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Dr. Shyam

Orthopedist, Mumbai

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Dr. Shyam Orthopedist, Mumbai
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I'm a caring, skilled professional, dedicated to simplifying what is often a very complicated and confusing area of health care....more
I'm a caring, skilled professional, dedicated to simplifying what is often a very complicated and confusing area of health care.
More about Dr. Shyam
Dr. Shyam is a renowned Orthopedist in Paramount General Hospital, Mumbai. You can meet Dr. Shyam personally at Para Mount Hospital in Paramount General Hospital, Mumbai. Book an appointment online with Dr. Shyam and consult privately on Lybrate.com.

Find numerous Orthopedists in India from the comfort of your home on Lybrate.com. You will find Orthopedists with more than 36 years of experience on Lybrate.com. You can find Orthopedists online in Mumbai and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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#Consulting General S, Paramount General Hospital & I.C.C.U, Sakinaka Junction, Andheri-Kurla Road, MumbaiMumbai Get Directions
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I have LBP and radiation in both leg below waist since last 6-7 year & now pain in neck also. I have taken advised from orthopedician & he advised for MRI of spine. That report is normal.in other diagnosis my Vit D3 and folate label is lower for that I am taking folvite 5 mg OD & Ultra D3 weekly since last 1 month. But no improvement in pain and radiation. Pls advise.

BAMS, MD, Panchakrma
Ayurveda, Nashik
I have LBP and radiation in both leg below waist since last 6-7 year & now pain in neck also. I have taken advised fr...
Backache /pain has several reasons like muscle spasm, spine issue, injury etc. Condition may get worst if it keep untreated. Ayurveda is one of most popular treatment for joint pain & backache. The selection of remedy is based upon the theory of individualization and symptoms similarity . ayurvedic treatment not only gives complete relief from pain it also improves bone strength as well calcium absorption which is essential for all 206 bones & joint . You can easily take an online consultation for further treatment guidance and permanent cure without any side effects. tips for you :- 1) Do massage with warm sesame oil or suitable oil for 15 min., afterwards take hot fomentation for 10 min. 2) Start natural calcium supplement. 3) Do regular stretching exercise 4) In yoga DO BHUJANGASAN, HALASAN & SURYANAMASKAR.
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Rheumatoid Arthritis: A mystery solved with lucidity

MBBS, MD, Diploma in Echocardiography, Diploma in Rheumatology
Internal Medicine Specialist, Kolkata
Rheumatoid Arthritis: A mystery solved with lucidity

Vital notes:

  • RA is a chronic debilitating joint disease that affects small joints of hands and foot.
  • More common in females aged 20 to 50 years.
  • It is not synonymous with Rheumatic Fever which occurs in children aged less than 15 years.
  • It has got nothing to do with monthly Penicillin injections and checking ASO titre. Somebody on Penicillin injections or being checked for ASO titre should change the doctor immediately.
  • Untreated disease may cause deformity of hands and foot causing deterioration of quality of life.
  • Erosion of small joints along with loss of entire joint architecture is the basic disease process.
  • Early morning stiffness of joints along with swelling of one or more small joints of hands is very characteristic.
  • Treatment is done with Methotrexate, Hydroxychloroquine Sulfate, Sulfasalazine, Leflunomide and short courses of steroids.
  • Difficult diseases are treated with costly injections called biologics.
  • The motto of treatment is “ catch early, hit hard and achieve and maintain treatment goal “
  • Lung and cardiac complications are common in long term disease.
  • Rheumatologists but not the Orthopedicians nor neurologist are the best person to treat the disease.                    

 

Introduction:

Rheumatoid Arthritis is an autoimmune disease of mankind where the cells and molecules who are responsible for security of our body, misidentify the joint tissue as foreign substance and start destroying them similar to the way they usually do when a bacteria or virus enters the body. This misdirected attack towards our own body is called autoimmune phenomenon.

The worst affected parts of the body are the joints of hands and foot. These small joints that are responsible for performance of day to day activities like eating, holding, writing, typing, washing etc become painful and swollen causing stiffness and deformity.

This results in poor quality of life and subsequent depression. Early diagnosis and continuous treatment with specific medicines is cornerstone of treatment.

 

What are the symptoms?

Symptoms vary from person to person and also from early stage to late stage of the disease.

 In early stage there may be mild pain and stiffness involving 1 to 4 small joints of the hands and feet with a typical pattern of stiffness of those joints after rising from bed. During this phase it is very difficult to diagnose the disease. But it is very important to catch the disease in this stage. Researchers have proved that joint damage and bony erosions start even before the symptoms have manifested and hence earlier the treatments better the results.

In a full blown case of Rheumatoid arthritis the picture is very classical of a middle aged female presenting with pain and swelling of hand and foot joints along with early morning stiffness that responds to steroids brilliantly. Wrists and the knuckles are predominantly involved. Patients are unable to hold a pen or open the door or do cooking etc. Gripping the wrist firmly causes pain and the hand joints are warm.

In a advanced case of the disease we often find elderly people presenting with crooked hands with areas of permanent swelling and skin changes due to chronic friction. The skin fold may contract chronic fungal infections and the joints are swollen and painful.

A few other organs are damaged in silence and they create serious problem at the advanced stage of the disease. Lungs, Heart and Blood Vessels are frequently affected. There is accelerated cholesterol deposition in arteries of heart causing increased risk of heart attack and brain stroke. These patients frequently contract infections which are difficult to treat.

Involvement of spine or low back is uncommon. However, cervical spine or the neck region is the only part of the spine that may be affected in this disease.

 

What is the difference between Rheumatic Fever & Rheumatoid Arthritis?

There is a heaven & hell difference between these two entities. Rheumatic Fever is a disease of childhood. It usually occurs in children aged less than 15 years and is characterised by excruciating pain, swelling and redness of one or more big joints of arms and legs that responds excellently to Aspirin. This disorder may cause cardiac problems and is the leading cause of Valvular Herat disease in India. It is often characterised by some skin rashes and rarely neurologic problems. The disease process, the causative agent and the clinical symptoms are completely different from that of Rheumatoid arthritis.

 

Why Penicillin injections are given on a monthly basis?

Patients of Rheumatic fever often suffer a damage to the valves of the heart during the attack of Rheumatic fever. This damaged valves are potential sites of infections that may develop in the later part of the life. This infection is called Infective Endocarditis and may cause serious complications if not addressed properly. Penicillin injections are given as a form of prevention of development of this infection and have got no relationship with the wellness or cure of the disease. People who are aged above 15 years and are being treated with penicillin for the first time for joint pain occurring in small joints of hands should immediately change their doctor and consult a rheumatologist.

 

How is Rheumatoid Arthritis diagnosed?

Rheumatoid Arthritis is diagnosed by its classical symptoms and some laboratory investigations. To identify early rheumatoid cases we usually follow a scoring system which includes counting of number of joints involved, the duration of the symptoms, checking ESR and CRP in blood and looking for the positivity of Rheumatoid Factor and Anti CP Antibody. Patients with high values of Anti CP Antibody are very much likely to suffering from rheumatoid arthritis and also they are very much likely to suffer a aggressive disease course

 

Does each and every patient of rheumatoid arthritis develop crooked hands and foot?

No. Not all patients suffer from such a devastating complications. There are important characteristics which if present predict severe destructive disease. Females, Smokers, High values of Anti CCP or Rheumatoid Arthritis, Family History of Rheumatoid Arthritis, Early evidence of Joint destruction on X Ray are a few important features who will go forward to develop destructive disease.

 

How Rheumatoid Arthritis is treated?

Continuous Physical activity of the involved joints is the corner stone of treatment. More the joints are active, less the damage.

Cessation of smoking is mandatory. Smokers tend to develop early joint destruction

Medicines that used in treating rheumatoid arthritis are together called Disease Modifying Anti Rheumatoid Drugs or DMARDs.

Methotrexate, Hydroxychloroquine Sulfate, Sulfasalazine, Leflunomide are the principal DAMRDs. Of these, methotrexate is the backbone of therapy. Methotrexate is used on a once a weekly basis starting from a dose of 5 mg to 50mg/week and a weekly 5mg of Folic Acid supplement is given to neutralise the adverse effects of Methotrexate. The detail of the drugs is mentioned below.

 

Why I am being given Steroids?

Steroids are given for a short period of increased disease activity. In rheumatoid arthritis we do not prescribe steroids in a regular basis. It is often prescribed when the patient is put on the DMARDs for the first time and when there is break through pain or active disease during the treatment.

Steroids are used in low dose in a decreasing dosage pattern over weeks and usually are not continued more than a month.

 

What are Biologic agents? Why they are so costly?

Biologic agents are highly specific molecules who directly block the action of the culprit chemicals in our body that cause the joint destruction. They are highly researched molecule an d is manufactured abroad. They are usually available in injection formats and have their own side effect profile which includes reactivation of Tuberculosis and other opportunistic infections. Usually patients are checked for latent Tuberculosis Infections, HIV, Hepatitis B and C before the treatment is started.

Biologics cause excellent response to the disease causing alleviation of pain and swelling and sense of well being but unfortunately they do not provide any cure. Hence, if biologics are stopped then there are chances that the disease activity may worsen requiring more biologics or aggressive treatment with DMARDs.

I have very bad knee pain. Both the legs I have had to take pain killers for the last three days. Long hours standing lead to lot of pain in the knees. I also get cracking noise from my left knee when I squat. Inflammation redness in the heels. I also get lower back pain because of the same. Sometimes the vertebrate column connecting the neck and the upper back starts hurting.

BHMS
Homeopath, Sindhudurg
I have very bad knee pain. Both the legs I have had to take pain killers for the last three days. Long hours standing...
Knee pain can be treated wonderfully with Homeopathic medicines, which are natural and safe. Homeopathic medicines are helpful in both acute and chronic knee pain. Homeopathic medicines are very effective in managing knee pain of degenerative, traumatic as well as inflammatory origin. They help in relieving the pain in the knee and the accompanying symptoms such as swelling, tenderness and stiffness. Homeopathic Medicines for Knee Pain The recommended Homeopathic medicines for knee pain are Calcarea Carb, Rhus Tox, Colchicum, Ruta, calc fluor , calc phos, Symphytum, arnica etc.. you can consult me online for homoeopathic treatment without side effects.
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I have very back paining please tell me what the solution. please also revert as soon as possible & stomach pain also so please tell me any medicine.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
I have very back paining please tell me what the solution. please also revert as soon as possible & stomach pain also...
Sleep on a hard bed with soft bedding on it. SPRING BEDS, FOLDING BEDS OR THICK MATRESS ARE HARMFUL Use no pillow under the head. DO HOT FOMANTATION. Paracetamol 250mg OD & SOS x 5days. Caldikind plus 1tab OD x10. Do neck, back & general exercises. It may have to be further investigated. You will need other supportive medicines also. Make sure you are not allergic to any of the medicines you are going to take. If it does not give relief in 4-5days, contact me again.. Do not ignore .It could be beginning of a serious problem.
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I'm an student. I usually see people suffering from back aches in real young age so what is the reason behind this? Is this in regards with food or stress?

MPT - Orthopedic Physiotherapy, BPTh/BPT
Physiotherapist, Noida
I'm an student. I usually see people suffering from back aches in real young age so what is the reason behind this? I...
Food stress, deficiency of vit d, and calcium, bad posture, long sitting work, computer work strain full activity etc.
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MBBS, DNB - Neurosurgery
Neurosurgeon, Bangalore
Never neglect any neurological problem -Chronic headache, Chronic neck pain , Chronic back pain, Giddiness, Loss of awareness and Convulsions etc. Seek expert opinion.
1 person found this helpful

My eyes usually get allergic and I can do nothing but rub them, because they burn. I used flour methanol opthalmic solution, and it reduces. But it keeps coming back. What can I do about it?

DHMS (Diploma in Homeopathic Medicine and Surgery)
Homeopath, Ludhiana
My eyes usually get allergic and I can do nothing but rub them, because they burn. I used flour methanol opthalmic so...
Homoeopathic medicine EUPHRASIA 30 ( Dr Reckeweg) Drink 2 drops direct on tongue every 2-3 hrly EUPHRASIA EYEDROPS ( SBL ) pour into eyes 1-2 drops 3 times daily If no relief within 2 days,please cosult an Eye specialist for physical examination.
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Dear doctor I have an chronicle pain near my neck area. I got to know it is mayo fascial pain syndrome. My doctor has given me. Gabapin nt 400 and nucoxia Mr. I want to know will I be able to be back with my healthy neck muscles ever again. Please let me know the best treatments available in market for myofascial pain of neck. Regards Kanchan.

Fellowship In Arthroplasty and Arthroscopy, MS Orthopaedics, MBBS
Orthopedist, Gurgaon
Dear doctor I have an chronicle pain near my neck area. I got to know it is mayo fascial pain syndrome. My doctor has...
Yes the medicines are right, after the acute phase is over you need to do regular exercises of the neck musles to get back to normal.
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Hi, 4. 6 years back I had femur bone injury and at that time surgery was with rod placement but after 4. 6 years also the bone not attached and recently 15 days back when iam walking the rod inside was broken and the doctor suggested that in some people the bone might not form let go another surgery with pelvis bone replacement in gap of femur bone. And 10 days back I had a surgery with pelvis bone replaced in the gap of femur bone. My worry is till 4 years the bone not grown now is it will grow after replaced with pelvis bone please give me suggestion

MCh Ortho, ATLS (AIIMS), Diploma In Orthopaedics (D. Ortho), MBBS, MS - Orthopaedics
Orthopedist, Kolkata
Dear, sometimes the bones at fracture site are unable to form good new bone. In this case your nail broke due to continuous micro movement at the fracture site. Your doctor did the right thing to revise the fracture, freshen the edges and put in a healthy bone graft from the pelvis. Pelvis bone has more healing potential than femur. Send me a picture of your xrays so that I can give a better opinion.
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Sir, how could I bring color to my face? I'm back in color. Due to this my life isin problems.

MD- Ayurvedic Pathology
Ayurveda, Amritsar
Sir, how could I bring color to my face? I'm back in color. Due to this my life isin problems.
Use rose herbal face pack (mfg. By robin herbal healthcare products). Or take multani mitti 1 tablespoon add 1/4th tablespoon of jaiphal powder and 1/4th tablespoon of turmeric. Make a paste of it by adding raw milk to it. Apply it on the face and wash it before it gets completely dry or after 20 mins. Follow it for few days to see the change and take next advise accordingly.
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Hi doctor. My mom s 58. Old she s suffering from knee pain Oly in right leg. No other pain s she having. Left leg no problem. No pain there a swelling in leg. Also. Here weight s 72. She s taking a tend bp. Tablets. Oly in afternoon. But bp s normal oly.

Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Zirakpur
Hi doctor. My mom s 58. Old she s suffering from knee pain Oly in right leg. No other pain s she having. Left leg no ...
Can you pl send x-ray or USG report of knee to see if osteoarthritis etc is developing. If leg is paining entire length, it could be nervine problem or circulatory problem too. What's reading of BP, sugar, uric acid, RA factor, ESR? Pl consult online with reports. For the time being start giving her tab/ cap Haridra, rumalaya forte, guggul (all of Himalaya co.) and apply Rumalaya liniment over knee twice a day. Pl contact online with reports. Above medicine has no side effects. Can be given for long time.
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My left shoulder are dislocate little bit before few years but problem appear in these days. It pain some times but not too much.

Bachelor of Ayurveda, Medicine and Surgery (BAMS), DYA (DIPLOMA IN YOG & AYURVED), D.I.H.M (DIPLOMA IN INDUSTRIAL HEALTH MANAGEMENT)
Ayurveda, Nashik
My left shoulder are dislocate little bit before few years but problem appear in these days. It pain some times but n...
1) do massage with warm sesame oil or suitable oil for 15 min. Afterwards take hot fomentation for 10 min. 2) start natural calcium supplement. 3) do regular stretching exercise.
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I got an injury on my middle toe by playing football. It is sprained for two weeks. When I try to move my toes upside down. I get a cracking sound. Is it a problem? Or I should relax and give rest to my toes. My middle toe is bit inflated because of sprain. I used ice pack and volini. And I see improvement but the cracking sound and sprain worries me. Need help. Hope you will understand what I am trying to say.

Occupational Therapy (OT)
Occupational Therapist, Jaipur
I got an injury on my middle toe by playing football. It is sprained for two weeks. When I try to move my toes upside...
You are in right way, do the ice pack thrice a day with 15 minutes sessions, volini twice day in a separate time 30 minutes after ice pack and take rest no walking and standing for long duration. Take ultrasonic therapy. Later on use warm foamentation in late phase.
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Age 52 Female Symptoms: very severe pain in shin and knees, swelling in lower right leg, pain only when put pressure in leg. Does not feel during rest Can you please tell me what the problem is?

DNB (Orthopedics), fellowship in arthroscopy and sports medicine
Orthopedist, Ghaziabad
Age 52
Female
Symptoms: very severe pain in shin and knees, swelling in lower right leg, pain only when put pressure ...
Dear mam it may be because of stress (abnormal pressure of normal bone). May be age related change like osteopenia/ osteo arthritis.
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Sir, it has been an regular pain from back to toe to my mother. It has been 1 months since pain, generally it starts at after 10: 00 pm, she feels that the pain is somewhat running from back to whole leg. Please help me out. Age is 36 years. Thank you.

MPT - Orthopedic Physiotherapy, BPTh/BPT
Physiotherapist, Noida
Sir, it has been an regular pain from back to toe to my mother. It has been 1 months since pain, generally it starts ...
Sciatica pain is there take physiotherapy treatment swd tens and ultrasonic therapy and avoid long standing.
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What are the natural sources of iron in vegetarian instead of taking iron folic tablet in pregnancy which is creating constipation and how to increase hemoglobin naturally.

BHMS, MD - Homeopathy, Gold medallist
Homeopath, Navi Mumbai
What are the natural sources of iron in vegetarian instead of taking iron folic tablet in pregnancy which is creating...
Dear lybrate-user take beet root tomatoes carrots gud or jaggery khajur or date green vegetables. More and soups fruits more in diet. It Will help you
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I have had back pain for many years, and I am always taking pain-killing tablets. My doctor wants me to have a laminectomy, which he says will cure my problem. What sort of operation is a laminectomy?

Bechhlor of ayurvedic medicine and surgery
Ayurveda, Ghaziabad
I have had back pain for many years, and I am always taking pain-killing tablets. My doctor wants me to have a lamine...
A laminectomy is a surgical procedure that removes a portion of vertebral bone called lamina. Muscles are pushed aside rather than cut. Recovery are found in few days. In ayurveda you can avoid that surgery. For that, private consultation is must.
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Hi Doctor, kindly advice, my weight is 77 kg and I have started gym from last 6 days and my left leg is paining and when I do rest it falls a sleep and the pain is only down side from my knee.

Hand Surgery, M.S. (Orthopaedics
Orthopedist, Ahmedabad
Hi Doctor,
kindly advice, my weight is 77 kg and I have started gym from last 6 days and my left leg is paining and w...
Dear lybrate-user I think you have muscle pain due to gym exercises and it will heal in due course. Please apply ice for 20 minutes every hourly and take some rest. Don't do exercises which gives you pain.
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My mother is 65 years old she has pain in legs below knees her knees are alright but below it she feel severe pain sometimes and sometimes normal pain in both legs.

BHMS
Homeopath, Faridabad
My mother is 65 years old she has pain in legs below knees her knees are alright but below it she feel severe pain so...
Hello, give her Rhus tox. 200, 5 drops in the morning and bryonia 200, 5 drops daily evening. Five phos , 4 tabs twice daily. Revert me after 10 days.
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I am having pain in my lower back due to wrongly done work outs. I still want to continue my work out. What should I do.

BPTh/BPT
Physiotherapist, Gandhinagar
I am having pain in my lower back due to wrongly done work outs. I still want to continue my work out. What should I do.
If you have to still continue your work then you need to use lumbo sacral belt to avoid further strain on the back and try to avoid heavy weight lift and long drives and if you have sitting job then don't forget to take a few micro breaks every 20-30 min. And apply hot water bag at your back at bed time so you may have a no pain and get sound sleep.
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