Gastroenterologist Sanoat Maksudalievna Mamurova reflects on her patients, our tendency to endure pain, and why taking care of our health begins with paying attention to ourselves. Throughout my 45 years in medicine, I have come to realize one simple truth: people often find time for everything except their own health. We rush to work, take care of our families, and deal with everyday responsibilities. Sometimes we skip breakfast, grab a quick lunch, and have dinner late in the evening. And when we experience heaviness after eating, heartburn, or abdominal discomfort, we reassure ourselves: “I probably ate something that didn’t agree with me. It will pass.” And indeed, sometimes the discomfort goes away on its own. But at other times, what seems like an ordinary symptom may be a sign of a condition that requires medical attention. Throughout my career, I have met people with different personalities, backgrounds, and life stories. And each time, I am reminded that the person sitting in front of me is not simply a patient with a particular diagnosis, but a human being who may need both physical and emotional support. “Doctor, I Didn’t Think It Was Anything Serious…” I believe this is a phrase that almost every experienced physician knows well. Imagine a familiar situation. A person experiences discomfort after meals for a long time. At first, they ignore it. Later, they try changing their diet, taking familiar medications, or following advice from family and friends. For a while, they feel better. But then the symptoms return. Only then do they decide to seek professional medical advice. Situations like this are familiar to gastroenterologists. The causes of digestive discomfort can vary greatly, ranging from functional disorders to conditions that require medical examinations and treatment. That is why I always try to explain one important thing to my patients: do not diagnose yourself. Not every abdominal pain means gastritis. Heartburn is not always caused by what we eat. And the absence of severe pain does not necessarily mean that everything is fine. For me, it is important that patients understand what is happening in their bodies, why certain examinations are necessary, and what purpose each prescribed treatment serves. After all, successful care begins with mutual trust between a doctor and a patient. Our Bodies Know How to Warn Us. We Just Need to Learn to Listen The digestive system is a complex mechanism in which every organ plays an important role. The stomach, intestines, liver, gallbladder, and pancreas are closely interconnected. Their functioning can be influenced by diet, lifestyle, medications, emotional well-being, and many other factors. Over the years, I have become increasingly convinced of how important it is to explain even the simplest medical concepts to patients. For example, frequent heartburn is not always a harmless consequence of a heavy meal. Recurring abdominal pain, changes in bowel habits, unexplained weight loss, or persistent discomfort after eating are reasons to consult a physician and investigate the underlying cause. Difficulty swallowing, blood in the stool, persistent vomiting, and other concerning symptoms require particular attention. Sudden severe abdominal pain, vomiting blood, or passing black, tarry stools require emergency medical care. At the same time, I do not believe that people should live in constant fear of every sensation in their bodies. My role as a physician is not to frighten patients, but to help them understand when lifestyle adjustments may be sufficient and when professional medical care is necessary. Five Simple Habits Your Body Will Thank You For Many people believe that taking care of their digestive health means following strict diets, accepting numerous restrictions, and giving up their favorite foods. But developing healthy habits does not always require dramatic changes. First — try to maintain regular eating habits. There is no single ideal meal schedule that suits everyone. However, frequently skipping meals and then overeating can contribute to discomfort. The key is to find a routine that meets your body’s individual needs. Second — pay attention not only to what you eat, but also to how you eat. Eating calmly, choosing moderate portions, and avoiding habitual overeating may help reduce digestive discomfort. Third — avoid self-medicating. Even familiar medications for heartburn or abdominal pain should not become a permanent way of suppressing symptoms without identifying their underlying cause. Fourth — never ignore recurring symptoms. If discomfort keeps returning, interferes with your daily activities, or is accompanied by other changes in your well-being, it is important to seek medical advice. Fifth — remember that digestive health is closely connected to your overall lifestyle. Adequate sleep, physical activity, balanced nutrition, and stress management all play important roles in maintaining well-being. Most importantly, do not follow restrictive diets simply because they have worked for someone you know. Every person is different, and therapeutic diets for specific medical conditions should be tailored to the individual diagnosis. 45 Years in Medicine: What My Patients Have Taught Me With time comes the understanding that being a doctor is about much more than medical knowledge, diagnosis, and prescribing medications. Behind every consultation is a personal story. Some patients arrive feeling anxious because they fear a serious diagnosis. Others are exhausted by symptoms that interfere with their ability to work, rest, and enjoy everyday life. And some simply want to understand why they have been feeling unwell for so long. Every one of them deserves attention. I believe that every patient should have the opportunity to speak openly about their concerns, ask questions, and receive clear, understandable explanations. Sometimes, knowing the name of a disease is not enough. People want to understand how to manage their condition, which habits they should change, and what can genuinely help improve their well-being. Medicine is constantly evolving. New diagnostic technologies are emerging, treatment methods are improving, and clinical guidelines continue to develop. Yet one thing remains unchanged — the importance of human trust. Even after 45 years of professional practice, I remain convinced that a good doctor must not only possess knowledge and experience but also know how to listen. Do Not Put Your Health on Hold We often tell our loved ones: “Take care of yourself,” “Don’t overwork,” or “Please make sure you see a doctor.” But how often do we say these same words to ourselves? Taking care of our health does not have to begin with a serious diagnosis or complicated treatment. Sometimes the first step is simply noticing a recurring symptom, reconsidering everyday habits, or seeking professional advice at the right time. I wish more people would stop accepting pain and persistent discomfort as an unavoidable part of life. Do not wait until familiar symptoms begin to limit your opportunities, interfere with your work, disturb your rest, or affect the time you spend with loved ones. After 45 years in medicine, I have learned that health is not something we should remember only when we become ill. It is something we need to value and care for every single day. Take care of yourself. Listen to your body. And remember that seeking medical attention in time is an act of responsibility toward yourself and those you love.
Joint pain, fractures, sports injuries and modern treatment methods: what do global statistics tell us, and when is surgery truly necessary? According to the World Health Organization (WHO), approximately 1.71 billion people worldwide live with musculoskeletal conditions. These conditions are among the leading causes of reduced mobility and disability. The scale of the problem continues to grow. Population ageing, excess body weight, insufficient physical activity and the consequences of injuries are creating additional challenges for modern trauma and orthopaedic care. At the same time, modern diagnostic, treatment and rehabilitation methods can, in many cases, relieve pain, restore mobility and improve patients' quality of life. We spoke with Abduaziz Shadievich Babakulov, Head of the Traumatology and Orthopaedics Department at AKFA Medline, about the most common joint conditions, why injuries should never be underestimated and what modern orthopaedics can offer. 1. According to international statistics, musculoskeletal conditions affect more than 1.7 billion people. Why has this problem become so widespread, and what factors are driving the rise in cases? There are several reasons, and they act simultaneously. The first is population ageing: people are living longer, and age-related changes gradually accumulate in cartilage, bones, ligaments and muscles. Conditions that previously did not have time to develop are now seen in millions of patients. The second reason is lifestyle. Excess weight, sedentary work, long hours spent at a computer or in a car, and insufficient movement weaken the muscles that normally protect the joints and spine. Diabetes, smoking and vitamin D deficiency also deserve mention, as they adversely affect bone and connective tissue health. The third is injury: road traffic accidents, falls at home and sports-related injuries. An inadequately treated joint injury can often develop into post-traumatic osteoarthritis several years later. Finally, we have become better at diagnosing these conditions. However, it is important to understand that most are chronic: they do not simply disappear and their prevalence accumulates in the population. This is why, according to WHO, low back pain is now one of the leading causes of disability worldwide. 2. According to the Global Burden of Disease study, approximately 595 million people had osteoarthritis in 2020. Which joints are most commonly affected, and why is the condition now diagnosed in younger patients as well? The knees are affected most often, accounting for the largest proportion of osteoarthritis cases. Next come the hips, the small joints of the hands (particularly in women), and joints in the spine and feet. These joints either bear much of the body's weight or are used continuously throughout the day. Osteoarthritis is no longer exclusively a disease of older people. In younger patients, it most often develops after an injury, such as a meniscal tear, an anterior cruciate ligament tear or an intra-articular fracture. An injured joint no longer functions normally, so its cartilage wears out faster. Other causes include excess weight, congenital anatomical characteristics (such as hip dysplasia), altered leg alignment (bow legs or knock knees), occupational and sporting overload, and hereditary factors. Warning signs include pain when taking the first steps after rest, morning stiffness, joint crepitus and progressively restricted movement. The earlier treatment begins, the longer it may be possible to preserve the patient's natural joint. 3. According to WHO, approximately 1.8 billion adults worldwide do not meet the recommended level of physical activity. How does a sedentary lifestyle affect joint health, and why do even young people experience knee and spinal pain? Articular cartilage has no blood vessels of its own. It receives nutrients from synovial fluid, and this exchange takes place during movement, as loading and unloading alternate. In a sense, cartilage is 'nourished' by movement. A sedentary lifestyle makes this process less effective. In addition, muscles weaken without regular exercise. The quadriceps muscle is particularly important for the knee, acting as a shock absorber and stabiliser. For the spine, the back, abdominal and gluteal muscles perform this role. When this muscular support is weak, more load falls directly on the joints, ligaments and intervertebral discs. Among young people, knee and back pain is often associated with prolonged sitting, poor posture while using a computer or smartphone, and sudden transitions from inactivity to intense exercise, for example, sitting in an office all week and then playing football at the weekend. We see many patients with patellofemoral pain syndrome and non-specific low back pain. WHO recommends that adults perform 150–300 minutes of moderate-intensity physical activity per week, such as brisk walking, swimming or cycling, together with muscle-strengthening exercises at least twice a week. For most people, this is the best 'preventive medicine' for their joints. 4. International studies indicate that approximately 178 million new fractures occurred worldwide in 2019. Which types of fracture are the most dangerous, and how effectively can modern treatment restore the function of an injured limb? I would identify several particularly dangerous groups. These include proximal femoral fractures in older people (including femoral neck fractures). Without timely treatment, patients may become bedridden and develop pneumonia, thrombosis or pressure sores, while mortality in the first year remains high. Pelvic fractures are dangerous because of the risk of major bleeding; spinal fractures because they may damage the spinal cord; open fractures because of infection; and fractures involving blood vessel or nerve injury. Intra-articular fractures also deserve special attention: even if the bone heals successfully, an inaccurately restored joint surface may lead to osteoarthritis later on. Modern trauma surgery can achieve very good outcomes. Minimally invasive fixation techniques are used, including intramedullary nails and locking plates inserted through small incisions. We aim to operate on older patients with hip fractures within the first 24–48 hours and help them stand as early as the following day. For femoral neck fractures, we often proceed directly to joint replacement. With prompt and appropriate treatment, most patients return to their usual lives. The timing of medical assessment, the quality of surgery and subsequent rehabilitation are decisive. 5. WHO estimates that approximately 37 million falls require medical attention each year. Which symptoms after a fall or other injury require an immediate assessment by a trauma specialist? You should seek immediate medical attention or call an ambulance if, after an injury: – a limb looks visibly deformed or is in an unnatural position; – you cannot bear weight on a leg or move an arm or your fingers; – pain is severe and does not ease at rest, or swelling or bruising increases rapidly; – your fingers become numb, tingle, feel cold or turn pale, which may indicate nerve or blood vessel damage; – there is a wound over the injury, particularly if bone is visible; – a crack or pop was heard during the injury and the joint subsequently gives way or feels unstable; – back pain after a fall is accompanied by leg numbness or weakness, or problems with urination; – there has been a blow to the head, loss of consciousness, vomiting or a severe headache. Older people need particular attention. Even a seemingly minor fall from standing height can cause a femoral neck fracture. Pain in the groin or hip and difficulty putting weight on the leg after a fall warrant urgent investigation. As a general rule, if pain following an injury does not resolve within a few days, you should see a doctor, even if it 'doesn't seem serious'. Before being examined, do not attempt to straighten or reset the limb yourself, do not apply heat to the injured area and keep it at rest. 6. MRI, CT and digital X-ray imaging are now used to diagnose musculoskeletal injuries. How is the appropriate imaging method selected, and which injuries can remain undetected during a routine examination? The choice always begins with a clinical examination. The doctor assesses how the injury happened, considers the patient's symptoms and performs specific clinical tests before deciding which investigation is needed. We treat the patient, not the scan. X-ray imaging is the basic and most accessible method. It shows bones clearly, including fractures, dislocations and signs of osteoarthritis. Digital radiography produces higher-quality images with lower radiation exposure. Computed tomography (CT) is needed when a detailed assessment of bone is required, such as in complex intra-articular fractures, pelvic and spinal fractures, and surgical planning. Three-dimensional reconstruction allows the surgeon to 'see' the fracture from every angle in advance. MRI is the preferred method for soft tissues: menisci, ligaments, cartilage, tendons and the shoulder's rotator cuff. It can also identify bone marrow oedema, stress fractures and occult fractures. Ultrasound is sometimes added to assess tendons and joint effusions. Injuries that may be missed during a routine examination or even on X-rays include scaphoid fractures of the wrist, undisplaced femoral neck fractures, stress fractures, osteoporotic vertebral compression fractures, anterior cruciate ligament and meniscal tears, ankle ligament injuries and osteochondral lesions. The reverse is also important to remember: MRI is very sensitive and often detects age-related changes in the menisci or intervertebral discs in people over 40–50 who have no symptoms at all. MRI findings must therefore always be interpreted alongside the clinical picture. 7. The ESCAPE study, published in JAMA Network Open, showed that exercise therapy can be no less effective than arthroscopic surgery for certain degenerative meniscal tears. When is surgery genuinely necessary, and when can it be avoided? The ESCAPE study and several other studies have indeed changed treatment approaches. They concern degenerative meniscal tears in middle-aged and older adults, when the meniscus gradually wears down, often against a background of early osteoarthritis, without a significant injury. In such cases, a structured exercise therapy programme lasting several months produces results comparable to arthroscopy in terms of pain and function. Some patients who do not improve with exercise therapy subsequently undergo surgery, so conservative treatment does not rule out an operation later. For a degenerative tear without a locked joint, we therefore start with conservative management: therapeutic exercise, weight management, short courses of anti-inflammatory medication and, if necessary, intra-articular injections. It is important to understand that arthroscopy does not treat osteoarthritis itself. Surgery is genuinely indicated when: – the tear is traumatic, especially in a young, active patient, in which case we aim to repair and preserve the meniscus; – the joint becomes mechanically locked, meaning the knee 'jams' and cannot straighten because a meniscal fragment has moved; – the meniscal tear is accompanied by an anterior cruciate ligament tear and knee instability; – there is a meniscal root tear that causes complete loss of its function; – approximately three months of conservative treatment have failed. The decision is always individual and takes into account age, the type of tear, cartilage condition and the patient's activity requirements. 8. Global Burden of Disease researchers predict that the number of people with osteoarthritis could approach one billion by 2050. Can the progression of the condition be slowed, and which preventive measures have proven effective? Yes, it is possible to slow the progression of osteoarthritis, although modern medicine cannot yet fully restore worn cartilage. There are currently no medications proven to stop cartilage deterioration. The foundation of treatment is therefore lifestyle change rather than tablets. The measures with the strongest evidence base, included in international guidelines, are: – regular therapeutic exercise: strengthening the thigh and gluteal muscles, flexibility and balance exercises, and aerobic activities such as walking, swimming or cycling on a stationary bike; – weight loss and weight management; – patient education: understanding the condition and pacing physical activity appropriately; – comfortable footwear and, when needed, orthotic insoles or a walking stick for significant pain; – timely and comprehensive treatment of joint injuries, including ligament restoration and meniscus preservation; – injury prevention for athletes through dedicated warm-up programmes and neuromuscular training. As for popular chondroprotective supplements, hyaluronic acid and platelet-rich plasma (PRP) therapy, evidence of effectiveness is limited and conflicting, and leading international guidelines do not regard them as essential treatments. Their use is decided individually, but relying solely on them without making lifestyle changes is a mistake. 9. According to NICE clinical guidelines, losing 10% of body weight may provide greater benefit for people with osteoarthritis than losing 5%. How much does excess weight affect the knees and hips, and can weight loss reduce the need for surgery? The effect is substantial. While walking, every additional kilogram of body weight increases the load on the knee joint by approximately 4 kilograms, and even more during stair climbing or squatting. Consequently, losing just 5 kg reduces the load on the knee by approximately 20 kg with each step. But it is not only about mechanics. Fat tissue is a metabolically active organ that produces substances contributing to chronic inflammation throughout the body, including in the joints. This is why osteoarthritis is more common in people with obesity even in joints that do not bear body weight, such as the finger joints. Studies confirm that weight loss of 10% or more, combined with exercise, substantially reduces pain and improves joint function, with a noticeably greater effect than a 5% reduction. This is why NICE recommends aiming for that target. Can losing weight reduce the need for surgery? In the early and moderate stages of osteoarthritis, yes: it can delay joint replacement for years. In advanced disease, when cartilage has been destroyed, weight loss cannot replace surgery, but it can make the procedure safer. Severe obesity increases the risks of infection, thrombosis, other complications and wear of the prosthetic joint. Weight loss is therefore beneficial at every stage. 10. According to the International Osteoporosis Foundation, one in three women and one in five men over the age of 50 may experience an osteoporotic fracture during the rest of their lives. Why does fracture risk increase with age, and which preventive methods are most effective? Bone tissue loses density and strength with age. In women, this process accelerates sharply after menopause because oestrogen levels decline, which is why osteoporosis is considerably more common among women. Osteoporosis can remain asymptomatic for a long time, and the first sign is often a fracture itself. Another part of the problem is falling. As people age, muscle mass decreases (sarcopenia), balance, vision and coordination deteriorate, and some medications cause dizziness or drowsiness. Fragile bones combined with frequent falls are a major reason for fractures of the femoral neck, vertebrae and radius. The most effective prevention includes: – sufficient calcium, vitamin D and protein intake; – strength and balance training, which improve bone and muscle health and reduce the risk of falls; – avoiding smoking and excessive alcohol consumption; – bone density testing (densitometry) for women after 65 and men after 70, or earlier when risk factors are present; – prescribed medication for confirmed osteoporosis, which has been shown to reduce fracture risk; – a safer home environment with good lighting, no slippery rugs and grab rails in the bathroom. It is very important that anyone over 50 who has already experienced a fracture from a minor injury be assessed for osteoporosis. One such fracture substantially increases the risk of another. 11. According to a systematic review published in The Lancet, approximately 82% of total knee replacements remain in place without revision for 25 years. How reliable are modern artificial joints, and when is joint replacement the best treatment option? Modern joint implants are among the most reliable and successful devices used in surgery. The cited figures for 25-year knee implant survival were largely obtained with earlier generations of implants; today's materials, designs and surgical technologies are even more advanced. For most patients, this means that a joint replacement will last many years and, for older people, often for the remainder of their lives. Joint replacement becomes the best treatment when: – a patient has severe osteoarthritis with persistent pain, including pain at night or at rest; – pain and restricted movement seriously interfere with walking, working or daily self-care; – several months of conservative treatment have not helped; – there is avascular necrosis of the femoral head or severe joint deformity; – an older patient has sustained a femoral neck fracture. I would emphasise that indications are determined not by an image alone but by how much the condition reduces quality of life. Sometimes an X-ray shows severe changes while the patient remains active, and sometimes the opposite is true. It is also important to know that the entire joint does not always need to be replaced. If damage is confined to one compartment of the knee, a partial (unicompartmental) knee replacement may be possible. After modern surgery, patients can often stand the following day, and the outcome depends greatly on the quality of rehabilitation. 12. WHO estimates that approximately 2.4 billion people worldwide may need rehabilitation services. What role does rehabilitation play after fractures and orthopaedic surgery, and what advice would you give patients to maintain joint health for years to come? Rehabilitation is not an optional addition to treatment; it is a complete and essential part of it. An operation can be performed perfectly, but without proper recovery the patient may still have a poor outcome: a stiff joint, weak muscles and an abnormal walking pattern. Early mobilisation reduces the risk of thrombosis, pneumonia, muscle wasting and contractures. After joint replacement or fracture fixation, we aim to get patients on their feet within the first 24 hours. Rehabilitation then continues for weeks or months, restoring range of motion, muscle strength, balance and normal walking, followed by a return to work and sport. Much depends on the patient's own commitment and regular exercise at home. My recommendations for maintaining healthy joints in the long term are: – move every day and include strength training; – keep your body weight under control; – warm up before sport and increase exercise intensity gradually; – wear comfortable shoes and lift heavy objects correctly, bending your knees and keeping your back straight; – do not smoke, as smoking impairs fracture healing and tissue repair; – do not ignore pain or delay seeing a doctor after an injury; – after the age of 50, pay attention to bone health and have your bone density assessed. 13. Many patients complain of sharp heel pain, particularly when taking their first steps after waking up. This is often called a 'heel spur'. What actually causes the pain, can the condition be treated without surgery, and which treatments are genuinely effective? This is one of the most common misconceptions. Heel pain, especially during the first steps in the morning or after rest, is most often caused by plantar fasciitis: overload and degenerative changes in the plantar fascia where it attaches to the heel bone. The 'spur' itself, a bony projection visible on X-ray, is also present in many people who have no pain at all. It is a consequence of prolonged tension on the fascia rather than the cause of the pain. We therefore need to treat the overloaded fascia, not the 'spur'. Contributing factors include excess body weight, prolonged standing or walking, running, flat feet or high arches, tight calf muscles and a shortened Achilles tendon, and stiff or worn-out footwear. The good news is that in roughly 9 out of 10 cases, the condition resolves without surgery within several months. The most effective measures include: – daily stretching of the plantar fascia and calf muscles, particularly before the first steps in the morning; – comfortable, well-cushioned shoes and orthotic insoles with arch support; – weight loss and a temporary reduction in high-impact activities; – short courses of anti-inflammatory medication; – shockwave therapy for persistent cases. Corticosteroid injections provide only temporary relief and carry a risk of fascia rupture and thinning of the heel's fat pad, so their use is limited. Surgery is rarely needed and is considered when comprehensive conservative treatment has failed over 6–12 months. If heel pain occurs at night, is accompanied by numbness or begins after an injury, an examination is necessary: a stress fracture, nerve compression or another cause may be responsible. 14. Sometimes a person notices that their shoulder is starting to hurt and that lifting the arm or reaching behind the back is becoming increasingly difficult. Could this be a sign of a so-called 'frozen shoulder'? Why does the condition develop, and can full movement be restored? Yes, these symptoms may indicate adhesive capsulitis, also known as 'frozen shoulder'. In this condition, the shoulder joint capsule becomes inflamed, then thickens and contracts with scar tissue, effectively tightening around the joint. It most commonly affects people aged 40–60, with women affected slightly more often than men. The risk is significantly higher in people with diabetes or thyroid disorders and after injuries, operations or prolonged immobilisation of the arm. Frequently, no clear cause is identified. The condition has three stages: pain and stiffness first increase (the 'freezing' stage); then pain subsides but movement remains severely restricted (the 'frozen' stage); and finally mobility gradually returns (the 'thawing' stage). The entire process can take one to three years. It is important to distinguish frozen shoulder from rotator cuff injuries, impingement syndrome and osteoarthritis. In capsulitis, both active and passive movement are restricted: even the doctor cannot fully raise or rotate the patient's arm. An orthopaedic assessment is therefore necessary. Treatment is conservative in most cases: therapeutic exercises with gentle stretching within tolerable pain limits, anti-inflammatory medication and, in the early stage, an intra-articular corticosteroid injection that can effectively relieve pain. Patients with diabetes also need to control their blood glucose. If treatment is unsuccessful, hydrodilatation or arthroscopic capsular release may be considered. Most patients regain full or nearly full mobility, although some have a minor residual restriction. Patience and regular exercise are essential. 15. Many people, especially women, develop a 'bump' near the big toe. Why does hallux valgus (a bunion) develop, can special footwear and orthotic insoles stop it from progressing, and when does surgery become necessary? First, let me dispel a common myth: the 'bump' is not a deposit of salts. It is a foot deformity in which the first metatarsal bone deviates inwards and the big toe moves outwards towards the other toes. The prominent head of the metatarsal bone is what looks like a 'bump'. Heredity plays the main role: the condition often occurs in several generations of the same family. Narrow, pointed shoes, high heels, flat feet and weak ligaments make the deformity worse. This is why women are affected much more frequently. Comfortable shoes with a wide toe box and soft uppers, orthotic insoles, toe spacers and night splints can reduce pain, pressure and friction. But we must be clear: they cannot correct a deformity that has already developed, and there is no reliable evidence that they halt its progression. These measures relieve symptoms rather than cure the condition. Surgery becomes necessary when: – pain persists despite appropriate footwear and insoles; – finding suitable shoes becomes difficult; – the deformity continues to progress; – secondary changes develop, such as hammer toes, calluses and pain beneath the metatarsal heads. Surgery solely for cosmetic reasons, without symptoms, is generally not recommended. Modern surgery involves corrective osteotomies, including minimally invasive techniques performed through small incisions. Patients can usually begin walking in special postoperative shoes almost immediately, return to ordinary footwear after approximately 6–8 weeks and achieve full recovery in around 3–6 months. Global medical statistics show that musculoskeletal disorders and injuries remain among the most significant challenges facing modern healthcare. However, timely diagnosis, individually selected treatment and properly organised rehabilitation can often preserve mobility, prevent complications and improve quality of life. Particular attention should be paid to symptoms that patients often dismiss as temporary discomfort: heel pain, restricted shoulder movement, foot deformity or intermittent knee pain. These may indicate conditions that require professional assessment and an individualised approach to treatment. Modern trauma and orthopaedic care focuses not only on treating injuries but also on restoring people's functional abilities. AKFA Medline — a comprehensive approach to diagnosing, treating and restoring musculoskeletal health.
Head of the Ophthalmology Department, Consultant Ophthalmic Surgeon of the Highest Category, MD, PhD Jamshid Furkatovich Mamatov on eye diseases that can remain symptom-free for years, warning signs that should never be ignored, and mistakes that may cost a person their vision. We tend to assume that everything is fine with our eyes as long as we can see well. There is no pain, we can read text on our phones, recognize faces — so there seems to be no urgent reason to visit an ophthalmologist. But that is precisely where one of the major problems lies. According to the World Health Organization, at least 2.2 billion people worldwide live with near or distance vision impairment . Of these, at least 1 billion cases could have been prevented or remain amenable to correction . The leading causes of vision impairment worldwide include uncorrected refractive errors, cataract, glaucoma and diabetic retinopathy. The problem is not limited to the diseases themselves. Many people postpone an eye examination until their vision has already begun to deteriorate noticeably. Can a person see well and still have a serious eye disease? Why can glaucoma remain unnoticed for years? Does using a phone really damage eyesight? Should people wait for a cataract to “mature”? And which symptoms mean that an ophthalmologist should be consulted not tomorrow, but today? We discussed these and other questions with ophthalmologist Dr. Jamshid Furkatovich Mamatov. — Dr. Mamatov, can a person have an eye disease that is gradually threatening their vision while still seeing well? Yes, and that is the main danger. Many diseases do not initially affect visual acuity — the ability to distinguish fine details in the center of vision. Peripheral vision, contrast sensitivity or retinal blood vessels may be affected first. The brain compensates for some of these changes, while the second eye may partially compensate for a defect in the first. Epidemiological studies suggest that approximately half of people with glaucoma are unaware of their diagnosis. In areas where access to ophthalmic care is limited, the proportion may be as high as 90%. — What is glaucoma? Why can it develop for years almost unnoticed, and can vision already lost because of glaucoma be restored? Glaucoma is a chronic disease of the optic nerve in which nerve fibers gradually die and the visual field becomes progressively narrower. The main modifiable risk factor is elevated intraocular pressure (IOP). Why is it often unnoticed? There may be no pain, vision loss usually begins in the periphery, and central vision can remain relatively preserved until the later stages. The brain and the other eye can also mask the defects. By the time symptoms become noticeable, a significant portion of the visual field may already have been lost. Lost vision cannot be restored , because damaged optic nerve fibers do not regenerate. Treatment — including eye drops, laser procedures or surgery — has one main goal: to stop or slow disease progression. Clinical studies have shown that each 1 mmHg reduction in IOP is associated with approximately a 10% reduction in the risk of glaucoma progression. This is why early diagnosis is so important. Risk factors include: age over 40, glaucoma in parents or siblings, myopia, diabetes and long-term use of corticosteroid medications. Close relatives of people with glaucoma should undergo an eye examination. — If intraocular pressure is within the normal range, can a person be sure they do not have glaucoma? No. Normal-tension glaucoma exists, and it accounts for a significant proportion of open-angle glaucoma in some Asian populations, including Japan, Korea and China. In addition, IOP fluctuates throughout the day, while corneal thickness can affect measurement results. Diagnosis is based on a combination of findings, including optic nerve head examination, OCT (optical coherence tomography), visual-field testing, gonioscopy, pachymetry and follow-up over time. The opposite situation can also occur: elevated IOP without optic nerve damage, known as ocular hypertension . Such patients require monitoring but do not necessarily require treatment. — If someone wakes up and suddenly notices that vision in one eye has become worse, can they wait a few days? No. They should seek medical attention the same day, ideally within hours. Sudden loss or significant reduction of vision should be considered an emergency until proven otherwise. Do not use eye drops on your own and do not wait for the problem to “go away.” Sudden visual loss may also signal a major vascular event, including a TIA or stroke, so cardiovascular risk should be assessed after the ophthalmic examination. — How dangerous are sudden flashes, “lightning,” numerous black spots or the sensation of a dark curtain appearing from the side? They can be very serious. These may be signs of a retinal tear or retinal detachment, and an examination is required within 24 hours. With age, and earlier in people with myopia, the vitreous body can detach from the retina and exert traction on it. This may cause flashes of light. Blood or pigment can appear as numerous dark spots, while a “curtain” may indicate that the retina is already detaching. According to clinical recommendations, retinal tears are found in approximately 10–15% of patients presenting with acute posterior vitreous detachment. A retinal tear can often be sealed with laser treatment in an outpatient setting within minutes, preventing retinal detachment. Retinal detachment requires surgery, and the earlier it is treated — particularly before the central retina is affected — the better the outcome. The risk is higher in people with high myopia, previous eye trauma or previous cataract surgery. — When are ordinary “floaters” relatively harmless, and when can they indicate serious retinal disease? Usually less concerning: floaters that have been present for a long time, remain stable, are few in number, and are not accompanied by flashes, shadows or reduced vision. Warning signs: sudden onset, a significant increase in number, a “rain” or “soot-like” appearance, flashes, shadows or a curtain, reduced vision, onset after trauma or surgery, inflammation, or the presence of diabetes. Any new floaters require a dilated fundus examination. Even if no retinal tear is found, a repeat examination after several weeks may be recommended because a retinal tear can develop later. — Do phones and computers actually damage eyesight, or is the main issue how long and at what distance we use them? The problem is primarily related to viewing time and distance, not the screen itself. Screens do not cause retinal disease or permanently “ruin” eyesight in adults. However, during prolonged near work, people blink less frequently, which can lead to digital eye strain — dryness, burning, fatigue and headaches. There is currently no convincing evidence that blue light from screens damages the retina. A 2023 Cochrane review did not find a clear benefit of blue-light-filtering glasses for reducing visual fatigue, and the American Academy of Ophthalmology does not recommend them for this purpose. — Can frequent smartphone and tablet use increase the risk of myopia in children, and what role does outdoor time play? Yes, there is an association, and outdoor time is an important protective factor. Myopia is spreading rapidly. Projections suggest that by 2050, approximately half of the world's population may be affected by myopia. Prolonged near work, including smartphone use, has been associated with a higher risk of myopia. Daylight exposure and looking into the distance are protective. Randomized studies in schoolchildren have shown that additional outdoor time can reduce the incidence of new-onset myopia. The International Myopia Institute recommends approximately two hours outdoors per day . At the same time, children should be protected from excessive ultraviolet exposure with appropriate clothing and UV-protective sunglasses . According to WHO recommendations, screen use is not recommended for children under two years of age, while for children aged 2–4 years it should generally be limited to no more than one hour per day. When myopia is already present, its progression may be slowed using low-dose atropine, orthokeratology, specially designed spectacles and myopia-control soft contact lenses. These options should be selected by an ophthalmologist. — If a child starts squinting, sitting closer to the television or holding a phone very close to their face, how seriously should parents take these signs? Seriously. The child should undergo an eye examination within the next few weeks rather than waiting for a routine school screening. Children rarely complain because they do not know how other people see. Possible causes include myopia, hyperopia, astigmatism, strabismus and amblyopia (“lazy eye”) . Children should have their refraction assessed under cycloplegia , meaning after pupil dilation, because otherwise the measurement may be inaccurate. Amblyopia is most effectively treated before approximately 7–8 years of age; the effectiveness of treatment decreases later. — Is it true that if you start wearing glasses all the time, your eyes become “dependent” on them and your vision gets worse? No. This is a myth. Glasses do not weaken the eyes. Myopia is related to the elongation of the eyeball and progresses independently of whether a person wears glasses. The feeling that vision has become worse without glasses usually occurs because we become accustomed to seeing a sharp image. Under-correction does not slow myopia progression. In children, appropriate glasses are important for normal visual development; without them, amblyopia may develop. — Can eye exercises actually reduce myopia or eliminate the “minus” prescription? No. This is another myth. Eye exercises cannot reverse the anatomical changes responsible for myopia or eliminate the refractive error. The appropriate approach is accurate optical correction and, where necessary, evidence-based myopia-control treatment under an ophthalmologist's supervision. — Can vitamins, lutein, blueberries or various supplements genuinely improve vision? Most such claims are exaggerated. No dietary supplement restores normal vision or replaces glasses. Lifestyle measures that genuinely matter include not smoking, controlling blood pressure and blood glucose, protecting the eyes from UV radiation, and maintaining a diet rich in vegetables — particularly green leafy vegetables — and fish. — How safe is it to buy over-the-counter “redness relief” eye drops and use them regularly without consulting an ophthalmologist? It is not considered safe. Many such drops contain vasoconstrictors. They provide temporary relief but may cause rebound redness and dependence with regular use. In susceptible individuals, they may also trigger an acute angle-closure glaucoma attack. The main problem is that these drops can mask the underlying cause of redness, such as allergy, dry eye, inflammation, keratitis or glaucoma. A red eye accompanied by pain, photophobia or reduced vision requires an examination rather than self-medication. Self-use of steroid eye drops such as dexamethasone is particularly dangerous because they can cause glaucoma and cataract and may worsen herpetic keratitis. — If someone constantly experiences dryness, burning and a gritty sensation, are artificial tears enough? They may be sufficient for mild cases, but persistent symptoms require evaluation of the underlying cause. Dry eye disease is multifactorial. Possible underlying causes include meibomian gland dysfunction, blepharitis, allergy, Sjögren syndrome and other systemic diseases, medication side effects, contact-lens-related problems and incomplete eyelid closure. Treatment may include preservative-free lubricating drops, eyelid hygiene, warm compresses and modification of environmental factors such as air conditioning, dry air, dust and prolonged screen exposure. If symptoms persist for more than two weeks, or if there is pain, photophobia or reduced vision, medical evaluation is recommended. — How dangerous is it to occasionally sleep in contact lenses or wear them longer than recommended? It is dangerous, and even occasional overnight wear carries a risk. Sleeping in contact lenses increases the risk of microbial keratitis, including corneal ulcers. Reduced oxygen availability and easier bacterial penetration can result in serious infection. A corneal ulcer may lead to corneal scarring, permanent vision loss and, in severe cases, the need for corneal transplantation. — Should people still wait for a cataract to “mature,” or is that approach outdated? That approach is outdated. In the past, cataract surgery was more traumatic, so doctors often waited until the cataract became “mature.” Modern phacoemulsification with intraocular lens implantation is a minimally invasive procedure that usually takes approximately 15–20 minutes under local anesthesia. According to modern ophthalmic recommendations, the indication for surgery is vision loss that interferes with daily life — working, reading, driving or moving around safely. There is no need to wait for the cataract to become “mature.” Surgery may also be performed earlier for medical reasons, such as the risk of angle-closure glaucoma or the need to examine and treat the retina in patients with diabetes. — Can delaying cataract surgery for too long make subsequent treatment more difficult? Yes. A hypermature cataract becomes denser and more difficult to remove, while the risk of complications and corneal damage increases. In addition: Unfortunately, some patients present with very advanced, dense cataracts, making both surgery and recovery more difficult. — Is laser vision correction suitable for almost everyone nowadays? No. It is not suitable for everyone. The decision should be made after a comprehensive eye examination, including corneal topography and tomography. Important contraindications and limitations include: Laser vision correction does not eliminate age-related presbyopia. After approximately 40–45 years of age, reading glasses may still be needed. — Can an ophthalmologist identify signs of diabetes, hypertension or other systemic diseases during a routine eye examination? Yes. The retina is one of the few places in the body where blood vessels and neural tissue can be directly observed without an incision. A fundus examination can sometimes be the first step toward identifying an underlying systemic disease. — Which eye symptoms do you consider genuine “red flags” that should never wait for a routine appointment? In short: any sudden change in vision, eye pain or eye trauma should be treated as urgent. Same-day emergency assessment: Assessment within 1–3 days: — Do you often encounter situations in which vision could have been preserved if the patient had sought medical attention earlier? Unfortunately, yes. This is one of the most common causes of irreversible vision loss. Typical examples include: According to the WHO World Report on Vision (2019), at least 1 billion people worldwide have vision impairment that could have been prevented or has yet to be appropriately addressed. — If someone sees well, has no pain and has never visited an ophthalmologist, why should they undergo preventive eye examinations? To detect disease while there is still an opportunity to preserve vision. Many sight-threatening conditions, including glaucoma, diabetic retinopathy and macular degeneration, can be asymptomatic in their early stages. A routine eye examination usually takes 20–30 minutes and may include visual acuity testing, IOP measurement, fundus examination and, when indicated, OCT. An approximate screening schedule: DON'T WAIT UNTIL YOUR VISION GETS WORSE One of the most important principles in ophthalmology may sound paradoxical: good vision today does not always mean that your eyes are completely healthy. Some diseases develop gradually, and people simply adapt to the changes. Others may remain painless and cause little or no noticeable discomfort for a long time. In certain conditions, however, how quickly a person seeks medical attention directly affects whether their vision can be preserved. That is why preventive eye examinations are important — not only when vision has already deteriorated, but to identify problems before they begin to threaten sight. We often take our vision for granted — until we begin to lose it.
Neurology Without Myths: 15 Important Questions for a Neurologist Headaches, migraine, dizziness, numbness in the limbs, neck and back pain, and sleep disturbances are symptoms experienced by millions of people. Yet many continue to tolerate their discomfort, take painkillers on their own, or postpone seeing a doctor. According to the World Health Organization, in 2021, diseases and conditions affecting the nervous system affected approximately 3.4 billion people — around 43% of the global population. Neurological conditions are also among the leading causes of ill health and disability worldwide. Which symptoms should never be ignored? How is migraine different from an ordinary headache? Is a herniated disc always responsible for back pain? When is an MRI really necessary? These common questions are answered by Nigora Saidganievna Kadyrkhodjaeva, an AKFA Medline neurologist with 19 years of clinical experience, MD, PhD . Her professional interests include neurology, neuropsychology, transcranial magnetic stimulation (TMS), and the use of botulinum toxin therapy in neurology, including the treatment of primary chronic headaches. 1. What are the most common reasons patients consult a neurologist? The most common complaints include headaches, dizziness, neck and back pain, numbness or tingling in the arms and legs, muscle weakness, sleep disturbances, and memory problems. Patients may also seek neurological care for tremor, impaired coordination, tinnitus, changes in sensation, various pain syndromes, consequences of stroke, and conditions affecting the peripheral nervous system. It is important to understand that the same symptom can have very different causes. For example, dizziness may be associated with the vestibular system or may occur as a manifestation of other medical conditions. A neurologist’s task is therefore not simply to relieve the symptom but to identify its underlying cause. 2. Which neurological symptoms do people most often underestimate or ignore? Particular attention should be paid to sudden numbness or weakness in an arm or leg, especially on one side of the body, speech disturbances, facial asymmetry, sudden visual impairment, an unusually severe headache, and sudden loss of coordination. People also frequently ignore recurring headaches, intermittent numbness in the fingers, balance problems, back pain radiating into an arm or leg, memory problems, and sleep disturbances. If a symptom keeps returning, becomes progressively worse, or begins to interfere with daily life, it should not simply be tolerated. A medical assessment is necessary. 3. When does an ordinary headache become a reason to see a neurologist? If headaches occur regularly, become more severe, or change from their usual pattern, the cause should be investigated. It is particularly important to seek medical advice if: • the headache is new and unusually severe; • attacks are becoming more frequent; • the pain is accompanied by vomiting, visual or speech disturbances, sensory changes, or weakness; • the headache follows a head injury; • painkillers are required too frequently; • headaches interfere with work, sleep, or everyday activities. A sudden, extremely severe headache that reaches maximum intensity within seconds or minutes is an important warning sign and requires urgent medical evaluation. 4. What is migraine, and how is it different from an ordinary headache? Migraine is a neurological disorder in its own right, not simply a “very bad headache.” A typical migraine attack can last from several hours to several days. The pain is often throbbing, may be more pronounced on one side of the head, and can worsen during ordinary physical activity. Migraine headaches are often accompanied by nausea and increased sensitivity to light, sound, and smells. However, not every patient has the classic presentation. Diagnosis is therefore based primarily on the characteristic symptoms and the patient’s medical history. 5. What symptoms are typical of migraine, and what commonly triggers an attack? In addition to headache, patients may experience: • nausea; • increased sensitivity to light and sound; • irritability; • difficulty concentrating; • significant fatigue; • worsening symptoms with physical activity. Migraine triggers vary from person to person. Common triggers include too little or too much sleep, emotional stress, skipping meals, dehydration, certain hormonal changes, and sudden changes in daily routine. Keeping a headache diary can be very useful. Patients can record when an attack occurred, how long it lasted, possible triggers, associated symptoms, and medications taken. This helps the physician identify patterns and choose the most appropriate treatment strategy. 6. What is migraine with aura, and how does it present? Aura consists of temporary, reversible neurological symptoms that most commonly occur before the headache, although they may sometimes occur without a subsequent headache. Visual aura is the most common type. A person may see flashing spots, zigzag lines, flashes of light, or temporary blind spots in the visual field. Sensory symptoms are also possible, such as tingling or numbness that gradually spreads along the arm or face. Temporary speech disturbances occur less commonly. If these symptoms occur for the first time, particularly if they develop suddenly, they should not automatically be assumed to be migraine. Some manifestations can resemble a transient ischemic attack or stroke, so medical evaluation is important. 7. Can migraine be treated, and what modern treatments are available today? Migraine can be effectively managed with modern treatment. The main goals are to reduce the frequency, duration, and intensity of attacks and to improve the patient’s quality of life. Treatment generally has two components. The first is acute treatment, aimed at stopping or reducing an attack once it begins. Depending on the situation, a physician may prescribe migraine-specific medications or other appropriate treatments. The second is preventive therapy. This may be considered when attacks are frequent, prolonged, or significantly affect the patient’s daily life. Botulinum toxin therapy may be used in selected patients with chronic migraine. Modern neurology also offers newer preventive therapies that target biological pathways involved in migraine development. The choice of treatment depends on the frequency of attacks, associated medical conditions, previous treatment, and the patient’s individual characteristics. 8. Is a brain MRI necessary for frequent headaches or migraine? Not every person with headaches needs an MRI. If the clinical picture is typical of a primary headache disorder such as migraine, and the neurological examination does not reveal any warning signs, additional imaging may not be necessary. MRI is usually recommended when the physician needs to rule out a secondary cause of headache — for example, when the pattern of pain has changed, neurological symptoms have appeared, the clinical picture is unusual, or other concerning signs are present. The appropriate sequence is therefore to have a clinical consultation and neurological examination first, followed by diagnostic testing when indicated. 9. What causes dizziness, and when can it be a warning sign? Patients may use the word “dizziness” to describe very different sensations: a spinning feeling, instability, loss of balance, near-fainting, or a sensation of “brain fog.” The causes are equally varied. One common cause is benign paroxysmal positional vertigo, in which symptoms are triggered by changes in head position. Other causes may involve the inner ear, nervous system, cardiovascular system, or other medical conditions. If dizziness begins suddenly and is accompanied by speech disturbance, weakness or numbness in the limbs, double vision, severe loss of coordination, or a new intense headache, urgent medical attention is required. 10. What can numbness, tingling, or a “pins and needles” sensation in the arms and legs indicate? These sensations can have many different causes, ranging from temporary compression of a nerve to disorders affecting the spine, peripheral nerves, or central nervous system. For example, numbness in the hand may result from compression of a particular nerve, while symmetrical numbness in the feet may occur in peripheral neuropathy. The physician assesses exactly where the numbness occurs, how severe it is, and whether it is associated with pain, muscle weakness, or changes in reflexes. Medical evaluation should not be delayed if sensory changes are progressive or accompanied by muscle weakness. 11. What early signs of stroke should everyone know? The most important feature of stroke symptoms is that they usually appear suddenly. Face: Ask the person to smile. One side of the face may droop. Arm: Ask the person to raise both arms. One arm may drift downward or may not be raised at all. Speech: Ask the person to repeat a simple sentence. Their speech may become slurred, or they may be unable to speak correctly. Other symptoms can include sudden visual impairment, severe dizziness, loss of coordination, or numbness or weakness on one side of the body. If stroke is suspected, do not wait to see whether the symptoms disappear. Emergency medical assistance should be called immediately. The sooner the patient reaches a specialized medical facility, the greater the opportunity for effective treatment. 12. Why are neck and back pain now common even among younger people? Is a herniated disc seen on MRI always the cause of pain? No. Finding a disc protrusion or herniation on MRI does not necessarily mean that it is responsible for the patient’s pain. Changes in the intervertebral discs can also be found in people who have no pain at all. For this reason, a physician always interprets MRI findings together with the patient’s symptoms and the results of the neurological examination. Pain may arise from muscles, spinal joints, ligaments, irritation of neural structures, or other factors. Among younger people, a sedentary lifestyle, prolonged computer use, insufficient physical activity, inappropriate loading of the spine, and stress can all contribute to neck and back pain. The goal is to treat the patient and the actual cause of the symptoms — not simply an MRI image. 13. Can chronic stress, anxiety, and lack of sleep cause or worsen neurological symptoms? Yes. Sleep, emotional wellbeing, and the nervous system are closely interconnected. Chronic stress and sleep deprivation can worsen headaches, migraine, muscle tension, dizziness, difficulty concentrating, and fatigue. Some patients develop a vicious cycle: stress disrupts sleep, poor sleep increases the sensitivity of the nervous system, symptoms become more intense, and this in turn increases anxiety. However, it is incorrect to attribute every symptom solely to stress without proper evaluation. Other possible medical causes should first be excluded. 14. What mistakes do patients most commonly make when self-treating headaches, migraine, or other neurological symptoms? One of the most common mistakes is the uncontrolled and excessively frequent use of painkillers. When certain medications are used too often, headaches themselves can become more frequent, leading to what is known as medication-overuse headache. Another mistake is treating MRI findings instead of considering the patient’s actual clinical condition. Patients may also take medications “for circulation,” vitamins, sedatives, or other treatments without first establishing the actual cause of their symptoms. In neurology, an accurate diagnosis should come first. Treatment should then be selected according to that diagnosis. 15. What do you recommend for preventing neurological diseases and maintaining a healthy nervous system? There is no single universal pill that can protect the nervous system from every neurological disease. Everyday habits have the greatest long-term importance. It is important to: • remain physically active; • monitor blood pressure; • monitor blood glucose and cholesterol levels; • avoid smoking; • maintain a regular sleep schedule; • follow a balanced diet; • avoid chronic sleep deprivation; • avoid unnecessary or uncontrolled medication use; • pay attention to psychological and emotional wellbeing. Timely medical consultation is also extremely important. People should not wait until a symptom becomes unbearable. Recurrent headaches, sensory changes, severe dizziness, muscle weakness, and other neurological symptoms should be professionally assessed. The key message: do not simply get used to symptoms Headache, dizziness, or numbness does not always indicate a serious disease. However, it is not always possible to determine the cause without proper medical evaluation. In modern neurology, a diagnosis is not based on a single symptom or on an MRI result alone. The physician evaluates the patient’s complaints, medical history, and neurological status before deciding which additional investigations are actually necessary. If sudden weakness on one side of the body, facial asymmetry, speech or visual disturbance, or loss of coordination occurs, medical care should be sought immediately. Timely diagnosis not only allows the correct condition to be treated but also helps prevent unnecessary investigations and inappropriate self-treatment.
Diagnostics
