Are you exercising too much?
Dr M.S. Dhillon

In the modern world, with sedentary lifestyles becoming the rule, and the definition of malnutrition changing from “starving, underweight” people to today’s “overweight” population, the new mantra to regain health is exercise. This is prescribed by doctors, by trainers, by newspaper columns, and even your milkman, so to speak! Many over-enthusiastic exercisers then come to me with knee pain, especially if they start their exercise later than the age of 40; what happens in these cases is something that we all need to know about.

Exercise is good; that goes without saying. But sometimes one can have too much of a good thing. Generally speaking, physical activity, including exercise improves your cardiovascular status and joint health, reduces osteoporosis and is always recommended for better health. However, this is somewhat more complicated than just getting up and starting to run or exercise.

The question that arises is whether physical activity can also be excessive, when it becomes damaging rather than health promoting? Is there such a thing as too much physical activity? For example, do joggers increase their risk of knee osteoarthritis? Do weekend spurts of energetic activity increase injury risk? A new study claims that the answer maybe “yes”.

All middle-aged men and women who participate in excessively high levels of physical activity may actually be damaging their knees and increasing their risk of osteoarthritis. According to a study presented at the annual meeting of the Radiological Society of North America, people at risk for developing osteoarthritis may be able to delay or prevent the disease by simply changing their level of physical activity. These results indicated that participating in high-impact physical activity for more than one hour at least three times a week increases the risk of developing osteoarthritis. However, light exercise and avoiding the activities that require a great deal of knee-bending appeared to prevent or protect against osteoarthritis. This leaves middle-aged people with a very thin dividing line between good and bad exercise!

So, who or what decides? Judicious medical advice is often much better than an aggressive fitness trainer; your age, previous activity levels, associated medical issues, etc, all are deciding factors. Remember the other points that are bad for your knees: being excessively over-weight, having a knee injury, frequent knee-bending like squatting, and strenuous activities like jogging are considered risk factors for cartilage degeneration. Patients are thus counselled to make correct choices.

As you age, rather than high-impact activities like running or tennis, choose to walk or swim, or use an elliptical trainer. When you have joint pains, think of light exercise — not heavy exercise. Do some exercise nevertheless. Remember that walking is not the only exercise. If you can’t walk due to some reason, ask for advice to exercise your joints without aggravating pain. Just don’t give it up, as doing no exercise is the worst thing that you can possibly do.

The writer is Head, Department of Orthopaedics, PGI, Chandigarh. drdhillon@gmail.com

Robotic surgery in gynaecology
Dr Meenal Kumar

Rita, a 47-year-old female, went to a hospital with the complaints of profuse menstrual bleeding, pelvic pressure and pain, presumably due to fibroids in the uterus. After an ultrasound examination it was found that her uterus measured 15 cm by 8.5 cm by 10.2 cm. Afraid of the surgical knife, she requested for robotic surgery to remove the fibroid. The total operative time was 2.5 hours. The estimated blood loss was 100 c.c. She went home in a couple of days without any complications. The cost was about Rs 15 lakh. Most others are not so lucky!

Robotics in surgery is an emerging technology which is creating waves in North America and Europe. India, too, is not left behind with at least three health care centres acquiring robots. Robotic surgery is essentially another way of doing laparoscopic surgery albeit with better technical inputs and technology. The scope of robotic gynaecologic procedures using the Da Vinci robotic system ranges from tubal ligation or reversal of ligation to ovarian cystectomy to myomectomy to radical hysterectomy.

The system has an advantage of a three-dimensional field, greater surgical precision, decreased fatigue and tension tremor, as well as added wrist motion for improved dexterity and ease of suturing. But it comes with a heavy price tag. Aggressive marketing by manufacturers and hospitals may lead to unethical practices

Why robot?

When engaging the robot, the surgeon is able to sit in a comfortable position at a robotics console and work by viewing an enhanced three-dimensional image of the patient instead of the two-dimensional image allowed by the traditional laparoscopic approach. There is a real advantage because the robot’s arms can rotate 360° in any direction, with none of the restrictions in manoeuvrability that limit the movement of a human hand.

Through tiny 1-2 cm incisions surgeons can operate with greater precision and control, minimising the pain and risk associated with large incisions otherwise required in traditional surgery, while increasing the likelihood of a fast recovery and excellent clinical outcomes. It entails precision, miniaturisation, smaller incisions, decreased blood loss, less pain and quicker healing time.

Robotic surgeons offer a minimally invasive procedure for the treatment of cancer and other conditions involving the female genital tract. These conditions include the following:

l Endometrial and cervical malignancies
l Ovarian cancer
l Complex gynaecological problems

One in three women will have a hysterectomy before she turns 60. While no woman wants to face surgery, today the vast majority of gynaecological conditions — from endometriosis to uterine fibroids, heavy menstrual bleeding to cancer - can be treated effectively without a big incision. With Da Vinci surgery, hysterectomy requires only a few small incisions so that you can get back to life faster, within days rather than the usual weeks required with traditional surgery. If you have been putting off surgery to resolve a gynaecologic problem for fear of the knife, it’s time to ask your doctor about robotic surgery if you have money.

Robotic surgery may have to wait in India

There is no doubt that robot-assisted surgery has been very popular in effective and handling cardio-thoracic and prostate problems. Its entry into the treatment of benign and cancerous conditions in the gynaecology area is relatively new. It provides greater safety and precision but comes at a heavy cost and not all cases/conditions can be treated with this technology. The phrase “robot surgery” is so catchy that it is very easy to sell this concept to the unsuspecting public. Also one has to take into account the unique socio-economic conditions in India, where health care affordability should be the aim. While the rich can afford, it may remain a dream in the area of community gynaecology.

The writer is a Chandigarh-based senior gynaecologist. Email drkumar232@hotmail.com

Sinusitis a major source of trouble in winter
Dr Vikas Sharma

With severe winter hitting this part of the country, many people feel greatly uneasy. For some individuals, their sensitivity to cold weather makes them prone to all kinds of respiratory illnesses. These infections can be recurrent and can affect them all throughout the season. Frequent cold, cough and runny and congested nose are quite common. One of the most common fallouts of frequent cold is sinusitis (inflammation of the sinuses).

For individuals who are sensitive to cold weather and have recurrent upper respiratory infections, sinusitis can become a major source of disruption in their lives. Homoeopathic medicines are very helpful to such individuals. Not only do they treat the condition, they also help in eradicating the body’s sensitivity to cold weather.

Sinusitis is the inflammation of the sinuses, which are hollow cavities in our skull. Their main purpose is to make our skull lighter and provide resonance to our voice. The sinuses are connected to the back part of the nose through small openings called ostiums. These sinuses have a similar lining as that of our inside of the nose. Inflammation in the sinuses occurs when these small openings, which are at the back of our nose, get clogged due to swelling and discharges in the nose.

Clogging leads to the collection of discharges in the sinuses, which otherwise would have made their way out through ostiums. The collection of discharges in the sinuses gets infected by bacteria. This is what leads to inflammation in the sinuses. Frequent cold during the winters can cause congestion and swelling in the nasal passages, thereby making oneself quite prone to sinusitis.

Sinusitis can either be acute or chronic. Acute sinusitis tends to resolve within a couple of days and usually does not require much medication. Chronic sinusitis is more protracted and can last months and years. When an attack of sinusitis goes on for a period of more than six weeks, it is called chronic sinusitis. Individuals with sensitivity to cold weather are more prone to develop chronic sinusitis.

Symptoms of sinusitis depend on the severity of the infection. Feeling of congestion in the nose, face and head is the commonest of all the symptoms. This may be accompanied by severe pain in the face (especially above and below the eyes) and head (temples and deep pain behind the eyes). Thick yellowish green discharges from the nose are quite common. Morning headaches on rising are very typical of sinusitis. Fever is usually present in an infected case of sinusitis.

Homoeopathy can work wonders for people who are sensitive to cold weather. There are medicines which can be very effective in treating cough, cold and other respiratory illnesses that occur in winters. They also help in strengthening our immune system, thereby preventing recurrences. Homoeopathic medicines Silicea, Aconite, Kali Bichrome and Pulsatilla lead the table in treating the recurrence of sinusitis and cold. Silicea helps both ways. It is very effective in eradicating one’s sensitivity towards cold weather as well as treating acute and chronic sinusitis. Aconite is an SOS medicine. It is very useful in symptoms that come after an exposure to cold air.

The writer is the director of one of the most visited homoeopathic information websites — www. drhomeo.com