How long can you safely keep leftovers in the refrigerator?

Leftovers can be kept for three to four days in the refrigerator. Be sure to eat them within that time. After that, the risk of food poisoning increases. If you don't think you'll be able to eat leftovers within four days, freeze them immediately.

Food poisoning — also called foodborne illness — is caused by harmful organisms, such as bacteria in contaminated food. Because bacteria typically don't change the taste, smell or look of food, you can't tell whether a food is dangerous to eat. So if you're in doubt about a food's safety, it's best to throw it out.

Fortunately, most cases of food poisoning can be prevented with proper food handling. To practice food safety, quickly refrigerate perishable foods, such as meat, poultry, fish, dairy and eggs — don't let them sit more than two hours at typical room temperature or more than one hour at temperatures above 90 F (32 C).

Uncooked foods, such as cold salads or sandwiches, also should be eaten or refrigerated promptly. Your goal is to minimize the time a food is in the "danger zone" — between 40 and 140 F (4 and 60 C) — when bacteria can quickly multiply.

When you're ready to eat leftovers, reheat them on the stove, in the oven or in the microwave until the internal temperature reaches 165 F (74 C). Because they may not get hot enough, slow cookers and chafing dishes aren't recommended for reheating leftovers.

Courtesy - http://www.mayoclinic.org/

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What to Expect from Knee Replacement?

Knee arthroplasty or knee replacement surgery is for those whose knee joint has been badly destroyed which in turn causes chronic pain and impairment of functions. Knee arthroplasty is considered when all other treatments have produced no results. Generally patients suffering from osteoarthritis, in the age group beyond 50 years, are deemed to be prime candidates for a knee replacement surgery.

The Procedure

This is a surgical procedure where the diseased knee is either totally or partially replaced with an artificial (metal or plastic) joint. With advanced medical technology, it is now possible to perform keyhole surgeries or minimally invasive surgeries. The steps involved are:

1. Either general or spinal / epidural anesthesia is administrated to the patient.

2. While the patient is under, a 3-5 inch incision is made in the anterior / frontal part of the knee.

3. The knee part abutting the end of the femur or thigh bone is replaced with a metal component and the end abutting the top of the tibia (leg bone), is replaced with a furrowed plastic piece with a metal stem.

4. A plastic button maybe placed under the knee cap, depending on the condition of the kneecap.

5. The artificial parts or prosthesis function with the help of the surrounding muscles and ligaments.

In a knee replacement surgery, there is one other tissue called the posterior cruciate ligament that could be partially or totally replaced with a “polythene post”. The function of the posterior cruciate ligament is to support the hind leg from buckling backwards when the leg is in motion.

Benefits of Knee Arthroplasty

1. The incision made is very small in comparison to the traditional surgery.

2. There is lesser damage to the surrounding tissues, when an Orthopedic Surgeon is making the incision.

3. Instead of cutting through the tendons (traditional method), the Orthopedic Surgeon, operates between the fibers of the quadriceps muscles.

4. Healing time is quicker and extent of pain is considerably reduced.

5. Better motion due to less scar tissue formation.

Post Knee Arthroplasty

1. Hospital stay will be between 3-5 days.

2. A month or so later, the patient will observe a dramatic change in the movement of their knee joint.

3. There will be relief from the debilitating pain.

4. Post-surgery, the patient will be able to stand or move the joint. Generally, this can be done the very next day after the surgery.

5. To begin with the patient will walk with the help of parallel bars and later on with a walking devices like the walking stick, walker or crutches.

6. Six week later, the patient will be able to walk with minimum aid.

7. With the help of physiotherapy, the muscles are restored and the patient can then undertake any activity other than jumping or running.

Joint replacements initially were thought to last only 10 years but with advancing research it has been established that joint implants can last as long as 20 years, especially with advancing medical technology and avant-garde surgical techniques. 

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True beauty lies in motherhood!!

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Geriatric Depression: Causes, Symptoms and Treatment

Depression whether it occurs in the young adult or in the elderly is not normal. Generally, the tendency is to be dismissive of the condition, when it occurs in somebody 65 years old and beyond, attributing it to the normal aging process. On the contrary, it should be taken seriously and treated.

Depression in Senior Citizens is a mental and emotional disorder, and can have a negative and debilitating effect on the individual’s quality of life. However, the occasional “blue mood” or feelings of sadness are very normal.   

A significant percentage of the elderly suffer from subsyndromal depressions and if left untreated, it could evolve into a major depression disorder.

Some of the common symptoms associated with subsnydromal depression are:

-  Insomnia

-  Constantly feeling tired

-  Frequent thoughts of death

-  Trouble concentrating

-  Significant weight gain

-  Decelerated thinking

-  Hypersomnia

Causes

The causes of depression in the elderly cannot be isolated to any single factor but generally it is an amalgamation of biological, social and psychological factors. Reports from researchers suggest that the following could be the contributors to geriatric depression:

-  A family history of depression

-  Traumatic life events such as loss of a loved one or abuse

-  Low levels of crucial neurotransmitter chemicals in the brain

-  Limited mobility due to biological complications

-  Isolation

-  Fear of death

-  Prolonged substance abuse

-  Change of location or financial status due to retirement, difficulty in making the transition

-  Deaths of peers, friends, loved ones, widowhood or divorce

-  Chronic medical conditions

Signs and Symptoms of Geriatric Depression

Regardless of the age group, the signs and symptoms of depression are the same and these include:

-  Apathy

-  Crying spells

-  Changes in appetite

-  Fatigue

-  Feelings of worthlessness

-  Irritability

-  Lack of concentration

-  Physical aches and pains – more often than not, these physical aches and pains are not related to any other medical condition and are because of depression

-  Restlessness

-  Sadness

-  Sleeping problems

-  Thoughts of suicide

-  Withdrawal

Diagnosis

Detecting geriatric depression in an elderly person is quite difficult, so also diagnosing and treating it. A psychiatrist, who is a trained professional in both mental and emotional illnesses, can help diagnose symptoms of geriatric depression by checking the mood, behavior, everyday activities and family health history of the patient. There are also many tools available to help diagnose the type of depression (minor, major and Dysthymic disorders), a patient may have. The Geriatric Depression Scale or GDS is the most widely used scale to measure the level of depression in the elderly. A person is determined to have depression if the symptoms displayed are present, for no lesser than 2 weeks.

Treatment of Geriatric Depression

In the aforesaid paragraphs it has been discussed that geriatric depression cannot be attributed to any one cause. Likewise, there are multiple treatment options, each tailored to the needs of each patient. Discovering the right treatment may take time. Typically, any treatment devised will involve a mix of medication, therapy and lifestyle changes.

Several therapies are available, such as talk therapy, art therapy, cognitive behavior therapy and more. Lifestyle changes like increasing physical activities, having regular visits with family and friends, eating a well-balanced diet, finding a hobby or activity of interest, getting sufficient sleep, are used to treat depression in the elderly. There are a variety of medications that are used in the treatment of geriatric depression.

Living with and Managing Geriatric Depression

Aging certainly compounds the difficulties correlated to geriatric depression and can be difficult to diagnose. However, once diagnosed, with proper care and treatment, living and managing geriatric depression in an elderly loved one, is possible. The right treatment and care will vastly improve the quality of life of the elderly person, especially when family and friends participate, offering their support and help.

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Frozen Shoulder: Factors, Stages, Treatments

Stiffness around the shoulder joint, debilitating pain and limited range of movement in the shoulder are all symptoms of “Frozen Shoulder” or “Adhesive Capsulitis”. The onset of this disorder is very slow and to regain the use of the shoulder, free of pain is also a slow process.

Composition of the Shoulder

The shoulder comprises of a ball and socket joint. Three bones conjoin to form this joint –

1. The shoulder blade or scapula

2. The collarbone or clavicle

3. The upper arm or humerus

The head of the humerus fits into the shallow socket of the shoulder joint, and the connective tissue also known as the shoulder capsule, envelops the joint. Synovial fluid present in the shoulder capsule, lubricates the shoulder capsule and the joint and thereby enables the shoulder to move more easily. 

When the connective tissue in the shoulder capsule becomes rigid due to the formation of tight bands of tissue or adhesions, with a simultaneous decrease in the level of synovial fluid, it causes stiffness and limits the range of motion, of the shoulder. This condition is referred to as “Frozen Shoulder”.

Stages of Adhesive Capsulitis

• First stage or Freezing Stage – it is a slow process and with time the pain increases and becomes worse, consequently leading to loss of motion in the shoulder joint. It takes anywhere from 6 weeks to 9 months for the onset of a freezing shoulder
• In stage two (4 months to 6 months), or the Frozen state, the stiffness in the joint continues, however, the pain may subside slightly. During this stage, daily activities involving the movement of the shoulder will be very difficult
• In the Thawing or third stage, the motion in the shoulder begins to improve, but to regain complete or near to normal motion in the shoulder, it may be anywhere from 6 months to 3 years

Factors

• Affects people in the age group between 40 – 70 years
• People with chronic ailments like diabetes or suffering from stroke, hypothyroidism, hyperthyroidism, Cardiac and Parkinson’s diseases
• Can be caused by surgery, such as mastectomy, or due to a fracture or any other injury

Diagnoses

The doctor will either conduct a physical examination or will request for an x-ray or MRI to rule out other causes or injuries. The Orthopedic Surgeon may also request an Ultrasound if suspecting a thickening of the broad ligament (coracohumeral ligament), which helps strengthen the capsule in the shoulder joint. Thickening of the coracohumeral ligament or CHL is another suggestive factor of adhesive capsulitis or frozen shoulder.

Treatments

The minimum time taken for a frozen shoulder to regain its normal range of motion or near normalcy, could be 3 years, if left untreated.   

The aim of treating a frozen shoulder is to curb the pain and to improve the range of motion in the shoulder and to strengthen the shoulder.

Non-Surgical Treatments

Include:

• Prescription of anti-inflammatory, non-steroidal drugs such as analgesics or ibuprofen
• Injecting Cortisone, a steroidal medication, directly into the shoulder joint
• Physiotherapy and heat treatment – In some cases heat treatment may be employed to loosen the shoulder joint, before performing the stretching and range of motion exercises, which are performed under the supervision of a physiotherapist 

Surgical Treatment

When a patient diagnosed with frozen shoulder disorder, fails to respond to any of the non-surgical treatments, listed above, then surgery will be considered. 

The aim of performing surgery is to remove the stiffness from the joint and to stretch the connective tissue. This is done either by manipulation under anesthesia (MUA) or through shoulder arthroscopy. 

MUA – This procedure is performed by the Orthopedic Surgeon. Anesthesia is administrated and while the patient is under, the Orthopedic Surgeon will manipulate the shoulder joint to move, causing the capsule and scar tissue to either tear or stretch, consequently releasing the stiffness and increasing the range of motion.

Surgical Capsular Release or Shoulder Arthroscopy – After anesthesia has been administrated, the Orthopedic Surgeon will make 2 or 3 tiny, keyhole incisions into the afflicted shoulder. An arthroscope (camera measuring 3 and half millimeter) is inserted into one of the incisions. The images from the camera are projected onto a computer screen. Through the other two incisions, microsurgical instruments are inserted to surgically release the frozen shoulder.

Sometimes, the orthopedic surgeon may use both the manipulation and arthroscopy procedures simultaneously, to get the maximum outcomes. 

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Interventional Radiology Treatment of Acute Cholecystitis

Percutaneous Cholecystostomy is a minimally invasiver technique for the treatment of acute cholecystitis.  We recently performed the procedure for an elderly gentleman suffering with severe abdominal pain. With help of ultrasound and fluoroscopy in our cathlab, the gall bladder was punctured through the skin and liver (transhepatic approach).  A radio opaque dye was then injected into the gall bladder to confirm the position. Using modified seldinger's technique, a drainage catheter was passed into the gall bladder, draining the infected bile and sludge outside into a sterile bag.  The pain dramatically reduced and patient was discharged to home. 

Chiba Needle used to gain access into gall bladder

Dilator passed over hair wire by Seldinger Technique

Final position of drainage catheter

Illustration showing the procedure 

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Minimally invasive intervention for Liver Cancer

We recently performed superselective Trans Arterial Chemo Embolization (TACE) for liver cancer.  The patient was an elderly lady who had inoperable liver cancer. Using microcatheters (less than a millimeter diameter), we reached the arteries supplying the cancer.  The skin incision in the groin was less than 3 mm in size and no sutures were required. The chemotherapy agent(to kill cancer cells) was injected directly into the arteries supplying the cancer.  By this method, the general side effects seen with systemic chemotherapy will be markedly reduced. After the procedure, the patient needs to stay for a day or two for observation and can go back home. Regular monitoring of the cancer by CT scan is required to monitor shrinkage of the cancer. 

Hepatic Angiogram showing tumour vascularity

Selective chemo embolisation of tumour feeders

Post treatment CT showing selective uptake of agent within the tumour

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