Knee pain

Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis, gout and infections — also can cause knee pain.

Many types of minor knee pain respond well to self-care measures. Physical therapy and knee braces also can help relieve knee pain. In some cases, however, your knee may require surgical repair.

The location and severity of knee pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany knee pain include:

·         Swelling and stiffness

·         Redness and warmth to the touch

·         Weakness or instability

·         Popping or crunching noises

·         "Locking," or inability to fully straighten the knee

When to see a doctor
Call your doctor if you:

·         Can't bear weight on your knee

·         Have marked knee swelling

·         Are unable to fully extend or flex your knee

·         See an obvious deformity in your leg or knee

·         Have a fever, in addition to redness, pain and swelling in your knee

·         Fall because your knee "gives out"

Causes

Knee pain can be caused by injuries, mechanical problems, types of arthritis and other problems.

Injuries
A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself. Some of the more common knee injuries include:

·         ACL injury. An ACL injury is the tearing of the anterior cruciate ligament (ACL) — one of four ligaments that connect your shinbone to your thighbone. An ACL injury is particularly common in people who play basketball or go downhill skiing, because it's linked to sudden changes in direction.

·         Torn meniscus. The meniscus is formed of tough, rubbery cartilage and acts as a shock absorber between your shinbone and thighbone. It can be torn if you suddenly twist your knee while bearing weight on it.

·         Knee bursitis. Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint.

·         Patellar tendinitis. Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous cords that attach muscles to bones. Runners, skiers and cyclists are prone to develop inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the shinbone.

Mechanical problems

·         Loose body. Sometimes injury or degeneration of bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This may not create any problems unless the loose body interferes with knee joint movement — the effect is something like a pencil caught in a door hinge.

·         Knee 'locking.' This can occur from a cartilage tear. When a portion of cartilage from the tear flips inside the knee joint, you may not be able to fully straighten your knee.

·         Dislocated kneecap. This occurs when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee. You'll be able to see the dislocation, and your kneecap is likely to move excessively from side to side.

·         Hip or foot pain. If you have hip or foot pain, you may change the way you walk to spare these painful joints. But this altered gait can interfere with the alignment of your kneecap and place more stress on your knee joint. In some cases, problems in the hip or foot can refer pain to the knee.

Types of arthritis

·         Osteoarthritis. Sometimes called degenerative arthritis, osteoarthritis is the most common type of arthritis. It's a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age.

·         Rheumatoid arthritis. The most debilitating form of arthritis, rheumatoid arthritis is an autoimmune condition that can affect almost any joint in your body, including your knees. Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go.

·         Gout. This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.

·         Pseudogout. Often mistaken for gout, pseudogout is caused by calcium pyrophosphate crystals that develop in the joint fluid. Knees are the most common joint affected by pseudogout.

·         Septic arthritis. Sometimes your knee joint can become infected, leading to swelling, pain and redness. There's usually no trauma before the onset of pain. Septic arthritis often occurs with a fever.

Other problems

·         Iliotibial band syndrome. This occurs when the ligament that extends from the outside of your pelvic bone to the outside of your tibia (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners are especially susceptible to iliotibial band syndrome.

·         Chondromalacia patellae (patellofemoral pain syndrome). This is a general term that refers to pain arising between your patella and the underlying thighbone (femur). It's common in young adults, especially those who have a slight misalignment of the kneecap; in athletes; and in older adults, who usually develop the condition as a result of arthritis of the kneecap.

·         Osgood-Schlatter disease. This condition affects the softer area of bone near the top of the shinbone, where bone growth occurs. It's most common in boys who play games or sports that involve running or jumping. The discomfort can last a few months and may continue to recur until the child's bones stop growing.

·         Osteochondritis dissecans. Caused by reduced blood flow to the end of a bone, osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of a bone. It occurs most often in young men, particularly after an injury to the knee.

Risk Factors

A number of factors can increase your risk of having knee problems, including:

·         Age. Certain types of knee problems are more common in young people — Osgood-Schlatter disease and patellar tendinitis, for example. Others, such as osteoarthritis, gout and pseudogout, tend to affect older adults.

·         Sex. Teenage girls are more likely than are boys to experience an ACL tear or a dislocated kneecap. Boys, on the other hand, are at greater risk of Osgood-Schlatter disease and patellar tendinitis than girls are.

·         Excess weight. Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.

·         Mechanical problems. Certain structural abnormalities, such as having one leg shorter than the other, misaligned knees and even flat feet, can make you more prone to knee problems.

·         Lack of muscle flexibility or strength. A lack of strength and flexibility are among the leading causes of knee injuries. Tight or weak muscles offer less support for your knee because they don't absorb enough of the stress exerted on the joint.

·         Certain sports. Some sports put greater stress on your knees than do others. Alpine skiing with its sharp twists and turns and potential for falls, basketball's jumps and pivots, and the repeated pounding your knees take when you run or jog all increase your risk of knee injury.

·         Previous injury. Having a previous knee injury makes it more likely that you'll injure your knee again.

Complication

Not all knee pain is serious. But some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage and even disability if left untreated. And having a knee injury — even a minor one — makes it more likely that you'll have similar injuries in the future.

Effective Living Clinic

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Navi Mumbai 400703

Tel: 9987223811 / 9969105310

www.effectivelivingclinic.com

Get along with colleagues, live longer

People who have a good peer support system at work may live longer than those who don't.

This effect of peer social support was most pronounced amongst those aged between 38 and 43 years. Yet, similar support from workers' supervisors had no effect on mortality, the researchers found.

Besides, men who felt like they had control and authority to make decisions at work also experienced this "protective effect", according to the study reported in the journal Health Psychology.

Researchers rated peer social support as high if participants reported that their co-workers were helpful in solving problems and that they were friendly.

Researchers at Tel Aviv University looked at the medical records of 820 adults who were followed for 20 years -- from 1988 to 2008.

These workers came from some of Israel's largest firms in finance, insurance, public utilities, health care and manufacturing, according to a Tel Aviv statement.

They reported working on average 8.8 hours a day. One-third of them were women; 80 per cent were married with children; and 45 per cent had at least 12 years of formal education.

Asked why workplace control was positive for men but not women, lead researcher Arie Shirom said that for employees in blue-collar type of jobs, high levels of control were found in jobs typically held by men, rather than jobs typically held by women.

Meningitis - What I must know

Mayo Clinic  - Rejuvenate

Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord, usually due to the spread of an infection. The swelling associated with meningitis often triggers the "hallmark" signs and symptoms of this condition, including headache, fever and a stiff neck in anyone over the age of 2.  

Most cases of meningitis are caused by a viral infection, but bacterial and fungal infections also can lead to meningitis. Depending on the cause of the infection, meningitis can resolve on its own in a couple of weeks — or it can be a life-threatening emergency.

If you suspect that you or someone in your family has meningitis, seek medical care right away. Early treatment can prevent serious complications.

Symptoms

It's easy to mistake the early signs and symptoms of meningitis for the flu (influenza). Meningitis signs and symptoms may develop over several hours or over one or two days and, in anyone over the age of 2, typically include:

·         High fever

·         Severe headache that isn't easily confused with other types of headache

·         Stiff neck

·         Vomiting or nausea with headache

·         Confusion or difficulty concentrating — in the very young, this may appear as inability to maintain eye contact

·         Seizures

·         Sleepiness or difficulty waking up

·         Sensitivity to light

·         Lack of interest in drinking and eating

·         Skin rash in some cases, such as in viral or meningococcal meningitis

Signs in newborns
Newborns and infants may not have the classic signs and symptoms of headache and stiff neck. Instead, signs of meningitis in this age group may include:

·         High fever

·         Constant crying

·         Excessive sleepiness or irritability

·         Inactivity or sluggishness

·         Poor feeding

·         A bulge in the soft spot on top of a baby's head (fontanel)

·         Stiffness in a baby's body and neck

·         Seizures

Infants with meningitis may be difficult to comfort, and may even cry harder when picked up.

When to see a doctor
Seek medical care right away if you or someone in your family has signs or symptoms of meningitis, such as:

·         Fever

·         Severe, unrelenting headache

·         Confusion

·         Vomiting

·         Stiff neck

There's no way to know what kind of meningitis you or your child has without seeing your doctor and undergoing spinal fluid testing.

·         Viral meningitis may improve without treatment in a few days.

·         Bacterial meningitis is serious, can come on very quickly and requires prompt antibiotic treatment to improve the chances of a recovery without serious complications. Delaying treatment for bacterial meningitis increases the risk of permanent brain damage or death. In addition, bacterial meningitis can prove fatal in a matter of days.

Also talk to your doctor if a family member or someone you work with has meningitis. You may need to take medications to prevent getting sick.

Causes

Meningitis usually results from a viral infection, but the cause may also be a bacterial infection. Less commonly, a fungal infection may cause meningitis. Because bacterial infections are the most serious and can be life-threatening, identifying the source of the infection is an important part of developing a treatment plan.

Bacterial meningitis
Acute bacterial meningitis usually occurs when bacteria enter the bloodstream and migrate to the brain and spinal cord. But it can also occur when bacteria directly invade the meninges, as a result of an ear or sinus infection or a skull fracture.

A number of strains of bacteria can cause acute bacterial meningitis. The most common include:

·         Streptococcus pneumoniae (pneumococcus). This bacterium is the most common cause of bacterial meningitis in infants, young children and adults in the United States. It more commonly causes pneumonia or ear or sinus infections.

·         Neisseria meningitidis (meningococcus). This bacterium is another leading cause of bacterial meningitis. Meningococcal meningitis commonly occurs when bacteria from an upper respiratory infection enter your bloodstream. This infection is highly contagious. It affects mainly teenagers and young adults, and may cause local epidemics in college dormitories, boarding schools and military bases.

·         Haemophilus influenzae (haemophilus). Before the 1990s, Haemophilus influenzae type b (Hib) bacterium was the leading cause of bacterial meningitis in children. But new Hib vaccines — available as part of the routine childhood immunization schedule in the United States — have greatly reduced the number of cases of this type of meningitis. When it occurs, it tends to follow an upper respiratory infection, ear infection (otitis media) or sinusitis.

·         Listeria monocytogenes (listeria). These bacteria can be found almost anywhere — in soil, in dust and in foods that have become contaminated. Contaminated foods have included soft cheeses, hot dogs and luncheon meats. Many wild and domestic animals also carry the bacteria. Fortunately, most healthy people exposed to listeria don't become ill, although pregnant women, newborns and older adults tend to be more susceptible. Listeria can cross the placental barrier, and infections in late pregnancy may cause a baby to be stillborn or die shortly after birth. People with weakened immune systems, due to disease or medication effect, are most vulnerable.

Viral meningitis
Each year, viruses cause a greater number of cases of meningitis than do bacteria. Viral meningitis is usually mild and often clears on its own within two weeks. A group of viruses known as enteroviruses are responsible for about 30 percent of viral meningitis cases in the United States. As many viral meningitis episodes never have a specific virus identified as the cause.

The most common signs and symptoms of enteroviral infections are rash, sore throat, diarrhea, joint aches and headache. These viruses tend to circulate in late summer and early fall. Viruses such as herpes simplex virus, La Crosse virus, West Nile virus and others also can cause viral meningitis.

Chronic meningitis
Chronic forms of meningitis occur when slow-growing organisms invade the membranes and fluid surrounding your brain. Although acute meningitis strikes suddenly, chronic meningitis develops over two weeks or more. Nevertheless, the signs and symptoms of chronic meningitis — headaches, fever, vomiting and mental cloudiness — are similar to those of acute meningitis. This type of meningitis is rare.

Fungal meningitis
Fungal meningitis is relatively uncommon and causes chronic meningitis. Occasionally it can mimic acute bacterial meningitis. Cryptococcal meningitis is a common fungal form of the disease that affects people with immune deficiencies, such as AIDS. It's life-threatening if not treated with an antifungal medication.

Other meningitis causes
Meningitis can also result from noninfectious causes, such as drug allergies, some types of cancer and inflammatory diseases such as lupus.

Risk factors

Not completing the childhood vaccine schedule increases your risk of meningitis. So do a few other risk factors:

·         Age. Most cases of viral meningitis occur in children younger than age 5. In the past, bacterial meningitis also usually affected young children. But since the mid-1980s, as a result of the protection offered by current childhood vaccines, the median age at which bacterial meningitis is diagnosed has shifted from 15 months to 25 years.

·         Living in a community setting. College students living in dormitories, personnel on military bases, and children in boarding schools and child care facilities are at increased risk of meningococcal meningitis, probably because the bacterium is spread by the respiratory route and tends to spread quickly wherever large groups of susceptible teenagers or young adults congregate.

·         Pregnancy. If you're pregnant, you're at increased of contracting listeriosis — an infection caused by listeria bacteria, which may also cause meningitis. If you have listeriosis, your unborn baby is at risk, too.

·         Working with animals. People who work with domestic animals, including dairy farmers and ranchers, have a higher risk of contracting listeria, which can lead to meningitis.

·         Compromised immune system. Factors that may compromise your immune system — including AIDS, diabetes and use of immunosuppressant drugs — also make you more susceptible to meningitis. Removal of your spleen, an important part of your immune system, also may increase your risk.

Complications

The complications of meningitis can be severe. The longer you or your child has the disease without treatment, the greater the risk of seizures and permanent neurological damage, including:

·         Hearing loss

·         Blindness

·         Memory difficulty

·         Loss of speech

·         Learning disabilities

·         Behavior problems

·         Brain damage

·         Paralysis

Other complications may include:

·         Kidney failure

·         Adrenal gland failure

·         Shock

·         Death

Tests and diagnosis

Your family doctor or pediatrician can diagnose meningitis based on a medical history, a physical exam and certain diagnostic tests. During the exam, your doctor may check for signs of infection around the head, ears, throat and the skin along the spine. You or your child may undergo the following diagnostic tests:

·         Blood cultures. Blood drawn from a vein is sent to a laboratory and placed in a special dish to see if it grows microorganisms, particularly bacteria. A sample may also be placed on a slide to which stains are added (Gram's stain), then examined under a microscope for bacteria.

·         Imaging. X-rays and computerized tomography (CT) scans of the head, chest or sinuses may reveal swelling or inflammation. These tests can also help your doctor look for infection in other areas of the body that may be associated with meningitis.

·         Spinal tap (lumbar puncture). The definitive diagnosis of meningitis is often made by analyzing a sample of your cerebrospinal fluid (CSF), which is collected during a procedure known as a spinal tap. In people with meningitis, the CSF fluid often shows a low sugar (glucose) level along with an increased white blood cell count and increased protein. CSF analysis may also help your doctor identify the exact bacterium that's causing the illness. It can take up to a week to get these test results, If your doctor suspects meningitis, he or she may order a DNA-based test known as a polymerase chain reaction (PCR) amplification to check for the presence of viral causes of meningitis. This may provide results about your meningitis in as little as four hours and help to determine proper treatment.

If you have chronic meningitis caused by cancer or an inflammatory illness, you may need additional tests.

Treatments and drugs

The treatment depends on the type of meningitis you or your child has.

Bacterial meningitis
Acute bacterial meningitis requires prompt treatment with intravenous antibiotics and, more recently, cortisonelike medications, to ensure recovery and reduce the risk of complications. The antibiotic or combination of antibiotics that your doctor may choose depends on the type of bacteria causing the infection. Your doctor may recommend a broad-spectrum antibiotic until he or she can determine the exact cause of the meningitis.

If you or your child has bacterial meningitis, your doctor may also recommend treatments for:

·         Brain swelling

·         Shock

·         Convulsions

·         Dehydration

Infected sinuses or mastoids — the bones behind the outer ear that connect to the middle ear — may need to be drained. Infected fluid that has accumulated between the skull and the membranes that surround the brain also may need to be drained surgically.

Viral meningitis
Antibiotics can't cure viral meningitis, and most cases improve on their own in a week or two without therapy. Treatment of mild cases of viral meningitis usually includes:

·         Bed rest

·         Plenty of fluids

·         Over-the-counter pain medications to help reduce fever and relieve body aches

If the cause of your meningitis is a herpes virus, there's an antiviral medication available.

Other types of meningitis
If the cause of your meningitis is unclear, your doctor may start antiviral and antibiotic treatment while a cause is being determined.

Fungal meningitis treatments are associated with harmful side effects, so treatment is often deferred until a laboratory can confirm the cause is fungal.

Non-infectious meningitis due to allergic reaction or autoimmune disease may be treated with cortisonelike medications. In some cases, no treatment may be required, because the condition can resolve on its own. Cancer related meningitis requires therapy for the individual cancer.

Prevention

Meningitis typically results from contagious infections. Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette. You're also at increased risk if you live or work with someone who has the disease.

These steps can help prevent meningitis:

·         Wash your hands. Careful hand washing is important to avoiding exposure to infectious agents. Teach your children to wash their hands often, especially before they eat and after using the toilet, spending time in a crowded public place or petting animals. Show them how to wash their hands vigorously, covering both the front and back of each hand with soap and rinsing thoroughly under running water.

·         Stay healthy. Maintain your immune system by getting enough rest, exercising regularly, and eating a healthy diet with plenty of fresh fruits, vegetables and whole grains.

·         Cover your mouth. When you need to cough or sneeze, be sure to cover your mouth and nose.

·         If you're pregnant, take care with food. Reduce your risk of listeriosis if you're pregnant by cooking meat thoroughly and avoiding cheeses made from unpasteurized milk.

Immunizations
Some forms of bacterial meningitis are preventable with the following vaccinations:

·         Haemophilus influenzae type b (Hib) vaccine. Children in the United States routinely receive this vaccine as part of the recommended schedule of vaccines, starting at about 2 months of age. The vaccine is also recommended for some adults, including those who have sickle cell disease or AIDS and those who don't have a spleen.

·         Pneumococcal conjugate vaccine (PCV7). This vaccine is also part of the regular immunization schedule for children younger than 2 years in the United States. In addition, it's recommended for children between the ages of 2 and 5 who are at high risk of pneumococcal disease, including children who have chronic heart or lung disease or cancer.

·         Pneumococcal polysaccharide vaccine (PPSV). Older children and adults who need protection from pneumococcal bacteria may receive this vaccine. The Centers for Disease Control and Prevention recommends the PPSV vaccine for all adults older than 65, for younger adults and children who have weak immune systems or chronic illnesses such as heart disease, diabetes or sickle cell anemia, and for those who don't have a spleen.

·         Meningococcal conjugate vaccine (MCV4). The Centers for Disease Control and Prevention recommends that a single dose of MCV4 be given to children ages 11 to 12 or to any children ages 11 to 18 who haven't yet been vaccinated. However, this vaccine can be given to younger children who are at high risk of bacterial meningitis or who have been exposed to someone with the disease. It's approved for use in children as young as 9 months old. It's also used to vaccinate healthy people who have been exposed in outbreaks but have not been previously vaccinated.

Fancy body piercing? Get your hygiene right

Aparajit Sinha, 21, pierced his eyebrows in the first year of college to look cool. But within two days he had to take the studs out because of extreme infection and severe pain.

Body piercing has come a long way - from earlobes and the nose traditionally to eyebrows, belly button, lips and tongues now. But it needs care in the initial days to avoid infections.

Many youngsters impulsively head for piercing without taking note of their skin type, proper sterilisation and post-piercing care information.

"Lack of hygiene, lack of proper sterilisation of the area and the gun are the common reasons why pierced areas catch infection. Also, there are some people whose skin is very sensitive and when they clean the pierced area with antiseptic, they get irritant eczema," Sachin Dhawan, clinical and aesthetic dermatology at Artemis Health Institute in Gurgaon, told IANS.

Dhawan gets around 10 percent queries for piercing complications.

While piercing the earlobes and eyebrows result in common complications, nose or naval infections can be fatal. Nose infection could result in swelling and pain for a few days at the pierced site, says Mumbai-based cosmetic surgeon Meenakshi Agarwal.

Also, studs and rings can get caught in clothes, which can aggravate the problem.

"There are times when a stud gets caught in clothes and pulls the skin, leaving one in extreme pain. So this unexpected rubbing too can lead to further complications," said Mumbai-based dermatologist Ashwini Padmawar.

Experts also suggest that one should avoid going to any random piercing shop and opt for experienced hands to avoid infections.

"A lot of ENT surgeons and plastic surgeons also do piercing, it is safer to get it done from them, as they understand the body system better," said Agarwal.

Sixteen-year-old Anamika Kalsi, who got her belly pierced without informing her parents and chose a cheaper place for piercing, realised this later.

She covered her stomach all the time and didn't take precautions to clean up the spot. End result - major infection and ultimately she had to pop antibiotics to control inflammation.

This often happens because body piercing at a local shop or a jewellery shop is cheap - it could be done within Rs.500, but at such places people are not hygiene-conscious. On the other hand, a medical expert's charges start from Rs.2,000 onwards, but he or she takes all the precautions. In case there is any complication, they are capable of taking care of the problem before it goes out of hand.

So, it is advisable that one should go to experts and in case it doesn't fit into your budget, just make sure the gun or the hands used for piercing are clean, as simple hygiene steps can keep an infection at bay.

"One should put an antibiotic ointment and gently wash the area once a day for at least 15 days after the piercing to prevent infection," said Padmawar.

"If infections happen, they can be treated with antibiotic tablets and ointments for five-seven days. If allergies happen they need to be treated with anti-allergic and steroid antibiotic ointments," he added.