• 28Jan

    INJURIES TO THE ARTICULAR CARTILAGE: TREATMENT

    Healthy bones Osteoporosis Rheumatic No Comments

    Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
    If you are in a great deal of pain and discomfort, your physician may recommend use of NSAIDs. I personally believe that medication is a short-term solution, and other steps must be taken to correct this problem.

    Exercise
    When a joint is injured, the knee begins to swell, which can hamper the movement of the knee and can cause the muscles to atrophy or weaken, placing more force on the joint at a time when it is least able to sustain it. Therefore, it is very important to get the joint moving as soon as possible and to keep the muscles strong. For articular cartilage problems such as arthritis or chondromalacia, I recommend a low-impact exercise program that strengthens the muscles without stressing the joint. Activities such as swimming, riding a stationary bicycle, or even using a cross-country ski machine could be beneficial. (If you use a stationary bicycle, set the seat in such a way so that you do not bend you knee more than 90 degrees, because it often causes discomfort.) If you are disciplined about exercising, you may work out on your own. However, if you exercise haphazardly, you may need to work out with a trainer or at an exercise rehabilitation center. In this world of medical cost containment, there will unquestionably be a cutback in rehabilitative services, so that patients will be required to exercise on their own.

    “Washing Out” the Joint
    Very often, a patient with an injured joint may have difficulty extending her leg and keeps the knee in a flexed position. This is often due to a protective spasm of the hamstrings, and gentle exercise may help return the leg to normal motion. However, a “locked” leg may also result from a torn or jagged piece of cartilage that is caught in the joint (either between the tibia and the femur or the patella and the femur) and is preventing full extension. If your doctor suspects that this is the case, he may arthroscope the knee to “wash out” the debris and smooth out the surface. Although this isn’t a permanent solution, many patients feel better.

    Reattaching the Cartilage
    If a big piece of articular cartilage with its underlying bone is ripped off in an injury, it may be possible to reattach it back into position using wires or absorbable pins. If indeed, there is a significant bone attached, the injury is an osteochondral fracture, and if there is a short interval (roughly 4 to 8 weeks) between injury and surgery, there is an excellent chance that the fracture will heal if pinned back into position. If the injury does not include a bone surface, the articular cartilage by itself cannot be reattached with any certainty of success. Instead, attention is directed to the bone to produce fibrocartilage, which, although biomechanically inferior to articular cartilage, will fill the defect.
    It would be wonderful if there was a synthetic material that could be used to “paint” back missing areas of articular cartilage. Unfortunately, there is nothing comparable that is available now. Although investigation and experimentation is being done, today there are only three methods of replacing absent cartilage:
    Procedures designed to stimulate or regenerate the growth of cartilage cells.
    Bulk allografts (bone transplants).
    Cartilage cell growth and subsequent transplantation.

    Regeneration of Cartilage. Since the 1800s, scientists have dreamed of developing a way to get the body to regenerate articular cartilage, and although there have been some promising developments in this field, it is still highly experimental. In the body, cartilage is produced by special cells that, depending on their location, have the ability to produce either bone, fibrous tissue, or cartilage. We don’t know the precise triggers that “turn on” these cells and instruct them to produce cartilage. We do know, however, that injuring the bone can in many cases trigger the growth of cartilage. There are several ways that we do this, but basically they all involve making the bone bleed. In some cases, the surgeon will drill holes in the bone to stimulate these special cells to grow cartilage. Another procedure called abrasion arthroplasty involves a more aggressive procedure that causes more bleeding and hopefully produces more fibrocartilage. All of these procedures to stimulate fibrocartilage production can be done arthroscopically, but because the bone is actually involved, the procedures are associated with more discomfort than routine arthroscopy.
    Bulk Allografts. Bulk allografts are pieces of bone and/or cartilage that are taken from a cadaver and put in the patient. For years, this procedure has been done in tumor patients. Unfortunately, many of these cancer patients also underwent chemotherapy and radiation treatments and thus were immunosuppressed, which made them prone to infection. As a result, there was a rather significant complication rate—as high as 50 percent—including severe infection, possibly requiring amputation.
    The use of bulk allografts for cartilage transplantation in nonimmunosuppressed patients should result in a lower complication rate. As of this writing, however, there are too few cases to collect any significant data.
    Cell Transplantation. Cell transplantation is another experimental method of replacing lost articular cartilage that has received a great deal of publicity lately. In this procedure, cartilage cells are taken from the patient and then cultured in the laboratory. The cells multiply, producing an abundance of cartilage, and then are reintroduced surgically into the patient. Theoretically, cell transplantation will heal, thus restoring the surface with normal articular cartilage. This experimental procedure was recently reported in the Scandanavian medical literature. The results were promising; however, the patient population was small and primarily had minor defects on either the patellar-femoral or tibia surface. The femoral surface defects appeared to do better than the tibial defects. As exciting as this new procedure may be, it leads many unanswered questions including: How big a defect can be filled? Will it be applicable to all three compartments—the patellar-femoral, the medial femoral-tibial, and the lateral femoral-tibial? Will the patient be able to return to sports? Only time and experience will answer these questions.
    *27\185\2*

  • 20Jan

    SHIATSU: EXERCISES TO STRENGTHEN THE DIGESTIVE SYSTEM – CHEWING & EXERCISE

    Gastrointestinal No Comments

    1. Chewing
    Chew all your food until it becomes liquid (at least 50 times per mouthful). Chewing is the very beginning of the digestive process; if we fail to fulfil this simple task we can cause havoc to the remainder of the digestive system.
    Unfortunately many people eat on the run, or while preoccupied with other things and ingest them along with the food inflicting them on the digestive systems and perpetuating them. If we chew thoroughly we break this chain, as chewing causes us to slow down, creating a more harmonious eating experience, stress-free digestion and a happier digestive system.
    Please remember to chew very well, especially if you have a tendency to overeat.
    2. Exercise
    Keeping physically active does not necessarily mean jogging or going to the gym. Each type of physical activity has a different effect upon our physical and mental state.
    Long walks are especially recommended as is ‘constructive exercise’, like cleaning the house. House-cleaning not only gives you the opportunity to stretch your body in many ways as vigorously as you wish, but also creates order in your immediate external environment, and so in your body and your mind. Ever tried thinking clearly in a chaotic room?
    We tend to choose leisure activities that compound our nature, so that a more physically aggressive person will take up some vigorous sport, whereas someone who is inclined to daydream will gravitate towards meditation. However, very often the more physically oriented person would benefit from meditation, just as the person leading a more sedentary life would benefit from something more vigorous. Choose some activity that complements and harmonizes your nature.
    *174\326\8*

  • 12Jan

    HOW LONG DO SEIZURES NEED TO BE TREATED? WHAT IS THE BEST THAT CAN HAPPEN IF MY DOCTOR DISCONTINUES MY CHILD’S MEDICATION?

    Epilepsy No Comments

    The best that can happen is that your child will remain seizure free and that there will be an improvement in his learning and behavior. Many adults say, “I’m not so tired any more. I feel so much better. I can think much more clearly.” Many parents say, “Mary is a different child.
    Her school work is better. She’s not so irritable and she’s not so tired all the time. I never realized the medicine was affecting her in that way.” Another benefit is that your child would not have to take medication each day, a reminder of his potential problem. He would no longer have “controlled” epilepsy. Now he would be either “recovered” or “cured” and could get on with his life, unimpeded.
    For the normal child who has only a 5 to 10 percent chance of having another seizure, we would recommend discontinuing medication. In general, the consequences, should a seizure recur, will be small. For the handicapped child who may have a 50 percent chance of another seizure, we would also recommend trying to discontinue medication. The consequences of another seizure for him are also small, but since he may be less able to compensate for the subtle effects of medication on learning and behavior, the benefits of being free of medication may be even greater. Should a seizure recur, and if it is apparent that the child is functioning better off the original medication, it may be possible to substitute a less toxic anticonvulsant.
    On balance, we believe that avoiding the chronic effects of medication and their effects on learning and psychological function outweigh the risks of another seizure in most children who have been seizure-free for two years.
    *138\208\8*

   

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