Saturday, June 1, 2013

What Is Iliotibial Band Syndrome?


Do you know what is Iliotibial Band Syndrome or ITBS? To understand more about ITBS, it's essential to learn about the iliotibial band. The iliotibial band is a ligament that runs down the hip to the shin on the outside of the thigh. Working in conjunction with other thigh muscles, the iliotibial band offers stability to the knee joint. This band becomes narrow when it comes near the knee, and it can rub against the bone, causing inflammation.

ITBS is a common injury for serious runners, cyclists or hikers. When the leg is repeatedly turned inward, the iliotibial band is inflamed, and the result is Iliotibial Band Syndrome. This inflammation usually takes place on the outside of the knee joint at the end of the thigh bone where the lateral epicondyle is located. Under normal circumstances, the smooth gliding motion of the iliotibial band is facilitated a bursa which is found between the muscle and the bone. Once the iliotibial band is inflamed, it cannot glide quite as smoothly, resulting in pain in the knee. Since the pain occurs on the outside of the knee, many people who suffer from ITBS mistakenly assume that they have a knee injury.

One thing about ITBS is that it affects both amateur and seasoned athletes. When iliotibial band is inflamed, you will feel pain when you exert pressure on your knee joint. Some people stubbornly try to work through the pain but they will discover that the pain becomes more intense as they continue running, walking, or cycling as they exert more pressure on the knee joint. What are some of the symptoms of ITBS? The most common symptom of ITBS is the detection of pain on the outside of the knee. In the beginning stages, you may feel a pricking or stinging sensation, and then, you will feel some pain when your heel hits the ground. As the situation becomes worse, the pain may be so excruciating when you climb or descend a flight of stairs or even when you walk. In some cases, there will be a popping or snapping sensation when the knee is bent, and there may also be some swelling in the affected area.

How do you treat ITBS? The easiest treatment is rest. One of the main causes of ITBS is overexertion of the iliotibial band so it makes sense to rest the band to allow it to recuperate. Another treatment is to use ice on the affected area. This will help to settle the inflammation and relieve the pain. You have probably seen some professional athletes with ice packs on their knees so it's an effective treatment. There are also anti-inflammatory medications which may be helpful like naproxen and ibuprofen. It's best to consult your doctor before you take these medications because they may have side effects or interactions with other medications. Other types of treatments for ITBS include massage, physical therapy, and some special stretches or exercises. Depending on the severity of the ITBS, it can take weeks or months to recover fully so it requires a certain level of patience.

Treating a Degenerative Knee Condition - The Problem That Can Make You Want to Give Up


Are your knee(s) painful?

While osteoarthritis or degenerative knee conditions are not always an emergency condition, it is a severe condition that can cause debilitating pain and gets progressively worse over a period of time. In a worse case scenario, the joint can get severely deformed as alignment problems advance and can eventually cause someone to lose the ability to walk.

A.) Symptoms of A Degenerative Knee Condition

The symptoms of degenerative knee condition include:

1.) Pain in the knee when moving or standing still

2.) Stiffness in the knee joint

3.) Swelling around the knee

These symptoms usually bring the person who is suffering from osteoarthritis to the doctor as the pain worsens and their mobility gets increasingly more restricted.

B.) Diagnosing A Degenerative Knee Condition

Your doctor will confirm that you have osteoarthritis only after examining an X-Ray of the knees. A doctor will rarely make a clinical diagnosis of this condition as the symptoms can also mirror other conditions. Once the diagnosis is complete, you can then discuss treatment options with your physician.

C.) Treatment for A Degenerative Knee Condition

Treatment for this disease can range from over the counter pain medication to wearing a knee brace during flare-ups to getting actual knee replacement. The treatment depends upon the health of the individual, their age and the progression of the condition.

• Cortisone Injections: While cortisone shots are effective for relieving the pain, their effects are not long lasting. With these shots, you can expect to get relief from pain for anywhere from a few days to a couple of weeks. These shots can also be expensive and will require regular visits to the doctor administering the shots.

• Knee Surgery: Knee surgery is usually considered the last resort and is only recommended for those who have a severe case and for whom the success rate is potentially high. Surgery, which entails rebuilding the knee joint, is an invasive procedure. It can be very expensive and also takes months from which to recover. Rehabilitation will be a large part of recovery and can be indefinite, causing another dent in your finances. You should discuss this option thoroughly with your doctor and weight the risks as well as the benefits before opting to undergo full knee surgery to treat your degenerative knee condition.

• Knee Braces: Using a knee brace is the least invasive way to treat the condition. Let's face it, sometimes you need surgery, but these braces can be the one thing that helps take away your pain like no other! When you take your knee stability to the next level, you can feel relief as soon as the brace wraps snugly around the knee. Many people find this the preferred treatment option as it offers them relief from pain without hampering their mobility as they go about their daily tasks.

If you are concerned that you may have degenerative knee condition, you should seek a firm diagnosis from your doctor. While this is an incurable condition, there are millions of people who suffer from this type of chronic inflammation and who treat it with the use of over the counter pain pills and by wearing a knee brace.

Fighting Osteoarthritis: An All Natural Approach to Relief


Osteoarthritis is a form of joint disease that develops when cartilage deteriorates. Over time, the space between bones narrows and the surface of the bones change shape, leading eventually to friction and joint damage. Osteoarthritis can affect more than one joint in the body, but affects some more than others.

There are numerous causes of osteoarthritis. Some examples include:

Endocrine: Diabetes a disorder of the endocrine system may promote osteoarthritis. Other endocrine disorders also may increase risk, including acromegaly, hypothyroidism, hyperparathyroidism, and obesity. Diabetes can also cause nerve problems which cause loss of sensation in the limbs and joints, causing the body not to recognize when it is injured.

Inflammatory joint disease: This includes infected joints, chronic gouty arthritis, and rheumatoid disease.

Congenital: Abnormal anatomy such as unequal leg length may cause osteoarthritis.
Metabolic: Diseases causing errors of metabolism may cause osteoarthritis. Examples include Paget's disease and Wilson disease.

Genetic: A genetic defect may promote breakdown of cartilage. Examples include collagen disturbances such as Ehlers-Danlos syndrome.

Posttraumatic: There are many traumatic injuries of the joint that can promote osteoarthritis, such as a broken bone that heal out of alignment causing loss of stability, or damage to the joint cartilage. Microtraumas that occur over time, such as repetitive movements, or overuse can contribute to osteoarthritis.

Other causes include nutritional problems, hemophilia, and sickle cell.

Treatment of osteoarthritis begins by eliminating risk factors, early diagnosis and monitoring progression of the disease, and treatment of pain. Regaining mobility is important. The common course of treatment includes physical and occupational therapy, weight reduction, exercise, assistive devices (orthoses) drug therapy, and surgery.

Osteoarthritis increases aggregate health care expenditures by $186 billion annually. Osteoarthritis raised aggregate annual medical care expenditures in the U.S. by $185.5 billion according to researchers from Stony Brook University. The cost of Medication and surgery for osteoarthritis is significant. The average annual medication cost per individual is $4,434.50. Out-of-pocket medication expense averages $1,036.50 per person annually. These averages do not include the cost of office visits.

There are over 100 medications for osteoarthritis. However, most of these possess harmful side effects that are often worse than the symptoms of osteoarthritis. One of the most popular of these is Celebrex. On the Celebrex page of the website Rx List (rxlist.com), the first thing you are hit with are these two health warning associated with Celebrex:

WARNING

CARDIOVASCULAR AND GASTROINTESTINAL RISKS

Cardiovascular Risk

CELEBREX (celecoxib) may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. All nonsteroidal anti-inflammatory drugs (NSAIDs) may have a similar risk. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk.

CELEBREX (celecoxib) is contraindicated for the treatment of perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.

Gastrointestinal Risk

NSAIDs, including CELEBREX (celecoxib), cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events.

See rxlist.com/celebrex-drug.htm

According to rxlist.com the following is not a COMPLETE list of side effects associated with Celebrex.

Possible side effects of Celebrex

Serious side effects:

Chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance; black, bloody, or tarry stools; coughing up blood or vomit that looks like coffee grounds; swelling or rapid weight gain; urinating less than usual or not at all; nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; or bruising, severe tingling, numbness, pain, and muscle weakness.

Less serious side effects may include:

Upset stomach, mild heartburn, diarrhea, constipation; bloating, gas; dizziness, nervousness, headache; skin rash, itching; blurred vision; or ringing in your ears.

OTHER WARNINGS:
Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Another factor to consider in treating osteoarthritis with Celebrex and other similar drugs is the toxicity that builds up in our bodies from the use of prescription medication.

Due to the high number of side effects and other health risks, millions are now turning away from modern healthcare and turning to natural health alternatives, which provide a much safer treatment alternative.

What alternatives exist for osteoarthritis sufferers? In recent years the popularity of Glucosamine and Chondroitin products, such as Schiff Glucosamine Plus MSM 1500mg or a blend such as Doctor's Best Glucosamine/Chondroitin/MSM has continued to increase substantially.

Results from several well-designed scientific studies suggest that glucosamine supplements may be an effective treatment for osteoarthritis, particularly osteoarthritis of the knee or hip. In general, these studies suggest that glucosamine reduces pain, improves function in people with hip or knee osteoarthritis, reduces joint swelling and stiffness, and provides relief from osteoarthritis symptoms for up to 3 months after treatment is stopped. Most studies have shown that glucosamine needs to be taken for 2 - 4 months before it is effective, although you may feel some improvement sooner. Glucosamine and chondroitin can be used along with nonsteroidal anti-inflammatory drugs (NSAIDs) to treat osteoarthritis.

Other natural alternatives include:

Omega-3 fatty acids: Omega-3 fatty acids come in many forms, such as, but not limited to, Chinook salmon, sardines, cooked soybeans, baked or broiled halibut, steamed or broiled shrimp, raw tofu, baked or broiled snapper, and baked or broiled scallops. However, when your diet just doesn't contain enough of these omega-3 rich foods, there are numerous supplements available, such as Trident Krill Oil, 1000 mg, or Schiff MegaRed Omega-3 Krill Oil 300 mg.

Avocado soybean unsaponifiables (ASU): A few preliminary studies suggest that this natural vegetable extract may help reduce the symptoms of OA and possible even slow progression of the disease. ASU is available in supplements such as, ASU300-Avocado Soy Unsaponifiables, w/SierraSil, Nutramax Laboratories Incorporated - Avoca Asu, and Cosamin ASU Active People Capsule.

Devil's Claw: Several studies support the use of Devils claw (Harpagophytum procumbens) as an anti-inflammatory to relieve pain and stiffness of osteoarthritis, particularly of the knee, hip, and back. Devil's Claw is a desert plant found in the South African desert. For centuries the native people of the South African desert dried this root to treat pain. The most popular Devil's Claw supplements include: Nature's Way - Se Devil's Claw, 350 mg, and Nature's Answer Devil's Claw Root, 1-Ounce liquid.

Other natural alternatives include: Ginger, Willow Bark, Capsaicin cream, and boswellia. There are several natural cream blends such as Now Foods Joint Support Cream.

Take back control of your health by learning more about natural health alternatives today.

ACL Surgery - How to Save Money on Your Anterior Cruciate Ligament Reconstruction


Need an ACL Reconstruction? Scared of what it might cost you? Looking for ways to save a few dollars?

If you have been diagnosed with a torn Anterior Cruciate Ligament and need to have ACL Surgery, you need to be prepared for what it will cost you. As part of your necessary preparation for an ACL Reconstruction, It is important to find out about all the costs well in advance.

Here are a number of ways that you can save money on your knee surgery and recovery journey:

1. Get Private Health Insurance - Make sure that you obtain the right level of insurance cover. You'll especially want to look for higher levels of cover from orthopaedics and physiotherapy. Check the waiting times as some health insurance plans require you to have had the insurance in place for a certain amount of time before you can make any claims. And of course, shop around for your health insurance.

2. Borrow An Exercise Bike - One of the primary muscle groups that you'll need to strengthen and exercise after an ACL Reconstruction is the quadricep muscle group. One of the most effective ways to do this is to ride an exercise bike. My Orthopaedic Surgeon told me that if I did nothing else, I should ride an exercise bike regularly. If you can borrow one instead of paying to use the one at the gym, you could save yourself a lot of money.

3. Buy a Theraband ($5 investment instead of $100's of dollars at the gym) - There are many different types of exercises to strengthen your leg muscles following ACL Surgery, but one of the cheapest ways is to buy a theraband (quite possibly from your physiotherapist) for your strengthening exercises, such as for your hamstring.

4. Explore Insurance Claim Options - You may be in a position where you are able to make a claim against the insurance policy of another party that is partly responsible for your injury. For example, if you tripped or twisted in a public place where there was a hazard that should not ordinarily be there such as a hole or broken path, you may find that the local council or owner of the property has some form of insurance policy against which you can make a claim. They may be able to pay for all of it or perhaps just a part of it.

5. Use a Referring GP that Bulk Bills - You may find that you need to see your General Practitioner (that is, your local family doctor) at various points throughout your ACL injury experience. Your visits to the GP will generally be for initial diagnosis, referrals to Orthopaedic specialists, referrals for X-rays or MRI scans, to diagnose subsequent side effects following surgery, and for prescriptions. The cost of visits to the doctor can add up if you don't use a GP that bulk bills.

6. Don't buy all the prescribed pain killers - After an ACL reconstruction, your surgeon will most likely give you three prescriptions:

1) Anti-inflammatory tablets
2) Mild Pain killers
3) Strong Pain killers

With the advancements in ACL Surgery in recent years, they have also been able to minimise the amount of pain experienced after the Anterior Cruciate Ligament Reconstruction. In most cases, you will only need the mild pain killers if any at all. You may find that you don't need any pain killers at all, however for peace of mind most patients would buy the mild pain killers just in case.

7. Do a big grocery shop BEFORE your ACL reconstruction (so that you don't spend on food orders and deliveries for the first 2 weeks) - For the first couple of weeks after your ACL Surgery, you might find it difficult to drive or walk to the shops and then to push a trolley around while you do your grocery shopping. If you do make it that far, then you have the challenge of carrying the shopping bags into your home, not to mention being against your physiotherapists advice of carrying weights. The alternative to this is paying for takeaway food or ordering deliveries. This can be an expensive alternative.

8. Use your physio's equipment (instead of the gym) - A big part of your ACL Recovery Program will involve strengthening muscles that support your knee and many people benefit from going to the gym. However, many Physiotherapists also have some gym equipment in their clinic. One way to save on expensive gym visits and memberships is to ask if your Physiotherapist would be happy for you to use the equipment at the clinic for your exercises during the first couple months. At $10-20 per gym visit, you could save yourself hundreds of dollars.

9. Pay for your surgery up front (and ask for a discount for doing so) - If you are able to pay a lump sum for your surgery up front, then you may be pleasantly surprised when you ask your orthopaedic doctor and the anaesthetist for a bit of a discount for paying up front or prior to surgery. The potential discounts can add up to a few hundred dollars.

10. Use your credit card to obtain rewards points - Now this suggestion is more about making your dollars work a bit harder for you. You will find some great benefits from getting a credit card that gives you reward points for every dollar you spend. With the thousands of dollars you spend and the number of rewards points you can accumulate, by the end of your recovery program you may be able to redeem your points for something special to treat yourself or even travel flights to take yourself on a well-earned holiday.

While the 10 ideas listed here are an excellent place to start, it is important to be fully informed of the costs that will face you as you go through the process of recovering from your ACL injury and getting back to your favourite sport. hobbies, and a normal way of life.

Nowitzki Should Not Flop On His Bad Knee


Dirk Nowitzki is willing to wait out his swollen right knee while Dallas Maverick fans and coaches hold their universal breaths that the big German will not need arthroscopic surgery. At age 34 Nowitzki is undoubtedly in the tail end of his remarkable career but as of now the Mavericks are still Dirk's team. As Dirk goes so will the Mavs.

"I'm doing everything I can not to have surgery," Nowitzki told ESPNMonday after sitting out a second consecutive preseason game due to the knee. "I guess that's obvious that I really don't want it done now. If I want to do it, I would love to do it after the season, get through the season somehow, but the swelling came back three or four times now. That's obviously not good news.If it's going to keep swelling up on me, that's obviously not a way to go throughout an 82-game season and hopefully long playoff run."

There won't be any long playoff run if the knee is an issue all season and I can denote it will be an issue unless a doctor goes in and finds out what the problem is, right now. The troublesome knee has already been drained twice and Dirk says there won't be a third time. That means without surgery Nowitzki will trust his balky knee night after night on the hardwood of the NBA. Without getting the knee fixed it appears likely to me Nowitzki will miss multiple games scattered around the season. The Mavericks can't afford that.

Two years removed from winning the NBA Title the Mavericks are going to be a reach to make the playoffs this season WITH a healthy and productive Nowitzki. Without him they are a lottery team for the first time since 1999, Nowitzki's rookie year.

Who will play the Power Forward position in Dirks absence? Most of the minutes would go to 33-year-old Elton Brand. Nowitzki's knees are like gold compared to Brand's, who averaged 28 productive minutes with Philadelphia as a starter last season. Dallas will need more than 28 minutes from Brand if Dirk is out. I like Brandan Wright, but the 25-year-old played in a career high 49 games last season for Dallas and is not ready to step into such a major role.

The answer is to shut Dirk down right now. Today. Go get the knee scoped. Hopefully it's a minor issue that can be fixed and causes Nowitzki to miss 3 to 6 weeks. Worse case? There is structural damage to the knee and he misses the season. If that's the news, then that's the news. Coach Rick Carlisle can then move on and try to build the team this season around O.J. Mayo and the three rookies taken in the last draft, Bernard James, Jae Crowder and Jared Cunningham.

"Once they look in there, it might be a lot worse, might be a lot better. I guess that nobody really knows [the recovery time].", Nowitzki said. "No doctor in the world can tell you".

Do it now. Dallas will be at the Lakers to open the season on October 30. With or without Dirk.

Knee Arthritis Treatment And Pain Relief


Knee arthritis can also be called osteoarthritis. Osteoarthritis is essentially the wearing down of the cartilage surrounding the knee which occurs simply as people age. Another common form of knee arthritis is Rheumatoid Arthritis, which results in swelling within the joint and damage to the cartilage. Not only do these forms of knee arthritis affect the joints and cartilage, they can also have a serious impact on the surrounding ligaments, muscles and tendons.

Osteoarthritis is often the result of increased strain on the joint due to weight, or repeated injury or damage. Knee arthritis is definitely more common in middle aged to elderly persons. A younger sufferer of knee arthritis has usually inherited the condition- it does have a genetic disposition, or it can be the after affect of a serious knee injury- more common in sports men- specifically footballers. Rheumatoid arthritis is more common in younger people for this reason.

There are various warning signs for potential sufferers of knee arthritis- these could be restricted knee movement, localized swelling or inflammation and discomfort and pain. The most key indicator however is stiffness- when the knee has not been moved for a period of time, and then movement is not fluid- this is a possible indicator of knee arthritis. Another warning sign is a clicking sound coming from the joint when it is extended- this can be cause by other knee conditions other than knee arthritis however. Whatever the potential symptom, the patient will always need to have an X-Ray before any sense of a diagnosis can be performed by the recommending physician or doctor.

There are less related methods of testing for knee arthritis as well. The main one is simply a blood test- doctor's will be able to see deficiency in the blood results. An arthroscopy will also most certainly confirm the diagnosis of knee arthritis, however this will only be recommended if there is an intention to fix the knee arthritis.

Here are the 4 main treatments for knee arthritis:

Exercise - It has been proven that one of the most significant factors in causing knee arthritis is being overweight. If the sufferer can begin a gentle exercise regime in combination with a healthy diet, there is every chance that the knee arthritis symptoms will ease.

Physical therapy - There are sets of exercises which a physician or doctor can recommend. These exercises benefit the knee arthritis by focusing mobility in certain parts of the knee where the stiffness is occurring, thus easing the symptoms of the knee arthritis.

Medication - Often sufferers of knee arthritis will be administered basic pain killers such as Aspirin, but also Acetaminophen and other non-steroidal anti-inflammatory medications.

Surgery - Surgery on knee arthritis needs to be carefully considered and evaluated by your doctor before being pursued as a treatment option for knee arthritis. Certain factors such as health, weight age all need to be considered before deciding it is the best method to take. Usually all other methods of knee arthritis treatments will be exhausted before surgery will be considered.

Knee arthritis like most forms of arthritis can be easily managed and the symptoms controlled. It is crucial to diagnose as early as possible, as this will lead to a greater chance of curing the knee arthritis.

Friday, May 31, 2013

Arthritis - What to Expect at a Doctor's Examination


After conducting the necessary physical examination, especially on joints like your knees, hips and legs, your doctor will require a detailed enumeration of your medical history for a more accurate diagnosis. You will be asked questions about:


  • the first time you felt pain in your knee

  • whether you've had previous knee pain, and why

  • the length of time you've been experiencing pain

  • whether the pain is constant or intermittent

  • whether the pain affects one or both knees

  • the precise area where pain is felt - above, below, at the sides, or on the knee itself

  • the severity of the pain

  • whether the knee feels tender and battered

  • your ability to put weight on your knee or walk

  • any history of injury or accident involving the affected joint

  • whether the whole limb or just the knee has been used excessively

  • your normal day-to-day activities and exercise regimen

  • the home remedies you've used to treat the knee and whether they alleviated any of the symptoms

  • other signs like hip, leg or calf pain, and swelling of the knee and its surrounding areas

  • any incidence of fever

Your doctor may also order the following tests:


  • extraction of a fluid sample from your knee for analysis

  • knee x-rays

  • MRI scan of the knee to determine any tears in the ligaments or meniscus

To counter pain symptoms, your doctor may prescribe NSAIDs, non-steroidal anti-inflammatory drugs that are more potent than over-the-counter painkillers. For more severe symptoms, injectible steroids can be administered to cut down pain and inflammation.

Other methods of treatment may involve sessions with a physical therapist for stretching and strengthening joint exercises, or visits to a podiatrist for orthotics fittings. These remedies can avert the recurrence of arthritis symptoms.

When the disease has progressed to a stage where there is extensive bone and cartilage damage and severe pain and inflammation, surgery may be necessary to replace the affected joint. While minor injuries involving ligaments strains and tears will heal naturally with self-nurturing home care or the use of supportive apparatus, substantial tears and fissures, like a torn meniscus will require arthroscopic knee surgery.

Ligament and meniscus-related conditions result in slow and painstaking recovery, often involving the use of crutches and prolonged physical therapy.

Learning the Chip Shot


One vitally overlooked part of the game of golf is the chip shot. Very few people spend any time learning how to play the chip shot and even fewer actually practice it. Strangely enough for the vast majority of golfers it is one of the most often played shots after putting. You see the average club golfer is unlikely to hit even 50% of greens in regulation and must therefore rely on his short (chipping) game to get the ball on to the green and close to the hole.

The chip shot is very different to the full golf swing and the following tips will help you gain confidence in playing it. These instructions are for a right handed player.

The Set-up. Place the ball just back of center of your feet with your feet only twelve inches apart. Set the club down behind the ball and square to the intended target line. Not the target line is not necessarily the target and will depend on whether there is any break to be allowed for. (In this position it is a good idea to swing the club, using your shoulders arms and hands as a unit, to get a feel for the distance you want the ball to travel. Do this a few times so that you are comfortable with what you will be doing on the actual stroke).

Now move your left foot back about 4 inches - thus opening your stance. Crouch slightly so that your knees are bent in an easy comfortable position.

Now push your left wrist towards the target until your left arm and the shaft of the club form a straight line.

Shift your weight so that 80% of it is on the left side. You are now correctly set up.

The Takeaway. Start your takeaway with your shoulders making sure that your hands and arms only move as a result of the shoulder shift. The angle between your right arm and shaft must remain the same as it was at address throughout the swing. The same applies to the angle of the left arm and shaft.

The takeaway should follow along your toe line. Note that this is not the same as the target line. Having moved your left foot back in the setup your toe line cuts across the ball and will feel as if you are aiming left of target line.

This is correct.

There should be no leg movement at all. Make sure you do not move the knees at all during the swing and your weight should remain on your left foot.

The Downswing and Follow Through. Distance is controlled by the length of the backswing and this should never be more than the nine o'clock position. Once you have reached the required height of the backswing simply bring the club back along your toe line, again using your shoulders to initiate it and keeping the arms locked in position.

Once you have connected with the ball be sure to keep the arms and shoulders linked. Do not break the wrists or bend the arms. With a chip shot try to keep the club as low as possible through the ball and on the follow through.

Practice this shot from various distances around the green with a number of different clubs to get a feel for flight and roll control. Remember the idea behind chipping is shortest possible time in the air and longest possible time rolling on the green. So use whatever club it takes to get you on to the putting surface as soon as possible.

Spend a bit of time learning the chip shot and you will find that this is a most enjoyable part of the game and a great challenge, not the part that you have always feared.

I hope that these simple instructions will help you with your golf game and remember there is no point in learning the chip shot if you do not spend time practicing it until you become confident enough with it to use it on the course.

No Pain, No Gain: Why Knee Tendonitis Is Common And Other Things You Should Know About It


You have to admit that humans drive their own bodies to their death, every so often, man insists on doing things without regard for the body. Time takes its toll on the body as well, a fact that many people take for granted. Even athletes fade in time, no matter how much one exercises, take pills or deny aging, it is a natural occurrence that takes away with it the youth in all of mankind.

Knee tendonitis is a common ailment not just for sports individuals but for every normal person as well. The knee is a powerful junction that holds together the support for the entire body. The tendons are the ones responsible for connecting these bones to the muscle, thus they may be smaller but they play crucial parts. Without legs, man cannot stand up and what caps the femur to the fibia and tibula but the knees with all its joints and tendons.

When one is suffering from tendonitis, it simply means an inflammation of the tendons, and when it is said to be a knee tendonitis - it means that the tendons supporting the knee are the ones inflamed. Overuse is a common cause of knee tendonitis, many sports individual suffer from it but so can a normal person who by some accident has made the wrong twist and tore up the tendons.

The Three Types Of Knee Tendonitis

1. Patellar Tendonitis: This is also commonly referred to as jumper's knee and is the commonest type of knee tendonitis. The pain is often felt at the front of the knee where the portion of the tendon inserts under the kneecap. Because of this, sufferers are unable to kneel or have a hard time descending from a plight of stairs.

2. Quadriceps Tendonitis: The source of the pain can be similar to patellar tendonitis but only it occurs at the upper half of the knee. Though, this happens rarely and it can easily be controlled with traditional remedies.

3. Iliotibial Band Friction Syndrome: This pain for this radiates from the outer side of the knee. It is caused by exercise and prevention can only be achieved with proper rest.

Signs And Remedies For Knee Tendonitis

Aside from the obvious pain, simply touching the knee can be painful enough. Acute pain due to simple walking or running can easily be helped b y resting. But more severe types of the knee tendonitis keeps a person tied to his or her bed. There is extreme pain and small twitch can bring gruesome pain.

If in case you are just standing up for sometime and not doing anything "sporty" and then you feel pain around the area of your knee, you already have a severe type of knee tendonitis.

Acute pain from it can easily be treated by some minutes of resting, surgery is not yet an option. Pain relievers as well as anti-inflammatory drugs are recommended at this time. When the pain is worst, splinting the knee can help or if pain is at its maximum, only surgery can relieve anyone of it.

Adequate rest is the best advise for the relief of pain from kneecap. One should not try to exacerbate the knee or the consequences will be brutal.

5 Excuses That Stop People From Getting Important Joint Replacement Surgery


Many people need hip replacement surgery, hip resurfacing surgery, or knee replacement surgery and they know it. Their doctor has diagnosed the need for orthopedic surgery; they've researched their options but they just aren't doing anything about it. They're scared, unsure of what to expect, possibly under-insured or not insured at all and unable to afford it - or so they think.

Here are 5 excuses that are preventing people from getting much needed joint replacement surgery and getting their lives back:

Excuse 1: My doctor is always right and he said I didn't need a knee replacement, even though I have a hard time walking and my flexibility is no longer what it was. I just don't have the time to deal with getting a second opinion.

There are many reasons and factors that make up a doctors' opinion, including diagnostic test results, levels of pain, your insurance status, etc. but there's no reason not to get a second opinion. In fact, there are places online that let you ask a doctor his opinion and even evaluate your needs. They are free and carry no obligation and are performed by highly-trained specialists - not some Internet call center staffed with inexperienced and uneducated folks. Get a second opinion!

Excuse 2: If I postpone surgery I can probably find some alternative health option that won't involve a costly operation.

Sure, there are alternative methods of controlling the pain, such as stretching exercises like Yoga and treatments such as acupuncture. These are great ways of providing improved flexibility and minimizing the pain, but they are not going to allow you the same way of life you once had, and they are not going to completely rid you of the pain. If you need a hip or knee replacement surgery, then that's what you need.

Excuse 3: Joint replacement surgery is expensive and I'm under-insured or don't have insurance.

Having a hip or knee replacement surgery in the U.S. is quite costly without insurance. In fact, the cost of the surgery alone can top $50,000 or more, but with international orthopedic surgery options now available this is no longer a valid excuse. In New Zealand, you can get the surgery, the travel costs, the post-surgery hotel and all rehabilitation needs all for usually less than half this cost! And the facilities in New Zealand are state-of-the-art and doctors all English-speaking and highly trained (many in the US).

Did I mention that there's financial assistance available?

Excuse 4: Overseas medical or health tourism is scary!

There are destinations that can be out of the comfort zone for many American travelers - not just those seeking safe, quality surgical care. New Zealand, however, is a destination that many travelers put on their top 5 lists of places to see, and to experience it along with getting the surgery you need is simply a double-benefit. The hospital facilities are top-notch. The doctors and specialists are all highly trained. It's considered one of the safest and cleanest countries in the world, and the joint replacement surgery is affordable. What more could you want?

Excuse 5: There's so much to coordinate when it comes to surgery in the US or overseas. I just don't know where to start.

It can be daunting - and typically in the US you are sort of on your own. That said there are some health tourism organizations that assign a Personal Patient Coordinator to you from day 1. This person handles ALL logistics - from air travel arrangements, to surgical scheduling, to post-surgery accommodations, to rehabilitation schedules. In fact, they'll keep you company should you need to speak to someone and they'll even meet you at the airport. They'll probably become your friend!

Arthritis Knee Pain - What Are Your Options?


One of the most common ailments that affect numerous individuals of all ages is arthritis knee pain - in particular, Rheumatoid arthritis and Osteoarthritis. In spite of all advances in modern medicine, there is currently no permanent cure for all types of arthritis knee pain.

While there are specific exercises and physical therapy programs designed to alleviate pain to a certain extent, their results depend largely on the degree of pain and the stage of arthritis afflicting the patient, amongst a number of other factors.

Rheumatoid Arthritis

A common type of arthritis is rheumatoid arthritis, which initially manifests as sore or stiff joints in the elbows, feet, knees, and hands. Typically, the stiffness will start in the same joint on both sides of the body. Ultimately, the afflicted patient will feel a sense of fatigue and flu-like symptoms, accompanied by aches and pains as well as joint inflammation.

Osteoarthritis

Conversely, if pain is felt in any joint following a repetitive action, this might be indicative of another type of arthritis called Osteoarthritis. For example, an individual who has been an athlete for years may someday feel some pain in his/her knee without any evident cause. Standard imaging tests such as X-rays may uncover wear and tear in the cartilage of the knees, which weaken the joints and cause increasing pain.

Osteoarthritis commonly affects the hips, back, neck, and fingers. Swollen or misshapen fingers are telltale signs of the disease. In extreme cases, affected patients may find it difficult if not impossible to perform even simple activities such as walking, sitting down, or standing up. In such situations, joint replacement surgery may be the only course of action.

Treatment Methods for Arthritis Knee Pain

A common approach to treating arthritis in the knees is the use of knee braces, either off-the-shelf or custom-made. Off-the-shelf knee braces may not fit perfectly but are less expensive, whereas custom-made types are more expensive and are devised to fit both your knee and your specific condition.

While prescription drugs may help alleviate pain, they are seldom able to eliminate it completely. However, new remedies are now available to manage the painful symptoms of arthritis. In addition to standard medications, physicians may prescribe creams and ointments for oral application. NSAIDs are often the prescription of choice for a majority of doctors. Rheumatoid arthritis patients are commonly given biologics or anti-rheumatic medications, which can be injected at regular intervals to improve the patient's condition and to lessen the pain.

Another method that has been known to effectively inhibit the progression of the disease is doing regular arthritis knee exercises, including swimming, cycling, and walking. Regular exercise programs will help improve or restore joint function. These exercises need not be rigorous, as even simple steps can do wonders to your joints. Strenuous exercises that may further damage or aggravate your joints must be strictly avoided.

In extreme cases, knee surgery and chemotherapy may be necessary. Alternative methods such as acupuncture and magnetic pulse therapy have also become popular these days, owing to the many users who attest to their efficiency.

In general, if you decide to try standard or alternative treatment methods for arthritis knee pain, it's imperative that you consult a qualified physician before proceeding.

Knee Replacement Infections Part One


Infection after having your knee replaced is always a possibility. Though the percentages are small between 1-3 percent, great care is taken to prevent such an episode prior to your surgery. From the time you get your pre-surgical check up to the time you leave the hospital, there are a series of precautions that are followed to prevent this problem from happening.

Prior to your surgery all of us will should be given a pre-operative physical to make sure your body is strong enough to go through the rigors of surgery and ultimate recovery. The standard tests such as cardiac strength and efficiency are measured along with a blood test to make sure the blood is free from any markers that may impede your recovery or put you at risk for infection.

The surgical suite where the surgery will take place of course will be sanitized along with the surgeon wearing the proper attire for joint replacement surgery. If you have seen photos for instance of a joint replacement surgery, it look as if the surgeon is wearing a space suit. This allows for a complete germ free environment.

The surgical technique is a very important factor in the post-operative rates of infection. Most orthopedic surgeons that have multiple joint replacement experience under their belt and understand the importance of avoiding prolonged operating times. The longer your joint replacement is exposed the better the chance for post-operative infection. Most surgeons however can knock out a knee replacement anywhere from 55 minutes to and hour and a half.

Always inquire about the surgeons experience and the number of replacements he or she has done. The more they have completed the more efficient they have become.

Infection rates overall are very low. There are many other areas during your hospital stay that are regulated and infection proof policies followed to hopefully prevent germ exposure.

Thursday, May 30, 2013

How Holistic Medicine Can Help Cure Winter Aches


Winter is a long and dreaded season for most of us because it brings severe joint and body aches that make us cringe in pain. Heavy snow and freezing temperatures tend to cause various cold-related painful conditions such as arthritis, fibromyalgia, sinusitis, carpel tunnel syndrome or knee joint pain that can directly affect your daily activities. Considering effective pain management is necessary to cope with such conditions. Holistic medicine is one of the most worthwhile pain management techniques that can help cure winter aches and pains. Here is how holistic medicine can deal with annoying body aches during low temperature.

What causes Muscles Stiffness in Winter?

The major cause of winter-related joint pain is insufficient hydration level that leads to contracted muscles and disturbed muscle tone. It is advised to stay hydrated to prevent any muscle cramps, soreness or lethargy. Moreover, the sedentary and less active lifestyle during the winter season also tends to make the joints, tendons and muscles to stiffen up, making winter aches worse. Keeping your body warm and active in the winter will not stiffen up or hurt your joints. In addition, you can also choose holistic medicine that will help you deal with annoying winter pains.

Massage Therapy for Relieving Body Aches

Massage therapy is the most effective type of holistic medicine that keeps your muscles and joints warm and flexible, helping you to enjoy the winter season without any fear of pain. A massage therapist provides a variety of massage therapy techniques to increase joint mobility and flexibility, muscle strength, decrease soreness, stiffness and inflammation and promote blood flow. A massage practitioner provides gentle hand movements to the affected body parts which help relieve pain and facilitate joint movement.

Physical Therapy for Pain Management

It is another effective way to get rid of muscles and joint pain during winter season and keep your body more flexible and healthy. Physical therapy comprises of certain manipulative techniques that effectively reduce variety of health conditions such as neck and back pain, headaches, migraine, asthma and various other conditions. A physical therapist provides gentle, small and passive body movements to release muscle tension and spasm, facilitate joint movement, promote relaxation and improve overall bodily functions.

Gentle Joint Mobilization Techniques for Increasing Joint Mobility

The less active lifestyle during winter season cause muscle stiffness and joint immobility. Therefore, considering joint mobilization technique is undoubtedly a sensible choice in this regard. In gentle joint mobilization technique certain stretching and strengthening exercises are performed to restore body movements and improve range of body motions. This significant type of holistic medicine can help reduce pain and release muscle tension from areas such as neck, head, ankles, spines, ribs and neck. It is especially effective for managing arthritic joint pain, improving joint mobility and function and reducing pain in affected body areas.

If truth be told, using holistic healing techniques for pain management will definitely keep winter-related body aches and joint pains at bay. Holistic medicine is comprised of a variety of pain management techniques that help you address specific conditions that are provoked by freezing temperatures every year.

Runners Knee Brace For Additional Support & Pain Relief


A runners knee brace can provide additional support and pain relief at the same time. The braces are sometimes used to allow a player to continue with a game, if the pain is not debilitating or there is little swelling. Here's a look at some of the features you will find in the different braces on the market.

The smallest of the braces were designed by an orthopedic surgeon and are sold under the patented name "Kneed-IT". In addition to making use of compression therapy, which is the most common therapy found in the braces, the Kneed-IT brand makes use of magnet therapy, too.

The purpose of magnet therapy, as it relates to joints and bones is to reduce pain and improve blood flow. When the knees or other joints are inflamed or swollen, the cause is an immune system reaction to a perceived injury or infection.

A huge influx of white blood cells runs to the area, although in the case of runner's knee and similar problems, there is no infection and no need for the white blood cells. They can actually cause additional injury and/or damage to healthy tissues and joints. The magnets keep the blood moving.

Another patented runners knee brace is called the Cho-Pat. The renowned Mayo Clinic played a role in the development of the Cho-Pat braces. They make use of the compression therapy.

Compression therapy is the idea of placing a small amount of pressure on a tendon or joint in order to reduce stress somewhere else. In the case of the knees, the idea is to put pressure on the tendon below the kneecap, which improves the way that the kneecap moves over the joint.

Unlike the Kneed-it brand, which applies pressure only underneath the kneecap, the Cho-pat type applies pressure on the tendon above it, as well. This helps to strengthen the joints and reduces the risk of injury.

The heaviest runners knee brace provides the most support. The design has not been patented, as it is used in many therapeutic devices. Basically, the brace encompasses the entire knee, but leaves the area over the kneecap open, in order to allow for freedom of movement.

One of the exercises recommended for people that suffer from runner's knee is to move the kneecap in a circular motion, insuring that it is not "stuck". As long as the cap moves freely over the joint, injuries and pain are less likely. So, every good runners knee brace will leave the area over the kneecap open.

The latest materials for the braces include nylon and neoprene. Neoprene is one of the least likely materials to cause allergic reactions. It is a major component of diver's wetsuits. There may be some sweating in the area where the brace touches the skin. In order to reduce that, talcum powder or an antiperspirant cream or spray can be used.

A runners knee brace is usually durable enough to be worn again and again. So, once you decide which style is right for you, don't worry too much about the price. You should get your money's worth.

Running Knee Pain And Patellofemoral Syndrome - 5 Treatment Plans For Runner's Knee


Runner's knee is one the most common injury faced by many athletes. This injury definitely puts an end to any training program, even if the runner ignores it or is unaware of it; eventually the agonizing pain will catch up and force the runner from going any further. Thus shooting down any running goals or aspirations.

Causes of runner's knee

Your first line of defense against this injury should be preventing it from occurring in the first place. If you eliminate the root cause, you won't have to deal with the pain and frustration that comes with it. Here are the main causes:

- Weak and imbalanced leg muscle groups, especially when the quadriceps is weaker than the hamstrings.

- Running on hard surfaces, such as concrete or sidewalks.

- Running in the wrong shoes.

- Bad running form, especially overstriding and improper foot movement. - Overtraining and lack of proper recovery.

- Being unaware of pain signals.

- Problems with the feet...

How to treat runner's knee

Treatment should always be the second option. But when you already have it, it is too late to prevent it; therefore, I'm going to show exactly what you need to do for treating this condition.

1- Cold or hot

You should apply ice on your knee immediately after the training; this can lessen and control the symptoms, thus reducing both pain and inflammation. Later, you could apply heat using a hot bath or a hot pack; this relieves the chronic pain.

2- Limit your training

If you have runner's knee, you should diminish the intensity of training immediately, you could reduce your mileage and avoid running uphill or any of the above causes. But it is recommended to give you knee sufficient time to heal properly.

3- Medication

Anti-inflammatory drugs such as Ibuprofen or aspirin can help a lot with the pain and the swelling around the knee. You could take them during the first 15 days of treatment. A steroid injection may be administrated by a doctor.

4- Physical therapy

Your physical therapy plan should stress on strengthening and flexibility of your leg muscle groups-especially the hamstrings and the quadriceps. In fact, imbalanced leg muscle groups are one of the leading causes of runner's knee.

5- Surgery

Surgery should be your last option for treating runner's knee. Many of the above plans are well proven for alleviating this chronic injury, but if the pain persists, then you may need surgical intervention.

Dogs and Arthritis and Other Bone Related Illnesses


Adults aren't the only ones that suffer from arthritis and are seeking treatment for arthritis. Believe it or not, our four legged loyal companions also suffer from chronic arthritis pain that develop from their regular day to day activities of fetching balls, running in the park, jumping after that Frisbee.

Dogs develop arthritis in their joints mainly in their front and hind legs. Some common joint problems are chronic shoulder pain, in dogs it is referred to as Osteochonritis Dissecans. This is caused by a piece of bone becoming loose when they are young and also decreased blood flow to the shoulder joint. It is best to ask your veterinarian for the best shoulder pain treatment for your pet. The other sensitive area for arthritis in dogs are their elbow joints and wrist joints. Common elbow joints problem is elbow Dysplasia which is when bone fragments are in the joint and they fail to join. Those of us who suffer from carpal tunnel pain would be able to sympathize with our canine friends. Their wrist arthritis is caused by deterioration of ligaments that support the back of the wrist, also called carpal hyper-extension. As a result they don't put weight on the wrist, which lead to dog arthritis pain.

The lower part of dogs' limbs, the hip, knee, and ankle and ligament problems can develop into arthritis pain and require treatment for arthritis. A hip joint deformity called hip Dysplasia happens during your pets' growth. With hip Dysplasia the femur, or thigh bone, does not sit properly in the pelvic bone and over time causes pain that lead to arthritis and will require treatment for arthritis. The knee joint, actually similar anatomically to the human knee joint, undergoes similar health problems such as cranial cruciate ligament injury. Only in dogs it is called Caudal Cruciate Ligament Injury. It is a very common condition in dogs. Osteochondritis Dissecans is a common problem in the ankle joint, or hock joint as it is referred to in dogs. This is similar to the shoulder condition where a small piece of bone came loose in a small dog and now causes pain and inflammation.

The inflammatory arthritis and rheumatoid arthritis are common in people and less so in dogs. Nevertheless, just like in people joint pain should be taken seriously and a cause of pain should be identified. Your veterinarian will be able to diagnose the problem and provide treatment for arthritis if it is needed.

Best Knee Braces For a Meniscus Injury


How does the meniscus work? The knee joint is very important to perform many activities. The joint is made up of three bones: the shin bone (tibia), the kneecap (patella) and the thigh bone (femur).

The surface of these bones in the joint are covered with cartilage (a firm, rubbery tissue that cushions bones at the joints). This surface helps the bones move more smoothly and can limit any damage to the bones. The meniscus helps distribute weight and provide stability to the joint. It is located between the cartilage surfaces of the bones.

What is a Meniscus Injury? The meniscus can be found on both the inside and outside of the knee. Your meniscus is injured when these pieces of cartilage are torn. These tears can be partial or complete tears. This injury usually happens when you are rotating your knee while it has weight on it. For example, when your are pivoting or you suddenly change direction. Injuries of the meniscus are common in sports such as soccer and football.

If you have pain when you straighten your leg, it is a good sign you may have torn your meniscus. This pain can be mild to severe. Your knee may swell either immediately or several hours after the injury. You may hear a sound similar to a click or a pop. You knee may feel weak and lock. These are all signs that you may have torn your meniscus.

Should I use knee braces for a Meniscus Injury? It may be a good idea to use a knee brace for a meniscus injury. Knee braces for a meniscus injury can help you protect the meniscus. This prevents further injury and allows the meniscus to heal. These braces will make sure your knee joint is stable. This can help decrease the pain you feel. Knee braces for a meniscus injury provides your knee with compression and support. Many braces are cost-effective, easy to use, and comfortable to wear.

Knee braces for a mensicus injury include braces like: the Medtherapies Deluxe Hinged Brace, the DonJoy Drytex Economy Hinged Brace, and the Breg Economy Hinged Brace. These braces cost $57.95 (Medtherapies), $69.96 (DonJoy) and $84.95 (Breg). One of the most popular braces for a meniscus injury is the DonJoy brace. The DonJoy has great customer reviews as well. All of these braces are level II braces. This means that each of these braces provides a basic level of support and protection for your knee.

These prices have been referenced from Braceshop.com.

Weight Training Exercises to Perform Following a Knee Replacement


After having a knee replaced there are a series of exercises that you start from day one. They are for the most part very gentle geared toward developing muscle facilitation and muscle re-education. These involve several isometric exercises and range of motion activities. Later on in your rehabilitation generally in the two to three week range, light weights may be introduced by your physical therapist. This also may depend on your surgeons exercise protocol as well.

The exercises after surgery where weight training becomes involved is usually the straight leg raise, seated long arc quads, hamstring curls, abduction and adduction and the short arc quadricep exercises. If you are not familiar with the terms of these exercises you will be once your rehabilitation starts.

After eight to ten weeks out from surgery, you will with your surgeons approval and medical clearance, get more involved with further weight training and strengthening of the knee replacement and the entire leg in general. The knee replacement will not properly perform unless the entire leg is strengthened which will in turn prevent muscle imbalances that can present problems in regards to further pain and loosening of the knee components over time.

Some of the more popular and recommended weight training exercises will be the leg extension using both one and two legs with this exercise. You will need to concentrate on the surgical leg by implementing unilateral exercises so the stronger of the two legs does not do the majority of the work.

Hamstrings curls both standing and lying prone or seated should be included. The hamstrings are naturally weaker than the quadriceps so getting them involved is vitally important for balanced strength.

Calve raises is an excellent exercise for building lower leg development and promoting balance as well with your walking. Again it is recommended that you involve not only both legs but also complete the exercise with the surgical leg by itself.

Weight training not only for the gluteals but also your hip muscles with either standing or seated abduction and adduction should be included.

Weight training after surgery will not be for everyone. It will of course depend on your age, prior level of function and medical condition.

In today's world of joint replacement surgery more adults are younger than ever. It will be important for them to get back into the game of life as soon as possible. But make no mistake about it unless you are bed bound some sort of weight training for your replacement should be strongly considered.

Wednesday, May 29, 2013

How to Propose Marriage to a Man - 5 Ways to Knock His Socks Off!


This article is not for the faint at heart; it is for that woman who knows what she wants and will stretch out her hand and grab it. It is for that femme fatale who won't wait around like "the damsel in distress" for a guy to come and rescue. It is for that lady who is similar to "Edie Brits'" character in Desperate Housewives.

If you qualify, then read on to discover how you can propose marriage to your guy and knock him off of his feet (just don't swing too hard a'ight?).

Number 1 - Know Your Future Spouse

Before proceeding to the rest of the points below, you need to consider this point very seriously! There is no point proposing to your man (or any man for that matter) if he will be threatened by the gesture. So think about it seriously...

To know whether or not if that will be the case requires knowledge about your future husband - is he the type to be easily threatened by a marriage proposal from a woman? Is he mentally prepared for marriage? Is he an ego freak (that is, would he feel emasculated if you do the asking)?

You need to realize that he may want to be the one "on bended knees not you" - [Gloomy detour: I am reminded of that amazing group of fantastic singers; Boyz II Men. They sang "on bended knees" which happens to be one of my all time favorite jamz - I really miss them (sob!)]

Number 2 - Set the Stage

Now that you are sure your man is up for this, you need to put some thoughts into choosing the venue where you will propose to him.

This could be his favorite hangout (think; diner, snooker bar / joint, a secluded camping site, a fancy restaurant, a golf course at sunset etcetera. You must understand that this is not about you any longer so whether or not you think his favorite hang out is romantic or not is really not up to you. You should trust in the taste of your man.

Number 3 - Be Flexible

You need to be prepared to go with the flow. If you told him that you will take him out and he chooses to go to a French restaurant instead of the snooker bar, go with the flow.

The only reason why you would insist is if your plans involve other people or specifically pre-planned events.

Number 4 - Bring a Gift Along

Remember to buy and engagement gift - buy him an item that will last for a while. At this point you may choose to leave out an engagement ring as that might be too much for him (but again you know best).

Number 5 - Give Him Time to Be Shocked

Note that no matter how much your guy knows you, he really may not be prepared for this. So give him a while for the shock of it to wear off. Do not rush him.

Yoga As A Natural Cure For Psoriatic Arthritis


Psoriasis can lead to other health issues. If you have Psoriasis, you may develop arthritis. This happens to about 5% to 10% of people who have been diagnosed with Psoriasis. Symptoms vary from swollen and deformed feet and joints on the hand to pain on the knee joints etc, nail changes may occur. This condition is common in men when their Psoriasis is pustular. If you already have Psoriasis and developed joint paint or swelling in any part of your body, please ensure your physician is made aware.

Arthritis is a joint disease that can cause problems in any area of the body where two or more bones intersect.? The arthritis itself can affect the join in a number of different ways, targeting different areas such as the synovial, the muscles or tendons or the cartilage.? Cartilage is the soft protective material that protects the ends of the joints from rubbing against each other and the entire join is encased in a type of capsule that is lined with the tissue synovial. Some people take medication, but others have found relief from the pain in exercises performed at a gentle pace and intensity.? Yoga is the perfect example of this type of exercise.

? Yoga is a very old art originating in India about 4000 years ago.? It uses poses or postures along with deeply controlled breathing exercises that lead to benefits to the body mind and spirit.? Yoga is a very versatile form of exercise and meditation and it is used, in different forms, to treat a very wide range of medical conditions and injuries including such diverse areas as fibromyalgia, arthritic, migraine headaches, chronic pain, and sports injuries.

? The Yoga poses can be tailored specially for specific joints or combination of joints.? For instance a common area for arthritis to strike is the hands and knuckles and in this instance there would be a series of poses that straighten and lengthen the fingers, although the level of comfort in the arthritis sufferer always dictates the extent of this.? Stretching the hands also feed energy to that area of the body and over time will assist the arthritis in the fingers.? The heat generated by these movements is proven to be very beneficial for sufferers of arthritis.

Yoga is another natural way to take care of your Psoriasis. It has been proven to work wonders, just find what you are comfortable with and stick with the plan.

Hip Arthritis In India - Resurfacing And Proxima Hip Replacements as Treatment Options For Young


Hip arthritis in India affects young and middle aged persons unlike the west where Primary hip osteoarthritis predominantly affects the elderly. Surgery in this group of relatively younger patients requires newer techniques and implants. This article will shed light on the disease and the current modalities of treatment available.

Types of Hip arthritis

Hip arthritis is classified as Primary and secondary Osteoarthritis. Primary osteoarthritis is age related wear and tear arthritis. It is rare in India. Secondary osteoarthritis occurs at a younger age and is more common. Rheumatoid arthritis, avascular necrosis, traumatic arthritis and other connective tissue disorders like SLE, Psoriasis etc. all lead to secondary osteoarthritis.

Rheumatoid arthritis is an auto immune disorder, affects all joints particularly the small joints but also does not spare the hip and knees.

Avascular necrosis is a condition that reduces the blood supply to the end of the bone. It affects patients with excess alcohol intake, consuming steroids, connective tissue disorders like SLE. Systemic lupus erythematosus (SLE) is a connective tissue disorder affecting mainly young women A photo sensitive rash on the cheeks, renal involvement and arthritis are some notable features. Avascular necrosis affects a proportion of the patients with SLE.

Gaucher's disease is a genetic storage disorder. Post traumatic arthritis occurs after a severe injury to the hip. Fractures of the ball (top of the femur) or socket (acetabulum) can lead to arthritis after inadequate treatment.

Hip arthritis is very disabling as it is a small ball and socket joint unlike the Knee joint which is a large one. In advanced disease a total hip replacement was recommended by Orthopaedic surgeons until recently. Advances in orthopaedic surgery now cater to the specific requirements of these younger patients.

Surgical solutions

These are the mainstay of treatment as conservative measures fail to relieve pain. Total Hip replacement (THR) is a time tested operation and has a success rate of 93 % survivorship at 10 years.

The hip joint may need to be replaced with an artificial joint when it is irreversibly damaged and cannot be salvaged by alternate surgery. The patient complains of pain and restriction of movement. The pain may often be referred to the knee or felt in the knee and no hip symptoms. Occasionally the pain may be felt more in the buttock area rather than in front of the groin.

Who needs a hip replacement?

In India, many young patients with ankylosing spondylitis, avascular necrosis, post septic arthritis, post injury suffer from hip arthritis and are advised a hip replacement for disabling pain. Thus many hip replacement operations are performed in younger patients. The surgery should cater to the enhanced demands on an artificial joint by younger and more active patients. Naturally an operation designed for Western elderly patients is not suitable for younger patients.

What is a total hip replacement?

In this operation the ball shaped upper end of the thigh bone (femur) and the socket (acetabulum) are replaced. The ball is replaced with a long metal stem that is fixed into the upper end if the thigh bone. Its upper spherical end articulates with a cup shaped polyethylene socket that is cemented into the pelvis.

Conventional hip replacements sacrifice a great deal of normal bone as the head, neck, and upper part of the thigh bone is removed for implantation of the prosthesis. Moreover wear debris from the poly-etheylene liner lead to osteolysis and bone loss. When this first hip is to be changed or revised after its lifespan more bone loss occurs. Conventional hips have a small ball to reduce friction and wear, but the ill effect of this is an increased risk of dislocation. An average dislocation rate of 3- 4 % has been reported. These implants do not last very longer than 20 years and revision rates of 50% at 20 years have been reported. Survival rates are less satisfactory for the relatively younger active patients. Thus a total hip replacement is not an ideal implant for younger patients less than fifty years old who need a new hip.

Problems with conventional total hip replacement:

o Excessive bone sacrifice and loss

o Increased risk of dislocation

o Patients cannot squat or sit cross legged on the floor with out the risk of dislocation

o Range of movement is less

o Patients cannot involve in sports

o Poor survival in young and active patients they require earlier revision

o Revision surgery is difficult

o The hip feels less like a normal hip

o The cup wears with time and plastic from it harms bone

o Change in length of the leg after surgery leading to leg length discrepancy

Why remove normal bone when only the surface of the ball is bad?

This is the logic behind hip resurfacings. This bone preserving hip resurfacing involves replacing only the diseased bony surfaces of the head of femur and acetabulum. This involves sculpting the head of the femur and covering it with a metal cap and fixing an uncemented socket into the acetabulum to receive the head.

Hip Resurfacing- A bone preserving hip replacement!

Preservation of bone and less stress shielding makes it easy to revise this hip if needed. The large head size provides a very stable joint and recreates the sensation of a normal hip joint. Patients have gone back to playing Judo and Squash after this operation. Advances metallurgy makes the metal on metal articulation likely to survive longer in the young and active patient. With less metal inside the bone and less invasion of the medullary cavity of the femur, the risk of infection is reduced. Rehabilitation is faster and better.

Advantages of hip resurfacing:

o Allows the patient to squat and sit cross legged on the floor safely

o Allows a normal range of movement

o Sacrifices only the surface diseased bone and preserves normal bone

o Imparts a more normal sensation

o The joint is likely to last longer even in younger and active patients

o Earlier and faster rehabilitation

o Less risk of dislocation

o Easier to revise if needed

o No leg length discrepancy

Proxima hip replacement - A perfect bone preserving hip replacement?

This is the latest addition to the armamentarium of the hip surgeon in India. It is a bone preserving hip replacement. In this operation, the entire diseased head of the femur is removed. The lining of the hip socket is resurfaced with a metal cup. A tiny uncemented hip with a short stem called the Proxima hip is impacted into the upper end of the femur or thigh bone.

The size of the implant matches the natural one and hence the risk of dislocation is almost eliminated. It is recommended when the bony destruction is advanced and hence unsuitable for resurfacing and a total hip replacement would be overkill.

The advantages of the Proxima are:

o suited for minimally invasive surgery

o No thigh pain

o Metal on metal - confers longevity

o Conformity to normal size eliminates risk of dislocation

o Ability to correct biomechanical abnormalities makes this superior to resurfacing

o Imparts a more normal sensation

o Allows a normal range of movement and normal activities

Overview of Medical Tourism


Medical tourism encompasses the terms medical travel, global healthcare, and health tourism, and describes the practice of people traveling to receive medical treatment, whether necessary or elective. Alternatively, it also refers to the travel of health care providers to deliver healthcare to people in other countries. Medical tourism is becoming an increasingly popular practice among those who wish to have options when it comes to their healthcare. The services offered in a medical tourism setting are almost limitless and could include heart surgery, join replacement surgery, cosmetic surgery, dental surgery, and even in vitro fertilization. Furthermore, medical tourism can involve alternative treatments, psychiatry, and convalescent care. Those concerned about the quality of care in regard to medical tourism can look to the U.S.-based Joint Commission International, among other companies, which inspects and accredits healthcare facilities outside of U.S. Borders. Savvy patients will look for a facility or hospital that is accredited by a respected source when considering treatment abroad.

Interestingly, medical tourism is not as nouveau as many believe. While it has certainly experienced an increase in popularity in recent years, the concept of traveling for healthcare dates back many centuries. The ancient Greeks were known to travel to a territory called Epidauria, in the Saronic Gulf of the Mediterranean, to seek healing from the god Asklepios. Even early spas can, in retrospect, be called medical tourism. In the 1700s, people from all around England traveled to the small village of Bath to partake in the supposed healing waters of the natural mineral springs. Americans, as well as citizens of other First World countries such as Europe, Japan, Canada, and the Middle East are opting to seek medical treatment outside of their own borders. In 2007, it is estimated that approximately 750,000 Americans sought medical treatment abroad, and that number was projected to double in 2008.

Medical tourism continues to increase in popularity because of the many benefits that are associated with receiving medical treatment abroad. The primary benefits of medical tourism include cost, convenience, and the ability to combine travel to exotic locals with high-quality medical treatment. Those who reside in countries with lower health standards participate in medical tourism as a means to receive medical treatment that is superior to what is available at home. However, those from First World countries are more likely to travel for medical reasons. It is generally cited that people from countries such as the U.S., Great Britain, and Canada generally possess more wealth; that coupled with their high expectations of healthcare in general, leads First World citizens to seek out alternative options, whether on the surgery table or the psychiatrist's couch.

The primary reason that people elect to receive medical treatment abroad is cost. Even those with insurance may opt to travel for medical care, especially when the entire cost of the trip, including treatment, can be accomplished for far less than the cost of an insurance deductible. Those savings, coupled with the promise of a vacation to a far-off land, make medical tourism an attractive incentive to many. While it is normal to save as much as 50% on overall costs, in some cases the savings can be substantially more. Those traveling to India and Costa Rica can expect to save as much as 80-90% overall on some treatments when compared to the costs in North America or the British Isles. Medical tourists traveling to Thailand for heart surgery can expect to pay only 20% of what they would pay in the United States. Knee and hip replacement surgeries can cost anywhere between $25,000 and $50, 000 in the United States, but can cost as little as $5000 in countries like Columbia and India.

While the cost alone is certainly enough to get the attention of many people disillusioned with healthcare, there are other reasons that prompt people to grab their passports and head out on a dual-purpose journey. For many, convenience and speed are among the most-cited reasons for health travel. While there are many benefits to public healthcare, such as the system that is operated in Canada, a severe downside is the wait time that is often required for non-emergency care. To many, waiting six months for a hip replacement surgery is not only ludicrous, it's not an option. This is especially true considering that it is possible to travel to a medical tourism destination and receive a new hip in the matter of days or weeks. For those who cannot, or are not willing to, wait for health care, medical tourism is an increasingly attractive option.

It would be remiss to discuss medical tourism without addressing the risks involved. Those who reside in countries with high standards of living, the conditions in some countries that provide treatment to tourists is less than ideal. This is why it is important to seek out hospitals and treatment facilities that are accredited. In countries were political and other domestic issues can make travel dangerous, many companies that organize medical treatment abroad often provide case managers to assist with medical and non-medical issues both before and after travel. Because lower standards of living often carry the risk of infectious disease such as tuberculosis, typhoid, HIV, and amoebic dysentery, to name a few, it is important for medical tourists to consider all related health risks before embarking on a journey. Additionally, medical tourists that are generally ill should consider the risks associated with long flights, climate changes, and fatigue in general. Finally, medical tourists should consider cultur al and language barriers that might make the situation difficult.

Those considering medical tourism should also be aware of legal and ethical issues that may be present. Because laws and opportunities for litigation are different in other countries, people need to be aware of their rights when it comes to receiving medical care in another country. As far as ethics are concerned, medical tourists should be aware of issues surrounding organs and tissues that could be purchased illegally. Many naysayers cite that citizens of countries where medical tourism is growing in popularity often have trouble receiving healthcare because most doctors are focused on the foreigners who are coming into the country to receive medical treatment.

Overall, many proponents of medical tourism, or health travel, believe that the risks outweigh the benefits, especially when a person is diligent in doing their research and seeking out an accredited source for healthcare treatment. Of primary consideration is the cost savings that is associated with medical tourism, especially in countries where the cost of domestic healthcare is increasing at an ever-growing rate. Due to the technological advancements and global standards of care in the healthcare industry, medical tourists can enjoy treatments that are as good as, if not better than, the treatments they would receive on their home turf. When time is of the essence, many people come to find that the only way to get fast medical treatment is to travel. Add to that the enjoyment of having a vacation abroad in conjunction with a necessary or elective surgery or treatment, and many people decide that medical tourism is the answer. Thanks to increasing ease and relative low cost of international travel, getting to the destination isn't nearly as hard as it may have once been. In short, many people today are finding that the Greeks were pretty smart when they first introduced the idea of medical tourism thousands of years ago.

Advice in Decreasing Football Injuries


One of the most common injuries in football is an injury to the medial collateral ligament (MCL). The MCL holds the inside of your knee together, and keeps your leg from collapsing inwards. This ligament can be damaged by a blow to the outside of the knee pushing inwards. MCL strains and tears are fairly common in football. Mostly the center and the guards are ones who get this injury, due to the grip trend on their cleats (sometimes a helmet hits their knee). The number of football players who get this injury has increased in recent years. Usually the player can continue playing, perhaps with a brace.

Since most sports are full contact sports, injuries are common among players, especially football players. Of course, any sport has its number of injury to players. However, there are ways to prevent them while playing. If you're prone to knee injuries, then wearing a knee brace is one way to help prevent any injury to your knees. Another way is to properly warm the muscles and joints before you start playing, especially football since it is such a contact "knock em' down" sport.

Using stretching routines will warm up the muscles nicely before any type of sport specially the ligaments in your legs and arms. Ligaments are the easiest to injure no matter what sport you're playing. Muscles take more of the impact if you're playing football, but you can still end up with pulled muscles if they aren't warmed properly.

Besides doing stretching exercises you should also include some of these exercises into your warm up routine:

Do at least 10 reps of each:

Knee hugs - bring knees up to your chest

Backward lunge - step back on the toes of your foot

Forward lunge - step forward on the heel of your foot

Lateral squats - instead of down squats, squat to the side

Adding these to your normal warm up routine will warm up the tendons, muscles, ligaments, and joints. Stretching, of course, are the best to warm up the legs and arms, so you don't acquire any injuries. Even jogging can cause injury if you don't warm up the body first. If you're playing football, then warm-up routines are quite necessary to prevent injury.

In addition, wearing a knee brace can help prevent the twisting motion that causes the damage. Though, wearing a knee brace is a little awkward to begin with, the more you practice wearing it, the easier it will be to play with it on your knee. There has been great advancement in the industry of athletic knee braces, making it easier to help prevent these common injuries.

Rheumatoid Arthritis - A Disabling and Horrible Disease


What is Rheumatoid Arthritis?

Rheumatoid arthritis is a vicious disease that affects the joints of the body. It has been known to cause pain, swelling, and stiffness. If a single knee or hand has rumatoid arthritis, the other knee or hand will most likely develop it. Rheumatoid arthritis often occurs in more than a single joint and is capable of affecting any joint in the body. People diagnosed with rumatoid arthritis often get feelings of sickness and fatigue and are more prone to get fevers.
The length of rumatoid arthritis varies from a month to two years. After it has run its course, it leaves without leaving any damage . Many people experience times when the symptoms worsen (flares), and times when they improve (remissions). Others have a severe form of rumatoid arthritis that can last anywhere from a few months to a lifetime. This form of the disease can cause serious permanent joint damage.

Symptoms of Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. Some very common side effects include:

Joints are swollen, tender and warm

Joint inflammation often occurring in the wrist and finger joints closest to the hand

Joint inflammation affecting other areas such as neck, shoulders, elbows, hips, knees, ankles and feet.

Fatigue, fevers and an overal feeling of unwellness

Pain and stiffness in joints lasting for more than 30 minutes in the morning or after a long sleep

These symptoms can last for years!

What Causes Rheumatoid Arthritis?

The exact cause of rumatoid arthritis is unknown, but it is known that with this arthritis, a person's immune system attacks his or her own body tissues. Researchers are learning many things about why and how this happens. Things that may cause rumatoid arthritis are:

Genes (past on from parents): Researchers are discovering that certain genes may play in the role in the development of rheumatoid arthritis.

Environment: Some scientists believe that something must happen to trigger the disease process in people who have the genes that make them more likely to develop rumatoid arthritis.

Hormones: Other scientists and researchers believe a variety of other hormonal factors may also contribute to rumatoid arthritis.
Rheumtoid Arthritis Treatment:
There are many ways that doctors can treat rumatoid arthritis. The goals of treatment are to:

Reduce pain and swelling

Stop or slow down joint damage

Help people feel better and stay active

Treatment for rumatoid arthritis may involve:

Changes in lifestyle: Make sure to keep a good balance between exercise and rest, take care of your joints, eliminate stress from you life, and eating a health, well-balanced diet.

Medicine: A majority of people suffering from rumatoid arthritis take medicine for pain relief, to reduce swelling and to prevent the disease from getting worse.

Surgery: Many types of surgeries are available to those with severe joint damage.

Regular Doctor Visits: Visit your doctor on a regular basis so he/she can see if it getting worse, determine if the medicine is helping, and change the treatment if needed.

Tuesday, May 28, 2013

How To Lose Weight If You Have Knee Pain


It is a well-known fact that to lose weight you need to eat a balanced low-fat diet and exercise. After all, the more you exercise, the more fat you will burn and you bodyweight will drop. But what if you have an injury that prevents you from running, or even walking? How can you exercise at an intensity high enough to burn fat? The following article will give a few examples if different ways to exercise to lose fat if you suffer from knee of ankle injury which may limit the exercises you can perform.

Firstly, it is important to understand the importance of exercise. In order to lose weight you need to burn off more fat (or calories) then you take in. Sounds simple, but many people only concentrate on the diet aspect. This will give you some results, but you will accelerate you weight loss if you start exercising. You will not only lose weight, but also gain other health benefits such as a fitter, stronger heart and lungs, and you will decrease you risks of developing diabetes.

Now on to the exercises. To lose weight you need to be doing cardiovascular type exercises. In other words the exercise should elevate you heart rate, and keep it raised for an extended period of time. Some examples of these types of exercises are walking, jogging, swimming and cycling. Walking and jogging are the most common forms of exercise people do for weight loss, but if you have an injury such as knee arthritis walking can be limited. The best cardiovascular exercises that don't put strain through the lower limb joints are cycling (on a stationary exercise bike) and swimming. They are non-weight bearing exercises, which means your body weight isn't being transferred through your legs as you exercise.

Swimming is the best exercise for weight loss if you suffer from knee pain. Even if you cannot swim, there are many exercises that can be performed in the water which will help you lose weight. For example, simply walking continuously up and down the pool will elevate your heart rate to the fat burning zone. If you have a low-level of fitness a moderate paced walk will get to the fat burning zone. On the other hand if you are relatively fit, you may even need to jog. The buoyancy of the water will take a lot of your body weight, especially when in deep water (up to your shoulders). This will take all the pressure off your knees allowing you to exercise without pain.

Cycling on an exercise bike is another great way to exercise if you have knee pain. Not only will get an effective cardiovascular workout, you will also strengthen your quadriceps muscles (the muscles on the front of your thigh) which will decrease the knee pain. If you have limited movement in you knees, you may want to try raising the seat higher. The higher the seat is, the less you need to bend your knees, therefore you wont feel the pain.

In summary, exercising in water and stationary cycling are the two best exercises for weight loss if you suffer from knee pain. Stick to the guidelines of exercising for 20-30 minutes continuously, at least three days a week and you a guaranteed to get results.

Innocent-Resentments (Of All Men) (Part II)


St. Paul, Minnesota-2005

Narration by the Person Behind

Chapter Seven

(A Week later) Carla Lawson (who has, since her divorce from her husband some fifteen-years prior, taken back her maiden name) sits back in a wooden chair by her window looking out it, down three floors. Eyes drooping, remembering her years of marriage, her husband's drinking, and staying out late, the years he was in the Army, in Germany, and when she had joined him. The number of times she ran away from him, then came back, her hospital visits, her medications.... "I can't love them boys like I love my daughter, I'm scared of the boys now, they terrify me," she says out loud to herself, mumbling, motionless. Then moving her head in circles, as if to draw circles in the cloud she sees outside, lights up a cigarette-as often she does, one after the other-she's not supposed to smoke in her room, but she does, everybody does she tells the visiting nurse. She sees her ex-husband entering the room, remembers his shape, handsome, rigid, he enters the room, and slips through her day-dream so fast she's trying to backtrack and bring him back into her dream, but other intervening thoughts enter the path he was on before he reaches her window-and he vanishes. His high drunken faces come back to her in burps, fragmented images, pale eyes, high-blooded face. "I told her you weren't a bad father," she said staring out the window, "shut up!" seeing someone peeking into her conversation; she says, continues to look out the window, staring and not seeing, quieter than a mouse, "you got no affection or gentleness, you never had any" she says, then looks around to see if that peeping tom is still peeping inside her head, "You could have been better!" she tries to explain. She rubs her eyes, puts her hands on her knees, she says hardly, savagely, in silence-not one spoken word: it's getting ready to rain, and I got to go downstairs and give account to those damn board members, I should never had elected to be the treasure.

She wakes up from her sleep; she dozed off for a moment. Last time he called, Christopher Wright called her, was a year ago, talking about Natasha and Boris hitting the kids too much, and the state would not intervene. And the last time she called him was a year before that, trying to convince him to tell Natasha to call her because they were fighting and she wanted to make up she even told him "Natasha's the only one I care about." This now was fading in her mind, as she gained her composure sitting in that chair.

She now glances behind her to see if the peeping tom has manifested himself to a physical being, somewhere in her three-hundred and fifty square foot apartment, "Well......" she says, it's not real after all, awry she stands up as if to gain the rest of her composure to go downstairs to meet the board members of the establishment.

"I wonder what he's doing now?" she questions, in a mumble.

____________?__________

St. Paul, Minnesota-

2006, 2007, 2008, 2009, 2010, 2011

Narrated by Carla Larson

Chapter Eight

I wonder what he's doing now.

I wonder what he's doing now.

I wonder what he's doing now.

I wonder what he's doing now.

I wonder what he's doing now.

I wonder what he's doing now....

____________?__________

Lima, Peru, 2010

Narrated by Christopher Wright

Chapter Nine

"When I was poor, we were all knitted together like bees in a honeycomb, once I became rich and tried to help, they all flew away, thinking they were all innocent with their resentments: and it was time for me to pay for my sins."

____________?__________

Minnesota, 2004

(A phone conversation between Delilah and her sister Mini, in 2010 between Minnesota and Huancayo, Peru...)

Narrated by Delilah Wright

(Step-mother to the three children)

Chapter Ten

Did you know, a day in late summer of 2004, Christopher checked out one of his apartments Boris had worked on-he was his one of three of his handymen, putting in a new kitchen floor of tiles, there was small cracks between the tiles showing, consequently, a job done too fast, and overlooked-in essence, not well done at all. Within the hour, he had called his daughter up; they lived across the street from us back then, in one of our apartment buildings. That is, Christopher owned six buildings at that time-since Boris was a handyman, caretaker of two of his buildings, this one in question, being the one we lived in ourselves and the apartment was next to ours on the second floor.

Natasha had two boys, one eight, the other six, Christopher's grandchildren, we saw them quite often in those days and they took quite a liking for their grandfather, and he them, the youngest Willie, would ask his dad, often asked his dad, perhaps too often: "Why does grandpa work so hard and you just lie around?" I used to laugh at that, Boris being such a large man, and lazy as the day is long, pert near, or close to, two-hundred and seventy-five pounds, let's say, almost six-foot. And when Christopher explained to his daughter it was a bad job, she took offense, told her husband, "He yelled at me, and said you did a very bad job," and Boris came over like a mad elephant and tried to kill my husband, tried to break his ribs, I jumped on his back, and then I said, "Give me the key to the cellar room, you can still wash your cloths here, but you'll have to ask you father for the key from now on, I no longer trust your intentions." And had it been up to me I would have called the police and had him arrested for assault, but Christopher insisted he didn't want to, I think the reason being, the kids would have no father for a while, and he understood that better than anybody-because he never had a father, and a lazy no good for nothing father, one that loved his kids even if he slapped them in the back of the head too often, was better than no father at all, as long as he didn't damaged the kids none. He didn't drink any, and he didn't beat the kids to pulp, he just slapped the back of their heads too often too much. But that never hurt the kids all that much; it just gave them better reflexes, so it appeared.

"You'll never see your grandkids again," said Boris to Christopher, in a near whisper, as he left the house, walking down those wooden stairs like a lopsided elephant, with a smirk on his face.

I didn't know he had said that until Christopher, until he told me a year or so later, sometime later, and from thereon, they never spoke to us again, and if the kids tried to greet their grandfather, either Boris or the daughter, would slap the kids on the back of the head to apparently stop them.

"What did I do," asked my mother-in-law, one day, Teresa to her son, because they wouldn't speak to her either. And Christopher simple said, "It's all right, you didn't do anything, you didn't need to do anything."

It was like Boris and Natasha had to knock everything down in front of them, like they couldn't stand just anything that had to do with us thereafter, except giving bloody noses-passing through our yard to get to the nearby bar and visit their friends, and smirk some more if they saw us on the porch. Not sure why they even cross over that way. For the first year they walked around the house to get to Rice Street, or the local bar, now it was through the yard as if they were going to inherit it, and the daughter was simply notifying us of that. Boris was more apprehensive of doing it, so it looked on his face. But somehow I always think daughters no matter how much they tell everyone they hate their fathers, they don't mean it, they say it to make a point to someone impress someone else - maybe I'm wrong. They weren't sorry for a thing, and I wondered why Christopher didn't get Boris on an assault, he said, "If I did, the kids would never forgive me, nor ever really understand, and it's better for the kids, they'll learn someday by accident." And so that's what he said, and that's kind of what I figured.

____________?__________

Columbus, Ohio, 1998 (Now 2010)

Narrated by Sergei Wright

Chapter Eleven

"Once a bastard, always a bastard," that's what my brother said father was. That's what I told everybody he said, about my dad back then and what I tell them now if they ask me. I even tell them "You're lucky if you don't know him." I told him, my father, "I'm grown up now, you can't fool me anymore," and he didn't understand what I meant by saying fool him anymore, I suppose what I meant was I didn't have any more faith in him, I didn't believe a word he was saying even if he wasn't saying a word, but just thinking of saying a word, and not saying one. But what he said, he said, back in 1998, what Pavlenko said he said to dad was: "I'm a Marine now, and just as tough as you." And pa said "Prove it!" And Pavlenko resented that. And I knew, and pa knew he was on medication, like mother was on medication for twenty-years or more, the same debilitating illness. And Pavlenko said, "This is the last time you'll ever see me," because he didn't want to prove it, not sure why, he had actually built up a current, and their voices were high, and he meant it, but he didn't back up his word, and maybe father knew he wouldn't, or couldn't, but he created the devilment and perhaps got embarrassed he couldn't pull through it. He put pa in the corner, and as pa used to say "If you ever put someone in the corner he's got to fight or run like hell, or melt right there, you don't give him many choices, so it's best you leave a little room for both of you to wiggle out of..." and neither one left that inch to wiggle out of. And he told pa, I hated him just as bad as he hated him, and pa asked me, "Do you hate me like Pavlenko hates me?" And I said "No," but that was a lie too. Maybe not a complete lie not likes his lie mine was a white lie, a distortion-no, a generalization-no, I just left something out didn't say the whole thing: a deletion that's what it was. I didn't hate him; I simply resented him for thinking he was so innocent.

And paw told me, "If you spent more time teaching your daughter how to spell, than on the computer looking for a wife over in the Philippines, and riding on that motorcycle of yours, she'd be able to spell "Get," the proper way, not like she does now: "Git", and that infuriated me, and I told him to apologize to her, and now she doesn't want talk to Grandpa anymore because he won't apologize and I made an issue out of it. And grandpa isn't going to say he's sorry because he's not sorry, and doesn't understand why he should be sorry for correcting her-he wrote me and said: "That's a grandfather's job...!"

I told him then that I got my bad spelling from him and she got it from me, although he doesn't spell that bad anymore, he must have practiced, or he carries a dictionary around with him nowadays, since he got his Doctorate in Education, he can't afford to be a bad speller anymore, not to say he isn't, he just can't afford to show it like I do, and my daughter does. I don't blame her for not talking to dad, and I'm not sure if I blame him, but if I don't blame someone I got to blame myself, and I don't feel guilty. But perhaps that's my sin-no one else.

Then I got thinking: So what, so he did what he did, other father's have done worse, he has to pass through them gates to get to heaven just like I got to, just like everyone has to, God is no respecter of men: my father's own words, and that even Christ Himself, will not take a sinner in unless they've asked for, forgiveness, and have also forgiven another person, forgiven everybody who has ever done them wrong, and not forgiving is just as bad as about any sin I know of, and father knows that better than anyone I know of, and so he's taking that route to heaven I bet. Gee I thought I'd never understand why, but now I'm beginning to, believe that maybe I do. And that is all I'm thinking of at this moment.

I can just see us three kids now, when we were young, in that time, and day, we all followed him, trusted him, anyway followed him because we were supposed to, into hell or hi waters, we would have followed him, for the reason that he was who he was, then we came home, then we went back to our foster homes, then we grew up. Certainly, why not blame him now; because we can. I can remember if I didn't think about pa taking us, and just eating, it was off my mind. For a while anyhow: and Grandmother Teresa, never seemed to care much one way or the other, if she did she only showed it in giving us gifts, he was like her, he didn't want the responsibility, couldn't deal with it I suppose. But it's all right, I got used to it in time, I even expected it.

____________?_________ _

Lima, Peru, 2010

Narrated by: Delilah Wright

Chapter Twelve

Christopher, had come to the point, realizing that Pavlenko, who now lived in St. Louis, Missouri, with his daughter, he had never seen, never been told her name, unknown wife's name, and Natasha, her two boys of whom he had a very good relationship with until Boris took care of that, they still lived in St. Paul, Minnesota, in the same apartment building Christopher once owned, and he sold it, and told the new owner to leave the rent the same as it was, $450 dollars for four months, because he wanted to raise it to $750, of which, Boris only paid $100-dollars of the $450 anyhow because of the little work his son-in-law did and daughter did, said she did, but seldom did like cleaning up the hallways, and then we'd get a call from the tenants, to clean the hallways; and Sergei, now living in Ohio, and his son Sergei Jr, who lived in Florida, and his daughter who lived with his second divorced wife, in Florida, he had simply reached the point where it was utterly hopeless to try to put back any kind of a relationship with any of them, So here he was, "I'm tired of trying to fix up something I don't know anything about, old resentments, wounds that turned to scars, scars that healed but in the wrong places, where one can see them every day and maul over them. My mother was in an orphanage, and she never hated my grandfather for it, and I was in a foster farm because my mother had to work for and save money for three years, and here the children are in foster homes for six-years, and they hate me, and their ill mother. That's just fine. If anything they are downright honest about their feelings, coming out with them in the bright sunlight. They just don't know the circumstances, and likely never will; the only one here that is up to date is me. If they ever will be; one is just as wrong as the other. They got half of it right. But by and large, they aint got a thing to complain about."

I told Christopher, "Calm down, Christopher, you'll have another heart attack. Go to bed, rest you'll feel better." He read a disturbing e-mail from his son Sergei, scolding him again.

"I can't," he said. "I tried." He looked at me. "I'm the father, not him, and he's treating me like I was his son, it's better we have no communication than this?" he questioned, it was more a statement-question, one not to be answered but, thought through.

"Of course you're the father," I said. "Certainly, he is the son," I added. Not really knowing what in the world I was talking about, just trying to reconfirm, he was who he knew he was.

"No," he said "I don't feel like a father, and don't want to be one anymore if that is how it is; it is just as best we part even part that part."

"Yes," I said, "Do you want me to write him and say never to write again if he can't write something decent?"

"Yes," he told me. Then he said, "I'm tired," and went to bed.

The following day, I said: "It's all said and done, all open now between you and Sergei." And then I told myself to keep my mouth shut, stay out of it, although I objected to Sergei's insults on the internet to his father, and I wrote him and told him so. And it was then, he invited all the church members over to our house, and the nuns from the convent, and had ten papers made up, and had them all sign it, leaving them everything, two houses, three bank accounts, $100,000-dollars in books, and antiques, everything from shoe laces to diamond rings.

____________?__________

Interlude, 2005

Narrated by: the Person Behind

Chapter Thirteen

As for Christopher a simple and easy choice would be to mend fences or you don't mend fences and wash your hands good and clean of it all. And then there are those folks who say you want to mend them, or tell other people you want to, would like to mend fences, just for telling sake. And this is what Sergei was telling people, implying he'd like to do with his father...but? Yes, he had questions, too many. You might say it was to his advantage with his son, he looked good, giving him a tender and gentle heart, who's to say it couldn't melt over night? But that was faith and a lie and I mean, Sergei Jr, was a thousand miles away, but Christopher wrote Sergei one day said, "You better hope your emulating isn't picked up by your son," which never proved much because he never got an answer back. But he had not stopped giving his father advice on how to be a good father, and I doubt, Delilah, if anybody was happy about that.

It was in the winter of 2005 the unthinkable took place. Hate that was still under the bridge came out, enough to fill up the Mississippi River. And if his daughter didn't want anything to do with it, she was outvoted by John, the old caretaker, Christopher fired for stealing, everything he could get his hands on, and now living with Boris and his daughter across the street on Albemarle Street. Or maybe it didn't even take a vote, maybe she wanted to go along for the ride-that's to say? They knew Christopher was moving to Peru, he had sent them a Postcard, that took three days to get to them that would have taken three minutes to deliver to them across the street, but they were not talking to Christopher.

"I'll deliver it to them," said Delilah.

"No," said Christopher, "never mind that. I forgot how to talk to them nowadays." The bridge that was destroyed by them had become uncrossable, even for Delilah-but somehow she was willing to attempt to walk through fire to get to them for her husband. If it could have been it would have been, that Delilah would have sent fireballs down their chimney. All the efforts to settle things had come to a halt. Mike Hides, had even started a rumor with the neighbors, that Old Man Wright, was telling fibs of the lady next door, about her wanting to go to bed with him, and he extended that to other gossip in the neighborhood. You feel sadness over this, as Christopher did, a sadness that rises from the death of a child-will a literal death but close to it, a merciless separation that is forced upon you. In a world and in a sphere that one has only so many days to count until his last day approaches. If the kids forgot anything, it was one thing for sure; they created a conspiracy, a scheme, a plot, with the salamander, not realizing they can go on living in rain-soaked stumps. He may be the outcast, but they go on surviving. They are capable of regenerating lost limps. And Christopher knew himself better than most men know their bad habits. And so he didn't seek revenge that is why he gave his daughter reduced rent even after he sold the house, made a deal with the new owner. He knew revenge destroyed two, not one person in the overall picture; in this case a whole family was being on a Pilgrimage to the Village of Hades.

But he had been doing this for awhile, Mike had been spreading rumors for awhile, and when confronted by Christopher, saying, "If you're talking about me, tell them all I've done for you, already done for you, not your troubles, and your painless resentment and conspiracy toward me, and that, that you don't like me. And that you don't know why you don't like me, perhaps because your children admire me, and you less, or perhaps because the house you live in belongs to me, but tell them it is the house I wanted to give to you, the four-plex, but you was too lazy to take it, accept it, because you didn't want the responsibility of collecting the rent, and paying the rest of the house mortgage, which after you collected the rent you'd live free-so I told you and showed you. You didn't tell them that, did you? Of course you didn't, you're slow but not that dense, just resentful and revengeful and disrespectful and you'd rather accept the butts you father throws on the floor, than doing an honest day's work for me, that's called pride. You'll take the money alright but not the responsibility."

His wife would say, "My husband gives you vacations and cheap rent and money, and gifts, and all your father gives you Boris, are his old cigarette butts, and you respect him more, why?"

"I can say what I want to say," he'd say to Delilah, and she'd just shake her head; but the unbelievable took place that winter of 2005, but I guess they ain't the first critters to come up with such diabolical scheme, or schemes on their parents.

At this juncture Christopher was worn out, exhausted but still he restrained himself from wanting to close the door completely on their relationship, leaving it ajar for reconciliation.

John was the caretaker of Christopher's nine-plex, and overall handyman of the six properties. Knowing his ex employer, the one that was going to give him a free house also, if he proved to be loyal, but with Boris -and alleged daughter, they tried to set the house on fire, via the garage, setting several brooms together, and pouring gasoline on them, and on the cement, soaking into the cement, all the way to the car, lit it on fire, and ran like hell. It was 4:00 a.m., in the morning,

For what? For $450,000-dollars of liquid free assets; His will had not been altered yet: but it soon would be.

In time, Christopher would find out this supposed secret, of it being them who tried to set the fire in the garage, Boris had babbled it already to everyone in the neighborhood. It just happened to beDelilah heard a voice while they were sleeping; it sounded like Teresa's voice-her mother in laws, "Wake up, wake up, wake up..." an everlasting echo. And it woke Delilah up, and she woke her husband who was ill with a debilitating neurological disease, to escape the impending fire in the garage. Delilah then put it out with a wet towel. The footsteps outside in the Minnesota snow looked like Boris' that let up to the opened garage, and then it downed on Christopher Boris still had the garage key, and the neighbor indicated-had said "...it was a big man," that it could have been Boris: but it remains an unsolved mystery-for the police, because Christopher never would allow himself to crystallize such a theory to the point of involving the police for his own reasons: "Had the fire connected with the upper part of the inside garage," said the Fire Chief, "the whole house would have went up in a matter of minutes."