Friday, September 25, 2015

Knee Pain due to arthritis

If you occasionally find saying to yourself “my knee pain is getting worse” or “my knee pain is unbearable” you may not be alone. In data collected from 2010 to 2012 in a National Health Interview Survey 22.7% of American adults, or 52.5 million, had self-reported doctor-diagnosed arthritis. This number rises with age and included in the already projected 67 million people that will have arthritis by 2030. 

Of the three main types of joint conditions knee pain due to arthritis, or more specifically, osteoarthrits, is the one that occurs most often. Rheumatoid arthritis is primarily a small joint disease while psoriatic arthritis starts out as a skin condition on surfaces of knees, elbows, belly buttons, and genitalia and then could also spread to the joints. 

Osteoarthritis in the knee could be caused by either abuse of joints, such as jumping from unreasonable heights to hard floors, twisting sharply or as a result of trauma accident. Injury to joint cartilage as a result of abuse will sooner or later translate into arthritis pain.

The other reason for osteoarthritis is almost no activity; that would mean total lack of exercise involving the knee. This can be caused by sitting for long periods at your work or long distance driving where frequent walking or exercise breaks are not possible. Lack of fresh blood that keeps the joint supplied with nutrients and hauls away dead cells contributes to degeneration of cartilage, and result in arthritis pain.

What invariably makes osteoarthritis worse is being overweight. The CDC has determined women can reduce the risk of knee osteoarthritis by 50% with a reduction in weight of just 11 pounds.

Even though people take NSAIDs (nonsteroidal anti inflammation drugs) like Ibuprofen and acetaminophens such as Tylenol and Panadol for pain relief these drugs do nothing to address the root cause. Instead prolonged use of NSAIDs can cause stomach disorders such as ulcers and bleeding and acetaminophens are known to damage the liver. Some patients also take Glucosamine, Chondroitin, and Hyaluronic Acid supplements but long term benefits have not been conclusively proven in peer reviewed studies and clinical trials.

A continued regimen of exercise, starting with light movements and working up to more involved activity are better approaches to managing osteoarthritis and its related pain. It is exercise that will make muscles around the joints stronger and what will stimulate fresh natural hyaluronic acid and lubricin, the primary components of synovial fluid that provide healing and lubrication for joint function.

For people who do not, or are unable to, make changes in their lifestyle such as weight loss and regular exercise may eventually be heading towards a total knee replacement. It is neither a guarantee of a pain free life, nor total recovery of freedom or range of movement. 

Tuesday, September 15, 2015

What is TKR, TKA surgery, and Revision?

What is total knee replacement? TKR stands for total knee replacement but the medical establishment prefers to use TKA which stands for total knee arthroplasty thereby reserving TKR for total knee revision. Both TKR and TKA are considered major surgeries. According to DrugWatch there were 700,000 total knee arthroplasty operations in 2010, including 67,000 total knee revision surgeries for that same year in the U.S.

Don't watch it! Screen shot of Video of TKA procedure. Source Kirby L. Turnage, MD
What is total knee revision? Every year a certain percentage of total knee arthroplasty operations fail, either due to surgeon error, or component failure. In both of these cases the orthopedic surgeon may advise you to come back for a repeat surgery. If the original TKA was brutal enough you won’t be looking forward to the “revision” experience. They are more painful, invasive, costlier, and take much longer to heal. You can imagine how your body would scream when your bones are being chiseled, old cement is pried off, and chips of bone are being sliced and sawed away for the second time.

Is total knee replacement a disability? In many cases the procedure, after a period of rehabilitation, physical therapy, and prescription pain medication patients recover to varying degrees. Some say they regain significant mobility, others may not get to where they expected to be in terms of walking and moving about without much help. Then there are those who almost never recover and experience   disabling pain and severely restricted mobility.

People who often complain about “pain in my knees” should not let that situation slide too much. At the earliest indication of discomfort a doctor’s visit is imperative, and on your very first diagnosis of osteoarthritis is when its time to seriously start looking at alternatives to total knee replacement. That alternative will invariably be found in weight loss and exercise.
It can be done!

If your knee arthritis has been graded 3 or below you can still save your knees. See From Knee Pain to Knee Replacement book.

#knee pain, #osteoarthritis, #total knee arthroplasty, #knee joint, #total knee replacement, #total knee revision

Wednesday, May 20, 2015

An insidious disease with no prevention and no cure escapes the radar; Again!

The Death Causes map of the States compares and highlights the ‘leading single’ cause of death for local areas that exceeds national averages. Thus if 1% deaths due to cause X were recorded in a State and 0.2% nationally that disease will pop on this infographic being 5 times the country average. On the other hand 3% people die of cause Y locally but 2.9% in the entire country being only slightly higher (1.03 times) the national average, the cause or disease will not show on the map since it would be surpassed by cause X.
Source CDC.
The Most Distinctive Causes of Death by State, 2001-2010
Francis P. Boscoe, PhD; Eva Pradhan, MPH

One such disease is Cancer, the second leading cause of death in the U.S. after heart disease.  The State of Maine, for instance, has the highest rate of cancer deaths in the country but the Death Causes map shows Influenza as the leading cause of death.

As Mr. Boscoe, author of the report and the infographic explains:
“The map shows the causes of death that are the highest relative to the national average. For most states, this is a cause of death that is between 2 and 5 times higher than the national average. Cancer does not show up because cancer rates tend to be very similar in every state – there are no states where cancer is anywhere close to 2 to 5 times higher than the national average.”

The map does bring out some intriguing information: Above average firearm related deaths in Tennessee, New Mexico, and Arizona. HIV in Florida, and heart disease in Michigan. Kidney related diseases in Montana and Syphilis in Louisiana.

Bottom line: One must understand what numbers are being conveyed and how they have been arrived at.

Sunday, April 6, 2014

Mobile App: Don't be intimated by Vital information displayed on Patient Monitors

Quickly learn how to  make sense of vital health data with this app.

Sitting by the bedside of a loved one, relatives and friends are frequently confused and intimidated with all the numbers, charts, and beeping sounds coming from equipment the patient is connected to. What does it all mean? Is it some cryptic language only doctors and nurses understand? Not at all.

The Vital Signs Mobile App helps family, friends and patients learn how to interpret information presented on display monitors in hospital rooms.

Vital Signs is a valuable guide to understanding Pulse, Blood Pressure, Oxygen Saturation, and Carbon Dioxide readings.

It explains why blood pressure is shown as a set of two numbers? At what point your loved one’s oxygen level needs attention? What do the EKG charts tell you? Are you exhaling too much or too little carbon dioxide? How does a paper bag help with hyperventilation?

Find out how to read and understand critically important information displayed on patient monitors.

Thursday, January 16, 2014

Hot Yoga May not be so Cool.

Yoga is good for the body and mind. It promotes relaxation, health and calmness. Unless a person is suffering from large joint osteoarthritis or spinal injury it is helpful in maintaining good body conditioning. But hot yoga is not the same.
The human body and most living things have a fine tuned system that works with checks and balances to keep us alive and healthy for the most part. Confusing the body’s feedback and homeostasis systems can causes serious problems.

Hot yoga has that potential.

Source: Bikram Yoga Instructor Training Advertisement

Exercise and the body’s response

Conventional vigorous exercise accelerates our respiration rate which is a good thing. It helps carry wastes and toxins such as carbon dioxide out of the body through the lungs. At the same time it helps increase

Thursday, January 9, 2014

An Endoscopy related antibiotic resistant Super Bug.

You don’t have to be a medical tourist to acquire the New Delhi metallo-β-lactamase (NDM), an enzyme that breaks down carbapenems which are considered a “ last resort” remedy for infections like Escherichia coli.

Image Courtesy of Yuya Tamai
The NDM enzyme gives immunity to antibiotic resistant bacteria and has been traced to a hospital in Illinois. That is what patients who had endoscopies to examine their bile and pancreatic ducts, Endoscopic retrograde cholangiopancreatography ( ERCP), at the hospital found when they were called back for re-examination. Fifty of the 91 patients tested positive for the bacteria even though routine cleaning procedure of manual cleaning and high-level disinfection in automated endoscope reprocessors were followed for disinfection.

Wednesday, December 4, 2013

Out of sight, Out of mind!

Alzheimer's, blindness, sleep apnea, and jugular veins.

Alan Light contributed the following caption for his photograph: "This was one of the last public appearances, maybe the last, of Rita Hayworth. She lived ten more years in declining mental and physical health, dying of alzheimer's disease in 1987."
Rita Hayworth (October 17, 1918 – May 14, 1987) was an American actress, a pin up girl , a dancer and overall beautiful lady. She appeared in "a total of 61 films over 37 years. She is one of six women who have the distinction of having danced on screen with both Fred Astaire and Gene Kelly. She is listed by the American Film Institute as one of the 100 Greatest Stars of All Time." Wikipedia.

Slowly destroying memory, cognitive thinking, reasoning and behavioral skills Alzheimer's is considered to be an irreversible disease. Ranging from its mildest form to the most severe stage where patients are completely dependent on others for daily function. Symptoms usually first appear after age 60.

Thursday, November 28, 2013

One Weird Tip for Not getting sick during Thanksgiving.

The first tip:
+ Don't overeat. Of course that is easier said than done.

Okay may be try some more weird tips:

Friday, November 22, 2013

Lung Cancer; Why do non-smokers get it?

Indian Style Fried Okra. Courtesy of Jen R.
If you have had the displeasure of finding out that a close friend or relative was suddenly diagnosed with lung cancer even though they never smoked you would know how unbelievably confounding and puzzling it would be. Yet it happens!

Lung cancer is responsible for the highest death rate of all cancers, more than that of colon, breast and prostate combined

Saturday, November 16, 2013

Let us hope Chinese alternative medicine does not find out about this!

Researchers have identified two defects in expression of unfolded protein response mediators in mice and humans with Type 1 diabetes.
They administered tauroursodeoxycholic acid (TUDCA) to the mice in the pre-diabetic stage.
What is TUDCA?
It is a "chemical chaperone" found in bear bile. It is used in traditional Chinese medicine that has also been used to alleviate stress and symptoms in atherosclerosis and type 2 diabetes.

And the result! There was "a marked reduction of diabetes incidence in the T1D mouse models," the authors Source:Science Translational Medicine.

After this scientific validation the bear population around the world might be at great risk for poaching harvesting of body parts.

Image Courtesy of Doug Brown Flickr Photostream.

Tuesday, November 12, 2013

Take 'extra water' drinking advice with a pinch of salt. Literally!

In a recent Daily Mail article claiming to have taken 10 years off her looks Sarah Smith suggests she achieved this miracle by drinking 3 liters of water everyday. Ms. Smith who is 42 but according to herself looked 52, was able to accomplish this feat in 28 days.

This would be pretty good advice if it did not have the potential to encourage people to get carried away. Let us look at some numbers. 3 liters (One U.S. gallon = 3.78 liters) comes to 12.69 servings of 8-oz glasses. Conventional wisdom, which is certainly not written in stone, suggests we drink 8 of these glasses per day. Now this already puts Ms. Smith over the top by 4 extra glasses, undoubtedly helping her in her 'transient botox' demeanor.

To some degree water tolerability might be different for each individual but for people who might take this advice enthusiastically and guzzle down too many glasses in too short a time frame consequences could be disastrous.

In reality it would make eminent sense that the quantity of water consumed be closely matched with what the body loses. Besides evaporation through skin, breathing, perspiration, and defecation the bulk of water removal is handled by the kidneys. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a healthy set of adult kidneys processes about 190 liters of blood a day pumping out between 1 to 2 liters of urine. So how many 8-oz glasses are those two liters? That comes to 4 to 8 glasses (4.23 glasses per liter) of urine. The renal function in humans is, however, flexible enough to allow for some variation in water intake. With more water you get more diluted urine.

But when kidneys cannot quickly filter water out it gets reabsorbed in the bloodstream, building up the overall body water content. A slow buildup of water in the body beyond what can be handled by the kidneys is called chronic hyponatraemia.
Here is the downside.
A critical component of the 'homeostasis' work done by the human anatomy has to do with maintaining balance. To be more precise, electrolyte balance. One of the major body electrolytes is sodium. It is needed for neurons to fire signals and it, along with calcium, is what allows muscles to act on those signals.

When the body's water content rises too quickly with the kidneys being forced to filter the blood; the body, in its attempt to achieve sodium balance, osmotically pushes the excess water into tissue cells which have a higher concentration of sodium than the surrounding areas.

The cells swell as moisture in organs and tissues rises giving a misty glow and doing away with facial wrinkles. More water causes more swelling and dilution of sodium ions in brain and muscle tissue. Muscle tissue has a lot more flexibility to expand; not so for brain tissue that is confined by a hard, rigid skull.

Too much water intake in a short time causing blood sodium levels to fall below 120 millimoles per liter can result in headaches, confusion, convulsions, brain herniation, hallucinations and coma; and in the muscles, weakness, spasms and cramps. These conditions are known as 'fatal water intoxication' and acute hyponatraemia, sometimes tragically ending in death.

Who is susceptible? Athletes such as long distance marathon runners, psychiatric patients, vulnerable children being disciplined in the care of ignorant parents or babysitters, and 'Ecstasy' or 'Molly' drug users. Also people who take antidiuretic drugs, and those who use Tylenol (acetaminophen), or NSAIDS like aspirin and bufferin should be careful with excess water consumption.

Drink responsibly! It is much better to drink when thirsty and stop when quenched and not worry too much about arbitrary guidelines. What is more important is to worry about how quickly water is consumed in how short a time frame. If you must overdo it, it might be a good idea to add a pinch of salt to the water.  
Partial list of water intoxication deaths. Source: Wikipedia.

1991: Andy Warhol  October 24, 1995: Anna Wood, 15-year-old Australian schoolgirl after using Molly or Ecstasy (MDMA) followed by water intoxication.
November 16, 1995: Leah Betts, England, died on her 18th birthday party after using Ecstasy followed by water intoxication.
September 12, 1999: US Air Force basic trainee Micah J. Schindler died of heat stroke, severely complicated by water intoxication.
June 9, 2002: 4-year-old Cassandra Killpack of Springville, Utah died as a result of water intoxication when her parents disciplined her and forcefully fed her as much as one US gallon (3.8 l) of water in a short period of time.
October 12, 2002: 3-year-old Rosita Gonzalez of Hollywood, Florida died of water intoxication when her babysitter Nancy Gayoso punished her by forcing her to drink three US quarts (2.8 l) of water in a four-hour period.
2003: Walter Dean Jennings, freshman history major at SUNY Plattsburgh, water intoxication during hazing.
2005: Matthew Carrington, California State University, Chico water intoxication during hazing.
2007, Jennifer Strange, mother of three, in Rancho Cordova, California, water intoxication in contest to win one of Nintendo's Wii game consoles.
2008: Jacqueline Henson, 40-year-old British woman, four liters of water in under two hours to follow LighterLife diet plan.
2013: Luana Priscyla Fernandes Soares, 21-year-old Brazilian woman, during radio contest in Brazil, drinking over 5 liters of water in the first hour.
2013: 20-year-old Dutch student Lisa Nooij ,from water intoxication after using Molly or Ecstasy (MDMA) during a festival


Mail Online. "How drinking three litres of water a day took ten years off my face." Accessed 
November 12, 2013.
Mayo Clinic. "Water: How much should you drink every day? -" Accessed November 12, 2013. Jordi March i Nogué Urinary Sysem
Home Page - National Kidney and Urologic Diseases Information Clearinghouse. "Kidney Stones in Adults - National Kidney and Urologic Diseases Information Clearinghouse." Accessed November 12, 2013.
National Institute on Aging. "Scientific Images." Accessed November 12, 2013.
National Institute on Aging | The Leader in Aging Research. Accessed November 12, 2013.
SEER Training: Welcome to SEER Training. "SEER Training: Structure of Skeletal Muscle." Accessed November 12, 2013.
Home -- American Academy of Family Physicians. "Management of Hyponatremia - American Family Physician." Accessed November 12, 2013.

Wednesday, November 6, 2013

Turmeric! The Hot New Old Spice.

You have heard Dr. Oz sing its praises, you have tried Dr. Sanjay Gupta's turmeric tea recipe he shared on Dr. Oz' show, you have seen Michael Caine gush about it, and now you are being bombarded with endless turmeric supplement

Thursday, October 24, 2013

Stroke incidence rising dramatically among younger people

Over the last 20 years there has been a 25% increase in stroke cases among 20 to 64 year old's. In studies funded by the Bill and Melinda Gates Foundation, and published in The Lancet, the burden of stroke between the years 1990 to 2010 was found to cause over 61% of disability, and more than of 51% of deaths. The cause; hemorrhagic strokes.

Traditionally, as reported by the CDC, hemorrhagic strokes account for only 15% of this condition in the U.S.

Stroke Types:
Types of Stroke
Source: CDC
Ischemic Stroke is when blood flow to the brain is blocked by blood clots or fatty deposits also known as plaque in blood vessel linings. Blockages lead to tissue death quite quickly. A Transient ischemic attack (TIA) is a "wake up call" or "mini-stroke" that does not result in lasting damage. Recognizing and treating TIAs immediately can reduce the risk of a major stroke.

Hemorrhagic strokes are caused when a blood vessel bursts in the brain. There are two types; An Intracerebral hemorrhage floods the surrounding tissue with blood and is the more common type. The other type is Subarachnoid hemorrhage which results in bleeding in the area between the brain and the thin tissues that cover it.

Sources: "Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010 : The Lancet." Accessed October 24, 2013.
-Centers for Disease Control and Prevention. "CDC - DHDSP - Types of Stroke." Accessed October 24, 2013.

Tuesday, October 22, 2013

How dangerous are dental cavities?

A fungus and a bacteria team up to cause oral diseases, knock out human teeth and much more.

Dental disease is a global problem affecting up to 90% of all adults. In the U.S. 42% of children by the age of 11 have had cavities. Oral crevices and empty spaces along with different tissue types such as the tongue and mucous surfaces, a steady supply of saliva and any snacks and foods that go into the mouth support a complex microbial flora that may comprise of over 700 different bacterial species, according to a a new study published on the online journal PLOSPathogens.

Almost 300 of these microbes contribute to the periodontic pocket biofilm. Of these the predominant bacterium is Streptococcus Mutans that resides on the enameled surfaces and is responsible for most of the cavity formation and periodontal disease.

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