Wednesday, August 20, 2014
Saturday, May 17, 2014
Lots of patients are advised knee replacement! But do you really need it? How to really know if you require a surgery? Knee Replacement is a major surgery which should not be taken lightly. It's a great success for those who actually need it and can be a disaster for a patient who doesn't. The doctor is naturally the best person to make the decision. Sadly many doctors are doing unnecessary surgery for monetary gain. The time has come for patients to become smart! It is my wish that patients become aware enough to decide for themselves. Patients should be able to choose a good decision from a bad one. Enlightening patients has always been my sincere endeavour!
Knee replacement is the final option for a patient with arthritis. It is chosen when all else fails. The patient should have tried all possible treatment methods before considering surgery. Surgery is done for a patient who has constant and severe pain. Pain on getting up from the floor or when going up and down stairs, is common and doesn't usually warrant a knee replacement. However pain during walking is far more serious. Patients who need surgery can barely walk a few hundred feet. Every step is painful. They limp and walk very slowly. Many need a walking stick for support. Activities of daily living are affected. Such patients tend to remain at home. They will avoid social commitments that require them to leave the house. Getting up at night and going to the bathroom is a huge and painful effort. Painkiller medications are required to get through the day. If you are so disabled and have tried many types of treatments without much benefit, get a knee replacement done.It is a beautifully successful surgery after which you will become normal again. But if you are not so bad, then think again! Knee replacement may not be the best option for you. It may be wiser to wait a while and consider other options.
What has been the experience of patients who have undergone this surgery? Is it really successful? Does it give long term relief? Is the surgery painful? Before surgery, the patients are screened for infection and assessed for fitness. This involves investigations like blood tests, chest X-ray, etc. A physician checks the patient and certifies him or her fit for surgery. The patient is admitted one day prior to surgery. The surgery is done most often under spinal anaesthesia. A small injection is given with a thin needle in the lower back of the patient which makes the legs numb. The actual surgery lasts for 60 to 90 minutes. When the anaesthesia wares off, the patient experiences postoperative pain. The pain is severe for the first 2 to 4 days. Doctors usually have pain management protocols in place to manage the pain like epidural injections, blocks etc. After that the patient gets pain while exercising the knee (lifting the leg, bending the knee) and during walking. As time passes the pain reduces and completely disappears by 8 to 10 weeks. The patient starts walking on the second or third day after surgery. Post surgery the patient's leg becomes weak (due to cutting of muscle during surgery). Initially the patient needs a walker to walk. As time passes the leg becomes stronger and the patient can walk independently. Surgery also leads to swelling of the leg and the knee. This is a normal reaction to surgical trauma. The swelling automatically subsides in 12 to 16 weeks. After this period of recovery is complete, the patient truly experiences the benefits of surgery. The Person stops being a patient and becomes normal. He/she has complete relief from pain. He/she can walk normally (and fast) without a limp or stick. He/she does not need pain killers.
Even though knee replacement is a major surgery and has a long recovery time, it is a truly gratifying surgery which gives a person spectacular and lasting results.
Wednesday, December 18, 2013
It is normal to be afraid of surgery. If given a choice, all of us would stay away from surgery. Our reasons for avoiding surgery are obvious. Surgeries come with a baggage of complications. Rarely a complication is severe enough to offset any potential benefit promised by the surgery. The complication itself becomes a bigger problem than the original illness. A complication can happen with the best surgeon having the purest intentions. Therefore it is wise to be scared of surgery.
Yet we often find ourselves facing surgery. The truth is many problems cannot be solved effectively unless tackled by surgery. Surgery today is far more successful due to improved knowledge, experience and technology. Many patients have undergone surgery and have benefitted tremendously. So if a patient is offered surgery, how should he/she approach the situation?
The first question to be answered is 'Is my problem bad enough?' This is an obvious question and most patients address it correctly. Doing a major surgery for minor issues is a strict 'NO'. Often the alternative non surgical treatments are equally effective. Even though this is a simple decision to make, sometimes patients get carried away by social and economic pressures. I find patients asking for surgery just because they have seen a friend benefit from it or they have the money to buy it! Surgeries are of 2 types: the 'life saving' surgery and the 'quality of life' surgery. With life saving surgeries, the decision is easy. The problem is with 'quality of life' surgeries. For example: a decision to do angioplasty (heart) surgery is easy as it is life saving but a decision to do knee replacement is difficult as it is done to improve quality of life.
The second question is 'what is the risk-benefit analysis?' Is the benefit promised by the surgery more than the risk of something going wrong or a complication happening. The best surgeries are the ones that offer good results with little risk. For e.g. Knee Replacement completely solves the patients problem (huge benefits) and has a low complication rate. At the other end of the spectrum are surgeries that are new, experimental and unproven. Beware of these as failure rates are high and complications are more. In between are the surgeries that have proven good results but with a high complication rate. In this situation, I encourage patients to understand the risks completely by a detailed dialogue with the surgeon.
The next question is 'How good is the surgeon?' This is a difficult question for the patient to answer. As a general rule a specialist will be better. Patients gauge a surgeons skill by his success. Though patients don't have a better way, this method of finding a good surgeon is flawed. Success or fame is multi factorial and a 'famous' surgeon may not necessarily be the most skilled. One effective way is to speak to patients already operated by the surgeon. They often give lots of insight and improve your confidence.
The last question is 'Have I done my research?' We do a lot of research when we have to buy a new car or a new house. Similarly I encourage patients to do research when they are facing a surgery. Today is the age of information technology and all is available on the Internet. Details of the illness, the success rate of the surgery, the potential complications, the experience of other patients etc need to be researched by patients looking at a surgical option. The procedure should be discussed in detail with your surgeon. I see patients asking questions like 'Is there any guarantee for this surgery?' The answer is obvious and the surgeons who say 'YES' are lying. While this is not a sensible question to ask, there is a list of questions that every patient must ask his/her surgeon. 'What is the percentage of success of the surgery?', 'What are the complications?', 'What are the chances of something going wrong?', 'If a complication occurs, what is its treatment?', 'What is the recovery time?', 'How long will the surgical pain last?' are some of those questions.
To conclude, everyone would like to avoid surgery but sometimes we cannot. If facing surgery, we should arm ourselves with knowledge beforehand so that we can take intelligent decisions and avoid facing nasty surprises later.
Thursday, October 24, 2013
Thursday, September 26, 2013
Wednesday, August 14, 2013
A common myth among patients is that all bone related or orthopaedic problems are related to a lack of calcium. Daily, I see patients who are taking calcium supplements on their own accord. People especially women feel that they need to take calcium beyond a certain age, or taking calcium will prevent orthopaedic problems in the future. Usually it is a friend or family member that has scared a person into taking calcium supplements.
It is wrong to attribute all bone problems to calcium. Often the source of musculoskeletal pain is a joint! There are many joints in the body. Everyone is familiar with the large joints like the hip or knee and small joints like the ones found in the hand and foot. There are also lesser known joints like the facet joints found in the spine (neck and back). Inflammation of the joint is known as arthritis. Arthritis has little to do with the lack of calcium. Therefore taking calcium will not reduce joint pain!
So if lack of calcium does not cause joint pain, then what does a lack of calcium do? A decrease in the calcium content of bones is typically called osteoporosis (different from osteo-arthritis) There are other disorders of calcium like osteomalacia and rickets but these are rare. Osteoporosis affects women after menopause. It is the lack of female hormones (estrogen and progesterone) that leads to osteoporosis. Osteoporosis also affects men but at a later age and less commonly. Osteoporosis is a silent disease. That means that it causes very few or no symptoms. Many patients of osteoporosis will not know that they are suffering from it! This is similar to medical illnesses like diabetes and hypertension (high BP). Time and again the first symptom of osteoporosis is a fracture of the hip or a vertebra (spine fracture). Rarely osteoporosis may cause bone or muscle pain or tenderness (pain on pressing the bone).
BMD measurements have today become essential for fracture prevention and osteoporosis treatment, but due care is needed in utilising this asset.