Joint Replacement Surgery is a procedure where the damaged surface of the advanced arthritic joints are removed and replaced with artificial joints, such as metallic, plastic and ceramic joints.
These surfaces closely replicate the original anatomy.

When do you need a knee replacement?
When you suffer from severe pain or deformity in the joint (knee in this case), the pain or stiffness and deformity makes it difficult to perform simple tasks. Severe grade IV osteoarthritic knees of  people over 50 years when have pain, swelling and deformity fail to respond to medicines, physiotherapy, injections and rest.

Aim of the surgery

    Correct the deformity: Relieve the pain and give near full movements almost immediately after the procedure. Details including techniques and safety, it is a safe, rewarding surgery with a success rate of as high as 99.5% when done by an able and experienced professional.
    Anaesthesia: Usually it is the spinal cord epidural where one is rendered numb for 3 to 4 hours waist down. Sometimes a general anaesthesia is given. A 4 to 5 inches cut is made in front of the knee and all the damaged cartilages, bones, loose bodies are removed from the lower end of the thigh, upper end of the tibia (usually of few millimetres) and the surface re-crafted to match the size and shape of the artificial joint (it is usually imported). They are fixed with bone cement. The ligaments and muscles are reattached and the parts closed.
    Recovery: Stand up and walk a few steps with a walker the day after the procedure i.e. in 24 hours. Physiotherapy in hospital for 5 to 7 days and/or walking, progressively longer walks and exercises over the following 15 days. Stitches are removed in 15 days. The patient can return back to normal activity in 4 to 8 weeks the surgery.
    Activities: Normal walks of 3 to 5 km per day Climbing stairs, cycling, swimming, and driving can be performed with the new implant(s) now.
    Avoid: Squatting/kneeling Prohibited: contact sports like football, cricket, tennis; jumping; adventure sports Longevity of joints: 15-35 years depending on the materials used.

Joint Replacement Surgery - When Should You Go for  it

All you need to know about Premature Ejaculation

Many of the sexual issues are primarily not big problems. However, because of the taboo and inhibition around them, they are not discussed openly, hence they also fail to get resolved and become bigger. In fact most of the times there are no visible symptoms of any functional problems. Many of them are very basic issues and because of ignorance, myths, and social taboos lead to development of anxieties, distress and further worsening of the problem.

Often men are concerned about their performance in bed with their partner. They worry about- how best then can do, masturbation habits, size of penis and sperm quality. 

Consequences of Premature ejaculation (PE): 
Both you and your partner may end up experiencing highly unsatisfactory sex. In fact, it can significantly increase anxiety, which may deteriorate the problem. 

PE is one such sexual issue. It's not a disease; Not at all..!! 
If a person is sexually fit and experiences normal erections but just fail to hold the orgasm/ discharge for reasonable time then he is suffering from premature ejaculation. It's  a very normal problem, which if managed properly it can be easily resolved.

We will discuss this PE in 4 parts covering: what it is in actual, how does it happen, how to approach to resolve this problem with behavioural methods, exercise, techniques and medical remedies present in both modern and alternative medicine. 
Let s understand the problem in this 1st part!

What is Premature Ejaculation? 

Premature (early) ejaculation also referred to as rapid ejaculation; also called as early discharge. 
PE is the most common type of sexual dysfunction in men younger than 40 years and seen across all age groups. In elderly men (>60 years) erectile dysfunction is more common. A study conducted by the Journal of Sexual Medicine revealed that this condition is almost equally prevalent in sexually active men of all age groups. 
If a man experiences uncontrollable ejaculation (discharge of semen from your penis) either before or shortly after sexual penetration (usually within 1-2 minutes of penetration), he may be suffering from PE. The Mayo clinic at the United States defines PE as a condition in which  a man  always or nearly always ejaculates within one minute of penetration."

Instances of PE:
An occasional instance of premature ejaculation might not be cause of concern, but, if the problem occurs more than 50% of attempted sexual relations signifies existence of abnormal pattern for which treatment is required.

Premature ejaculation takes place with negligible sexual stimulation and even before the desire 
to ejaculate. Another way of describing PE by most therapist or clinicians is the occurrence of ejaculation sooner during sexual intercourse than he or his partner would like. 

This broad definition thus avoids specifying a precise  normal  duration for sexual activity and reaching a climax. The duration of sexual activity is highly variable and depends on various factors specific to each individual. Take a situation, a male may reach orgasm after 7 to 8 minutes of sexual intercourse, but if his partner is able to achieve climax mostly in 5 minutes and both are satisfied with this timing, then this is not defined as PE. 

Alternatively, a male might delay his ejaculation for up to 15- 20 minutes of sexual intercourse, but if his partner, even with foreplay, requires 25-30 minutes of total sexual activity before reaching climax, he may still consider his ejaculation premature because his partner has not been satisfied (at least, not through intercourse). But in routine practice this kind of situation is NOT called as PE. So every individual and every couple is unique. Same individual may have different sexual behaviour with different partners and different circumstances. Varied situations and varied places of performing the act have a vital role to play in determining the outcomes of individual sexual performance/s.



Knowing Premature Ejaculation - PART 1: Understanding What is PE

Many people suffer from a low libido problem. This can be a problem for their partners as well as for themselves. A low sex drive can also reduce one's self esteem and confidence. In severe cases it also leads to depression.

Factors which cause low sex drive:
1. Sexual problems: Many sexual problems also lead to a low sex drive. An inability to experience orgasm even after a lot of attempts can make one indifferent to sex. Some people also experience pain because of a tight vagina. In such cases their desire to have sex reduces greatly.

2. Medical diseases: Many medical conditions also affects your libido, such as cancer, arthritis, blood sugar (diabetes), artery diseases, high blood pressure and neurological diseases.

3. Medications: Some people suffer from depression and anxiety disorders. To get over these disorders most doctors prescribe them antidepressants and anti-anxiety pills, these medications create a very low libido.

4. Habits: Many lifestyle habits such as over-consumption of alcohol can make your sex drive reduce a lot. Smoking also decreases the blood flow in your body which may make your libido fall.

5. Surgery: Reconstructive surgeries such as breast reconstruction surgery and genital tract surgery can also affect sexual desire and give your body signals to not engage in an intercourse.

6. Fatigue: Tiredness because of physical activities or caring for your old parents or young children can also make you uninterested in sex. Your body and brain might not have the energy to engage in an intercourse due to fatigue.

7. Menopause: The levels of estrogen reduce greatly during menopause. Low estrogen levels make your vagina dry hence sex can be uncomfortable and painful. Women also go through hormonal changes which make them suffer from a low libido.

8. Pregnancy: After pregnancy, breastfeeding your baby becomes an everyday activity. This can reduce sexual desire because of the pressure of caring for a new born baby.

Regular exercising complemented with enough sleep is known to reduce stress thus giving you a high sex drive. Avoid consuming alcohol. Testosterone replacement therapy (a therapy used for treating erectile dysfunction) also treats low desire.

Worrying Factors That Lead to a Low Sex Drive

Low levels of testosterone can end up affecting various aspects of a your life. It can affect your libido, your performance in bed along with your motivation and energy. Testosterone replacement therapy can bring the levels back to what they were before and restore his lost confidence, energy and vigour.

Testosterone is a hormone which is mainly produced in the testicles. Testosterone controls bone density, distribution of fat, muscle mass and strength, body and facial hair, red blood cell production, sex drive and production of sperms.

Testosterone levels generally lower with age, especially after 30. Usually, in older men, low levels of testosterone result in androgen deficiency. Androgen deficiency affects the muscle mass, bone density, weight and can drastically change sleep patterns as well. On the other hand, testicle injury, testicular cancer or treatment for it, hormonal disorders, infections, HIV/AIDS, chronic kidney or liver disease, type 2 diabetes and obesity can lead to low testosterone levels as well.

While testosterone replacement therapy (TRT) seems very desirable, there are certain risks and benefits which need to be considered.

Factors to be considered before opting for it

1. Sleep apnea is one of the risk factors of TRT. In this condition, breathing stops and starts repeatedly when you sleep.

2. Acne problems and other skin disorders

3. Swollen breasts. Men with breast cancer should not opt for this treatment.

4. TRT can trigger noncancerous prostate growth.

5. Sperm production is limited or the testicles might shrink

6. Chances of deep vein thrombosis (blood clots in veins) leading to pulmonary embolism (clots burst and lodge into your lungs) are increased.

Benefits of getting a testosterone therapy done

1. Sexual drive, performance and function are improved.

2. Mineral density of the bones gets restored

3. Healthy weight loss, thus improving your body composition

4. Muscle strength and mass improves

5. Mood and energy gets a boost

6. Cognitive functions improve

7. Lessens the risks of type 2 diabetes and cardiovascular diseases

8. Improves metabolism

9. Reduces chances of anaemia or improves the condition if you are already suffering from it

Risks and Benefits of Testosterone Therapy

Swallowing food comes naturally to human beings. But when there is a problem, it is usually called Dysphagia. Esophagus, a muscular tube-like organ located at the back of our throat, usually helps in swallowing food and transferring them to our stomach. When esophagus does not function properly, dysphagia happens. Patients suffering from brain or nerve disorder, seniors and babies might have this problem. 

People with dysphagia might witness the following issues:

Difficulty in swallowing solids and liquids.
Gaging, choking or coughing usually occurs when trying to swallow.
Experience pain when trying to swallow and also heartburn.
Swallowed food might come back up either through mouth or nose.
A chronic problem might result in weight loss.
Causes:
There are 2 main reasons, why the Esophagus might become dysfunctional.

Due to some medical condition the muscles and nerves that help the esophagus work have stopped working.
The esophagus is blocked by something.
There can be a number of reasons for both the condition. Here are the reasons why the muscles and nerves might not work.
Certain diseases can create problems with your nervous system, which in turn can affect the esophagus. These diseases are polio, multiple sclerosis, muscular dystrophy, Parkinson s disease.

A brain stroke, spinal cord injury or brain injury can also affect swallowing.
Polymyositis or Dermatomyositis are immune system problems that can cause swelling or weakness.
The muscles of esophagus suddenly squeeze, which is called esophagus spasm.
Scleroderma causes the esophagus to become thin and weak.
The esophagus might be blocked because of these reasons:

Esophagus might have malignant or non-malignant tumours.
Esophagitis is a medical condition when the esophagus is infected, got some allergy or even if a pill got stuck on it.
People suffering from reflux diseases often experience the acid that backs up into the esophagus. This can cause an ulcer on it resulting in scars. Scars make Esophagus narrower, making it difficult to swallow.
There are small sacs called Diverticula on the esophagus or the throat, often making it difficult to swallow.
Lymph nodes, tumours, bone spurs can also obstruct esophagus and create difficulty in swallowing.

Difficulty in Swallowing - Are You at Risk of Dysphagia?

Chickenpox is an airborne illness, which spreads effortlessly through sneezes and coughs of an affected individual. The disease is highly contagious and is caused due to an infection by the varicella zoster virus (vzv). The characteristic features are skin rashes that form small, itchy blisters. It may also spread through contact with the person affected with blisters.

Symptoms
The early signs in teenagers and adults (loss of appetite, nausea, pain in muscles and headache) followed by the trademark rash or oral sores and mild fever that indicate the presence of the ailment. In children, there is an absence of the early signs. The rashes begin as red spots on visible areas of the body and thereby increases in severity as time progresses.

At the stage of blister, intense itching occurs. Visible symptoms develop in the oral cavity and tonsil in the form of ulcers, which can be extremely painful. These symptoms appear between 10 to 21 days of contact with the infected person. Since the nasal excretion contains the virus, the infected person becomes infectious around 2 days before the visible symptoms appear. Usually, the condition self resolves in around 2 weeks.

Prevention
Chicken pox can be prevented by:
1. Maintaining proper hygiene standards. The infected person should be kept in isolation. The virus is susceptible to disinfectants, heat and detergents.
2. In most top countries, compulsory vaccination is followed to prevent chicken pox. After the first immunization, the second dosage is recommended after 5 years.

Treatment
Easing the symptoms is the main focus of treatment. The infected are advised to remain at home, in isolation, in order to prevent the spread of the disease. Measures should be taken to avoid scratching so that secondary infections are prevented. Good hygiene and using of warm water to clean the skin daily, is mandatory. Paracetamol might be used to reduce fever. Treatment using antivirals (with 24 to 48 hours of onset) is recommended for adults, but not for children. Water intake to reduce dehydration and headache is advised. 

Since chickenpox is more severe in adults than it is in children, parents usually favour their wards receiving the virus at an early age. This is countered by doctors who believe that children are safer using vaccination, which is the virus in a weakened form, rather than the disease that may prove to be fatal.

All About Chicken Pox

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