Hip replacement

 

 

Overview

                                                                         

 

During hip replacement, a surgeon removes the damaged sections of your hip joint and replaces them with parts usually constructed of metal, ceramic and very hard plastic. This artificial joint (prosthesis) helps reduce pain and improve function.

 

Also called total hip arthroplasty, hip replacement surgery might be an option for you if your hip pain interferes with daily activities and nonsurgical treatments haven't helped or are no longer effective. Arthritis damage is the most common reason to need hip replacement.

 

 

Why it's done

Conditions that can damage the hip joint, sometimes making hip replacement surgery necessary, include:

                                                        

Osteoarthritis. Commonly known as wear-and-tear arthritis, osteoarthritis damages the slick cartilage that covers the ends of bones and helps joints move smoothly.

Rheumatoid arthritis. Caused by an overactive immune system, rheumatoid arthritis produces a type of inflammation that can erode cartilage and occasionally underlying bone, resulting in damaged and deformed joints.

Osteonecrosis. If there isn't enough blood supplied to the ball portion of the hip joint, such as might result from a dislocation or fracture, the bone might collapse and deform.

You might consider hip replacement if you have hip pain that:

                                  

Persists, despite pain

Worsens with walking, even with a cane or walker

Interferes with your sleep

Makes it difficult to get dressed

Affects your ability to go up or down stairs

Makes it difficult to rise from a seated position

Request an Appointment at Mayo Clinic

Risks

Risks associated with hip replacement surgery can include:

 

Blood clots. Clots can form in your leg veins after surgery. This can be dangerous because a piece of a clot can break off and travel to your lung, heart or, rarely, your brain. Your doctor may prescribe blood-thinning medications to reduce this risk.

Infection. Infections can occur at the site of your incision and in the deeper tissue near your new hip. Most infections are treated with antibiotics, but a major infection near your prosthesis might require surgery to remove and replace the prosthesis.

Fracture. During surgery, healthy portions of your hip joint might fracture. Sometimes the fractures are small enough to heal on their own, but larger fractures might need to be stabilized with wires, screws, and possibly a metal plate or bone grafts.

Dislocation. Certain positions can cause the ball of your new joint to come out of the socket, particularly in the first few months after surgery. If the hip dislocates, your doctor might fit you with a brace to keep the hip in the correct position. If your hip keeps dislocating, surgery is often required to stabilize it.

Change in leg length. Your surgeon takes steps to avoid the problem, but occasionally a new hip makes one leg longer or shorter than the other. Sometimes this is caused by a contracture of muscles around the hip. In this case, progressively strengthening and stretching those muscles might help. You're not likely to notice, small differences in leg length after a few months.

Loosening. Although this complication is rare with newer implants, your new joint might not become solidly fixed to your bone or might loosen over time, causing pain in your hip. Surgery might be needed to fix the problem.

Nerve damage. Rarely, nerves in the area where the implant is placed can be injured. Nerve damage can cause numbness, weakness and pain.

Need for second hip replacement

Your prosthetic hip joint might wear out eventually, especially if you have hip replacement surgery when you're relatively young and active. Then you might need a second hip replacement. However, new materials are making implants last longer.

 

How you prepare

Before surgery you'll meet with your orthopedic surgeon for an exam. The surgeon will:

 

Ask about your medical history and current medications

Examine your hip, paying attention to the range of motion in your joint and the strength of the surrounding muscles

Order blood tests, and an X-ray. An MRI is rarely needed

This preoperative evaluation period is a good time for you to ask questions about the procedure. Be sure to find out which medications you should avoid or continue to take in the week before surgery.

 

Because tobacco use can interfere with healing, stop using tobacco products for at least a month before surgery and for at least two months after surgery. If you need help to quit, talk to your doctor.

 

Don't have dental work, including teeth cleaning, two weeks before surgery.

 

What you can expect

When you check in for your surgery, you'll be asked to remove your clothes and put on a hospital gown. You'll be given either a spinal block, which numbs the lower half of your body, or a general anesthetic.

 

Your surgeon might also give you a nerve block by injecting an anesthetic around nerves or in and around the joint to help block pain after your surgery.

During the procedure

The surgical procedure takes a few hours. To perform a hip replacement, your surgeon:

 

Makes an incision over the front or side of your hip, through the layers of tissue

Removes diseased and damaged bone and cartilage, leaving healthy bone intact

Implants the prosthetic socket into your pelvic bone, to replace the damaged socket

Replaces the round ball on the top of your femur with the prosthetic ball, which is attached to a stem that fits into your thighbone

Techniques for hip replacement are constantly evolving. Surgeons continue to develop less invasive surgical techniques, which might reduce recovery time and pain.

 

After the procedure

After surgery, you'll be moved to a recovery area for a few hours while your anesthesia wears off. Medical staff will monitor your blood pressure, pulse, alertness, pain or comfort level, and your need for medications.

 

How long you stay after surgery depends on your individual needs. Many people can go home that same day. You'll be asked to breathe deeply, cough or blow into a device to help keep fluid out of your lungs.

 

Blood clot prevention

After your surgery, you'll be at increased risk of blood clots in your legs. Possible measures to prevent this complication include:

 

Moving early. You'll be encouraged to sit up and walk with crutches or a walker soon after surgery. This will likely happen the same day as your surgery or on the next day.

Applying pressure. Both during and after surgery, you might wear elastic compression stockings or inflatable air sleeves similar to a blood pressure cuff on your lower legs. The pressure exerted by the inflated sleeves helps keep blood from pooling in the leg veins, reducing the chance that clots will form.

Blood-thinning medication. Your surgeon might prescribe an injected or oral blood thinner after surgery. Depending on how soon you walk, how active you are and your overall risk of blood clots, you might need blood thinners for several weeks after surgery.

Physical therapy

A physical therapist might help you with exercises you can do in the hospital and at home to speed recovery.

 

Activity and exercise must be a regular part of your day to regain the use of your joint and muscles. Your physical therapist will recommend strengthening and mobility exercises and will help you learn how to use a walking aid, such as a walker, a cane or crutches. As therapy progresses, you'll usually increase the weight you put on your leg until you're able to walk without assistance.

 

Home recovery and follow-up care

Before you leave the hospital, you and your caregivers will get tips on caring for your new hip. For a smooth transition:

 

Arrange to have a friend or relative prepare some meals for you

Place everyday items at waist level, so you won't have to bend down or reach up

Consider making some modifications to your home, such as getting a raised toilet seat if you have an usually low toilet

Put things you need, such as your phone, tissues, TV remote, medicine and books near the area where you'll be spending most of your time during recovery

Six to 12 weeks after surgery, you'll have a follow-up appointment with your surgeon to make sure your hip is healing properly. If recovery is progressing well, most people resume at least some version of their normal activities by this time. Further recovery with improving strength will often occur for six to 12 months.

 

Results

Expect your new hip joint to reduce the pain you felt before your surgery and increase the range of motion in your joint. But don't expect to do everything you could do before the hip became painful.

 

High-impact activities — such as running or playing basketball — might be too stressful on your artificial joint. But in time, you might be able to swim, play golf, hike or ride a bike comfortably.

Jan Ricks Jennings, MHA, LFACHE

Senior Consultant

Senior Management Resources, LLC

Jan.Jennings@EagleTalons.net

JanJenningsBlog.Blogspot.com

412.913.0636 Cell

724.733.0509 Office

February 1, 2022

                                                                            

Lewy body dementia

 

Overview

Lewy body dementia, also known as dementia with Lewy bodies, is the second most common type of progressive dementia after Alzheimer's disease. Protein deposits, called Lewy bodies, develop in nerve cells in the brain regions involved in thinking, memory and movement (motor control).

 

Lewy body dementia causes a progressive decline in mental abilities. People with Lewy body dementia might have visual hallucinations and changes in alertness and attention. Other effects include Parkinson's disease signs and symptoms typical of Parkinson’s disease, such as rigid muscles, slow movement, walking difficulty and tremors.

 

Symptoms

Lewy body dementia signs and symptoms can include:

 

Visual hallucinations. Hallucinations — seeing things that aren't there — might be one of the first symptoms, and they often recur. People with Lewy body dementia might hallucinate shapes, animals or people. Sound (auditory), smell (olfactory) or touch (tactile) hallucinations are possible.

Movement disorders. Signs of Parkinson's disease (parkinsonian signs), such as slowed movement, rigid muscles, tremor or a shuffling walk can occur. This can lead to falling.

Poor regulation of body functions (autonomic nervous system). Blood pressure, pulse, sweating and the digestive process are regulated by a part of the nervous system that is often affected by Lewy body dementia. This can result in sudden drops in blood pressure upon standing (orthostatic hypotension), dizziness, falls, loss of bladder control (urinary incontinence) and bowel issues such as constipation.

Cognitive problems. You might have thinking (cognitive) problems similar to those of Alzheimer's disease, such as confusion, poor attention, visual-spatial problems and memory loss.

Sleep difficulties. You might have rapid eye movement (REM) sleep behavior disorder, which can cause you to physically act out your dreams while you're asleep. This might involve behavior such as punching, kicking, yelling and screaming while sleeping.

Fluctuating attention. Episodes of drowsiness, long periods of staring into space, long naps during the day or disorganized speech are possible.

Depression. You might develop depression.

Apathy. You might lose motivation.

Causes

Lewy body dementia is characterized by the abnormal buildup of proteins into masses known as Lewy bodies. This protein is also associated with Parkinson's disease. People who have Lewy bodies in their brains also have the plaques and tangles associated with Alzheimer's disease.

Risk factors

A few factors seem to increase the risk of developing Lewy body dementia, including:

 

Age. People older than 60 are at greater risk.

Sex. Lewy body dementia affects more men than women.

Family history. Those who have a family member with Lewy body dementia or Parkinson's disease are at greater risk.

Complications

Lewy body dementia is progressive. Signs and symptoms worsen, causing:

 

Severe dementia

Aggressive behavior

Depression

Increased risk of falling and injury

Worsening of Parkinsonian signs and symptoms, such as tremors

Death, on average about seven to eight years after symptoms start.

Jan Ricks Jennings, MHA, LFACHE

Senior Consultant

Senior Management Services, LLC

 Jan.Jennings@EagleTalons.net

JanJenningsBlog.Blogspot.com

 

412.913.0636 Cell

724.733.0509 Office

 

January 30, 2022

                                                                                Rheumatoid arthritis

 

Overview

 

 

Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels.

 

An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues.

 

Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

 

The inflammation associated with rheumatoid arthritis is what can damage other parts of the body as well. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities.

Symptoms

Signs and symptoms of rheumatoid arthritis may include:

 

Tender, warm, swollen joints

Joint stiffness that is usually worse in the mornings and after inactivity

Fatigue, fever and loss of appetite

Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.

 

As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.

 

About 40% of people who have rheumatoid arthritis also experience signs and symptoms that don't involve the joints. Areas that may be affected include:

 

Skin

Eyes

Lungs

Heart

Kidneys

Salivary glands

Nerve tissue

Bone marrow

Blood vessels

Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place.

 

When to see a doctor

Make an appointment with your doctor if you have persistent discomfort and swelling in your joints.

 

Causes

Rheumatoid arthritis is an autoimmune disease. Normally, your immune system helps protect your body from infection and disease. In rheumatoid arthritis, your immune system attacks healthy tissue in your joints. It can also cause medical problems with your heart, lungs, nerves, eyes and skin.

 

Doctors don't know what starts this process, although a genetic component appears likely. While your genes don't actually cause rheumatoid arthritis, they can make you more likely to react to environmental factors — such as infection with certain viruses and bacteria — that may trigger the disease.

 

Risk factors

Factors that may increase your risk of rheumatoid arthritis include:

 

Your sex. Women are more likely than men to develop rheumatoid arthritis.

Age. Rheumatoid arthritis can occur at any age, but it most commonly begins in middle age.

Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.

Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.

Excess weight. People who are overweight appear to be at a somewhat higher risk of developing rheumatoid arthritis.

 

Complications

Rheumatoid arthritis increases your risk of developing:

 

Osteoporosis. Rheumatoid arthritis itself, along with some medications used for treating rheumatoid arthritis, can increase your risk of osteoporosis — a condition that weakens your bones and makes them more prone to fracture.

Rheumatoid nodules. These firm bumps of tissue most commonly form around pressure points, such as the elbows. However, these nodules can form anywhere in the body, including the heart and lungs.

Dry eyes and mouth. People who have rheumatoid arthritis are much more likely to develop Sjogren's syndrome, a disorder that decreases the amount of moisture in the eyes and mouth.

Infections. Rheumatoid arthritis itself and many of the medications used to combat it can impair the immune system, leading to increased infections. Protect yourself with vaccinations to prevent diseases such as influenza, pneumonia, shingles and COVID-19.

Abnormal body composition. The proportion of fat to lean mass is often higher in people who have rheumatoid arthritis, even in those who have a normal body mass index (BMI).

Carpal tunnel syndrome. If rheumatoid arthritis affects your wrists, the inflammation can compress the nerve that serves most of your hand and fingers.

Heart problems. Rheumatoid arthritis can increase your risk of hardened and blocked arteries, as well as inflammation of the sac that encloses your heart.

Lung disease. People with rheumatoid arthritis have an increased risk of inflammation and scarring of the lung tissues, which can lead to progressive shortness of breath.

Lymphoma. Rheumatoid arthritis increases the risk of lymphoma, a group of blood cancers that develop in the lymph system.

 

Jan Ricks Jennings, MHA, LFACHE

Senior Consultant

Senior Management Resource, LLC

 

JanJennings@EagleTalons.net

JanJenningsBlog.Blogspot.com

 

724.733.0509 Office

412.913.9636 Cell

 

January 29.2022

 

  

                                                                Cardiomyopathy

 

Overview

Cardiomyopathy (kahr-dee-o-my-OP-uh-thee) is a disease of the heart muscle that makes it harder for your heart to pump blood to the rest of your body. Cardiomyopathy can lead to heart failure.

 

The main types of cardiomyopathy include dilated, hypertrophic and restrictive cardiomyopathy. Treatment — which might include medications, surgically implanted devices, heart surgery, or in severe cases, a heart transplant — depends on which type of cardiomyopathy you have and how serious it is.

 

Types

Dilated cardiomyopathy

Hypertrophic cardiomyopathy

Symptoms

There might be no signs or symptoms in the initial stages of cardiomyopathy. But as the condition advances, signs and symptoms usually appear, including:

 

Breathlessness with activity or even at rest

Swelling of the legs, ankles, and feet

Bloating of the abdomen due to fluid buildup

Cough while lying down

Difficulty lying flat to sleep

Fatigue

Heartbeats that feel rapid, pounding or fluttering

Chest discomfort or pressure

Dizziness, lightheadedness, and fainting

Signs and symptoms tend to get worse unless treated. In some people, the condition worsens quickly; in others, it might not worsen for a long time.

 

When to see a doctor

See your doctor if you have one or more signs or symptoms associated with cardiomyopathy. Call 911 or your local emergency number if you have severe difficulty breathing, fainting or chest pain that lasts for more than a few minutes.

 

Some types of cardiomyopathies can be passed down through families (inherited). If you have the condition, your doctor might recommend that your family members be checked.

 

Causes

Often the cause of the cardiomyopathy is unknown. In some people, however, it is the result of another condition (acquired) or passed on from a parent (inherited).

 

Certain health conditions or behaviors that can lead to acquired cardiomyopathy include:

 

Long-term high blood pressure

Heart tissue damage from a heart attack

Long-term rapid heart rate

Heart valve problems

COVID-19 infection

Certain other infections, especially those that cause inflammation of the heart

Metabolic disorders, such as obesity, thyroid disease, or diabetes

Lack of essential vitamins or minerals in your diet, such as thiamin (vitamin B-1)

Pregnancy complications

Iron buildup in your heart muscle (hemochromatosis)

The growth of tiny lumps of inflammatory cells (granulomas) in any part of your body, including your heart and lungs (sarcoidosis)

The buildup of abnormal proteins in the organs (amyloidosis)

Connective tissue disorders

Drinking too much alcohol over many years

Use of cocaine, amphetamines, or anabolic steroids

Use of some chemotherapy drugs and radiation to treat cancer

 

Types of cardiomyopathies include:

 

Dilated cardiomyopathy. In this type of cardiomyopathy, the pumping ability of your heart's main pumping chamber — the left ventricle — becomes enlarged (dilated) and cannot effectively pump blood out of the heart.

 

Although this type can affect people of all ages, it occurs most often in middle-aged people and is more likely to affect men. The most common cause is coronary artery disease or heart attack. However, it can also be caused by genetic defects.

 

Hypertrophic cardiomyopathy. This type involves abnormal thickening of your heart muscle, which makes it harder for the heart to work. It mostly affects the muscle of your heart's main pumping chamber (left ventricle).

 

Hypertrophic cardiomyopathy can develop at any age, but the condition tends to be more severe if it occurs during childhood. Most people with this type of cardiomyopathy have a family history of the disease. Some genetic mutations have been linked to hypertrophic cardiomyopathy.

 

Restrictive cardiomyopathy. In this type, the heart muscle becomes stiff and less flexible, so it cannot expand and fill with blood between heartbeats. This least common type of cardiomyopathy can occur at any age, but it most often affects older people.

 

Restrictive cardiomyopathy can occur for no known reason (idiopathic), or it can by caused by a disease elsewhere in the body that affects the heart, such as amyloidosis.

 

Arrhythmogenic right ventricular dysplasia. In this rare type of cardiomyopathy, the muscle in the lower right heart chamber (right ventricle) is replaced by scar tissue, which can lead to heart rhythm problems. It is often caused by genetic mutations.

Unclassified cardiomyopathy. Other types of cardiomyopathies fall into this category.

 

Risk factors

There are a number of things that can increase your risk of cardiomyopathy, including:

 

Family history of cardiomyopathy, heart failure and sudden cardiac arrest

Long-term high blood pressure

Conditions that affect the heart, including a past heart attack, coronary artery disease or an infection in the heart (ischemic cardiomyopathy)

Obesity, which makes the heart work harder

Long-term alcohol misuse

Illicit drug use, such as cocaine, amphetamines, and anabolic steroids

Treatment with certain chemotherapy drugs and radiation for cancer

Many diseases also raise your risk of cardiomyopathy, including:

 

Diabetes

Thyroid disease

Storage of excess iron in the body (hemochromatosis)

Amyloidosis

Sarcoidosis

Connective tissue disorders

 

Complications

An enlarged heart

Cardiomyopathy can lead to serious complications, including:

 

Heart failure. Your heart cannot pump enough blood to meet your body's needs. Untreated, heart failure can be life-threatening.

Blood clots. Because your heart cannot pump effectively, blood clots might form in your heart. If clots enter your bloodstream, they can block the blood flow to other organs, including your heart and brain.

Heart valve problems. Because cardiomyopathy causes the heart to enlarge, the heart valves might not close properly. This can cause blood to flow backward in the valve.

Cardiac arrest and sudden death. Cardiomyopathy can trigger abnormal heart rhythms that cause fainting or, in some cases, sudden death if your heart stops beating effectively.

In many cases, you cannot prevent cardiomyopathy. Let your doctor know if you have a family history of the condition.

 

You can help reduce your risk of cardiomyopathy and other types of heart disease by living a heart-healthy lifestyle and making lifestyle choices such as:

 

Avoiding the use of alcohol or cocaine

Controlling high blood pressure, high cholesterol, and diabetes

Eating a healthy diet

Getting regular exercise

Getting enough sleep

Reducing your stress

 

 

Many patients suggest to their physicians that the quality of their interactions, our mindfulness and the efficiency of their visits mean health care like they have never experienced.

Cardiomyopathy is a medical term for a number of genetic and nongenetic diseases involving the heart muscle that adversely affect the heart's mechanical pumping function and its electrical system. It can occur in people of all ages, races, or genders, and it is a frequent cause of sudden cardiac arrest and sudden cardiac death.

Jan Rick Jennings, MHA, LFACHE

Senior Consultant

Senior Management Resources, LLC

JanJennings@EagleTalons.net

JanJennings@Blog.Blogspot.com

 

 

412.913.0636 Cell

724.733.0509 Office

                  

January 26, 2022