What Are the Risks of Delaying My Knee Replacement Surgery?

Patients delay knee replacement surgery for a number of reasons, mostly out of fear and misinformation. �Most patients delay unnecessarily for several perceptual reasons: fear of the unknown, fear of surgery, fear of �losing� a body part, fear of the post-op surgery pain, fear that they will end up worse than they started.� But once they have undergone knee Replacement patients are thankful and wish they had done it sooner.
The risks related to delaying knee replacement surgery often involve the deterioration of the joint, increased pain, and lack of mobility. Depending on the severity of the joint disease, a surgeon may attempt several less invasive, non-surgical methods first (including glucosamine, anti-inflammatory medications, cortisone injections, and physical therapy). If none of these methods appear to be working or if the patient has become sedentary due to joint pain, knee replacement surgery is recommended. For many of the reasons listed above, patients sometimes consciously delay their knee replacement surgery, which can have some of these risks:

* risk of deformities developing inside and outside the joint
* risk of muscles, ligaments and other structures becoming weak and losing function increased pain / inability to manage pain
* increased disability/lack of mobility
* difficulty with normal activities of daily living


When a knee replacement surgery is delayed, there are also several risks that arise with regard to the surgical procedure. For example, the risk of deformities due to postponement tends to make knee replacement surgery a more complicated process. The surgery may then take longer and require a longer amount of time under anesthesia. In addition, postponement can limit knee replacement options. For example, joint disease that is spotted early on and treated may only require a "unicompartmental knee joint on the medial side." But after delay, destruction to the knee joint becomes so severe that a total knee replacement (a more complex surgery) is required - with possibly even the addition of a knee cap ("patellar") resurfacing. Recent studies have shown that timing does make a difference in joint replacement surgery. �Timing of surgery may be more important than previously realized and, specifically, that performing surgery earlier in the course of functional decline may be associated with better outcome.� In other words, if surgery is performed early it may be more successful. When a patient is relatively healthy and gets a knee replacement, the patient is more likely to recover sooner and with less complications. Knee replacement surgery is not recommended for everyone, and one must consult the doctor if it is required. But if you are a knee replacement surgery candidate, postponement can lead to a number of unnecessary and avoidable issues.

Dr. Harinder Batth
M.S ( PGI)
Orthopedic Surgeon
9888003333�

In today's busy and stressful life, number of new diseases are coming up which are actually modifiable. Common person can never think of losing their vision because of there stressed life which they think is a part of life.
One such disease is Central Serous Retinopathy. In this disease fluid ( subretinal fluid) gets accumulated between sensory retina and retinal pigment epithelium. It is seen more commonly in males but doesnt mean females are less involved. There
are known factors which predispose the patients for this disease like hypertension, type A personality, use of steroids in any form. Endogenous steroids and increasd sympathetic activity are also contributory.
My purpose of writing this article is not to tell about the dsease per se as information regarding CSR can be retrived from multiple sources, but to make people aware about the small modifications in life which can help to decrease recurrence thus increasing the possibility of retaining good vision.
Just telling the patient to avoid sress doesnt finish our duty towards patient . Patient actually doesnt know what to do and how to do, so he/she ends up doing nothing . The whole purpose of our examining patient finishes. The best part of CSR is it is self resolving, so ask patient to relax by going for morning walk , doing meditation , reading books( whether religious or whatever he likes), listening to music, playing games , drawing, may be shopping....
I jst talked about this to a sister in the hospital what would you do relax yourself if you get full one week leave( which is no doubt unthinkable in our set up), her reply was,I will sleep, and go for shopping because then I have to join back. That means people are more worried about futur and dont live and enjoy present. Maximum of patients of CSR wich we see has stress has the precipitating factor and no other factors mentioned above.
Believe me this is the only disease where you can control your vision with a smile on your face. Always remember to avoid-HURRY, WORRY and CURRY.....

Inclusion Of Ayurveda In Primary Education

- Professor, Vd. M. P. Prabhudesai
Bhaisheb sawant Ayurved Mahavidyalaya,
Sawantwadi, Dist.- Sindhudurga, Pin � 416510.
Maharashtra, INDIA.

[ There was an All India Level Convention arranged on the subject � 'Ayurveda - Education & Research', in Coimbtore (India) in July 1991. It was sponsored by Gujarat Ayurveda University (Jamnagar), Central Council of Indian Medicine, L.S.P.S.S. (Coimbtore), & A. V. R. Foundation (Coimbtore). The thoughts delivered by Dr. M. P. Prabhudesai were accepted by the convention in form of resolution, which was passed unanimously. Those thoughts are being elaborated as follows --].
Dear & honorable audience / readers, before going to plan the education - policy for the under-graduate & post-graduate courses of Ayurveda, it is my earnest request to go through the following facts.
Our present educational policy is based totally on the guidelines laid down by the Western educationalists (including Lord McCauley), which were influenced by the political elements present before our independence. But, one should never forget that there was 'The Best System of Education' available in our India since good old days. Not only that, we had our own best universities like Takshashila, Nalanda which imparted best quality education, even to foreign students. Unfortunately, this fact has been totally forgotten / ignored by the present educationalists & by the political leaders as well, who always try to enforce 'their own'(?) guidelines. The nations, which are always, alert about the greatness of their own country, their own tradition, heritage & culture and self-respect can flourish & progress like anything in a very short period, e.g. Israel, Japan. Instead, even after 44 years of Independence, we Indians are totally dependent upon the Westerns, almost for everything. A total period of 25 years (??) was elapsed from independence, to get Government � recognition to Ayurveda, after which the B.A.M.S. (Ayurvedacharya) course was adopted by various universities in India. This recognition was thought about only after the realization of Ayurveda-awareness aroused in Western-countries. This is one example of our typical Indian (and not Bharatiya)-mentality
At present, Ayurvedic education is approved at college-level. Unfortunately, first five-six months of the student admitted for Ayurvedic course, are wasted simply in getting accustomed to the Ayurvedic basic principles & the specific terminology. They are never been taught anything about Ayurveda up to twelfth standard, which is supposed to be the minimum basic qualification to get admission to B.A.M.S. The students get worried about, when they come across the names of Ayurvedic scientists like Charakacharya, Sushrutacharya, Vagbhatacharya etc. & similarly, the basic principles like Tridosha Siddhant, Panchamahabhoot Siddhant etc. During ten years of my teaching experience (1977�1986) in Ayurvedic colleges in Mumbai, I have experienced that, due to the fact mentioned above, many scholar students have left the course to seek admission for another course and in this way, Ayurveda has lost the talent.
This never happens in case of the students who get admission to a course (other than Ayurveda), related with modern science. Explanation of this fact is quite clear. The student is familiar with the basic principles & the terminology of modern science, which he knows even from his primary education. So, he can easily 'digest' the courses like M.B.B.S., Engineering, Science-subjects, Commerce etc. when he gets admission there.
In present situation, there seems only one solution for this, and that is ---- to include introduction of the basic principles of Ayurveda along with the concerned scientists & philosophers, very from the primary education, that too, step by step.
It is assumed that the national policies regarding various subjects, including educational one, should be based on the culture & heritage, social-lifestyle, geographical situation and similar other factors which are concerned with that particular country. While experiencing the 'present yearly changing pattern' of the education-system prevalent in India, it is quite evident that this assignation is not followed at all. There may be various reasons behind this situation. But it is regretted to observe that nobody, either any political or any social leader has ever tried to seek any solution and to follow it, honestly. According to me, the cause of this fact can be our 'traditional slave-psychology'. Our so-called thinkers are always worried about the western scientist's approval (??) / criticism, even if they decide to think anything new to the westerns. That will be the "holiest day" when our own thinkers will be out of this psychological-dependence. It will not be out of the subject, to quote here the famous sher ---
IwX hr H$mo H$a ~wb�X BVZm Ho$
ha VH$ara Ho$ nhbo, IwXm IwX ~�Xo go nyN>o -
"" ~Vm Voar aOm �`m h� ?''
If we leave our inferiority-complex and if we try to revise and follow our own system of education based on Ayurveda and other Indian Philosophical-Sciences (Darshan-Shastras) that are supplementary & closely related with our social, moral, psychological, cultural and geographical conditions; then only our 'Bharat' will shine like anything, always ahead, among the world.
Ayurveda, our own medical science is totally relevant with our Hindu-culture, Hindu-lifestyle & Hindu-religion. (The word 'Hindu' used here implies � An ideal living-style matching with the Indian-culture; and not the present constricted meaning made famous by our politicians.) Even though, the students completing their primary, secondary or even college education are familiar only with the basic principles of modern science; but they never know anything about the philosophical foundation upon which our Indian Sciences are based. On the contrary, it is seen that 'the thinkers' in India go on jesting & criticizing this ancient Indian Medical Science, of being based on imaginary and strange philosophy that has no practical background & without any research. Naturally, the younger generation of students is more attracted towards Modern Medical Science that has got world-wide reputation & dignity, easier access in getting Govt. facilities, dazzling background, propaganda of its researches, which claim to give quicker results in treating diseases & so on. That is why, the student who has passed twelfth standard & who is inclined to get admission for a medical course; tries hard for the M.B.B.S. course on top priority. When it becomes impossible to get admission there or for similar courses based on modern science, then he becomes helpless & gets admission, reluctantly, to the Ayurvedic course, i.e. B.A.M.S., where, as narrated in the beginning, he experiences totally different atmosphere, as Ayurveda is based on entirely different basic principles, not known to him before.
Now we will go through few examples proving my thoughts -----
1. In the present system of education, the student learning in primary school knows about the square meal, vitamins, calories etc. as essential information about diet. But he never knows that, according to Ayurveda, 'all eatables available in the world are divisible in six tastes (Rasa) and our daily meal should contain all the six tastes in a particular proportion'. He may know this basic rule, only after getting admission to Ayurvedic course, that too after twelfth standard. Otherwise this rule may remain unknown to him for his whole life. In reality, I do not think, any other science, except Ayurveda, has ever thought about 'the diet' in all respects. At the time, when the western world had progressed (??) in consuming roasted meat instead of eating it raw, we Bharatiyas used to have delicious & dainty dishes containing all six tastes. In fact, the detailed description about dietetics regarding � when / where / how / what & how much to eat, who should eat, not only that but why to eat; is so elaborately available, with due explanation, in Ayurvedic texts that if one tries to write in details, thousands of pages will be insufficient, or if one tries to speak, he may require many days to explain in details. Even then, there is no any single reference about 'the Ayurvedic view of diet' in present primary or further education.
2. The student learning in primary education knows 'the Darwin's theory of evolution'. Similarly, he knows various hypothesise regarding the origin of this globe. But it is almost rare for him to know 'the Prakriti-Purush Siddhant' described in Bharatiya Sankhya-philosophy or the basic Bharatiya ideas about Srishti-Utpatti described according to 'Pilu-Paka', 'Peethar-Paka' and 'Dwyanuk-Tryanuk' Siddhantas are never heard.
3. The names of the modern scientists that give a nice tongue-exercise while pronunciation like Newton, Luis Pasture, Graham Bell, Einstein, Madam Curie, Galileo, Harvey etc. are well-known to the primary students, along with their topics of research as well. But they do not have mere acquaintance with the Bharatiya scientists like Charakacharya, Sushrutacharya, Vagbhatacharya, Bhaskaracharya, Kanad Maharshi, Aryabhatta (this is the only exception, due to our patriotic scientist, The President of Bharat at present, Dr. Abdul Kalam, who named the satellite), Dalhan, Dridhabala, Madhavacharya, Bhrigu etc. The Vedic Mathematics, which aroused an excitement in the western world due to its speed competing with the computer, we remained inert about it for so many days. Many such examples can be quoted.
My suggestion regarding inclusion of Ayurvedic Principles in the syllabus of primary education may have a few objections: ~
� Originally, all the Ayurvedic literature is in 'Sanskrit' language; so it may prove to be very difficult either to learn or to teach it.
The solution for this problem can be as follows � the teachers of primary schools should undergo a special orientation-course to learn basic principles of Ayurveda, which should be explained in the regional language after keeping the original terminological Sanskrit words as they are. Similarly, the Sanskrit-language, which is an optional subject at secondary-school level, should be made compulsory from primary level. It is my earnest suggestion that the Sanskrit should be approved as our National Language by making special necessary amendments in our constitution. (So that it may be possible to nullify the opposition of the South Indians to the present national language, i.e. Hindi). Then after, I would strongly propose to upgrade the Sanskrit Language to become the international language, as the scientists (especially the Western Ones) have accepted it as a language that can be easily & totally fed to computers.
� The other objection will be � will the Westerns understand, whatever we try to teach about Ayurveda & other Bharatiya Philosophy in the specific terminology and will they approve it?
My answer to this query is � we need not worry about that. If at all the Westerns are keenly interested to know our Oriental Sciences they have to get accustomed to our Sanskrit language & terminology as well. If it is inevitable to learn Russian, German or French when our Bharatiya students wish to get further education in Russia, Germany or France, then why should we waste our energy to try to translate our inherited wisdom in their language (which is almost always impossible, due to the want of clarification of the real / implied meaning), to make them understand our science? We 'Indians' unnecessarily make a bugbear of English language. We feel helpless if we do not have mastery over it. But it is my own experience that English is not much honored in Europe except England. It will not be out of track if I narrate my experience regarding this.
In May 1989, I was invited to read my research-paper in The World Congress of Yoga & Ayurveda, in Italy. Then there was a study-tour in Switzerland, Germany, Holland, France & England. During the whole tour, I experienced that very few people could speak or understand English, except at the international airports, at starred hotels and in England itself. In the roadside restaurants or in coffeehouses we had to convey our message through gesticulations by hand and the people were proud & alert regarding their own language. During lunch-recess we had been in a library in Rome. After going through the register, we asked the librarian, "Don't you have any English books here?" and she burst out angrily, "Why you want English books? You better learn our Italian language & you will get the whole knowledge you want, which, perhaps, may not be available in English." What a live & burning pride for her own language and her own nation! And we Indians (not Bharatiyas or Hindustanis) are still to fix a single name for our country!!!
� There might be one more objection � Ayurveda is not based only on axiom, so does not have any practical approach. The Tridoshas (i.e. Vat, Pitta, & Kapha) and Pancha-Mahabhootas described in it, cannot be demonstrated individually & practically. On the contrary, the modern medicine is practical-based science. Various bacteria (that are responsible for diseases, according to this science), the blood & its components, various invasive & non-invasive diagnostic techniques etc. can be perceived through our sensory organs. If this is the fact, then why to learn Ayurveda?
If one goes through the basic principles of Ayurveda with minute observation, the answer is quite evident. The 'Pratyaksha Pramana' ("Aj� �{V' which means Bp��`J�`, i.e. axiom) is accepted also by Ayurveda. But according to it, its pervasion through our sense organs is very limited, while the real knowledge remains beyond the capacity of our sense organs & that is unlimited.
"��`j� {h A�n�, AZ�n� A��`j��&' - Chraka Samhita.
This is one of the basic principles of Ayurveda. So that, Ayurveda has accepted two more Pramanas, i.e. AZw_mZ (means inference) & Am�monXoe (means e�X�m_m�` i.e. admonition by authorized seers); out of which 'inference' is accepted, to some extent, by the modern medicine. But, all the Basic Bharatiya Darshan Shastras also accept the third one, i.e. admonition & Ayurveda is no way an exception to this. In fact, according to Bharatiya philosophy, Anumana is superior to Pratyaksha & Aptopadesha is supposed to be the supreme one. This is simply a philosophical explanation.
But one may agree that, though not perceivable, the presence of Tridoshas (i.e. Vata, Pitta & Kapha) either in natural or unnatural state, can easily identified with the help of the guidelines laid down by Ayurveda. It is always experienced practically, that proper treatment given in various diseases (due to the vitiated state of Tridoshas), according to the Aptopadesha, relieves the patient from diseased state. In certain diseases where modern medicine falls short in curing them, like jaundice, urinary stones, asthma, rheumatic disorders, various digestive disorders, certain female-specific diseases, some types of cancer etc., Ayurveda certainly proves to be better in giving successful results, that too, without any surgical intervention. If this fact is proved, the ultimate inference that could be drawn is � 'inclusion of basic principles of Ayurveda in primary education is a must'.
While narrating the rules for maintenance of health, Ayurveda has thought about 'the psyche' (the body) & 'the mind' individually. The rules regarding physical health are described under the heading "{XZM`m�'(the daily regimen) & "F$VwM`m�' (the seasonal regimen), while the rules regarding mental health are described under the heading "gX�d��m' (the daily behavior). If, our own ancient medical science i.e. Ayurveda, having such a nice background, is included in the primary education, our students & because of them their guardians as well, will have an introduction with our real Bharatiya thoughts, will improve their health and at the same time, I am quite confident that only Ayurveda will be an additional asset to get the motto of W.H.O., i.e. ' health to all', in reality.
'Mass-immunization' is compulsorily undertaken everywhere, with investment of so many crores of currency, to implement the above motto of W.H.O. But, it is realized that in the idea of 'health' only 'body' is taken into consideration. It is observed that, due to various vaccinations & successful (??) treatment against various diseases, the average length of human-life seems to be elongated; but it will be self-deception to declare that the human-health is improving. Because, majority of the chronically diseased patients disagree to live with 'such life dependent on mouthful of medicines'.
To my mind, the above motto of W.H.O. may turn into reality, only if, Ayurveda is included in primary education & daily and seasonal regimen and behavior is strictly observed according to it; because the basic aim of Ayurveda is, to gain not only elongated but also disease-free healthy life. This may be clarified by following example �_wI (the mouth) is under influence of Kapha dosha, according to Ayurveda. The eatables that are bitter or astringent in taste, control Kapha dosha from getting increased, but sweet eatables help Kapha to increase. Once this secret is known, the students along with the whole community, will stop using tooth-powders / pastes of the well-known multinational companies and because of this only precaution, many of the teeth complaints that are getting increased day by day, would be prevented.
In our good-old literature, we read that the saints & the kings in ancient days could live for some thousands of years, even though there were no any vaccinations or the modern amenities available. This was possible only because of observing the daily & seasonal regimen along with daily behavior according to Ayurveda.
Ayurveda states that 'Sadvritta- palan' (ethical behavior) is essential for healthy mental state and I am quite sure that if this is included in primary education, in Ayurvedic manner, many of the unethical deeds, seen increasing during present days among the younger generation, will be certainly checked.
In this way, if the education of Ayurveda, which is supplementary for the sound state of physical as well as mental health of the community & which forms the basis for the student seeking admission in Ayurvedic college, is included at primary level; then, I am quite confident that, the talented class of students, which used to turn towards Ayurveda unwillingly & helplessly, will give its first preference to Ayurveda with due interest & willingness.

"Wishing best of health to all"


Contact :~
Prof. Vd. M. P. Prabhudesai
A / 8, Vijayanand Society,
New Khaskil Wada, Sawantwadi,
Dist. - Sindhudurga �416 510.
Maharashtra, INDIA.
+919422435323

Bad Breath � Halitosis
A cause of social embarrassment & possible means of cure

Causes of Halitosis
� Conditions & circumstances which cause or aggravate bad breath
� Condition which promotes the growth of oral bacteria
� Not cleaning or not able to clean ,those areas where bacteria reside
� Food
� Smoking
� Xerostomia
� Periodontal disease
� Sinus
� Dental conditions
� Untreated Medical conditions
� Dentures

Pathogenesis
Consumption of food containing sulfur compounds
Principle food for the bacteria to grow
(sulfur compound)
Principle causative agent for bad breath
(bacteria)
Accumulation of waste products in the mouth

The Unpleasant odour can be due to:
� Hydrogen peroxide
� Methyl mercaptan
� Cadaverine � the smell associated with corpses
� Putrescine - which is responsible for much of the odor of decaying meat
� Skatole � the characteristic smell of human
� fecal matter
� Isovaleric � the smell of sweaty feet

Food supply for bacteria
� Diet rich in proteins like
� Meat
� Fish
� Sea foods
� Dairy products
� Cereal grains
� Nuts
� Seed from pods ( beans, peas & lentils)
� Favorite desserts ( cakes & pies )

Location /Area for survival of bacteria
� Tongue ( anterior & posterior )
� Periodontal Sources
Diagnosis
� Test for you to check your own breath
� Usage of a spoon

� Organoleptic judging of bad breath
� Gas Chromatography for evaluation of bad breath
� Halimeter
� BANA test

Cure of Halitosis
� Minimize the amount of the food available for these bacteria
� Minimize the total no. of these bacteria that exist
� Minimize the availability of the types of environments in which these bacteria prefer to live
� Make an environment in which these bacteria do live less hospitable
� Employ the use of products that can neutralize the odor causing volatile sulfur compounds themselves
� Cleaning your teeth & gums can help to cure bad breath
� Use of Mouthwashes can help to cure bad breath
� Other cures include
- Drink plenty of water
- Rinse with water often
- Stimulate the flow of saliva
- Clean your mouth, especially well after eating protein rich diet.
Regards

Dr. Sumit Dubey
New Delhi

HYDERABAD: A Srinivas, 44, underwent a heart valve replacement surgery at a city hospital. Like all other patients undergoing surgery, he too needed blood. But being O-ve (Bombay phenotype), a very rare blood group, he could not get any donor after a relentless search. Left without any option, doctors put him on iron supplements for seven days following which they withdrew two units of blood (medically called auto transfusion), and performed the surgery.

People like Srinivas are universal donors but when it comes to receiving blood, they have to depend on O-ve (Bombay phenotype) donors only, specialists say. "Considering his heart condition, it was necessary to perform the surgery at the earliest. After exhausting all the options of getting blood from other sources, we decided to harvest blood drawn from the patient and use it for surgery," said Dr Amrendra Singh, cardiac surgeon, Kamineni hospital, L B Nagar, who performed the surgery along with his team. This was second such case in Dr Singh's 10-year career.

Srinivas underwent the surgery with doctors taking extra precaution to conserve the blood. His two units of precious blood were used for the operation and has been discharged from the hospital. According to specialists, O-ve blood group is rare and its Bombay phenotype subgroup is its very rare variant. It is found in four (persons) out of ten lakh population.

"People with this blood group should donate blood for emergency situations. While negative blood groups are always short in supply, it is worse when it comes to O-ve (Bombay phenotype). In emergency situations such as accidents, it can be life threatening," says a surgeon from Nizam's Institute of Medical Sciences. He added that auto transfusion is the only way for these patients but it works out only for elective surgeries and not emergencies.

Dr Ramesh Babu Byrapaneni, chief cardiologist and MD of Medwin hospital says that the hospital had done a similar case almost a decade ago. "We got a patient from the Jehovah's Witnesses (a quasi Christian Sect) which does not accept blood transfusion at all. For this patient, we had to go for auto transfusion," said Dr Ramesh. Further, Dr Ravi N Bathina, cardiologist at Care hospital added that it is a safe procedure and common in countries like US. Dr Ravi, who has worked in the US said that he did not come across such a case in his practice in India.

According to officials at NTR Blood Bank, it takes months and sometimes years to get this blood group. Last year, NTR blood bank could arrange four units of this blood group after much effort