Dr. Mehta's Hospitals

The after effects of any surgery can be harsh on the body. Post knee replacement surgery, one will need to remain in a straight and relaxed position for a long time due to the bed rest prescribed by the orthopaedic specialist. Yet, it is important to carry out some kind of activity after the surgery so as to make the knee strong, firm and ready to be normal again.

Here are a few physiotherapy exercises that can help post knee replacement patients: 

• Heel Slide: The heel slide is a good option for those who are going through bed rest. This exercise ensures that you work your knee in a suitable way as the bending motion gets the knee to get used to being functional again. Due to the posture of the patient, this does not put pressure on the knee. Slowly bring your heel up, stop and then slide it down. Repeat at least ten times for each knee before increasing it to twenty times. 
• Kicks: While you are lying down, you can render small kicks into the air. Repeat at least ten times for each leg before increasing it gradually to twenty kicks per leg. This should be done when you are lying flat on your back. This exercise can help in flexing and strengthening your quadriceps. Hold the kick for at least five to ten seconds before you relax and repeat with the other leg. 
• Sitting Flex: You can also sit in a chair and flex your knee, holding the leg out in front of you for at least five to ten seconds, before slowly bringing it down and lifting again. This will help in strengthening the thigh and knee to a great extent.

You will need to exercise regularly in order to recover well after a knee replacement procedure.

A person is said to have great vision more in the metaphorical way than in the literal sense. However, having both is just so important, especially as the ability to see reduces as a person gets older. Old age comes with its own set of problems, and vision loss is one of them. If kept in check from an early age, however, vision loss can be deferred indefinitely.

While a person's eyesight is likely to deteriorate over the course of his life, there is a lot which can be done in an effort to make sure that this is not the case. To start with, it makes good sense to be regular with eye check-ups. After a person attains the age of sixty, he or she should have a doctor take a look at his or her eyes on a yearly basis. There is no point trying to conserve eye sight if a person is too late in taking corrective action. By paying a visit to the ophthalmologist, a person will get to know the exact problem that he is suffering from.

• One of the main things which can be done in order to preserve the health of a person's eyes until he or she reaches an advanced age is to stop smoking in all forms. As a matter of fact, tobacco leads to cyanide entering the blood stream and this does a lot of damage to the eyes. In fact, quite a few irreversible conditions of the eye are caused due to this.
• Exercise is said to be good for a person at any age for a variety of reasons and it is really good for even the eyes, though the link may not be immediately so clear. It reduces the risk of age related degeneration by up to 70 per cent!
• What is really interesting about a person's eyes is that they can be signs of trouble in other parts of the body. For example, if a person has blurry vision, they should get checked for diabetes. Also, eyes which do not produce enough natural lubrication can show a risk of rheumatoid arthritis and perhaps even thyroid disease.

All in all, a person's eyesight is so crucial to his or her overall health and wellbeing. We have only one pair of eyes, so we might as well take care of them!

Pregnancy is a special period that every woman waits with bated breath. While the happiness and excitement are there, the health of the mother and baby are extremely important as well. Incidences of complications during pregnancy and childbirth are not new. Many pregnant women suffer from preeclampsia (high blood pressure often associated with the presence of proteins in the urine), and gestational diabetes, which, left attended can be risky for both the mother and the baby. Lack of awareness and proper guidance are often found to be the main contributors, affecting the maternal and fetal health during pregnancy. The NICE (National Institute for Health and Care Excellence) suggests that complications or not, all women should be under medical guidance and assessment during pregnancy.

Antenatal Care and Assessment has been a revelation ensuring that a woman enjoys a safe and healthy pregnancy sans any complications. There are regular health check-ups, diagnostic and screening tests and prenatal counseling for the pregnant women and their families. The initiatives have been truly noteworthy, bringing about a significant reduction in the incidences of miscarriages and other pregnancy-related complications.

What does Antenatal Care and Assessment include?
Each trimester brings about changes that need care and attention. The Antenatal Care involves assessing and guiding a pregnant woman and their loved ones as the pregnancy progresses through each trimester.

• The diet can play a crucial role during pregnancy. A pregnant woman should eat a nutritionally enriched diet as the fetus receives the nutrients directly from the mother. Antenatal care lays great emphasis on the diet of the pregnant woman.
• De-worming and immunization programs are carried out to immunize the mother and the baby against harmful infections, including, tetanus and malaria.
• Antenatal care is a complete package that includes prenatal as well as postnatal care and assessment so that the mother and the baby enjoy good health.
• Pregnancy brings about a new phase in the life of couples. While most couples accept the changes graciously, many find it difficult to cope with the situation. Thus, the program aims at counseling such couples both mentally as well as emotionally so that things get a less stressful and challenging. The program also educates the other family members and loved ones about prenatal and postpartum care and management.

Many women have benefitted immensely from the antenatal care and assessment programs, safeguarding the mother and the baby from various health problems. In fact, efforts are being made to aware and educate the rural India about the immense health benefits associated with the antenatal care.

Cancer has unfortunately become a common condition. This is largely because of an unhealthy lifestyle and pollution that surrounds us. Some people have a higher risk of cancer as compared to others. Understanding your risk of suffering from a form of this disease can put you in a better position to fight against it.

Here are a few elements that can help you understand your risk of having cancer.

• Immunosuppression: People with a compromised immune system are at a high risk of cancer. For certain medical procedure, it may be necessary to temporarily suppress the immune system. This can also increase a person’s risk of cancer. An organ transplant is one such procedure. The four most common types of cancer that can be caused by a suppressed immune system are lung cancer, kidney cancer, liver cancer and non-Hodgkin lymphoma.
• Obesity: Being overweight or obese can increase a person risk of many types of cancer including breast cancer, and cancer of the colon, rectum, kidneys, esophagus, pancreas, gallbladder and endometrium.
• Radiation: Exposure to certain types of radiation can damage DNA and mutate cells causing cancer. This includes x rays, radon, gamma rays and some other forms of high energy radiation. A person may be exposed to these types of radiation during certain medical procedures such as chest X rays, PET scans, and CT scans. Working in nuclear power plants can also put a person at risk of exposure to these types of radiation. Tanning booths and sunlamps are another sources of UV radiation that can cause cancer.

People say that marriage makes a man and woman complete, but it is a child that completes a family!

Sadly, World Health Organization (WHO) researchers claim that in 2010, 48.5 million couples worldwide were unable to have a child. Nevertheless, thanks to the Medical science elevations, that invented (IVF) In vitro fertilization, which is the panacea of all the infertility ailments.

However, there are several factors that play a crucial role in deciding the outcome of the IVF procedures. They are:

• Use of donor eggs: If a woman is over 35-40, donor eggs become a significant consideration, as there may be a higher rate of IVF success. The probability of pregnancy for women over 40 also increases if donor eggs are from younger women.
• Lifestyle habits: Women who have poor lifestyle habits have a much lesser IVF success rate. Also, being obese or underweight can increase the risk of infertility as well as miscarriage. Most importantly, women who smoke can face multiple problems, such as:
  • They require higher dosages of fertility drugs to stimulate their ovaries.
  • They require almost twice as many IVF attempts.
  • They experience more failed fertilization cycles.
• Fertility clinic: A reliable, licensed clinic for IVF procedure is of great importance as they will have well trained and experienced staff to conduct the IVF procedure. Also, in a good clinic, the laboratory and technology used by the clinic will be of required standards that can add up to the success factor.

Every month, IVF clinics see a substantial amount of childless couple walking in with despair but later walking out with their bundle of joy. As it is always said, “Optimism is the faith that leads to achievement”, it is recommended to pay a visit to the clinic, go through the initial screening and hope for the best.

We have more than 200 bones in our body and each of them is susceptible to bone cancer. However, long bones in the arms and legs are most susceptible to this condition. Bone cancer can be primary or secondary. Primary bone cancer involves uncontrolled and abnormal cell division within the bones while secondary bone cancer refers to cancer that originated somewhere else in the body and later spread to the bones. While children and adults are equally at risk for primary bone cancer, adults and elderly people are more susceptible to secondary bone cancer. If diagnosed early enough, bone cancer can be treated and even cured with surgery, chemotherapy or radiation.

Hence it is essential to recognize the signs and symptoms of bone cancer. Here’s what you should look out for.

• Swelling: In some cases, the abnormal growth of bone cells can result in the formation of a lump of mass that may be felt through the skin. In other cases, the affected area may also show signs of swelling.
• Breaking of the Bone: Cancer can weaken the bones and make them more brittle. This may make the bones more susceptible to fractures. A bone breaking in an area that has been painful or sore for a long period of time may be a sign of cancer. This is known as a pathologic fracture.
• Reduced Flexibility: If the tumour is located near a joint, it may affect the range of movements possible and make simple actions uncomfortable. For example, a tumour around the knee may make walking and climbing stairs a painful exercise.

Other symptoms to look out for are sudden and drastic weight loss, tiredness, excessive sweating at night, fever and difficulty breathing in case cancer has spread to other organs. Since many of these symptoms are common to other medical disorders, you should conduct a doctor immediately if you notice any of them. A physical examination and a couple of tests along with a biopsy will be required to confirm a diagnosis of bone cancer.

The heart pumps pure blood to all parts of the body through a network of arteries. These are thicker in the beginning and become finer and thinner as they reach the various organs. These arteries are lined by a layer of epithelial tissues and as blood flows through them, the heavier cholesterol / fat molecules settle down along the walls.

This attracts more and more fat molecules to settle down.  This is known as atherosclerosis (hardening of the arteries). Over a period of time, the vessels circumference reduces and the blood supply to the target organ reduces. This impacts proper functioning of these organs and when this happens to the major organs like the heart, kidney or the brain, conditions like stroke or thrombosis or heart attack can occur.

This condition, known as coronary artery disease, is becoming a major cause of deaths.  While that is the bad news, the good news is that it is largely lifestyle dependent, and if steps are taken, it can be prevented, and in the early stages, the damage completely reversed.

Preventive measures:

1. Diet: A low-fat, high-fiber, heart-healthy diet consisting of Omega-3 fatty acids is recommended by doctors, especially to people who are prone to develop heart disease.  This also requires reduced salt, increased unsaturated fats, reduced triglycerides and reduced sugar.  Include loads of fresh fruits and vegetables, whole grains, nuts and seeds and fish oils. Include multivitamins or other supplements after checking with your doctor.

2. Exercise:  Regular exercise in any form increases the efficiency of the circulatory system, keeps the cholesterol levels in check and helps in blood pressure management.  Exercise in any form is advisable, based on individual preference. A moderate physical activity of 30 to 45 minutes per day is advisable.

3. Smoking: This is one of the major risk factors for smoking, and quitting or controlling smoking is one of the best methods to prevent coronary artery disease.

4. Alcohol consumption:  While moderate alcohol consumption is believed to be healthy for the heart, excessive alcohol consumption is a strict no-no.  Binge drinking especially is shown to cause heart attacks.

5. Weight management: Check with your doctor on what is ideal BMI for you and work out a plan to keep your weight under check.

6. Regular medications: If you are on blood pressure or diabetes medications, ensure you do not miss them.  Keep a constant check to ensure your readings are managed well.

7. Watch out:  Ask your doctor if there are specific symptoms that you need to watch out and seek medical support if you see any of them.

Coronary disease is not treatable fully, but can be prevented and managed effectively to improve the overall quality of life.

Urine is normally pale yellow or straw coloured. However, for various reasons, this can change. In fact, the change in the colour of urine is one of the first indications of a deeper underlying problem. This would also be one of the questions that the doctor would ask when suspecting any problem with the urinary tract, starting from infection to stones to cancer.

Hematuria is, therefore, a symptom and not a problem in itself. Some of the reasons for hematuria – presence of blood cells in the urine, producing a light pinkish urine, are listed below.

1. Urinary tract infections – starting from urethra all the way up to the kidneys

2. Glomerulonephritis

Kidney Stones

1. Prostate enlargement

2. Tumours/cancers in the kidney, bladder, or prostate

3. Heavy exercises causing trauma to any of the internal urinary tract organs

4. Bleeding disorders

5. Certain medications

6. Appendicitis

7. Tuberculosis

As the disease progresses higher in the urinary tract, the severity of hematuria also increases. Though hematuria is a symptom in itself, there are some associated symptoms which are listed below-

• Fever

• Fatigue

• Abdominal pain

• Reduced appetite

• Urge to urinate

• Dysuria

• Painful/burning urination

• Feeling of incomplete emptying

• Nocturnal urination (if prostate is enlarged)

• Cloudy urine

• Nausea, vomiting

• Kidney pain (with stones especially)

Homeopathy believes in treating the person as a whole and not just the presenting symptoms. The doctor will ask a number of questions, some pertaining to unrelated organs, which will help them identify the reason for the hematuria. The treatment prescribed will be customised to the patient in question, but some of the common ingredients used in hematuria management are given below.

1. Hematuria from all causes can be managed with Terebinthina.

2. Bladder hematuria is better managed with Erigeron Canadense at 80% concentration while renal hematuria responds better to the same at 60% dilution.

3. Inflammatory hematuria can be reduced with Cantharis (80%)

4. Renal hematuria is better managed with Gossypium herbaceous (60%).

5. Renal colic with pain in the glans, groyne, and thighs responds well to Pereira brava.

6. Cocus cacti thrice a day is useful where there is itching of the urinary meatus along with the passing of red-coloured urine.

7. When there are small stones or sand particles in the urine along with pain at the end of the micturition process, Sarsaparilla thrice a day is known to be beneficial.

8. In some other people, Arnica Montana, Cantharis, phosphorus, and Hepar Sulphur are also used to relieve symptoms of hematuria.

As with any homeopathic treatment, the actual ingredient chosen would depend on the actual symptom that the patient presents with. Though these compounds are used, self-medication is not advisable. Talk to a specialized homeopath who will identify the right ingredient for a given clinical presentation.

HIV infection is the causative factor of the acquired immune deficiency syndrome (AIDS). Worldwide research is being conducted and treatment strategies are being formulated to combat this fatal disease. Fighting HIV is not an easy task, since the disease cannot be completely reversed. However, worldwide use of anti-retroviral therapy has helped in controlling the spread and transmission of disease. Use of medications, regular screening and close contact with caregivers and physicians is necessary for proper management of the disease. Despite, available treatment options, a difficult obstacle that arises before or during the treatment is drug resistance.

Drugs are aimed at targeting the disease-causing pathogens like bacteria and viruses. These pathogens, over a period of time, develop the ability to acquire resistance against the targeted drugs. The pathogens continue multiplying despite the presence of the drug in the system. In today’s scenario, the potent drug combination of anti-retroviral therapy (ARV) has been successful in remarkably reducing HIV-related mortality. However, an increased emergence of resistance to the drug therapy is concerning.

Amongst the various drug classes available in the ARV, no drug is resistance-proof. The drugs belonging to the same class have a similar mechanism of action against the virus. So resistance developed against a particular class of drug inevitably leads to resistance against all the other drugs belonging to that class. An individual with HIV infection may have one or more drug-resistant mutations, which makes the person less sensitive to one or more anti-retroviral drugs. When the replication of virus in the system is not suppressed fully, a resistance towards it develops.

Non-compliance of the ARV results in resistance. Resistant viruses can spread the infection and affect ARV therapy. Drug resistance is usually attributed to inadequate adherence to the regimen. But in some cases, strict adherence to the drug is seen, yet there is a presence of resistance due to poor absorption. This implies that since the drug is not getting adequately absorbed in the body, it is unable to prevent the replication thus leading to drug resistance.

Anti-retroviral treatment is aimed at limiting the replication of HIV in the body. Various drug classes target different steps of replication, which stops further replicating and infecting of the cells. The nucleo-capsid contains viral genome and three enzymes vital to HIV life cycle:

• Reverse transcriptase - Transcribes viral RNA genome into complementary deoxyribonucleic acid (DNA)
• Integrase - Facilitates incorporation of pro-viral DNA into host cell genome
• Protease - Cleaves viral polypeptide into individual functional enzymes

Drugs targeted on these steps are as follows

• Nucleoside and non-nucleoside reverse transcriptase inhibitors like Nevirapine and Efavirenz act on the reverse transcriptase enzyme.
• Integrase inhibitor Raltegravir acts on the Integrase enzyme.
• Protease inhibitors like Ritonavir, Indinavir, Saquinavir act on the Protease enzyme.
• Fusion inhibitor Enfuvirtide acts to prevent fusion of HIV with cell membranes.
• CCR5 inhibitor Maraviroc block the CCR5 co-receptor.
• A viral mutation occurring at any stage of this process can affect the efficacy of the drug therapy.

The emergence of drug resistance can be managed by evaluation of drug absorption and ensure strict adherence to the drug schedule. Genotype tests can be done to look for drug-resistant mutations in genes. Phenotype tests are done for measuring the ability of a virus in an individual to undergo replication in different drug concentrations. A successfully administered and effectively acted first-line drug treatment, preferably a 3-drug combination, reduces the chances of drug resistance in future.

Breast cancer is the most common forms of cancer in females, affecting one in every eight women in the US. There are huge awareness campaigns, which revolve around ways to recognize if you are prone for it and how to identify the disease in its early stages. Knowing the symptoms can help in early diagnosis and thereby early intervention and better prognosis.

How and why of breast cancer?
The breasts produce milk through the glands, which also contain connective tissue including fat, fibrous tissue, nerves, blood vessels, etc. The milk reaches the exterior through a fine network of ducts. Most cancers develop as small calcifications in these ducts, which continues to grow and spread to distant organs.

Warning signs and symptoms: Given the high incidence of breast cancer, knowing the symptoms helps in early identification. Read on to know more, especially if there is a family history.

1. Any change in the size, shape, or contour of the breasts
2. Appearance of a lump in the breasts or the armpits
3. Presence of a clear or bloody discharge from the breast
4. The breast or the nipple turning red
5. Sudden thickening of breast tissue or skin that continues for a while
6. Change in the feel or look of the skin (dimpling, puckering, scaliness, reddishness, warmth, etc.)
7. Hardening of the tissue under the breast skin
8. Difference in appearance or feel of one area in comparison with other areas

The presence of any of these or a combination of these symptoms should be an indication for a detailed checkup. As mentioned, early diagnosis helps in reducing complications and improving prognosis. It is also good to know risk factors, which also indicate if you need to watch for symptoms.

• Family history: Breast cancer runs in families, and if you have a first-degree relative with breast cancer, watch out for symptoms.
  • Tested positive for BRCA1 and BRCA2
  • Family history of other cancers
• Age: Women over the age of 50 are at an increased risk of developing breast cancer.
• Race: Caucasian women carry greater risk than African-American women.
• Hormones: Increased use of estrogen increases the chances of developing breast cancer. Therefore, women who have used birth control for long time or are on hormone replacement are at greater risk.
• Abnormal gynecologic milestones: Women who have abnormal menstrual milestones are more predisposed to developing breast cancer. For instance, girls who attain menarche before age of 12, get pregnant after 30, and reach menopause after 55. Women with menstrual irregularities including cycles earlier than 26 days and later than 29 days are also likely to have hormonal issues and are, therefore, at higher risk of breast cancer.
• Other factors: Smoking, alcohol abuse, and obesity also increase the chances of a woman developing breast cancer.