Category Archives: Medicine & Health 疗池

Sport Injuries on the Knee Joint

By Dr Tan Boon Cheong, MBBS (MU), MS Ortho (MU)

Irrespective of the participating level, namely recreation or professional.  Injury is a constant treat. Of all the sports injuries in our body parts, sports injuries around the knee is one of the most commonly seen in orthorpeadic practice.

Sports injuries on the knee joint can involve the ligaments, meniscus, joint cartilage, bone or the muscles. But in this short article, we will discuss injuries we commonly come across namely ligaments injuries and meniscus injuries. The ligaments that usually injure are anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). (ACL and PCL are more commonly involve). We have 2 meniscus in our knee and they act as stress absorber.

Knee ligamental injury is one of the most common sport injuries. It usually happen in contact sports such as football and hockey, although other types of sports may also give rise to this injury when one fall with the knee in an arkward position. During this injury, the patient may experience the knee buckling or jumping out of space or may hear an audible “pop” sound. This patient may or may not be able to stand up or walk or he/she may need an assistant to carry him/her. The knee will swell within hours and the pain intensity will increase.

Meniscus injury are produced most commonly by rotation when the flexed knee move towards an extended position, thus it can happen during landing from a jumping position such as in badminton, basketball or volleyball game. The symptoms depends on the severity, the location and the type of the tear. It can be presented with pain, swelling and lock knee (bucket handle tear).

The initial management for knee injuries is RICE which is pneumonic for rest, ice compression and elevation. Immobilization of the affected knee may be necessary as part of pain management and also provide support to the knee. One should consult an orthopaedic surgeon for further evaluation on the extent of the injuries. A simple knee x-ray can be perform to look for any bony fracture or ligamental avulsion fracture but x-ray can not be used to visualize soft tissue such as ligaments, meniscus and cartilarge. Thus an MRI of the knee is needed as part of diagnosing ligamental and meniscus injuries. Once the diagnosis has been established, then a decision of conservative or surgical management can be made.

Irrespective of the mode of management, physiotherapist play a huge part in the management of sports injuries on the knee. During the acute phase of injury, physiotherapy helps to reduce pain and swelling. At the same time to maintain the range of motion and minimize muscle wasting and maintain muscle tone. After the acute phase, physiotherapy will help in rehabilitation of the affected knee to its pre-injury condition. For patient who undergo surgery, post surgery physiotherapy is a must for the knee to go back to its pre-injury functional or performance level.

Surgical Management

Torn ligament can’t heal by itself neither it can be suture end to end. Thus, it needs to be reconstructed. Ligament reconstruction surgery in this modern day is done arthroscopically (key hole surgery) rather than open surgery except LCL which lie outside the joint capsule. Thus the recovery period is shorter. Arthroscopy reconstruction using hamstring tendon, allograft or patella tendon is commonly perform for ACL and PCL tear.

Not all meniscus tear need to undergo surgery and not all meniscus tear which undergo surgery can be repaired. Depending on the severity, location and type of tear. The management can be varied. Stable tear with minimal symptoms, physiotherapy will do a good job with the patient will be able to return to normal activities. Not all patient who undergo meniscus surgery can have their meniscus repair as  some of the tear is irreparable thus the tear part which is not stable will be trimmed away (meniscectomy).

Having mentioned all the above, not all sports injuries will end up with ligaments or meniscus tear. Most of the time, the injuries are minor such as muscle sprain, bursitis, small tear on the muscle and etc which may be settled by good physiotherapy.

­HOW DO YOU KNOW YOU HAVE PARASITE ?

by Dr Mecherl Lim MD (MA) Naturopath (ND), Holistic Kinesiology

 

 10 MESSAGES FOR YOU TO MONITOR YOURSELF

• If you grinde your teeth in your sleep.

• If you have pain or ache  in your muscles or joints.

• If you have been diagnosed with iron deficiency anemia.

• If you have trouble falling asleep or you wake up multiple times during the night.

• If you have unexplained constipation, diarrhea, gas, bloatedness, or other symptoms of IBS.

• If you get skin irritations or unexplained rashes, hives, rosacea or eczema.

• If you experience fatigue, exhaustion, depression, or frequent feelings of Apathy.

• If you never feel satisfied or full after your meals.

• If you travelled internationally and remember getting travelers diarrhea while abroad.

• If you have a history of food poisoning and your digestion has not been the same since.

HOW TO TEST FOR PARASITES?

Most Allopathic doctors will run a conventional stool test if they suspect a parasite, however these are not as accurate as the comprehensive stool test that we use in our Functional Medicine.

CONVENTIONAL OVA & PARASITE STOOL TEST

Conventional stool tests can identify parasites or parasite eggs in your stool, yet this test comes with many limitations. The problem with this test is that it is only conditionally successful. This test require three separate stool samples that must be sent to the lab for a pathologist to view under a microscope.  Parasites have a very unique life cycle that allows them to rotate between dormant and alive.

In order to identify them in this conventional test, the stool sample must contain a live parasite and the parasite must remain alive as the sample is being shipped to the lab. The pathologist must be able to see live parasite swimming across the slide. While this can certainly be a useful test, for some people, they are unable to identify dormant parasites, and of false negatives with this type of stool test.

FUNCTIONAL MEDICINE COMPREHENSIVE STOOL TEST

In my practice, I use a comprehensive stool test on all my patients. The comprehensive test is much sensitive than the conventional test stool test because it uses POLYMERASE CHAIN REACTION (PCR) Technology to amplify the DNA of the parasite if there is one. This means that the parasite can actually be dead or in its dormant phase and it will be detected on this test.  As this test utilises PCR technology, it is not reliant on a pathologist seeing a live parasite swimming on the slide.  I frequently diagnose parasite in my patients that we missed on conventional stool test.

HOW TO TREAT PARASITES?

The Comprehensive Stool Test is able to identify its different parasites, so when I know which parasites my patient has.  I use prescription medications that target specific species of parasites. If, however, the parasite cannot be identified, I usually use a blend of Herbs from Dr Mecherl Herbs formula which consists of extracts of many herbs combinations such as black walnut, cloves, sweet wormwood, tribulus etc.  These herbal formulas provide a broad spectrum of activity against the most common pathogens present in the human GI tract, while sparing the beneficial gut bacteria.  Before starting an anti-parasite herbal supplement, I recommend you to consult your physician and have a liver enzyme checked if you have a history of liver disease , heavy alcohol use or previous history of elevated liver enzymes, If you think you might have a parasite, I encourage you to find a Functional Medicine physician.

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MY MOTTO is IT ALL STARTS IN YOU GUT & YOUR GUT IS THE GATEWAY TO HEALTH. A HEALTHY GUT MAKES A HEALTHY PERSON.

Next ISSUE : Have you got the GUTS to be REALLY healthy?

Visit http://www.drmecherlherbs.com or Facebook: drmecherherbs for further enquiries.

Out of Reach

by Dr Benjamin Cheah Tien Eang, Consultant Physician & Rheumatologist

The saga involving Martin Skreli unearthed some dark truths about the pharmaceutical industry. Skreli, as the then CEO of Turing Pharmaceuticals, increased the price of an existing antiparasitic medication by 5,556% and there was nothing anybody could do about it but only to hate him.

However, it did expose the lack of drug pricing regulations in the pharmaceutical industry. Till today, no one has any idea how drug prices are decided upon. Justifications for pricing a medication more steeply ranges from the high cost of research to manufacturing. Hence, many newer treatments are placed out of reach for the average Joe without an insurance plan.

Science and technology has allowed us to now develop targeted treatments for many diseases. Picking off a sole target responsible for the causation of disease, can not only provide superior results versus conventional treatments, but with less side effects. Unfortunately many of these ‘smarter’ drugs are expensive and hence unavailable in many parts of the world.

For developing countries, the average household income is hardly sufficient to survive the rising cost of living. The price of some medications can be more than the monthly income of most households. Pricing based on the gross domestic product (GDP) or the gross national income (GNI) of a country is hardly a consolation as it is not reflective of the average disposable income of a family. Governments struggle to cope with escalating drug prices as it creates a significant constraint on their budgets.

Keeping innovative and superior treatments out of reach to those that need them the most is a betrayal to Mankind. As profits for pharmaceutical companies sore annually, patients are left poorer and in dire straits. Something must be done to justify drug prices in a more transparent manner. It can literally be a matter of life and death.

In rheumatoid arthritis for example, a new class of medications called “biologics” has revolutionised the treatment of this once debilitating disease. Preventing irreversible joint damage and relieving debilitating pain is now an achievable dream for these patients. Or so we may think.

Unfortunately, “biologics” are priced so steeply that it keeps it out of the hands of the majority of patients. Moreover, they are needed on a long term basis. Imagine spending all your savings on a medication that is suppose to make one’s life better. As patients reach deep into their pockets to solve their physical pain, another equally paralysing menace emerges. I call it the ‘financial pain’. Make no mistake of its equally destructive force.

So we spend so much money thinking that we are making a difference to the lives of patients, only to realise all we did was to shift the dust.

This conundrum raises the question of what constitutes an advancement in Medicine. A true advancement is when we can develop an innovative treatment that can be enjoyed by all of Mankind. It is not to enrich certain quarters but is to be shared by all that inhabit this little planet.

Perhaps it is wishful thinking, but there is little harm in dreaming.