give them the best sports medicine and surgery facilities for any ortho problems they can come up with.
Regards

Chockalingam

Arthroscopic Surgery at Trichy, Key hole surgery to joints, cartilage tears and ligament reconstruction

Trichy as I left over seventeen years has not changed much. I can say only few major developments and it is busier with more traffic. but still i can reach from point A to Point B in less than half an hour at any point of time of the day. This is great considering that it is one of the major second tier cities in India. It also boasts an international airport and a major Railway interlink Juncion.

The people are many, mostly small business and agriculture base in earnings. BHEL is still the largest industry in the region with so many allied engineering firms nearby and linked to BHEL. Education is one of the strong points of Trichy and it has not changed as it used to be. There are more good schools and the old schools still retain their place as mine ERHS School.

The health needs of the people is still largely filled by the specialists in their own area of expertise and many private hospitals are giving good quality treatment. However health awareness has increased dramatically and people are aware of surgical methods of treatment to cure their illness.

For Example, bypass surgeries and cataract surgeries are so common for people to resort to improve their quality of life. Ortho problems are recognized as needing specialist treatment. People resort to surgical treatment of fractures without hesitation as they recognize that this can return them to normality more surely and quickly as opposed to conventional immobilization methods

So what else has changed in Trichy. Arthroscopy was introduced when i did my postgraduation in the 1990s with only the telescope without the monitor. However I am able to provide the state of the art High Definition Arthroscopic surgery to most joints in our body for treatment purposes.This is essentially key hole surgery to the joints as what a laparascopy surgery to cure gallstones etc

My patients have benefited from meniscal surgery including arthroscopic repair, ligament surgery including arthroscopic anterior and posterior cruciate ligament reconstruction, shoulder surgery including arthroscopic Bankart's repair and rotator cuff repair, arthroscopic ankle decompressions, and so on.

Compare the surgeries i was performing in UK before i left over two years ago to practice in Trichy and I am able to deliver the same to our patients and people. This is apparent in the arthroscopic techniques and joint replacement surgery,i use more than in any other sub speciality of Orthopaedics.

This is what has changed in Trichy from my point of view. Seventeen years ago, arthroscopic surgery was literally unheard of in Trichy from patients Access or awareness. Now our patients in Trichy are benefited from this state of the art treatment facility at our hospital.

Total Knee Replacement: India What we know and our Experience at KMC Hospitals Group

Total Knee Replacement: What we know and our Experience at KMC Hospitals Group
Dr S ChockalingamD.Ortho, FRCS [UK],FRCS [Tr & Ortho], Dr P R Ramasamy MS [Ortho], FRCS [UK]

This is an article I wrote for KMC News which is distributed to Referring and primary care doctors in Trichy Region on 14th December 2009

Total Knee Replacement is one of very successful and common Orthopaedic Operations we do at KMC Hospitals. The incidence of this surgery increasing in number reflects what is happening around the world.[Ref 1] The reason is why it is not more popular than it is at the moment is the cost of the surgery. This is obviously the point I would like to start of this brief about this surgery. The reason it is expensive at present to the reach of the common man is the technology that goes behind in the implant that is used.[ref 2]

The implant often made of strong Cobalt Chrome alloy, though titanium and ceramic are used in some designs. Any metal however polished, will have surface irregularities if one looks under the electron microscope. The surface finish and the material then become very important in reducing this irregularity and thus help in reducing the wear of the material with which this articulates.[Ref 3 and 4]

The material with this metal articulates is a specialized plastic called Ultra High Molecular Weight Polyethylene. Newer highly cross linked Polyethylene has come into use in hip replacement surgery.[ ref 5] However the quality of the Plastic used is controlled in the way this plastic insert is manufactured. This helps in the long term success of the knee replacement surgery.

The long term success of the knee replacement surgery is more important that looking at short term benefits of this surgery.[Ref 6] Any material placed between the end of the femur and tibia will relieve the arthritic pain. What is more important however is the durability of the material in staying without damaging the underlying bone!

The damage to the underlying bone is the worst scenario when faced with the failed knee replacement surgery. One fears this as the damage often starts without any warning such as pain. When one faces a failed knee replacement, the surgical challenges becomes daunting and more importantly becomes very expensive.
This brings me back to the opening paragraph of this brief, the cost of this joint replacement surgery.

A little bit more cost at the initial replacement surgery has been shown to reduce the chances of revision surgery in the long run. Revision surgery after total knee replacement is not something an ordinary individual can tackle not only as a patient but also financially. One cannot expect the Government to subsidize that cost as well as it will be impossible.

What we do at KMC Hospitals to ensure the long term success of this surgery are as follows.
We have a dedicated team involved in this surgery. The chances of infection developing after such surgery should be kept to absolute minimum and we do this by controlling the theatre environment and the personnel involved. We have only used prosthesis which has follow up data in the long run. Post operative protocols have now been developed to suit our working conditions. There are specific appropriate pain control and rehabilitation in place for these patients, both of which go hand in hand.

I have shown some examples of patients we have operated and what they look like and what they can do after such major surgery!

After total knee replacement this patient is able to sit cross legged! and riding a two wheeler at four weeks!, a patient works as a security at the age of 70 going to work by bicycle|!




Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005 Jul;87(7):1487-97.

Kester MA, Herrera L, Wang A, Essner A. Knee bearing technology: where is technology taking us? J Arthroplasty. 2007 Oct;22(7 Suppl 3):16-20

McEwen HM, Barnett PI, Bell CJ, Farrar R, Auger DD, Stone MH, Fisher J. The influence of design, materials and kinematics on the in vitro wear of total knee replacements. J Biomech. 2005 Feb;38(2):357-65.

Lancaster JG, Dowson D, Isaac GH, Fisher J The wear of ultra-high molecular weight polyethylene sliding on metallic and ceramic counterfaces representative of current femoral surfaces in joint replacement. Proc Inst Mech Eng H. 1997;211(1):17-24.

Wang A, Yau SS, Essner A, Herrera L, Manley M, Dumbleton J. A highly crosslinked UHMWPE for CR and PS total knee arthroplasties. J Arthroplasty. 2008 Jun;23(4):559-66. Epub 2008 Feb 13.

Ritter MA. The Anatomical Graduated Component total knee replacement: a long-term evaluation with 20-year survival analysis J Bone Joint Surg Br. 2009 Jun;91(6):745-9.
.

Empower with Knowledge: Ortho Problems Awareness Campaign at Puthur Trichy India

4th September 2010

Empower with Knowledge:

This is the theme we took on when we decided to meet the pensioners who have many ortho problems. Myself and Dr Aravindan decided to address the pensioners in Trichy on the current Ortho Problems. When possible i will upload my powerpoint presentation used for this talk.

The Bone And Joint Decade announced by the WHO was the basis of this talk concentrating on the arthritis, osteoporosis, back problems and road traffic accidents. We were able to highlight the problems and the treatment methods and preventive methods adopted to the World Class Standards.

I have written enough on the ortho problems already and i will stop here

Regards

Chockalingam

The Proof is in the pudding: Awareness strategy adopted for Total Knee Replacement

10th June 2010
Total Knee Replacement is one of the successful surgeries, in Orthopaedics and Surgery in General. The surgery has the benefit of relieving one's pain and improving the quality of life for an individual. This can be proved by various quantification methods such as Joint Specific Scoring Systems, and Quality of Life improvement tools.

I use these tools in my practice to the standards followed in the UK Joint Replacement Units. The quality of improvement can be quantified in other methods such as QALY. This method shows that the qualtiy of life improvement for the years ahead is comparable to Cardiac Bypass Surgery and better than cataract surgery.

Remember these two surgeries compared are done more frequently than the Knee Replacement surgery. Hence when I started my practice, we sat down with the marketing department at KMC Speciality hospital and worked on a strategy to improve the awareness.

I decided one of the ways would be to take the outcome improvement to the public directly and orgnaised the meeting called Meet Our Patients. We called on the press to interact with my patients who had knee replacement directly with no preconditions.

Patients were more than happy to narrate their quality of life improvement directly to the press who in turn took to the public through their media.

Proof is in the pudding,Right!. We are now in the process of orangising the awareness of arthroscopy in joint problems. I am calling more than 100 of my patients who had arthroscopy of knees, shoulders,ankles, elbow at KMC Speciality to come and narrate their experiences directly to the press.

We are calling this Sports Injuries and Arthroscopy Awareness meeting and organised this sunday.

I will post more on this later.

Regards

Chockalingam

The Bone and Joint Decade 2000-2010, Ten years on........

This is an article I am writing for increasing the awareness of bone and joint disorders among the public and the medical community alike.I hope you find it useful

World Health Organisation [WHO] endorsed the launch of “Bone and Joint Decade [BJD]- 2000 to 2010” in Geneva in January 2000. The key goal is “to keep the people moving by prevention and treatment of bone and joint problems. This will in turn reduce the cost and the burden to the individuals, the carers and the society at large”.

BJD-India duly followed with National Action Network launched from Pune by eminent doctors. This was endorsed by the Government of India. As we are on the verge of this decade behind us, it is time for us to reflect and hence this article.

Arthritis affecting a joint such as knee and hips are very common in India. Every other person over the age of 65 in India is affected with arthritis. Unfortunately the treatment is not sought or often delayed.

The road traffic accidents are not only common, but also results in severely injured people. The deaths are frequent and multiple numbers of people are involved in the same accident. This is reflected in the Official statistics of the department of Road Transport and Highways, Government of India.

Unfortunately such affections of the bone and joints leave people with physical disability. The patients become dependent on the family and the society adding to the mental suffering. Some of the patients are left crippled due this pain. The true extent of their suffering is revealed in the limitation of their activities of daily living let alone their limitations in the society.

When one is not able to do even routine activities such as walking, secondary health problems arise. These include sedentary lives, increasing obesity, diabetes, high blood pressure and heart diseases. WHO recognised this growing trend in the society often leaving a financial burden.

Diet and exercise play important role in the health of our bone and joints as much as for our heart. Yet our life style had become sedentary. Increasing incidence of overweight and obesity has aggravated the bone and joint problem such as arthritis. Specific remedies for certain arthritis such as Rheumatoid are not sought. These lead to crippling deformities and disabilities. On the other hand, there is misuse of pain killers leading to other problems such as kidney failure.

Wearing a seat belt is the most effective way to prevent injuries when travelling in a car or a bus. Yet many of us remove the seat belts or consider it a hindrance to wear. Traffic rules and restrictions are rarely followed resulting in serious and disabling injuries.

“A painful advanced arthritic joint can be cured with a joint replacement” is a well known fact to many in a Western country such as UK. However people in our villages are left suffering due to the lack of awareness. This lack of awareness is present even in educated persons living in cosmopolitan cities.

With this launch of Bone and Joint Decade, WHO highlighted the need for the improvement in the diagnosis and treatment of such disorders. WHO encouraged prevention through education campaigns. Ten years on since the Bone and Joint Decade launch by the WHO, the real question had there been an any improvement at all ?

In spite of all being written early in this article, there is certainly more awareness created by this WHO initiative. The government of India through its participation in this Bone and Joint Decade has shown its commitment in prevention and treatment of these disabling conditions.

Government Welfare schemes helping them finance the treatment ensures that poor are not left alone in this treatment reach. One has to mention one such scheme for the people below the poverty line at this juncture which has benefited and continues to a huge number of financially disadvantaged section of our society.

More people are seeking treatment rather than neglecting these ailments. They are asking for the accurate diagnosis as much as the treatment itself. This is especially facilitated when they see others benefited due to the treatment options such as joint replacements. People have started to recognise the fact that “Early and appropriate treatment of injuries prevents long term disability”. Technological advances such as key hole treatment of joint problems with arthroscopy are now known.

Every year many hospitals follow the activity week to focus their year long efforts to the public in October[ 12th to 20th of October of 2010 for this year]. Many hospitals and doctors are conducting free camps to facilitate such an awareness. Their efforts should be lauded with reverence for the public service.

There is certainly a larger section of our public where the awareness has not reached as we still see a significant number of disabled people due to the bone and joint problems. Hence more concerted efforts should be done from the community in general and the medical community in particular.

Education in road traffic accident prevention should reach the “prospective road users” namely our children. Public awareness campaigns should increase in number and reach the inner villages. Medical schools should increase the training given to the doctors in dealing with bone and joint problems. There is a need for the entire community to celebrate this bone and joint week in October.

May I conclude this article saying that “Let the end of the Bone and joint Decade -2000-2010 herald a new beginning in spreading awareness of the increasing number of Bone and Joint problems. These are either preventable and when affected, many of them are certainly curable”

Dr S Chockalingam
Consultant Trauma and Orthopaedic Surgeon
KMC and KMC Speciality Hospitals,
Trichy

Health Awareness among men over forty years of age, meet by Sugam Charity

Sugam Charity Health Awareness meeting 2 on 11th of April 2010

Following the successful meet organized for women over forty on the 13th feb 2010, Sugam Charity organized the second meet for gents over the age of forty years. The aim of the meeting was to spread the awareness of life style diseases which are rife in this age group.

The format of the meet is to give awareness talk to spread the knowledge and to provide an individual assessment of these people. This is different to the master health check up though one part of it is based on the master health check up as described below.

Master Health Check up is now given as a standard to most corporate employees as part of their corporate social responsibility. The corporate bodies also take up this role to ensure they have healthy employees who in turn will take less sick leave and increase their productivity.

However this type of check up is not given to the people in the villages, one due to the lack of model of someone giving them the option of health check up as corporate bodies. but it is mainly due to the lack of awareness. sporadically the Sons and Daughters who are working in cities bring their kith and kin for these health check up, however the common man misses out.

This type of health check up can bring up the problems, hopefully at an earlier stage so that the treatment can be effective. It would also ensure people with risk factors are advised accordingly so that life style diseases do not affect them in the future.

The second part of this activity is where the charity wants to concentrate. Spreading the awareness by giving them not only their health information but also with an interactive forum at their doorstep.

This has been made very much possible by the talks given by the doctors and more importantly by the Nursing School Principal of KMC, Trichy and her Team. We at Sugam Charity cannot thank them enough as they do this on a sunday when most of us would rather spend relaxing at home. We also thank the Management of the KMC and KMC speciality hospitals for allowing us to use their team the education materials for this public exercise activity.

We at Sugam Charity hope that we have done some good to these people, only time can tell us so.

Regards

Chockalingam