Questions

• My wife has lifestylelimiting pain from knee osteoarthritis. What is this condition, and how is it treated? Should she have a “gender-specific” total knee replacement?
• What should I do if I find a lump in my breast?
• Lately, my husband has been coughing and choking during meal times. His doctor referred him to speech therapy, but he’s not having trouble speaking. Why would he need to see a speech-language pathologist?

My wife has lifestylelimiting pain from knee osteoarthritis. What is this condition, and how is it treated? Should she have a “gender-specific” total knee replacement?

David J. Casey, M.D.
Orthopaedics
Pinehurst Surgical
(910) 235 -9767

Arthritis is a progressive disorder characterized by deterioration of joint cartilage. Osteoarthritis (OA) affects the hips, knees and spine of 21 million Americans over the age of 45. Women are three times more likely than men to suffer from OA. Twice as many women suffer from OA of the knee, and women are more likely to experience OA in both knees. Men, on the other hand, are more likely to suffer OA of the hip.

Patients with OA experience pain, swelling and restricted range of motion. They are often comfortable at rest, and note that their pain increases with weight bearing. They feel aching in the joints during rainy weather, and stiffness after sitting or inactivity, and they may hear grinding noise in the joint.

Joint cartilage lacks blood flow and cannot be repaired. As a result, the main treatment goals are to relieve pain and prevent progression of the condition. Patients have no control over their family tendency for OA, but they can correct factors that cause strain such as obesity and vigorous exercise or activity.

Non-operative treatment includes physical therapy, assistant devices (cane or walker), activity modification, anti-inflammatory medication, cartilage supplements and joint injections. Operations are the last resort for lifestylelimiting pain when non-operative treatments fail, and include knee arthroscopy, partial knee replacement and total knee replacement.

Knee arthroscopy and partial knee replacement have limited roles. The “gold standard” remains total knee replacement with 90 percent of patients reporting excellent results 12 to 15 years after surgery.

The knee is a hinge joint that consists of three bones: the femur (thigh bone), the tibia (shin bone) and the patella (knee cap). During knee replacement surgery, arthritic cartilage is removed and the bone ends are sized and reshaped so that the knee replacement parts fit the patient’s individual anatomy as closely as possible. When knee replacements were first designed, they came only in two sizes. Over the past 20 years, however, many implant manufacturers have developed more anatomically correct implant designs with more size choices that allow the surgeon to match the anatomy of male and female patients.

What should I do if I find a lump in my breast?

The risk of breast cancer increases gradually as a woman gets older. Although it can occur at all ages, the disease is uncommon in women under the age of 35.

All women age 40 and older are at a higher risk for breast cancer with most breast cancers occurring in women over the age of 50. In fact, the majority of women with breast cancer (eight out of 10) are over the age of 50.

Besides age, there are certain risk factors that increase the chances that a woman will develop breast cancer. Some of the most common are:

• Personal history of breast cancer (each breast can be
  affected independently)
• Family history of breast cancer among close relatives
  (mother, daughter, siblings, first cousins)
• Childbearing later in life (after the age of 30)
• Women who began menstruating early (before age 12) or
  reached menopause after the age of 50
• Excessive alcohol consumption
• Obesity and high fat diets

Although a breast mass found in a woman under the age of 35 is usually a fibroadenoma or a cyst, any new breast lump warrants close observation and evaluation. If a woman in this age group decides to monitor the mass through a menstrual cycle, she should do so through one cycle only. If it persists, she should have a biopsy, no matter how old she is.

If the woman is over the age of 40 and does not undergo a yearly mammogram, she should make an appointment with her physician and request an ultrasound or a mammogram for evaluation. Any woman over the age of 50 who finds a new breast mass should call her physician immediately and request a mammogram prior to her office visit. That way the physician can direct further evaluation as needed and without delay. The default position for evaluation of a breast mass is always a medical evaluation.

Women can take a role in the early detection of breast cancer by doing regular self-breast examinations and scheduling an annual mammogram. Breast cancer is not preventable but, with early detection, it is curable. Stage I breast cancer has a 90- to 95-percent cure rate, so early detection may just save your life.

Difficulty swallowing can be found in any age group, but it is especially common among the elderly. The term “dysphagia” refers to the feeling of difficulty in passing food or liquid from the mouth to the stomach. An interruption in the swallowing process can happen as a result of stroke, brain injury, cancer, Lou Gehrig’s disease, Parkinson’s disease, Alzheimer’s disease, Multiple Sclerosis, renal failure, respiratory problems or heart problems.

People normally swallow hundreds of times a day. Symptoms of swallowing disorders may include a feeling that food or liquid is sticking in the throat, discomfort in the throat or chest, and coughing or choking caused by small amounts of food, liquid or saliva being sucked into the windpipe and down into the lungs (“aspiration.”)