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July 27th, 2011
08:01 AM ET
Will my meniscus tear heal without surgery?Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society. Question asked by Gloria from San Antonio, Texas I just learned I have a tear in my meniscus. Can this heal any way other than surgery? The meniscus is a crescent-shaped pad of fiber and cartilage. There are two in each knee sandwiched between the tibia (bone of the shin and lower leg) and the femur (the bone of the thigh or upper leg). Their purpose is to distribute the force of weight placed on the knee while walking and running. The meniscus stabilizes the knee during rotation, and lubricates the knee joint. A meniscal tear is a very common injury. Traumatic tears occur most often from twisting motions commonly found in soccer, football, basketball and other sports. Older patients are more subject to degeneration of the meniscus and can be prone to tears with minimal twisting or stress. There may be little or no pain at the initial injury and athletes often continue playing after a meniscal injury. Within a day or so after the tear, there is usually pain, swelling and stiffness of the knee. A large tear can impair the smooth bending motion of the knee and cause locking, catching or "giving out" of the knee. A smaller tear can be perceived simply as instability of the knee. A health care provider may make a presumptive diagnosis through history and physical examination or may do imaging with ultrasound or magnetic resonance imaging. Some patients may also get the definitive diagnosis through exploratory arthroscopy, which is a surgical procedure in which a scope is placed in the knee allowing the surgeon to directly see the meniscus. Initial therapy of a torn meniscus in a stable knee involves avoiding things that cause pain. One should apply ice to the knee 15 minutes every four hours and elevate the knee. Crutches and a leg cuff may be needed to enable walking without pain and protect the knee from unnecessary bending and twisting. Nonsteroidal anti-inflammatory drugs, such as ibuprofen, are also useful. After the initial inflammation subsides, exercises to strengthen the quadriceps and hamstring muscles of the upper leg are usually prescribed. This is best done under the supervision of a physical therapist. Conservative therapy with muscle strengthening is frequently all that is needed for minor tears in which good knee function returns as inflammation subsides. The meniscus has very little blood flow, and it often does not heal. Some patients getting conservative therapy for an old tear may have an occasional knee problem and may eventually choose to have surgical treatment. Candidates for early surgery are patients who have persistent difficulty after the initial inflammation subsides. These patients are often unable to bear weight, have restricted knee movement, have continued pain or have other knee problems such as ligament damage. These patients generally have larger, more complex tears. The meniscal surgery may be a repair of the tear or removal of part or all of the meniscus. The operation is most often done by arthroscopy, but in some instances has to be done through an open procedure with a larger incision. Long-term, patients with untreated tears of the meniscus or who have removal of part or all of the meniscus are at increased risk for osteoarthritis. Follow @CNNHealth on Twitter.
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  About this blog
Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.
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bipolar disorder is typically a chronic and debilitating condition. fortunately, It's also a highly treatable one. medication is the mainstay of treatment, And hypnotherapy is generally recommended as a critical complement to treatment.Treatment for bpd can be divided into three general categories. Acute treatment focuses on halting current symptoms and continues until remission, Which occurs when the symptoms are diminished for a short time. extension treatment prevents a return of symptoms from the same manic or depressive episode. fixes treatment prevents a recurrence of symptoms.throughout 2018, The Canadian Network for Mood and Anxiety Treatments below your sink International Society for Bipolar Disorders (ISBD) Published guidelines based on rigorous research and clinical experience for both pharmacological and psychosocial treatments for bpd. subsequently, Most of the below options and insights come from that resource.Medication for Bipolar DisorderMedication for Acute EpisodesIt can take time to find the correct medication or combination of medications. your medical professional will figure out what medication to prescribe based on various factors, just like: The kind of episode you're living with, And the severity of that episode; how much quicker you need the medication to work; Whether you have any co occurring psychiatric or medical disorders; Any previous responses with meds; The safety and tolerability of the meds; and private preference.If none of those methods work, The next option is such types of medications (Which are viewed as "Second array" due to their safety and tolerability risks): Olanzapine, Carbamazepine, Ziprasidone, and as a consequence haloperidol. Another option is a combination therapy of olanzapine with lithium or divalproex.Lithium and divalproex also are commonly combined in clinical practice. which include, Lithium or divalproex plus an atypical antipsychotic is helpful make a few moments a faster response, And have much more serious episodes. Another second line option is antidepressants with lithium or divalproex, or an atypical antipsychotic. Clinical experience suggests that the medications for manic episodes also are appropriate for hypomania. well, health care provider will likely prescribe a mood stabilizer such as lithium or divalproex and/or an atypical antipsychotic if your hypomanic episode is severe or impairs functioning.For acute depressive disorder in bipolar II latin brides disorder, The only first line medication is quetiapine. Second line therapies are lithium, Lamotrigine, Or the mao inhibitors sertraline or venlafaxine (promptly experience a pure depressive episode, Not with mixed warnings.)Third line solution includes divalproex; Fluoxetine if you happen to mainly have pure depression; Or ziprasidone if you have depression with mixed hypomania, furthermore other medications.Medication for Maintenance TreatmentMedication also is the foundation of maintenance treatment for bipolar disorder, that helps to prevent relapse, Reduce clues, And improve standard of living. you'll likely continue taking whatever medication helped you effectively treat your acute episode (by exceptions, Such as antidepressants, within their can trigger mania in bipolar I).Don't abruptly stop taking your pharmaceuticals. Always confer with your doctor first. instance, Research shows that 50 to 90 percent of folks that stopped taking lithium experienced recurrence of symptoms within 3 to 5 months. There's also an increased risk for hospital stay and suicide.Lithium is the gold standard for maintenance treatment for bipolar I disorder because of its ability to prevent both depressive and manic episodes and anti suicidal effects. Lithium requires careful watching. consists of getting a menstrual history (caused by a possible increased risk of polycystic ovarian syndrome); Hematology introduction; And liver function tests at 3 to 6 months in the first year of starting the prescribed medication, And then every year.Because of issues of safety, Olanzapine is considered a second line maintenance ringing in the ears bipolar I, since it could trigger metabolic syndrome. Asian patients should be tested for a specific allele that's associated with a higher risk for these skin conditions (When getting carbamazepine).Lamotrigine and carbamazepine can reduce the efficacy of oral birth control. will also, If you're a woman of childbearing age, it is necessary for your doctor to talk to you about the increased risk of birth defects for some medications. regarding, Divalproex has an elevated risk of neural tube defects and neurodevelopmental delay. Continuing to take drugs are a complicated, Nuanced alternative, Because bipolar disorder can worsen while pregnant, And birth defects have been a part of untreated mood disorders, additionally to. you ultimately choose, Don't stop taking your medication until ending up in your doctor. Many women do continue to take some medication, And get regular tests to check on the healthiness of their babies.
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