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Xarelto, like Eliquis and Pradaxa, are members of a class of drugs known as New Oral Anticoagulants (NOACs). While, technically, they are not a blood thinner like Coumadin (Warfarin), as they are closer to a class of medications known as statins, their respective makers hope they will go head-to-head with Warfarin and eventually replace it as the treatment of first resort for many patients.

pills.jpgWarfarin itself has a rather interesting history, as it was first discovered in relation to a disease that was killing cattle in the 1920s. After being created, it was then marketed as a rodenticide agent, and later used (unsuccessfully) by the United States Army as an experimental suicide agent. Eventually, it became used for its current purpose to treat atrial fibrillation patients.
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While total knee replacement surgery is primarily done in older patients who have suffered years of arthritis, there is another group of patients who might be in need of an artificial knee joint. This group consists of younger athletes and those who may not even be athletes, but frequently engage in running activities such as races, marathons and triathlons.

cyclist-and-jogger-1353678-m.jpgFor many of these people who are experiencing knee pain, there is a fear of going to a doctor. Their fear is based upon a belief their doctor will tell them they need a knee replacement, and after they get one, they will never be able to run again, because an artificial joint was not designed for repeated impact of regular running.

As discussed in a recent news article from the San Francisco Examiner, doctors who frequently work with patients who enjoyed running believe every year a patient can get out of their natural knee, the better. This does not mean dealing with pain until it becomes unbearable, but rather trying less invasive surgical techniques short of total knee replacement. Some of these techniques include arterial cartilage paste grafting and rebuilding a patient’s damaged meniscus or replacing it without replacing the entire knee joint. This is sometimes known as a reconstruction or partial knee replacement. Robotic surgical techniques can be used to perform a series of less invasive replacements of individual knee components. This is in contrast to the traditional advice, which is often to do nothing until the pain becomes too bad to handle after years of further deterioration.
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Boston’s PBS affiliate, WGBH, recently featured a program showing what it is like to be in the operating room during a minimally invasive total hip replacement surgery. Traditional methods involved making a 12-inch incision along the side of a patient’s hip and dislocating the hip joint from the pelvis. This method, still used in patients over 60 and who have other health issues, requires patients to stay in the hospital for days or even weeks and undergo a slow and painful recovery process. The large incision also increases the risk patients will develop a serious infection following surgery.

doctorpatientrelationship.jpgWith minimally invasive techniques, only a six-inch incision is needed at the top of a patient’s hip, and dislocation is not required in many cases. This means a patient can typically go home that same night and sleep in his or her own bed. This also means there will be less pain during recovery, less risk of an artificial hip failure, and less time away from work or one’s other daily routine.

The reason doctors are able to perform a minimally invasive total hip replacement surgery is though the use of modern technology. It all begins with surgeons and radiologists working together to take a CT scan of the patient’s pelvic area while he or she is in the operating room. Doctors then use a computer and the CT image to make a three dimensional virtual model of exactly how the operation will work. There is an electronic signaling device used to guide the surgeon while he or she is watching a monitor while the movements occur inside the patient.
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Many doctors tell overweight patients suffering from knee problems that being obese is a major contributing factor to their joint damage. This is the same information that doctors have been telling their patients for decades and should come as a surprise to nobody. However, many patients are already dealing with enough joint deterioration to need a total knee replacement procedure sooner rather than later.

weight-scale-1186277-m.jpgA recent news article from U.S. News and World Report takes a closure look at this issue. One patient interviewed for the story was 60-years-old and was in need of a total knee replacement procedure. She was retired as a schoolteacher because her severe arthritis made it virtually impossible for her to do her job. She could not walk up and down the building’s three flights of stairs any longer. She had no cartilage left her in one knee by that point. She was experiencing bone on bone friction every time she walked.

She said she was always overweight since she was child. As an adult, she spent years trying to a find a surgeon who would be willing to perform a total knee replacement while she was obese. She was told to have bariatric surgery, lose weight, and come back for another consultation. She was not willing to have bariatric surgery, due to all of the dangers she had learned about the procedure.
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When we think of total hip replacement surgery, we typically think of older patients. Many times, a hip replacement is needed to treat years of pain caused by increasing osteoarthritis.

In some elderly patients, more commonly women, a fall can result in a broken hip, which is often treated with hip replacement surgery. However, hip replacement surgery is not only used on elderly Americans. Sometimes hip replacement surgery patients are much younger.

surgeon-2-179919-m.jpgAccording to a recent news feature from Health Line, hip replacement surgery is commonly performed in young patients who suffer from juvenile arthritis. More specifically, physicians are using it to conditions known as juvenile rheumatoid arthritis (JRA) and juvenile idiopathic arthritis (JIA), which is a form of arthritis that can occur at any age (most commonly young patients) and is caused by an autoimmune response. These conditions can be treated with a total hip replacement, as would be done with patients in their 60s and 70s. But the problem lies with the expected lifespan of the artificial hip implant.

Under normal conditions, including wear and tear from for ordinary use, an artificial hip implant, if designed properly, will last around ten years, though sometimes longer. When a patient is around 70 years of age, the lifespan of the hip is similar to the lifespan of the patient, so this does not present a significant problem. It is not as if a properly constructed artificial hip will simply fail all at once. Rather, years of wear will make it become loose and start to cause pain to the patient.
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Each year, more Americans are choosing to undergo total knee replacement surgery than ever before. The surgery involves removing a patient’s deteriorated natural knee and replacing it with an artificial joint. The most common cause of knee problems leading to a total knee replacement is arthritis. Osteoarthritis affects millions of patients and typically gets worse as the patient gets older. The pain gets to a point where the patient can no longer stand it, and he or she elects to undergo a joint replacement procedure. There are other medical conditions that require a total knee replacement, such as sports injury or a serious accident, such as a fall.
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According to a recent news feature from the Madison Record, a woman in Texas is suing Bayer Pharmaceuticals AG, and its United States marketing partner Janssen Pharmaceuticals (Johnson & Johnson) for injuries she alleges was a result of her Xarelto prescription.

woman-in-hospital-1051476-m.jpgXarelto is the brand name for a drug known as rivaroxaban. It is a member of a class of drugs known as New Oral Anticoagulants (NOACs). Patients who suffer from various medical conditions including atrial fibrillation (Afib) require an anti-clotting agent. If blood clots form, they can block the flow of blood, causing strokes and other serious issues. If a clot forms and breaks loose, it can travel to other parts of the body, such as the lungs, where it can cause serious internal bleeding known as a pulmonary embolism or PE. Until the creation and FDA approval of NOACs, including Xarelto, Pradaxa, and Eliquis, the most commonly used medication was Warfarin, which is the generic form of Coumadin.

While Coumadin is effective in treating Afib patients, it does require very frequent blood tests to monitor dosage, and patients must also watch their diets closely, as certain foods can alter the rate at which Coumadin is absorbed. If the dosage is off, the patient can have serious consequences including bleeding disorders.
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According to a recent news article from U.S. News and World Report, many patients have an option of choosing between partial knee replacement or total knee replacement, longevity or satisfaction, and standard or robotic-assisted surgery.

knee1.jpgOne patient interviewed for the article had knee replacement surgery on both his left and right knees. He is somewhat satisfied with the standard partial knee replacement he had around five years ago, and he is very happy with the computer-assisted/robotic partial knee replacement he had in his other knee around a month ago. He reports the second surgery had much a shorter and smoother recovery period.

While it should come as no surprise that medical technology involving hip replacement surgery has become more advanced in the past five years, this article demonstrates the vast number of decisions that must be made regarding this surgery.
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While the need for a total hip replacement surgery sometimes results from an elderly patient suffering a broken hip or as result of a serious car accident, it is often the result of a patient living many years with severe osteoarthritis. At some point, it becomes so painful that cortisone shots and over the counter painkillers stop working, and patients decide to have their surgeons implant artificial hip joints.

electric-guitar-1381930-m.jpgAccording to a recent news article from Ultimate Classic Rock, TESLA singer Jeff Keith recently had his hip replaced, and the band had to cancel some upcoming tour dates where they were scheduled to perform with Def Leppard and Styx. A band representative says TESLA will be back on the road in time for their summer tour.

TESLA’s management said they had already cut back on the band’s touring schedule and cancelled some dates because the pain from the arthritis in Keith’s hips made it extremely difficult for him to continue performances. The band was faced with a need to decide quickly on what do with respect to Keith’s condition, and a decision was made for him to have a total hip replacement procedure as quickly as possible, which is what happened.
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In the last decade, marketing of testosterone replacement drugs has increased to astounding proportions. At this same time, sales of testosterone replacement therapy drugs have risen over 400 percent. These numbers certainly imply a causal relationship. What has not been demonstrated is any increase in the frequency of a very rare medical condition known as hypogonadism, which is the FDA approved reason for doctors to administer testosterone to patients.

Thumbnail image for money-trading-4-1415242-m.jpgThe author of a recent article in Forbes believes these increased sales and marketing efforts is a result of a practice by the drug companies he called “disease-mongering.” The author looks how the slew of commercials during the news or live sporting events tells us testosterone hormone can help with a low libido, increase energy levels to where they were during our youth, and show healthy middle-aged men in the commercials. This trend, he says should be banned outright by the United States Food and Drug Administration (FDA).

Essentially, drug companies and their respective marketing departments are trying to convince men that they go through what is equivalent to female menopause, and taking testosterone replacement drugs can help alleviate the symptoms.
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