Source: http://www.ufunk.net/en/insolite/x-ray-gifs/
https://www.behance.net/gallery/18065111/X-Ray-Gifs
Images Cameron Drake / via
Thursday, November 26, 2015
X-Rays
Source: http://www.ufunk.net/en/insolite/x-ray-gifs/
https://www.behance.net/gallery/18065111/X-Ray-Gifs
Images Cameron Drake / via
Monday, August 25, 2014
The Plastic Brain
Read this quote about how Merzenich thinks about his brain's decline.
"I want to put my brain to the best possible use as long as it is possible."
"Science tells us that a key to sustaining and growing our neurological abilities is seriousness of purpose. I am old enough to have retired, but shall not withdraw to a life of comfort and ease because I know that the brain slowly dies when nothing that it does matters to it. ... understand that what sustains your brain sustains you. You need to continue to work at things that support your brain's health now, and continue to work in ways that support it out to the end of your time on Earth."
- Dr. Michael Merzenich
Brain Plasticity sites:
Tuesday, August 5, 2014
Neon in Vancouver
Neon used to rule the night in Vancouver, especially on the famous Granville Street entertainment strip. At one time the city was second only to Shanghai for the most neon signs.
Monday, August 4, 2014
Yoga Pose near Taj Mahall
· "Breathe and everything changes." ~Seane Corn in this week's show, Yoga, Meditation in Action: http://www.onbeing.org/program/yoga-meditation-action/248 …
Triple Arthrodesis post operative X-Ray
Dr. Lam Foot / Ankle Straight Talk: October 2012
www.drkevinlam.com
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Case #2: Post operative Triple Arthrodesis 3 years later without pain in the ankle or foot.
Source: http://www.drkevinlam.com/2012_10_01_archive.html
Triple Arthrodesis
This is a procedure I have undergone:
Triple Arthrodesis
What is triple arthrodesis?
Triple arthodesis is used to address many types of foot deformity and pain. This procedure fuses three joints in the back of
the foot. These joints, shown in the image to the right, are the talonavicular (blue arrow), subtalar (red arrow) and calcaneocuboid (green arrow).
 The talonavicular (blue arrow), subtalar (red arrow) and calcaneocuboid (green arrow) joints |
|---|
What are the goals of triple arthrodesis?
Surgeons try to avoid fusions, but sometimes pain and deformity are so severe that this procedure offers the best chance of producing a less painful foot with better alignment. Fusions often improve stability and allow for easier standing and walking. The triple arthrodesis is a time-tested, durable procedure.
What signs indicate surgery may be needed?
Triple arthrodesis is indicated for severe arthritis, instability or deformity that cannot be controlled with nonsurgical approaches. Other conditions, such as severe flatfoot, abnormal connections between bones, excessively high arches and joint instability due to neuromuscular disease, can also warrant treatment with fusion.
When should I avoid surgery?
Patients who are still growing are not ideal candidates as they may develop additional deformity as they grow. Patients who use tobacco, have an active infection or have poor healing potential are at higher risk for complications. Nonsurgical measures such as bracing and anti-inflammatories should be attempted first. If another surgical procedure that leaves the joint intact can achieve the same goal, this is preferred over a fusion.
General Details of Procedure
Two incisions are generally required for this procedure. The traditional method involves one incision on each side of the foot.
Within each joint cartilage is removed, bony surfaces roughened, and defects filled. Once all three joints have been prepared, they are put into place and hardware is placed to stabilize the reconstruction and promote healthy fusion.
  Typical incision sites for a triple arthrodesis |
|---|
Specific Technique
The surgeon confirms proper position of the bones with an X-ray while in the operating room. Then all incisions are closed and covered with bulky dry sterile dressings. To lessen post-operative pain, the nerves around the knee or ankle may be numbed with medication.
What happens after surgery?
The rate of healing is variable and is influenced by many factors. In general, the foot is kept elevated with no weight on it for the first two weeks to minimize swelling and allow healing of the skin. Stitches may be removed two to three weeks after surgery.
Different weight bearing protocols may be used. After signs of healing are noted, progressive weight bearing is allowed until full weight bearing is reached. This typically takes three months. A removable boot may be used rather than a cast.
Potential Complications
Successful triple arthrodesis is appreciated by patients. Most feel that the loss of motion is a very acceptable trade-off for pain reduction. In the first two to three weeks, the most likely complication is wound breakdown and/or infection. These are best avoided by not smoking, elevating the foot, avoiding any weight on the foot, and keeping the surgical dressing clean and dry.
There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
The most common long-term consequence of triple arthrodesis is gradual development of arthritis in other joints of the foot and ankle. These changes can take years or even decades to develop and many never become noticeable to the patient.
Frequently Asked Questions
Will I have stiffness after surgery?
Yes, you can expect some degree of stiffness in your foot as a result of the surgery. You will maintain up-and-down motion, but side-to-side motion will become limited. This will be most noticeable on uneven surfaces but is usually a good trade-off for reasonable pain relief, improved stability and/or deformity correction.
Will I be able to return to my usual activities?
You can generally expect to return to most activities in life, but the stiffness in side-to-side motion will limit sports participation.
You can generally expect to return to most activities in life, but the stiffness in side-to-side motion will limit sports participation.
When can I expect to have recovered from a triple arthrodesis?
A significant amount of healing will occur in the first three months. However, it takes about one year for maximum improvement.
A significant amount of healing will occur in the first three months. However, it takes about one year for maximum improvement.
Are there side effects to triple arthrodesis?
As one part of the foot is made stiffer, other structures are forced to accept more stress, which increases the chances that they may wear out. This often takes many years or decades to become noticeable.
As one part of the foot is made stiffer, other structures are forced to accept more stress, which increases the chances that they may wear out. This often takes many years or decades to become noticeable.
When will I be able to take a shower?
Generally, showering is allowed once all wounds have healed. This usually takes place within the first two to four weeks depending on swelling and soft-tissue health.
Will I be able to fit into regular shoes?
Typically patients fit into a shoe after surgery better than before surgery.
Typically patients fit into a shoe after surgery better than before surgery.
When will I be able to bear weight on my foot?
Partial weight bearing typically is allowed once incisions have healed. Full weight bearing generally takes between two and four months.
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find an Orthopaedic Foot & Ankle Surgeon" tool at the top of this page or contact your primary doctor.Partial weight bearing typically is allowed once incisions have healed. Full weight bearing generally takes between two and four months.
Source: http://www.aofas.org/footcaremd/treatments/Pages/Triple-Arthrodesis.aspx
Tuesday, June 3, 2014
Prostate Cancer
HEALTH
Study May Alter Approach to Prostate Cancer
By ANDREW POLLACK
JUNE 1, 2014
A study supports chemotherapy for men early in their treatment for advanced prostate cancer.CreditGerry Broome/Associated Press
CHICAGO — Many men with prostate cancer put off using chemotherapy as long as possible, fearing its side effects.
But a new study has found that men given chemotherapy early in their treatment for advanced disease lived a median of nearly 14 months longer than those who did not get early chemotherapy.
A study supports chemotherapy for men early in their treatment for advanced prostate cancer.CreditGerry Broome/Associated Press
CHICAGO — Many men with prostate cancer put off using chemotherapy as long as possible, fearing its side effects.
But a new study has found that men given chemotherapy early in their treatment for advanced disease lived a median of nearly 14 months longer than those who did not get early chemotherapy.
The result could upend the established treatment practice, researchers said here on Sunday.
“We haven’t seen survival benefits like that for any therapy in prostate cancer,” said Dr. Michael J. Morris, an associate professor at the Memorial Sloan-Kettering Cancer Center, who was not involved in the study but was selected to publicly comment on it at the annual meeting of the American Society of Clinical Oncology.
Another study being presented on Sunday found that drugs called aromatase inhibitors might be better than the standard drug tamoxifen in preventing a recurrence of disease in premenopausal women with early breast cancer.
Both studies are being featured in the plenary session on Sunday, meaning they were deemed among the most noteworthy of the more than 5,000 studies being presented at the meeting.
“We haven’t seen survival benefits like that for any therapy in prostate cancer,” said Dr. Michael J. Morris, an associate professor at the Memorial Sloan-Kettering Cancer Center, who was not involved in the study but was selected to publicly comment on it at the annual meeting of the American Society of Clinical Oncology.
Another study being presented on Sunday found that drugs called aromatase inhibitors might be better than the standard drug tamoxifen in preventing a recurrence of disease in premenopausal women with early breast cancer.
Both studies are being featured in the plenary session on Sunday, meaning they were deemed among the most noteworthy of the more than 5,000 studies being presented at the meeting.
In a conference that typically celebrates the latest and greatest drug, all four studies chosen for the plenary session this year are about better ways of using older drugs, showing that there can be a lot to learn even after drugs get to market.
Dr. Nicholas J. Vogelzang, an author of the study on prostate cancer, said that the findings would change practice and that he had already started discussing this option with patients. The challenge, he said, is getting men to agree.
“Not many of them want to do chemotherapy, even though the numbers are convincing,” said Dr. Vogelzang, who works at the Comprehensive Cancer Centers of Nevada.
The study’s findings apply to a fairly narrow group of patients — men whose cancer has already spread beyond the prostate gland at the time of diagnosis, or whose cancer has come back after surgery or radiation treatment and still remains susceptible to hormone therapy.
Only a small fraction of men have metastatic prostate cancer at the time of the initial diagnosis because prostate cancer screening using a blood test typically detects the disease before it has spread.
But screening is expected to become less common because a government advisory committee, the United States Preventive Services Task Force, has recommended against routine screening, saying that more men are harmed by unnecessary treatments for prostate cancer than are saved from death by screening. That could lead to an increase in men whose initial diagnosis is metastatic cancer, Dr. Vogelzang said.
The study, sponsored by the National Cancer Institute, involved 790 men who received either only hormone therapy or hormone therapy in addition to at most six infusions of docetaxel spaced three weeks apart.
Those who received the chemotherapy lived a median of 57.6 months, compared with 44.0 months in the control group, a difference of 13.6 months. The difference in survival was even greater — 17 months — for the patients whose cancer had spread more extensively. Dr. Morris of Sloan-Kettering said those men were the best candidates for early chemotherapy.
Docetaxel is sold under the brand name Taxotere by Sanofi, but generic versions are also available. It was approved for metastatic prostate cancer in 2004. In the last few years, several other drugs have been approved, like Zytiga from Johnson & Johnson and Xtandi from Medivation and Astellas Pharma.
But docetaxel and the newer drugs are typically used after hormone therapy has stopped working. In that setting, each of them has extended median survival by about two to five months in clinical trials.
Dr. Matthew R. Cooperberg, associate professor of urology at the University of California, San Francisco, said doctors were starting to use the newer agents before docetaxel, pushing chemotherapy further back in the sequence.
So the new study “is, to an extent, bucking the tide,” he said. “This trial may be evidence that the role for chemo is earlier, when patients are healthier and the disease burden is relatively low.”
The results also raise the question of whether the other prostate cancer drugs would also provide a much greater survival advantage if used earlier. Some trials are underway to determine that.
One issue is that early treatment is often handled by urologists, not oncologists. And many urologists do not administer chemotherapy.
Dr. Morris said he did not think earlier use of docetaxel would diminish sales of the newer agents. Men will eventually become resistant to hormone therapy, he said, and will need the newer agents.
Dr. Nicholas J. Vogelzang, an author of the study on prostate cancer, said that the findings would change practice and that he had already started discussing this option with patients. The challenge, he said, is getting men to agree.
“Not many of them want to do chemotherapy, even though the numbers are convincing,” said Dr. Vogelzang, who works at the Comprehensive Cancer Centers of Nevada.
The study’s findings apply to a fairly narrow group of patients — men whose cancer has already spread beyond the prostate gland at the time of diagnosis, or whose cancer has come back after surgery or radiation treatment and still remains susceptible to hormone therapy.
Only a small fraction of men have metastatic prostate cancer at the time of the initial diagnosis because prostate cancer screening using a blood test typically detects the disease before it has spread.
But screening is expected to become less common because a government advisory committee, the United States Preventive Services Task Force, has recommended against routine screening, saying that more men are harmed by unnecessary treatments for prostate cancer than are saved from death by screening. That could lead to an increase in men whose initial diagnosis is metastatic cancer, Dr. Vogelzang said.
The study, sponsored by the National Cancer Institute, involved 790 men who received either only hormone therapy or hormone therapy in addition to at most six infusions of docetaxel spaced three weeks apart.
Those who received the chemotherapy lived a median of 57.6 months, compared with 44.0 months in the control group, a difference of 13.6 months. The difference in survival was even greater — 17 months — for the patients whose cancer had spread more extensively. Dr. Morris of Sloan-Kettering said those men were the best candidates for early chemotherapy.
Docetaxel is sold under the brand name Taxotere by Sanofi, but generic versions are also available. It was approved for metastatic prostate cancer in 2004. In the last few years, several other drugs have been approved, like Zytiga from Johnson & Johnson and Xtandi from Medivation and Astellas Pharma.
But docetaxel and the newer drugs are typically used after hormone therapy has stopped working. In that setting, each of them has extended median survival by about two to five months in clinical trials.
Dr. Matthew R. Cooperberg, associate professor of urology at the University of California, San Francisco, said doctors were starting to use the newer agents before docetaxel, pushing chemotherapy further back in the sequence.
So the new study “is, to an extent, bucking the tide,” he said. “This trial may be evidence that the role for chemo is earlier, when patients are healthier and the disease burden is relatively low.”
The results also raise the question of whether the other prostate cancer drugs would also provide a much greater survival advantage if used earlier. Some trials are underway to determine that.
One issue is that early treatment is often handled by urologists, not oncologists. And many urologists do not administer chemotherapy.
Dr. Morris said he did not think earlier use of docetaxel would diminish sales of the newer agents. Men will eventually become resistant to hormone therapy, he said, and will need the newer agents.
Read More:
Tuesday, January 29, 2013
A double arm transplant for U.S. Army vet
The army sergeant lost four limbs in a roadside bomb in Iraq in 2009. Now he is on the mend following a double arm transplant. .
DOUBLE ARM TRANSPLANT RECIPIENT BRENDAN MARROCCO SAYING: "I just want to get to the point that I can be completely on my own and get back to enjoy life."
Double-arm transplant surgery is rare. This was the first successful procedure of its kind to be conducted at Johns Hopkins, in Baltimore, Maryland. Marrocco is also the first U.S. soldier in the Iraq and Afghanistan wars to survive losing all four limbs.
DOUBLE ARM TRANSPLANT RECIPIENT BRENDAN MARROCCO SAYING: "You know I never really accepted the fact I didn't have arms so now that I have them again it's almost like it never happened. It's like I went back four years and I'm me again.
It's awesome." The rare surgery took 13 hours and involved 16 doctors who all volunteered.
Source:
A double arm transplant for U.S. Army vet | Video | Reuters.com
Saturday, October 6, 2012
Synthetic Marijuna Fact Sheet
1. What is Synthetic Marijuana? Synthetic Marijuana is a man made drug that is not marijuana.
It was invented to act like marijuana; however, it is more powerful and more dangerous than marijuana.
This fake marijuana, often called Spice, K2 or Legal Phunk, is sprayed on real plant products, like leaves, and sold as incense or potpourri. It is usually smoked,but can be eaten too.
When used, it can be very dangerous. Other names for this include Lava Red, Aroma, Dream, Mr. Nice Guy, and many more.
Beware of name changes as they are changed often as is the chemical make‐up.
2. Where is K2/Spice (synthetic marijuana) sold?
K2/Spice can be bought very easily on the internet. They can also be found in head shops, smoke shops,convenience stores and some gas stations.
Government officials are trying to make them illegal, but as of yet, they remain legal.
3. Why is K2/Spice (synthetic marijuana) sold if they are drugs and harmful?
K2/Spice are sold in a way that outsmarts state and local regulations by stating on the package that they are “not for human consumption.” Because of this, it is very difficult to regulate and track. It is cheap, easy to purchase, sold as fake (synthetic) marijuana that doesn’t show up on standard drug tests.
4. How does K2/Spice (synthetic marijuana) affect you?
People who use K2/Spice or any other synthetic marijuana experience:
Fast heart rate Convulsions (seizures)
Seeing things (hallucinations) Weakness
Dry mouth Passing out (coma)
Death has resulted in some cases!
5. What happens to the people who use K2/Spice (synthetic marijuana)?
When people use K2/Spice (synthetic marijuana), they can have heart attacks, brain damage, kidney failure and scary hallucinations (seeing things) that last for many days.
6. Who uses K2/Spice (synthetic marijuana)?
K2/Spice (synthetic marijuana) are used by all people, regardless of age, gender, or status.
Bottom Line: K2/Spice (synthetic marijuana)
A. It is very easy to get.
B. It is very dangerous and can lead to heart attacks, brain damage, kidney failure and scary images/hallucinations.
For More Information
www.upstatepoison.org
synthetic_marijuna_fact_sheet_public.pdf (application/pdf Object)
Link: http://www.upstate.edu/poison/pdf/news_releases/synthetic_marijuna_fact_sheet_public.pdf
....................................................................................
P.S. This information is posted here because medical marijuana is sometimes used to alleviate the symptoms of multiple sclerosis, cancer and 'aids'. This is a warning to not cut corners and to not use anything but the Real McCoy when it comes to treating your m.s. symptoms.Marijuana has gained the status of alternative medicine... .
synthetic_marijuna_fact_sheet_public.pdf (application/pdf Object)
Friday, October 5, 2012
Robotic device helps WakeMed patients walk - Health/Science - NewsObserver.com
Patient wears a robotic exoskeleton to help him walk at WakeMed Rehab in Raleigh on Thursday, September 27, 2012. WakeMed is one of sixteen sites across the country that are starting to use the robotic exoskeleton, designed by Ekso Bionics, to help patients learn or re-learn to walk.
For now, the Ekso is an aid for physical therapy clinics with the help of therapists trained in its use, but the company is working on a sleeker, cheaper model for home use, which it hopes to begin selling in two years.
WakeMed began using the device this week. Initially the hospital is using it on patients with spinal cord injuries who can’t walk on their own, but it plans to eventually use it on other kinds of cases, such as stroke patients.http://www.newsobserver.com/2012/09/27/2373685/wakemed-gets-wearable-robot.html
Elsewhere, the device is already used for patients with other health problems, including multiple sclerosis, amyotrophic lateral sclerosis (Lou Gehrig’s Disease) and traumatic brain injuries.
For patients who spend significant amounts of time in wheelchairs, being able to spend at least a little time in the device regularly is likely to offer improvements in a host of functions, such as circulation, respiration and digestion, said Cathy Smith, director of outpatient rehabilitation at WakeMed.
It may help those with partial spinal cord injuries regain some function more easily.
Harder to quantify are intangible benefits, such as what it means for someone who has been in a wheelchair for decades to simply to be able to stand, walk around and look people in the eye again.
The Ekso looks like a kind of mechanized, computerized combination of a backpack and leg braces. Patients wear it with straps below the knees, on the thighs, around the stomach and over the shoulders. Plates under each foot are attached to motors and lift up. More than two dozen sensors feed information into the Ekso’s computer, which uses it to decide how and when to step.
Patients must have at least some upper body strength to use Ekso because they must use a walker or crutches when wearing the device to ensure their balance. For the current model, they also must be lighter than 220 pounds and between 5 feet 2 inches and 6 feet 2 inches in height.
The device has three modes. In the most advanced, fully automatic mode, the device takes a step when the patient shifts his weight to the side and leans forward.
They have to work up to that, though. In the most basic mode, therapists talk the patient through the proper motions, and one of them uses a hand-held remote control to trigger each step. In an intermediate mode, the patient triggers each step via a button on one crutch.
The learning curve
Ayscue was still in the first mode Thursday, and all the patients using it will be for a while as they and the WakeMed therapists learn how to use it.
Eventually he will transition to trigger his own steps with buttons on one crutch.
The batteries last about three hours, but can be quickly swapped out for fresh ones.
The Ekso is designed to carry its entire weight, about 45 pounds, but the patient’s weight goes through the patient’s own legs, something the company believes will help fight the loss of bone density, a common problem for those who spend significant time in wheelchairs.
About 350 patients nationwide have used the device so far, said Bender, the company CEO. So far, there have been no falls. But using it in a controlled environment with trained experts just inches away is much different from using it at home.
A home model will be more elaborate in its function, but lighter, slimmer, and have a look that’s more low-key, he said.
“We have to design a system that’s comfortable enough and appealing enough that’s it’s something you would be proud to wear,” he said. “There could be more than one model, and eventually it could become like when we choose our pants in the morning, the jeans of the future.”
That first “personal unit” also will need to have fall-prevention features. Also, cost and who pays are key issues. The current model costs $140,000, with a $10,000 annual service contract, Bender said.
The company is trying to reduce the cost and working with several rehab hospitals on research into the health benefits of getting people back on their feet and walking each day. If the various health benefits can be quantified, he said, the device could become a reasonable thing for insurance companies to cover.
The long-term potential that the Ekso suggests is limited by little more than the speed of improvements and imagination, Bender said.
“Maybe devices could help arthritis suffers with their mobility, or help people like you and me do something outrageous like climb Mount Kilimanjaro,” he said.
The potential market is huge, with nearly 70 million people worldwide who need wheelchairs, many in a position to benefit from assisted walking.
The company has a couple of competitors, Bender said, but it expects more. “It’s just too obvious,” he said. “Just look at all the unbelievable developments we have seen for amputees.
“Now it’s time for people with neurological problems – their time is now and this is just the beginning.”
As Ayscue was being strapped into the Ekso he quipped that he felt like astronaut John Glenn. And WakeMed’s CEO, Bill Atkinson, who had joined a small crowd of other hospital employees marveled at what he was seeing.
“A lifetime of changes in health care and rarely does it walk right in front of you,” Atkinson said. “For these patients, this is like the first steps on the moon.”
After a few dozen steps, the motors overheated and Ayscue had to pause and sit until they cooled.
Company technicians said the problem was that Ayscue still has limited muscle function and his own muscles were fighting the machine, which has been programmed to take relatively slow, short steps until he’s adept enough to go faster.
New software is on the way that will allow them to dial down the assist from the robot so it can more easily accommodate patients with at least limited function. For now, he needs to dial down himself. If he can.
“The motion just feels so natural, I guess in my mind I think I can walk just like I used to,” he said. “That’s the deal with the machine. I need to get used to it so that we can work together.”
Source link: http://www.newsobserver.com/2012/09/27/2373685/wakemed-gets-wearable-robot.html
Robotic device helps WakeMed patients walk - Health/Science - NewsObserver.com
Wednesday, February 29, 2012
Knee Replacement May Be a Lifesaver for Some - NYTimes.com
Knee Replacement May Be a Lifesaver for Some - NYTimes.com
Stuart Bradford
Stuart BradfordBy the time 64-year-old Laura Milson decided to undergo total knee replacement after 12 years of suffering from arthritis, even a short walk to the office printer was a struggle.
After her surgery last August at the Rothman Institute at Thomas Jefferson University in Philadelphia, Ms. Milson spent a week in rehabilitation and says she hasn’t stopped walking since. “My son says to me, ‘You have to slow down,’ and I say, ‘No, I have to catch up!,’ ” she said. “It’s a whole different life.”
For Ms. Milson, who lives in Shrewsbury, Pa., replacing the joint in her right knee came with a surprising bonus: a 20-pound weight loss in two months. “I joked with my doctor, ‘I think you put a diet chip in my knee,’ ” she said. “The weight just sort of came off.”
Now she has joined Weight Watchers to drop a few extra pounds and is training for a three-day breast cancer walk in October.
For years surgeons have boasted of the pain relief and improved quality of life that often follow knee replacement. But now new research suggests that for some patients, knee replacement surgery can actually save their lives.
In a sweeping study of Medicare records, researchers from Philadelphia and Menlo Park, Calif., examined the effects of joint replacement among nearly 135,000 patients with new diagnoses of osteoarthritis of the knee from 1997 to 2009. About 54,000 opted for knee replacement; 81,000 did not.
Three years after diagnosis, the knee replacement patients had an 11 percent lower risk of heart failure. And after seven years, their risk of dying for any reason was 50 percent lower.
The study, presented this month at the annual meeting of the American Academy of Orthopedic Surgeons, was financed with a grant from a knee replacement manufacturer. It was not randomized, so it may be that these patients were healthier and more active to start with.
Still, the researchers did try to control for differences in age and overall health. And the findings are consistent with large studies of knee replacement and mortality in Scandinavia. Given the big numbers in the study and the size of the effect, the data strongly suggest that knee replacement may lead to improvements in health and longevity.
The theory behind knee replacement, said the study’s lead author, Scott Lovald, senior associate at Exponent, a scientific consulting firm in Menlo Park, is that it improves quality of life. “At the end of the day, we’re trying to figure out if quantity of life increases as well,” he added, noting that the team was conducting a similar review of Medicare data on the long-term benefits of hip replacement surgery.
The founder of the Rothman Institute, Dr. Richard H. Rothman, who has performed 25,000 joint replacement surgeries in his career, urged caution in interpreting data that are not randomized and controlled. Not every patient with knee arthritis is a candidate for joint replacement surgery, he said.
“People can tolerate a lot of knee disability for reasons we don’t totally understand,” he went on, adding, “If the pain is acceptable, you live with it; if it’s not acceptable, we’ll operate on you.”
Dr. Rothman said that whether patients experience better health after surgery depends on motivation — how motivated they were to stay fit before surgery and how motivated they are now to become more active.
“For the motivated patient, it allows them to walk through that portal and become better conditioned and lose weight,” he said. “It’s not a weight-reduction program. It’s a potential avenue to improve your level of fitness, weight, cardiovascular health and mental health.”
Edward Moore, a 94-year-old retired chemist in Woodbury, N.J., underwent knee replacement three years ago after pain began limiting his activity. Given his age, his own daughter had worried that the recovery would be too difficult. But Dr. Rothman agreed he was healthy enough for the procedure.
“I didn’t do much mulling about it,” Mr. Moore said. “It just seemed like the knee would be hampering me for the rest of my life, and that sounded like a bad idea.”
Mr. Moore said he had an uneventful recovery, and in September, two days after his 94th birthday, he took his wind surfer to Lakes Bay near Atlantic City. “I got up on the board, and I sailed,” he said.
William Mills, 63, of Philadelphia, had been suffering for about four years with severe pain in both knees when he opted for double knee replacement in 2006. He said his activity had dropped off, and while he could still play golf, he could no longer walk the course. Even going to a restaurant had become a burden if he couldn’t find a parking space nearby.
“I think one of the things people don’t understand about knees is how bad it is,” said Mr. Mills, a bank executive. “It changes everything. I couldn’t walk two city blocks. It was just slowly but surely changing my life where I was unable to really enjoy things.”
But while the rehabilitation of both knees was “the hardest thing I’ve ever done in my life,” he has no regrets. Six months after surgery he took part in a 250-mile bike ride in Germany. He has made a few compromises — he no longer skis, and plays doubles tennis instead of singles — but he says he now rarely thinks about his knees.
“Before surgery, I felt like I was 10 or 15 years older than I was,” he said. “Now I probably feel like I’m 10 or 15 years younger than I am.
“I can understand why people might live longer, because you want to. You really feel good again.”
Saturday, February 11, 2012
Walk More
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