Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Breaking the bones of the hip (hip fracture) is common in the elderly. This is a result of two major factors that affect older people: (1) an increased risk of falling because of poor stability (from a decrease in muscle, joint, and nerve function) and poor vision; and (2) weak bones that break easily because of osteoporosis.
It has been estimated that 250,000 (a quarter of a million) people in the United States suffer hip fractures each year!
A hip fracture is a terrible injury. It typically requires major surgery for repair. Operations involve either metal pinning with screws and/or plates or replacement of the hip joint with artificial parts. These operations can be complicated by infections, blood clotting, bleeding, and failure of the repair work. After such a surgical procedure, long and aggressive rehabilitation programs are necessary for optimal success. For the very frail, elderly person, ultimate recovery can be extremely difficult and long-term loss of independence, nursing-home placement, and even death can result.
Prevention of hip fractures is a key part of caring for the health of the elderly. Elderly people can take measures to decrease their own risk for hip fractures. These measures include participating in regular, proper exercise, "clearing the runway" in homes for walking and transferring, undergoing regular general and eye-health checkups, and addressing osteoporosis (bone-density exams, calcium and vitamin D intake, and osteoporosis medications when indicated).
A total hip replacement is a surgical
procedure whereby the diseased cartilage and bone of the hip joint
is surgically replaced with artificial materials. The normal hip
joint is a ball and socket joint. The socket is a "cup-shaped" bone of the pelvis called the acetabulum. The ball is the head
of the thigh bone (femur). Total hip joint replacement involves
surgical removal of the diseased ball and socket and replacing
them with a metal ball and stem inserted into the femur bone and
an artificial plastic cup socket. The metallic artificial ball
and stem are referred to as the "prosthesis." Upon inserting
the prosthesis into the central core of the femur, it is fixed
with a bony cement called methylmethacrylate. Alternatively, a
"cementless" prosthesis is used which has microscopic
pores that allow bony ingrowth from the normal femur into the
prosthesis stem. This "cementless" hip is felt to have
a longer duration and is considered especially for younger
patients.
Who is a candidate for total hip replacement?
Total hip replacements are performed
most commonly because of progressively worsening severe arthritis in the hip
joint. The most common type of arthritis leading to total
hip replacement is degenerative arthritis (osteoarthritis) of
the hip joint. This type of arthritis is generally seen with aging,
congenital abnormality of the hip joint, or prior trauma to the
hip joint. Other conditions leading to total hip replacement include
bony fractures of the hip joint, rheumatoid arthritis, and death (aseptic necrosis) of the hip
bone. Hip bone necrosis can be caused by fracture
of the hip, drugs (such as prednisone and prednisolone),
alcoholism, and diseases (such as
systemic lupus erythematosus).
The progressively intense chronic pain together with impairment
of daily function including walking, climbing stairs, and even
arising from a sitting position, eventually become reasons to
consider a total hip replacement. Because replaced hip joints
can fail with time, whether and when to perform total hip replacement
are not easy decisions, especially in younger patients. Replacement
is generally considered after pain becomes so severe that it impedes
normal function despite use of anti-inflammatory and/or pain medications.
A total hip joint replacement is an elective procedure, which
means that it is an option selected among other alternatives.
It is a decision which is made with an understanding of the potential
risks and benefits. A thorough understanding of both the procedure
and anticipated outcome is an important part of the decision-making
process.
Pneumonia is inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
An arrhythmia is an abnormal heart rhythm. With an arrhythmia, the heartbeats may be irregular or too slow (bradycardia), to rapid (tachycardia), or too early. When a single heartbeat occurs earlier than normal, it is called a prmature contraction.
A pulmonary embolism occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Osteoarthritis is a type of arthritis caused by inflammation, breakdown, and eventual loss of
cartilage in the joints. Also known as degenerative arthritis. Osteoarthritis
can be caused by aging, heredity, and injury from trauma or disease.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Fractures occur when bone cannot withstand the outside forces applied to the bone. Fractures can be open or closed. Types of fractures include: greenstick, spiral, comminuted, transverse, compound, or vertebral compression. Common fractures include: stress fracture, compression fracture, rib fracture, and skull fracture. Treatment depends upon the type of fracture.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Medical shock is a life-threatening medical condition. There are several types of medical shock, septic shock, anaphylactic shock, cardiogenic shock, hypovolemic shock, and neurogenic shock. Causes of shock include heart attack, heart failure, heavy bleeding (internal and external), infection, anaphylaxis, spinal cord injury, severe burns, chronic vomiting or diarrhea. Low blood pressure is the key sign of sock. Treatment is dependant upon the type of shock.
Aseptic necrosis (avascular necrosis or osteonecrosis) is a condition that develops when blood supply diminishes to an area of bone and causes bone death. Though aseptic necrosis may be painless, pain is often associated when the degenerating bone is used. If caught early, aseptic necrosis may be treated by grafting new bone into the degenerating area. In later stages, joint replacement surgery may be required.
Blood is a liquid that flows within blood vessels. It is
constantly in motion as the heart pumps blood through arteries to the different organs and cells of
the body. The blood is returned back to the heart by the veins. Veins are
squeezed when muscles in the body contract and push the blood back to the heart.
Blood clotting is an important mechanism to help the body repair injured
blood vessels. Blood consists of:
red blood cells containing
hemoglobin that
carry oxygen to cells and remove
carbon dioxide (the waste product of metabolism),
white blood cells that fight
infection,
platelets that are part of the clotting process of the body, and
blood plasma, which contains fluid, chemicals and
proteins that are important for
bodily functions.
Complex mechanisms exist in the bloodstream to form
clots where they are needed. If the lining of the blood vessel...
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