ortho questions part 2: Patients queries answered

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

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

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

Question # 6

Sir

My father is 71 yrs old and met with an accident a year ago. His left knee was injured and after medication, the wound subsided. Since then he suffers from severe swelling in the knee till the ankle within very few metres of walking. Swelling gets reduced if he takes rest or uses creep bandage. Is there any solution for this without going for surgical procedures, considering his age?

He has mild Filariasis due to heredity and consumes Eofil Forte 5 times a month.

Regards 

Answer:

Your father needs to see an Ortho Surgeon who will be able to differntiate the pain due to arthritis from other causes. The swelling may be due to blockage of veins called deep vein thrombosis or as a result of it. He may need a compression stocking if it is due to the thrombosis.

Question # 7

Dear Sir,

Around first week of Jan 2012 I had undergone Arthroscopically treatment on replacement of the completely teared ligament in my left knee and which was corrected by replacing a tissue from the knee with 2 biodegradable screws drilled and fixed to the upper and lower part of the left knee.

Even almost a year of completion I am presently unable to restore my original activities  like a normal human of 32 years of age having pains around the surgical area if I stand or sit or walk or climb contionously for a period of more than 2 hours of time. Please clarify me when I will become a completely normal human of those at this age.

Thanks and Regards,

Answer:

Cruciate Ligament reconstruction surgery of the knee will result in a stable knee and should not leave you with pain. If pain is the problem, the possibilities are meniscal tear or early arthritis or chondral damage. It would be best you go back to the surgeon who operated on you and discuss the reasons for the pain and the treatment of the same.

Question # 8

Dear Sir,

First of all thank to you for such a noble initiative, and greetings to Chockalingam Sir. I have following problem. I am 31 years old. I had some pain in my lower back since the age of 17 years but it was so mild that I seldom paid attention to it. 3 years back during some stretching exercise I got stiff neck and shoulder which got worsened by neck exercise. Later when I visited doctor they diagnosed me with Spinabifida Oculta and sacrolisatic L1. (uneven growth at lower joint and improper formation of backbone) My pain alleviated with the help of some medicine and warm water application.

Also, Doctor told me that it is not very uncommon deformity and gave an injection in my sole for the pain. Also he told that if pain increases he will do surgery for the same.  Now, at present my lower back pain is negligible but I still I have some stiffness in my neck and sometimes there is tingling sensation in my left hand. Please suggest.

Answer:

I am unable to understand the problem you have. Spina Bifida Occulta will not result in pain. Sacralisation of L5 and not L1 is probably what you mean. Sacralisation will not result in pain if the adjacent discs and facet joints are normal. Injection in my sole for the pain, you have mentioned, sole means the foot, but you have not mentioned any symptoms in your sole or a diagnosis to go with it.

Question # 9

Sir.

My mother was suffering from chronic arthritis. Her legs were not upright they were tilted. As per advice of GSVM medical college Kanpur doctor, we went for her surgery and a pin was inserted in her legs, in 2002.After that her pain still continued. Doctors continued to say that everything will become normal. Seeing her worsening condition and pain we went for her total knee replacement in 2009 after having 1.5 years of research and suggestions of doctors. But her woes still continues. Let me put in points

1.     She is having stiffness and pain in portion below the knee and above knee in both the legs.

2.     The doctors have advice not to use any ointments or creams in the stiching scars of both her legs.

3.     Scars are creating itching and she is helpless

4.     We have one physiotherapist regularly coming for exercises.

5.     Eating so many pain killer medicines, some pain killers advised by doctor created reaction ,

now she is not taking any medicine unless, pain makes her restless.

Suggestions required for.

1.     Can she use any pain relief ointment, for below knees pain?

2.     Which ointment she can use for getting relief from itching feeling from scars.

3.     Which exercises you suggest for her side pains

4.     Can she use any pain killers any safe medicine you can advise?

5.     The knee, sometimes swells if she walks to much any advice for this.

I have tried to put some points which comes to me during my discussions with my mother , request you to please suggest what else shall I ask her. (Which may be important for medical requirement?)

She is now 67 years of age.

Regards,

Answer:

Total knee replacement surgery will result in painless joint which would enable your mother to be able to walk distances without pain. If she is experiencing pain in the knee then you need to consult the surgeon who operated on her to ensure that everything is fine with her new joint. Itching of the skin is not uncommon in the first year but rarely after three years. She should not be on any painkillers nor should she need a physiotherapist after this long. Swelling is not uncommon. Kindly have her leg and knee checked by the surgeon.

Kindly read through my blog to know what to expect.

http://chockalingamdr.blogspot.in/2012/07/total-knee-replacement-at-trichy.html

Question # 10

Dear    Dr. M.K

This is a very good initiative which has been introduced in Ashok Leyland.  Dear Dr S. Chockalingam,

I am 38 years female with intermittent low back pain and left knee pain since 1 year. All my reports, viz., CRP, Uric Acid, ASO titer, RAF, CBC, TSH, are within normal limits. I had shown orthopedic doctor here and for knee he said I had chondromalasia patella. I took calcium, calcibest sachet, Vit D injection which gave relief to my back pain. I got relief from knee pain after taking Diacerin-GM. I have been told I can take Diacerin intermittently and that I may be suffering from nonspecific arthritis. 

I have noticed that my knee pain is aggravated on prolonged sitting for more than 2 hours. If I am standing I am pain free, but I cannot sit in one place for long time. At present I am taking Diacerin intermittently with calcium tablets.

I have this weird phenomena which has been going on since 6-7 months where in once in every 1-1 Ω months I will have low grade fever 99 F associated with severe low back ache with left or right knee pain which is unbearable as well as upset stomach semisolid stool. It will last for 2 days and then it goes away on its own. After which I am absolutely fine. No pains, no weakness, malaise or fever or lose stool etc.  

At present I am pain free and waiting for my next bout of above mentioned phenomena. Kindly guide what I should do or whom I should show or any other tests if you recommend. I have already seen a Internal medicine physician, two orthopedics.     

Thanks & Regards,

Ans: An opinion from a Rheumatologist may complete your assessment. Back pain is very common in general population and you may be one of the patients who have mechanical back pain and knee pain secondary to Chondromalacia patella or early patellofemoral arthritis. At your age, you should have routine exercises to your back and knee to strengthen your muscles. Please refer to the following sites.

http://orthoinfo.aaos.org/topic.cfm?topic=a00302

http://orthoinfo.aaos.org/topic.cfm?topic=A00300

knowledge Nugget 3: Ladies and Gents over 50: Walk regularly

Weight bearing Exercise is good to prevent osteoporosis which is bone loss as one grows older and one loses hormones. The hormones a lady produces while still having periods helps in protecting the bones and once she reaches menopause the hormones stops and osteoporosis will develop

Walk in the name of exercises, hobby, seeing places or in the name of religion every day

Best Wishes

chockalingam

Knowledge Nugget 2: know the glycemic index of your food: aim for a low index food

look at the chart as above and aim for keeping your food's GI index very low.

avoid carrots and potatoes with regular intakes

i know of people who take rice and avoid bananas as they have been told that the bananas are not good for Diabetes. however eating rice is worse

eat fruits like apple and orange and substituting for rice is better

Eat more of these foods as below

Best Wishes

Chockalingam

Knowledge nugget 1:ideal body weight and your waist circumference

Keep your body weight less than "your height minus 100"

keep your waist circumference less than 90 if you are a man and less than 80 cm if your are a lady
that is 35.5 inches for a man and 31.5 inches for a woman

Best Wishes

Chockalingam

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