Brain tumours are created when cells in your brain grow in an abnormal and uncontrolled way. Brain tumours can be malignant, which means they’re cancerous, or benign (not cancerous).

You can get a brain tumour at any age but they’re more common after you reach 50. Children can also get brain tumours.

If brain tumours develop from normal cells in your brain, they’re called primary brain tumours. If the cancer spreads from another part of your body, it’s called a secondary brain tumour. And, this spread of cancer is called metastasis. We’ll focus on primary brain tumours here.

Types of Brain Tumour

There are different types of brain tumour that are usually named after the type of brain cell they develop from. They can also be named after the area of the brain where they’re growing. We describe the most common types below.

Gliomas

These are the most common type of brain tumour. They grow from glial cells, which support the nerve cells in your brain. The most common types of glioma are:

  • astrocytomas and glioblastomas
  • oligodendrogliomas
  • ependymomas
  • Meningiomas

About one in five brain tumours in adults is a meningioma. These tumours start in the layers of tissue that cover your brain (the meninges) and are more often benign.

Pituitary Tumours

About one in 10 brain tumours develops in the pituitary gland – a gland in your body that produces natural chemicals called hormones. These are called adenomas and are usually benign.

Medulloblastomas

Medulloblastoma usually develops in the cerebellum, which is at the back of your brain. It rarely affects adults but is the most common brain tumour in children.

Symptoms of Brain Tumours

The exact symptoms you’ll have will depend on the size of the tumour and where it is in your brain.

Symptoms you can get as a result of increased pressure on your brain from the tumour include:

  • headaches – these are often worse at night and early in the morning but may wear off as the day goes on
  • feeling sick or vomiting
  • blurred vision
  • If you are experiencing the symptoms for a while, see a doctor.

Diagnosis of Brain Tumours

Your doctor will ask you about your symptoms and examine you. They’ll do some tests to assess your reflexes, co-ordination, muscle strength, memory and vision too.

You might need to have some more tests to confirm if you have a brain tumour, and to find out what type you have.

  • Blood tests – these assess your general health and check for specific chemical markers in your blood.
  • Magnetic resonance imaging (MRI) scan – this uses magnets and radio waves to produce images of the inside of your brain.
  • Computerised tomography (CT) scan – this uses X-rays to make a three-dimensional image of your brain.
  • Electroencephalogram (EEG) – this uses electrodes that are attached to your scalp to record your brain activity to look for anything unusual.

Brain Tumour Grading

You may need to have a biopsy to find out the type and grade of your tumour. Your doctor will use your CT and MRI scans to accurately find the position of the tumour and remove a small sample of tissue. They’ll send this to a laboratory to be tested. They might do this as part of an operation to treat a brain tumour.

This sample will be graded from one to four, based on how fast your tumour is likely to be growing. Grade one is a low-grade, slow-growing tumour that’s the least likely to spread and four is malignant and the most likely to spread. Doctors can also test the genetic information of your tumour, which may guide them in deciding which treatment is best for you.

Treatment of Brain Tumours

Different brain tumours develop in different ways. Your treatment will vary depending on which type you have, how advanced it is, and where it is in your brain. Your doctor will discuss what your treatment options are and give you advice and information.

Observation

If your tumour is slow-growing and you don’t have many symptoms, you might not need any treatment straight away. Your healthcare team will monitor you closely and you’ll have routine check-ups and scans.

Surgery

The aim of surgery is to remove as much of the tumour as possible. For some types of brain tumour this can cure them. And for others, it can slow down the growth of tumours and help to ease your symptoms.

You may be able to have open surgery, which is called a craniotomy, or keyhole surgery. This will depend on the type of brain tumour you have, as well as its size and position. If you have a pituitary tumour, your surgeon may be able to remove it through your nose, which is called transsphenoidal surgery.

You’ll usually be given a general anaesthetic during these operations, which means you’ll be asleep. But you might need to be awake for the procedure if your surgeon needs to check how your brain is working during the operation. This is important if your surgeon is removing tumours from areas of your brain that control functions such as movement, feeling and speech.

Non-surgical treatment

Radiotherapy

Radiotherapy uses a targeted beam of radiation to destroy your tumour while aiming to minimise any damage to your surrounding healthy tissue. You usually have radiotherapy after surgery to kill any remaining tumour cells, but sometimes you can have it as an alternative to surgery.

You may have radiotherapy everyday over two to six weeks, or as a single very highly focused treatment called radiosurgery. Another name for this type of radiotherapy is stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT), which you might hear called cyberknife or gamma knife treatment.

Chemotherapy

Chemotherapy uses medicines to destroy cancer cells. Only a few chemotherapy medicines work for brain tumours. The ones that are most commonly used are temozolomide, or a combination of, or just one of, the medicines procarbazine, lomustine and vincristine.

You might have chemotherapy on its own or in combination with other treatments. Temozolomide tablets are often used alongside radiotherapy to treat brain tumours called glioblastomas. You might also have this treatment if your tumour comes back after having other types of chemotherapy.

When your surgeon removes your tumour, they might put small implants called wafers into the affected area of your brain. These will release chemotherapy medicines to kill any remaining cancer cells.

Steroids

Steroids are hormones (chemicals) that your body makes to help reduce swelling. Synthetic (man-made) steroids can help to reduce swelling from your brain tumour, surgery or radiotherapy.

Call +65 64712674 for an appointment to see our brain specialist today.

 

The soft tissues of the ankle can be torn, partly torn or overstretched as an acute traumatic injury which can happen at any age. If it is severe, there may also be bone damage which may not be obvious at first.

Types of Ankle Sprain

Inversion and Eversion Ankle Sprain

In an inversion sprain, which is the most common, the foot and ankle turn inwards, and the lateral ligament takes the brunt of the force, sometimes cracking the fibula, and occasionally the medial malleolus too. In an eversion sprain the ankle twists outwards, straining the medial ligament, with damage to the medial malleolus and fibula in severe cases. In a dorsiflexion sprain the foot is forced upwards, compressing the structures at the front of the ankle. In a plantarflexion sprain the foot is forced downwards, and the soft tissues on the top of the ankle are strained, while those behind the ankle are compressed.

What you Feel During Ankle Sprain

When the injury happens, there may be a lot of pain, or very little. Pain and stiffness may come on later. You may still be able to walk, or at least hobble, putting your foot down. With your foot off the ground, you can usually move the foot up and down, at least a little, but rotation is painful, difficult or impossible. Swelling may develop immediately or later. Bruising may appear around the joint straight away or later. A minor crack in any of the bones may cause localised swelling and tenderness if you press on it.

The amount of pain you feel does not necessarily reflect the degree of tissue damage. If a ligament is completely torn, there may be surprisingly little pain, but the ankle feels unstable and tends to give way if you try to put weight through the foot.

Causes for Ankle Sprain

Ankle sprain can be caused by putting your foot down awkwardly, stepping on a ball or stone, catching your foot in a hole, tripping over the edge of a step or an opponent’s foot, or using sports shoes which do not fit properly, or which have too much or little grip for the playing surface. Ankle sprain happens more easily if you have stiff feet, knees or hips, or have suffered previous sprains or leg injuries which have created imbalance in the leg muscles and impaired your balance mechanisms.

Treatment for Ankle Sprain

For the first few days you may need an ankle support or firm bandaging and crutches. You should try to do frequent short walks taking a little weight through your foot.

Call +65 6471 2674 (24 Hour) to see our doctor and seek treatment regarding ankle sprain today.

The bones around the ankle can be broken by severe twisting stress or vertical impact. This is an acute traumatic injury which can happen at any age. If the ankle joint is displaced, it is a fracture-dislocation. Damage to the bone’s cartilage surface within the joint is called an osteochondral fracture.Injury to the talus, fibula or malleoli can cause cartilage or bone fragments to break off and form loose bodies in the ankle joint. Osteochondritis dissecans is a particular type of damage in a bone’s cartilage surface, which happens especially in teenagers. In young children whose bones are still quite soft, fractures are termed ‘greenstick’.

Type-III-ankle-sprain

What You Feel When You Have Ankle Bone Traumatic Fracture

A bone fracture can be surprisingly painless at first, and may seem no worse than a sprain. You may be able to put your weight on the foot. However, in a bad break there is acute pain, usually accompanied by swelling, bruising, perhaps bleeding, and visible deformity of the leg. Walking is painful or impossible. The ankle feels weak and becomes stiff. You may have throbbing pain at night or when you sit still. In the later stages you may notice a deep aching in the bones, which is a sign that they are healing.

Causes for Traumatic Ankle Bone Fracture

A broken ankle can be caused by a fall, a wrench with the foot stuck in the ground, landing awkwardly from a jump, or a direct blow. Compression fractures happen more easily if your ankle is stiff or taped rigidly. You are more vulnerable to fracture if your bones are weakened by calcium deficiency, disease or osteoporosis.

Treatment for Traumatic Ankle Bone Fracture

You should receive immediate treatment in hospital. You may need surgery to stabilise the broken bones. Otherwise your leg may be immobilised in a plaster cast or a splint from the foot up to the knee or hip. In the early phase of healing, during the first ten days or so, the bones start the process leading to union, which normally happens after six to twelve weeks. Once the broken bone ends are joined together, the bones strengthen up and become slightly enlarged. Over the following months the damaged bones remodel themselves and gradually resume their normal shape.

Call +65 6471 2674 (24 Hour) to see our doctor and seek treatment regarding ankle fracture today.

For the vast majority of people, your doctor will be able to work out what’s wrong with you by:

  • listening to you describe your symptoms
  • examining you joints
  • examining your range of movement
  • looking at your medical history
  • looking at the medical history of your family
  • ordering certain tests (e.g. x-rays, blood test, MRI)

Putting your symptoms into words into words can be difficult. It may help you to think about how you would answer the following questions before you visit your doctor.

  • Which of your joints affected?
  • Have you noticed that your range of movement has changed?
  • Have you started to find it difficult to carry out certain tasks (e.g. buttoning up clothes) that never used to be a problem?
  • Have you experienced any swelling around your joints?
  • How often do you have pain or stiffness?
  • Do your symptoms get worse at certain times of days or after doing certain things?
  • What makes your symptoms better or worse?

Testing for Arthritis

Although there is no single diagnostic test that can confirm explicitly whether or not you have arthritis (be it osteo- or rheumatoid), there are a number of tests that can help your doctor piece together the evidence. The most common of these are blood tests and scans.

Blood Tests

There are a number of reasons why the doctor treating you may order a blood test:

  • to help them confirm that you have arthritis
  • to rule out other illnesses
  • to see how advanced your arthritis is
  • to see if your treatment is working.

Blood samples will usually have to be sent away to a laboratory for analysis and so it may take several days for the results to come in. In the laboratory, there are a number of things that can be measured, including:

Rheumatoid Factor (RF)

This is a type of antibody, a special type of blood cell that helps to fight infections. Rheumatoid factor can sometimes be used to show whether or not you have rheumatoid arthritis. The test should only be used to diagnose rheumatoid arthritis together with other pieces of evidence.

Full Blood Count (FBC)

This measures the levels of a whole host of cells and substances in your bloodstream. It can reveal anaemia or a high white cell count. Both of these are usually just part of the disease and inflammation of rheumatoid arthritis, but sometimes anaemia can be due to lack of iron and a high white count may indicate infection.

Erythrocyte Sedimentation (ESR)

This test measures how quickly your red blood cells (erythrocytes) settle down when they are spun around and then left to stand. The ESR is a means of measuring how much inflammation your arthritis is currently causing. Other tests which measure the amount of inflammation include plasma vicosity and the C-related protein (CRP) tests.

X-rays

As a disease like osteoarthritis progresses, the damage to the bone can become more pronounced, and it is at this stage that X-rays are most useful.

X-ray OA Knee

MRI scans

MRI (Magnetic Resonance Imaging) scans are relatively quick and easy ways of obtaining detailed images of the inside of the body, without having to perform surgery.

MRI scanners use radio waves (which are safer than X-rays) and high-powered magnetic field to create two- or three-dimensional images. MRI scanners in particular can distinguish between bone and soft tissue and therefore provide a more detailed picture of the state of a joint as a whole (and not just the bone).

How is Arthritis Treated?

The way in which your arthritis is treated depend on the type of arthritis that you have. However, the overall aims of any treatment programme are to:

  • reduce or relieve pain
  • reduce inflammation
  • improve your mobility
  • improve your quality of life.

Treating Arthritis with Medications

  • For osteoarthritis, drug treatment revolves around providing pain relief.
  • For rheumatoid arthritis, drugs can be used to relieve pain and reduce inflammation but may also be used to slow down the progression of the disease itself.

Treating Arthritis with Injection

  • For osteoarthritis, Synvisc injection can be explored.
  • For rheumatoid arthritis, anti-inflammatory injection is recommended.

Treating Arthritis with Surgery

Although most people with arthritis will never need surgery, it can be used as a last resort if all other treatment options failed to work or if the joint is very badly damaged.

Joint Replacement

This procedure involves the total replacement of the affected joint (usually the hips or knee). During the operation, the surgeon will remove the damaged joint and replace it with an artificial one (made from plastic, ceramics or metal). Joint replacements usually last between 10 and 20 years.

Hip Resurfacing

Resurfacing the damaged joint is a less drastic alternative to replacing the joint completely, and is most usually performed in younger people with arthritis. Typically, the surface of the joint (usually the hip joint) is replaced by a metal hemisphere and the joint socket is lined with a metal shell.

Call +65 6471 2674 (24 Hour) if you wish to see our doctor and seek treatment regarding arthritis.

 

Learning how your joints function and what happens when your arthritis symptoms flare up can help you to understand your condition and make it easier to live with.

We have already seen how arthritis is a disease that causes pain and inflammation in the joints. It doesn’t matter which type of arthritis you have been diagnosed with, if it is not managed properly you will usually end up in a certain amount of pain and may have problems getting around and doing certain things. That said, the two major types of arthritis, osteoarthritis and rheumatoid arthritis, are actually quite different in terms of:

  • their symptosm
  • the rate at which they develop
  • the people they affect
  • the way in which they are treated

These differences arise because what’s actually going on in the joints is very different. Although both conditions involve the breakdown of cartilage in the joint, osteoarthritis is due to age related changes in which the cartilage becomes thinner in some joints, and the joint becomes less cushioned, whereas rheumatoid arthritis is related to a problem with the body’s own immune system.

Osteoarthritis occurs when the cartilage starts to disappear and the lubricating (synovial) fluid loses its protective cushioning properties.

Osteoarthritis

Osteoarthritis is also known as degenerative arthritis, because the cartilage that protects the bone gradually gets worn away (or degenerates). If the cartilage wears away completely then the ends of the bones can end up rubbing together, which can be extremely painful.

At one stage, scientists believed that osteoarthritis was a natural (and inevitable) consequence of getting older, but we now know this to be untrue. The real story is probably much more complicated. Although it is true that the older you get, the more worn out your joints become, not everyone of a certain age automatically develops arthritis. It is more likely that osteoarthritis can be put down to changes taking place in the miscroscopic structure of the joints. These changes may start with the cells that make cartilage. The changes that go on in your joint(s) if you have osteoarthritis usually happen in a certain order.

  • The cartilage in the joint roughens and becomes worn down (and may disappear altogether).
  • Tiny cracks may start to appear in the cartilage.
  • Extra bone is laid down to replace the damaged or lost cartilage. The bone underneath the cartilage thickens and grows outwards.
  • The amount of bone laid down far exceeds the quantity that is actually needed to replace the damage cartilage.
  • Bony outgrowths (called osteophytes) start to form along the damaged joint.
  • Fragments of bone may break off into the joint, which cause the joint to become inflamed and swollen (and painful_.
  • The synovium starts to produce more synovial fluid than usual, which adds to the swelling in the joint.
  • The loss of cartilage, the wearing of bone and the bony outgrowths can all start to change the shape of the joint. This forces the bones out of their normal position and causes deformities.

Rheumatoid Arthritis

A case of mistaken identity

Rheumatoid arthritis can be traced back to a malfunction in the immune system. The body produces antibodies that attach the cells of the joint lining (the synovium) because it mistakes it for a foreign invader, making it painful, unstable and deformed.

At the moment, no-one knows exactly what causes them but the more we understand autoimmune diseases, the easier they will be to treat and even prevent. At the moment, however, there are some gaps in what we know.

The immune response

So what are antibodies and what do they do? Antibodies are made by white blood cells called B-lymphocytes. They can be thought as Y-shaped structures, with a special region at the tip that recognises and attaches to specific foreign substances, called antigens. Once it has bound to  the antibody, the antigen is neutralised so that it is no longer harmful. This process is known as immune response.

Of course, if the immune response is triggered inappropriately, perfectly healthy and harmless cells may become damaged. This is what happens in the joints when autoantibodies are made in people with rheumatoid arthritis.

Our blood is made up of three types of cell: white blood cells, red blood cells (which help to form blood clots). White blood cells are a key part of the body’s defence mechanism against infection.

How does autoimmunity cause inflammation and pain?

Rheumatoid arthritis usually progresses in three distinct stages:

  1. The synovium swells up and becomes inflamed as so-called inflammatory cells in the blood (specialised cells that are responsible for controlling inflammation) flock to the place where they are needed (i.e. the joint). This causes pain, warmth, redness and stiffness.
  2. The inflammatory cells in the synovium grow very rapidly, which causes the synovium to thicken and swell together.
  3. The inflamed cells then start to break down the bone and cartilage of the joint, often causing the joint to lose its shape and become unstable to move as it once did.

Call +65 6471 2674 (24 Hour) to make an appointment with our doctor to treat arthritis today.