Hemiarthroplasty for fractured hip

Hemiarthroplasty.
That day, for the very first time, I heard that word.
I cup my head and face in my hands, digesting hard every single word from the doctor in front of me.
My mom is trembling beside me. Shocked.
Only after 1 month we found out this truth, a painful truth.

In the first week of Hari Raya, while my sisters and I were chit chatting in the kitchen, enjoying a delicious chocolate cake moist, we suddenly heard a bang. It was 12 midnight sharp. We quickly checked and found my mom lying on the floor painfully in front the of the kitchen door. She was throwing a small plastic bag of rubbish when she accidentally stepped on a pair slippery slipper next to the rubbish bin. She couldn't get up. My brother scooped and held her to the car. We went to the clinic but the X-ray was closed at 10pm. The doctor wrote a letter and asked us to bring her to hospital. At Hospital Sg Buloh (government hospital), the doctor checked her up and casually said "Mak cik tak yah risau. Tak ada patah. Tak perlu X-ray." (Don't worry aunty. No fracture. No need X-ray.)

Believing the stupid doctor, we assumed it was just a torn muscles, no fracture. For 1 month, we tried various traditional massages but still she felt the pain on her left thigh joint. Seeing her condition wasn't getting any better, I decided to bring her to a specialist. She resisted. By nature, she's a person who easily feel scared and afraid. I ignored her resistance and drove her to the specialist hospital.

As soon as Dr Muiz saw my mom entering his room with her crutches, seeing my mom's left leg, he already had something in his head. Without telling us his speculation, he first sent her for an X-ray.

In front of our very own eyes, he explained the X-ray result. Comparing the left hip condition with the right one, we were very shocked and speechless. It was a fractured hip. Fracture neck of femur, to be exact.
There was no other option but a surgery! Hemiarthroplasty surgery!

Incompetent government hospital

Dr Muiz said, when elderly fall down, rule #1 is she/he must take X-ray!

How could the government hospital be so casual about it? So irresponsible!
We drove all the way to the hospital that midnight just to get an X-ray when the doctor confidently said nothing to worry, no X-ray needed!

I believe that we are not the first one who was tricked by the incompetent government hospital. There are so many similar cases out there. Can we sue the hospital?

Hemiarthroplastry

Hemiarthroplastry is an operation that is commonly used to treat a fractured hip. Hemi means half, and arthroplasty means joint replacement. The two make up hemiarthroplasty, half joint replacement. It only replaces the ball portion of the hip joint, not the socket portion. In total hip replacement, the socket is also replaced. 

How does the hip joint work?

The hip joint is one of the true ball-and-socket joints of the body. The hip socket forms a deep cup that surrounds the femoral head, the ball of the upper thigh bone. The surface of the femoral head are covered with articular cartilage, a slick material that allows the surface to slide against one another. Blood supply to the femoral head only comes through the neck of the femur.




Hemiarthroplasty prosthesis

Amazingly, not only vehicles have spare parts but human body has too. The fractured femoral head can be replaced with a metal head called hemiarthroplasty prosthesis. 

The prosthesis is composed of a metal stem that fits into the hollow marrow space of the thighbone (the femur) and a metal ball that fits into the socket of the hip joint.

 There are 2 types of prosthesis:
1) unipolar prosthesis
- it has a solid metal ball that replaces the femoral head

2) bipolar prosthesis
- it has a femoral head that swivels where it attached to the stem
- designed to reduce the wear and tear on the articular cartilage inside the socket

It is unclear whether the swivel offers any significant advantage. Both types seem to work well.


Nevertheless, the original bones, Allah's creation can never be challenged. SubhanAllah.
There are few limitations with the prosthesis. The rule of thumb is to ensure that the knee cannot be higher than the hip joint when bending. Some limitations to avoid dislocation are:
- can no longer squat (cannot bend the hip more than 90 degree)
- cannot cross the legs
- must sit on a chair. Cannot sit down on the floor. For performing prayer, she can no longer do the normal way. She must sit on a chair to do so.

What Your Doctor May Not Tell You About(TM) Hip and Knee Replacement Surgery: Everything You Need to Know to Make the Right Decisions

Before operation

The biggest challenge was to convince my mom to go for the surgery. She refused. She was scared that she would die. To be honest, this is the first time ever for someone in my small family going for a surgery. My dad, sisters, brother and I tried to convince her by giving her advice and moral support. She was still reluctant.

One day, I showered her and saw the skin on her thigh went wrinkled and shrunk. I cried and asked her to go for the surgery before it is too late.

Other family members and her friends visited her and gave motivation and moral support for her to be strong to go through the surgery. Finally, she agreed.

During the operation

Anesthesia

Anesthesiologist provides 2 options to my mom: 1) Whole body anesthesia and 2) Half body anesthesia (from waist down). He said option 2 is less risky and allow her to recover faster after the surgery. Despite being scared, she took option 2 because she was afraid that she couldn't wake up again if she takes option 1 but with a condition. She requested to close her eyes and ears so she couldn't see and hear anything. They only stuffed cotton on her ears but she can still hear everything. The funny thing is that somehow she found great courage and able to chit chat with the doctor during the operation.

Implant insertion

The surgeon makes an incision on the side of the thigh to allow access to the hip joint. Only then, he saw that the femoral head is no longer inside the socket, but it was dislocated to the back of the hip. From the front view of the pelvis X-ray, we won't be able to tell this. The dislocated fractured head knocked on nearby parts of the body causing a small crater formed on top of the head. The surgeon removed the head. He inserted the metal stem of the prosthesis into the femoral canal. Since my mom is over 50 years old, her bone was not that strong. Hence, the surgeon used the epoxy-type cement to bond the metal stem to the bone. He then attached the metal ball and relocated back into the hip socket. Before he close the incision, he makes sure that the hip works properly and the joint moves easily.

Alhamdulilah everything went well. Thanks to Allah, my mom does not suffer any other critical illnesses such as high blood pressure, diabetes, heart problem etc which make the surgery less risky.

After the operation

The operation took 2-3 hours. Having risk-free condition, she was immediately transferred to her ward room for rest. Doctor advised her to only take in food after 5 hours to give some time for the anesthetic to fade away. The next day, only after the blood at the incision part went dry, the doctor applied water proof plaster.

Physiotherapy

Only on the third day, she started to go through the physiotherapy. The therapist guide her on how to get up from bed, how to walk and how to climb the stairs. For a start, she should only apply around 20% of her body weight on the operated leg.

Now, she's back at home. Recovering. Her next visit to doctor would be end of this month.
I pray to Allah so that she can recover fast and well. InsyaAllah. Ameen.

My mom's X-Ray result (Before and After operation)

Fracture neck of femur (Before operation) 

After hemiarthroplasty operation

In the first X-ray picture, you can see the head of the left thigh bone is fractured. Front view of the x-ray couldn't tell the exact condition in which the fractured head was actually dislocated and was behind the hip instead of inside the socket.

The later picture shows the shining metal ball bonded to the thigh bone, replacing the fractured head of femur.

Please pray that my mom recover fast and well and she can walk without limping and live her life happily.
InsyaAllah. Ameen.

P/S: For those out there, please remind your old folks to be extra careful and avoid falling down because elderly suffer more risk due to the fall as their bones are aging.

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I believe in only ONE chance

On the 3rd day of Ramdhan, my throat suddenly felt so painful, swollen. Trouble sleeping. Took wood peppermint cough syrup and sucked in lozenges. Shivering. Took panadol. Still shivering. Took another panadol. Slept.

The next day, I took MC and went to see my doctor. Hey.. I was still fasting, okay. Just a little pain doesn't hinder me from observing fasting in this holy month. Alhamdulilah... I still managed to make it.

I don't mind driving further from my new house to see my doctor whose clinic is near to my old house. It's worth it, I tell you!

I told him what's bothering me and he examined me. He took his pen, started drawing on his writing tablet and on his computer screen, appeared an uvula with 2 little circles on the side. I asked him, what's that little circles? He said bacteria! Hahahaaa....

If you flipped through my medical records in his computer, you will see uvula picture in each page. I once read article saying that according to my birth date, my weakness lies on the throat. It's indeed true. My throat is quite sensitive.

Dr Thong: How's your new house?
Me : Ahaa.. you know
Dr Thong: Your mom came last time and told me about it.
Me : Oh yeah.. Well, it's good :-) See.. I still come to see you even though
it's further.
Dr Thong: You know why? I always prescribe good medicine. Many other doctors and even some of my friends, they simply prescribe normal medicine. Easy to claim. For good medicine, you need to itemize it. And you have to login to the computer system and submit the claim within certain time else the claim forfeited. They are too lazy and don't want to be bothered with this tedious work. My friend asked me "Why do you bother to do that? Simply give normal medicine and then if they are not well, they will come again. I said to them, "I believe in only ONE chance"

"I believe in only ONE chance". That's what my doctor said to me. And that's what make him so different than any other doctors I have met.

Dr Thong is like my family doctor. He knows my whole family. We visit him every time we fall sick.

There was the time, when my throat and coughing recurring and I visited him a few times. Still not getting well. He then gave me a strong medicine and advised me that he only prescribed this to asthma patient. But I'm not. So, take wisely and stop immediately if I feel it's too strong. Few days later, I got a call from him. I was surprised that a doctor called me! He asked whether I get better. And I said yes. My aunt said maybe the doctor likes me. Not bad to have Chinese husband for me since I have Chinese look a bit. So funny. Of course not. He just concern whether I get better or experience any side effect due to strong medicine. And I believe he's married too. Hahahahaa..

There was also a time when I asked him for a particular medicine I used to take when I was in Singapore. Dr Christine in DBS Building, Tg Pagar, Singapore, is my favorite doctor. What I like about her medicine prescription, not only they are good but also they come with full drug name printed label. So, I know what drugs I am taking.

For coughing : Phenexpect cd expectorant
For sore throat: Mac dual action blackcurrant flavour hexylresorcinol
(Ernest Jackson)
For flu : Chlorpheniramin tablet 4mg
For phlegm/sore throat: Korzen sinsia serratiopeptidase 5mg (this is my most favorite. It's very effective!)

Unfortunately, I can't find these drugs in Malaysia, not in pharmacies and not even in clinics. So, I asked Dr Thong whether he has such drug supplies. No, but he will check it up. You know what, in my next visit, I got Mac dual action blackcurrant prescription from him :-)

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Jungle trekking @ FRIM

It's been years since KLGamblerz get together for adventure trip. On Sunday 16 Jan 2011, half of the geng went to FRIM, Kepong. I never been there before even though I stay not far from it.

Founder and pioneer members of KLGamblerz gang are Erik (aka Oggy), Paklah, Kak Rasha (aka cheesechoc), Baie (aka cataly5t), Kapes and me (aka speed). Now, the gang has grown with new members with Rania and Rafiq (Kak Rasha & Baie's kids), Intan (Paklah's wife) and Mardhiah with 2 kids (Kapes's family).



First pic: from left, Erik, Wanie, Paklah & Intan.

I was not feeling quite well actually (sore throat) and went to clinic the day before. But, I stubbornly insisted of joining the trip. Perhaps, due to the medicine I took after Subuh prayer, I was asleep and didn't notice my alarm ringing. I woke up by the call from Paklah and it was already 8.20AM and we are supposed to meet up at FRIM at 8.30AM! Well done. I quickly took shower, got ready, grab some bread with planta for breakfast on the way, dash off and drove like mad. I reached FRIM around 8.45AM, emmm..not bad.



We first headed to information center to get some brochures to find out what activities we can do here. Unfortunately, the information is limited and we only got a so-not-helping map. We started with trekking on Salleh trail followed by Rover trail. Salleh trail is interesting because we have to walk through the forest along narrow rooted path. Roger trail is wider and developed which can be used by vehicle and bicycle.

We finally stopped at the Malay Tea House, where I had Misai kucing herbal tea well-known for detox, slimming and traditionally used for kidney bladder stones, liver, gallbladder, diabetic problems, urinary tract infections, to reduce cholesterol and high blood pressure. It is also taken for rheumatism and gout, although its effectiveness for these problems has not been scientifically verified. Researchers have found it to be mildly antiseptic as well.

Misai means whiskers, kucing means cat, so together it makes out as cat's whiskers. The reason behind the name is because the medicinal plant has a unique flower, white and bluish in color with far-exerted filaments that looks like cat's whiskers.

Common names for this pant are Misai Kuching (Malaysia), Kumis Kucing and Remujung (Indonesia), Java Tea and Kidney Tea (European), Yaa Nuat Maeo (Thailand).

Scientific Names are Orthosiphon Stamineus Benth, Ocimum Aristatum BI., Orthosiphon Aristatus (Blume).

Plant family: Lamiaceae, Labiatae

It is a medicinal plant, native in South East Asia (Malaysia, Indonesia, Thailand) and some part of Tropical Australia. It is a herbaceous shrub which grows to a height of 1.5 meter. In the wild, the plant can be seen growing along the forest edges, roadsides and wasteland.



The funny thing is that we end up playing "tutup botol" (direct translation is bottle cap - the game I used to play when I was kid. I was "jaguh kampung" in this game!) and "congkak" - traditional Malay game at the Malay Tea House. We make ourselves home!

There are many other activities available in FRIM like bird watching, jogging, mountain bike, picnic, camping, botanical garden and the best of all, canopy walk but it was closed for maintenance until March.

We are determined to come again for weekend treat to explore more!

P/S: It served me right, due to my stubbornness joining the trip despite not feeling well, I suffered fever and on MC for 2 days! kuikuikui...

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Bipolar disorder

During my business trip to Singapore, I knew I would spent most of the time waiting. So, I grabbed one story book which I bought almost 2 years ago at book auction at a very cheap price. But never read.

At the airport, while waiting for my flight, I opened the book and started immersed myself into another world, far from my own reality. That's the best part of reading books! Oh... I miss the moment I used to read in MRT on the way to and from workplace. Since moving back to KL, I couldn't get such moment anymore since I have to drive!

Love Comes Tumbling, that's the book title. To my surprise, it is not merely a love story but more than that. I never realized that I have kept such a great story book for such a long time, unread. I'm glad that I finally read it!

The story brought me to understand a mental illness called bipolar disorder.

Bipolar disorder or manic-depressive disorder is a psychiatric diagnosis that describes a category of mood disorders. Greg, the best-selling author, experienced mania and depressive episodes. His mood swing from abnormally elevated energy levels, referred as mania or if milder, hypomania to depression which associated with distress and disruption and elevated risk of suicide.

During his mania episode, he met and fell in love with Lucy, an Artist who run her own graphic design firm with her partner, Fint, a gay. Lucy who was just lost her fiance, Brendan, due to car accident was reluctant to start a new relationship but eventually she fell for Greg, the energetic guy who lifted up her melancholy life to cheerful, worry-free life.

After Greg was diagnosed with bipolar disorder, she hang on to the fragile relationship and took care of Greg's motherless children, Rachel and Toby while Greg struggling to fight his disease with psychiatric treatment. Long term treatment with lithium will help the imbalance chemical in the brain for mood stabilization.

I have always enjoy reading materials with facts and reality than merely empty entertainment because I can learn and explore new things which I never encountered.

Thumbs up to the writer, Denise Deegan!

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