Pro­longed pain in an­kle joint needs re­view

The Weekend Australian - Travel - - Health - LINDA CAL­ABRESI

Ten months ago I had a to­tal an­kle re­place­ment due to worn-out car­ti­lage. I still suf­fer from sore­ness and some pain, es­pe­cially when I bear weight. I go to the gym on a reg­u­lar ba­sis — row­ing ma­chine, tread­mill, bi­cy­cle — to try to en­sure good an­kle move­ment. I think it helps, but there does not seem to be any end in sight, es­pe­cially re­gard­ing the pain. Any sug­ges­tions? TO­TAL an­kle re­place­ment is a rel­a­tively new pro­ce­dure com­pared to hip and knee joint re­place­ment surgery. Fun­da­men­tally it is more dif­fi­cult to achieve a good re­sult, be­cause the range of move­ment at the an­kle is far greater than th­ese other joints. The gen­eral think­ing is that it takes about three months to re­cover from a to­tal an­kle re­place­ment. The re­cov­ery phase can take longer in some peo­ple, but the fact you are con­tin­u­ing to have symp­toms af­ter 10 months would sug­gest that you need to have the spe­cial­ist look again at your an­kle. It may be sim­ply that you need more time to re­cover, or per­haps you have been do­ing too much too soon on that an­kle be­fore the bone achieved max­i­mum strength. It is also pos­si­ble that you may have had a com­pli­ca­tion of the surgery, such as loos­en­ing of the com­po­nents of the re­place­ment. A re­assess­ment by the or­tho­pe­dic sur­geon is cer­tainly war­ranted. Linda Cal­abresi is a GP and ed­i­tor of Med­i­calOb­server. Send your queries to linda.cal­abresi@medobs.com.au I know that omega 3 fatty acids are good for you. Are there any other nat­u­ral sources of th­ese, other than fish? THE three most im­por­tant omega 3 fatty acids in nu­tri­tion are al­pha-linolenic acid (ALA), eicos­apen­taenoic acid (EPA) and do­cosa­hex­aenoic acid (DHA). Aside from cold-wa­ter, oily fish, which are high in EPA and DHA, other good sources of omega 3 fatty acids in­clude flaxseed oil, which is high in ALA. The body is able to syn­the­sise all the other im­por­tant fatty acids from ALA. Strangely enough, ki­wifruit also con­tain a high per­cent­age of omega 3 fatty acids, as do wal­nuts, one of the few va­ri­eties of nuts that do. The ev­i­dence would sug­gest it is cer­tainly worth­while try­ing to in­crease your omega 3 fatty acid in­take, as they have been shown to have ben­e­fi­cial ef­fects on a num­ber of med­i­cal con­di­tions in­clud­ing car­dio­vas­cu­lar dis­ease, de­pres­sion and arthri­tis. While a healthy diet is al­ways the pre­ferred op­tion, if eat­ing omega-3 rich foods is dif­fi­cult for you, there are al­ways sup­ple­ments. Af­ter many years of suf­fer­ing episodes of gid­di­ness, my 63-year-old mother has re­cently been di­ag­nosed as hav­ing Me­niere’s Dis­ease. Is this some­thing that can be cured or is she likely to con­tinue to have th­ese at­tacks into the fu­ture? ME­NIERE’S dis­ease gen­er­ally in­volves a triad of symp­toms, namely episodes of ver­tigo or dizzi­ness, in­creas­ing deaf­ness, and tin­ni­tus — a buzzing or ring­ing noise in the ear. Your mother is un­lucky in that Me­niere’s is a rel­a­tively rare con­di­tion af­fect­ing only about one in 2000 peo­ple, but on the plus side, while the symp­toms can be dis­tress­ing, the con­di­tion is not fa­tal. It is thought to be caused by an ab­nor­mal­ity of the fluid in the in­ner ear, that part of the ear that deals with bal­ance and hear­ing. Un­for­tu­nately Me­niere’s is a pro­gres­sive dis­ease, with all the symp­toms get­ting worse over time, in par­tic­u­lar the deaf­ness. While there is no known cure for Me­niere’s, there are a num­ber of treat­ments that are ef­fec­tive in less­en­ing the symp­toms, es­pe­cially the at­tacks of gid­di­ness. Th­ese in­clude di­uret­ics and a low-salt diet. Avoid­ing nico­tine and caf­feine has also been shown to help. In se­vere cases surgery may be nec­es­sary.

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