Never ignore knee pain
Dr M.S. Dhillon

With the onset of winter, the refreshing morning air is replaced by the cold drafts that blow an ill wind. Many people around the age of 50 now realise that their joints feel stiffer, and often hurt, allowing less freedom of motion than they enjoyed in the years past.

The 50-plus generation has now noticed that winters no longer herald the arrival of colourful migratory birds, but portend the onset of significant knee pain, which is often the first indication of Osteoarthritis (OA) — a degenerative knee joint disease. To minimise disability and reduce deterioration, medical science has evolved newer methods for the cases which have just started to hurt.

Depending on your condition, there are multiple ways to manage knee osteoarthritis. It goes without saying that weight control, strengthening of specific muscles, application of many physiotherapeutic modalities and judicious use of some medical agents under proper advice can help in alleviating the distress. Many people are scared of the surgical aspects of management, and they need to know that replacement surgery is the end stage management when all other modalities have failed. And these usually fail when they are either not applied properly, or some issues like weight loss and exercise are not addressed. Medicines are sometimes abused for their pain killing properties, little realising that these chemicals destroy the lining of your stomach if used indiscriminately, and in the long run could harm your kidneys and liver.

However I am not against medical management of arthritis. I just advocate usage of drugs under better supervision and with proper understanding of their effectiveness.

But can we reduce the progression of the disease? Osteoarthritis, the most common form of arthritis, is most focussed on the knees of Indians; here the knee cartilage protecting the ends of the bones gradually deteriorates. Thereafter, the joint fluid — called synovial fluid — loses its shock-absorbing qualities. The bones then begin to rub against each other, causing pain, stiffness and loss of movement in the joint.

Many new drugs have been evolved with a supposedly “chondro-protective” function; this basically means that these dietary supplements, when taken orally and at the correct time, can retard the progression of joint cartilage wear. To be most effective, these have to be combined with all the modalities listed above.

Another way for pain relief without the systemic complications is via local injections into the joint. Previously steroids and local anaesthetics were injected, but these are being gradually discarded in osteoarthritis due to potential side-effects. A new technique called visco-supplementation may become a local solution to a local problem. This process involves removing the diseased joint fluid and replacing it with a biological substance that mimics natural joint fluid. This supplements the elasticity and viscosity in the diseased knee joint, reducing pain and improving mobility.

I started using this as a three or five-injection regimen in 2001 in India; our results and world-wide research have shown encouraging results. Recent changes in visco-supplementation medication have made drugs available as a single injection for patients in early stages of osteoarthritis. With a single injection in the knee, patients avoid the stress related to repeat injections and experience reduced pain for many months with minimal side-effects.

A note of caution: Although these new methods grease up the knee, what actually caused OA may still be resolved. These injections are not a CURE, but a temporary control of symptoms for a few months to years, till you can exercise, lose weight, etc. If your knee degenerates more, then surgical options should be explored. It is better to consult a doctor for the best possible treatment options, since the side-effects of various medications will not be known to patients. Remember that besides the above treatment, controlling weight, ensuring adequate sunlight, exercising moderately five times a week and taking the right diet can work wonders for your health.

The writer is Professor and Head, Department of Orthopaedics and Physiotherapy, PGI, Chandigarh.

EYESIGHT
Pink eyes? Counsult an ophthalmologist soon
Dr Mahipal S. Sachdev

Sushant (name changed) had been suffering from itching in the eyes for the past few days. At first, he thought it was normal due to pollution and did not take much care about it. But the situation became worse when his eyes won’t stop burning, and on his friend’s advice, he visited an ophthalmologist.

Sushant was suffering from the infectious inflammation of the eye which is more commonly called pink eye and when eyes won’t stop burning, the situation is known as conjunctivitis.

Conjunctivitis is the most common eye problem one can have. It is an inflammation of the conjunctiva, the clear membrane that covers the white part of the eye and lines the inner surface of the eyelids. Many people know the more common name for conjunctivitis, which is pink eye/eye flu.

Conjunctivitis/eye flu is very common in this season because the bacteria tend to grow much faster in this environment.

There are mainly three types of conjunctivitis:

1. Infectious conjunctivitis: It is usually caused by either bacteria or viruses

2. Allergic conjunctivitis: This occurs more frequently among children with allergic conditions such as hay fever/ asthama

3. Irritant conjunctivitis: This type can be caused by chemicals such as those in chlorine (chlorinated water in swimming tank) and soaps or air pollutants such as smoke and fumes.

The different types of conjunctivitis can have different symptoms. In addition, symptoms may vary from person to person.

• Mostly both eyes are affected, but often one starts before the other.
• The eye is red, with the blood vessels over the white of the eye more visible and swollen. The lining of the eyelids also looks redder or pinker than usual.
• The eye is sticky, with a discharge, which is worse when you wake up.
• The eye is itchy or painful.
• Sometimes people do not like to be in bright light (photophobia).

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. Email: drmahipal@gmail.com

Clean your tongue while brushing teeth
Dr H.S. Chawla

Tongue-cleaning, quite prevalent in our country, is not that common in the West. Here are some facts to help you decide whether or not you should clean your tongue.

Both dental caries (cavities) and gum diseases are caused by bacteria in the mouth. The difference between a disease-free mouth and one with dental disease is that individuals prone to dental disease harbour a larger number of bacteria in their oral cavity compared to the ones with no disease.

Dental diseases, to a large extent, are preventable. One way of prevention is to reduce the number of bacteria in your mouth. If you succeed in this direction, you are less likely to develop dental disease.

In order to reduce their number in your mouth, you should know where bacteria live in the mouth. Bacteria, in fact, are present everywhere in the oral cavity, including your saliva. But, basically, there are three major areas of bacterial deposits in the mouth, viz. tooth surfaces, gingival sulcus and top /dorsal surface of the tongue.

The top surface of your tongue is studded with papillae. If you carefully view your tongue in front of a mirror, they can be seen with the naked eye as small multiple projections placed very closely. They are of three different types, each with a different function. Their technical names are filliform, fungiform and circumvalate papillae.

Bacteria lodge in large numbers and multiply undisturbed between papillae. On the anterior part of the tongue, the bacterial count is low and they are primarily aerobic — the ones which grow and live in an oxygen-rich environment. Their number is low because they get dislodged due to the friction produced from chewing food items, and are engulfed into the stomach. On the posterior part of the tongue, the bacteria are larger in number and anaerobic — these can live and multiply without the presence of oxygen. Anaerobic bacteria are harmful to dental health and contribute to the development of dental cavities as well as gum disease. Their number is more on the posterior part of the tongue because here the tongue does not get rubbed and cleaned as a result of friction from food.

If you clean your tongue regularly along with the cleaning of teeth, two radical changes take place in the bacterial ecology of the tongue. First, the total number of bacteria on the top surface of the tongue decreases. Secondly, the anaerobic microbes on the posterior part of the tongue get replaced with aerobic bacteria. This shift in the bacterial population results in the bacterial ecology becoming less disease-producing.

How to clean the tongue?

The tongue is cleaned with the help of a soft-bristle tooth-brush; the same that you use for your teeth. The tongue cleaning can be done anytime during brushing. It is best done after brushing your teeth, but before completely spitting out the toothpaste. The method consists of moving the brush backwards and forwards five or six times with a light force on the tongue. This can be repeated with fewer numbers of strokes when you are brushing your teeth the second time; the second time brushing is, in fact, recommended.

The warning note is not to exert pressure while cleaning the tongue as excessive friction causes enlargement (hypertrophy) of the papillae. The papillae in the individuals who brush vigorously become large and white, giving the appearance of white hair on the tongue. This condition of the tongue is called “white hairy tongue”. If you stop applying force while cleaning the tongue, the condition will revert to normal.

Can plastic strip-cleaners be used?

Invariably, more pressure is unconsciously exerted with these strips while cleaning the tongue. This causes enlargement of the papillae on the tongue. Enlarged papillae provide more space for the bacteria to house and grow in large numbers. The result is that your tongue looks whitish and dirty. You tend to scrub the tongue more vigorously to clean the white looking patch, which leads to further increase in the size of the papillae — and a vicious cycle sets in. So, tongue strips are not recommended.

Datun (green sticks) and tongue cleaning

Datun chewing has a unique effect on the cleaning of the tongue. The chewing of datun gives automatic frictional rub to the lateral sides as well as on a part of the top surface of the tongue. It does not mean that datun is more effective for the cleaning of the teeth. Datun is just 45 per cent effective compared to the tooth brush; it is an adjunct for the cleaning of teeth and not the sole means.

So, while brushing your teeth, it is imperative to clean the top surface of the tongue in order to reduce the overall load of bacteria in the mouth. It can be carried out with a soft tooth-brush using light pressure.

The writer is a former Professor and Head, Oral Health Sciences Centre, PGI, Chandigarh. Email: chawlahs@gmail.com