Friday, October 17, 2014


Neck pain is common and most of us have experienced it at some point. It brings with it the anxiety of a serious illness like spondylitis!  Fortunately most cases of neck pain are not due to spondylitis. One of the commoner and less understood causes is trapezitis!
The Trapezius Muscle
The trapezius is a large muscle that forms the nape of the neck. It extends from the neck to upper back and fans out to the shoulder. The muscle has many functions but the most relevant one is to lift the head to look upwards. Any work that requires the head to be stable like working on a computer, reading a book, working on a kitchen table, driving for long or watching television etc. brings the trapezius into action. With our modern lifestyle, one can imagine the extent of overuse and often abuse this muscle faces!
Fatigue and inflammation of this muscle leads to trapezitis. The symptoms are typical. It starts with mild pain or discomfort in the nape of the neck at the end of the day. Initially a good night’s rest solves the problem. In the early stages, massaging the muscle or a hot water bag brings relief. As time passes, the attacks become more frequent and painful. The muscle goes into spasm and feels hard to touch. The pain becomes constant and is not relieved easily. Eventually the pain and spasm can become unbearable. At this point, the patient seeks medical intervention and needs muscle relaxant tablets to decrease the spasm. Understandably this disorder is confused with spondylitis. However it is a different illness with a different approach to treatment.
An acute episode of trapezitis is treated with anti – inflammatory, muscle relaxant tablets. In addition, patients require physiotherapy modalities, a soft cervical collar and rest. A physiotherapist will use interferential therapy (IFT) and short wave diathermy (SWD) to reduce the spasm. The severe pain settles in 7 to 10 days.
We cannot avoid our daily routine and daily work! So how do we protect our trapezius from fatigue and bouts of inflammation? Firstly one must strengthen the muscle so that it can take the rigours of our routine. One needs to do neck and shoulder exercises regularly. Here I will emphasise the importance of doing exercises that involve the hands going above the head (overhead exercises). Swimming is an ideal exercise for trapezitis and regular swimmers seldom get such pain. The second philosophy of treatment concentrates on the ergonomics of work! Poor postures are ripe environment for trapezitis. Working with a laptop on bed or watching televisions lying down are a strict NO. Chairs at work should have a lumbar support. One should sit erect. Avoid slouching. The computer screen should be at eye level. A break is necessary every 20 minutes during long hauls in front of the computer or long drives. One should get up, move around and stretch the neck, shoulders and back.   

Trapezitis is a modern day epidemic brought on by our lifestyle. Awareness of the issue and a logical approach to the problem will help most people avoid it all together!  

Wednesday, August 20, 2014

The Sunshine Vitamin

As research continues to shed new light, scientists are realizing that vitamin D has many critical functions in the body. It works more like a hormone rather than a vitamin and affects the performance of almost every cell of the body. 

1.      We all know that vitamin D is critical in maintaining adequate amounts of calcium and phosphorus in bones and teeth. In simple words it helps keep bones and teeth strong and protects against osteoporosis and dental caries. However we need vitamin D for many other roles. 
2.      It is important in the regulation of the immune system. It produces anti - bacterial and anti- viral substances and helps fight infections like common cold and influenza. 
3.      It helps to keep the brain functioning normally in later life and prevents mental illnesses like dementia, Alzheimer's disease, schizophrenia and depression
4.      Vitamin D helps maintain ideal body weight. Those with vitamin D deficiency are likely to be obese and fail at attempts to reduce body weight via diet and exercise. 
5.      It plays a role in preventing inflammatory disorders like Rheumatoid Arthritis (multiple joint pains), inflammatory bowel disease, psoriasis and eczema
6.      It reduces the frequency and severity of asthma and allows for speedy recovery from tuberculosis
7.      It reduces the risk of heart attacks and protects against high blood pressure and diabetes. 
8.      Vitamin D has recently been shown to be critical for a normal pregnancy. It prevents pregnancy related illnesses, reduces risk for premature deliveries and reduces infertility
9.      It reduces risk of all types of cancer. 

What are the daily requirements of this valuable vitamin? Most authorities recommend around 600 IU of vitamin D daily. Infants less than one year old need 400 IU and adults above 70 years of age need 800 IU.

Now that we realise the critical benefits of vitamin D, we must find out how to get it! Unfortunately getting vitamin D from diet alone is an uphill task. Few foodstuffs are a good source of vitamin D. Vitamin D rich foods include beef liver, egg yolk, certain types of cheese and certain types of fish. One egg gives approximately 40 IU of vitamin D. Unfortified milk (milk is fortified with vitamin D in America and European countries as a government initiative) is a poor source of vitamin D. 
Sunlight is an additional source of vitamin D. It is important as dietary sources of vitamin D are few. Ideally we should get 90% of our daily vitamin D requirement from sunlight. UV rays in sunlight convert a type of cholesterol found in the skin to vitamin D. Modern lifestyle has limited our exposure to the sun. There are many variables that affect the ability of the skin to produce vitamin D. As a result it is difficult to recommend how much sunlight is enough. Most authorities recommend between 5 to 30 minutes of sun exposure to your unprotected face, arms, legs or back between 11 am and 3 pm two to three times a week.  Early morning or late evening sunlight does not work as UV rays are not able to penetrate the atmosphere. Ability to produce vitamin D also depends on the colour of the skin. Fair skin people need less sunlight than darker ones in whom melanin (skin pigment) restricts entry to UV rays. Exposure to sunlight should be direct as UV rays are restricted by glass (window panes) and sunscreen. Weather conditions, cloud cover, pollution and clothing also affect vitamin D production in the skin. At the same time too much sun exposure is detrimental.

Certain groups of people are at higher risk for vitamin D deficiency. These include pregnant and breast feeding women, children between 6 months and 5 years, persons older than 65 and persons who keep their skin covered or stay indoors (don't get enough exposure to sunlight). At risk individuals need to discuss with their doctor and get vitamin D supplements. In America and some European countries, milk and fruit drinks are fortified with vitamin D.

Few sources of vitamin D in diet coupled with poor exposure to sunlight and lack of fortified foodstuffs (especially in India and Asia) makes huge sections of the population at risk for vitamin D deficiency. Everyone should get their blood levels of vitamin D tested. If deficient, appropriate changes must be made in lifestyle to increase exposure to sunlight. If that is not possible, vitamin D supplements are necessary.

Vitamin D deficiency is a modern and very real epidemic that has silently contributed to increase rates of osteoporotic fractures, heart attacks, influenza, rheumatoid arthritis, cancer and premature births! The general public needs to become aware of this hidden deficiency and take immediate corrective measures! 

Saturday, May 17, 2014

​Life After Knee Replacement​

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.