#after major surgery (hip/knee replacements etc) | Explore Tumblr Posts and Blogs

kneepaintreatmentinindia · 3 years

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Knee Pain Treatment in India - Removemypain

How Common Is Persisting Pain After Knee Replacement And Why Is It Important ?

Pain is the most important indication for joint replacement surgery and although surgery is successful in a vast majority of patients, some continue to have persisting pain. As per research evidence, approximately 9% after hip and 20% after knee replacement have an unfavourable pain outcome. 20% implies 1 in 5 patients, a significant number. Despite the high prevalence, the condition remains under acknowledged and can be rightly addressed as a silent epidemic.

Persistent pain not only has an adverse impact on the quality of life but often leaves patients confused or blaming themselves for the pain or the decision to go ahead with surgery. It can have an impact on mobility, general health, mood, sleep and lead to functional limitation with social isolation. When no obvious cause is found, the problem may be downplayed leading to the dissatisfaction, frustration, anger, tension or breakdown of the doctor–patient relationship, promoting doctor shopping. Somewhat ironically, persisting pain can sometimes be a consequence of surgery that was performed to alleviate pain.

Risk Factors for Persisting Pain after Knee Replacement

Persisting pain may have more than one reason, with a wide range of factors influencing the outcomes. It is important to know about these as some of them are modifiable.

Some of the known risk factors include

Poor mental Health including major depression, anxiety

Catastrophization (Constant worrying and exaggerated negative orientation towards pain experience)

Presence of other chronic pain conditions

Surgical factors include infection, instability, implant loosening or failure, alignment problems with the implant (misalignment), soft-tissue impingement, nerve injury and extensor mechanism problems (patellar malt racking and non-resurfaced patella)

Severe preoperative pain. Some studies have linked poorly controlled pain after the operation to increased chance of developing chronic pain whereas other studies have found insufficient evidence.

High number of comorbidities (other medical problems). Pre-existing heart disease has been found to be an independent risk factor for pain at 5 years after knee replacement. The peripheral edema (swelling), sedentary lifestyle/ reduced engagement with physical therapy may contribute to increased pain levels.

Young age and female gender

Pain Assessment

Most patients with persisting pain after the replacement surgery would return to the operating surgeon for a reassessment. Sometimes a second opinion from another surgeon is sought. Careful assessment in required to identify the problem and this involves detailed history, clinical examination (including the spine, hip and knee), psychological exploration, review of preoperative images & operative records, new investigations (serological, radiological and microbiological), assessing response to treatments and joint aspiration/ diagnostic injections if indicated. Sometimes despite extensive evaluation and best attempts using all modern technology at our disposal, the cause of pain cannot be identified. In such cases a trial of conservative therapy including pain relieving medications and physical therapy is often suggested.

Management Of Persisting Knee Pain After Knee Replacement Surgery

Treatment of chronic pain after knee replacement is challenging. It requires a multidisciplinary team approach with input from orthopaedic surgeon, pain physician, physiotherapist, psychologist and many others. The aim is generally improvement in function and quality of life. Once the cause of persisting pain is known the treatment can be directed accordingly.

Anatomically the cause of pain may be located

Extra articular (outside the knee joint at a distant site such as spine)

Peri articular (around the joint) such as tendinitis (ten on problem), bursitis (inflammation of bursa)

Intra articular (inside the joint) such as joint instability, loosening of implant, issues related to size/type of implant, infection, osteolysis (loss of bone), kneecap problems

How Can A Pain Physician Help ?

A pain specialist plays an important role in management of persistent pain and this includes

Identifying the type /source of pain. This is especially relevant when issues with implant have been excluded and surgery is not required/not possible. Diagnostic joint injections can help differentiate whether the pain is coming from inside the joint or from an external source. If required, some joint fluid can be aspirated (removed) at the same time to evaluate for infection. Similar injections can be used to identify pain sources around the joint by trigger point injections, nerve blocks etc.

Regulating pain medications. This is an essential component of overall management, best performed by professionals who are aware of all options and their limitations. Pain physicians are more familiar with use of stronger pain killers and some options such as capsaicin & Lidocaine patches as they use it more often. Sometimes small changes in medications can make a huge difference in the pain levels.

Treating nerve pain. Nerve pain after knee replacement often goes unrecognized and may be responsible for persisting pain in approximately 6%-13% of patients. Typically, it presents with electrical shock like or burning sensation, numbness or altered sensitivity, although it can also present as an aching sensation associated with stiffness. Sometimes thickening of the nerve (neuromas) can be a source of persistent pain.

Infrapatellar branch of the saphenous nerve. This is a small nerve running from the inner to the outer side of the knee below the kneecap. An injury to this nerve or a neuroma can be a common cause of persistent knee pain. Pain physicians can treat this successfully in an overwhelming majority of patients with nerve blocks, radiofrequency or cryoablation procedures.

Nerve blocks are offered if nerves are suspected to be the pain generator. A simple OPD performed procedure can often help identify the pain source and provide prolonged relief.

Pulsed Radiofrequency can be performed as a day case in an attempt to prolong the pain relief, in case the effect of the nerve block is short lasting. This is similar to nerve block but uses special needles and a radiofrequency machine to interfere with the pain signals being transmitted to the brain.

Cryoablation. This specialised technique involves application of cold to cause temporary disruption of the nerves ability to transmit pain signals without causing permanent nerve damage.

Other specialist interventions used to provide pain relief include

Radiofrequency Ablation of Genicular nerves. Knee joint is supplied by many nerves and these are collectively addressed as genicular nerves. This procedure involves an initial diagnostic test whereby a small amount of local anaesthetic is injected close to these nerves. If this produces effective pain relief then one proceeds with the radiofrequency ablation. In radiofrequency ablation special types of radio waves are used to create a heat lesion around the nerves interrupting the transmission of pain signals to the brain. These nerves are approached with help of needles placed under x-ray and ultrasound guidance with no requirement for any surgical incisions. This is a safe, non-surgical procedure performed as a day case under local anaesthesia.

Cooled Radiofrequency Ablation. Cooled Radiofrequency treatment is a minimally invasive treatment performed on a day care basis under local anaesthesia. The treatment aims to deactivate the nerves responsible for transmitting pain signals from the painful knee. It involves placing needles close to these nerves under x-ray or ultrasound guidance followed by heating of nerves to reduce the pain signals being transmitted. It differs from conventional Radiofrequency (described earlier) as it has water circulating through the device and can create a larger treatment area increasing the chances of success. Normal activities can generally be resumed soon after the procedure.

Spinal Injections – All nerves supplying the knee joint originate from the spine and interventions targeted on these (such as pulsed radio frequency of dorsal root ganglion) can help reduce the pain.

Identifying your needs and directing you to other experienced professionals (such as physiotherapists, occupational therapists, psychologists) as required.

Tag = Knee Pain Treatment in India, Knee Pain Treatment in Delhi, Pain Specialist in Delhi

#Pain Specialist in Delhi #Knee Pain Treatment in Delhi #Knee Pain Treatment in India

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commander-rahrah · 4 years

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RESIDENCY: SECOND CHANCES (AN OPEN HEART FIC II): PART ONE

Pairing: MC (Jordynne Holland) X Ethan Ramsey X Bryce Lahela; MC X Bryce; MC X Ethan. Please note that both pairings are present in this fan fiction — off & on, at the same times, and the relationships do ebb & flow. Please keep this in mind. Thank you.

Masterlist: Click Here

Chapter Rating: T

Word Count: 4100+

Description: What happens between the end of Book One, and the start of Book Two. Picking up from the ending of Open Heart Book 1 and the last chapter of Residency (masterlist posted above)

Disclaimer: Characters, storyline, and parts of the dialogue are taken from Pixelberry’s Choices. They fully own the characters, dialogue, backgrounds, etc. MC Jordynne’s background is my own creation, based loosely off of MC in-game’s personality and provided with more details.

Author’s Note: Annnnnnd we are back with Residency Part Two! Second Chances! I really wanted to explore what led to Ethan leaving for South America… For Two Months… Your girl hates a time jump and she hates even more when there are missed opportunities for angst and drama!!

As always any likes, reblogs, and comments are very appreciated. If you would like to be added/removed from the tag list please just let me know!

Taglist: @drakewalkerfantasy @owleyes374 @lahelable @mayar-mahdy @paisleylovergirl @nicquix @emilymay100 @octobereighth @llamasgrl @timmagicktoad @lilyofchoices @msjpuddleduck @mfackenthal @paulfwesley @ccolz88-blog @mindlessdreaminxo @jooous @lapisreviewsstuff @choicesarehard @themingdynasty @omgjasminesimone @hopelessly-shipper @binny1985 @perriewinklenerdie @jens-diamondchoices @indiacater @chasingrobbie @writingsbymissy @dimitriwife @tacohead13 @amy-choices @violinet

Previous Updates: Residency — Part One Part Two Part Three Part Four Part Five Part Six Part Seven Part Eight Part Nine Part Ten Part Eleven Part Twelve Part Thirteen Part Fourteen Part Fifteen Part Sixteen Part Seventeen Part Eighteen Part Nineteen Part Twenty

Previous Update

PART ONE:

Light trickled in through the office window — casting everything in a yellow light. The leather books lining the walls — some of the spines worn from years of referencing them. Framed diplomas and awards on the walls — not put up by him, but by the adamant advice of the board. They wanted to show off their decorated diagnostician.

Ethan Ramsey was leaning back in his desk chair, surveying the space around him carefully. Re-familiarizing himself with the space after his time away.

But now he was back.

His decision to come back was his own. But he was blindsided by everything else — Harper stepping down and Naveen replacing her was a shock. He was conflicted thinking of Naveen as administration now — hopeful that perhaps he had someone on his side now, but strained in wondering if it was really what the old man wanted.

And then there was Jordynne.

No — Doctor Holland, he corrected himself.

As he thought of her, images immediately began to play in his head like a slideshow. The previous night and how they had gotten lost in each other. The intimacy and passion and pleasure they shared in her tiny bedroom.

How intriguing it had been to see her personality and life displayed to him throughout her bedroom. The framed photos of her family on the walls, her perfectly organized, color coded bookshelf but her chaotic closet spilling at the seams. Ethan never thought he could be that excited at seeing someone else’s stacks of books on a nightstand — but with her he was.

And then their conversation. It wasn’t really a conversation — more of a quiet understanding. They both knew what it meant with him coming back to the hospital. But as he had opened his mouth to speak about it, Jordynne had silenced him with a kiss.

“Just be here with me — right now. Okay?” She had whispered through the kisses.

So that’s what he did.

But now — back in his pressed pants and lab coat, sitting in his office — his head was swimming. Going back to the way things were — he wasn’t sure how to do that. It was a lot harder now. A lot more complicated.

Ethan Ramsey had always been a man of conviction. Rules and regulations. Usually, they were his own rules, that were made with the official ones in mind that he would bend and twist as needed. So he had made a line for him and Jordynne — that wasn’t to be crossed. But they did — time and time again.

Now that she was going to be on the Diagnostics team, that line seemed more complicated than ever. He was her boss now — her direct report, not just her attending. But that also meant that they would be spending more time together than ever.

Why did Naveen put them in this situation?

Standing up abruptly, the chair behind him moved backward from being knocked by the backs of his knees.

Marching down the hallway, Ethan headed towards the elevator. He had a few glances at him in it — other staff whispering about him being back. But he had kept his arms crossed over his torso, keeping his guard up as to not initiate any conversations.

His leather dress shoes clicked down the hall as he made his way to the Chief of Medicine’s office. The door was already open.

“Ahh, Ethan. It took you longer than I anticipated to come see me up here.” Naveen spoke as he stepped away from hanging up a frame on the wall. He stepped back, putting his hands on his hips and looked at Ethan with a smile.

“I needed to process.” He stepped into the room, his hand hovering on the doorknob.

Naveen noticed, “Close the door.” The pair shuffled towards his desk and sat on opposite sides of it.

Ethan glanced over to see the frame he had been hanging — it was the pair of them, accepting an award. The same photo that was hanging on his living room wall.

“So, my friend, what is it your processing?”

“Why you’re in that chair.”

“Because,” He thought for a moment — his finger moving over his moustache, “Because we need to make sure that Edenbrook can continue to do good things. Harper’s heart wasn’t in it, anyone could see that. So, we needed to make sure that someone who knew how good this place is took this chair.”

“I— I just never thought you would be administration.”

Naveen let out a low belly laugh, “Me neither. But a few days ago, I had also accepted my fate that I was going to be a cadaver. You just never know.”

“Hmm,” Ethan grunted.

“That’s not what’s really bothering you.” His mentor had always known how to read him — he should have known better.

He let out a sigh — hesitating before finally speaking, “I really wish you considered it more before you decided to put Dr. Holland on the diagnostics team.”

Naveen’s eyebrows rose, “You think I didn’t think it through? Is there another resident you would rather have on your team?”

“No — I, of course not.” He shook his head, scoffing, “I don’t want to work with any of those imbeciles.”

“So Dr. Holland is the correct decision.”

“Yes. No. It’s—“

“Complicated?” Naveen offered with a smirk.

Ethan let out another heavy sigh, “Yes.”

“Ethan — I thought it would be less complicated for you by making the final decision. I selected her — not you. And I have my own reasons for doing so.” He leaned back in his chair, studying him, “She’s damn good.”

“She is.” He didn’t miss a beat.

“So you agree. Perfect.”

Ethan stumbled on his words, “I— she — we,”

A chuckle escaped Naveen, “I don’t think I’ve ever seen you so flustered before.”

For a moment, he dropped the act. “I just thought that with me coming back — it would be different. You are healthy again, so there isn’t a secret case. She’s a resident now, not an intern. But now — she’s on my team, she’s my direct report. Distancing myself from her — how is that going to work now?”

His thick eyebrows furrowed with worry, “You want to distance yourself from her? Do you really think that will work?”

No.

He answered in his head. When he saw her down the hallway that morning it had made his heart flutter. The smallest of things, even on the off chances of seeing her — the way she tightened her ponytail, when he got a whiff of her perfume, her quick jabs back when he got sarcastic, the way the corner of her eyes stretched when she laughed.

“Maybe.” He said out loud.

_______________________________________________________________________

“Chronic obstructive pulmonary disease...”

A dark-haired man was sitting stunned on a chair in the sterile hallway — his hands folded carefully onto his lap as he processed.

Jordynne stood in front of him, a clipboard clutched to her chest as she looked between him and through the room’s window at the woman she had just diagnosed. She had been observing her and doing tests for the majority of the morning.

“Can — can it be cured?” He stuttered.

“No,” she said simply — a sad smile spreading across her face. “But it can managed and treated.”

He looked up at her, his eyebrows furrowing a little less. “I — I have no idea what to do. My dad dealt with all this stuff for her and now—,”

Jordynne slid into the chair next to him, her body angled towards him a little. “I know it's a lot to take in. But we can discuss treatment options, pain management.”

A grateful smile spread across his face, “That — that would help. Thank you.”

“How about we get you a coffee, and I’ll get paged once your mother wakes up?” She offered.

With a nod, the pair stood up and made their way to the cafeteria. Jordynne grabbed a coffee for the man, and a green tea for herself — she knew better by now than to drink the cafeteria’s attempt at caffeine.

They settled into a table near the window — and they took a moment to watch the pedestrians strolling by.

“So, what can we do? For my mom?” He broke the silence after taking a long sip of his coffee.

Jordynne wrapped her fingers around her own cup — warming up her fingers. “Honestly, one of the best things she can do is quit smoking. But we can start her with an inhaler — a combination of steroids and bronchodilators. If it progresses, she may need oxygen therapy… or surgery.”

Her patient’s son’s eyes went wide as he listened to the information, “Could it lead to cancer?”

“She has a higher risk of developing lung cancer.” She stated simply, her eyes studying him.

“That’s how we lost Dad…” He looked out of the window — suddenly looking lost.

“I’m sorry, Justin.” She chewed on the inside of her cheek.

“Don’t be. You’ve nothing to be sorry for.” His mouth spread into a smile — it was nice. “Besides, I would be completely clueless about all of this if it weren’t for you. You’re very intelligent.”

“Oh, thank you,” Her cheeks flushed with embarrassment at the compliment. “I’m just doing my job.”

“Well, you are very good at it. I couldn’t imagine, doing something like this.” He pointed up, indicating to the many floors of patients above them.

“What do you do?”

“I work at a marketing firm.”

“That sounds exciting.”

“Ha,” He let out a dry laugh, “It’s different than this for sure. I sit in a cubicle and stare at a computer all day.”

Jordynne crinkled her brows, “But you like it, right?”

He thought for a moment before nodding, “Yeah, yeah I do.”

“Then that’s what matters...” But her voice trailed off as she watched Ethan step up to the coffee station nearby. She could hear the mutter of Justin’s voice in front of her — but couldn’t make out any of the words.

Should she say something to him? Would it be more weird if she didn’t say anything at all?

“Dr. Ramsey, hi?” Her voice was uncertain as she watched him nervously pour creamer into his travel mug.

“Dr. Holland!” He jumped at the sound of her voice — his open mug spilling onto his dress shirt. “Ow!” He winced as the hot coffee split on him.

“Ohmygosh,” She got up quickly and crossed over to him. Without thinking about it, she grabbed a handful of napkins and started plotting his blue dress shirt.

Ethan watched her for a moment before he stepped back with a cough, “It’s quite alright, Dr. Holland. I can take it from here.”

She stepped back embarrassed — realizing what she was doing. Looking over her shoulder she remembered where she was. “Dr. Ramsey, this is Justin Ramirez — Mrs. Ramirez’s son, my patient in 515.”

He finished wiping his hands on a napkin before crossing over and putting his hand out to shake. “Sorry to meet you in these circumstances,” They shook hands for a moment, “I can assure you that your mother is in great care with Dr. Holland.”

“Thanks, I’ve seen that.”

Her face went pink at the compliment as she stood awkwardly near the table — unsure if she should sit or stand. She wasn’t really sure how to act right now. “We’re just reviewing treatment plans.” She blurted out.

“Right...,” He looked between the two of them, his blues eyes scrutinizing, “Well make sure you save the time to explain it to the patient too, Dr. Holland.” With a nod, he tightened the hold on his travel mug before turning on his heel and heading out the cafeteria door.

“Sorry about that — I,”

“No worries, I—“ But Justin trailed off, looking over her shoulder.

Jordynne jumped in her chair a little as she felt someone grab onto her shoulder. Straining her neck, she looked up the see Bryce — his mouth upturned in his usual wide smile. “Hey gorge—,” But he stopped himself as he realized she wasn’t alone. “I’m sorry, I thought you were alone, Dr. Holland.”

Moving his hand off of her shoulder, he stretched it across the table, “I’m Dr. Lahela.”

“Hi, Justin Ramirez.” He said, shaking yet another hand in the hospital cafeteria.

“Mrs. Ramirez’s son? In room 515? I’ll be going up there later this afternoon to discuss surgery options.”

“Right.”

“Well, I will see you up there later then. Dr. Holland — we’re still ok for lunch?” His caramel eyes caught hers, the edges crinkling as he smiled down at her.

She gulped, “Yeah, I’ll see you then.”

Did her voice sound squeaky? It sounded squeaky.

“You’re a popular doctor.” Justin said after Bryce had walked away.

“Or it’s just a small cafeteria.” She let out a sigh of relief as her pager went off, “Looks like your Mom woke up.”

“Yeah? Good, let’s go.”

Jordynne lingered at the table for a moment longer — letting him get a few paces ahead of her. Swallowing, she resolved herself a bit before following in behind him.

_______________________________________________________________________

“Two months.”

Ethan was back in Naveen’s office — his feet planted in front of his desk. He was staring down at the old man, watching him read the application he had sat down in front of him.

“Two months?” Naveen repeated, finally looking up at Ethan. His eyebrows were furrowed, deep lines forming in his forehead.

He chewed the inside of his cheek for a moment, “In South America.” He said it as neutral as possible.

Naveen reread over the page, flipping it back and forth. His mouth turned into a frown, “When you said distance yourself I didn’t think you meant flying to a different continent.”

Neither had Ethan. But it had fallen onto his lap. An unopened email he had long forgotten about in the chaos of the last few days.

He had forgotten he had even thrown his name into the ring — reaching out to the World Health Organization to volunteer. For literally anything. Anywhere.

It had been a way to get away from Edenbrook and Boston. A way to forget about his failure. Failures. Multiple.

But now — it could just be for a break. A reset.

To distance himself.

“Sign it.”

“No.” The Chief of Medicine barked, putting the papers back down and pushing them towards Ethan.

“Naveen—“

He straightened up — setting his jawline as he stared at him. “Not until you tell me why.”

“I can’t,” Ethan let out with a sigh. “I— I need more time. I’m not ready.”

“Ready for what?” Naveen raised a brow, “You’ve been running the diagnostics team since I left.”

“To act like I don’t...,” He trailed off, “To act like I don’t care for her. The way I do. The way a boss shouldn’t. I’m not ready.”

“Fine.” The old man signed the form, placing it carefully on the edge of his table for Ethan to take, “When this doesn’t work — don’t come crying to me. I warned you.”

_______________________________________________________________________

The next day came by in a blur. Jordynne had missed all this — her suspension had proved how much she loved being a doctor.

She hadn’t missed giving people life-changing diagnoses — but that was apart of the job description. She was leaning against Danny’s nurse station, watching Justin saying goodbye to his mother through the window to her room.

He had come in to check on her before going to work. They had decided to hold her for another day of observation, but he couldn’t take any more time off.

Watching the son and mother hug made her heartache. Her homesickness had never been worse.

Blinking back to reality, she watched as Justin approached her — a sad smile on his face.

She pushed herself off of the nurse’s station and headed towards him, “You okay?”

“Yeah, I just wish I could stay longer.”

“Well, I assure you that your mother is in the best care. Danny is the charge nurse for this shift, and honestly, he could probably run this whole building.” She assured him.

“Oh yeah, that reminds me,” He dug into his back pocket and pulled out a folded paper, “Here, I wanted to give you my number...”

Her green eyes widened in shock, “Oh! I’m flattered but—“

But he quickly stopped her, “For my mom’s file. In case something happens.”

“Right. I’m an idiot.” Jordynne felt her entire face turn hot with embarrassment. “I’m so sorry, I don’t—“

“No! You’re really not.” It was his turn to reassure her now, “I thought about it actually,” He lowered his voice a little, “I was gonna ask you out.”

“Oh?” She blinked in surprise.

“I mean — you’re incredibly smart and hot and like, just the right amount of intimidating.” He laughed nervously, “But I got the sense that you were already seeing someone. When that doctor came over and introduced himself yesterday in the cafeteria?”

Which one?

Jordynne thought to herself. God, she seriously was the worst person.

“It’s probably not a good idea to date my mom’s doctor anyways.”

She nodded with pursed lips — taking the sticky note he had offered and placing carefully onto her clipboard. She hugged it to her chest, “If there are any updates throughout the day, we’ll give you a call.”

She forced a smile on her face — trying to hide the winding gears going off in her mind.

_______________________________________________________________________

At the end of her shift, Jordynne was wrapping up the rest of her paperwork. She and her friends were hovering around the nurse’s station — itching to get out on time for once so they could head down to Donahue’s and get a good spot for once.

Just as she slid the last of her patient’s charts over to the charge nurse, the intercom buzzed.

“Dr. Holland to Chief of Medicine’s office. Dr. Holland to Chief of Medicine’s office.”

“What’s that about?” Sienna quickly asked — her eyebrows furrowed in concern.

“Yeah — I thought everything was good?” Elijah piped in.

“It is.” She raised her hands up, trying to calm them down, “Seriously.”

“It’s only day two of her being back. What’s the Chief of Medicine’s going to want anyway?” Jackie piped in, shrugging her shoulders as she finished up her own paperwork.

“Yeah, plus she did save the dude’s life.” Bryce offered, leaning casually onto the station. He was right next to Jordynne — she swore she could feel the heat radiating off of him.

“Right...,” Sienna and Elijah said in sync.

“Seriously, I’ll be okay. I’ll meet you guys at Donahue’s.” She started to turn on her heel, but fingers grabbing onto her elbow stopped her.

It was Bryce. “I’ll save you a seat.” He said simply, before flashing her a brilliant smile and letting go of her arm.

“Thanks,” She breathed in, feeling a little winded all of the sudden. Turning on her heel, she blinked back to reality and started heading towards the elevator.

She knocked gently on Naveen’s office door — before a soft voice told her to come in. Stepping inside, her eyes were immediately drawn to the old man sitting behind the desk — a warm smile was spread across his face.

“Hi, Dr. Banerji,” Jordynne said as she closed the door softly behind her.

“Now,” He got up to greet her, moving around from behind the desk, “How many times do I have to tell you — it’s Naveen, my girl.”

“You’re the Chief of Medicine. I can’t call you that.”

“And you’re the young doctor who saved my life.” He motioned for her to take a seat, before doing the same, “And besides, we are friends and we respect each other. So it’s Naveen.”

“Okay. Naveen.” Her mouth has turned upward — a warm sensation of pride filling her chest.

“So, how does it feel to be back?”

“I’m... ecstatic. And grateful.” She paused for a moment, before continuing, “Everything that I went through — the trial, and suspension — it just really showed me how this is what I’m meant to do.”

“I couldn’t agree more. And how do you feel about the fellowship?”

“Excited.” She said quickly — but chewing the inside of her lip gave her away, “But nervous at the same time. It will be —“

“Different?” He offered.

“Mhmm.” She hummed.

“Well, it will start in about two months' time. Once the new wing is completed, the diagnostics team will have a brand new office and your fellowship will commence.” Naveen hesitated before licking his lips, “It will also coincide with Ethan’s return.”

Jordynne furrowed her brows in confusion, “What do you mean? He’s already back.”

“Ah — so I see he has left that part for me.” He avoided her stare for a moment.

“I don’t— what are you talking about?”

“Ethan has accepted a team lead position for a project with the World Health Organization. They are going to be stationed in the Amazon.”

Her mouth fell open, “The Amazon? Rainforest? In South America?”

“For two months.”

“Two... Two months?” She couldn’t help but repeat everything back she was hearing. She couldn’t believe what she was hearing.

“I’m sorry he didn’t tell you himself.”

She could tell by Naveen’s tone that he did not approve of Ethan’s decisions.

“I— I don’t understand. He just got back.”

“What I’m thinking is, his world just got turned upside down. He doesn’t do change very well. Perhaps this will let him straighten things out.” He said it like it was a practiced line.

“By living in the rainforest for 2 months? How will that get him back to normal?” She asked, completely exasperated.

“No idea!” He let out a dry laugh, “You should tell him that.”

“When does he leave?”

“Tomorrow morning. He actually just wrapped up for the day — so he can prepare.”

Her shoulders sank — he left. Without telling her any of this. Without a goodbye. Was she supposed to just walk past his office and figure it out? Get an out of office email notification back?

“You can still catch him. Go to the parkade.” He winked a brown eye at her, waving his hands to shoo her out of the door.

Jumping out of her seat, she started speed walking down the hallway — weaving past the few administration staff lingering in them. Some of them flashed her some odd looks, but a doctor speeding through a hallway wasn’t the weirdest thing to see in a hospital.

When she got to the parkade door, she took a big breath, tucked some of the hair falling out of her ponytail behind her ear, and pushed through the door.

Her green eyes searched for his familiar black car, walking as she looked. She stopped in her tracks as she noticed him — his hand lingering on his open door as he went to go sit in his car.

So he really was going to just leave without saying anything.

“Were you even gonna say goodbye?” She asked — her voice echoing a little in the concrete parkade.

His head whipped around to her voice, his eyes wide as he stared at her. Closing the door to his Mercedes, he took a few long strides until he was a few feet away from her.

“I — Who told you?” He avoided meeting her stare.

“Naveen.”

He let out a sigh, “Of course.”

“You didn’t answer my question.” She said, her jaw set into a hard line.

“I — I wasn’t not going to say goodbye.” He put his hands in his jacket pocket — clearly nervous. “Things just happened so fast.”

“Right.” She didn’t look like she believed him, “So South America?”

“Mostly Peru and Brazil.”

“Malaria?”

He nodded in reply.

Confusion spread across her face, causing a line to form in between her brows, “Why are you doing this?”

“What?”

“Why are you really going, Ethan?”

“People are suffering and I can help them.” He stated simply.

“The same thing is happening here in Boston.” She countered, crossing her arms of her chest.

“Well, I made a commitment to the organization. So I’m going.”

She let out an involuntary sigh, “I thought we were going to try and be normal about all of this, Ethan.”

“This is normal. I’m a highly qualified diagnostician and doctor who is traveling to a region in desperate need of quality medical assistance and advancement.”

She shook her head at him, “That’s not what I meant.”

“Well, that’s the reason.” His tone was flat and final.

“Fine.” She bit down on her bottom lip, “Safe travels.”

He nodded in thanks. The pair standing in awkward silence for a moment — finally meeting one another’s eye. She searched his blue eyes — looking for even just the smallest glint of something. But she couldn’t find it — his well-practiced mask was already on and it seemed it wasn’t going to be coming off.

Jordynne let out a sigh that echoed through the parkade, before turning on her heel and marching away. The heavy metal door let out a large bang as it closed behind her.

Part Two

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robotictotalkneereplacementindia · 4 years

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Computer Assisted Knee Replacement in Jaipur joint Replacement in Jaipur

The new technology provides you with better treatment to support your body without feeling extensive pain. Such kinds of technologies make your body to work properly and allow you to do regular activities in your mundane life such as run, walk, crouch, jump, stand, sit, jog, etc. several knee problems are there that may create major issues in your life. Sometimes, to perform a replacement of your joint will be the last option you are left with.

Dr Anoop Jhurani introduced the joint replacement via computer-assisted knee replacement in the Rajasthan. This new technology has changed many lives by accomplished successful surgeries. After using such techniques, Dr Anoop Jhurani not only has given the painless treatment to his patient, although he provides the best treatment of knee, joints or hip replacements in Rajasthan.

Computer Assisted Knee Replacement in Jaipur joint Replacement in Jaipur

Computer Assisted Knee Replacement in Jaipur The varieties of joint effects are there, so treatment has to be there to cure them. Many knee problems or other joint issues are growing within people. They might have no idea to cure their trouble, which they have got additionally into their lives. Nobody could say that it might get severe if we continuously avoid it either intentionally or unintentionally.

Traditional methods are also there to heal such problems but they take a lot of time from people to recover the pain. Computer-assisted technology is there to perform the knee replacement, joint replacement or hip replacement. It makes things easier. Mainly, it takes less time to recover in comparison to the traditional one.

Dr Anoop Jhurani is the best surgeon of joint replacement in Jaipur. You may visit his clinic to get relieved from your pain if you are getting any kind of pain. The recovery through computer-assisted replacement is surprisingly amazing and it gives you relief from the pain as soon as possible, though it totally depends on the human being and the precaution you need to look after the surgery.

#Computer Assisted Knee Replacement in Jaipur

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dranoopjhurani · 5 years

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Computer Assisted Knee Replacement in Jaipur joint Replacement in Jaipur

Dr. Anoop Jhurani introduced the joint replacement via computer-assisted knee replacement in the Rajasthan. This new technology has changed many lives by accomplished successful surgeries. After using such techniques, Dr Anoop Jhurani not only has given the painless treatment to his patient, although he provides the best treatment of knee, joints or hip replacements in Rajasthan.

Computer Assisted Knee Replacement in Jaipur joint Replacement in Jaipur

Dr. Anoop Jhurani is the best surgeon of joint replacement in Jaipur. You may visit his clinic to get relieved from your pain if you are getting any kind of pain. The recovery through computer-assisted replacement is surprisingly amazing and it gives you relief from the pain as soon as possible, though it totally depends on the human being and the precaution you need to look after the surgery.

#Computer Assisted Knee Replacement in Jaipur joint Replacement in Jaipur

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zw-gia-to-xamogelo · 5 years

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Tips for Medical Travelers

Do Your Research study when Choosing a Medical Provider

Las Vegas has been blessed with excellent medical professionals and a lot of quality healthcare facilities and centers. Even so, as a potential patient and tourist, it is essential that you take the required time to research your options to select a physician and medical facility that fits your requirements and budget. Failure to do so could cause an undesirable medical tourist experience if not a fair procedure outcome. In the previous chapter, you will discover a list of suggested centers with their contact details.

Do not be Shy

When investigating your alternatives, don't hesitate to request for details such as medical professional's CV's, medical outcomes or medical facility performance indications that will help in your choice making procedure. The majority of healthcare facilities will be more than happy to provide this info. As taking a trip client, it is essential that you have as much information as possible to make a decision that will be in your best interest.

Bring a Companion

Bringing along a buddy is continuously recommended, particularly if you will be undergoing a treatment that will leave you disabled for any length of time. Companions can offer much required physical and psychological assistance that can make your medical tourism experience much less stressful.

Travel Easily After Surgical Treatment

Depending on the kind of surgery you have gone through, it might be smart to buy tickets in first or company class. This is specifically real for orthopedic procedures such as hip and knee replacements, heart surgery, and neurosurgery-- where area and the possibility to extend your legs will lower the threat of Deep Vein Thrombosis and permit a much more comfy flight. It is likewise suggested to travel light, particularly if you are going alone. You don't wish to be dragging heavy luggage after a delicate surgical treatment.

Offer Yourself Bonus Time

Not only will this give you time to completely recover, however, but it will also provide you with a little buffer time in case you must invest more time in the hospital than you initially prepared for. This is your unique chance to dedicate time to yourself and your healing procedure.

Keep Your Medical Records and Important Contact Information in your Purse or Hand Luggage

Ensure to keep crucial details useful at all times. Be especially cautious not to pack medical records, prescriptions, or essential contact info in checked baggage as these can be lost or momentarily delayed.

Network with other Clients who have already been to Las Vegas for Medical Tourism

One of the most excellent ways to prepare for your medical trip to Las Vegas is to speak with past clients about their experience. Talk to your Las Vegas physician or medical facility contact and request to speak to previous clients. This detail is invaluable for picking your location for medical or wellness care.

Get as Much Details about the Medical Treatment Process as Possible

How much will the surgery or treatment expense?

Who will select you up at the airport?

Who will be your primary contact at the healthcare facility or center?

The number of appointments you will need?

For how long you will remain in the hospital?

How will you receive from the hospital to your hotel?

How long is the post-procedure recovery duration

Request a detailed schedule of tests and visits, etc

Take a look at the medical tourism Pro website to find out which vaccinations or tablets you need, if any, to visit your chosen destination.

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stefanduell · 6 years

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#Repost @physioosteogram . Great post by @optimize.physiotherapy on how important it is to MOVE and LOAD to recover faster from an injury! 🔑 ↘️ Rest is important when we are rehabbing an injury or are in pain. Rest is a broad term however, and does not mean that we should avoid movement at all costs. ➡️ Rehab of any musculoskeletal injury requires movement. Not only movement at the specific Injured area, but overall human movement must be restored as quickly as possible. 🔹 Yes, tissue sometimes needs time to heal (especially when dealing with surgeries, tears, bone breaks etc.). We must respect that. But this does not mean that we should restrict other forms of movement that don’t negatively hinder healing. In most cases, introducing load and movement as soon as possible after an injury or while in pain yields the best results. 🔑 Complete rest is rarely the answer. Relative rest and working around injuries is a much better solution...doing as much as you can while still respecting tissue tolerance. ❌ Examples: 1️⃣ Acute low back pain. ➖ I have had many clients come to me who have said that they literally laid in bed for days following a back injury. Yes, pain levels can be extreme at times, but introducing movement (even at the areas above and below the injury) and getting the body gradually moving is VERY important for recovery. It can be counterintuitive, but putting someone though a mobility session who is in acute pain can quickly chip the pain down to a fraction of what it was (neurologically). 2️⃣ Knee and hip replacement surgeries. These major surgeries used to mandate 1 or more FULL weeks of bed rest in the hospital. Now, doctors enforce that patients get up and moving hours after the surgery and patients will often get out of the hospital in 1-2 days, walking on their own (with a gait aid of course). ✅ Whether a major or minor MSK injury, movement reintroduction is the answer. . #health #fitness #fit #healthylifestyle #healthy #medicine #hospital #injury #pain #rehab #recovery #physicaltherapy #training #movement #physiotherapy #mobility #strength #crossfit #weightlifting #yoga #functionaltraining #healing #gym #exercise #osteopathy #physiology https://www.instagram.com/p/BnhZ9k_HO5Y/?utm_source=ig_tumblr_share&igshid=ttanmffavz3r

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kneereplacementinjaipur · 2 years

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Computer Assisted Knee Replacement in Jaipur joint Replacement in Jaipur

#Computer Assisted Knee Replacement in Jaipur

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juniperpublishers-orthopedics · 2 years

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How Long Do I Need To Suffer Pain and Invalidity?

Editorial

Osteoarthritis in hips, knees and other major large joints is a progressive and chronic debilitating disease characterized by pain and limitation of movements. Worldwide this disease is on the increase due to people living longer and more active lives.

When first symptoms appear, doctors will offer palliative treatments to kill pain, which will help for awhile, and in many cases patients develop health complications due to taking anti-inflammatory or pain killers.

In many countries of the third world and even in the developed world, patients have to suffer pain and limitations for months or years, waiting while their joints are destroyed and in need of the old, dreaded, expensive and not free from severe complications joint prosthesis surgery. By the time patients are operated, their muscles have weakened and lost strength needing prolonged rehabilitation for their limbs to function properly.

Mr. Mc Kee FRCS, and his Assistance Mr. Farrar in Norfolk - England initiated total hip prosthesis replacement as a new era for treating hip osteoarthritis in the 60s., this was improved after Mr. John Charnley introduced plastics and acrylic cement. Total Hip Prosthesis (THP) has helped millions of people worldwide and today there are on the market dozens of different types of hip prosthesis joints.

At the XIX World congress of Surgery of the International College of Surgeons (ICS), in March 1974, the most renowned surgeons of the day; like Mr. Mc-Kee, Mr. Ring, Mr. Wilson from England, together with the very few surgeons performing this surgery in Europe, Latin America and Australia communicated their experiences in this field. The problem of infection, metal rejection, loosening of prosthesis and metallic particles appearing around operated areas were already causing concern, especially in my case, as I was performing this surgery in private hospitals since 1972. After this congress the FDA in the USA allowed the use of acrylic cement in humans, since then very little has changed. We have almost the same complications as 50 years ago as the method of introducing a stiff metallic element (prosthesis) into a constant remodelling bone structure is the same.

Total Hip prosthesis so far has been the treatment for destroyed hip joints, ignoring other solutions for treating the initial lesions in the articular cartilage, that trigger osteoarthrosis that needs replacement by a metallic prosthesis. This kind of surgery is very expensive, not free from complications and by increasing Revision surgery, which is the proof of device failure or surgical procedure, thus creating a huge business and increasing expenditure for patients and society.

We should follow the dental method of treating caries avoiding the destruction and removal of the tooth by resurfacing the decay. By resurfacing lesions in the articular cartilage as soon as diagnosed, it is possible to avoid the rough surface contacting healthy cartilage, which triggers changes in the joint, facilitating its destruction.

New advances in X ray visual devices. Arthroscopy, bio-materials, stem cells therapies, etc, innovative methods to approach joints avoiding puncturing the capsule etc , can make it possible in the near future to resurface initial lesions to save joints and save funds to National Health Authorities and patients. See: biototalhip.com.

We need to mobilize the medical world, research centers, orthopedic manufactures, Governments and Health Authorities to find new methods using new biotechnology to resurface with biomaterials lesions in joints to avoid the appearance of osteoarthritis.

With the economical crisis that societies are facing and worldwide increase of osteoarthritis, it is extremely important to save funds for other diseases. $83 billion will be expend in the next 10 years in the USA in joint prosthesis surgery. This amount of money will increase due to increase of Revision surgery in operated younger patients. Worldwide is the same situation.

The amount of energy consumed to manufacture prosthesis due to materials and metals used, make this production unfriendly to the environment and pollute the soil when patients are buried with them.

We need to open a line of discussion among experts to direct all our resources to find a more modern and biological way of treating osteoarthritis at its different levels of disease.

To Know More About Orthopedics and Rheumatology Open Access Journal Please click on: https://juniperpublishers.com/oroaj/index.php

For more Open Access Journals in Juniper Publishers please click on: https://juniperpublishers.com/index.php

For more about Juniper Publishers Please click on: https://juniperpublishers0.wixsite.com/juniperpublishers

#Hand surgery #Osteoporosis #Orthopedic oncology #pediatric orthopedics

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nisarghospital · 2 years

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Physiotherapy Awareness & Education | Best Orthopedic Surgeon In Vadodara | Bone And Joint Dr In Vadodara

Physiotherapy Awareness & Education

Have you recently undergone major surgery, and are looking for ways to restore your movement? Or have you experienced a serious knee injury that’s hindering your mobility? Wouldn’t it be great if you could improve your movement, coordination, and overall quality of life with drugs and surgery?

Is your answer to any of the above questions a resounding “yes”? Then it’s high time you start looking for physiotherapy in Vadodara.

What is Physiotherapy?

Also known as physical therapy, physiotherapy is a science-based treatment used to restore and maintain a patient’s movement. It’s particularly used to restore movement and function after a patient’s mobility is affected by injury, surgery, or an illness.

Most people looking for physical therapy in Vadodara often seek treatment only after they’ve experienced weeks or months of pain and disability. But working with the right physiotherapist even helps prevent critical injuries and restores your body’s balance.

Here are some of the key benefits of physical therapy:

● It provides relief from neck and back pain

● It helps prepare your body for major surgery, such as knee or hip replacement

● It helps you regain movement after a serious injury or accident

● It helps restore movement following a heart attack or brain stroke

● It prepares a woman’s body for natural childbirth

Apart from a natural pain relief technique, physiotherapy helps manage several chronic diseases, such as osteoarthritis, multiple sclerosis, sciatica, fibromyalgia, etc.

Get Top-Notch Physiotherapy in Vadodara

A simple Google search for “physical therapy near me” will provide you with plenty of leads for physiotherapy in Vadodara. But if you want to find licensed and experienced physiotherapists who will provide you with a customized treatment plan, contact Nisarg Hospital Vadodara today.

#Best Orthopedic Surgeon In Vadodara Best Gynecologist In Vadodara Hospital In Baroda Bone And Joint Dr In Vadodara Best Multispeciality Hos

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devidwelliams · 3 years

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Is hip and knee pain making your life hell? If this is the case, then your condition requires immediate attention.

A painful hip or knee region cannot effectively support your body weight. So, you would not perform your job, manage household work, play sports, etc. You will even find it difficult to sit or sleep comfortably.

Due to all of these limitations, many people start considering joint replacement surgery or taking painkillers. But, many people are still not aware of the importance of physical therapy in getting rid of hip and knee pain.

The best part about physical therapy is that it is the natural approach to managing pain.

Different Causes Of Hip And Knee Pain

For a lifetime, your knees and hips perform a lot of work. These joints withstand the majority of your body weight. So, these are prone to several ailments and injuries. Different causes of stiffness and pain are as follows:

Osteoarthritis

Ruptures, sprains, and strains

Bursitis

Runner’s knee

Other health or lifestyle changes or challenges can even worsen a case of knee or hip pain. One of the most common examples of this involves carrying extra weight.

Again, a postural imbalance or musculoskeletal misalignment can put unnecessary stress on a knee or hip. Lack of exercise can weaken the muscles that can even cause chronic strain and joint instability.

How Can Physical Therapy Help?

Physical therapy generally works by improving the functionality of your joint while also easing your stiffness and pain. So, now, you do not have to rely on heavy drugs like opiates or specific procedures like joint replacement surgery.

Whenever you experience pain, the most crucial step is to schedule your appointment with a professional physical therapy clinic.

After visiting the clinic, physical therapy will first assess your present condition. Based on that, they will prescribe specific exercises that are aimed to address your particular condition. It includes:

Step exercises

Hamstring curls

Leg lifts

Hip flexion, abductor, or extension exercises

Mini-squats

Heel-to-buttock-exercises

Hip rotations

Knee lifts

Even a simple activity like walking plays a vital role in reducing pain and restoring your mobility.

Depending on the severity of your condition, the physical therapist may recommend specific physical therapy approaches.

It includes massage therapy, ultrasound therapy, ice or heat therapy, laser therapy, or orthotic footwear. All of these approaches are meant to normalize your musculoskeletal balance.

Final Verdict

So, it is evident from the above section that it is possible to successfully overcome knee and hip pain with the help of physical therapy.

The next time, whenever you experience any pain in the hip and knee area of your body, you should straightforwardly approach a therapist.

They will make you get faster and return to your standard functionality as soon as possible. Whatever stage of pain you are in, it is never too late to relish the benefits of physical therapy.

#physical therapy #knee pain #health and wellness #health and fitness #work life balance

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anayajain · 3 years

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Have Some Knowledge about Orthopedics and Some of Its Surgeries

In the current time, medical science has reached a different level. Things that were difficult in the last 30-40 years have now become easy and yes, people are taking benefits from various approaches. You may have heard about several departments of medical science that focus on providing treatment to different parts of the body. In this section, you will get to know about one of the chief branches that any of us may need at some point of life. We are talking about orthopedics that looks after the diagnosis, prevention, care, and treatment of the musculoskeletal system. Additionally, some information regarding various types of orthopedic surgery will be mentioned in the below section.

About Orthopedics

Our musculoskeletal system involves some of the major components of the body like:

* Muscles

* Bones

* Ligaments

* Soft Tissues

* Tendons

The specialist from this field is known as an orthopedist or an orthopedic doctor. Due to numerous events, a person may require visiting such professionals. For example, different kinds of pain like hip pain, knee pain, ankle pain, back pain, shoulder pain, foot pain, elbow pain, wrist or hand pain can bother a person. Some conditions like ligament tear, dislocated bone, muscle injury, compression fractures, or tendon injuries may also require immediate medical help.

Many conditions can settle down with the help of non-surgical approaches. Like, based on the problem, the orthopedic surgeon can recommend medicines, injections, or physical therapies. But, a lot of people have to go through orthopedic surgery as the last treatment option.

Let's know about some of the widely used surgeries.

1. Joint Replacement Surgery

You can find the presence of various joints in the body. Sometimes, their health can get upset due to some reasons. In cases when they become damaged or dysfunctional, the orthopedic surgeon recommends joint replacement surgery. It mainly comes into use when non-surgical methods don't prove valuable for the patient in reducing down his troubles. Here, the surgeon removes out the damaged joint and then replaces it with an artificial one called a prosthesis. People are taking benefits from a wide range of joint replacement surgeries like hip replacement, knee replacement, and shoulder replacement.

2. Arthroscopy

This minimally invasive surgery, also known as keyhole surgery, is used to find and treat the problems of the joint. If a person is suffering from damage, injury, or inflammation to the joint, the surgeon may guide him to have an arthroscopy. It can be used in almost every joint of the body but is mainly preferred for the knee, hip, shoulder, elbow, ankle wrist. The procedure of this orthopedic surgery involves making a small incision to the joint side and inserting a narrow telescope attached with a camera. The camera then delivers the inside view to the monitor outside by which the surgeon can identify what's happening to the joint.

3. Spinal Surgeries

A lot of issues are linked to the spine. That can be in the form of pain, movement problems, or injuries. Some conditions can be all right by non-surgical options. But in serious cases, implementing orthopedic surgery treatment becomes necessary. A wide range of spinal surgeries is there to observe in the orthopedic department. Some of them are spinal fusion, disc replacement, discectomy, laminectomy, vertebroplasty, kyphoplasty, and endoscopic spine surgery, etc.

4. ACL Reconstruction

ACL, full named as the anterior cruciate ligament is a vital ligament present in the knees. And yes, it is more at risk of suffering from an injury. This ligament can tear due to some activities that include sudden stops and changes in direction. ACL can't heal on its own. And especially when it is completely torn, there will be a need to go for orthopedic surgery treatment. During the procedure, the torn ligament is removed. The surgeon takes a piece of tendon from another part of the body or a deceased donor and then places it as a substitution.

5. Joint Fusion

Arthritis is a severe joint disease that can worsen the condition of our joints. If someone is suffering from the pain of arthritis, joint fusion can be an option. This orthopedic surgery apart from the joint replacement surgery proves to be effective in cases of damaged and painful joints. The procedure involves cutting off the ends of the bones along with damaged cartilage and then joining or fusing two ends of the bones. Consequently, it becomes stabilized and the motion remains absent in the joint. With the help of such procedures, a person finds relief from pain that has been done because of instability.

6. Soft Tissue Repair

There can be a presence of some soft tissue injuries in the life of a person. For example, tendinitis or bursitis. To fix such conditions, the surgeon may take help from orthopedic surgery.

7. Fracture Repair Surgery

If a fractured bone is placed in the wrong position, it will heal into an incorrect place. Thus, a person will have to face some problems. Some fractures call for a surgical treatment to hold the bone in its actual place. During this kind of orthopedic surgery treatment, the surgeon fixes the broken bone by using screws, pins, rods, and plates.

#orthopedic #orthopedicsurgery #orthopedicsurgerytreatment

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your-dietician · 3 years

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Weight control key in arthritis prevention, management – Expert

New Post has been published on https://depression-md.com/weight-control-key-in-arthritis-prevention-management-expert/

Weight control key in arthritis prevention, management – Expert

An Abuja-based general practitioner, Dr Dennis Otu, speaks to GODFREY GEORGE about the causes and remedies of arthritis

What is arthritis and how does it present itself in its host?

Arthritis is a disease which leads to pain and swelling of one or more joints. Some may be because of wear and tear, like the osteoarthritis, but gasteothritis leads to inflammation, so limiting the definition to only inflammation of the joint does not do justice. Traditionally the suffix “-itis” refer to inflammation. However, inflammation in this case is a sign rather than a specific disease. It can present in many ways; such as joint pain, joint swelling, restricted movement of those joints, deformity of the joints, front-line or particular tenderness, sometimes as muscle weakness and wasting, pathologic fracture. How it presents depends on the type of arthritis. However, the symptoms listed above cuts across most of them.

What are the causes of this condition?

The causes depend on the type. Some are caused by wear and tear due to age. When you have an accident, for instance, it can lead to trauma. This ‘trauma’ is a medical term which means ‘wound’. In geasteoarthris is caused by the deposition of urate crystals and other crystals in the joints. This is also what causes a condition known as ‘gout’ or ‘pseudo gout’. Psoriasis is another cause of arthritis. There are also autoimmune responses. This is when the immune system produces antibodies against one’s own body. In some cases, it causes major complications. Normally, the immune system produces antibodies which fight against diseases, but when these anti-bodies begin to fight against the host, then, that can lead to arthritis. There can be foreign body reactions and idiopathic causes.

Are there any risk factors? What are they?

The risk factors are not unconnected to the types. There are several risk factors which are usually related to the type. The ones we’d address are the ones which affect Nigerians. The risk factors for osteoarthritis include ageing, hereditary factors, gender/hormonal factors, obesity, high bone mineral density. We have some mechanical factors such as trauma (wound), the shape of one’s joint, joint alignment and usage. Someone who does contact sports such as wrestling, boxing, karate, judo, etc, are more susceptible to developing arthritis. This is because the way they exact energy on their joints and the kind of trauma (physical injury from a mechanical force) they are susceptible to makes them more at risk. We also have some musculo-skeletal disorders caused by deformities in the joint area. Others include some recreational factors. Also, previous joint injury can also be a risk factor. Someone who had had injury on the joint area before may develop the condition much later in future.

What differentiates the condition from normal swelling or tenderness of the body, maybe from stress-related activities or sprain?

The major difference between them is that, for sprains, they are just muscle injuries which do not affect the joint. In arthritis, there is progressive damage to the joint. That is the damage affects the surfaces of the joints that are making contact. This progressive joint damage can lead to a loss of articular cartilage, subchondral osteosclerosis, osteophyte formation, remodeling of joint contour, etc.

The two common types of arthritis are rheumatoid and osteoarthritis. What differentiate both of them?

Rheumatoid arthritis is caused by auto-immune reactions, where the body’s immune system fights against the body instead of against diseases. That is, one’s immune system attacks one instead of attacking a foreign body, it can lead to rheumatoid arthritis, whereas osteoarthritis is due to wear and tear.

Are they the only types there are?

We have gout, pseudogout, septic arthritis, reactive arthritis, viral arthritis, psoriatic arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, neuropathic arthritis, polymyalgia rheumatica, etc. We also have viral arthritis, which are caused by viruses. This is why people living with HIV/AIDS can have arthritis because of the human immuno virus. Juvenile idiopathic arthritis occurs in children but the causes are unknown.

Is it a condition of the aged?

It is not a condition of the aged. It can happen to anybody. For the juvenile idiopathic arthritis, we can see that it can happen to children. Psoriasis and septic arthritis can also happen to both young and old people. But, when it comes to osteoarthritis, it mostly happens to the old people.

Is there reasonable research in this area of medicine?

There is ongoing research in the area of pathology. These are developmental researches also in the area. So, of course, there is reasonable research in the area. Efforts are still being made to develop new and innovative treatments every day, so we can say it is still a work-in-progress.

The main goals of arthritis treatments are to reduce symptoms and improve quality of life. Does this mean one cannot be totally free from the condition?

It depends on the type and extent of damage to the joint. How the patient was treated can also be a factor. So, if a person develops septic arthritis, and it was diagnosed early and the person undergoes adequate treatments, that person can go back to living a normal life. However, I need to point out that someone who had had arthritis and was treated still stands a chance of developing the condition in future. It is not an impossibility. The person may develop another type of arthritis even after being treated for one. So, it can be safe to say previous history of arthritis is a risk factor for future occurrence of other types of arthritis.

What is the diagnosis like for patients when they present themselves at the hospital?

Like every other medical diagnosis, a case of arthritis is diagnosed by taking a good medical history, examining the patient, and requesting appropriate laboratory and radiologic investigations. When a patient presents him/herself in the hospital and says he/she has pain, the doctor has to look at other factors like age, gender and the kind of job the person does. Is (s)he into contact sport? Is there a history of walking unaided? You take the range of motion and take some modules. You do other baseline investigations and send for an x-ray. You would then know if it is arthritis or something else.

Women are more likely than men to develop rheumatoid arthritis. How true is this assertion and what do you think women should do?

It is very true. Infact, from the statistics in the United States, among the Caucasians, the female to Male ratio is 3:1. This means, for every man who has arthritis, there are three women with the condition. Women’s joints are more lax than men’s—the bones move around more and are less stable within the joint. When joints have less stability, they are more prone to injury, and injuries can lead to arthritis.

Are there any preventive measures you’d recommend?

I would recommend weight control. Since being overweight is a risk factor, one has got to watch what one eats. It is a no brainer. There is this saying, “You are what you eat!” If you are overweight, this means you would be exerting a lot of pressure on your legs and this can lead to serious problems for you, as your legs may not be able to carry your body. People should embrace healthy food choices and lifestyle; cease smoking, moderate intake of alcohol – or none at all – aerobic exercise, stretches, use of protective gear when engaging in contact sports, control of blood sugar, (since diabetes can also be a risk factor considering the fact that it is a multi-faceted disease) routine screening and baseline investigations, avoiding a sedentary lifestyle.

Arthritis is more than just wear and tear or an old person’s disease and it is the leading cause of disability in America. Is this true for us in Africa?

There’s more to arthritis than just wear and tear and it’s a major cause of disability, not just in America, but in Africa.

What is the worst that can happen?

The worst intra-articular complications of arthritis are joint destruction, deformity and disability; pathologic fractures. There are also extra-particular complications which depend on the type of arthritis, and in some cases is life threatening.

What is the treatment plan and what is expected of these patients after that?

The first treatment is what I term as ‘patient education’. The patient needs to be aware of what is wrong with him or her and what led to the condition. (S)he also needs to be aware of how the treatment would go, what the outcome would be if followed or not followed. They actually have the right to know these things, and if you explain this thing to them, you have helped solve the problem halfway. Then, we may use exercise (aerobic conditioning and strengthening), reduction of adverse mechanical factors (pacing of activities, appropriate footwear), weight reduction if obese, analgesia, use of disease modifying therapy, local corticosteroid injections, physiotherapy (physical treatment such as heart therapy, cold therapy, physical aids and appliances), surgery (hip replacement, knee replacement). Also, the patient can be encouraged to develop coping strategies.

Are there nutritional expectations?

A well balanced diet rich in vitamins, minerals, antioxidants and other nutrients play a big role in not only arthritis but other disease conditions since it is crucial for weight management.

Is it hereditary?

Some hereditary factors are known to play a role in the development of some types of arthritis

Is there anything you think the government should do to help out since this is one of the commonest diseases in Africa?

Yes, of course. The scope of medical insurance should be expanded to cover those suffering from chronic illnesses especially the elderly since they are more commonly affected.

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backpaintreatmentinindia · 3 years

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Persisting Pain After Knee Replacement

How Common Is Persisting Pain After Knee Replacement And Why Is It Important ?

Risk Factors for Persisting Pain after Knee Replacement

Persisting pain may have more than one reason, with a wide range of factors influencing the outcomes. It is important to know about these as some of them are modifiable.

Some of the known risk factors include

Poor mental Health including major depression, anxiety

Catastrophization (Constant worrying and exaggerated negative orientation towards pain experience)

Presence of other chronic pain conditions

Severe preoperative pain. Some studies have linked poorly controlled pain after the operation to increased chance of developing chronic pain whereas other studies have found insufficient evidence.

Young age and female gender

Pain Assessment

Management Of Persisting Knee Pain After Knee Replacement Surgery

Anatomically the cause of pain may be located

Extra articular (outside the knee joint at a distant site such as spine)

Peri articular (around the joint) such as tendinitis (ten on problem), bursitis (inflammation of bursa)

Intra articular (inside the joint) such as joint instability, loosening of implant, issues related to size/type of implant, infection, osteolysis (loss of bone), kneecap problems

How Can A Pain Physician Help ?

A pain specialist plays an important role in management of persistent pain and this includes

Nerve blocks are offered if nerves are suspected to be the pain generator. A simple OPD performed procedure can often help identify the pain source and provide prolonged relief.

Cryoablation. This specialised technique involves application of cold to cause temporary disruption of the nerves ability to transmit pain signals without causing permanent nerve damage.

Other specialist interventions used to provide pain relief include

Identifying your needs and directing you to other experienced professionals (such as physiotherapists, occupational therapists, psychologists) as required.

Tags- Knee Pain Treatment in India Back Pain Treatment in India Pain Management in South Delhi

#kneepaintreatmentinindia #painmanagementindelhi

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