Is it essential to go for physio after a knee replacement op? ‘Older people usually need more physio to rebuild strength’
QI’M DUE to have a knee replacement soon and have been told I will need physiotherapy afterwards.
I live miles from the hospital and would need to pay for taxis every time. Couldn’t I exercise at home?
AHAVING a knee replacement is a major operation which involves cutting not just the skin, but also the strong ligaments that support the joint and the tendons that attach the new parts to muscles and enable it to move.
A crucial part of recovering well is physiotherapy and the NHS recommends a minimum of six weeks of this (the same applies to a hip replacement).
Physiotherapy is not only essential in getting the joint moving again but can help improve pain management, giving you confidence in knowing what you can and cannot do, which should gradually improve over time. It can also help with your balance and help to prevent falls.
Recent research shows that younger patients living in urban areas were more likely to go to physiotherapy after surgery but older patients usually need more, not less, than younger people in order to rebuild strength.
Doing exercises at home and gradually becoming more active and independent is important but many older people lose confidence in what they can and cannot do, how far they should push themselves and how much pain is reasonable to expect.
So I really would encourage you to go to as many physio sessions as you can, as it will help you to get back to moving normally again as quickly as possible.
QI HAD a stroke last year and my speech was affected for a while before returning to normal. But this year, all of a sudden, it has gone completely. I have had speech therapy but it did not work. I have to write everything down and tell people in writing that I can’t talk.
Why has this happened and is there anything I can do?
AA STROKE occurs when the blood supply to part of the brain is lost, damaging the area of the brain that it supplies.The functions of different parts of the body are controlled by different parts of the brain, so the symptoms of a stroke can vary depending on which part of the brain has been affected and also the size of the damaged area.
If the part of the brain that controls speech is damaged, then talking can become a problem, ranging from difficulty in finding the right words to slurring or being completely unable to speak.
Most people with communication difficulties do recover to some extent and if there was only damage to a small area of the brain, then speech can return. But if the blood supply is blocked again, which may happen in a narrowed artery, then further brain damage can occur, with more long-lasting effects.
Recovery from this can be difficult to predict and in some, sadly, there may be some permanent loss of speech ability.
Even if you don’t recover very much, there are many ways to communicate that don’t rely only on speaking.Your facial expressions, eye contact, writing and drawing can all help, along with technology.
A good speech and language therapist will not only help you to try to talk, but will also focus on teaching you other coping strategies, including gestures, alphabet charts and notebooks – anything that helps you to get across what you want to say.
It may be worth asking your GP if you could have some more sessions.You can also get a lot of help from the Stroke Association and their support groups (0303 3033 100, stroke.org.uk).
QI HAVE had a very bad attack of hand, foot and mouth virus since last November. My hands were covered in blisters and I was put on steroids for five days. I also had swelling in my fingers and difficulty walking.
Two weeks ago my thumb nails came off and now my other nails are shedding. My doctor couldn’t offer any advice. I asked if I was lacking vitamins or if a blood test would be useful, but he didn’t think so. Do you have any advice?
AHAND, foot and mouth disease is usually a short, mild illness that mainly affects children. It generally starts with feeling being a bit unwell for a day or two, with a slight fever, followed by spots in and around the mouth.
A day or so later, spots develop on the skin – usually the hands and feet – but sometimes on the legs, buttocks and genitals too.The spots are similar to those of chickenpox but are smaller and aren’t usually itchy, though they can be a bit sore.
It is caused by a viral infection, so antibiotics do not help, but both the spots and fever usually clear within a few days.
Occasionally hand foot and mouth can occur in older children, but the disease is usually very mild compared to younger children, though occasionally it can cause more severe symptoms.
However, it does not cause blistering and your symptoms do not sound to me like hand, foot and mouth, but rather a type of eczema called pompholyx.
This causes blisters across the fingers, the palms and sometimes the soles of the feet and is usually seen in people over 40.The blisters usually heal within a few weeks, but the skin tends to become dry, then crack or peel. If the nail beds are affected, the nails may be deformed, or become very brittle.
It’s not clear what causes pompholyx. It may be triggered by an allergic reaction to something that has touched your skin or an infection on your skin.
It can be treated with steroids and though it may occur once and never come back, it may come and go over several months or years, so if your skin continues to blister then go back to your GP.
If you have a health question for Dr Leonard, write to her in confidence at the Daily Express, One Canada Square, Canary Wharf, London E14 5AP or email yourhealth@ express.co.uk. Dr Leonard regrets she cannot enter into personal correspondence or reply to everyone.