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