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The Knee and its Structure

The knee is human body’s largest joint and its healthy maintenance is required to perform most of everyday activities, easily. The knee is made up of the lower end of the thighbone which is called the femur, the upper end of the shinbone which is called the tibia, and the kneecap which is called the patella. The ends of these three bones where they meet are covered with a smooth substance that protects the bones and enables them to move easily (articular cartilage). The C-shaped wedges located between the femur and tibia are menisci. These act as “shock absorbers” that cushion the joint. Large ligaments hold the femur and tibia together to provide stability, the long thigh muscles provide strength to the knee. Large ligaments hold the femur and tibia together and provide stability whereas, the long thigh muscles provide strength to the knee. All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage, reducing friction to nearly zero in a healthy knee. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony which results in pain, muscle weakness, and reduced function.

What is Arthritis and different types of arthritis?

The most common disease responsible for disrupting the harmony and causing chronic knee pain and disability is arthritis. Swelling and tenderness in any of the joints of our body, including the knees is referred as arthritis.

Although there are many types of arthritis, mostly knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

  • Osteoarthritis is an age-related type of arthritis. It occurs in people 50 years of age and older but may occur in younger people, too. In this type of arthritis, the cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
  • Rheumatoid arthritis is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”
  • Post-traumatic arthritis is a type of arthritis that can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, leading to knee pain and limiting knee function.

Treatment of Arthritis

Treatment of arthritis concentrates on providing relief from symptoms and improving function of the joint/knee. You may need to try multiple treatments or combine several treatments from the following to help you in getting relief from your arthritis.

  • Lose some weight (in case of overweight or obese patients)
  • Exercise: Muscle strengthening around the knees through exercise restores stability of the knee joint and reduces pain. Stretching of muscles through exercise aids in maintaining the mobility and flexibility of the knee joint
  • Pain-killers: These include over-the-counter paracetamol, naproxen, diclofenac, etc. However, these should not be continued for more than 10 days without your doctor’s consultation.
  • Corticosteroid or hyaluronic acid injections directly in the knee: Corticosteroids act as powerful anti-inflammatory agents whereas hyaluronic acid is a kind of lubricant in the knee.
  • Alternative therapies such as topical counter-irritant creams containing capsaicin, acupuncture therapy or supplementation with glucosamine and others can sometimes help to improve arthritis symptoms.
  • Physical or Occupational Therapy can also aid in teaching you ways of performing routine activity through exercises or alternate ways of performing routine work.
  • Using braces: Devices such as braces can either transfer the weight from the sides of the knee affected by arthritis or even support the entire knee.
  • Surgery: When every treatment from the above options fail to provide relief from arthritis of the knee, your doctor can recommend surgical options such as arthroscopy (removing the debris in the joint through a tiny telescope and other small equipments), osteotomy (altering the alignment of the knee by changing the knee’s shape) or total knee replacement (where the natural worn out knee joint is replaced by an artificial knee joint made of metals or plastic).

Usually, the treatment of arthritis is dependent on the specific type of arthritis present. But, sometimes the patients may need to try several different treatments, or combination of treatments before they determine what works best for them. However, in most cases, an exact diagnosis increases the chances for successful treatment of arthritis. After undergoing treatment, the doctor may recommend some physical therapy to help the patient regain strength in the knee and to restore range of motion making it possible to perform daily activities more effortlessly.

Cardiovascular diseases (CVDs) also called Heart diseases are a group of disorders of the heart and blood vessels. The numerous problems causing most of the CVD is atherosclerosis (blockages in coronary arteries), a process mainly governed by lifestyle factors. As per World Health Organization, It is estimated that 17.7 million people died from CVDs in 2015, representing 31% of all deaths taking place worldwide; more people die every year from CVDs than from any other cause.  Cardiovascular diseases are showing an increase among the Indian population. CVDs form a significant share of 24% from the 53% of all the deaths attributed to non-communicable diseases (NCDs) in India, as per the nation-wise statistical estimate of the WHO on NCDs.

In older men, nearly all heart attacks are caused by atherosclerotic blockages in coronary arteries. Classical coronary artery disease (CAD) is also dominant amongst young adults. Around 60% of these younger adults are affected by CAD in a single coronary vessel, whereas the older adult patients are more prone to get affected by CVD in multiple arteries. The rate of coronary heart disease in young Indian men is almost twice as high as that in their western counterparts and there is evidence that Cardiovascular diseases (CVD) affect Indians at least 10 years earlier as compared to their counterparts in Europe. CVD stays the number-one danger to the health of women. There is a strong gender difference in CV-related death, with more affected women dying each year as compared to the affected men. The lifetime risk of a woman dying from heart disease is eight times more than that of breast cancer. Also, People with diabetes, particularly type 2 diabetes, may have the following conditions like Hypertension, cholesterol, poor sugar levels etc. that contribute to their risk for developing cardiovascular disease.

Listen to Dr. Nimit Shah as he takes the time to explain the various causes of heart attacks in the country and the different treatments available for the same.

Listen to Dr. Nimit Shah, Interventional Cardiologist in the UK, Dr. Nimit Shah talks about the various risks and benefits of angioplasty, the different kinds of angioplasty procedures, and the different kinds of drug stents available in the country for the same.

Read more about Meril’s  state of the art Drug Eluting Stent Evermine50 herehttps://bit.ly/331QdkF

COVID-19 is a worldwide illness currently affecting millions of patients. Patients suffering from cardiovascular diseases (CVD) are especially vulnerable to respiratory tract infections, including COVID 19 and also these patients are at an elevated risk of ill health and even death from COVID 19.  However, the extent of damage in heart patients is currently uncertain.

As per evidence, patients with known CVD have a case fatality rate of 10.5% in case of a COVID 19 infection. Also, evidence suggests that 16.7% of COVID 19 patients, having CVD, develop abnormal heartbeat while 7.2% patients get acute cardiac damage. Cases of acute-onset heart failure, heart attack and other fatal cardiac symptoms have also been reported in COVID 19 patients with CVD. Heart complications in COVID 19 patients are comparable with SARS and MERS patients.

Suggested precautions for CVD patients to prevent COVID 19 infection

Following precautions are advised for CVD patients to prevent COVID 19:

  • Maintain your recommended blood sugar and blood pressure levels through regular intake of medicines. Currently, it is recommended to continue the prescribed ACE inhibitors or ARBs for hypertension, despite some reports of raised risk to COVID-19 susceptibility.
  • Frequently monitor your blood sugar and BP levels to rapidly identify any irregularities and get appropriate treatment adjustments
  • Get enough supplies related to your co-morbid testing and medications, in case of local worsening of outbreak, for at least 15 days.
  • Practice frequent handwashing with soap and water
  • Practice good respiratory hygiene by covering your mouth and nose with a tissue or bent elbow, in case of coughing or sneezing
  • Avoid touching your face, nose and eyes
  • Avoid unwanted travel and socializing
  • Stay vaccinated for each available infectious disease
  • Eat plenty of fruits and vegetables
  • Consume yogurt and probiotics for a healthy digestive system
  • Sleep for at least 8-9 hours to reduce stress and maintenance of immunity levels
  • Avoid crowd exposure
  • Avoid handshaking
  • Immediately contact your doctor if you develop any respiratory symptoms such as cold, cough, feeling difficulty in breathing or fever.
  • Last but not the least, stay hydrated.

And, of course, continue to stay active and follow an overall healthy regime. Stay connected with the people you love via phone calls, chats or emails because this kind of isolation can take a toll on your physical health and well-being. It’s important to understand that we all need to be extra vigilant in case we leave home especially people with underlying cardiovascular issues. Be mindful that every surface is a probable source of infection and everything that you bring inside your house could be affected by the virus. While this pandemic is a concern for the entire world, people with a known history of hypertension and cardiac disease have to be even more careful and nowhere is the saying “Prevention is better than Cure” more applicable than in such people.

Piles mostly occur due to certain factors such as chronic constipation, chronic diarrhoea, lifting heavy weights, pregnancy, and straining while passing a stool. However, your lifestyle plays a significant role too – what you consume in a day or how regular you are at exercising. Studies suggest that due to the desk-bound urban lifestyle, many people are at an increased risk of getting piles. Thus, making certain changes to your day to day life may help you avoid conditions such as piles. The habits include consuming a high fibre diet, avoiding smoking and drinking, practicing good bowel movements and so forth. 

Haemorrhoids may not be the best of the topics to discuss but one in every few individuals suffer from them. Persistent irritation, bleeding, and unavoidable pain are just a few symptoms which can become severe after a certain point of time. Fortunately, there are numerous precautions to prevent piles from interfering with your daily life.

  • Fibre Rich Diet: One of the easiest ways for a regular bowel movement is to increase fibre intake in your diet. Filling up on fibre and avoiding foods such as fast foods, meat, frozen foods etc. helps people with infrequent bowel movement and chronic constipation. Piles prevention food items such as whole grains, legumes, vegetables, and fruits are loaded with fibre, thus making stools softer and easier to pass and can help prevent hemorrhoids. Patients with a high risk of hemorrhoids should choose high fibre breakfast cereals. Additionally, high fibre supplements are also available for these at-risk people.
  • Drink plenty of water: The best way to prevent piles is to consume foods and liquids that make your stools soft so they can pass easily. Drinking eight to ten glasses of water and other liquids may help you with that. This is a non-invasive and simple strategy to prevent them as it is a condition that is mostly linked to dehydration.  Drinking sufficient water every day does not just help you with piles but benefits your body entirely.
  • Regular Exercises: Regular exercising helps in bowel movements, improving circulation, and strengthen muscles in the pelvic area and lower back, thus preventing piles. However, if you already have a history of piles, you may want to steer clear of heavy weight lifting and other strenuous exercises. You can opt for light exercises such as yoga or regular jogging/walking.
  • Don’t make laxatives your friend: Avoid frequent use of laxatives (stool softeners) as they can cause a rise in pressure during bowel movements, thus leading to piles. The overuse of laxatives can lead to dehydration and mineral deficiencies. They can also cause long-term damage to the digestive system.
  • Don’t hold back: No matter how busy you are or what situation you are in when you have to go, go. Don’t try to suppress your urge to empty your bowels as it is one of the simplest ways to prevent hemorrhoids. If you feel you have to pass your stools, immediately do so as holding your urge for a prolonged period may later cause straining during bowel movements.
  • Avoid straining: Straining isone of the most common causes of painful and bleeding piles. Don’t excessively strain and put extra pressure during bowel movements as it may be harmful for you. Other reasons for straining could be pregnancy, chronic cough, and lifting heavy objects.

The above mentioned points may help prevent piles but they cannot cure them. If you think that you have the same symptoms as that of piles, then consulting your doctor must be your first step. Avoid exacerbating your signs with these steps. Consult your doctor if you’re experiencing severe pain, light or heavy bleeding after passing stools and if the patient is a child below 12 years of age.

Hemorrhoids are affecting more and more people in India because of stress, insomnia, constipation, and a growing inclination for fast food in the sedentary lifestyle of urbanites. Every year, almost 10 million people in India suffer from pain caused by piles. In the majority of the cases, hemorrhoids resolve on their own by simple lifestyle modifications. But the patients who are distressed due to large, swollen, and prolapsed pile may have to be treated with surgery. And, if you have recently undergone a haemorrhoid surgery then you must know the difficult part is over. Now, all you need to do is take care of little things to make the recovery faster and smoother.

Typically, the recovery from a piles treatment or surgery lasts one to six weeks, depending upon the severity of the hemorrhoids, the type of treatment, and the number of hemorrhoids removed. Most of the patients begin to feel better by the end of the first week, especially when the patient can keep their bowel movements smooth or a little loose. Mostly, the doctor may recommend a stool softener, a laxative, or both to prevent straining with bowel movements. During the recovery, pain can be critical if the stool becomes hard or if straining is needed to have a bowel movement. It is highly recommended to have a good routine to avoid constipation after piles operation. One should even remember that the medications that are prescribed to the patient for the recovery period can also cause constipation, so who usually takes constipation medication may need more than their typical regimen to prevent constipation. Let us now take a look at a few factors that one must consider and what is considered as a strict No-No post a piles surgery. 

Here are some effective steps, one should take to promote faster healing post a haemorrhoid surgery.

  • Only after a few days of surgery, the patient can return to regular foods and gradually increase the amount of fibre in their diet.
  • The patient should stay hydrated by drinking 8-10 glasses of water per day.
  • It is recommended to use stool softener so that the patient won’t have to strain during a bowel movement.
  • After the piles surgery, practising Kegel exercises (contraction and relaxation of anal opening) for 3-4 times a day can reduce the false sensation of defecation.
  • The patient should make some lifestyle changes like losing weight, maintaining balanced diet, etc.
  • Taking a small walk and drinking at least 2 glasses of water can help the patient feel the urge and pass soft stools in the morning.
  • The patient should take sitz baths at least 3-4 times a day to keep the anal area clean. 
  • Applying medicines to numb the area before and after bowel movements can help reduce pain or discomfort caused by the surgery.
  • Patient must exercise regularly or have basic to medium level of physical activities to avoid stiffness and other health issues.

Things to avoid after a piles surgery

Here are some points that should be avoided in order to minimize the pain and prevent the recurrence of the hemorrhoids after the surgery.

  • The patient should not consume anything for 4 hours after the piles operation. Later, start with liquids and eat a bland diet (plain rice, bananas, applesauce, etc.).
  • Avoid strenuous activities that include heavy lifting, running, jogging, football, and cycling, etc. for 1-2 weeks after the surgery.
  • The patient should avoid straining for a longer time during your bowel movements.
  • It is advisable to avoid the use of dry toilet tissue. Instead, the patient can use wet cotton to clean themself
  • Stop eating foods that cause constipation, such as cheese, white bread, dairy products, process food, etc.
  • The patient should avoid sitting for a long period. 

Usually, surgery cures piles. But the long-term success of a piles surgery depends a lot on your ability to make changes in your daily lifestyle and bowel habits to avoid constipation and straining. However, not all hemorrhoids can be prevented, but following these dietary and lifestyle recommendations can help you prevent the recurrence of hemorrhoids and avoid further treatment.