DOC I HAVE A KNEE LIGAMENT INJURY
Knee Ligaments Injury is a common disorder of the knee caused by damage of the ligaments of the knee.
There are 4 ligaments, 4 bands of tough tissues in the knee to stabilize the joint :
1.Anterior Cruciate Ligaments (ACL) - starts from front of middle of lower tibia to middle of the back of femur
2.Posterior Cruciate Ligaments (PCL)- starts from middle of front of femur to the middle of back of tibia.
3.Medial Collateral ligaments (MCL) located on the inside of the knee
4.Lateral Collareral Ligaments (LCL) located on the outside of the knee
The causes of Knee Ligaments Injury are:
Injury to the knee ligaments are the main cause.
1.Anterior Cruciate ligament of the knee-soccer players who use rapid twisting movements of the knee (as when the knee stops and changes directions suddenly) are at higher risk of Knee Ligaments Injury .
The anterior Cruciate ligaments can also be injured when the twists on landing or as a direct result of a direct contact or collision during a soccer tackle.
2.Posterior Cruciate Ligament of the the Knee- injury to the posterior Cruciate Ligaments of the knee occurs when direct force is applied to the the front of the knee especially when the knee is bent.
The ligament can also be pulled or stretched in a twisting or hyperextension injury.
3.Collateral ligaments - injury to the Collateral Ligaments such as a fall or direct hit to the knee.
It can also occur as a twisting injury.
It can also occur together with ACL and PCL ligaments injury.
4.Obesity cause more strain on the Knee Ligaments
The symptoms and signs of Knee Ligaments Injury are:
Symptoms:
1.Immediate Pain in the knee after injury
2.Swelling of the knee within 1 to 12 hours
3.Difficulty in bending or straightening the knee
4.A popping sound occurs when the anterior cruciate ligament ruptures
5.difficulty in walking because of the pain
6.instability in the knee with the joint giving way during sport or daily activities.
Diagnosis:
1.history of a fall or injury followed by limitation of movement of the knee
2.MRI will show if there is Knee Ligaments damage
3. An X-ray is done to exclude fracture of the bone
The Treatment of Knee Ligaments Injury is:
Conservative treatment:
1.rest,elevation and ice compress treatment of the knee upon injury
2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain relief and reducing inflammation
3.Muscle relaxant to relax muscles
4.crutches can reduce the weight off the affected limb
5.Physiotherapy such as traction, shortwave diathermy help to increase knee muscle strength and improve flexibility of movement of the knee
Surgery is usually indicated in Knee Ligaments Injury if the condition does not improve with conservative treatment.
1.A keyhole or arthroscopic repair is done to repair the torn ligaments
2. A cast is placed around the knee to protect followed by physiotherapy 1-2 days after surgery.
Prognosis depends on the severity of the ligament injury
In most cases Knee Ligaments Injury may recover with conservative methods.
Some cases however may require surgical treatment
Prognosis is good after surgical treatment.
Prevention is to avoid weight bearing, reduce obesity and muscle strengthening exercises.
Tuesday, September 20, 2011
Sunday, September 18, 2011
A Family Doctor's Tale - MENISCUS TEARS
DOC I HAVE A MENISCUS TEAR
Meniscus tear is a common disorder of the knee caused by contact or non-contact activity when a weight bearing knee moves or twists suddenly resulting in a tear of the meniscus.
It can also occur from wear and tear through repeated usage of the meniscus which is a cartilage acting as a shock absorber during weight bearing activities.
The meniscus helps to maintain the knee stability .
It is more common in footballers especially above the age of 30.
The causes of Meniscus tears are:
Several conditions has been blamed:
1.Repetitive movements of the knee-soccer players who use repetitive movements are at higher risk of Meniscus tears.
2.Normal wear and tear- with age the blood supply to the knee is reduced resulting in degeneration of the meniscus.
3.trauma - injury to the meniscus such as a fall or direct hit to the knee
4.Obesity cause more weight bearing effect on the meniscus
Symptoms of Meniscus tears:
1.Pain in the knee
2.swelling of the knee
3.inability to bend or straighten the knee
4.locking of the knee
5.difficulty in walking because of the pain
Diagnosis:
1.history of a fall or injury followed by limitation of movement of the knee
2.MRI will show if there is a meniscus tear in the knee joint
The Treatment of meniscus tears is:
Conservative treatment:
1.rest,elevation and ice compress treatment of the knee
2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
3.Muscle relaxant to relax muscles
4.crutches can reduce the weight off the affected limb
5.Physiotherapy such as traction, shortwave diathermy help to increase knee muscle strength and improve flexibility of movement of the knee
Surgery is usually indicated in Meniscus tears if the condition does not improve with conservative treatment.
A keyhole or arthroscopic repair is done to remove the torn meniscus
Physiotherapy starts the day after surgery.
The prognosis of meniscus tears is:
Prognosis depends on the severity of the meniscus tear.
In most cases Meniscus tears may require surgical treatment
Prognosis is good after surgical treatment.
Prevention of Meniscus tears is:
Avoid obesity and weight bearing on the knee
Avoid strenuous physical activity of the knee
Avoid sudden turning and twisting of the knee
Meniscus tear is a common disorder of the knee caused by contact or non-contact activity when a weight bearing knee moves or twists suddenly resulting in a tear of the meniscus.
It can also occur from wear and tear through repeated usage of the meniscus which is a cartilage acting as a shock absorber during weight bearing activities.
The meniscus helps to maintain the knee stability .
It is more common in footballers especially above the age of 30.
The causes of Meniscus tears are:
Several conditions has been blamed:
1.Repetitive movements of the knee-soccer players who use repetitive movements are at higher risk of Meniscus tears.
2.Normal wear and tear- with age the blood supply to the knee is reduced resulting in degeneration of the meniscus.
3.trauma - injury to the meniscus such as a fall or direct hit to the knee
4.Obesity cause more weight bearing effect on the meniscus
Symptoms of Meniscus tears:
1.Pain in the knee
2.swelling of the knee
3.inability to bend or straighten the knee
4.locking of the knee
5.difficulty in walking because of the pain
Diagnosis:
1.history of a fall or injury followed by limitation of movement of the knee
2.MRI will show if there is a meniscus tear in the knee joint
The Treatment of meniscus tears is:
Conservative treatment:
1.rest,elevation and ice compress treatment of the knee
2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
3.Muscle relaxant to relax muscles
4.crutches can reduce the weight off the affected limb
5.Physiotherapy such as traction, shortwave diathermy help to increase knee muscle strength and improve flexibility of movement of the knee
Surgery is usually indicated in Meniscus tears if the condition does not improve with conservative treatment.
A keyhole or arthroscopic repair is done to remove the torn meniscus
Physiotherapy starts the day after surgery.
The prognosis of meniscus tears is:
Prognosis depends on the severity of the meniscus tear.
In most cases Meniscus tears may require surgical treatment
Prognosis is good after surgical treatment.
Prevention of Meniscus tears is:
Avoid obesity and weight bearing on the knee
Avoid strenuous physical activity of the knee
Avoid sudden turning and twisting of the knee
Friday, September 16, 2011
A Family Doctor's Tale - MALE MENOPAUSE
DOC I HAVE MALE MENOPAUSE
Male menopause or andropause is a condition which is due to lack of or absence of testosterone in men especially at the age above 50 years .
There are two types of andropause found in adult men:
1.Normal hormone levels through puberty and adulthood with normal sexual development is presented with the rapid drop of testosterone levels around the age of 50
2.Psychological type of andropause occurs gradually with gradual drop of male hormones, DHEA and human growth hormones.
This usually occur in older patients such as in the 60 to 70 age group.
What are the causes of Male Menopause?
Common causes for male menopause are:
1.age related lowering of blood testesterone
2.injury to the testes and male reproductive system
3.Surgical removal of testes and male reproductive system due to cancer
4.auto-immune diseases such as systemic lupus erythrematosis
5.geneteic abnormalities which cause premature testicular failure such as chromosomal mosiacism
6.generalized vascular conditions such as diabetes
7.orchitis or infections of the testes such as mumps(which is fortunately almost eradicated by immunization)
8.heavy smoking reduce blood flow to testes
9.chemotherapy which destroy the production of male hormones
10.pituitary tumors which control the production of male hormones.
What are the symptoms and signs of male menopause?
Symptoms of andropause:
1.Tiredness, general weakness
2.Reduced libido
3.Reduced sexual potency
4.Hot flushes
5.Sleep problem
6.Joint pain
7.Irritability and anger
8.depression
9.Changes in skin and hair growth
10.Pre-aging
How is the diagnosis of Male Menopause made?
Male menopause is a simple endocrine problem which causes the testosterone in the blood to diminish with age.
The diagnosis is made by measuring
1. free testosterone blood levels (mean=700ng/dl , range =300-1100ng/dl)
2. computing the free androgen index (FAI) (total testosterone x 100 /sex hormone binding globulin). (range=70-100%).
If the free androgen index is less than 50% , symptoms of male menoopause appears.
3.A comprehensive medical and psychological assessment should also be done
What is the treatment of Male Menopause?
Testosterone Replacement Therapy like the Hormone Replacement Therapy of female menopause is the main form of treatment:
1.Tablets:
Methyltestosterone (Android,Virilon,Testred, Oreton) 10mg,
Testosterone undecanoate (Restandol, Andriol) 40mg, essentially a testosterone in oil preparation (not available in the USA)
Mesterolone (Proviron) 25mg -- less potent
2.Transdermal therapy
Testosterone--transdermal (Testoderm, Testoderm TTS, Androderm)
3.Injections
Testosterone cyprionate 100mg/dl
Testosterone Propionate in oil 100mg/ml
Testosterone Enaanthanate 200mg/dl
The usual dose is 1cc injected weekly or bi-weekly. This method of administration removes the risk of liver damage which may be caused by oral methyl testosterone .
4.Sub dermal Pellets
Testosterone pellets for male hormone deficiencies are inserted under the skin and dissolve slowly over a period of approximately three to four months.
What are the risks?
1.Prostate cancer-- There is no evidence in the medical literature that testosterone replacement therapy increases the risk of prostate cancer.
2.Heart disease-- increasing male androgen levels would also increase serum cholesterol and serum LDL-Cholesterol levels. .
3.Liver Disease--the only orally available forms of testosterone for men contain methyl testosterone.
If used for sustained periods of time, it can damage the liver.
4.Suppression of testicular function-- whenever any hormone is administered, the gland which normally produces it ceases to function.
Patients with borderline low testosterone levels may commit themselves to lifelong therapy if they start with testosterone replacement.
What are the benefits?
The administration to testosterone to men with true testosterone deficiency states will improve their health and sense of well being.
Male menopause or andropause is a condition which is due to lack of or absence of testosterone in men especially at the age above 50 years .
There are two types of andropause found in adult men:
1.Normal hormone levels through puberty and adulthood with normal sexual development is presented with the rapid drop of testosterone levels around the age of 50
2.Psychological type of andropause occurs gradually with gradual drop of male hormones, DHEA and human growth hormones.
This usually occur in older patients such as in the 60 to 70 age group.
What are the causes of Male Menopause?
Common causes for male menopause are:
1.age related lowering of blood testesterone
2.injury to the testes and male reproductive system
3.Surgical removal of testes and male reproductive system due to cancer
4.auto-immune diseases such as systemic lupus erythrematosis
5.geneteic abnormalities which cause premature testicular failure such as chromosomal mosiacism
6.generalized vascular conditions such as diabetes
7.orchitis or infections of the testes such as mumps(which is fortunately almost eradicated by immunization)
8.heavy smoking reduce blood flow to testes
9.chemotherapy which destroy the production of male hormones
10.pituitary tumors which control the production of male hormones.
What are the symptoms and signs of male menopause?
Symptoms of andropause:
1.Tiredness, general weakness
2.Reduced libido
3.Reduced sexual potency
4.Hot flushes
5.Sleep problem
6.Joint pain
7.Irritability and anger
8.depression
9.Changes in skin and hair growth
10.Pre-aging
How is the diagnosis of Male Menopause made?
Male menopause is a simple endocrine problem which causes the testosterone in the blood to diminish with age.
The diagnosis is made by measuring
1. free testosterone blood levels (mean=700ng/dl , range =300-1100ng/dl)
2. computing the free androgen index (FAI) (total testosterone x 100 /sex hormone binding globulin). (range=70-100%).
If the free androgen index is less than 50% , symptoms of male menoopause appears.
3.A comprehensive medical and psychological assessment should also be done
What is the treatment of Male Menopause?
Testosterone Replacement Therapy like the Hormone Replacement Therapy of female menopause is the main form of treatment:
1.Tablets:
Methyltestosterone (Android,Virilon,Testred, Oreton) 10mg,
Testosterone undecanoate (Restandol, Andriol) 40mg, essentially a testosterone in oil preparation (not available in the USA)
Mesterolone (Proviron) 25mg -- less potent
2.Transdermal therapy
Testosterone--transdermal (Testoderm, Testoderm TTS, Androderm)
3.Injections
Testosterone cyprionate 100mg/dl
Testosterone Propionate in oil 100mg/ml
Testosterone Enaanthanate 200mg/dl
The usual dose is 1cc injected weekly or bi-weekly. This method of administration removes the risk of liver damage which may be caused by oral methyl testosterone .
4.Sub dermal Pellets
Testosterone pellets for male hormone deficiencies are inserted under the skin and dissolve slowly over a period of approximately three to four months.
What are the risks?
1.Prostate cancer-- There is no evidence in the medical literature that testosterone replacement therapy increases the risk of prostate cancer.
2.Heart disease-- increasing male androgen levels would also increase serum cholesterol and serum LDL-Cholesterol levels. .
3.Liver Disease--the only orally available forms of testosterone for men contain methyl testosterone.
If used for sustained periods of time, it can damage the liver.
4.Suppression of testicular function-- whenever any hormone is administered, the gland which normally produces it ceases to function.
Patients with borderline low testosterone levels may commit themselves to lifelong therapy if they start with testosterone replacement.
What are the benefits?
The administration to testosterone to men with true testosterone deficiency states will improve their health and sense of well being.
Wednesday, September 14, 2011
A Family Doctor's Tale - SLEEPING SICKNESS
DOC I HAVE SLEEPING SICKNESS
Sleeping Sickness is a acute infection of humans and cattle caused by the protozoan hemoflagellate of the genus Trypanosoma.
The trypanosoma brucei protozoan is an elongated protozoan hemoflagellate with prominent nucleus kinetoplast and flagellum (hair).
It can occur in 2 forms:
1.West African caused by T.gambiense
This protozoan has a human host and is spread by the tsetse fly (also known as Glossina palpalis)
These flies inhabit shady areas by rivers or streams.
2.East African caused by T.rhodesiense
This protozoan is mainly a parasite of the wild animals especially the the bushbuck.
Humans are incidental hosts.
When the tsetse fly bites an infected host the trypanasomes pass into the midgut , migrates to the salivary glants, muliply in 2 bto 5 weeks and pass out in the saliva when feeding on a new host.
Early in the human disease, the lymph nodes and spleen are enlarged, infiltrated with plasma cells and macrophages (enlarged neutrophils and lymphocytes).
The disease can spread to the brain and result in swelling and damage of the brain.
Symptoms:
Incubation period is usually 10 days.
1.Anodular lesion (chancre) occur at the site of the bite of the tsetse fly and persist for 2-3 weeks.
2.Systemic invasion of the trypanosomes occur months after the bite resulting in:
a.fever
b.lymphadenopathy - nodes are firm but not tender usually
c.spleen enlargement
d.rashes erythematous and urticarial forms
e.localized edema
3.Months after the first symptoms:
a.mild behavior changes
b.mild personality changes
c.hallucinations
d.delusions
e.drowsiness during the day
f.manic depression
g.chorea
h.convulsions
i.coma
In Rhodesian sleeping sickness, the symptoms are more acute in onset:
1.fever
2.jaundice
3.malaise
4.heart failure
Rhodesian sleeping sickness is more rapidly fatal and occur in outbreaks.
Diagnosis:
1.characteristic fever, jaundice and drowsiness
2.Fluid from chancre and enlarged lymph nodes are taken to test for trypanosomes
3.Blood test for trypanosomes using thick blood film especially in Rhodesian Sleeping Sickness
4.Cerebrospinal fluid is taken to examine for trypanosomes in advanced stage of the diesease.
The IgM antibodies may be markedly increased with only moderate increase in total protein.
5.MRI of the brain my be necessary to find cause of drowsiness
The complications of Sleeping Sickness Fever are:
1.Psychiatric disease may affect victims
2.neurological disturbances(seizures,cranial nerve signs and coma) may indicate damage in the brain
3.Coma and death
Treatment:
1.Sleeping Sickness can be treated with Suramin an anti-protozoan drug if the central nervous system is not affected.
2.Melarsoprol with or without suramin is given if the central nervous system is infected.
Both medicines have serious side effects but their use can be life saving.
Other medicines include:
1.Eflornithine (for gambiense only)
2.Pentamidine
3.General measures which are mainly supportive:
1. Rest
2. drinking lots of water to prevent dehydration will help.
3. Paracetamol for fever, severe headaches and body aches to reduce the discomfort.
4. Intravenous fluids for hytopotension and dehydration.
5. Dietary supplements to build up nutrition and health
Prognosis:
1.depends on the virulence of the strain of trypanosome infecting the patient
2.depends on the stage of disease when treatment is instituted.
The earlier the stage of illness, the better will be the effect of the treatment.
Prevention:
Sleeping Sickness Fever is spread only through the bite of the infected tsetse fly.
To prevent Sleeping Sickness fever, you must prevent the breeding of its carrier, the tsetse fly.
1.THe use of mosquito nets prevents bites from the tsetse flies at night.
2.Wear clothes that are not brightly colored and covers the wrists and ankles.
Pentamidine injections protect against Trypanosome gambiense, but not against rhodesiense.
Sleeping Sickness is a acute infection of humans and cattle caused by the protozoan hemoflagellate of the genus Trypanosoma.
The trypanosoma brucei protozoan is an elongated protozoan hemoflagellate with prominent nucleus kinetoplast and flagellum (hair).
It can occur in 2 forms:
1.West African caused by T.gambiense
This protozoan has a human host and is spread by the tsetse fly (also known as Glossina palpalis)
These flies inhabit shady areas by rivers or streams.
2.East African caused by T.rhodesiense
This protozoan is mainly a parasite of the wild animals especially the the bushbuck.
Humans are incidental hosts.
When the tsetse fly bites an infected host the trypanasomes pass into the midgut , migrates to the salivary glants, muliply in 2 bto 5 weeks and pass out in the saliva when feeding on a new host.
Early in the human disease, the lymph nodes and spleen are enlarged, infiltrated with plasma cells and macrophages (enlarged neutrophils and lymphocytes).
The disease can spread to the brain and result in swelling and damage of the brain.
Symptoms:
Incubation period is usually 10 days.
1.Anodular lesion (chancre) occur at the site of the bite of the tsetse fly and persist for 2-3 weeks.
2.Systemic invasion of the trypanosomes occur months after the bite resulting in:
a.fever
b.lymphadenopathy - nodes are firm but not tender usually
c.spleen enlargement
d.rashes erythematous and urticarial forms
e.localized edema
3.Months after the first symptoms:
a.mild behavior changes
b.mild personality changes
c.hallucinations
d.delusions
e.drowsiness during the day
f.manic depression
g.chorea
h.convulsions
i.coma
In Rhodesian sleeping sickness, the symptoms are more acute in onset:
1.fever
2.jaundice
3.malaise
4.heart failure
Rhodesian sleeping sickness is more rapidly fatal and occur in outbreaks.
Diagnosis:
1.characteristic fever, jaundice and drowsiness
2.Fluid from chancre and enlarged lymph nodes are taken to test for trypanosomes
3.Blood test for trypanosomes using thick blood film especially in Rhodesian Sleeping Sickness
4.Cerebrospinal fluid is taken to examine for trypanosomes in advanced stage of the diesease.
The IgM antibodies may be markedly increased with only moderate increase in total protein.
5.MRI of the brain my be necessary to find cause of drowsiness
The complications of Sleeping Sickness Fever are:
1.Psychiatric disease may affect victims
2.neurological disturbances(seizures,cranial nerve signs and coma) may indicate damage in the brain
3.Coma and death
Treatment:
1.Sleeping Sickness can be treated with Suramin an anti-protozoan drug if the central nervous system is not affected.
2.Melarsoprol with or without suramin is given if the central nervous system is infected.
Both medicines have serious side effects but their use can be life saving.
Other medicines include:
1.Eflornithine (for gambiense only)
2.Pentamidine
3.General measures which are mainly supportive:
1. Rest
2. drinking lots of water to prevent dehydration will help.
3. Paracetamol for fever, severe headaches and body aches to reduce the discomfort.
4. Intravenous fluids for hytopotension and dehydration.
5. Dietary supplements to build up nutrition and health
Prognosis:
1.depends on the virulence of the strain of trypanosome infecting the patient
2.depends on the stage of disease when treatment is instituted.
The earlier the stage of illness, the better will be the effect of the treatment.
Prevention:
Sleeping Sickness Fever is spread only through the bite of the infected tsetse fly.
To prevent Sleeping Sickness fever, you must prevent the breeding of its carrier, the tsetse fly.
1.THe use of mosquito nets prevents bites from the tsetse flies at night.
2.Wear clothes that are not brightly colored and covers the wrists and ankles.
Pentamidine injections protect against Trypanosome gambiense, but not against rhodesiense.
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