Arthritis crippling the young
Dr Manuj Wadhwa

Arthritis has emerged as the most common ailment in the country and around 65 crore population will suffer from the disease by 2013.

When you think of arthritis, you think it affects only the elderly. Contrary to this misconception, arthritis these days is found increasingly among the younger population. However, age is not a factor for arthritis; it can affect young and old alike. Higher levels of stress coupled with modern lifestyles are increasing the incidence of arthritis.

Today in Punjab alone there would be close to 25 lakh arthritis patients and the number is increasing rapidly. There are more than five lakh patients with advanced arthritis of which 50,000 would require immediate surgery. Rheumatoid arthritis is also significantly increasing every year. Obesity coupled with increasing sedentary lifestyle has made Punjabis vulnerable to arthritis.

Today, most importantly, arthritis is affecting the younger population. Earlier, arthritis patients would come to me when they were 65 years of age or so. But now I see patients who are younger and in the age group of 40-45 years which is normally considered to be one’s golden years of life.

Almost every day, I get at least one case of a young arthritis patient. The hard fact is that arthritis is not fatal. But the cruel fact is that arthritis cripples the patient for life. In other words, arthritis is a progressively degenerative disorder, which becomes increasingly painful if it strikes one at an early age. Once diagnosed, it cannot be eliminated. Lack of nutrition, especially among women, and higher levels of obesity and inactivity are the main reasons why arthritis is becoming more common in western India, according to experts.

Think twice while relishing those greasy paranthas, makhan, ghee, etc. These not only add to extra pounds around your waist, but also to the pain you feel while squatting and sitting.

While orthopaedic surgeons are operating on patients aged between 12 and 95 years for various replacements, it is people in the age group of 55 to 65 years who are mostly affected by various forms of arthritis. Sometimes a replacement surgeon operates as many as 15 patients in a day. But thankfully, latest technology has now come to the aid of those suffering from various forms of Arthritis.

The computer navigation system provides greater accuracy and precision in joint replacements. Also, with computer navigation, the surgeon knows how one’s components are doing while bending, stretching, etc.

The navigated open platform is supported by three camera eyes working in tandem like a network of satellites. “The navigation platform is a wireless system and is minimally invasive. It offers the surgeons 3D navigation support system. While it is the surgeon who performs the surgery, the computer puts together all information coming in from the patient and the instruments, and tells the surgeon where the precise incision should be made. Given that every patient’s geometry is different, this level of patient-specific, computer-guided accuracy is unprecedented in the history of replacement surgery.

After performing more than 10,000 replacement surgeries in North India I feel that the less surgical cut and dissection associated with the new technique reduces pain, size of the scar and allows a patient to start walking early. Also, with this special technique, no blood is lost during and after the surgery.The computer navigation also ensures increased longevity of the replacement. The surgery reduces most of the pain and allows one to walk long distances, climb stairs, stand for a long time and do low-impact activities comfortably.

It is not just the surgical techniques that have improved over the years; the survival period of implants too have gone up. Over the last few years, procedures have evolved and the survival time of implants has also gone up. At present, the survival time for an implant in a patient’s joints is about 15 years. The designs of these implants have also evolved with high performance implants being the new mantra. High Flex Implants also have the added advantage of low wear. The increased life expectancy of Indians coupled with their more active lifestyles, patients today demand more than pain-free mobile joints. They want their unhindered lifestyle to continue and they remain engaged in the activities of their choice like sports, travel, driving, trekking, sitting on the floor and socialising.

The fourth generation highflex implant is an advanced design available today to meet the needs of the demanding population. Highflex implant offers bone preservation, retaining most of the vital natural bone, tissue and ligaments, thanks to the bio-mechanical design advancements due to the software design simulators and other technological advancements. High flexion up to 150° is as good as a normal person’s movement allowing a patient to do every possible normal activity like squatting, sitting on the floor and physical work as if one was back to his or her younger active days enjoying life to the fullest extent.

“It has been observed that while the earlier designs could only survive to a maximum of 15 years, these latest fourth generation implants survive longer. The fact is the material advancement like cross-linked poly inserts and the highly polished cobalt chrome tibia bone base plates enable wear reduction. After replacement surgery with highflex implants, patients have been able to get back to high-level sports like skiing, sailing and mountaineering without any compromise.

Another latest trend is personalised solutions for knee replacement surgeries which were hitherto performed only in advanced countries like the US and Australia. These surgeries are now possible even in our country. Personalised solution, which is now available in India, is a surgical instrumentation and computer software system that is designed to aid in knee implant positioning and procedure efficiency. Procedures require less instrumentation and eliminate up to nine surgical steps compared to total knee replacement performed without personalised solutions.

With people now being affected by arthritis as early as 30 years of age, especially in urban settings it has now become a serious cause for concern. In the West, there is a growing awareness of bone disease. Australia, for instance, has put osteoporosis on its list of national priority disease.While such moves are yet to take place in our country, the positives are that awareness levels are increasing and so is the availability of latest techniques and implants.

The ever-demanding patient of today expects the following in a replacement surgery:

• Accuracy and precision in joint replacements
• Less surgical cut and dissection
• Less instrumentation and surgical steps
• Reduced pain and size of the scar
• No loss of blood during and after the surgery
• Increased longevity of the replacement
• To be able to walk long distances, climb stairs, stand for a long time and do low impact activities comfortably after surgery
• High flexion up to 150° which is as good as a normal person’s movement

Beware of summer diarrhoea
Dr Harh Sharma

During summer a lot of cases of diarrhoea are reported to every doctor, clinic and hospital. With temperature going up, the number of cases of diarrhoea also seem to be keeping pace. Though it seems a common and a harmless trouble, it is one of the biggest killers, more so in the case of children and infants. More than 15 lakh children die due to this seemingly innoccuous malady. It is, in fact the second biggest killer of children.

Considering its potential danger, every parent should know about the causes, prevention, treatment and management of diarrhoea and the various danger signs associated with it. First of all, let us understand that it is not the temperature per se that is responsible. It has to do with infections. Hot weather provides a very conducive environment for the bacteria and the viruses to grow quickly. They are present in large numbers almost everywhere and pose a strong threat to everyone. The slightest carelesness while taking water or food from a source about which you are not very sure can catch you unawares quickly. Therefore, it makes sense to carry your own water bottle in summers. This small precaution can be a big help in preventing an infection from reaching your digestive system.

A common practice in our country is to keep edibles uncovered. This is commonly seen in almost every market of our cities. Flies, mosquitoes and other insects can infect an edible substance in a very short time, making it unfit for human consumption as the bacteria and viruses start multiplying quickly at a furious rate. These micro-organisms are not visible to the naked eye, but they are there all the same. So, do not think that if you have not seen houseflies making a meal of your salad, it is safe and uninfected. It may still be carrying enough germs to cause a violent infection. It is better to consume fruits and vegetables immediately after cutting.

One more common source of catching infection happens to be the swimming pools. While taking a bath before and after a swim is advocated everywhere, it is not religiously adhered to. There is also the possibility that the water may not be clean enough or may not have been changed for quite a few days. Try not to swallow water from the pool. It is always better to take all the precautions if you are fond of swimming. Having a bath with soap after swimming is always recommended and can be of immense help in preventing infections.

Dehydration and its signs

The biggest threat that diarrhoea causes is from the loss of vital fluids and electrolytes. It can cause serious dehydration. The signs of dehydration are increased thirst, dryness of the mouth, a decreased output of urine, the dark yellow colour of the urine, sunken eyes and dry, shrivelled skin. It needs to be managed proactively. Ideally, the management should start before dehydration has set in.

Managing dehydration

Take a lot of fluids. Simple water may not be enough as electrolytes are also lost. The easiest option is to take ORS. It is easily available everywhere and has the right mix of all the necessary electrolytes.

In case ORS is not available, add some sugar and a pinch of salt to a glass of water. Avoid giving tea and coffee as they act as diuretics and lead to loss of water.

The writer is a Mohali-based senior homoeopathic doctor. Email: drharshsharma@gmail.com

Bad cough is lung cancer’s main symptom
Jeremy Laurance

It is Britain’s most lethal cancer but most people do not know the principal symptom that may indicate its presence.

While there is wide awareness that a breast lump is  a warning sign of breast cancer and that bleeding could indicate bowel, kidney or bladder cancer, only one in 10 people knows that a persistent cough could point to  lung cancer.

The Be Clear on Cancer campaign launched with adverts on TV, radio, print and online will urge anyone who has had a cough for more than three weeks to visit their doctor.

The government campaign is supported by celebrities, including comedian Ricky Gervais  and Manchester United manager Alex Ferguson, who will be pictured holding x-rays of healthy lungs.

Care Services Minister Paul Burstow said: “Lung cancer is the biggest cancer killer in this country but worryingly many people don’t know the signs and symptoms that could save their lives. The earlier lung cancer is diagnosed, the better the chance of survival.

“The message from this campaign is simple; if you have a persistent cough for three weeks or more, visit your GP.”

The danger of a persistent cough is less appreciated than the change in the appearance of a mole on the skin which is known by 25 per cent of people to be a warning sign of skin cancer, according to a survey by Cancer Research UK in 2010.

Lung cancer affects 41,000 people every year in the UK, most over the age of 55,  and causes 34,000 deaths. Cases have been declining in men as a result of the decline in smoking that started in the 1950s and 1960s, but are still rising in women who took up smoking later. It takes around 30 years for lung cancer to develop.

When diagnosed at its earliest stage, as many as 80 per cent of people are alive five years after diagnosis compared with only 7 per cent diagnosed at a late stage.

Professor Sir Mike Richards, National Cancer Director for England, said: “It is vital that cancer patients get treated quickly so they have the best chance of surviving. We have made early diagnosis central to our Cancer Outcomes Strategy. Earlier diagnosis of Lung Cancer combined with the best treatments could help save an additional 1,300 lives a year.”

British actor and comedian, Ricky Gervais, whose mother died of lung cancer at the age of 74, said: “It’s devastating when you see someone you love dying from lung cancer. It’s a horrible, horrible disease. My mother’s death was very sudden and you can’t help wondering if things would have been different had it been spotted earlier. If you’ve had a bad cough for three weeks and you can’t get rid of it, just make an appointment with your GP today.”

Paula Chadwick, chief executive of the Roy Castle Lung Cancer Foundation, said:  “We really hope people will begin to associate a persistent cough as a symptom of lung cancer, the way they associate a lump as a symptom of breast or testicular cancer.

“The reality is it probably will be just a cough but if it is something more serious, getting it diagnosed early could just save your life.” —The Independent