Saturday, July 05, 2014

The Brazilian star will miss the semi and the final too !!!

Sports and injuries go side by side. A player who does not sustain injury is a virtual player. Football player sustain numerous injuries. Most of the renowned players have undergone surgeries for their knees, ankles and wrist.  Ronaldo (BRAZIL) underwent 3 surgeries for his injured knee ligament. He was prone for knee injury as his body was disproportionate. In spite of repeat injuries he could push himself and compete with the world’s giants.  The other giant injured his ankle, Ronaldo (PORTUGAL). He had just recovered and was dragging himself to represent his country for this world cup. In general football players sustain lower limb injuries more than anything else. Toe injuries, ankle twisting, knee twisting, hamstring pull, muscles tear are few of the common injuries. Apart from these they have fair chances to sustain upper limb injuries, like wrist ligament injuries, finger injuries and shoulder elbow trauma while protecting themselves during landing.  Back injuries are not that common as they have good reflex to protect their back and they are trained to protect back during fall and landing. Football player prioritize and try to prevent knee and back injuries as they take longer to heal and require prolong rest and surgeries many times. Trauma and rest for a football player is a huge loss. It is a physical as well as a monitory loss for them.  So they are trained such a way that they pretend to fall and they hardly sustain injuries. They know how to protect various body parts during fall. But not all the time it works, and they too sustain real injuries. Let me concentrate to the injury that very few players have sustained so far. Most unlucky was Neymar who sustained this injury last night.
Spine injuries for the world rated player is a nightmare to the doctor and the player as well.  To examine, opine and treat such demanding professionals is a herculean task. No single surgeon or physician is ready to take up such challenges. That is the reason a group of physicians and surgeons are appointed to treat such players. The best in the globe are hired to treat the best in the world. But even for the best It’s a heart pounding task to decide to operate or not to operate.
Neymar sustained a direct knee thumping over his back by defender Juan Zuniga. Immediately he fell down.  This mode of direct thumping in the center of back results the fracture of spinous process of the vertebra. The direct injury in the side (off center) may result fracture of transverse process of vertebra.  But it requires more impact as transverse process is way deep and covered by muscles. It also results the hyperextension (backward bending) of the spine resulting the opening up of the anterior column resulting injuries of the ligaments of anterior column. This is what I feel Neymar has sustained. Other possibility of injury is hyperextension injury of his back while landing. This is high-energy trauma, which can cause more extensive injury than the previous one. This can virtually cause trauma to all the column (anterior, middle and posterior) of the vertebra. In that case his recovery will take a longer, as he might need surgery as well.
There are very few posts regarding his injury. The team of doctors first verifies these injuries and then they are circulated to the media. So Far he has been evaluated with X-ray and CT scan. CT scan was suggestive of fractures. This much was given to the media early morning. Few more details have been disclosed day time. The specific level of vertebra L3 is disclosed, the part that got fracture is the transverse process of L3. The associated injuries of ureter and kidney is to be seen in such cases. Probably he will be evaluated through MRI again and the injury details will be officially disclosed. That is what I believe the experts are planning.  The official doctor of the Brazilian team Rodrigo Lamsar says “ Unfortunately, he is not going to be able to play. He is very, very sad. It’s not serious in the sense that it doesnot need surgery, but he will need to immobilize it to recover” and the expected recovery period is few weeks….

With his statements what I can presume is  he has suffered a fracture of transverse process  of L3 and that is being treated conservatively with rest and immobilization. This is moderately a painful condition. The movement in the hip and lower limb will increase pain as iliopsoas muscle is attached to the fractured tip and that muscle in attached to the part of femur in the LT below hip joint. So initial few days will be complete rest to manage pain. Spine immobilization will be done by lumbar brace. A minimum immobilization of 6 weeks is an optimal time for such fractures to heal. Sometimes it takes a longer course and takes up to 12 weeks. In rare cases it fails to unite and stays ununited. But it does not require surgery.  By this time the ligamentous injury also heal. But, Does this mean he will be able to play after 6 weeks or 12 weeks in the worst case. The answer is a BIG NO. The immobilization and rest will waste his back muscles; his thigh muscles and entire fitness will be low. So he will take few more months to regain his fitness. I feel a minimum of 3-5 months will take to bring his form back. During this time he will miss couple of interesting games including the semi and possibly the final too.

Tuesday, April 08, 2014

Feeling better....

Feeling better at the end of 4th day. The first ever experience with viral diarrhea will last in my life, if not for always, for few years sure. I think I need to think about vaccines if they are available in Kathmandu. Every year viral fever threats me and the symptoms persists for a fortnight, dry cough, early morning cough with sputum, red eyes and malaise persists for couple of days though the fever and chest symptoms subsides. I don’t think my immunity has been so weak. May be the new and virulent strains of virus are evolving. I guess google would give me the ways and means to increase the immunity. I doubt vegie are prone to viral illness. I don’t have data to support my own statement.

I can see everybody happy in the home now. My concern was different. I had almost isolated myself because there were new born in family. I bless them not to contract any viral illness me as a source. And the virus was really stubborn this time. It was a tough time to stay inside room for 4 complete days and night. It was almost like a prison for me. Thanks to laptop, mobile, landline and few books that made it possible. I think from tomorrow onwards I will resume few of my works. But I cannot imagine how will I recover my strength. I am really weak and lost few pounds. May all virus leave in peace. I have sacrificed a lot for you. Please allow me to go for work from tomorrow.

Monday, April 07, 2014

When you are helpless....

When we are sick we go to a doctor. Many people have come to me with their high hopes. I am sure I have done a justice to most of them with the knowledge and ability I have. I have operated few thousands of patients who had their hand, arm wrist, shoulder, leg, ankle, thigh or hip fractures. Few had their spine fractures, with less mobile legs and are happily walking without walking aids now, after surgery. I remember their face one by one and the happiness in their face is what I meant and what I was dreaming for.
All of a sudden I am not happy. My daily routine is disturbed, my work, my surgery ad the connection with the patient has lost.  I am bed bound for last three days and every second is like an hour for me. And every hour is like a day. Frequent electricity cut down and exhausted and dried laptop cell has made me miserable to get connected with the friends inside and outside the country. My cellphone is too old. I am planning to buy a new one for ages and the day has never come to me. I planned to buy Samsung galaxy S2. Since then many new phones have become the sensation in the market. Now S5 has hit the market and youngsters are far ahead with the latest gadgets. I am stuck with the Galaxy Ace. I tried to upgrade but never got a chance to put so much of money. When you feel you have stepped up into other responsibilities, you step down your necessaries. Chalta hai! Chal raha hai! This is what has happened to me and I am carrying a same old phone. The GPRS is too slow and 3G is fast and smart enough to suck its battery. This is somewhere my problem lies.
I am not bothered with the problems with my machines. Problems with my body bother me much. It’s almost 8 days I am not well. It started with viral like illness. Had throat sore, dry cough, myalgia, watery eyes and what not. I was recovering though I was not bed bound. But last three days are worst for me. I suffered an uncontrolled diarrhea. It has limited my mobility, no work, no progress and no positive thoughts. The frequency, the amount and the consistency is same.
I have always been no no to diseases. This is for the first time I have become so weak, and sympathetic about myself. I feel I never loved myself and I never had thought I can be sick. A simple disease had kept me in the bed and I have no solution for it. I am always scared with food and water borne disease. This is the reason I never prefer to dine outside, no matter how close the person has invited. I never take food from outside, except tea and coffee. Tea and coffee has always been my weakness so I cannot avoid them. I definitely have reduced the cups and quantity but cannot not leave without it.
I myself treated the diarrhea first and it did not bother my medications. My friend is treating it and the progress is nil. My friend claims it is none other than a viral diarrhea. I node my head, I have no arguments for it. He says it will resolve in few days time. I don’t know how much is the few days time? 3 4 5 6 or 7 days from the day of onset. Virus behaves differently in individuals and the minimum days for me is God only knows. I am tired of siting over the comode. Neither it hurts, nor it pains. But my intestine makes so much of movements. That’s all I can feel.
I am disproportionately weak but the treatment continues.  When you are sick you need your people near by saying take it easy. I feel I am alone. Anshu is out of town with the new borne. Missing the cries, missing those fearless and careless smileys in his face. Badly missing son and his mom. Please come soon.

Sunday, March 30, 2014

The status update...

I left the place where i was working in July 2012. I left for the good cause. I thought i need to train myself. I also planned to learn from the people who deserve to train. After all, I landed in delhi again for six months. Delhi is the nearest station which never made me anxious while traveling. I have been more than 50 times to delhi and the journey continues. I have good memories, i have bad memories of Delhi but still i love to talk about good and i am going to delhi for good reason once again. I joined Medanta as a clinical fellow in hand and upper extremity surgery with my boss Dr VG.

While i was in delhi i had an opportunity to present my research paper in Dubai. Anshu was always interested to visit Dubai as she has lot of school friends from Dubai.  We managed to visit Abu Dhabi with a mexican couple who were married 25 years back in dubai. I had an opportunity to meet Dr Chitaranjan Ranawat, a famous US surgeon whom i wanted to meet once in my life time in Dubai conference.   Indeed Dubai was a good vacation for both of us.  Anshu flew to Kathmandu and i continued with Medanta. There was no reason to be sad in delhi for entire fellowship. Finally days were close to leave delhi. I had three option in my hand. First was to join malaysian MSU from March 2013. I left MSU idea because the minimum contract period was 2 years. Salary was nice and in fact it offered job for both of us with good package. Second was Medanta. Chairman and the AD offered me a consultant post. It was lucrative but this again was going to separate us. Anshu had no license to work in India. After all she is a gynecologist and why should she suffer her career for me. Third was to join singapore fellowship. International orthopaedic society had selected me for a six months fellowship in singapore. So i opted a third one. It was a good decision.

Came back to Kathmandu in Feb 13. Was not in a mood to continue previous hospital where moron and idiot were in dozens. Was interested to join hospital for a short period as i had to leave for singapore in next 4 months. Had talk with various hospitals, but i found reasonable to join Sumeru.