Weight loss surgery is a commonly performed surgical procedure. 42.7% of Americans suffer with severe obesity and it affects 9.2% of the population [1]. Additionally, the number of people affected with obesity continues to increase, despite the different diet and fitness programs available. …
Weight loss surgery is a commonly performed surgical procedure. 42.7% of Americans suffer with severe obesity and it affects 9.2% of the population [1]. Additionally, the number of people affected with obesity continues to increase, despite the different diet and fitness programs available. According to the American Society for Metabolic and Bariatric surgery, a patient is eligible for gastric bypass if they are 100 lbs or more overweight and have been unsuccessful at maintaining a healthy weight despite putting in effort. A patient is considered for bariatric surgery if their BMI is over a certain amount and have comorbidities, for example, hypertension and diabetes.
The weight loss process is not a simple surgical solution and involves many different factors that affect the patient. In order for the patient to have the best chance of success the bariatric surgery expert team employs an integrated and multidisciplinary team of specialists that provides the patients with personal care. In addition to the medical team and support staff, the team should also comprise of therapists, coordinators and nutritionists.
PatientPartner™ offers an additional an additional member to ensure your success. We connect you a patient who’s recovered from surgery and understands what you’re going through for free!
Bariatric surgeons
The bariatric surgeon will serve as the quarterback for your team, ultimately performing your selected procedure. The procedures are collectively known as bariatric surgery in which changes are made to the digestive system to help patients lose weight. Bariatric surgery is performed when diet and exercise have not helped you lose weight or when you have serious health problems because of being overweight.
Bariatric physician
A bariatric physician is a medical doctor that specializes in obesity and nutrition. The physician uses a broader treatment plan, tailored to meet your needs and preferences. The plan includes any medications that you may need, guiding you towards the right resources for mental, physical and nutritional support. The physician may also advise the patient’s weight loss surgery.
Certified bariatric nurses
A certified bariatric nurse is a professional nurse certified from the ASMBS’ Certified Bariatric Nurse program. The nurse has specialized skills and knowledge needed for delivering quality care to bariatric surgery patients and for quality care to morbidly obese patients outside of the surgical procedure itself.
Bariatric dietician
A bariatric dietician works as a part of the bariatric surgery expert team. Diet and lifestyle change prior to surgery is an important component of weight loss surgery. This is where the bariatric dieticians come in. They work to help patient get ready for weight loss surgery by assisting in outlining their diet and lifestyle approach.
Psychologist
The mental component when making the weight loss journey is as important or even more important than the physical one. Psychologists specializing in bariatric medicine help patient’s start to work through the issues and habits even before they have surgery. Through various modalities the psychologists help patients make small changes in their diet and lifestyle before. Sticking with therapy from pre-op through the recovery process is crucial to success.
Support Groups
In addition to a professional helping patient’s through the weight loss journey, there is no substitute the support of others who are undergoing or have gone through the process themselves. Not only can they provide support, but also tips and mentorship so the journey can be a little easier for newer patients. Not sure where to start looking for a support group? Check out PatientPartner’s™ very own Facebook support group here!
Physical therapist
A physical therapist will evaluate your strength, physical endurance, mobility, balance, flexibility and determine your current fitness level. The therapist will use these findings to develop a personalized exercise program for you to follow before and after the surgery. Having a regular, enjoyable fitness routine is an important aspect of the weight loss journey. A physical therapist can help you get started on the right track and also give you instructions for mobility, rehabilitation and precautions after surgery!
Ready to start your weight loss journey? Or unsure of even where to start?
Connect with a PatientPartner™ today for free to talk about the experience 1-on-1 with a patient who has undergone the journey or join our Facebook Support Group for discussions, tips, events, and more info!
References
1. https://blog.nasm.org/weight-loss-surgery-considerations
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse …
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
The community services industry is a crucial part of the healthcare system, one that is often overlooked. Social workers and care managers are responsible for handling clients and for directing clients to the right services to receive the care they need. Although the two roles may appear similar, …
The community services industry is a crucial part of the healthcare system, one that is often overlooked. Social workers and care managers are responsible for handling clients and for directing clients to the right services to receive the care they need. Although the two roles may appear similar, there are some key differences between them.
The main difference between social workers and care managers is that social workers primarily focus on improving the individual’s personal life, whereas, case managers assist in practical tasks, for example, connecting clients to rehabilitation programs if they are injured or welfare services if they are financially struggling.
Social worker
A social worker’s job is to assist clients and help them manage difficult life circumstances, for example, disability, illness, poverty and other such issues. Social workers may work in correctional facilities, child welfare agencies, hospitals, schools and community health centers. Social worker’s role varies depending on where they are employed. The role of social workers also includes advocating for public issues and helping marginalized and vulnerable patients seek justice. They also play a role in developing policies, delivering education and training. Most social workers work within specialties of mental health, the healthcare system, alcohol and substance abuse, child and family care.
Social workers are expected to:
• evaluate the needs of patients
• provide counselling
• respond to crisis, for example, child abuse
• maintain client records; assist with applications and paperwork with insurance or care facilities
• advocate patient rights
• follow up with patients to make sure that they are getting the services that they need.
At a minimum, social workers have obtained a bachelor’s degree, however, to practice in a clinical capacity they have to have their master’s.
Care manager
A care manager’s role is slightly broader than that of a social worker. Care managers are responsible for coordinating care and ensuring that clients have access to the services they need.
Their role includes:
• creating personalized care plans for patients.
• developing treatment plans
• identifying and recruiting healthcare providers or services.
• Facilitating patients’ treatment and ensuring their treatment requirements are met.
• Educate patients on procedures, instructions from healthcare providers and referrals.
• Linking patients to social services, transportation assistance and translational services.
• Regularly following up with patients to evaluate their progress to ensure improved health outcomes.
• Maintaining records.
For example, if a patient needs antibiotics, nursing services and durable equipment delivered; the care manager will be one of the members coordinating those things.
Care managers require a 4 years bachelor’s degree from an accredited program in public health, health information management and a related area.
Social works and care managers are very knowledgeable in navigating the healthcare system and serve as an important resource not only for the patient, but the medical team as well. Utilizing them to their full extent while in the hospital or pre-op will help your recovery process be a smooth and successful one.
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Am I Left On My Own If I’m Discharged Home?
When a patient is discharged home from the hospital, it doesn’t mean you are left on your own to recover!
A support system in addition to your friends a family will be there to help you have the optimal recovery as well. Whenever you are in doubt, …
Am I Left On My Own If I’m Discharged Home?
When a patient is discharged home from the hospital, it doesn’t mean you are left on your own to recover!
A support system in addition to your friends a family will be there to help you have the optimal recovery as well. Whenever you are in doubt, or have any questions reach out to your surgeon or doctor’s office.
Prior to discharge home, or prior to surgery a case manager or social worker will speak with you and your medical team about what specialized staff you may need to help you recover. Let them know of any logistical challenges such as stairs in home, limited help at home, or transport issues as early as possible!
Let’s go through the different types of staffing that may be there to help you at home after surgery and their roles
Who Will Help Me When I’m at Home?
Post-Op Visiting Nurse Services
Some medical treatment may still need to perform while you are recovering at home, requiring someone who is licensed to perform such duties. Not only will they be there to administer the treatments, they will also be your medical liaison between you and the doctor. They will be reporting how well you are recovering, if any medical or surgical issues exist.
Their duties also include:
Home health aide
Home health aide can assist people with cognitive difficulty, chronic illness or aging. A home health aide helps improve the quality of life with professional and hand-on care. Home health aide provides basic health assistance and companionship. For example, for bathing and dressing, housekeeping, monitoring medication, grocery shopping, meal preparation and planning, transportation to doctor’s appointments, companionship visits, organization of schedules and appointments and physical exercise. Home health aides also help with specific in-home care related to Alzheimer’s disease or dementia, hypertension, stroke recovery, heart disease, cancer recovery, hospice and palliative care.
Home-care physical therapy
Physical therapy care can be provided in a variety of different settings. If you are hospitalized, therapy will be provided by a physical therapist at the hospital. However, if you have difficulty leaving the house for physical therapy, a physical therapist may come to your house to help restore normal functional mobility. Or home physical therapy will be continued from your inpatient program to assist in your recovery.
Home-care physical therapy in case of:
• An acute or severe condition and leaving the house presents as a health risk.
• Limited functional mobility.
• Lack of adequate or access to transportation to go to your physical therapist.
• You are more comfortable with a physical therapy session in your home.
Occupational therapy
Although it may seem there is overlap between Physical and Occupational Therapy, there are differences between the two. Occupational therapy helps you adapt and perform any kind of task in your home, at work or school; things that you do everyday, that may need to be modified while you recover. The occupational therapist teaches you how to use assistive devices if you need them. They help you change your movements, take care of yourself, stay active and play sports.
Occupational therapy also helps you do specific things, for example:
• Eat without help
• Participate in leisure activities
• Bathe and get dressed
• Clean up around the house and do laundry
How Am I Going to Pay for Services at Home?
Services are prescribed for a length of time and frequency; many time’s services like this will be covered by insurance or with a small co-pay. If you are looking to extend the length or increase the frequency of your services, that may need to come out of pocket. Let your doctor know if you feel you may need more services, they will usually try to get it authorized through insurance first.
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
After your surgery, ideally you are discharged home. But what happens if you are not safe or medically stable enough for home? Are there other better options besides staying in the hospital where complications can still occur?
What is hospital discharge?
Hospital discharge is a process …
After your surgery, ideally you are discharged home. But what happens if you are not safe or medically stable enough for home? Are there other better options besides staying in the hospital where complications can still occur?
What is hospital discharge?
Hospital discharge is a process that you go through when you leave a hospital after treatment. The hospital discharges you to go home when you no longer need inpatient care. However, if you require additional care, you will either be sent to another type of facility or be sent with home care services.
Oftentimes patients may not have fully recovered or have a medical condition and require additional care. Therefore, after discharge, you will go through a transition of care. You will be given a different level of care outside the hospital. For example, you may be sent to a skilled nursing facility if you need further care and are not yet ready to go home. Additionally, if you need physical rehabilitation, you will be sent to a rehab facility. Healthcare providers in these facilities will ensure that you get the treatment that you need and oversee your continuing care.
Different discharge options available for patients
Long-term acute care hospitals (LTACHs)/Acute Rehab Facilities (ARF)
Long-term acute care facilities are specialized in treatment of patients with serious medical conditions and require ongoing intensive care. The LTACH's are often located near or inside an acute care hospital, however, they function and are licensed independently from the main hospital. The types of patients typically seen in LTACHs must need more than 25 days of hospitalization.
The average length of a patient’s stay in LTACHs is 30 days. Patients typically admitted require:
• Prolonged ventilation use
• Ongoing dialysis because of chronic renal failure
• Intensive respiratory care
• IV transfusions and medications
• Care for burns or complex wound care
SAR/SNF (sub-acute rehab or skill nursing facility)
SAR/SNF care includes a higher level of patient stability and focuses on increasing your independence. It provides a different staffing ratio compared to hospital care because the patient no longer requires acute care. The goal of SAR/SNF care is to help you transition back to your prior functional level before hospitalization.
The services provided in this level of care may include:
• Clinical nutritional therapy
• IV antibiotic therapy
• Wound care
• Speech therapy
• Occupational therapy
• Physical therapy
• Nursing care
If you are discharged to home, don't worry! Likely you will be getting services at home to help you recover safely and smoothly at home. These services can include home PT/OT, home health aides, and visiting nurses.
Check out our blog post next week where we go into home services in detail!
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
We want to empower patients on their surgical journey so that they can be fully aware of what options exist and be an active advocate for themselve or their loved ones.
Interested in knowing how we do that?
Check out this interview with our Co-founders George and Pat!
Right Device is …
We want to empower patients on their surgical journey so that they can be fully aware of what options exist and be an active advocate for themselve or their loved ones.
Interested in knowing how we do that?
Check out this interview with our Co-founders George and Pat!
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse …
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner …
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Understanding Custom Knee Replacement and Its Benefits – What Options Do You Have?
Knee Replacement Surgery can be the last hope for patients who have developed severe knee arthritis and no other treatment option seems to work for them. Knee replacement surgery has proven to be an effective …
Understanding Custom Knee Replacement and Its Benefits – What Options Do You Have?
Knee Replacement Surgery can be the last hope for patients who have developed severe knee arthritis and no other treatment option seems to work for them. Knee replacement surgery has proven to be an effective treatment for knee arthritis [1]. Traditionally, the implants for knee replacements have been pre-fabricated in a variety of sizes. The most recent development into this specialty is custom knee replacements where the implant is custom made for each patient, guided by CT and MRI.
First, we’ll look at what both a standard knee replacement entails and then a custom knee replacement.
Standard Knee Replacement Surgery
The knee replacement implants have three basic components i.e. the tibial component, the femoral component, and the spacer. When the knee replacement surgery is performed, the tibial component is placed on top of your shin bone while the femoral component fits at the end of your thigh bone. The spacer is actually a plastic component that goes in between the other two metal components. Sometimes, another small piece of plastic is also used in the procedure and it is placed at the back of the kneecap.
When performing a standard knee replacement surgery, the surgeon cuts away a part of the patient’s shin and thigh bones and a metal prosthesis is used as a replacement for those parts of the knee joint. In case of standard surgeries, most of the prostheses used in knee replacements were bought “off the shelf” and have a wide variety of sizes to fit each patient as best as possible.
Custom Knee Replacement Surgery
The primary difference in case of custom knee replacement surgery is that it uses customized knee implants that have been tailored specifically to each patient’s individual needs. Before the surgery is carried out, you undergo a computerized tomography scan which gives a detailed image revealing the bony anatomy of your knee, hip, and ankle.
After the scan, the surgeon uses the information obtained for carefully examining the 3D images of the joints. Eventually, the exact measurements of your knee joint’s size, position, and shape are obtained using computerized technology. These measurements are then used for fabricating a total knee joint prosthesis that fits precisely to your knee’s shape and contour.
Dr. Raj Sinha talks about why he’s elected to use custom knee replacements for his practice below.
What Are Some Proposed Benefits to a Custom Knee Replacement?
The idea behind custom knee replacement implants is to provide:
• Better fitting knee joint prosthesis [3]
• Reduced bone cutting required during the procedure [3]
• The natural shape of the knee and joint line is preserved [7]
• Improved stress distribution as compared to conventional knees [6,8]
• Custom knee replacement is possible for both total and partial knee joint replacement
In addition to the benefits mentioned above, ideally less work needs to be done during surgery for determining proper alignment and ensuring that the knee implant is positioned properly. That’s because the prosthesis has been custom made for you.
Surgeons also believe that it helps to perform the surgery more quickly and there is least tissue disruption in the process [2, 6]. Hopefully, more accurate placement of the implants would allow them to last longer as they won’t wear out too quickly and will offer improved mobility to the patients.
Is It A Reliable Choice to Switch to A Newer System?
As custom total knee replacement is a comparatively newer concept, limited research is available to determine whether or not the custom prostheses offer better results in comparison to the standard “off-the-shelf” knee replacement options. Early studies so far show that the custom knee is comparable to standard knee replacements [3, 6] but there isn’t any concrete data available to reflect that the new system is overall better [3, 4, 5]. Additional long term studies are still being conducted.
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
References
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device …
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Here at Right Device we are always about putting patient's first and our PatientPartner Program (TM) is meant to do just that!
We connect patients who are about to have a knee replacement, hip replacement, etc with patient's who have previously had that surgery so you get to know the REAL …
Here at Right Device we are always about putting patient's first and our PatientPartner Program (TM) is meant to do just that!
We connect patients who are about to have a knee replacement, hip replacement, etc with patient's who have previously had that surgery so you get to know the REAL experience.
Patient Partner's are there to guide you through your surgical journey each and every step of the way. Our Patient Partners are also medical professionals as well! Such as Nurse Practitioners, Medical Device Experts, Nutritionists and Rehab Specialists!
Interested in more? Check out a real PatientPartner(TM) experience below!
Ready to sign up? Speak with a Patient Partner today!
Calista avoided scheduling her total knee replacement for nearly three years because she was nervous about the recovery process. The day before her surgery, she used thee PatientPartner(TM) program to speak with a recovered TKR patient, hoping to ease her pre-surgery jitters. Calista was matched with Robin who also happened to be an OR Nurse at the same hospital Calista was having surgery at!
She was able to hear Robin's surgical story and learn some of the best practices for recovery.
After her call, Calista felt a sense of assurance and comfort and was ready for surgery. It turns out Robin was working the day of Calista's surgery and was assigned to be Calista's nurse!
Rightdevice is so proud of meaningful connections the PatientPartner(TM) program creates. Calista and Robin's story is a true testament that having a friend throughout the surgical journey truly makes a world of difference.
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Programas well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
The recovery process is one that will take up much of your time and energy. Having your home prepared before coming back from surgery will help make the recovery process that much smoother.
Check out these tips to help you prepare your home for post-op recovery!
Your physical therapist or …
The recovery process is one that will take up much of your time and energy. Having your home prepared before coming back from surgery will help make the recovery process that much smoother.
Check out these tips to help you prepare your home for post-op recovery!
Your physical therapist or occupational therapists may send you home or recommend additional equipment to help you manage your recovery at home as well!
Want some inside tips on how to prepare yourself and your home for surgery? Speak with a Patient Partner who has had your surgery for free to learn about the real experience!
Make daily activities easier making them more accessible!
Consider on preparing sleeping and bathroom arrangements onto the ground floor if possible.
Don’t be afraid to ask for help
After surgery, many everyday activities become a lot harder to manage than you would think. Don’t be afraid to ask for help! It is much better to be safe than risk a fall or complication. Prior to surgery speak with your surgeon about post-op options ranging from a home health attendant or rehab facility to ensure your recovery is safe!
Bathroom setup
Some people require modifications to be made to the bathroom to suit their post-op needs. One of them is to add non-slip mats and also raising the height of the toilet seat.
There is also the possibility that it is necessary to incorporate safety bars in the bathroom:
When bathing make sure:
Avoiding Falls
Pets can become a tripping hazard, therefore, it is recommended that during the first weeks of recovery to possibly arrange for alternative care of a pet.
If necessary, use equipment that helps you maintain balance such as a cane, walker, crutches, wheelchair depending on what your physical therapist recommends!
Want some inside tips on how to prepare yourself and your home for surgery? Speak with a Patient Partner who has had your surgery for free to learn about the real experience!
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Programas well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Scoliosis is when there is an abnormal curvature in a developing child's spine.
Occasionally, surgery is needed to correct the curvature.
Check out our latest video where Ameeka George, CPNP explains what surgical options exist for treating scoliosis.
Right Device is here to ensure …
Scoliosis is when there is an abnormal curvature in a developing child's spine.
Occasionally, surgery is needed to correct the curvature.
Check out our latest video where Ameeka George, CPNP explains what surgical options exist for treating scoliosis.
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Scoliosis is when there is an abnormal curvature in a developing child's spine.
Occasionally, surgery is needed to correct the curvature.
Check out our latest video where Ameeka George, CPNP explains when it may be possible to treat scoliosis without surgery and what options exist.
…
Scoliosis is when there is an abnormal curvature in a developing child's spine.
Occasionally, surgery is needed to correct the curvature.
Check out our latest video where Ameeka George, CPNP explains when it may be possible to treat scoliosis without surgery and what options exist.
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Scoliosis is when there is an abnormal curvature in a developing child's spine.
Occasionally, surgery is needed to correct the curvature.
Check out our latest video where Ameeka, CPNP talks about when surgeons begin looking at performing surgery and what could happen if surgery is not …
Scoliosis is when there is an abnormal curvature in a developing child's spine.
Occasionally, surgery is needed to correct the curvature.
Check out our latest video where Ameeka, CPNP talks about when surgeons begin looking at performing surgery and what could happen if surgery is not performed.
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Scoliosis is when there is an abnormal curvature in a developing child's spine.
But did you know there's different types and options in how scoliosis is treated?
Check out our latest video where Ameeka, CPNP talks about the different types of scoliosis and when surgical intervention is …
Scoliosis is when there is an abnormal curvature in a developing child's spine.
But did you know there's different types and options in how scoliosis is treated?
Check out our latest video where Ameeka, CPNP talks about the different types of scoliosis and when surgical intervention is needed.
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
I have lived with chronic pain now for seven years, and one thing I am certain of is that I am more susceptible to flare ups and bad pain days before and after surgery, This can be related to pre-surgery stress, and the physical and mental trauma after surgery. Whether it’s my back in agony from …
I have lived with chronic pain now for seven years, and one thing I am certain of is that I am more susceptible to flare ups and bad pain days before and after surgery, This can be related to pre-surgery stress, and the physical and mental trauma after surgery. Whether it’s my back in agony from the limp in my step, the left ankle stabbing in pain after a walk, or the majority of my joints aching from an extremely arthritic day, my chronic pain can happen suddenly and take over for hours, a day, or even multiple days. As an individual living with chronic pain for many years, I have gained ways to aid my pain and manage pain levels overtime. Of course there is no miracle cure, and often pain levels get out of control making no strategy or technique helpful. However, working toward managing your pain level everyday, especially before and after surgery, is essential to the quality of life when living with chronic pain. Here are some of my tips and tricks to hopefully help you manage your pain levels.
Get Moving
Sometimes this sounds contradictory, as our pain can be so debilitating that even walking out the door is too painful; however, if you are capable, moving your body can aid inflammation and relieve some of your pain. Try stretching, yoga, going for a walk, or light swimming.
Heat and Ice
Use the benefits of heat and ice as often as possible. This can come in the form of a hot bath, followed by an ice bath or cold shower, or a heating pad or water bottle, followed by an ice pack in the desired areas.
Non-Narcotic Pain Remedies
Explore natural remedies for pain relief. There are many herbs, supplements, oils and topical creams/gels that are extremely calming and aid muscle pain.
Don’t Forget About Proper Nutrition
Ensure to get your daily water intake, as well as eat proper, nutrient-rich meals. Explore certain diets/recipes that are focused.
Sleep Works Wonders
Get on a good sleep schedule. Sleep is a significant part of our bodies healing process, so having a good amount of hours of sleep each night is crucial.
Communicate With Your Doctor About the Options
Talk to your doctor about prescription medication. While these medications may not be ideal, they may be what gets your pain levels managed in order to improve the quality of your life for the time being. These medications are created to help individuals like myself, so when used safely and properly, they can be of great help. My doctor and I have a strong and open form of communication in regards to narcotics. This helps us both be accountable in regards to my narcotic intake. I also keep a log in my calendar, where I write down the dosage I took that day. At the end of the week I am able to see the total dosage, and compare to other weeks (this is especially helpful for post-surgery). When taking prescription medication, a support group is extremely helpful. This can be in the form of friends, family, or a therapist to talk to.
Daily Self-Care
Include self-care into your daily routine. This can look like taking a bath, watching a show, reading a book, having a lay down, making a nice meal, or whatever it is that makes you happy and brings you some peace.
Forgive Yourself
Go easy on yourself. If you can’t make an appointment, plans with a friend, or even get outside for a walk one day, that’s okay. Your body needs rest and to reset, in order to have better days.
Want to know more about her or additional resources to connect with?
Check out her linktree here: https://linktr.ee/livingnowwithmaia
Maia Vezina is a 26 year old educator from Nelson, British Columbia, who lives with life-long physical, mental and emotional injuries from a head-on collision in 2013. While her life was drastically changed by one drunk driver's decision, Maia has found much joy in her new journey towards healing. Maia strives to support and be an advocate for those who have experienced trauma and live with chronic illness through sharing her story, and continues to follow her passion for teaching and life-long learning, while working towards rehabilitation.
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
About Me
On June 9, 2013, my mother and I were hit head on by a drunk driver. I had just completed my first year of University and was returning home for the summer; however, instead of spending the summer in my hometown, it was spent in the hospital recovering from over a dozen injuries. The …
On June 9, 2013, my mother and I were hit head on by a drunk driver. I had just completed my first year of University and was returning home for the summer; however, instead of spending the summer in my hometown, it was spent in the hospital recovering from over a dozen injuries. The impact left me with fractures in my left ankle, right foot, both femurs, right knee, pelvis, both forearms, right wrist, left collarbone, left first rib, and left cheek bone, as well as a massive third degree burn on my thigh, hernias and gangrene intestines. In addition to the physical damage, I began to struggle with post-traumatic stress disorder (PTSD), anxiety and depression. After three months of constant surgeries, scans, and testing, I was transferred to a rehabilitation clinic to learn how to walk on my right leg and gain some strength, and then returned to university in an electric wheelchair when my mother was flown to a different province for additional medical aid with my father by her side. It wasn’t until three months afterwards, six months in total, that I was able to walk on both legs without the constant need of a walking device.
I have been in and out of surgeries since the day of the crash, and have developed many conditions from the collision and from past surgeries, including osteoarthritis, avascular necrosis, nerve damage, bone cysts, muscle atrophy, and more. I’ve had a total of fifteen surgeries related to the crash, and a total of five surgeries on my left ankle, as the talus was shattered by the engine and no surgery has been successful in regards to providing pain relief or enhancing mobility. The avascular necrosis has created blood loss in the talus, ultimately leaving some areas of the talus bone dead and very unstable, which has caused fear of collapsing in the near future. Therefore, I had a TTC fusion in March of 2020 in hopes to stabilize the ankle and lessen the chronic pain I feel daily in that area.
Each surgery I have undergone in the past seven years prepares me for the next in some way, whether it’s how to mentally prepare myself, what questions to ask my doctor, or what supports and/or devices I will need for recovery. I have learnt over time how vastly important it is to be prepared for your surgery, a well as for what is to come post surgery, as some surgeries can leave you extremely dependent on others and make even the smallest tasks difficult or simply not doable. Below is a list of general surgery tips in order to prepare you for your surgery. Depending on the surgery you are receiving, some may not apply or can be adapted.
Do Your Research
Do your research about the surgery you are having or considering. When doing research, ensure you are exploring several sources, including online and in person. Some sources may not contain as much information or be as credible as others, so gaining information from a variety of sources will greatly aid your knowledge on the surgery you are receiving or considering receiving. Reach out to your general practitioner, surgeon, and consider getting another opinion from a second surgeon. When being knowledgeable on the surgery, the general idea of pre and post surgery will be significantly clearer.
Have a Personal Notebooks
Have a personal notebook where you can write down questions, thoughts and information on your surgery. This notebook can be used during your pre surgery appointments, as your questions for your surgeon will be in the notebook and you can write down their answers in the notebook.
Communicate and Ask Questions
Communicate with both your surgeon and your general practitioner in regards to both pre and post-op, as your doctors will be able to give you information on what devices you may need, how much time you may need to take off of work, what medications you will need to manage pain levels, and what form of therapies you may need afterwards.
Things to ask your doctor(s) before surgery:
Ask your doctor/surgeon on general information regarding the surgery.
How long will I be in the hospital for?
You may be day surgery or overnight, depending on the surgery, so gaining this information will prepare you to have a safe ride there and home, as well as have the essential materials for overnight stay at the hospital.
What medications will I be on to manage pain? Who will prescribe these medications afterwards if my pain continues?
Ask your doctor about what to expect in regards to pain, and while pain types and levels will vary depending on the person and surgery, having an idea of what to expect can help with mental preparation and finding ways to manage pain.
What devices do I need for surgery?
These can include crutches, other various walking devices, air cast, shower chair, and so on. Ask your doctor for a prescription for insurance purposes.
How long will I be “out” for? The answer will depend on the type of surgery you are receiving, and how your body responds to the surgery. Having this information will give you a general idea of how much time you may need to take off of work, how long you may need to be put on bedrest for, if you need help afterwards surgery and who will help you during this time, and when you can get back to regular activities and routine.
Prepare Your Home for Surgery
Prepare your home before your surgery. You may need to change your sleeping arrangements, move your furniture, install certain devices for post-surgery aid, and/or rearrange your cabinets in order to reach personal or kitchen supplies.
Take Time to Mentally Prepare for Surgery
Find ways to mentally prepare for your surgery, as your body will be going through a trauma, which can greatly impact your mental health. If you already have a therapist, try and book in before your surgery, as well as sometime afterwards when you are able to attend appointments again (or book a phone appointment). Have a journal to write down your thoughts regarding surgery, and reach out to friends and family. If possible, try and get exercise every day leading up to your surgery. Make your home/living space as comfortable and peaceful as possible, and utilize the calming space before and after surgery.
Check out Part 2 next week!
Want to know more about her or additional resources to connect with?
Check out her linktree here: https://linktr.ee/livingnowwithmaia
Maia Vezina is a 26 year old educator from Nelson, British Columbia, who lives with life-long physical, mental and emotional injuries from a head-on collision in 2013. While her life was drastically changed by one drunk driver's decision, Maia has found much joy in her new journey towards healing. Maia strives to support and be an advocate for those who have experienced trauma and live with chronic illness through sharing her story, and continues to follow her passion for teaching and life-long learning, while working towards rehabilitation.
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
The Coronavirus pandemic has affected all aspects of daily life, and the ease of which it spreads poses a great risk not only in daily life, but especially those in hospitals. Because of this high risk ideally you should hold off your surgery until the situation is under better control. But …
The Coronavirus pandemic has affected all aspects of daily life, and the ease of which it spreads poses a great risk not only in daily life, but especially those in hospitals. Because of this high risk ideally you should hold off your surgery until the situation is under better control. But unfortunately, that is not always possible and surgery may be unavoidable. This latest blog series talks about what to expect in your surgical experience and some things that you should consider during these times.
In Part 3 we talk about things that your hospital should be doing to help protect you from possibly being infected by COVID-19.
*Disclaimer: Your individual hospital, state, city or county may have individual guidelines regarding which surgeries can proceed. Please check with your surgeon or hospital regarding these policies and whether surgery is safe at this time.
Notice if staff, visitors and patients being screened for symptoms such as fevers, chills or coughs at the hospital entrances. This is the first line of defense for many clinics and hospitals as it is an effective way to filter out higher risk people who may be symptomatic.
Distance markers should be easily seen to help maintain a 6-foot distance between people in all locations where people can gather. Such as: lobbies, registration lines, cafeteria and clinic waiting rooms. If you can, see if you can wait outside of a waiting room when waiting to be called for your appointment, imaging or lab draw.
One of the simplest and most effective ways to prevent the transmission of COVID-19 and other possible pathogens is making sure your hands are clean and by wearing a mask. All staff should be wearing surgical masks and sanitizing their hands in between patients. Hand sanitizer stations should be easily locatable so that you can sanitize your hands after touching things such as door handles, pens or magazines. Many clinics should have cleaning wipes around that you may use to wipe off your seat prior to sitting down, as well as staff cleaning high traffic areas in the hospital.
To help decrease the risk of person-to-person contact, see if your healthcare system is offering telemedicine appointments in lieu of in-person appointments. Many follow up appointments or initial consults can be performed via telemedicine to resolve routine issues or determine whether you may need to come into the office or not.
In order to prevent overcrowding in patient rooms, lobbies, and other areas many hospitals may limit visitors to one visitor per patient or to family only. The time at which visitors may visit may be limited as well. This helps maintain social distancing as well as decrease the risk of someone bringing in COVID.
As areas of higher risk for infections, hospitals have a huge responsibility to limit the spread of COVID-19 and infections in general. The above things are just some of the things that your hospital should be implementing to maintain your safety. Likely your hospital is going above and beyond to ensure patient and staff safety. Be sure to check with your local hospital or clinic to see what they have implemented to help protect you.
Missed Part 1? Check it out here!
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
The Coronavirus pandemic has affected all aspects of daily life, and the ease of which it spreads poses a great risk not only in daily life, but especially those in hospitals. Because of this high risk ideally you should hold off your surgery until the situation is under better control. But …
The Coronavirus pandemic has affected all aspects of daily life, and the ease of which it spreads poses a great risk not only in daily life, but especially those in hospitals. Because of this high risk ideally you should hold off your surgery until the situation is under better control. But unfortunately, that is not always possible and surgery may be unavoidable. This latest blog series talks about what to expect in your surgical experience and some things that you should consider during these times.
In Part 2 we talk about what to expect during the peri-operative experience.
*Disclaimer: Your individual hospital, state, city or county may have individual guidelines regarding which surgeries can proceed. Please check with your surgeon or hospital regarding these policies and whether surgery is safe at this time.
Many hospitals have updated their policies in order minimize the spread of coronavirus, and many policies are continually updated as the landscape changes. For the same reasons some hospitals have postponed minor surgeries or temporarily halted all elective surgeries.
If you have to get surgery, how has the surgical experience changed? And what should you expect prior to surgery? Here are some things to expect:
In addition to your usual pre-operative screening such as: a physical check-up, imaging, and blood work, expect to have a COVID-19 swab or blood test at some point prior to your operative date. If you test positive, your date may be postponed by a few weeks and you may be tested again prior to the new date.
Despite how healthy or ready you may be, your surgery can still be delayed or postponed because of logistical reasons. As hospitals have changed their protocols for surgery and almost in all cases, staff, surgical equipment, patient bed and operation theaters are disinfected with extra care to prepare them for the next surgery. Because of this, hospitals may need to reschedule cases. An emergency surgery may also need to be bumped ahead pushing the other cases, or the overall situation may be exacerbated enough that all elective cases need to be rescheduled.
Despite all the care that goes into ensuring that patients and staff remain safe, the hospital remains a place of increased risk of infection. Even under normal circumstances hospital acquired infections do occur, and at some hospitals COVID patients may share the same building as non-COVID patients.
It might be a difficult time for the relatives and loved ones of the patients because some hospitals have put restrictions on visitors in order to avoid overcrowding. Many hospitals are limiting patients to one visitor at a time as well as stricter visiting hours. Plan to have visitor’s alternate visits and ask that they not visit if they feel symptomatic. Remember these policies are for your safety as well.
To keep everyone safe not only are patients screened but visitors and staff as well. At entrances of hospitals expect to report if you have had any symptoms such as fever, chills, cough, shortness of breath or traveled to any high-risk areas in the past two weeks. A temperature will likely be taken as well.
If you do have any of these symptoms, report them to your surgeon’s office or to your hospital liaison as soon as possible. Although your surgery may need to be delayed it is better to be safe and to help keep others safe.
Even under normal circumstances, the longer a patient stays at a hospital the higher the risk of infection. Your goal should be to be discharged as soon as safely possible, expect alternative care options from your social worker to help facilitate earlier discharge. Options may include increased home health aide time, or in-home PT/OT. Also, you may be a candidate for same day surgery, where you get your surgery in the morning, and if deemed stable can be discharged home that same day.
In the worst case scenario, you contract COVID-19 while at the hospital, your stay may be extended until your medical situation is optimized. Once you are stable, plan to quarantine at home for 2-weeks after discharge. If you have high risk individuals at home such as elderly parents or small children, your social worker will help you decide on an alternate discharge plan until it is safe to be discharged home. Options may include being discharged to relatives or to a rehab facility until 2-weeks is up.
Undergoing surgery is already a big decision and COVID-19 will be around for a while. If surgery is unavoidable, being prepared will help you have a successful surgery and recovery.
Check out our Part 3 in this series “How To Tell Your Hospital Is Protecting You" to see what measures your hospitals should have to limit the spread of COVID-19.
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
The Coronavirus pandemic has affected all aspects of daily life, and the ease of which it spreads poses a great risk not only in daily life, but especially those in hospitals. Because of this high risk ideally you should hold off your surgery until the situation is under better control. But …
The Coronavirus pandemic has affected all aspects of daily life, and the ease of which it spreads poses a great risk not only in daily life, but especially those in hospitals. Because of this high risk ideally you should hold off your surgery until the situation is under better control. But unfortunately, that is not always possible and surgery may be unavoidable. This latest blog series talks about what to expect in your surgical experience and some things that you should consider during these times.
In Part 1 we talk about certain changes in the healthcare system and risk factors that you should consider to help determine whether or not your surgery should be postponed.
*Disclaimer: Your individual hospital, state, city or county may have individual guidelines regarding which surgeries can proceed. Please check with your surgeon or hospital regarding these policies and whether surgery is safe at this time.
The highest, obvious risk factor is the contraction of coronavirus since your hospital may be treating or have treated COVID-19 patients. Hospitals on a whole are considered vectors for the transmission of viruses and bacteria and strict precautionary measures are taken by hospitals to reduce infections but precautions must be taken by surgical patients. At any step along the surgical process, a patient may be at risk from contracting COVID-19.
Spread of COVID-19
The virus itself is spread through respiratory droplets when a person talks, coughs or sneezes. Many infected people are asymptomatic, and may not even know they are infected or unaware they are infecting others. Wearing a mask when staff enter your room, or while you are around others during the peri-operative process will help greatly decrease the risk of spreading or contracting the virus [1].
Risk of Severe Illness Increases with Age
The risk of severe, symptomatic illness increases dramatically with age. 8 in 10 COVID-19 Related deaths have been in adults 65 years and older [1] .
It has been observed that certain people with additional medical conditions are at higher risk from severe illness, especially those that may be immunocompromised. Underlying medical conditions that may place a patient at higher risk include:
o Cancer
o Chronic Kidney Disease
o COPD
o Post-Organ Transplant
o Obesity (BMI >30)
o Serious heart conditions: heart failure, coronary artery disease, etc
o Sickle cell disease
o Type 2 Diabetes
o See here for full CDC list
After surgery one of the most important phases begin and that is recovery. Many times patients will need additional help at home such as a home health aide, visiting nurses to check on the wound/dressings as well as physical/occupational therapy. Sometimes if patients do not progress after surgery as quickly as anticipated, a rehab facility may be an additional option. All of these services have been affected by COVID-19 in one way or another. There may be more difficulty in obtaining services in a timely manner after surgery, and you may need more help than originally anticipated from family or friends.
Patients going for surgery in this situation must consider that there can be an increased risk of death after surgery if they are COVID-19 positive. A study [2] showed that patients undergoing surgery after contracting coronavirus have increased risk of post-operative death. Researchers found that amongst SARS-CoV-2 infected patients who underwent surgery, mortality rates approach those of the sickest patients admitted to intensive care after contracting the virus in the community. If you do test positive pre-op, it would be advised to postpone your surgery by at least 2 weeks or until you have a negative test.
Despite the COVID-19 risk some of the medical and surgical procedures are inevitable and patients cannot do without undergoing them. This may be due to the necessity of certain treatments that cannot be interrupted or the procedure may save the life of a patient. For these procedures be sure to have your operative game plan fully laid out to avoid any bumps in the road.
COVID-19 has made health care very difficult and complicated procedures like surgeries are even more difficult to manage. Knowing the risks and precautions can help the patients going for surgeries to take care of them. We have discussed some of the risk factors which must be kept in mind and discussed with your medical team. Right Device is here to ensure your operative game plan is ready prior to surgery so that even in these uncertain times you will have the best outcome.
Check out Part 2 to see how your operative experience will change with COVID-19.
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
References
University of Birmingham. (2020, May 29). COVID-19 patients who undergo surgery are at increased risk of postoperative death. ScienceDaily. Retrieved July 20, 2020 from www.sciencedaily.com/releases/2020/05/200529190739.htm
COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. The Lancet, 2020; DOI: 10.1016/S0140-6736(20)31182-X
Paul S Myles, Salome Maswime. Mitigating the risks of surgery during the COVID-19 pandemic. The Lancet, 2020; DOI: 10.1016/S0140-6736(20)31256-3
Once your surgery is complete, the real work of recovery begins. Although the recovery process is different for every patient, there are a few recommendations that can help make the process a little easier. However, there are some people who require more detailed care depending on the type of …
Once your surgery is complete, the real work of recovery begins. Although the recovery process is different for every patient, there are a few recommendations that can help make the process a little easier. However, there are some people who require more detailed care depending on the type of surgery and the patient's physical condition.
Here are some tips on how to reduce the recovery time if you are undergoing surgery.
Your surgeon and surgeon’s office will be there for you before, during and after your surgery. Making sure you follow the instructions will help make the recovery process easier as well as provide a blueprint.
Seeing your doctors and surgeons after your surgery will be important to make sure that you are healing well and that your recovery is on the right track. It is also a good opportunity for you to bring up any concerns or questions regarding the recovery process and how it may affect your other health disorders. Even if you feel well, it is a good idea to go to your follow up appointments. Likewise, it is also necessary to verify the medication during recovery to see if it is convenient to make an adjustment in the patient's doses.
Anytime an incision is made into the body, there is a risk of infection. Prior to entering the OR you will be wiped down with alcohol wipes, and prior to incision the surgical site will be cleaned as well. Your surgeon will also give you a dose of antibiotics during surgery and you may receive a few doses after surgery. When you are discharged, be sure to monitor your incision and dressing.
Some signs of infection may include:
Call your surgeon’s office if you notice these things and you may have a visiting nurse to help you check your dressing and incision site as well. Try to not touch the dressing or incision unless absolutely necessary and only as per your discharge instructions. If you must, clean the site with alcohol wipes and use gloves. Wash your hands before and after.
During the recovery process, you must maintain a healthy and balanced diet, to strengthen the immune system and accelerate tissue regeneration. Staying hydrated is also very important. Getting the right nutrition is a vital part of the recovery process! Although you shouldn’t force yourself to eat till you are sick, you should attempt to eat in small, frequent meals. Adding your favorite protein shake or smoothie is a great way to add additional calories and protein to your diet without stuffing yourself!
Not sure where to begin? Schedule an appointment with our Registered Dietician here who’s sessions are covered by your insurance!
During the postoperative stage, the patient should take into account that coughing or sneezing suddenly can cause considerable damage to his incision. For this reason, you should apply a little pressure to the top of the wound before coughing or sneezing, especially if the incision is in the abdomen.
In addition to keeping your hands clean before touching your wound, it is recommended to gently wash the incision with soap and water only, unless your doctor specifies other recommendations.
Avoid removing the scabs that form around the incision, as this can cause the wound to heal slowly and delay recovery. Also, try as much as possible not to swim, go to the beach or the hot tub in the first stage of recovery.
In case of any irregularity in the incision, bleeding, shortness of breath, inability to move, dizziness, weakness or fever, it is recommended that you consult your surgeon’s office right away. If you are unable to contact the doctor or if the discomfort persists, you should go to the emergency room.
Pain is a part of the healing process and should be expected. The medications should help make the pain MANAGEABLE to help you during the recovery process. Do not be worried about utilizing the medications if needed, but take them as directed and only as needed.
Keeping your pain at a tolerable level will allow you to keep moving while minimizing your healing time.
Walking after an operation is one of the fundamental aspects in the recovery process of a patient, it may not seem so relevant, but this allows the person to stay active, recover their physical condition, and helps to avoid other serious complications such as thrombosis.
Conclusion
Keep in mind that the recovery process is a journey and may take some time before you come back 100%. The journey is also not a linear one as well, there may be set back, and sometimes may take more than one route. Listen to your surgeon’s instructions, communicate with the other members of your healthcare team, and remember that you will recover!
Have additional questions about post-surgery care? Sign up with our Nurse Practitioner Patient Partner today for free!
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Part 2 now available
Injuries, unfortunately, are becoming the norm among female sports, don’t look too far and there are always a few athletes in super huge knee braces or sitting on the sidelines fresh out of ACL surgery. And worse, large numbers of these women are having more than one …
Injuries, unfortunately, are becoming the norm among female sports, don’t look too far and there are always a few athletes in super huge knee braces or sitting on the sidelines fresh out of ACL surgery. And worse, large numbers of these women are having more than one injury or surgery. We know it’s common, we realize it’s a problem; but why is it happening and what can we do to fix it?
Studies show, female athletes are 2-8 times more likely to tear their ACL than their male counterparts [1]. Factors contributing to ACL injury risk in female athletes vary from environmental, structural, hormonal, anatomical and muscular. While we cannot change all of these risk factors, addressing preventable factors and increasing our knowledge towards non-preventable factors can dramatically decrease the incidences of injury.
When I was thirteen years old I tore my ACL playing soccer, and after a year of surgery and grueling rehabilitation, I returned to soccer only to tear my ACL, MCL and meniscus on my other knee. After having my second ACL surgery at age fourteen, we realized my surgeries had failed and the error cost me my knees. Ever since then, I have needed countless surgeries and have done years of research in order to understand why this happened to me, and why it happens so easily to women. In this blog, we’ll briefly see which factors are modifiable factors and non-modifiable, but definitely stay tuned for the next following blogs which take a deep dive into each topic.
In part 2 unmodifiable Variables, I will discuss some of the reasons relating to hormones and anatomy that predispose female athletes to ACL injury. While we cannot change hormones and anatomy, we can learn more about the biomechanics of female athletes and how we can help them as strength coaches. In Part 3, some of the modifiable variables are discussed and in Part 4, you can learn more about how to prevent ACL injury and what exercises or areas of the body are the most important to focus on for young female athletes.
We’ll get you started back on your recovery, faster, stronger and smarter in no time!
Age
One might think that the older a female athlete is, the more likely she is to have an injury. But in fact it’s a bit of the opposite; the most high risk demographic for female athletes are those between the ages of 12-17 [2]!
Hormones
Although no definitive studies showing direct correlation between hormonal changes and ACL injuries, multiple studies suggest that sex hormones and the menstrual cycle have an effect on the ACL and injury rate [3,4,5]. Increases in estrogen may affect the tensile integrity and collagen production [6, 7]. This amounts to increased laxity in joints, particularly to the ligaments where one of their main functions is to provide structural support. Since estrogen levels are regulated in the menstrual cycle, the risk for injuries in female athletes rise and fall depending on when they are in their cycle!
Hips and Anatomical Differences
Male and female hip structure differ in anatomy, specifically in a particular anatomical feature known as the Q angle. The Q angle is the angle measuring for the midpoint of the patella (knee cap) to the anterior superior iliac spine (ASIS) at the front of the hip. The degree of differences in the angles may affect how much forward stress is placed on an athlete’s knees. Other anatomical differences such as knee valgus, knee shape, over pronation at the foot and more may affect injury rates as well [8].
Neuromuscular Imbalances
Neuromuscular control is basically the connection between the brain and muscles telling which muscles to fire and when, and the muscles, tendons, and ligaments providing feedback to the brain. A decrease in neuromuscular control makes an athlete vulnerable because improper or even delayed firing sequencing in muscles lead to compensations in movements or reductions in reaction time which will make the athlete more prone to chronic stress and injury [9]. Fortunately, this is something that can be trained and re-tooled! Many athletes also have compensations related from sitting too much like tight ankles and impaired quad/hamstring function which can also affect injury rates.
Jenna Minecci
9x Surgery Survivor/Strength Coach/Author/Athlete
B.S., CPT, CES, PES, FMS, MWod Pro
@Jennactive
jminecci@gmail.com
Jenna Minecci is a passionate Personal Trainer and Strength Coach dedicated to helping others prevent injury, prepare for surgery and recover exceptionally from any surgery they have. After having 4 ACL reconstructions fail on her as a teenager, she has now had 9 surgeries and counting. Her goal is to educate and empower others facing difficult surgeries and recovery journeys. She currently works at Lifetime Fitness in Atlanta, Georgia where she specializes in Corrective Exercise, Knee Rehabilitation and ACL Injury Prevention.
She is also the author of the book Surviving 7: The Expert’s Guide to ACL Surgery.
Follow Jenna on social media @Jennactive.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
References
Boden, Sheehan. Torg, Hewett. “Noncontact anterior cruciate ligament mechanisms and risk factors.” Sep, 2010. https://insights.ovid.com/pubmed?pmid=20810933
Beck, Nicholas A., et al. “ACL Tears in School-Aged Children and Adolescents: Has There Been an Increased Incidence over the Last 20 Years?” Pediatrics, vol. 137, no. Supplement 3, 2016, doi:10.1542/peds.137.supplement_3.554a.
Wojtys, Edward M, et al. “The Effect of the Menstrual Cycle on Anterior Cruciate Ligament Injuries in Women as Determined by Hormone Levels.” The American Journal of Sports Medicine, U.S. National Library of Medicine, 2002, www.ncbi.nlm.nih.gov/pubmed/11912085.
Myklebust, G, et al. “A Prospective Cohort Study of Anterior Cruciate Ligament Injuries in Elite Norwegian Team Handball.” Scandinavian Journal of Medicine & Science in Sports, U.S. National Library of Medicine, June 1998, www.ncbi.nlm.nih.gov/pubmed/9659675.
Slauterbeck, J R, and D M Hardy. “Sex Hormones and Knee Ligament Injuries in Female Athletes.” The American Journal of the Medical Sciences, U.S. National Library of Medicine, Oct. 2001, www.ncbi.nlm.nih.gov/pubmed/11678515.
Hansen, Mette, and Michael Kjaer. “Sex Hormones and Tendon.” Advances in Experimental Medicine and Biology, U.S. National Library of Medicine, 2016, www.ncbi.nlm.nih.gov/pubmed/27535256.
Smith, Helen C, et al. “Risk Factors for Anterior Cruciate Ligament Injury: a Review of the Literature-Part 2: Hormonal, Genetic, Cognitive Function, Previous Injury, and Extrinsic Risk Factors.” Sports Health, SAGE Publications, Mar. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3435909/
Grelsamer, R P, et al. “Men and Women Have Similar Q Angles: a Clinical and Trigonometric Evaluation.” The Journal of Bone and Joint Surgery. British Volume, U.S. National Library of Medicine, Nov. 2005, www.ncbi.nlm.nih.gov/pubmed/16260666.
Smith, Helen C, et al. “Risk Factors for Anterior Cruciate Ligament Injury: a Review of the Literature - Part 1: Neuromuscular and Anatomic Risk.” Sports Health, SAGE Publications, Jan. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3435896/.
Written By: Patrick Frank
Sports are a healthy, fun pastime and captivating form of entertainment, helping people aspire to greater fitness and come together in pursuit of a common goal. However, since they often require rigorous training, intense exercise, heightened flexibility, and bodily …
Written By: Patrick Frank
Sports are a healthy, fun pastime and captivating form of entertainment, helping people aspire to greater fitness and come together in pursuit of a common goal. However, since they often require rigorous training, intense exercise, heightened flexibility, and bodily strain, athletic activities carry the risk of injury.
Overexerting yourself to throw the javelin farther, kick the soccer ball into a faraway goal, or slam a tennis ball into your opponent’s court could harm or even seriously impair your body. Sports medicine practitioners help patients maintain their health and treat athletic injuries so they can keep playing. Orthopedics, doctors who diagnose and treat Musculoskeletal Conditions, often specialize in sports medicine because athletes regularly harm their muscles, bones, ligaments, tendons, or related tissues. Sports medicine also incorporates elements of preventive medicine and nutritional science, helping patients preserve their fitness and wellbeing to perform well on the field or court.
Since sports often require repeated movements, putting pressure on the same joints and bones each time, certain conditions are more common than others. Some of the most frequently reported sports-related injuries include:
Plantar fasciitis: The tissue that runs from your heel to your toes is called “fascia.” If it becomes damaged or stretched, the bottom of your foot may experience sharp pains and swelling.
Hamstring pull: Excessive jumping or running can overextend the muscles along the back of your thigh.
Achilles tendinitis: The “Achilles” muscles adjoining your calf with your heel can become swollen and uncomfortable, most often in runners.
Concussion: A traumatic injury to your head can damage the protective gel and fluid coating your brain, temporarily impairing your cognitive function and causing fatigue. This is particularly common in high-impact contact sports such as football or rugby. If left untreated, concussions can be fatal, so it is important to see a sports medicine specialist as soon as possible if you experience a blow to the head during athletic activity.
Ankle sprain: Stretching or rupturing your ankle ligaments can be uncomfortable and impair your mobility. This injury can occur during any sport that requires repetitive foot movements.
Shoulder injury: Any sport that involves throwing or hitting, such as tennis or baseball, can cause shoulder injuries such as inflamed joints or torn ligaments. The rotator cuff tendons of the shoulder are particularly prone to sports-related damage.
Quadriceps strain: If the quadriceps muscles in the outer thigh become overworked, stretched, or torn, usually due to repeated squatting or lunging motions, they can interfere with your ability to walk and stand properly.
Hip bursitis: The hip’s “bursa” are fluid-filled membranes that pad the joints. Biking, running, or standing for long periods can cause them to swell.
Epicondylitis: Also called “tennis elbow” for the sport that most frequently causes it, this is a swollen outer elbow joint.
Lower back pain: Running, bending over, and twisting can put undue pressure on your lower back vertebrae, muscles, and ligaments, harming them. Many athletes believe aching in the lower back is a normal part of exercise, but it is actually a symptom of what could be a serious injury such as a spinal fracture. If you experience chronic back pain, especially after playing or training for sports, contact your doctor for an assessment. Stretching before you exercise can help strengthen and stretch your lower back muscles to reduce your risk.
Shin splints: These are sharp pains that result from running. They can be caused by an improper foot arch, weak hip or abdominal muscles, swollen shin muscles, or even stress fractures, small cracks in the leg bones.
Torn ACL (knee): The anterior cruciate ligament, or “ACL,” helps your knee move properly. Overuse or rapid twists can damage or tear the ACL, limiting your leg movement. This injury can take up to nine months to heal.
Palletofemoral syndrome: Repeated impact or strain can begin to dissolve or fragment the knee cap’s cartilage, making bending down very uncomfortable and causing an unsettling cracking noise when using the knee.
Groin pull: Jumping, sprinting, and sudden movements can injure the muscles that connect your pelvis to your upper thighs, causing a groin pull. You may hear a crackling sound as you strain these muscles and then feel a prolonged aching when you attempt to use your thighs, especially when lifting or closing them.
Sports medicine specialists and orthopedists specializing in sports injuries can help diagnose and treat any of the above conditions to allow for freer movement and alleviate your symptoms.
RELATED: Find a qualified orthopedic surgeon in your area
https://www.docshop.com/education/orthopedic/sports-medicine
#kneereplacement #totaljoint #reconstruction #hip #knee #hipreplacement #rightdevice #mediccaldevice #device #surgery #stress #patient #hospital #doctor #sportsmedicine #aclrepair #mclrepair #acl #healthcare #health #wellness #rotatorcuff #repair #transparency
Written By: Daniel Kao, AGACNP-BC
The number one cause of mortality in both men and women in the U.S. is heart disease, which accounts for 23.1% of deaths. Much of the patient education we see everywhere around us revolves around the prevention of heart disease through diet, exercise, smoking …
Written By: Daniel Kao, AGACNP-BC
The number one cause of mortality in both men and women in the U.S. is heart disease, which accounts for 23.1% of deaths. Much of the patient education we see everywhere around us revolves around the prevention of heart disease through diet, exercise, smoking cessation and medications. Once a patient is diagnosed with heart disease their chances of a cardiac event such as a heart attack goes up exponentially. Coronary Artery Disease (CAD) is a specific disease which falls under the umbrella of cardiovascular diseases.
Atherosclerosis can be simply defined as the build-up of fatty deposits and plaque inside coronary arteries; restricting blood flow which oxygenates the muscles of the heart. As blood flow becomes more and more restricted it may result in symptoms such as chest pain that goes away with rest, shortness of breath, dizziness, nausea or heart palpitations. Ultimately, once the artery becomes occluded the patient will have a heart attack.
Once someone develops coronary artery disease and has symptoms, many patients question whether it is safe to exercise again. In fact, not only is exercise alright for patients in early stages of CAD or stable CAD, but it is encouraged. A 2018 study of over 1700 CAD patients evaluated leisure time physical activity and risk for cardiac death over the course of 2 years. They found that patients who did not engage in physical activity still had 4.9-Fold (95% CI 2.4 To 9.8, P <0.001) chance of cardiac death, while those who at least engaged in physical activity but stopped had 2.4-Fold (95% CI 1.3 To 4.5, P <0.01) risk for cardiac death compared to those who irregularly worked out.
The question then becomes what type of rehabilitative exercise is not only safe for CAD patients but the most effective?
One study compared compared 21 patients on a walking treadmill at high intensity (80-90% Of VO2 Peak) to moderate intensity (50-60% of VO2 Peak) at three times a week for 10 weeks. They found that VO2 peak (Aerobic Capacity) increased by 17.9% in the high intensity group compared to the 7.9% moderate intensity group[2].
Another meta-analysis study using the same end variable of VO2 peak, compared High-Intensity Interval Workouts (HIIT) to Moderate Intensity Continuous Training (MCT). Ten studies with 472 Patients were analyzed. They found that HIIT resulted in increased VO2 Peak more than MCT but the advantages of MCT were that the subjects had increased weight loss and decreased resting heart rate[3].
Although the long term benefits of increase in parameters such as aerobic capacity remains to be seen, the short term benefits provide plenty of reason for an individual to begin a rehabilitative exercise program. The ability to perform daily activities without becoming short of breath or dizzy will dramatically increase the quality of life in a person affected by CAD.
Prior to starting any workout regimen or rehabilitative program, especially in persons with CAD, they should see a Physician to be medically cleared.
#kneereplacement #totaljoint #reconstruction #hip #knee #hipreplacement #rightdevice #mediccaldevice #device #surgery #stress #patient #hospital #doctor #sportsmedicine #aclrepair #mclrepair #acl #healthcare #health #wellness #rotatorcuff #repair #transparency
.
References
Lahtinen, M., Toukola, T., Junttila, M. J., Piira, O., Lepojärvi, S., Kääriäinen, M., . . . Kiviniemi, A. M. (2018). Effect Of Changes In Physical Activity On Risk For Cardiac Death In Patients With Coronary Artery Disease. The American Journal Of Cardiology, 121(2), 143-148.
Doi:10.1016/J.Amjcard.2017.10.002Rognmo, Ø, Hetland, E., Helgerud, J., Hoff, J., & Slørdahl, S. A. (2004). High Intensity Aerobic Interval Exercise Is Superior To Moderate Intensity Exercise For Increasing Aerobic Capacity In Patients With Coronary Artery Disease. European Journal Of Cardiovascular Prevention & Rehabilitation, 11(3), 216-222.
Doi:10.1097/01.Hjr.0000131677.96762.0cLiou, K., Ho, S., & Fildes, J. (2016). High Intensity Interval Versus Moderate Intensity Continuous Training In Patients With Coronary Artery Disease: A Meta-Analysis Of Physiological And Clinical Parameters. Heart Lung Circ., 166-174. Doi:doi: 10.1016/J.Hlc.2015.06.828
#bloggingtips #WixBlog
Spine Surgery Overview
Written by Dwight S. Tyndall, MD, FAAOS
If you’ve struggled with back pain for any length of time, you may be wondering if spine surgery is your only treatment option. Sometimes, surgery is the only treatment. However, there’s good news. The vast majority of back …
Written by Dwight S. Tyndall, MD, FAAOS
If you’ve struggled with back pain for any length of time, you may be wondering if spine surgery is your only treatment option. Sometimes, surgery is the only treatment. However, there’s good news. The vast majority of back problems can be remedied with non-surgical treatments—often referred to as non-surgical or conservative therapies.
Aging, improper body mechanics, trauma and structural abnormalities can injure your spine, leading to back pain and other symptoms such as leg pain and/or numbness or even leg weakness. Chronic back pain is a condition that generally requires a team of health professionals to diagnose and treat. Before resigning yourself to surgery, consider getting opinions from several spine specialists. This investment of time and information-gathering will help you make an informed treatment decision that will best support your lifestyle and desired level of physical activity.
What about conservative treatment?
As with all non-emergency spinal surgeries, a trial of non-operative treatment, such as physical therapy, pain medication—preferably an anti-inflammatory, or bracing should be observed before surgery is considered. The trial period of conservative treatment varies, but six weeks to six months is the general timeframe.
Spine surgery may be recommended if non-surgical treatment such as medications and physical therapy fails to relieve symptoms. Surgery is only considered in cases where the exact source of pain can be determined—such as a herniated disc, scoliosis, or spinal stenosis.
Open surgery vs. minimally invasive surgery
Traditionally, spine surgery is usually performed as open surgery. This entails opening the operative site with a long incision so the surgeon can view and access the spinal anatomy. However, technology has advanced to the point where more spine conditions can be treated with minimally invasive techniques.
Because minimally invasive spine surgery (MISS), does not involve long incisions, open manipulation of the muscles and tissue surrounding the spine is avoided, therefore, leading to shorter operative time. In general, reducing intraoperative (during surgery) manipulation of soft tissues results in less postoperative pain and a faster recovery.
Imaging during spine surgery
Computer-assisted image guidance allows surgeons to view the operative site in far finer clarity than traditional visualization techniques. In addition, implants such as rods or screws can be inserted and positioned with a greater degree of accuracy than is generally achieved with conventional techniques.
In computer-assisted image guidance, images taken preoperatively (before surgery) are merged with images obtained while the patient is in surgery, yielding real-time views of the anatomical position and orientation of the operative site while the patient is undergoing surgery. Preoperative computed tomography (CT) and intraoperative fluoroscopy (real-time x-ray) are generally used, as these enable surgeons to operate with a high level of precision and safety.
Not all patients are appropriate candidates for MISS procedures. There needs to be relative certainty that the same or better results can be achieved through MISS techniques as with an open procedure.
Surgical approaches
Whether open surgery or MISS, the spine can be accessed from different directions. These are referred to as surgical approaches and are explained below:
Anterior approach: As the name implies, the surgeon accesses the spine from the front of your body, through the abdomen.
Posterior approach: An incision is made in your back.
Lateral approach: The pathway to your spine is made through side.
Common surgical procedures
There are a number of conditions that may lead to spine surgery. Common procedures include:
Discectomy or Microdiscectomy: Removal of a herniated intervertebral disc. Therefore, removing pressure from the compressed nerve. Microdiscectomy is a MISS procedure.
Laminectomy: Removal of the thin bony plate on the back of the vertebra called the laminae to increase space within the spinal canal and relieve pressure.
Laminotomy: Removal of a portion of the vertebral arch (lamina) that covers the spinal cord. A laminotomy removes less bone than a laminectomy.
Both laminectomy and laminotomy are decompression procedures. “Decompression” usually means tissue compressing a spinal nerve is removed.
Foraminotomy: Removal of bone or tissue at/in the passageway (called the neuroforamen) where nerve roots branch off the spinal cord and exit the spinal column.
Disc replacement: As an alternative to fusion, the injured disc is replaced with an artificial one.
Spinal fusion: A surgical technique used to join two vertebrae. Spinal fusion may include the use of bone graft with or without instrumentation (eg, rods, screws). There are different types of bone graft, such as your own bone (autograft) and donor bone (allograft).
A fusion can be accomplished by different approaches:
ALIF, PLIF, TLIF, LIF: All pertain to lumbar interbody fusion used to stabilize the spinal vertebrae and eliminate movement between the bones.
Anterior Lumbar Interbody Fusion Posterior Lumbar Interbody Fusion Transforaminal Lumbar Interbody Fusion indicates a surgical approach through the foramen.Lateral Interbody Fusion in which the minimally invasive approach is from the side of the body.
Spinal instrumentation
Examples of spinal instrumentation include plates, bone screws, rods, and interbody devices; although, there are other types of devices your surgeon may recommend in treatment of your spinal disorder. The purpose of instrumentation is to stabilize or fix the spine in position until the fusion solidifies.
An interbody cage is a permanent prosthesis left in place to maintain the foraminal height (eg, space between two vertebral bodies) and decompression following surgery.Interspinous process devices (ISP) reduce the load on the facet joints, restore foraminal height, and provide stability in order to improve the clinical outcome of surgery. An advantage of an ISP is that it requires less exposure to place within the spine and therefore is a MISS procedure.Pedicle screws help to hold the vertebral body in place until the fusion is complete.
Some patients are at-risk for their fusion not to heal properly or completely. Your surgeon may refer to this as a non-fusion, pseudarthrosis or a failed fusion. To help avoid fusion problems, your surgeon may recommend a bone growth stimulation. There are different types of stimulators; those implanted internally and others that are worn about the body area, such as the neck or low back.
Should surgical treatment be your only recourse, it may help to understand that minimally invasive spine surgery offers many benefits. Patients who want to return to work and active play, as well as the elderly or those with major spinal problems, often achieve a higher level of function once symptoms are alleviated.
https://www.spineuniverse.com/treatments/surgery
#kneereplacement #totaljoint #reconstruction #hip #knee #hipreplacement #rightdevice #mediccaldevice #device #surgery #stress #patient #hospital #doctor #sportsmedicine #aclrepair #mclrepair #acl #healthcare #health #wellness #rotatorcuff #repair #transparency #spine
By: Nick Blaylock
In 2011, an article published by Dennis C. Wilder in The Journal of the American Intelligence Professional titled, “An Educated Consumer Is Our Best Consumer” examined the CIA’s 50% approval rating from the general public. Wilder wrote, “although some argue that the IC …
By: Nick Blaylock
In 2011, an article published by Dennis C. Wilder in The Journal of the American Intelligence Professional titled, “An Educated Consumer Is Our Best Consumer” examined the CIA’s 50% approval rating from the general public. Wilder wrote, “although some argue that the IC (Intelligence Community) by its very nature should not have a public profile, that philosophy may be outdated in the Age of New Social Media.1”
He brought forth a valuable point—consumers who are kept in the dark are left to their own devices in explaining the world around them. Wilder’s article is a call for increased transparency in this Digital Age. Transparency that seeks to lessen the void of knowledge that exists between organizations and their consumers. Like the CIA, the level of transparency in the healthcare industry is less than ideal and consumers are becoming more and more skeptical about it.
Before you discount such an idea, consider these results of a 2017 Gallup Poll:
16% of Americans believe the state of our Healthcare system is in crisis and 55% believe there are major problems2. Now, can we really explain in an article whether or not these Americans are correct in their assumptions? No. The point is that the perception is that the only way to find out for sure is through increased transparency. What will that process look like? It will be long and arduous as the Healthcare industry is massive, complicated, and hosts several departments within. We do, however, have to start somewhere.
Why RightDevice?
RightDevice was established for that very reason. As of now, 94% of patients with medical device implants do not know what device is inside their body. Think about that for a moment—you have a device inside of you, and you do not know who manufactured It! You took your doctor’s word. Now, this is not to say by any means that you should not take your doctor’s word. Nothing can replace the advice of your doctor, but why not approach a life-changing decision with as much information as you can?
Medical research can be intimidating, there are lots of long Latin words and sometimes over exaggerations. We have purposely designed our website to mitigate some of that intimidation and enable patients to head into surgery feeling as confident and knowledgeable as possible.
Through increased patient awareness, there will be less opportunity for ambiguity in the healthcare industry.
#totaljoint #reconstruction #hip #knee #hipreplacement #rightdevice #mediccaldevice #device #surgery #stress #patient #hospital #doctor #sportsmedicine #aclrepair #mclrepair #acl #healthcare #health #wellness #rotatorcuff #repair #transparency #kneereplacement
References
The Importance of Shared Decision Making
Written By: Daniel Kao, AGACNP-BC
What Is Shared Decision Making?
Although many patients may not have heard the term Shared Decision Making (SDM), it is a model that has been around since 1951, and one may participate in without even knowing it. …
The Importance of Shared Decision Making
Written By: Daniel Kao, AGACNP-BC
What Is Shared Decision Making?
Although many patients may not have heard the term Shared Decision Making (SDM), it is a model that has been around since 1951, and one may participate in without even knowing it. Shared Decision Making involves a conversation between healthcare providers and patients to determine goals of care, treatment options, patient preferences, values and expectations of both the provider and patient; a cornerstone of patient centered care. Surprisingly, it wasn’t until recently that doctors would consider a patient’s opinion in their treatment course. The first formal study to evaluate whether an equitable doctor-patient relationship is beneficial was in 1959. The study found that “modern” doctors who were more accepting of an active role from the patient found that they were more likely to include new innovations in therapy for their patients. “The patient should have the freedom and chance to say what he thinks about a certain therapeutic Approach.” The words shared decision making didn’t enter into the healthcare field until 1982, when a president’s commission for the study of ethical problems in medicine recommended that physicians need to involve patients into their own care2.
Barriers to Shared Decision Making
Despite how natural it may seem for a shared decision making model to exist, there are many barriers that exist where this model may not be implemented in a clinical practice. One of the more serious mindsets that exist is the myth that “not everyone wants shared decision making.” A 2018 study performed where the use of SDM was implemented in the Emergency Department (ED) found that all patients surveyed wanted at least some degree of involvement in medical decisions made3. Another systematic review which looked at 5 studies regarding the use of SDM in the ED found that patients would benefit from decision making involvement and that there is no reason not to implement SDM into clinical practice4. Another barrier that may persist is that the provider may feel like they are already engaging in SDM. A 2013 systematic review of 33 studies found that many places had very little patient involvement practices (OPTION Score 23+/- 14 On 0-100 Scale). Those that did have higher SDM efficacy implemented SDM and longer time spent with patients5. Although providers may not be actively disengaging from SDM, and in fact do participate but it may be that they do not engage patients enough.
Efficacy Of Shared Decision Making
Despite how good SDM may sound in theory is there quantitative evidence showing the advantages of SDM? A literature review of nine articles that studied the Quality of Life (QoL) in patients with low risk prostate cancer with SDM, demonstrated a positive and significant correlation between QoL and SDM7. Patients that had a good relationship with their providers felt a higher Quality of Life in various aspects such as self-efficacy, decisional control and knowledge. Another study looked at 86 studies involving over 20,000 participants to evaluate how decision aids helped patients make treatment decisions. It found that patients became more decisive, found decisions that reflected their own values, and increased their knowledge base8.
Conclusion
The more empowered a patient is, the more effective the shared decision making model can be. It can only help the patient when they are engaged and given the tools to learn more about their conditions and the options they have. The initial steps in helping the patient rests with the provider. As the one who has the expertise, it is up to the provider to help make the confusing medical world understandable. Although the physician may need to be more proactive in initiating SDM, there needs to be an active role by the patient to participate as well. If the patient is willing to tell the provider their wishes, the provider can help tailor medical treatment that is best for the patient. Right Device seeks to empower the patient through education;
Visit Www.Rightdevice.Com to find out what surgical implant options are right for you.
#totaljoint #reconstruction #hip #knee #hipreplacement #rightdevice #mediccaldevice #device #surgery #stress #patient #hospital #doctor #sportsmedicine #aclrepair #mclrepair #acl #healthcare #health #wellness #rotatorcuff #repair #transparency #kneereplacement
References
Why Do Knee Replacements Fail?
Writter By: Rightdevice Team
Five Reasons Why Knee Replacements Fail
While most knee replacements will function well for years, patients should be aware of the signs of failure—including increased pain or decreased function—that may require a corrective …
Why Do Knee Replacements Fail?
Writter By: Rightdevice Team
Five Reasons Why Knee Replacements Fail
While most knee replacements will function well for years, patients should be aware of the signs of failure—including increased pain or decreased function—that may require a corrective procedure known as revision total knee replacement, if necessary.
"A failed knee implant is usually caused by wear and tear with subsequent loosening of the implant. Other causes are infection, instability, fracture, or stiffness," says Dr. Amar Ranawat, a hip and knee specialist in the Adult Reconstruction and Joint Replacement Division of Hospital for Special Surgery in New York City.
Each year, more than 300 patients elect to receive revision knee surgery at Hospital for Special Surgery, despite the fact that their original surgery was performed elsewhere.
The most common symptoms of a failed knee implant are pain, instability, swelling and stiffness across the entire knee (generalized) or in a small section (localized).
Although knee replacements normally perform well for at least 15-20 years in more than 95 percent of patients, Dr. Ranawat says there are five primary reasons why a knee implant fails:
Wear and loosening: Friction caused by joint surfaces rubbing against each other wears away the surface of the implant causing bone loss and loosening of the implants.Infection: Large metal and plastic implants can serve as a surface onto which bacteria can latch.Fracture: Fractures around the knee implant that disrupt its stability may require revision surgery.Instability: A sensation of the knee "giving away" may mean that the soft-tissue surrounding the knee is too weak to support standing and walking. Improperly placed implants may also cause instability.Stiffness: Loss of range of motion which causes pain and a functional deficit.
Revision total knee replacement is a complex procedure that requires extensive pre-operative planning, specialized implants and tools, prolonged operating times and mastery of difficult surgical techniques. It usually takes longer to perform than the original knee replacement, says Dr. Ranawat, and is composed of the following stages:
Pre-surgery: Preparation includes X-rays, laboratory tests, knee aspiration and in some cases additional assessments, such as bone scans, CT scans or magnetic resonance imaging (MRI).Surgery: The implant is removed and bone grafts may be used to fill larger areas of bone loss. In some cases, metal wedges, wires or screws may be used to strengthen the bone. Finally, specialized revision knee implants are inserted.Post-operative care: This is very similar to the care of the original knee replacement. Dr. Ranawat's prescription includes a combination of physical therapy, blood management and pain medication. A brace or splint may be used to protect the joint after the surgery.
Dr. Ranawat says that more than 80 percent of patients who undergo revision knee surgery can expect to have good to excellent results. However, he cautions that complete function is not restored for all patients and “up to 20 percent of patients may still experience pain following surgery for months or even years."
With the right tools at hand, revision total knee replacements can deliver the best outcomes possible. A center devoted to bone, joint, muscle and tendon conditions, like Hospital for Special Surgery, has the surgical expertise and resources necessary to deliver the best prognoses and to promise the best outcomes possible for this complex—but necessary—procedure.
Hospital for Special Surgery performs more knee replacements and more hip surgeries than any other hospital in the nation. Visit our Revision Total Knee Replacement page for more information.
About Hospital for Special Surgery
Hospital for Special Surgery (HSS) is the world’s leading academic medical center focused on musculoskeletal health. HSS is nationally ranked No. 1 in orthopedics and No. 3 in rheumatology by U.S. News & World Report (2017-2018), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. HSS has one of the lowest infection rates in the country. HSS is an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. HSS has locations in New York, New Jersey and Connecticut.
#kneereplacement #totaljoint #reconstruction #hip #knee #hipreplacement #rightdevice #mediccaldevice #device #surgery #stress #patient #hospital #doctor #sportsmedicine #aclrepair #mclrepair #acl #healthcare #health #wellness #rotatorcuff #repair #transparency #totaljoint #reconstruction #hip #knee #hipreplacement #rightdevice #mediccaldevice #device #surgery #stress #patient #hospital #doctor #sportsmedicine #aclrepair #mclrepair #acl #healthcare #health #wellness #rotatorcuff #repair #tranperancy
https://www.hss.edu/newsroom_five-reasons-why-knee-replacements-fail.asp
Hip replacement is one of the most performed surgeries today. In addition to the increase that is expected in the coming years, specialists increasingly serve patients between 45 and 65 years, among whom hip problems can have a great influence on their sex life.
Hip replacement surgery reduces …
Hip replacement is one of the most performed surgeries today. In addition to the increase that is expected in the coming years, specialists increasingly serve patients between 45 and 65 years, among whom hip problems can have a great influence on their sex life.
Hip replacement surgery reduces pain and improves mobility in patients who have suffered arthritis/osteoarthritis for many years. This facilitates many activities of daily living, including sex.
Improvement Indicators
According to various studies published by the American Academy of Orthopedic Surgeons (AAOS), before hip surgery, 60% of patients have problems in sexual activity (pain, stiffness, limitation with certain postures ...). However, after surgery, more than 80% of patients experience considerable improvements in their sex life, libido, and self-esteem.
Recovery Tips
After the hip surgery, there is a recovery time in which you must progressively and unhurriedly explore the limits of your comfort. Most surgeons recommend waiting for a period of six weeks to restart sexual activity. However, this will depend on the type of surgery, the patient's age, the involvement of other joints and other variables.
It is important to mention that the risk of dislocation is greater during the first three months, so in that period, postures that require hip flexion above 90º should be avoided. Also, make sure that during sex the knee on the affected side does not rise above the level of the hip and does not cross beyond the midpoint of your body (the navel).
It is also very important the intervention of the physiotherapist who can inform about the deadlines and the safest way to have sex.
Once past what experts call 'safety period', most patients manage to flex the hip up to 120 ° and even the youngest patients are urged to force until they reach the mobility of the opposite hip or a normal hip, being able to bring the legs almost to touch with the chest.
Despite the concern that it generates in patients, sexuality is not always an issue that is dealt with in-depth in Trauma/pre-op consultations. It is very important to have confidence in your doctor and ask the necessary questions, because the positions and roles of each member of the couple can be altered while the patient regains confidence.
Below are some examples of positions that surgeons recommend and do not recommend after hip surgery.
In today’s world consumers are becoming more knowledgeable about their purchasing decisions and are demanding more information before they are willing to commit to buying just about anything. This is completely understandable given the immense amount of information that we have to process every …
In today’s world consumers are becoming more knowledgeable about their purchasing decisions and are demanding more information before they are willing to commit to buying just about anything. This is completely understandable given the immense amount of information that we have to process every day. Why wouldn’t someone want all the information available before making a purchase?
This concept only magnifies when the purchase becomes larger and more expensive, for example when buying a home or a car. People will do hours upon hours of research: what’s the neighborhood, school district, does it have a yard; or what’s the horsepower, does it come with leather, how big is the trunk, etc...
Imagine if the questions were; Will I be able to walk again? Will I have to have another surgery? How long will I not be able to work? When you put it that way, what's more important, your health or your car? This leads to the biggest question…… Why has this NOT happened in the healthcare industry?
Patients show up to hospitals only having limited information about their health problems, and know even less on the options they have for solutions. We find this so backwards, being in good health is vital to a long and happy life. We believe patients deserve all the information possible to help them make their healthcare decisions.
This is this our mission at rightdevice. We are here to bring information and transparency into an industry that desperately needs it. rightdevice is a platform built for patients to research medical devices for their upcoming surgery. We understand that surgical information is complex, so we have made it easy to use, unbiased, and simplified the information, so patients of all backgrounds can be informed on their healthcare decisions.
Having any surgical intervention is a life-altering experience and can be daunting and scary which leads to patients feeling unsure, unprepared and full of anxiety and stress.
I think we can all agree that this unacceptable. The worst part is today’s current solution is so far from this concept. Which is exactly why we felt the need to fix it.
Rightdevice was started out of the simple idea that patients have a choice. With one half of the founding team coming from the medical device industry and the other coming from the world of platforms that we are familiar with today. Coming directly from the medical device industry we saw that patients were getting the cheapest and sometimes the incorrect products for their operations. If patients were given a choice, the product they received wouldn’t even be considered an option. So why does this happen? Hospitals trying to drive costs down, pushing constant demand for higher profits.
n laymans terms, imagine your car is needing a new tire, your old one has been worn down with no tread so you head to your local tire shop. You pay full price for a brand new tire that should last you 10’s of thousands of miles, but when the car rolls out of the shop they put spare tires on all your wheels. I know this analogy sounds funny, but it’s clear that it is a bad deal, and a situation no one would ever want to be in. This happens every day in the healthcare industry with no end in sight unless patients exercise their voice.
But, the best solution to combat this problem is patient education and empowerment. Patients need to realize they are the buyers in all healthcare decisions and have every right to ask questions, demand more information, and seek the best care possible. We are here to create a community of empowered patients, trusted professionals, and (starting one surgery at a time) changing patient outcomes.
Welcome to our community.
Welcome to rightdevice.
By Adam Felman
This article was originally published on July 31, 2017 on MedicalNewsToday
The word "health" refers to a state of complete emotional and physical well-being. Healthcare exists to help people maintain this optimal state of health.
In 2015, the population of the United …
By Adam Felman
This article was originally published on July 31, 2017 on MedicalNewsToday
The word "health" refers to a state of complete emotional and physical well-being. Healthcare exists to help people maintain this optimal state of health.
In 2015, the population of the United States (U.S.) spent an estimated $3.2 trillion on healthcare costs.
However, despite this expenditure, a study by the U.S. National Research Council, pu on healthcare costs.However, despite this expenditure, a study by the U.S. National Research Council, published in 2013, showed that Americans die at a younger age and experience more illness and injury than people in other developed countries.ed that Americans die at a younger age and experience more illness and injury than people in other developed countries.
Good health is central to handling stress and living a long and active life.
What is health?
ShareHealth is not just absence of disease but a state of overall wellbeing.
In 1948, the World Health Organization (WHO) defined health with a phrase that is still used today.
"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." WHO, 1948.
In 1986, the WHO further clarified that health is:
"A resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities."
This means that health is a resource to support an individual's function in wider society. A healthful lifestyle provides the means to lead a full life.
More recently, researchers have defined health as the ability of a body to adapt to new threats and infirmities. They base this on the idea that modern science has dramatically increased human awareness of diseases and how they work in the last few decades.
Types
Mental and physical health are the two most commonly discussed types of health. We also talk about "spiritual health," "emotional health," and "financial health," among others. These have also been linked to lower stress levels and mental and physical wellbeing.
Physical health
In a person who experiences physical health, bodily functions are working at peak performance, due not only to a lack of disease, but also to regular exercise, balanced nutrition, and adequate rest. We receive treatment, when necessary, to maintain the balance.
Physical wellbeing involves pursuing a healthful lifestyle to decrease the risk of disease. Maintaining physical fitness, for example, can protect and develop the endurance of a person's breathing and heart function, muscular strength, flexibility, and body composition.
Physical health and well-being also help reduce the risk of an injury or health issue. Examples include minimizing hazards in the workplace, practicing safe sex, practicing good hygiene, or avoiding the use of tobacco, alcohol, or illegal drugs.
Mental health
Mental health refers to a person's emotional, social, and psychological wellbeing. Mental health is as important as physical health to a full, active lifestyle.
It is harder to define mental health than physical health, because, in many cases, diagnosis depends on the individual's perception of their experience. With improvements in testing, however, some signs of some types of mental illness are now becoming "visible" in CT scans and genetic testing.
Mental health is not only the absence of depression, anxiety, or another disorder.
It also depends on the ability to:
-enjoy life
-bounce back after difficult experiences
-achieve balance
-adapt to adversity
-feel safe and secure
-achieve your potential
Physical and mental health are linked. If chronic illness affects a person's ability to complete their regular tasks, this may lead to depression and stress, for example, due to money problems.
A mental illness such as depression or anorexia nervosa can affect body weight and function.
It is important to approach "health" as a whole, rather than its different types.
Factors for good health
Health depends on a wide range of factors.
A person is born with a range of genes, and in some people, an unusual genetic pattern can lead to a less-than-optimum level of health.
Environmental factors play a role. Sometimes the environment alone is enough to impact health. Other times, an environmental trigger can cause illness in a person who is genetically susceptible.
Access to healthcare plays a role, but the WHO suggests that the following factors may have a bigger impact on health than this:
-where a person lives
-the state of the surrounding environment
-genetics
-income
-education level
-relationships with friends and family
These can be summarized as:
The social and economic environment: Including how wealthy a family or community is
The physical environment: Including parasites that exist in an area, or pollution levels
The person's characteristics and behaviors: Including the genes that a person is born with and their lifestyle choices
According to the WHO, the higher a person's socioeconomic status (SES), the more likely they are to enjoy good health, a good education, a well-paid job, afford good healthcare when their health is threatened.
People with a lower socioeconomic status are more likely to experience stresses related to daily living, such as financial difficulties, marital disruption, and unemployment, as well as social factors, such as marginalization and discrimination. All these add to the risk of poor health.
A low socio-economic status often means less access to healthcare. People in developed countries with universal healthcare services have longer life expectancies than people in developed countries without universal healthcare.
Cultural issues can affect health. The traditions and customs of a society and a family's response to them can have a good or bad impact on health. For example, around the Mediterranean, people are more likely to consume high levels of fruits, vegetables, and olive, and to eat as a family, compared with cultures with a high consumption of fast food.
How a person manages stress will affect health. People who smoke, drink, or take drugs to forget their problems are likely to have more health problems later than someone who combats stress through a healthful diet and exercise.
Men and women are prone to different health factors. In societies where women earn less than men or are less educated, they may be at greater risk than men for poor health.
Preserving health
The best way to maintain health is to preserve it through a healthful lifestyle, rather than waiting until we are sick to put things right.
This state of enhanced well-being is referred to as wellness.
The McKinley Health Center at the University of Illinois IL defines wellness as:
"A state of optimal well-being that is oriented toward maximizing an individual's potential. This is a life-long process of moving towards enhancing your physical, intellectual, emotional, social, spiritual, and environmental well-being."
Wellness promotes an active awareness of and participation in health, as an individual and in the community.
Maintaining wellness and optimal health is a lifelong, daily commitment.
Steps that can help us maximize our health include:
-a balanced, nutritious diet, sourced as naturally as possible
- regular exercise
- screening for diseases that may present a risk
- learning to manage stress
- engaging in activities that provide purpose and connection to others
- maintaining a positive outlook and appreciating what you have
- defining a value system, and putting it into action
Peak health will be different for each person, and how you achieve wellness may be different from how someone else does.
It may not be possible to avoid disease completely, but doing as much as we can to develop resilience and prepare the body and mind to deal with problems as they arise is a step we can all take.
Updated: Sep 10
Is your child or a friend's child having Orthopedic/Spinal surgery?
This week we have Ameeka George, MS, CPNP from Columbia University Medical Center/Children's Hospital of New York's Pediatric Orthopedic Surgery Dept answering your questions!
Submit your questions in …
Updated: Sep 10
Is your child or a friend's child having Orthopedic/Spinal surgery?
This week we have Ameeka George, MS, CPNP from Columbia University Medical Center/Children's Hospital of New York's Pediatric Orthopedic Surgery Dept answering your questions!
Submit your questions in the comment box below or e-mail us at info@rightdevice.com to have them answered in a special blog post next week!
Reviewed by: Daniel Kao, AGACNP-BC
Joint replacement is a surgical procedure in which you supplant the joint injured by a prosthesis. This type of intervention can relieve the patient's pain and help him move more easily, feel better and recover his quality of life. The hips and knees are the …
Reviewed by: Daniel Kao, AGACNP-BC
Joint replacement is a surgical procedure in which you supplant the joint injured by a prosthesis. This type of intervention can relieve the patient's pain and help him move more easily, feel better and recover his quality of life. The hips and knees are the joints that are most frequently replaced, but can also be done on shoulders, ankles, and elbows.
This type of operation is becoming more common. According to estimates by the United States Institutes of Health (NIH), more than one million people undergo hip or knee replacement surgery in that country each year. Research has shown that this procedure can help even elderly patients recover mobility and feel better.
Here are some of the questions you should ask your surgeon for your surgery (we have provided some general answers, but your case may differ slightly):
1. How to know if I need joint replacement surgery?
Through a physical examination and appropriate x-rays, the doctor will determine if you are a candidate for this type of surgery. In general, when joint pain is intense, constant, it limits walking or other daily activities and is not relieved with medications and general measures, the best option for the patient is surgery.
2. What does the surgery consist of?
The operation consists in replacing the damaged parts of the joint with two metal or ceramic components that are fixed to the patient's bone with cement loaded with antibiotics. Among them, a high-density polyethylene is placed that gives congruence to the components, favors sliding and allows the physiological absorption and distribution of loads.
Although the prosthesis can also be fixed by using some ultra-porous metals such as tantalum, studies suggest that the best fixation and the best results are obtained with cementation. The cementing technique is always essential to achieve a good long-term result. This also has the advantage of adding cement loaded with antibiotics, in what is known as the double antibiotic prophylaxis (intravenous antibiotics and local antibiotics in the cement) which has been shown to reduce infection rates.
The components of the prosthesis are usually chromocobalt, titanium or other materials such as oxinium that is both hard as metal and low friction as ceramic. In patients allergic to metals, hypoallergenic or titanized prostheses are used.
See videos of a hip and knee replacement below!
Knee replacement
Hip replacement
3. What anesthesia is used for hip or knee joint replacement surgery and how will postoperative pain be relieved?
Generally, the anesthesiologist performs a regional block through a catheter placed in the back in combination with sedatives through an IV, so that the patient will not experience any pain during surgery.
An anesthesiologist will speak with you prior to surgery to determine which type of anesthesia will be best for you.
In the postoperative period, a combination of oral and IV pain medications will be available to help control the pain. Oral pain regimens consist of an anti-inflammatory, acetaminophen as well as an opiate if needed. Upon discharge you will receive a prescription for a short course of pain medications like ones you may have received in the hospital.
4. How long is a hip or knee joint replacement surgery and how will my surgical wound be?
The operation to replace hip or knee lasts approximately 90 minutes. The intervention is performed through an incision in the lateral part of the hip of about 10 cm. and in the case of the knee in the anterior part of it of approximately 12 cm. stitches or staples are removed after approximately 14 days.
5. How long will my new joint last?
Prostheses placed during joint replacement surgery have a life expectancy based on their materials. However, this may vary according to the patient's age, weight, daily activity and co-morbidities. Like any medical device, joint prostheses are prone to wear, which could lead to mechanical failure. In order to prolong the functionality of the prosthesis, the patient should follow the surgeon's recommendations after surgery.
6. What are the major risks?
All surgical interventions have their benefits and risks, joint replacements are major surgical procedures and can, therefore, present complications in some patients. Some complications that may arise may be:
Infection of the wound, dislocation of the components, blood clots in the legs or lungs (deep vein thrombosis or pulmonary embolism) among others. To avoid these complications, you may receive post-operative antibiotics and may be prescribed a blood thinner for a short time.
7. What care should I take after a hip or knee joint replacement surgery?
Although each case is different, in general the care is as follows:
-Use of dynamic compression stockings on both legs for three weeks
-Wound care as instructed by your surgeon
-Maintain a healthy diet
-Taking medications prescribed by the doctor and as instructed
-Follow range of motion precautions instructed by your surgeon and physical therapist
-Perform exercises prescribed by the doctor and physical therapist
-Avoid high impact or high-risk fall activities
-Go to your appointments after surgery
Have additional questions? Sign up today to speak with a device expert or another patient about their experience!
Written by: George Kramb
The medical device industry has experienced a boom in recent years, this has gone hand in hand with the development of state-of-the-art devices that provide greater benefits to patients.
Medical devices are instruments and implements used in the diagnosis or …
Written by: George Kramb
The medical device industry has experienced a boom in recent years, this has gone hand in hand with the development of state-of-the-art devices that provide greater benefits to patients.
Medical devices are instruments and implements used in the diagnosis or treatment of various pathologies; Medical devices can be simple, such as bandages and crutches, or complex, such as prostheses and pacemakers. The overwhelming diversity of brands and medical devices that currently exist in the market makes it impossible for doctors to know all these devices, how it works, its benefits and how to implant them during surgery. This is where medical devices reps play a crucial role.
Medical Device Reps Keep Your Surgeon Up-to-Date
The main function of the reps is to keep health professionals up to date with regard to the new medical devices available in the market and the benefits they can bring to their patients with respect to the older versions. Reps must have basic knowledge in the area of expertise of each of the doctors they visit so that they can offer the right products for each doctor.
In addition to supplying the medical devices that hospitals request, sales representatives also ensure that surgical teams know how to precisely handle medical devices and their components.
Sales representatives are highly trained in the handling and operation of medical devices, in fact, some companies train them as if they had to perform the surgery themselves. At an educational center in Colorado, future representatives learn how to cut a hip bone and implant an artificial hip.
Medical Device Reps Help Surgeons in the OR
Reps often have more knowledge about medical devices than the surgeons who use it, which is why they have become a great support for the medical team during surgery. Therefore, the presence of reps in the operating room has become increasingly frequent in recent years.
Hospital managers have allowed representatives of medical device companies to actively participate in the logistics, instrumentation, and training of surgical staff in the management of medical devices, as well as collaborate in solving intra-operative problems related to placement or manipulation of the devices to be implanted.
Reps have a unique experience and vision, as they literally observe and participate in procedures dozens of times a week, even some may have witnessed more surgeries with a particular device than many surgeons. This experience is very useful, and they often end up rescuing surgeons from difficult situations during complex surgeries such as vertebral fusions or complete joint replacements.
What Rules do a Medical Device Rep Follow?
While medical devices reps provide great collaboration to surgeons, there are certain rules that they must follow when they are in the operating room. First of all, reps cannot touch the patient or anything that is sterile, and furthermore, the promotion or sale in the operating room is prohibited.
Reps Make Sure Your Surgery Runs Smoothly- From Start to Finish
Logistics is another great part of the reps' work, delivering the instruments in the hours before dawn for the hospital to sterilize them, keeping the tools and components of the device in the right place, etc.
The logistic role has been played essentially by manufacturers instead of hospitals in recent decades. Therefore, surgeons currently rely on reps more than anyone else in the room. Often reps are the first people that surgeons call when they schedule surgery, to make sure everything is in order with respect to the device to be used.
How do Medical Device Reps Help Patients?
Reps also play a leading role in the marketing of medical devices. Therefore, they are in constant contact with patients who may potentially need their devices, answer any questions they may have and keep them informed of any discounts or promotions offered by the manufacturers of the product. In addition, after placing the device, the representatives usually establish a follow-up of the patients to evaluate the performance of the equipment and the satisfaction of the client.
In summary, the representatives help both surgeons and patients by providing useful information and training regarding medical devices. Its presence in the operating room helps to ensure that doctors use the devices correctly and can reduce the amount of time required for surgical procedures, thus improving subsequent results and patient safety.
Ameeka George, MS, CPNP is a board certified Pediatric Nurse Practitioner specializing in Pediatric Orthopedic-Spine Surgery, with an emphasis on Cerebral Palsy, Scoliosis and autism.
Last week we had her take user submissions to answer questions about Pediatric Ortho-Spine Surgery! Here were …
Ameeka George, MS, CPNP is a board certified Pediatric Nurse Practitioner specializing in Pediatric Orthopedic-Spine Surgery, with an emphasis on Cerebral Palsy, Scoliosis and autism.
Last week we had her take user submissions to answer questions about Pediatric Ortho-Spine Surgery! Here were the top 3
Surgery for scoliosis is called a posterior spinal instrumentation and fusion (PSIF). During surgery, the patient lies on their stomach and the surgery is done from the back. There are lots of specialists in the room including nurses, anesthesia, neuro-monitoring specialists, and of course your orthopedic surgeon! These are just to name a few ☺ Time of surgery is variable, but for idiopathic scoliosis in otherwise healthy kids it’s about 5-6 hours in the room including set up time for anesthesia. Kids are usually in the hospital for 3-5 days on average.
Your child will have pain after surgery, but it is well managed during their hospital stay using multimodal techniques. This varies by hospital, but on average, narcotics are used initially for severe pain via patient controlled analgesia (PCA), but this is supplemented with IV Tylenol and/or Motrin, massage, ice, music/light therapy, and distraction techniques. The goal is to safely manage your child’s pain wherever they are! You will also be discharged with medication for pain and constipation to manage postoperative symptoms as the first week home is usually the hardest. You’ll be supported every step of the way.
Scarring is a concern for many patients! This depends on the type of surgery, but for spine surgery the incision is about the thickness of a pencil line. Very thin! Initially, the important part is keeping the incision out of direct sunlight so wearing something like a rash guard when outside can be helpful and of course applying sunscreen often. Many people like to use special scar creams like Mederma, however we have found that just something as simple as cocoa butter with Vitamin E can be super helpful! The important part is really rubbing it into the scar, not necessarily the amount applied
Let’s face it. There is just not enough time in a doctors day to spend with patients. Today the average amount of time a doctor spends with a patient is 7min. That is 7min to get all the information you need about your upcoming surgery. Quite frankly it is just not enough. Think about how many …
Let’s face it. There is just not enough time in a doctors day to spend with patients. Today the average amount of time a doctor spends with a patient is 7min. That is 7min to get all the information you need about your upcoming surgery. Quite frankly it is just not enough. Think about how many questions you have every time you leave the hospital that go unanswered. You are left to your own devices to figure out how to prepare for your surgery and what it means for your life afterwards. Rightdevice is here to change that. We listened to our members and are happy to announce the launch of our pre-op prep consultation program!
At no cost we are providing patients with an opportunity to get answers to the questions they have, spend time learning more about their surgery and their options, and get what they need to feel prepared going into their next conversation with their doctor. All with a board certified Nurse Practitioner and licensed Medical Device Rep.
WE KNOW HOW YOU FEEL AND WE ARE HERE TO HELP.
Schedule a pre-op consultation now and start learning more about your options with rightdevice!
Arthroplasty is another name for knee replacement surgery. This surgery is meant to replace a worn out, diseased, or a damaged knee. An artificial joint is used as a replacement to help reduce joint pain and help return the patient back to normal, daily living [1].
Adults ranging from 60 to …
Arthroplasty is another name for knee replacement surgery. This surgery is meant to replace a worn out, diseased, or a damaged knee. An artificial joint is used as a replacement to help reduce joint pain and help return the patient back to normal, daily living [1].
Adults ranging from 60 to 80 years old consider this surgery and require it when the pain becomes unbearable or it beings to interfere with daily life. Some patients may be eligible for a partial knee replacement, which may be performed on people between 55 and 64.
What are the leading causes of needing knee replacement surgery?
There are a few reasons a damaged knee is replaced. One of the most common reasons is osteoarthritis [2].
Osteoarthritis:
This is one of the types of arthritis where the cartilage gets worn out. This cartilage is present on the gliding surface of the knee and gets stiff as well. Due to the stiffness and damaged cartilage, pain occurs. Not just that, but the wear and tear of cartilage leads to tension between the bones. They rub against each other, leading to less mobility and increased chronic pain. People who are 50 or older are more susceptible.
Photo courtesy of Lynx Healthcare
Rheumatoid arthritis:
Another type of arthritis is rheumatoid arthritis, which is an autoimmune disease [3]. Here, the synovial membrane is attacked by the body’s immune system, causing severe damage to the membrane. Articular cartilage also gets affected in return and this damages the membrane and cartilage leading to the surgery.
Photo courtesy of Mayo Clinic
Traumatic arthritis:
Any critical knee injuries like ligament damage, meniscus tear, or fracture can lead to traumatic arthritis. As the name suggests, the pain and damage are caused by mini trauma due to the sudden impact of the accident. This trauma affects articular cartilage and osteoarthritis takes place. When this happens, the knee joint becomes stiff causing severe knee pain.
Additional causes:
Other causes for a knee replacement can be gout, unusual bone growth, death of bone structure, and the loss of cartilage. People are advised to consult their Primary Care Physician or Surgeon to see if they are candidates for surgical intervention.
Have more questions about your upcoming knee replacement? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
References
"Knee Replacement Surgery - WebMD." 22 Apr. 2019, https://www.webmd.com/osteoarthritis/guide/knee-replacement-surgery. Accessed 4 Dec. 2019.
"Osteoarthritis - Symptoms and causes - Mayo Clinic." 8 May. 2019, https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925. Accessed 4 Dec. 2019.
"What is Rheumatoid Arthritis? - Arthritis Foundation." https://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-arthritis.php. Accessed 4 Dec. 2019.
The Morning of Surgery
Undergoing surgery is a very stressful situation, with all the unknowns and anxiety, especially if it is your first time. But the hospital staff are available to try to make things easier for you.
When you arrive at the hospital, your personal data will be requested, …
The Morning of Surgery
Undergoing surgery is a very stressful situation, with all the unknowns and anxiety, especially if it is your first time. But the hospital staff are available to try to make things easier for you.
When you arrive at the hospital, your personal data will be requested, to ensure you are the correct patient, and you will be asked to change your clothes for a surgical gown. Also, a member of the medical team will explain the steps to follow and verify that you are fasting to give the green light to the surgery. Fasting is an important step to make sure your stomach is empty, so if there is vomiting it will not enter the lungs. Your surgeon and anesthesiologist will also see you prior to surgery for any last minute questions.
What happens next?
The surgical team is made up of 3 subgroups that work together. These groups are made up of anesthesiologists, surgeons and nurses. The team will work like gears to give you the best possible care.
When everything is ready for surgery, you will receive anesthesia. Upon arrival at the anesthesia room, you will be connected to the monitoring team and will measure your pulse and blood pressure readings. Subsequently, you will have venous access, so that the anesthesiologist can administer the medications. This is the point where you can be asked to start counting slowly from ten, you won't even reach seven.
Will I be aware of what's happening?
If your operation requires general anesthesia, you will remain in an unconscious state during the entire process. You will not have pain or any other sensation. While you remain in this state, the anesthesiologist will control your vital signs at all times, so you will be under rigorous and thorough surveillance throughout the process.
Keep in mind that there are different levels of sedation. The level of sedation reflects the patient's ability to feel and respond to pain and oral instructions. Before reaching the state of deep sedation, you will go through lower levels of sedation in which you will be able to breathe on your own without help and you will even be able to answer the doctors' questions. Once you have reached deep sedation, you will be connected to a mechanical ventilation machine to ensure your breathing. Remember that this type of anesthesia aims to relieve pain during the surgical procedure and reduce discomfort during surgery.
Who else is with the surgeon?
While the anesthesia team monitors your vital signs, the surgical team performs the surgery. The surgeon will have at least one assistant, in cases of complex surgeries such as the removal of a head/neck tumor there may be up to 3 surgeons and 7 assistants.
The nurses will be responsible for providing the surgeon and surgical assistants with the instruments you need. In addition, they keep the accounting of all the material used to ensure that you do not leave the operating room with unwanted extras.
Once the surgery is completed, the surgical team will close your wounds. The anesthesia will be reversed and you will be taken to the recovery room. There you will be attended to until you are ready to be discharged. In this room there will be a monitoring of your surgical wound, vitals, and you will also receive drugs to reduce pain.
Once you are awake and comfortable, you will be taken back to the room where your family members are waiting for you, and you can start with a light diet. Depending on the surgery performed and your clinical evolution, you may go home the same day.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
You may have heard of professional athletes suffering from a knee injury called ACL tear, or have known someone to have suffered from a ACL injury. But what is the ACL, how does it get injured, and what are some treatment options?
What is Anterior Cruciate Ligament?
The anterior cruciate …
You may have heard of professional athletes suffering from a knee injury called ACL tear, or have known someone to have suffered from a ACL injury. But what is the ACL, how does it get injured, and what are some treatment options?
What is Anterior Cruciate Ligament?
The anterior cruciate ligament (ACL) is one of the knee ligaments that help stabilize the knee joint. The ACL connects thighbone (femur) to shinbone (tibia).
Anatomy of the Anterior Cruciate Ligament
How Does ACL Tear Happen?
The anterior cruciate ligament is the foremost commonly disrupted ligament of the knee. This can occur when athletes stop, slow down, or change directions suddenly while they’re running and while landing incorrectly or flat-footed from a jump. ACL may also be torn when the knee is hyper-extended. Athletes who participate in sports such as soccer, football, tennis, netball, basketball or volleyball, snow skiing, high jumping or who do gymnastics are more likely to twist their knees by mistake which cause ACL Tear.
ACL tear mechanism
What are the signs and symptoms of ACL Tear?
More common signs and symptoms of an ACL Tear include:
A loud "pop" or a "popping" sound or sensation within the knee
Severe pain and inability to proceed activity and feeling discomfort while walking
Rapid swelling
Decreased range of motion
Instability with weight bearing
Is your sports career is over now, after ACL injury ?
Can you get back in the game?
Short answer is No! Your sports career is not over yet. You not only recover fully but can also come back faster and stronger than ever.
In this modern era of technology and advancement there are lots of different treatment options available which depend on the severity of the ACL tear or injury and you can get completely recover after the treatment and you can run marathon. Many of those breaks, sprains, and tears aren’t the career-enders that athletes fear anymore.
For example the inspiring story of Adrian Peterson: who had a left knee ACL tear in 2011. In 2012, 10 months after his initial injury, he completely exceeded expectations, running for a career-best 2,097 yards whereas averaging 6.0 yards per carry with 12 touchdowns (and a Pro Bowl performance).
Treatment options:
Non surgical options:
Non surgical options are for patients who have sustained mild or minor injury (Grade 1 injury).
First aid- Mild injuries can be treated using the RICE acronym. Rest, Ice, Compression, and Elevation
Medication- Anti-inflammatory (NSAIDs), such as ibuprofen, can help to reduce swelling and pain.
Immobilization- a brace may be recommended to protect the knee from instability, Crutches may also be recommended to prevent you from putting weight on your leg.
Physical therapy and rehabilitation- may be started after swelling has decreased; Specific exercises will restore function to your knee and strengthen the leg muscles that support it.
Surgical options:
Surgical options are required for Grade 2 and 3 injuries, which require ACL reconstruction. Surgery is normally scheduled after the inflammation has resolved.
Performing an ACL reconstruction too early incredibly increases the hazard of arthrofibrosis, or scar tissue forming within the joint, which would risk a loss of knee motion.
ACL reconstruction surgery procedure:
The ligament is reconstructed with a tissue graft, either from a cadaver (allograft) or from one of your own tendons. This graft will act as platform for a new ligament to develop on.
Grafts or new ACL can be created from a number of different tissues on the knee including: the patellar tendon, which runs between the kneecap and the shinbone (which currently remains the gold standard); the quadriceps tendon, which runs from the kneecap into the thigh; or the hamstring tendon at the back of the thigh.
The reconstruction process involves:
The new ACL secures the tibia and re-stabilizes the knee.
ACL reconstruction surgery procedure
Photo courtesy of Tower Orthopedics
After the surgery procedure:
You will be monitored in the recovery room until you are more awake and stable. Nearly all ACL cases go home the same day with a knee brace and crutches for 1-4 weeks.
What about ACL complete recovery?
Recovery
Whether your treatment includes surgery or not, physical therapy plays a crucial part in helping you regain knee strength and movement, and getting you back to normal activities. In case you experience surgery, your physical therapy will begin 2-3 days after surgery with focus on returning movement to the joint and surrounding muscles.
Can you jump or run again after your complete recovery?
Yes! With the right recovery and a lot of mental toughness, athletes can return better, faster, and stronger.
Have more questions about your upcoming knee replacement? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
American football is the paradigm of contact sports; therefore, it is one of the high-performance activities in which players are at greater risk of injury. During the playoffs, the intensity, passion, and strength with which the players play each game increases, this undoubtedly represents a …
American football is the paradigm of contact sports; therefore, it is one of the high-performance activities in which players are at greater risk of injury. During the playoffs, the intensity, passion, and strength with which the players play each game increases, this undoubtedly represents a risk factor for injuries due to the powerful impacts.
Various epidemiological studies have shown that older players may be at greater risk of injury, while experienced teams and coaches can reduce this risk.
It is important to keep in mind that injuries can occur not only during matches but also during training days. The intensity of contact when tackling, blocking, and other physical interactions between players, as well as the speed at which they are played, are elements that can condition the development of severe injuries. The most frequent injuries among active football players are the following:
Knee injury: Cruciate ligament rupture, collateral ligament sprain, meniscus rupture. Injuries to the knees can be caused by strong blows, a fall or some sudden change in the direction that a player was running. The knees are the area with the highest number of injuries among NFL players.
Ankle injury: Sprained ankle. At the same injuries in the knees, ankles suffer much from the strong impact and falls.
Injuries to the legs in general, thigh or ankle: tendon deformation, sprains. These injuries are the product of heavy blows and the enormous wear to which they are subjected during the season, adverse weather conditions also favor this type of injury.
Tendon injury: tears and ruptures, are usually the result of poor warming or muscle overexertion
Shoulder injury: Dislocated shoulder, joint injury. Any player can suffer a shoulder injury, but the QB has the highest risk of problems in this joint. This is due to the wear and tear that occurs in this joint when launching the football.
Head injury: Contusion. Brain contusions are some of the most feared injuries due to their clinical implications both in the short and long term. These injuries usually happen when helmet-helmet or helmet-field shock occurs. The NFL has implemented measures so that a player after suffering this type of injury leaves the game to be evaluated immediately by a medical team.
When highly competitive athletes suffer some type of injury, surgery is usually used to ensure adequate and prompt healing of the injured tissues. An overview of some injuries suffered in the past by top NFL players is provided below.
Notable Player Injuries and Their Recovery Process
Adrian Peterson, ruptured anterior cruciate ligament (ACL)
In December 2011 the stellar runner Minnesota Vikings Adrian Peterson suffered a torn anterior cruciate ligament after receiving a direct hit on his knee by safety Redskins DeJon Gomes. The injury was diagnosed after the game by MRI.
The ligaments are cords of connective tissue that join the bones that make up a joint. The anterior cruciate ligament, one of the two ligaments that cross the middle of the knee, connects the femur with the tibia and helps stabilize the knee joint.
In 2012 Peterson underwent surgery for reconstruction of the broken anterior cruciate ligament. During surgery, the broken ligament is removed and replaced with a graft. Autografts are usually performed in which the patellar tendon, quadriceps tendon or hamstring tendon of the same patient is used. Another option is the allograft, in which the tissue of a deceased donor is used.
The surgery is usually performed by arthroscopy, in which small incisions are made in the knee through which the surgeon inserts the arthroscope. A camera at the end of the arthroscope transmits live images from inside the knee to a screen in the operating room, this allows a better visualization of the structures and precision during surgery. Subsequently, the surgeon performs perforations or tunnels in the femur and tibia to place the graft, which is then secured to the bones with screws or other fixation devices. The graft will serve as a scaffold on which new ligament tissue can grow.
If an autograft is used, the surgeon will make another incision in the knee and take the replacement tissue. Finally, the small incisions made are closed by stitches.
Early mobilization after surgery is recommended to strengthen the ligament and prevent fibrosis. Physical therapy is essential for the full recovery of the joint functionality.
Marcus Mariota, ankle fracture
In December 2016, the Tennessee Titans quarterback, Marcus Mariota, suffered a fracture of the right fibula after being captured by Jaguars defensive tackle Sheldon Day.
The ankle is a complex joint that is composed of 3 bones, the internal part is made up of the tibia (tibial malleolus), the external part by the fibula (peroneal malleolus), and the lower part by the talus. Ankle fractures are usually caused by two mechanisms, twisting or direct impact on the ankle.
The goal of surgery is to reduce the fracture and reconstitute the anatomical structure of the joint to preserve its functionality. If the shape and anatomy of the ankle are not restored correctly, wear of the cartilage that lines the joint occurs, which inevitably leads to osteoarthritis.
During the surgery, an incision is made on the ankle to access the focus of the fracture. Once the broken bone fragments have been identified, they are placed in their anatomy position (open reduction) and fixed using metal plates and / or screws (internal fixation). This fixation provides stability so that movement can begin shortly after surgery.
Eric Berry, Achilles tendon rupture
In September 2017, the safety of the Kansas City Chiefs, Eric Berry, suffered a rupture of the Achilles tendon and therefore underwent surgery for repair.
The Achilles tendon joins the calf muscles to the calcaneus bone and its main function is the elevation of the heel of the foot from the ground. It is the thickest and strongest tendon in the body and is inserted into the calcaneus bone. It is usually broken 2 or 3 centimeters above the insertion due to the poor vascularization that it has in this area.
A total rupture of the Achilles tendon will require surgical treatment while in a partial rupture of the Achilles tendon may not need surgical repair and the use of a cast should be weighed for 3 to 6 weeks in order to regenerate the tendon. The advantage of surgical treatment is the low incidence of recurrence of tendon rupture, while the disadvantage is the postoperative complications of any surgical wound.
During the surgery, an incision approximately 8 centimeters in length is made from the calf to the ankle. The anatomical planes are separated until the two ends of the torn Achilles tendon are reached. After suturing the Achilles tendon, the plantar muscle tendon is used to reinforce the two ends of the repaired tendon. Another common repair implements the use of suture anchors which would secure the superior (upper) section of the tendon to the calcaneus (heel) bone.
It is important to protect the reconstructed Achilles tendon by its own physiological envelope (fascia) or with the help of a special dressing that prevents the adhesions of the Achilles tendon to the skin. Finally, the anatomical planes of the skin are sutured.
It is common to use a drain for 1 or 2 days to avoid the accumulation of blood remains in the wound since these can cause complications in good tissue healing.
The postoperative period requires the use of walking crutches since the leg operated on the floor cannot be supported.
The angle between the foot and leg is maintained at 90º by means of a plaster splint in order to avoid ankle stiffness during the first two weeks.
Darrius Guice, meniscus tear
In September 2019, Washington Redskins runner Darrius Guice suffered a meniscus tear at the conclusion of a 23-yard run, Packers safety Darnell Savage hit him in the legs while the runner fell at the floor.
The menisci are cartilaginous structures that are part of the knee joint and whose function is to increase the articular surface, which allows a more homogeneous distribution of the weight load between the femur and the tibia. In addition, the menisci provide stability to the knee, improve its functionality and, thanks to its padding, provide better shock absorption and a consequent reduction of cartilage wear that covers the bones that form the knee.
Currently, the treatment of this injury is usually performed by arthroscopy since it is a minimally invasive surgery that allows meniscus repair without opening the knee, thus reducing hospitalization and recovery times.
During the procedure, the surgeon inserts the arthroscope through a small incision near the knee to visualize the structures of the joint and repair the injured meniscus by suturing or anchoring. Surgical instruments can be inserted through other small incisions.
Drew Brees, finger surgery
In September 2019, the New Orleans Saints quarterback, Drew Brees, suffered a broken ligament when he hit the hand of Aaron Donald, the Los Angeles defensive tackle.
After carrying out the corresponding imaging studies, it was evident that Drew Brees had suffered a rupture of the ulnar collateral ligament, which stabilizes the thumb joint and plays a fundamental role in the functions of said joint, whose main action is to perform the clamp.
During the surgery, a longitudinal incision is made on the ulnar (external) area of the thumb joint to expose the injured ligament. Subsequently, a perforation is performed in the reinsertion zone where an intraosseous anchor is placed to which the ligament is fixed by resorbable sutures. Subsequently, the hand is immobilized for 3 weeks and then physiotherapy begins with flex-extension movement.
Matt Kalil, hip tear
In September 2016, the left tackle of the Minnesota Vikings, Matt Kalil, underwent surgery to repair a tear hip suffered during a regular-season game.
The hip is a joint composed of a sphere-like articular surface and a cavity. The edge of the cavity is covered with a ring of cartilage called the labrum. This protects the bone and helps isolate the joint. The tearing of this cartilage causes irritation of the hip, pain, and limitation of movement.
The only way to cure a tear hip is through a type of surgery called hip arthroscopy. During surgery, the doctor makes small incisions called portals, through which the surgeon inserts the arthroscope to clearly visualize the joint.
Labrum tears can be removed or repaired. The torn labrum segment can be removed by trimming or by ablation (heating the tissue to remove it). The repair of the torn labrum is carried out by suturing the tear to the bone. In this case, an anchor point is placed in the bone to tie the labrum to that point with suture thread. Once the surgeon finishes the procedure, the portals (incisions) are closed and covered with a bandage. A few weeks after surgery, physiotherapy should be performed to speed up the recovery process.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Patients who undergo hip replacement expect to regain their lifestyle and eliminate pain. This is achieved in most cases, but returning to your daily activities will take time. Staying active in the recovery process will help you speed up the recovery time and improve the results of the surgery. …
Patients who undergo hip replacement expect to regain their lifestyle and eliminate pain. This is achieved in most cases, but returning to your daily activities will take time. Staying active in the recovery process will help you speed up the recovery time and improve the results of the surgery.
The return to daily activities varies depending on the type of replacement performed and the individual characteristics of the patient. In the follow-up consultations, your doctor will evaluate your progress and advise you about what exercises you can perform. Even though you will be able to resume most activities, you may want to change the way you do them. For example, you may have to learn new ways to flex to protect your new hip. You also should use a cane, walker, or crutch to distribute your weight support and not overload the joint
Return to everyday activities
After surgery, it is essential to stay active and perform light activities according to your tolerance. The key is not to overload the joint too much. While some days are better than others, you will notice a progressive improvement over time.
Driving
You will be able to drive again when you are no longer taking narcotic pain relievers and when the strength and reflexes have returned to normal. This usually happens within a period of approximately 1 month. However, your doctor will help you determine when to drive again, since all patients are different.
Sexual activity
Depending on your condition, you may resume sexual activity within 6 weeks after surgery, as long as there is no significant pain. Initially, you should opt for positions that do not require flexion or adduction of the hip. As your hip heals, you will be able to take a more active role.
Check out our Sex After Hip Replacement Blog for more tips!
Return to work
The return to work depends on the activities you perform and the evolution of your recovery. However, most patients return to their work activities within 3-4 weeks.
Sports and exercises
Patients undergoing hip replacement surgery may resume their sports activities within 2-3 months. Your doctor may recommend using a stationary bike to help you recover muscle tone and hip flexibility.
After this recovery process, you can return to practice the sports of your choice. You can walk as much as you want, but remember that you should still comply with the exercises prescribed by your doctor and physiotherapist.
In general, low-impact physical activities, such as playing golf, swimming, hunting, biking and playing light tennis, put less stress on the hip joint and are preferred over high-impact activities such as running, racquetball and ski.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
The medical device industry has shown rapid growth in recent years, the diversity of products is so wide and varied that they become indispensable in health care. From bandages, gloves, condoms, to heart valves, stents, orthopedic prostheses, and pacemakers are developed and perfected year after …
The medical device industry has shown rapid growth in recent years, the diversity of products is so wide and varied that they become indispensable in health care. From bandages, gloves, condoms, to heart valves, stents, orthopedic prostheses, and pacemakers are developed and perfected year after year by medical device companies to meet the high standards of quality and regulations in different countries. It is an industry valued at approximately 828 billion dollars and with enormous growth potential.
During 2019, 50% of total global revenues in the medical device industry have been distributed in 15 companies, which operate in various categories, becoming leaders in the global industry. Its sales reveal consumption trends, geographic data, life expectancy, health spending, diseases with a greater incidence in the population and in the same way, the total investment destined for research and development, as a growing sector becomes attractive for investors.
As a result of this growth, recent years have been characterized by mergers between large companies that strengthen the offer, in order to offer complete solutions to an increasingly demanding market. The consolidation between companies allows a reduction of costs and greater investment in the development of new medical devices.
Next, we will review the most profitable medical device companies today.
Johnson & Johnson
Market value: 385 Billion dollars
Yearly Revenues: 81 Billion dollars
Johnson & Johnson is the largest company in the medical device industry. The medical devices section of this international company is composed of the groups: Global Medical Solutions, Global Orthopedics and Global Surgery.
Among its subsidiaries also stands out Biosense Webster, leader in the production of advanced diagnostic tools, therapy, and cardiac mapping.
Johnson & Johnson and its subsidiaries develop and manufacture products used in various areas of medicine such as orthopedic surgery, cardiovascular surgery, diabetes, vision care, and general surgery. This year its sales grew worldwide by 1.5% and its main contributors had high sales in the areas of visual health, surgery, wound closure, biosurgery, and electrophysiology.
Medtronic
Market value: 156 Billion dollars
Revenues: 30.6 Billion dollars
Medtronic is one of the largest companies in the medical device industry, has more than 85,000 employees in more than 160 countries and has executive offices in Ireland and operational headquarters in Minneapolis. Its implantable devices used in the cardiovascular area stand out, such as the Wide MRITM and Compia MRITM Quad CRT-D or Micra TPS pacemakers.
The company experienced a 1% increase in revenue compared to the previous year's figures and reported growth in all groups and regions. The revenue increases are due in large part to the acquisition of Mazor Robotics, a company specializing in the development of robotic guides for spine and brain surgery. This agreement was carried out at the end of 2018 and provided the company with large revenues in 2019.
Philips Healthcare
Market value: 44 Billion dollars
Revenues: 20 Billion dollars
Philips Healthcare is a diversified technology company that has produced more than 450 products and services. Recently Phillips bought PathXL, a company focused on the analysis of digital pathology images. This acquisition has allowed the company to have great growth in the medical device industry
Stryker
Market value: 77 Billion dollars
Revenues: 13.6 Billion dollars
Stryker is a US-based medical technology company that develops prostheses for joint replacements, surgical equipment, medical machinery, neurosurgical and spinal devices, among many others. The company had overall revenue growth of 9.3% in 2019, as well as strong growth in the three business segments: orthopedics (5.9%) MedSurg (8.6%) and neurotechnology and spine (18%).
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Knee replacement surgery is an increasingly common procedure worldwide. In the United States, approximately one million patients undergo this surgery every year. The rapid advance of technology has allowed medical device companies to regularly introduce new implants designed for durability and …
Knee replacement surgery is an increasingly common procedure worldwide. In the United States, approximately one million patients undergo this surgery every year. The rapid advance of technology has allowed medical device companies to regularly introduce new implants designed for durability and better functioning, thus improving patient satisfaction.
Traditionally, the choice of the medical device to be implanted relied mainly on surgeons, who incorporated the newest devices from their preferred provider into their surgeries. However, it is the patient who will carry this implant with them, therefore, the final decision on which device to use should be the patient's.
What makes an implant right for you?
At the time of performing an orthopedic implant, there are different factors that condition the medical device and the surgical technique to be used. These factors include decisions such as the implant materials (metal, polyethylene or ceramic), the support structures used, the implant fixation methods and the type of surgical incision.
The variations based on the characteristics of the device and the surgical technique are immense, therefore, most surgeons work with a small number of implants and improve their technique to obtain better results with said device. This situation is an important condition in the surgeon's preference. Therefore, some surgeons do not individualize the selection of implants, although there is a wide range of options for each patient in the market.
In some medical conditions, the choice of devices may be reduced. For example, in patients older than 75 years, the risk of dying in the years following surgery is ten times greater than the risk that the prosthesis presents a failure. Therefore, older patients are unlikely to obtain additional benefits from a state-of-the-art implant that provides greater longevity, since they have a higher risk of presenting surgical complications if re-intervention is necessary. This suggests that traditional devices whose complication rates have been well studied may be the best option.
Beyond the differences between the brands and the designs available, the surgeon must explain to the patient why the chosen device is the best for their particular case. However, if the patient is not convinced by the surgeon's recommendations and prefers to use another device, he/she is fully entitled to seek another provider that offers a different set of implants.
It is clear that young and active patients can benefit from newer and more durable devices, therefore, the options are broader.
Patients may differ with the surgeon in terms of the device chosen and its possible risks and benefits, so it is recommended that the doctor request the patient's opinion and discuss possible options. This incorporation of a shared decision-making framework generates a stronger relationship with the doctor.
The Right Device should be decided on a Conversation
To mitigate the tension between the views of the doctor and the patient, the ideal is for the surgeon to assess the individual needs of each patient and notify any information they deem pertinent about the procedure to be performed.
This approach allows shared decision-making, in which the experience of the doctor and the patient's preferences are integrated to define the selection of the device to be used, so that both are as compliant as possible. This allows establishing a patient-centered process in which their particular characteristics are taken into account and their opinion is considered in the selection of the treatment.
Some may consider that the details of the medical device to be implanted are too complex for most patients to understand and discuss with the doctor. In fact, a considerable number of patients want this type of decision to be left to the surgeon. This should also be respected, but the patient will also be offered the opportunity to get involved in decision making and share their preferences and concerns with the surgeon. However, some patients may still allow surgeons to make the final decision, always considering the options that best fit the patient's needs.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Written By: Patrick Frank
NUMBER OF PATIENT VISITS TO A HOSPITAL A YEAR
There Are 5,686 Hospitals In The U.S., According To The American Hospital Association. Of These, 2,904 Hospitals Are Nonprofit And 1,060 Are For-Profit. Additionally, 1,010 Are Owned By State Or Local (County, Hospital …
Written By: Patrick Frank
NUMBER OF PATIENT VISITS TO A HOSPITAL A YEAR
There Are 5,686 Hospitals In The U.S., According To The American Hospital Association. Of These, 2,904 Hospitals Are Nonprofit And 1,060 Are For-Profit. Additionally, 1,010 Are Owned By State Or Local (County, Hospital District) Government Entities.
There Was An Average Of 104 Inpatient Hospitals Admissions Per 1,000 People In 2014, Down From An Average Of 111.8 Days In 2011. This Data Suggests On Ongoing Shift From Inpatient To Outpatient Care, Which Has Been Driven Largely By Advances In Minimally Invasive Surgical Techniques As Well As Advanced Anesthesia Techniques That Allow Patients To Recover More Quickly From Surgical Procedures.
18. In 2012, The Latest Year For Which Data Is Available, The Average Length Of Stay For An Acute Care Hospital Admission Was 4.5 Days.
There Was An Average Of 2,145 Outpatient Visits Per 1,000 People In 2013, Up From An Average Of 2,105.6 Days In 2011, Further Supporting The Trend Of Inpatient Surgeries Moving To The Outpatient Setting.
Emergency Departments Are Critical Units Within Hospitals As They Account For The Majority Of Inpatient Admissions.
The Average Cost Per Inpatient Day In 2014 Was $2,346 For Nonprofit Hospitals And $1,798 For For-Profit Hospitals. At Nonprofit Hospitals, The Average Cost Per Inpatient Day Was Highest In California ($3,533) And Lowest In South Dakota ($1,321). Among For-Profit Hospitals, The Average Cost Per Inpatient Day Was Highest In New Jersey ($4,656) And Lowest In South Dakota ($434).
In 2011, The Latest Year For Which Data Is Available, There Were 44.5 ED Visits Per 100 Persons In The U.S., According To The CDC. This Translates To Roughly 136.3 Million Visits Total That Year. Of That Total, Approximately 40.2 Million ED Visits Were Injury-Related.
The Percentage Of Emergency Department Visits Resulting In Hospital Admission Was 11.9 Percent, And The Percentage Of Emergency Department Visits Resulting In A Transfer To A Different Hospital Was 2.1 Percent.
NUMBER OF DOCTOR APPOINTMENTS SCHEDULED A YEAR
Number of visits: 884.7 millionNumber of visits per 100 persons: 282.0Percent of visits made to primary care physicians: 52.2%Most frequent principal illness-related reason for visit: medicationMost commonly diagnosed condition: essential hypertensionSource: Https://Www.Cdc.Gov/Nchs/Fastats/Physician-Visits.Htm
WHAT IS THE AVERAGE CONSUMER SPEND ON HEALTHCARE A YEAR?
According To The Most Recent Data Available From The Centers For Medicare And Medicaid Services (CMS), "The Average American Spent $9,596 On Healthcare" In 2012, Which Was "Up Significantly From $7,700 In 2007."
It Was Also More Than Twice The Per Capita Average Of Other Developed Nations, But Still, In 2015, Experts Predicted Continued Sharp Increases: "Health Care Spending Per Person Is Expected To Surpass $10,000 In 2016 And Then March Steadily Higher To $14,944 In 2023."
Indeed, Average Annual Costs Per Person Hit $10,345 In 2016. In 1960, The Average Cost Per Person Was Only $146 — And, Adjusting For Inflation, That Means Costs Are Nine Times Higher Now Than They Were Then.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
From 9x Surgery Survivor and Author, Jenna Minecci (@jennactive)
Let's set the stage, it's the quarterfinals and your high school soccer team is on the brink of victory. Your teammate crosses the ball to you and just when you’re about to kick the game winning goal.....POP!!!!! you tear your …
From 9x Surgery Survivor and Author, Jenna Minecci (@jennactive)
Let's set the stage, it's the quarterfinals and your high school soccer team is on the brink of victory. Your teammate crosses the ball to you and just when you’re about to kick the game winning goal.....POP!!!!! you tear your ACL. It's not supposed to end like this... but now it’s time to have a major knee surgery and what do you do?
Typically, most people find a surgeon in your network, book an appointment, meet with the doctor and schedule out an operation. We have all heard our fair share of terrible surgery stories from friends and loved ones so why haven’t we changed our approach to having surgery?
With countless surgeons, new techniques, and updated devices appearing each year, why are most of us still unprepared? With an influx of online information and more technology than ever, one would think it would be a simple task to research and understand how to receive the best care for the best long-term outcome after a major surgery.
Think about it, we have so many resources available to us in order to self-diagnose, self-prepare and be self-aware; yet most patients entering surgery are hoping for the best and simply trusting the process.
Isn’t this backwards?
Think of surgeons as mechanics for our body; most of us do thorough research when it comes to our cars because there is so much stigma around bad parts and bad service; but why not do the same for your body and health?
1. Do your research.
Even though surgical technology is far more advanced than it was thirty years ago, not all procedures, techniques, devices, or surgeons are created equal. Your quality of life, long term, is extremely important and can be dependent on small variables in your procedure. These variables can determine whether your operation will be successful but also effective for your body and it’s unique needs and characteristics for your long-term goals. Become a student of your procedure: how it is performed, the goal of the operation, and how successful the surgery is. Understand the different options you have regarding techniques, devices, or graft types used because those can vary surgeon-to-surgeon. Become well versed in the advantages and disadvantages of all these options because it can drastically affect your outcome. Do your homework, so that you
can be involved and informed in the decision making process. This is your decision, choose wisely by researching and educating yourself.
2. Be your own advocate.
After doing your research, you can now become an educated decision maker in your surgical process. Get involved! Communicate with your surgeon and, if possible, seek opinions from multiple surgeons accessible to you. Ask your friends, colleagues, and neighbors for advice and recommendations. Discuss and interview surgeons so you can be involved in the process. By doing all of this you allow yourself to make the best possible decision for your surgery, who
performs it, and how they do it.
Here are some great questions to ask:
-How many cases do they perform each year? Look for a surgeon in a large city who performs at least 50 to 100 per year. If they are not doing a minimum of one of these operations each week then there is someone out there better suited for the job.
-Are they sports medicine trained? (for sports injuries)
-Did they do a specific fellowship where they learned how to do this operation?
-Do they have any long-term outcome studies with this procedure?
-Do you have a former patient I could talk with?
-Are they a specialist in this operation? Do they recommend someone more appropriate for your needs?
-Have they had success with other patients of similar histories and long term goals as you?
The more you become a part of the discussion the better prepared you will be for your surgery. This process will continue post operatively as your surgeon will perform your procedure, and then it
is up to you to ensure you receive high quality rehabilitation and a full recovery. Knowledgeable and proactive patients take better time and care with their recoveries and end up having more adherence to physical therapy and rehabilitation. Knowledge is your power!
3. Be mentally and physically prepared.
There will be obstacles and setbacks. This will temporarily turn your life upside down. Are you ready for this? Have you prepared yourself and the life around you to achieve the best possible outcome after surgery? Don’t rush this process, take time to get through the surgery and back to your life.
Carefully and meticulously think about your responsibilities: your work schedule, kids, pets, your living and sleeping situation (while on crutches), food, and other daily needs that you might need help with. How are you going to finance this? What is your plan for recovery, physical therapy, and at home care? This will take planning, support, and great execution to allow for a less stressful recovery environment.
Your outcome, experience with surgery, and recovery will be directly correlated with your mental and physical strength. Recovery is not a linear progression. There will be setbacks and extremely hard moments so begin preparing your mindset for the daunting challenge to stay disciplined and focused during your rehabilitation. Mindset training was a huge piece of my recovery which allowed me to stay focused, not give up or feel depressed, or worse go too fast with my
recovery. Additionally, physical strength is absolutely necessary at this point. Even if you have limitations heading into surgery, in most cases it helps tremendously to take time pre-op to
strengthen your core and be as strong and flexible as possible before going under the knife.
There are many simple pre-surgical exercises that can be recommended to prepare you, which will only help as you typically return to these same simple exercises shortly after your surgery. Recovery from surgery is largely impacted by your health and diet so taking time before surgery to implement better nutrition habits, healthier sleeping habits, and losing some of that stubborn weight to help your efforts post-op. Navigating crutches, loss of mobility and strength, and regaining function will also be much easier if you are in good shape. Take all of these factors into consideration when planning out a surgery date and allow yourself the timing to adjust and prepare yourself for success.
You deserve the best!
Always remember, don’t take surgery lightly. Prepare, plan, research, get involved and be your own advocate! A healthy body has a better post-surgical outcome. Mindset is everything and Motion is Lotion! If you need any help, advice, or inspiration; I am always here to help.
Always be positive!
Jenna Minecci
9x Surgery Survivor/Strength Coach/Author/Athlete
B.S., CPT, CES, PES, FMS, MWod Pro
@Jennactive
jminecci@gmail.com
Jenna Minecci is a passionate Personal Trainer and Strength Coach dedicated to helping others prevent injury, prepare for surgery and recover exceptionally from any surgery they have. After having 4 ACL reconstructions fail on her as a teenager, she has now had 9 surgeries and counting. Her goal is to educate and empower others facing difficult surgeries and recovery journeys. She currently works at Lifetime Fitness in Atlanta, Georgia where she specializes in Corrective Exercise, Knee Rehabilitation and ACL Injury Prevention.
She is also the author of the book Surviving 7: The Expert’s Guide to ACL Surgery.
Follow Jenna on social media @Jennactive.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
The healthcare system today is a convoluted labyrinth of confusing lingo and bureaucratic red tape.
Right Device wants to empower patients by providing knowledge and resources to patients about their upcoming surgery. But we aren't the only ones putting patients first. Check out these 14 other …
The healthcare system today is a convoluted labyrinth of confusing lingo and bureaucratic red tape.
Right Device wants to empower patients by providing knowledge and resources to patients about their upcoming surgery. But we aren't the only ones putting patients first. Check out these 14 other companies also raising the "blue curtain."
1. Healigo
Healigo is a digital platform that allows physiotherapists to be in contact with patients and send them exercise programs directly to their smartphones. In this way, patients can see tutorials of the exercises from their homes, which allows greater adherence to the rehabilitation plan. Through this software, patients can also receive reminders to perform their exercises and can report their daily progress to the physiotherapist. This platform allows for generating more income and increasing the quality of care and customer satisfaction.
2. Medbridge
MedBridge offers high-quality and easy-to-use software that allows patients to access a wide variety of physiotherapeutic exercises to perform from the comfort of their homes. These programs offer greater comfort for the patient and therefore greater adherence to treatment.
Medbridge offers more than 5,000 HD video exercises developed by professionals, which can be applied in a wide variety of pathologies such as musculoskeletal injuries, stroke, neuropathies, among others. The videos include voice-over and written instructions in English and Spanish, which ensures that patients perform the exercises properly.
Through this platform, physiotherapists can schedule personalized exercise routines for their patients and update them as patients progress in their therapeutic program.
3. Physitrack
Physitrack is an application that allows you to send videos of narrated and high definition exercise programs directly to the patient's cell phone or computer, thus promoting commitment and adherence to treatment. In addition, this platform contains an integrated system for conducting video consultations and demonstrations of live exercises.
This platform allows the physiotherapist to integrate and classify their patients, collect and analyze results, manage patient admission, and expand clinical consultations. Physitrack helps provide patient-centered care through real-time information.
4. SeamlessMD
SeamlessMD is a digital tool that allows health professionals to guide their patients during their recovery process. This application helps to establish better monitoring of the patient, which allows reaching the therapeutic objectives quickly. In addition, it allows establishing an interactive service that includes reminders, to-do lists, videos, and evidence-based education.
5. mPOWEr
This is an application that allows monitoring of the surgical wound after surgery, in order to identify early signs of infection or other complications. The follow-up is established through photos and direct communication between the patient and the surgical team.
This interface helps surgeons to closely monitor multiple surgical patients, thus improving the quality of care and avoiding costly and uncompensated readmissions.
6. Buddy healthcare
This application provides patients with precise instructions about the steps to follow before and after undergoing surgery. The chronological order of events makes it easier for patients to follow everything that must be completed throughout this process.
Through the application, patients can easily complete all forms related to the intervention such as the pre-anesthesia questionnaire, and send them to the clinic safely.
This system guides patients regarding pre-surgery preparations such as when to stop eating, drinking, and what medications to take or discontinue before the intervention.
BuddyCare helps faster recovery after surgery. Patients receive instructions regarding the exercises they should perform, how to perform wound care, and what medications to take after surgery. In addition, an interactive timeline allows care personnel to monitor whether or not postoperative instructions have been followed.
7. Reflexion Health
Reflexion Health is an application that offers the opportunity to enjoy physical therapy from your home. This platform offers personalized training in the performance of specific exercises, clinical supervision by physiotherapists, and consultations with specialists. This allows patients to accelerate the recovery process from home.
8. Force therapeutics
This platform uses digital connections to involve patients in the recovery process. Patients communicate with their care teams at any time, which allows them to keep up to date on the patient's progress and provides the opportunity to clarify certain doubts that may arise during recovery. In addition, personalized digital content is delivered daily to each patient to educate them about their pathology.
9. Tapcloud
TapCloud is a very useful application for both the medical team and patients, as it simplifies care plans by increasing patient compliance, customizing and updating care plans for each patient, and allows minute-by-minute registration of the patient's health, which helps to quickly identify alarm signs and prevent the development of complications. This platform improves patient results, optimizes the allocation of resources and increases patient satisfaction.
10. MyRecovery
MyRecovery allows patients to be guided through the recovery process by providing advice and suggestions certified by specialists. This application improves communication between patients and doctors, thus reducing anxiety and strengthening the doctor-patient relationship. Myrecovery helps to standardize and rationalize the pathways of care and, therefore, to reduce the cost of clinical care. In addition, this platform allows doctors to closely monitor the progress of patients.
11. Twistle
Twistle is a digital platform that optimizes medical care by improving communication between doctors and patients, allowing for adequate patient follow-up. This platform sends personalized information to patients about the pathology they suffer. In addition, it ensures compliance with preparation instructions, appointments, therapies and medications, which leads to better results, including greater clinical quality and safety.
12. Peerwell
Peerwell is an application that helps people with chronic musculoskeletal pathologies to reduce their symptoms by performing exercises programmed by professionals. This platform can avoid the need for surgical intervention, or when surgery is unavoidable, it helps patients in the home recovery process, accelerating their incorporation into their daily routine. PeerWell is an extension of the health care team that works to reduce patient risk, control costs and improve back-to-work times.
13. Mobomo|Pulse
Mobomo|Pulse is a medical care platform whose objective is to help patients recover after orthopedic surgery. Through the application, providers guide the activity of their patients and monitor their progress. This platform helps reduce post-surgical complications and accelerates the return of the patient to daily activities.
14. Favorhealth
This application works as a virtual medical assistant that helps the surgical team to guide patients to prepare properly for their surgery. An adequate pre-surgical orientation avoids the cancellation of surgeries and last-minute inconveniences which could lead to additional expenses.
In addition, this platform allows the patient to be continuously monitored after surgery, thus reducing unnecessary visits to hospitals, post-surgical complications, and readmissions. Through virtual records and a dashboard to help doctors monitor progress, she helps ensure that patients follow the proper instructions and that doctors are notified about the progress of patients.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
From Ameeka George, MS, CPNP
When your child is possibly diagnosed with a complex disease like Cerebral Palsy, life can get very stressful and confusing, with more questions than answers. Check out our roadmap to Cerebral Palsy to better inform you, and help you start the conversation with …
From Ameeka George, MS, CPNP
When your child is possibly diagnosed with a complex disease like Cerebral Palsy, life can get very stressful and confusing, with more questions than answers. Check out our roadmap to Cerebral Palsy to better inform you, and help you start the conversation with your pediatrician.
What is Cerebral Palsy (CP)?
Cerebral Palsy, commonly referred to as CP, is a group of motor disorders that affect a person’s ability to move and maintain balance/posture [1]. It is the most common motor disability in childhood affecting 1 in 345 children[1]. There are varying degrees of involvement ranging from mildly affected (GMFCS 1) to severely affected (GMFCS V). There is a classification system that was developed to categorize the degree of motor impairment. Remember that this does not correlate to cognitive abilities! CP is believed to be caused by brain damage sustained while the child is in utero or during the birth process [1]. The etiology of CP is actually unknown and is being researched quite extensively. It is important to learn the early signs of CP and keep track of children’s milestones so that they can be appropriately managed and plugged into services at an early age!
What specialist should I connect with if my child is diagnosed with CP?
Your child’s pediatrician/pediatric provider is going to be the most important provider as they are seeing your child and evaluating them frequently during the first few years of life for well child checks. Developmental surveillance is very important for diagnosis CP. Your child may be referred to a pediatric neurologist, developmental pediatrician, and/or pediatric physiatrist should CP be suspected by their primary care provider [2]. At some point, your child should also be evaluated by orthopedics for surveillance and treatment as well. Typically, this is not the first provider that you will be referred to. Last, but not least you will need to be plugged in with early intervention services including physical therapy, occupational therapy and speech therapy if needed. Your child’s PCP can assist with all of these referrals - this is your point person!
What should I ask my Pediatrician?
-Is my child meeting his or her milestones?
-Always make sure to check in with your PCP about your child’s milestones if you are concerned! The AAP recommends formal developmental surveillance at 9 months, 18 months and 24 or 30 months till age 2.
-Does my child need early intervention?
Ask your PCP about early intervention! They can direct you to your local state office. See the link below for direct information by state for early intervention services.
https://ectacenter.org/contact/ptccoord.asp
How is CP diagnosed?
Generally diagnosed based on clinical exam and abnormalities noted in tone and/or gross motor delays in the first 2 years of life [3].
The clinical imaging modality of choice is a brain MRI. Sometimes cranial ultrasound can be done, but it is not necessary required to make the diagnosis.
How is CP treated?
Treatment for CP is a team effort! Your PCP will become your point person for referrals and your child should receive individualized care based on his or her specific needs. Treatment often starts with therapy, medicine management for tone (spasticity) ,and routine follow up with orthopedics for any alignment issues that develop as a result of the abnormal tone associated with CP. Remember, you are not alone! The most important thing to remember is that you will have a team of specialists to guide you every step of the way :)
Ameeka George, MS, CPNP is a board certified Pediatric Nurse Practitioner specializing in Pediatric Orthopedic-Spine Surgery, with an emphasis on Cerebral Palsy, Scoliosis and autism.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
References:
When you’re discharged from the hospital, you may have received a huge packet of information regarding medications, when to make an appointment for follow up, any tests or imaging you might have received and most importantly how to take care of your wound.
We know that it is a lot of …
When you’re discharged from the hospital, you may have received a huge packet of information regarding medications, when to make an appointment for follow up, any tests or imaging you might have received and most importantly how to take care of your wound.
We know that it is a lot of information, and it may be a little confusing. Check out this wound guide to know what to look for, how to take care of it, and how to prevent infections.
Your primary dressing is the dressing that you have when you leave the hospital. Many surgeons have the primary dressing remain on anywhere from 5-7 days. You should do your best to keep it dry and clean until your surgeon says it is ok for you or your visiting nurse to take it off.
If water gets underneath the dressing, it may cause the skin or incision underneath to break down, increasing the risk for infection.
Some tips to help you keep your dressings dry are:
Sponge bath or use approved body wipes as a substitute for showering until the primary dressing can come off
Plastic bags or plastic wraps can be used to wrap an arm and a leg to keep the dressing dry. Remember to tape the bags and do not immerse fully in water
For smaller extremities such as fingers and hands, non-lubricated condoms can be used. Be sure to seal the end with waterproof tape and avoid as much water as possible
Specialty bandage covers can be purchased as well, to better cover your dressing
Image courtesy of Sunrise Specialty
Now that your dressing can come off, how should you take care of your incision? To help maintain the integrity of your incision, remember to not immerse your incision in hot tubs, baths or the beach until cleared by your surgeon.
Whether you have staples, sutures or glue to close your incision, many times it’s ok to shower directly over them! Remember to let the soap and water rinse over the incision and do not scrub the incision site. Also, do not put any creams or lotions over the incision as it may cause irritation and skin breakdown.
Once it is fully healed, are you allowed to put any lotions or creams to help with scarring.
When coming out of the shower, remember to pat, and not rub the incision dry! This will help keep your incision closed for good healing.
After your shower you can place dry gauze and paper tape over the incision to prevent irritation from clothing and to soak up drainage.
Avoid touching your incision as much as possible, and use gloves that you can purchase from your local pharmacy.
Some drainage from your incision is completely normal and is expected! You may accidentally over exert one day or have a harder than usual session with PT causing a little bit of bleeding as well.
Normal drainage that is expected from the wound will be light red color or straw colored. Some oozing with blood will be expected as well.
Remember to change your gauze and tape at least once daily and as it gets soiled. If you notice there is an increased amount of drainage over time, or you are changing your gauze and tape multiple times a day because it keeps soaking, contact your surgeon.
Although some drainage is to be expected, there are some types of drainage that are more concerning. The biggest concern to any surgical site or wound is infection. If you notice purulent drainage, greenish-tinged drainage, or pus-like drainage from the wound contact your surgeon immediately. They may prescribe antibiotics or have you come into the office for further evaluation.
Dehiscence
One complication that should require an immediate call to your surgeon or going to the emergency room is if you notice that your incision has opened up. This may be due to poor wound healing, or if you accidentally over exert yourself one day and tear a staple or stitch.
Cover the wound with dry tape and gauze to help protect it from further infection and reach out to your surgeon.
Infections
Unfortunately, any surgical procedure increases the prospects of infection. Signs that you should reach out to your surgeon’s office immediately are
Your wound has become red, warm to the touch, swollen and enflamed
You notice purulent drainage or pus
Fevers, chills, nausea or vomiting
If you notice you become more short of breath, call 911
We hope that with these tips, it will help you have a healthier, safer and faster recovery!
References
Right Device is here to ensure your operative game plan is ready prior to surgery. Sign up today to access our surgery database! Join our Patient Partner Program as well as speak with someone who has had the exact same surgery or with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
With the COVID virus forcing many states to cancel elective surgeries, chances are that if you had a surgical procedure scheduled for this spring or summer it’s now been postponed or cancelled. This may seem like a set back for you moving forward with your life or recovery process, but it doesn’t …
With the COVID virus forcing many states to cancel elective surgeries, chances are that if you had a surgical procedure scheduled for this spring or summer it’s now been postponed or cancelled. This may seem like a set back for you moving forward with your life or recovery process, but it doesn’t have to be that way! In fact, taking this advantage of this time to further prepare for your upcoming surgery will shorten your recovery time, decrease pain, and begin good habits to prevent having more surgeries.
Check out these 5 tips to taking advantage of your elective surgery being postponed!
Getting yourself into physical shape prior to surgery has been shown to improve immediate post-op function [1]. This will help you maximize the benefits of your surgery. Many surgeons now require that their patients undergo a pre-habilitation program prior to surgery. Take advantage of the additional time to continue your prehab exercise regimen and even begin working on some rehab exercises to be ahead of the curve! Many physical therapist clinics now offer telehealth sessions that can be done from home. This is particularly helpful when you may be working from home due to the Corona Virus and may need your workouts modified!
Proper nutrition is a key component to helping you recover from your surgery! Having enough intake of protein is key for wound healing, and forming antibodies to fight infections [2]. Increasing protein also means looking at alternative sources of protein such as beans, chicken, fish, and tofu. Red meat has been shown to increase inflammation that may impair wound healing [2]. An undesired side effect that may occur post-operatively is constipation, due to the anesthesia, medications or changes in bowel regimen. Ensuring that you have enough fiber in your diet will help you avoid that discomfort! Many patients also experience a lack of appetite after surgery, making it difficult to eat enough calories for proper recovery. Take the time now to stock up on protein shakes or try out different smoothie recipes that you may enjoy when you get back from surgery!
An unfortunate part of surgery will be pain during the recovery. The expectation then becomes not to have the pain be non-existent, but to be at a manageable level. Part of your pain regimen will have pain medications involved, but exploring alternative strategies will allow you to not only rely on medications for pain management. Alternative methods such as mindfulness meditation [3], Reiki therapy [4], visualization therapy [5], and pet therapy [6] have been shown to help reduce pain and anxiety! There are many apps out there such as Headspace that can help you start your meditation practice for free! Starting early will help you get into the mindset easier when the pain is at its worst and also reduce the anxiety of something as serious as a surgical procedure!
Many times the days and weeks leading up to surgery are a whirlwind and before you know it, the day is here and you still may have many questions. Take the additional time to learn more about your surgery, what the recovery process is like, and what medications may be involved. The additional time may also give you an opportunity to speak with your provider to answer any last minute questions that you may have!
Once the surgery is done is when the hard work really begins. Taking the extra time to make sure your home is properly prepared will make your life much easier and recovery less stressful. Make sure that anything that could be a trip hazard is cleared out of the way as well as things that may be high out of reach where it is accessed easier. If your bedroom is upstairs it may be well worth considering making arrangements to sleep downstairs. Finally, make sure to have your refrigerator and freezer stocked with easy to make or ready made meals!
Hope these tips will help you make the most of your time if your surgery has been delayed!
Daniel Kao is an Orthopedic Acute Care Nurse Practitioner currently practicing in New York City. He received his B.S. in Physiology at UCLA and then completed his BSN and MSN at Columbia University. When he's not working you can find him looking for the next great beer.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
References
Jahic, D., Omerovic, D., Tanovic, A. T., Dzankovic, F., & Campara, M. T. (2018, December). The Effect of Prehabilitation on Postoperative Outcome in Patients Following Primary Total Knee Arthroplasty. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30814777
Nutrition Guidelines Following Surgery. (n.d.). Retrieved April 2, 2020, from https://www.theportlandclinic.com/wp-content/uploads/nutritionalguidelines.10813-3.pdf
Zeidan F, Adler-Neal AL, Wells RE, et al. Mindfulness-meditation-based pain relief is not mediated by endogenous opioids. Journal of Neuroscience. 2016;36(11):3391-3397.
Thrane, S., & Cohen, S. M. (2014, December). Effect of Reiki therapy on pain and anxiety in adults: an in-depth literature review of randomized trials with effect size calculations. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147026/
Molinari, G., García-Palacios, A., Enrique, Á., Roca, P., Fernández-Llanio Comella, N., & Botella, C. (2018, July 1). The Power of Visualization: Back to the Future for Pain Management in Fibromyalgia Syndrome. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29294081
Marcus, D. A., Bernstein, C. D., Constantin, J. M., Kunkel, F. A., Breuer, P., & Hanlon, R. B. (2012, January). Animal-assisted therapy at an outpatient pain management clinic. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22233395
As we learned from the previous blog, female athletes are 2-8 times more likely to tear their ACL than their male counterparts [1]. In this blog, we’ll take a deeper look at unmodifiable factors that affect the injury risk for female athletes. Although we cannot physically change these factors, …
As we learned from the previous blog, female athletes are 2-8 times more likely to tear their ACL than their male counterparts [1]. In this blog, we’ll take a deeper look at unmodifiable factors that affect the injury risk for female athletes. Although we cannot physically change these factors, it’s important to be aware of them so we can mitigate the risk where we can!
Miss the early parts? Check out the links below to catch up!
Age
The most at risk population for ACL injury are female athletes ages 12 -17 [2] because during this time their bodies are changing dramatically both anatomically and hormonally. Estrogen levels increase, a menstrual cycle begins and the pelvis widens to support the birthing process and child bearing capabilities one day. That is a whole lot to be happening to a 12-17 year old girl! All of that change is new for the body and can have many diverse side effects and that much change in a body is enough to disrupt the system. Take that disrupted system, without preventative training to account for the new set of variables, and throw it onto a soccer field, you can see how increased risks associated with puberty in a woman can be very disadvantageous for an athlete.
Hormones
With so many hormonal and structural changes occurring between the ages of 12-17, this leads into our next factor: the menstrual cycle and the hormonal changes.. Research shows sex hormones such as estrogen, testosterone and relaxin has effects on the ACL, which may play a role in the laxity of the ligament [3, 4, 5].
The hormones in the menstrual cycle influence ACL tear rate by altering the structure of the ACL. For example, relaxin a protein used to relax the uterus, has receptors that help it bind to the ACL decreasing the tensile integrity [3]. Estrogen receptors, which may play a role in joint laxity, have also been found in ACL’s of female athletes [5]. The ACL and many other ligaments in the body are made up of high levels of collagen in order to maintain their structure. This could theoretically increase injury incidence rates of ACL tears during the pre-ovulatory phase spanning 1 to 14 days of the menstrual cycle where sex hormones are more prevalent [6]. Because higher estrogen levels are typically recorded in women during puberty and child bearing years [7], it may be a small factor in the higher incidences of ACL tear in women of those ages, specifically during the teenage years. Although all the hormones involved in normal functioning of the menstrual cycle are the same, there are varying levels of hormones for each woman and for each time frame of life. This means some women will be more susceptible to the effects of hormones on their ACL injury risk.
Imagine stepping onto the soccer field and all of your ligaments are in a laxity phase. Now, I’m certainly not advocating that all women should stop playing sports during the 1-14 days where there is increased estrogen production in the menstrual cycle but with all of these factors contributing to the high incidence of ACL injuries in female athletes it further concludes that ACL injury prevention programs should be in place for all female athletes starting at about age 10. The bottom line is know your risks so you can change your results.
Anatomical Differences
Unfortunately, the anatomical differences in males and females may also lend to increased risk for female athletes. Even after adjusting for proportional differences, the female ACL is smaller in length, cross-sectional area and volume [8], which puts it more at risk under the same conditions as a male athlete. Differences in lower leg alignment such as anterior pelvic tilt, hip anteversion ("twist of the hip") and tibiofemoral angle and quadriceps angle [9, 10] may affect how the female athlete bears different loads when they perform high intensity activities [11].
Photo courtesy of Next Level Rebel
Differences in hip width cause an increased Q angle in women compared to men [12]. The Q angle is the angle measuring for the midpoint of the patella (knee cap) to the ASIS at the front of the hip [13]. It was originally thought that the larger that angle is, the more lateral force on the patella or kneecap, creating more force at the knee. Multiple recent studies that the Q angle alone plays a smaller role than previously thought [14, 13]. Other factors in combination with an increased Q angle, such as differences in lower extremity alignment and tibial plateau puts the knee in many more compromised positions causing more situations to occur where an athlete is susceptible to an ACL tear [15, 16].
A normal Q angle in women is about 17 degrees and a normal Q angle in men is about 14 degrees [14]. A wider Q angle may contribute to Knee Valgus. Knee Valgus is when the knee naturally buckles inward during a load like a squat, and unfortunately through development females are prone to maintaining increased knee valgus [11]. Knee Valgus is very common in women and men alike but because of increased static knee valgus in females, landing in the wrong position can be a lot more detrimental to a female athlete [17]. Women are much more prone to having Knee Valgus because of weak hips, wider Q angle, and being taught to sit like a lady for all of their life.
Photo courtesy of Science Direct
In my experience, most Knee Valgus in men and women occurs because of weak hips, tight ankles, and impaired quad and hamstring function [18]. Many of these are all common dysfunctions of sitting too much and can be corrected by incorporating a proper strength training and corrective exercise program.
Photo courtesy of Light and Glory Fitness
There are a few other structural differences that make women more prone to ACL injury than men like the overall size/shape of the knee, how that relates to the tibial plateau and over pronation at the foot [19, 20].
For more information on these topics, find my book Surviving 7: The Expert’s Guide to ACL Surgery on Amazon.
Jenna Minecci
9x Surgery Survivor/Strength Coach/Author/Athlete
B.S., CPT, CES, PES, FMS, MWod Pro
@Jennactive
jminecci@gmail.com
Jenna Minecci is a passionate Personal Trainer and Strength Coach dedicated to helping others prevent injury, prepare for surgery and recover exceptionally from any surgery they have. After having 4 ACL reconstructions fail on her as a teenager, she has now had 9 surgeries and counting. Her goal is to educate and empower others facing difficult surgeries and recovery journeys. She currently works at Lifetime Fitness in Atlanta, Georgia where she specializes in Corrective Exercise, Knee Rehabilitation and ACL Injury Prevention.
She is also the author of the book Surviving 7: The Expert’s Guide to ACL Surgery.
Follow Jenna on social media @Jennactive.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
References
Boden, Sheehan. Torg, Hewett. “Noncontact anterior cruciate ligament mechanisms and risk factors.” Sep, 2010. https://insights.ovid.com/pubmed?pmid=20810933
Nessler, T., Denney, L., & Sampley, J. (2017, September). ACL Injury Prevention: What Does Research Tell Us? Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577417/
Dragoo, J. L., Lee, R. S., Benhaim, P., Finerman, G. A. M., & Hame, S. L. (2003). Relaxin receptors in the human female anterior cruciate ligament. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12860548/
Shultz, S. J., Schmitz, R. J., Nguyen, A.-D., Chaudhari, A. M., Padua, D. A., McLean, S. G., & Sigward, S. M. (2010). ACL Research Retreat V: an update on ACL injury risk and prevention, March 25-27, 2010, Greensboro, NC. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938324/
Chidi-Ogbolu, N., & Baar, K. (2019, January 15). Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341375/
Arendt, E. A., Bershadsky, B., & Agel, J. (2002). Periodicity of noncontact anterior cruciate ligament injuries during the menstrual cycle. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11974671/
Shirtcliff, E. A., Dahl, R. E., & Pollak, S. D. (2009). Pubertal development: correspondence between hormonal and physical development. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727719/
Chandrashekar, N., Slauterbeck, J., & Hashemi, J. (2005, October). Sex-based differences in the anthropometric characteristics of the anterior cruciate ligament and its relation to intercondylar notch geometry: a cadaveric study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16009992/
Nguyen, A.-D., & Shultz, S. J. (2007, July). Sex differences in clinical measures of lower extremity alignment. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17710908/
Hertel, J., Dorfman, J. H., & Braham, R. A. (2004, December 1). Lower extremity malalignments and anterior cruciate ligament injury history. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24624006/
Shultz, S. J., Nguyen, A.-D., & Schmitz, R. J. (2008, March). Differences in lower extremity anatomical and postural characteristics in males and females between maturation groups. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18383647/
Sutton, K. M., & Bullock, J. M. (2013, January). Anterior cruciate ligament rupture: differences between males and females. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23281470
Nguyen, A.-D., Boling, M. C., Levine, B., & Shultz, S. J. (2009, May). Relationships between lower extremity alignment and the quadriceps angle. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881465/
Mohamed, E. E., Useh, U., & Mtshali, B. F. (2012, June). Q-angle, Pelvic width, and Intercondylar notch width as predictors of knee injuries in women soccer players in South Africa. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462540/
Hertel, J., Dorfman, J. H., & Braham, R. A. (2004, December 1). Lower extremity malalignments and anterior cruciate ligament injury history. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938060/
Mizuno, Y., Kumagai, M., Mattessich, S. M., Elias, J. J., Ramrattan, N., Cosgarea, A. J., & Chao, E. Y. S. (2006, January 1). Q‐angle influences tibiofemoral and patellofemoral kinematics. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1016/S0736-0266(01)00008-0
Department of Orthopaedics. (n.d.). Anterior Cruciate Ligament Rupture: Differences Between... : JAAOS - Journal of the American Academy of Orthopaedic Surgeons. Retrieved from https://journals.lww.com/jaaos/Abstract/2013/01000/Anterior_Cruciate_Ligament_Rupture__Differences.7.aspx
Loudon, J. K., Jenkins, W., & Loudon, K. L. (1996). The Relationship Between Static Posture and ACL Injury in Female Athletes. Journal of Orthopaedic & Sports Physical Therapy, 24(2), 91–97. doi: 10.2519/jospt.1996.24.2.91
Chappell, J. D., Yu, B., Kirkendall, D. T., & Garrett, W. E. (2002). A comparison of knee kinetics between male and female recreational athletes in stop-jump tasks. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11912098
Huston, L. J., & Wojtys, E. M. (1996). Neuromuscular performance characteristics in elite female athletes. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8827300
In the fight against COVID, there seems to be conflicting information by the hour and many treatments are being tried. But one medication has made it out into the mainstream media, as “the” medication to take to treat COVID: Plaquenil. Although it is being used extensively with some promising …
In the fight against COVID, there seems to be conflicting information by the hour and many treatments are being tried. But one medication has made it out into the mainstream media, as “the” medication to take to treat COVID: Plaquenil. Although it is being used extensively with some promising results [2], Plaquenil is not a drug that magically cures COVID and especially not one that you should be asking for from your doctor to prescribe for you to take home.
In this post, we go into the reasons why.
What is Plaquenil?
Plaquenil, also known as hydroxychloroquine or chloroquine, is a drug commonly used to fight certain types of malaria, lupus, and rheumatoid arthritis. It destroys the malarial parasites by increasing the pH, which interferes with many of its cell functions [1]. This is the mechanism that many think as to why it may be effective against the Coronavirus [2].
In many hospitalized patients, Plaquenil is just one of the medications being used against the fight against COVID. Currently, it is not FDA approved for COVID treatment it has been granted an emergency exemption to be used off-label, as research continues on Plaquenil and other medications like it [3].
Reason 1: Optimal Dosing is still unknown [4]
Whenever we receive a prescription for a medication, it contains an exact dosage along with instructions on when and how to take it. Unfortunately, every drug contains side effects that may harm our bodies or interact with other drugs. Multiple studies are conducted on each drug so that the optimal dose is found where we can benefit the most from it, but also reduce the harm it may have on our bodies.
For Plaquenil there are no studies that have been conducted that look into what the optimal dose is against COVID. Plaquenil has many side effects and interactions with other drugs, and if taken without being carefully monitored in a hospital, it may do your body more harm than good.
Reason 2: Side Effects and Drug Interactions
Plaquenil is known to contain side effects that are more serious than other drugs. Until dosing is found out, it is impossible to know what side effects the drug may have on your body if you take it at home.
Some of the more severe side effects include:
Severe drops in blood sugar, which may result in a hypoglycemic coma [5, 6] . This is especially dangerous for those who may have diabetes
It may lower the function of your immune system [7], which would help your body fight off infections, or make it a lot harder for those with immunocompromised systems to fight off infections; such as cancer patients.
It may cause liver failure if too much is taken [7]
Plaquenil, especially with other drugs, may affect your heart beat. It may be worse for those with existing heart conditions [8].
Plaquenil on its own may cause any of those side effects listed above, especially if taken at unsafe dosages. But if combined with certain medications used to treat the heart, liver, or kidneys it may make those side effects worse, at even small doses. Some common medication groups that have interactions with Plaquenil are:
Heart medication: Digoxin, amiodarone
Insulin/anti-diabetic drugs
Antibiotics: azithromycin, moxifloxacin, cyclosporine
Anti-epilepsy drugs
Cancer treatment drugs
Reason 3: May be dangerous for pregnant women
In previous studies, Plaquenil has been detected in the umbilical cord at levels similar to the mother’s blood level [9]. At smaller doses, Plaquenil has been shown to have little effect on the baby, but in higher doses in animal models, the drug has been found in eye tissue which may affect fetal eyesight [9, 10, 11]. Plaquenil was also found in the breast milk of those breastfeeding [11, 12]. Although no adverse effects have been found, we do not know if there is a certain dosage which may result in side effects and it is best not to take the risk at this time [11, 12].
Conclusion
With COVID remaining in the forefront of the minds of many, it is easy to get lost and connect with the latest headline or what we may have heard. Plaquenil remains just one of the possible treatments in the fight against COVID. Since there is so much to be learned about the virus and the medications being used, it is best to listen to your doctor about what is best for you.
COVID Resources
How to prevent the spread of Coronavirus
Daniel Kao, AGACNP-BC, is an Acute Care Nurse Practitioner currently practicing in NYC.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
References
Travassos M, Laufer MK. Antimalarial drugs: An overview. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 15, 2019.
Yao, X., Ye, F., Zhang, M., Cui, C., Huang, B., Niu, P., … Liu, D. (n.d.). In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed?term=32150618
Commissioner, O. of the. (n.d.). Coronavirus (COVID-19) Update: FDA Continues to Facilitate Development of Treatments. Retrieved from https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-continues-facilitate-development-treatmentsCommissioner, O. of the. (n.d.). Coronavirus (COVID-19) Update: FDA Continues to Facilitate Development of Treatments. Retrieved from https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-continues-facilitate-development-treatments
Cansu DU, Korkmaz C. Hypoglycaemia induced by hydroxychloroquine in a non-diabetic patient treated for RA. Rheumatology (Oxford). 2008; 47(3):378-379. [PubMed 18222983]
Unübol M, Ayhan M, Guney E. Hypoglycemia induced by hydroxychloroquine in a patient treated for rheumatoid arthritis. J Clin Rheumatol. 2011; 17(1):46-47. [PubMed 21169846 ]
FDA Safety Alert, April 1, 2020
Simpson TF, Kovacs RJ, Stecker EC; American College of Cardiology. Ventricular arrhythmia risk due to hydroxychloroquine-azithromycin treatment for COVID-19. Updated March 29, 2020. Accessed March 30, 2020. https://www.acc.org/latest-in-cardiology/articles/2020/03/27/14/00/ventricular-arrhythmia-risk-due-to-hydroxychloroquine-azithromycin-treatment-for-covid-19
Costedoat-Chalumeau N, Amoura Z, Aymard G, et al, "Evidence of Transplacental Passage of Hydroxychloroquine in Humans," Arthritis Rheum, 2002, 46(4):1123-4. [PubMed 11953993]
Levy RA, Vilela VS, Cataldo MJ, et al, "Hydroxychloroquine (HCQ) in Lupus Pregnancy: Double-Blind and Placebo-Controlled Study," Lupus, 2001, 10(6):401-4. [PubMed 11434574]
Motta M, Tincani A, Faden D, et al. Follow-up of infants exposed to hydroxychloroquine given to mothers during pregnancy and lactation. J Perinatol. 2005;25(2):86-89. [PubMed 15496869]
Götestam Skorpen C, Hoeltzenbein M, Tincani A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016;75(5):795-810. [PubMed 26888948
Welcome to Part 3 of our Blog Series where we talk about why female athletes are more prone to ACL injuries and what we can do to minimize risk!
Miss the early parts? Check out the links below to catch up!
Blog 1: Overview
Blog 2: Non-Modifiable Factors
In the last blog, we saw which …
Welcome to Part 3 of our Blog Series where we talk about why female athletes are more prone to ACL injuries and what we can do to minimize risk!
Miss the early parts? Check out the links below to catch up!
Blog 2: Non-Modifiable Factors
In the last blog, we saw which factors could not be physically altered to decrease ACL injury risk in females. But today we’ll look at what we can train to not only prevent injury, but improve performance as well!
Neuromuscular Imbalances
As mentioned way back in blog 1, neuromuscular control is the connection between the brain and muscles telling which muscles to fire and when, and the muscles, tendons, and ligaments providing feedback to the brain. A decrease in neuromuscular control makes an athlete vulnerable because improper or even delayed firing sequencing in muscles lead to compensations in movements or reductions in reaction time which will make the athlete more prone to chronic stress and injury.
Men and women are created differently; we all know that. On top of having a general decrease in muscle mass, strength and power compared to men [1]; most females are also quad dominant meaning they heavily utilize the quadriceps muscles during actions that require quads, hamstrings and glutes. This is important to note because if the muscles are not firing in the proper sequencing there could be greater risk of injury. For example, the hamstrings control eccentric forces and help an athlete to safely slow down after accelerating. If there is a delay in the firing of the hamstring complex (where the quads fire first causing forward stress on the knee) then that muscle group is not able to fire quickly enough to help the athlete safely slow down, stop, or change direction; causing the ACL to take over in attempts to stabilize and most likely will sprain or tear. It is ideal for the hamstring complex to be at least 60% strength of the quads [2].
A decrease in neuromuscular control is common in women and puts passive stress on the ligaments in the knee [1]
Women are also more likely than men to have leg dominance issues. Leg dominance occurs typically when the dominant leg is stronger and/or more reactive than the non-dominant leg. Most athletes have a dominant leg that they kick, throw or shoot with but female athletes are more likely to have a difference in strength from the dominant leg to the non-dominant leg.
Any time there are discrepancies on one side of the body versus the other, the athlete is more prone to injury because of the change of efficiency of the mechanics involved in certain motions performed. This can happen when one leg is stronger than the other, when one leg is more flexible or mobile than the other, or as discussed previously; when an injury results in decreased reaction time on one side versus the other. This is important to note because any athlete who has had a previous injury and especially any athlete who has had an ACL surgery is going to be more prone to experiencing leg dominance and another ACL injury [3].
For more information on these topics, find my book Surviving 7: The Expert’s Guide to ACL Surgery on Amazon.
Check out Part 4 here!
Jenna Minecci
9x Surgery Survivor/Strength Coach/Author/Athlete
B.S., CPT, CES, PES, FMS, MWod Pro
@Jennactive
jminecci@gmail.com
Jenna Minecci is a passionate Personal Trainer and Strength Coach dedicated to helping others prevent injury, prepare for surgery and recover exceptionally from any surgery they have. After having 4 ACL reconstructions fail on her as a teenager, she has now had 9 surgeries and counting. Her goal is to educate and empower others facing difficult surgeries and recovery journeys. She currently works at Lifetime Fitness in Atlanta, Georgia where she specializes in Corrective Exercise, Knee Rehabilitation and ACL Injury Prevention.
She is also the author of the book Surviving 7: The Expert’s Guide to ACL Surgery.
Follow Jenna on social media @Jennactive.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
References
Voskanian, N. (2013, June). ACL Injury prevention in female athletes: review of the literature and practical considerations in implementing an ACL prevention program. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702781/
Boden, Sheehan. Torg, Hewett. “Noncontact anterior cruciate ligament mechanisms and risk factors.” Sep, 2010. https://insights.ovid.com/pubmed?pmid=20810933
Imwalle. Myer. Ford. Hewett. “Relationship between hip and knee kinematics in female athletes during cutting maneuvers: a possible link to noncontact anterior cruciate ligament injury and prevention” Nov. 2009.
So you’ve injured your ACL and need to undergo an ACL repair.
Many factors can play a role in the cause of an ACL injury, especially among female athletes. Part of the rehab process involves working on the modifiable factors to reduce the risk of re-injury, and maintaining stability. …
So you’ve injured your ACL and need to undergo an ACL repair.
Many factors can play a role in the cause of an ACL injury, especially among female athletes. Part of the rehab process involves working on the modifiable factors to reduce the risk of re-injury, and maintaining stability. Interested in finding out more about these risk factors? Check out our Female ACL Injury Blog Series by Jenna Minecci!
But what now?! What should my rehab goals be?!
Although this is devastating for most people, what’s even more devastating is the need for repeat surgery due to complications. A lot of these complications do arise from premature return to activity. About 20% of athletes under the age of 25 re-injure themselves after surgery and even higher in younger athletes [1,2,3]. The literature and orthopedic surgery community has been grappling with this question of when is it safe to return. There is a subjective self- readiness scale (ACL-RSI) that is often used for athletes to return to sports based on when they “feel ready.”
It was recently published in the American Journal of Sports Medicine that this does not correlate with the physical readiness to return to sports and likely should be used with caution as the sole measure to determine if the athlete should return to sports [4]. There are some recent guidelines revealing that the criteria to return to activity is “simply” when the repaired knee exhibits the same strength, proprioception and function as the contralateral knee [5].
The criteria are as follows [5]:
Approximately equal strength of quadriceps, hamstring, hip musculature
Equal balance on single leg stance with eyes both open and closed
Ability to perform dynamic movements in all directions
Sport specific movements can be performed at full speed without producing pain or instability (can be a ramp up process)
These are a great set of criteria to follow and no athlete should return until they have achieved all 4. There is no time limit to meet these goals, but the literature suggests it should take about 8-12 months to achieve on average [5]. There are certainly athletes returning sooner than this, maybe around the 6-month mark, but it would be important that they meet the 4 criteria listed above before safely returning to activity. It is equally important to ensure that the athlete is psychologically ready to return to sports as well [6]. It’s important as a practitioner to advise the patient that they do risk re-injury and/or graft failure should they return to activity prematurely.
Ameeka George, MS, CPNP is a board certified Pediatric Nurse Practitioner specializing in Pediatric Orthopedic-Spine Surgery, with an emphasis on Cerebral Palsy, Scoliosis and autism.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
References:
1) Wiggins, A. J., Grandhi, R. K., Schneider, D. K., Stanfield, D., Webster, K. E., & Myer, G. D. (2016). Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine, 44(7), 1861–1876. doi: 10.1177/0363546515621554
2) Dekker, T. J., Godin, J. A., Dale, K. M., Garrett, W. E., Taylor, D. C., & Riboh, J. C. (2017). Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction and Its Effect on Subsequent Anterior Cruciate Ligament Injury. The Journal of Bone and Joint Surgery, 99(11), 897–904. doi: 10.2106/jbjs.16.00758
3) Kay, J., Memon, M., Marx, R. G., Peterson, D., Simunovic, N., & Ayeni, O. R. (2018). Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 26(4), 1019–1036. doi: 10.1007/s00167-018-4830-9
4) O’Connor, R. F., King, E., Richter, C., Webster, K. E., & Falvey, É. C. (2019). No Relationship Between Strength and Power Scores and Anterior Cruciate Ligament Return to Sport After Injury Scale 9 Months After Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine, 48(1), 78–84. doi: 10.1177/0363546519887952
5) Friedberg, R. P. (2020, March 4). Anterior cruciate ligament injury. Retrieved April 8, 2020, from https://www.uptodate.com/contents/anterior-cruciate-ligament-injury?csi=f7ef92f8-9ec9-4a76-8bd7-6c21f995a59a&source=contentShare
6) Czuppon, S., Racette, B. A., Klein, S. E., & Harris-Hayes, M. (2013). Variables associated with return to sport following anterior cruciate ligament reconstruction: a systematic review. British Journal of Sports Medicine, 48(5), 356–364. doi: 10.1136/bjsports-2012-091786
Congrats on making it through the full series! In Part 4 of this blog series, we’ll tie everything together so you will be well on your way to being faster, stronger, and smarter than before!
Miss the early parts? Check out the links below to catch up!
Blog 1: Overview
Blog 2: …
Congrats on making it through the full series! In Part 4 of this blog series, we’ll tie everything together so you will be well on your way to being faster, stronger, and smarter than before!
Miss the early parts? Check out the links below to catch up!
Blog 2: Non-Modifiable Factors
While female athletes have an increased number of risk factors; don’t forget that up to 70% of ACL injuries are non-contact in nature [1], a common example being that an athlete might pivot or slow down and experience an ACL injury. Many of these non-contact injuries can be prevented when implementing a proper strength and conditioning program with a focus on strength training, jumping, landing and cutting.
When Can Strength Training Be Started?
All female athletes should be in strength training and can start as a youth. The good news is this type of training helps keep youth athletes healthy, will benefit their athletic abilities and develop long term habits to keep them healthy throughout their lives [2]. Strength training is also important for athletes as it helps them to work on their biomechanics, become more aware of their bodies in space and decrease injury risk. Female athletes should be specifically focused on increasing core strength in addition to doing functional leg exercises with a trained expert to help with their form and technique [1]. In particular, hamstring and glute strength can be extremely important for the female athlete to help with their quad dominance issues, and overall hips and core strength can be essential to combat the weakness associated with having wider hips. Exercises using your Hip Abductors are very important for these athletes.
What Type of Areas Should My Training Be Focused On?
Another important training method for female athletes is to learn and practice proper jumping, landing, and turning motions as well as safely accelerating, decelerating and changing directions at different speeds [3, 4]. These can all be replicated to the desired sport and level of intensity. Regular skills training mimicking the athlete’s sport and position can prepare them for the movements and reactions they need to make instantaneously on their field, allowing for better mechanics and a decreased injury risk. This type of training is more advanced and is best done with trained professionals and after the girls have completed off- season strength training work.
While there is a lot you can do to prevent ACL injury, it is important to remember the basics. Most college athletes receive specialized strength training and aren’t quite as at risk as the middle school and high school girls. In middle and high school, it tends to be less organized and funding and resources for additional strength coaching usually goes to the men’s teams.
For these younger athletes, starting simple is still a great and important implementation for injury prevention to help these ladies.
Simply adding in core exercises like planks, side planks, and sit ups is effective. Integrating a proper dynamic warm up, a cool down utilizing foam rolling and a running program where athletes run and jog in multiple directions instead of just forward is also a great start. Even simple exercises geared towards strengthening the glutes and core like doing banded monster walks is a crucial piece for these 10-17 year old ladies. Practicing proper mechanics, learning from strength training and applying them into sport-like movements can be essential for female athletes to enhance their natural abilities, decrease their compensations and increase their reaction time and ability to move around more safely and efficiently in sport. Whether your sport is basketball, soccer, football, skiing, hiking, surfing or even Olympic weightlifting; there are many things you can be doing to protect your knees.
Do your research, know your risks and take action!
For more information on these topics, find my book Surviving 7: The Expert’s Guide to ACL Surgery on Amazon.
Jenna Minecci
9x Surgery Survivor/Strength Coach/Author/Athlete
B.S., CPT, CES, PES, FMS, MWod Pro
Jenna Minecci is a passionate Personal Trainer and Strength Coach dedicated to helping others prevent injury, prepare for surgery and recover exceptionally from any surgery they have. After having 4 ACL reconstructions fail on her as a teenager, she has now had 9 surgeries and counting. Her goal is to educate and empower others facing difficult surgeries and recovery journeys. She currently works at Lifetime Fitness in Atlanta, Georgia where she specializes in Corrective Exercise, Knee Rehabilitation and ACL Injury Prevention.
She is also the author of the book Surviving 7: The Expert’s Guide to ACL Surgery.
Follow Jenna on social media @Jennactive.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
References
Voskanian, N. (2013, June). ACL Injury prevention in female athletes: review of the literature and practical considerations in implementing an ACL prevention program. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702781/
Nessler, T., Denney, L., & Sampley, J. (2017, September). ACL Injury Prevention: What Does Research Tell Us? Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28656531
Hewett, T. E., Lindenfeld, T. N., Riccobene, J. V., & Noyes, F. R. (1999). The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10569353
Noyes, F. R., Barber-Westin, S. D., Smith, S. T., Campbell, T., & Garrison, T. T. (2012, March). A training program to improve neuromuscular and performance indices in female high school basketball players. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22289699
We are excited to have with us Kerry Morris (@lifeisajourknee) for the next few weeks to talk about a commonly looked over aspect of injury, surgery and recovery. Mental health!
Check out her story below, and in case you missed it her amazing podcast episode with us here!
My Story
…
We are excited to have with us Kerry Morris (@lifeisajourknee) for the next few weeks to talk about a commonly looked over aspect of injury, surgery and recovery. Mental health!
Check out her story below, and in case you missed it her amazing podcast episode with us here!
My Story
Ignorance is bliss. Many of us spend our lives oblivious to the potential dangers and pitfalls that we can fall victim to in the world, especially when it comes to our knees. One split second composed of the wrong movement or pivot, can wreak havoc on our bodies and our minds. In my experience, unprecedented damage to my knee resonated like shockwaves through my body. I tore my ACL ligament in May of 2018 in my living room. I can attest that having never had any physical damage to my body, this experience of severe pain was as scary as it was mentally debilitating. The momentary lapse of judgment with my misguided sense to step on a bee, led to a long road of recovery, temporary physical impairment and mental anguish.
The emphasis in Orthopedics is to “fix” the physical problem, however fixing the problem does not encompass or address the emotional trauma experienced by the patient. It is not the standard of care in Orthopedics to review the potential mental health resources, such as a local Sports Psychologist or other mental health counselor with the patient. Instead the attention is primarily focused on the physical aspect, such as the physical therapist options based on locality. While I can appreciate the enormous impact that physical therapy has on recovery for an injury like mine, I can not fathom why Orthopedic procedures are not also focused on the severe impact of emotional trauma.
How an injuries affect you mentally
The mental component affects every patient to some extent. Sports athletes with full scholarships to college who lose their future educational and athletic prospects due to an injury. The decrease in one's social life due to the lack of mobility also plays a role in one's self identity. People with pre existing mental health disorders become more displaced with exacerbated anxiety and catastrophic thought patterns. Future plans are cancelled. Parents cannot play with their children. Additionally, some patients simply do not have anyone to listen to them or aid them in their recoveries. The shock of the trauma, the inability to walk normally, the impact of white coat syndrome, the unknown, the fear, and the loss of self are compounded. Thoughts such as “Who am I now? Will I ever be the same? Will I ever play sports again? Will I ever be able to workout again?” This injury creates the likeness of a beautiful home with a weak foundation.
My Mission
I started using social media to reach out to knee patients shortly after my knee injury. I wanted an outlet; I wanted people who could validate and normalize my anger, confusion, sadness and anxiety. I found a home with my virtual friends on Instagram. I created @lifeisajourknee for the simple reason that I was going to connect with knee patients with all types of ailments, globally, to bring this issue to the forefront. As time went on, I decided that I wanted to open my page up to Orthopedic Surgeons, Athletic Trainers, Physical Therapists, Sports Psychologist and Personal Trainers. If I wanted to make a change I knew I would have to be impactful. Since I started the page in May of 2018, it has grown to nearly 7,000 people, industry-wide who support my mission. Orthopedic Surgeons’ from all over the world write to me and inform me that they REFER patients to me or that I opened their eyes to the emotional impact of the patients.
I am using my platform to create change. I would like Orthopedic medicine to view mental health standards of future patients as an important pre-surgical or post-injury “check point.” It takes less than a minute to ask the important questions, “How are you doing” or “Are you aware of any mental health resources to assist you in this process, if needed.” To simply ignore or cast aside the major impact that this has on mentality is to disregard the patient's OVERALL health. Most patients are not aware of their options to seek counseling or they try to be strong in the face of struggle. The messages that I receive daily from folks all over the world simply reinforce my mission; people are struggling with their knee ailments and they do not have a voice to advocate for their mental health. I want to be a voice for the voiceless. This is a crucial platform that is growing daily. My advocacy grows with the interest of my virtual world.
5 Tips on How You Can Advocate for Yourself!
What can knee patients do for themselves? Listed below are my top 5 most important advocacy tips for my Jourknee Family:
MENTAL INTEGRITY
Find it within yourself to seek the mental health that you need. Inform your family, friends, surgeon and primary that you are struggling with your knee surgery
IN IT TO WIN IT
Become your biggest advocate in the fight to overcome this adversity
TRUST YOUR GUT
If something isn’t feeling quite right etc trust your own vibes, ask PT/doctor, be safe rather than sorry, for me this is peace of mind.
IGNORE THE NOISE.
Ignore the emotional vampires who try to destroy your happiness or outlook on your future
FOCUS ON YOUR STRENGTH
You are stronger than you think.
Part 2 with Overcoming Mental Roadblocks here!
Interested in more?
You can check out her site here: https://linktr.ee/Lifeisajourknee
Or her IG here: @lifeisajourknee
And she will be speaking at ACL Study Day 2020 and can be heard in person or on livestream
KERRY MORRIS, BS, MPA, is a former patient of ACL surgery and Massachusetts native. She tore her ACL in May of 2018 and underwent surgery in June of 2018. As a non athlete, she found herself with an infamous sports injury in the world of orthopedics. Her world was turned upside down. Through pain and persistence she learned that the mental and emotional health was just as paramount as the recovery process. After months of physical therapy; ignorance was no longer bliss. Throughout her recovery, it became a profound goal of hers to help others through the use of her Instagram handle @lifeisajourknee. Through this digital avenue, she has reached out to thousands of knee surgery patients from all over the world. She believes that it is not enough to suggest that physical therapy and "at-home" rehab will cure the invisible scars that are left as a heavy burden on the minds of patients. Her goal is to support igniting the change that is needed to respect mental health therapy in the same way physical therapy is regarded for recovery.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
One of the biggest changes to occur when the COVID-19 pandemic began to come across the U.S. was the cancellation of numerous elective surgery cases to help stem infections, free up resources as well as keep patients and hospital staff safer.
According to information provided by the National …
One of the biggest changes to occur when the COVID-19 pandemic began to come across the U.S. was the cancellation of numerous elective surgery cases to help stem infections, free up resources as well as keep patients and hospital staff safer.
According to information provided by the National Center for Health Statistics of the Centers for Disease Control, in the United States around 40 million surgical operations were performed in 2000, of which 58% were women. These figures include both emergency and elective procedures.
Simply put, elective surgeries constitute a surgical procedure that is not classified as life saving and the main purpose is to improve quality of life
Elective surgeries improve the quality of life of patients. Some of these surgeries include reconstructive procedures such as tummy tuck, rhinoplasty, or breast augmentations that may not be "prescribed" by a doctor, but allow the patient to improve their physical condition and consequently raise their self-esteem.
There are also other operations such as eye surgery or joint replacements , which contribute to improving functional life, despite the fact that non-surgical options may exist.
Additionally, some elective procedures are essential to lengthen life, such as angioplasty that is used to dilate an artery to restore obstructed blood flow. However, as opposed to emergency surgery that must be performed immediately, this surgery can be scheduled according to the availability of the patient and the surgeon.
There are various elective surgeries, among the best known are the following:
Plastic Surgery: It is that intervention that aims to restore or improve the physical appearance of the patient.
Refractive Surgery: It is a surgical intervention that consists of improving the refractive capacity of the eye to correct any visual defect.
Gynecological Surgery: It is the one performed on the female reproductive system, which may be medically necessary or optional.
Exploratory Surgery: It is the operation that is performed to determine the cause and significance of a medical condition, or to take tissue samples.
Cardiovascular Surgery: It is an intervention that is executed to improve the cardiac function and blood flow of the patient.
Musculoskeletal Surgery: Covers the implementation of orthopedic surgical procedures.
Insurers and surgeons may have you see various specialists, including ones you may see already for pre-operative clearance. It is important to look into your insurance to make sure you know what procedures are and are not covered. Many times elective surgeries may only be eligible for partial or no reimbursement.
Although elective surgery may seem routine and simple, surgeons will want to make sure you are still in optimal physical condition for surgery. You may still need to undergo imaging, lab draws, as well as exams for an initial evaluation. This will help the surgeon customize the surgery for you and to ensure you are able to undergo the rigors of surgery.
Other preparations before the operation will be determined by the type of surgery. For example, bariatric surgery may require the patient undergo a certain amount of weight loss prior, or the need for pre-surgery physical therapy for a joint replacement.
The recovery period of the patient after the operation will depend on the surgery performed. Many elective surgeries now are moving toward same day discharge. Be sure to ask what goals you may need to meet prior to discharge, and what goals you should be working toward during the rehabilitation process. Also know what signs and symptoms to look for in case you need to reach out to the surgeon’s office or go back to the hospital.
Any procedure, no matter how small, carries risks. Be sure to go through all the risks with your surgeon and what they may do to minimize risks. Some common risks include infection, blood clots, and constipation.
The degree of efficacy, mortality, and morbidity are linked to a procedure. Be open to having a frank discussion with the surgeon to discuss all possibilities. Your surgeon can provide the patient with statistical information on the success rates that a given surgery can have.
With elective surgeries there are many different types of the same surgery with technology and procedures constantly being updated. Be sure to do your research to know what options are out there, and discuss with your surgeon with what option is the best for you!
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
This week we continue the second part in our newest blog series with Kerry Morris! We take a look this week and the mental health aspect of an injury and how we can turn our fears into empowerment!
Missed part 1? Check it out here!
The Mental Roadblocks
One of the constant thoughts I …
This week we continue the second part in our newest blog series with Kerry Morris! We take a look this week and the mental health aspect of an injury and how we can turn our fears into empowerment!
Missed part 1? Check it out here!
One of the constant thoughts I had throughout my injury and recovery was a resounding, “WHY ME!” I am an organized person and I had my life planned out on the perfect path, and nowhere, and I mean NOWHERE in that plan, was “tear my ACL.” I never thought I would have knee issues. The diagnosis was devastating and the idea of surgery was worse.
The problem was that no one in my family or social circle had knee issues and therefore, I couldn’t find an outlet to normalize the emotions I felt of frustration and anxiety.
Will I ever walk again? Will I always be in pain? What does your knee feel like after surgery?
I found I had all of these questions in regards to my physical and emotional state and I was left to suffer in silence.
Any type of knee injury is impactful, in that, you lose your mobility, and with a loss of mobility, is a loss of self. I wanted to know if anyone felt like I did. The first action that I took was to start a significant search on google on my injury, surgery procedures and recovery time in physical therapy. I found some articles on WebMD, Healio, Health magazine, blogs etc. However, the research provided some great information as much as some scary information. Blogs were filled with folks who had the best or the worst experiences in the operating room and thereafter. When you are innocently searching for information, you sometimes start to believe everything you read when you are trying to make sense of it. I received the same type of feedback if I asked anyone about their surgical experience, it was always filled with stories of pain and horror. At times, it felt like people wanted to scare me.
It took me a month or so but I began to realize that my research and conversations were more of a detriment to my psyche than anything else. I also realized that everyone’s pain tolerance is different, and so what may feel painful to one person may not register as that same threshold to me. I also recognized that everyone's genetic makeup and medical history is different than mine, so experiences would be different as well.
Once I had this epiphany, I was able to compartmentalize any further unsolicited information that would, for all intensive purposes in the past, darken my door.
I then realized that I needed factual information. I wanted to know the entire process from A-to-Z and in order for me to do that I needed to solicit information from the industry professionals.
I started by:
WRITING questions down for my surgeon, physical therapy etc. appointments so I wouldn’t forget in the moment.
I also EVALUATED what I felt and why
Realizing ACL surgery was a CHOICE. Therefore, no matter how many sleepless nights I incurred, crying in a depths of despair, I was making the choice to have surgery. I focused on my goals and journaled how I felt about THE CHOICE that I was making.
Once I organized my thoughts on the matter, it became less burdensome to think about surgery because I had a list of reasons as to why I wanted it. I wanted to come to grips with the facts. From there I had the power over my injury and my recovery.
The unknown is a scary place to be
Immobility can feel detrimental to your sense of self
Patience is needed with the process
You do not need to accept every opinion from others as TRUTH
You do not need to listen to anyone’s opinion that isn’t a professional
It’s perfectly fine to get a second opinion from a orthopedic professional
Be your own advocate
If you don’t vibe with your Physical therapist, surgeon, etc, find another, do not be timid
Ask questions for FACTUAL answers
Check out Part 3 Here!
Interested in more?
You can check out her site here: https://linktr.ee/Lifeisajourknee
Or her IG here: @lifeisajourknee
And she will be speaking at ACL Study Day 2020 and can be heard in person or on livestream
KERRY MORRIS, BS, MPA, is a former patient of ACL surgery and Massachusetts native. She tore her ACL in May of 2018 and underwent surgery in June of 2018. As a non athlete, she found herself with an infamous sports injury in the world of orthopedics. Her world was turned upside down. Through pain and persistence she learned that the mental and emotional health was just as paramount as the recovery process. After months of physical therapy; ignorance was no longer bliss. Throughout her recovery, it became a profound goal of hers to help others through the use of her Instagram handle @lifeisajourknee. Through this digital avenue, she has reached out to thousands of knee surgery patients from all over the world. She believes that it is not enough to suggest that physical therapy and "at-home" rehab will cure the invisible scars that are left as a heavy burden on the minds of patients. Her goal is to support igniting the change that is needed to respect mental health therapy in the same way physical therapy is regarded for recovery.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
This week is the final post in our blog series with Kerry Morris! We take a look this week a powerful tool to help you evaluate your emotional and mental health after an injury!
Missed the beginning? Check out
Part 1
Part 2
Emotional and Mental Health is a Critical to Recovery …
This week is the final post in our blog series with Kerry Morris! We take a look this week a powerful tool to help you evaluate your emotional and mental health after an injury!
Missed the beginning? Check out
Emotional and Mental Health is a Critical to Recovery
As a knee patient advocate and former ACL patient, I learned very early on that it is essential to ensure that your mind and body are equally as healthy as each other. It is easy to discount our emotional well-being as we navigate our physical health. If we pause and take a moment to conceptualize the silent impact that our mind takes during our knee recovery it truly is astounding.
How many thoughts per day are you having about the future of your mobility, your pain, or the outlook of your life after surgery?
Using the Pain Catastrophizing Scale to Help You Advocate for Yourself
In doing research on how we can better our emotional health, it was important to me to be able to provide my jourknee followers with a tool to evaluate their emotional roadmap.
I stumbled upon; The Pain Catastrophizing Scale, the scale was created in 1995 as a self report measure of thirteen questions, scored from 0 to 4 . The highest score of fifty-two indicates high levels of anxiety, depression and catastrophic thinking. Additionally having a high score may indicate the need to seek mental health services about your situation.
I am not a doctor but I can attest that I would have tested near the high score with relation to this scale during my recovery. This test is eye opening for patients and all orthopedic industry providers. I truly feel this is a scale that should be given to all orthopedic patients. As it would give the surgeon or PT an idea of where we, as patients, are coping with our diagnosis.
I have heard from many Orthopedic surgeons and industry related professionals who were not aware of the mental trauma a knee injury presents until it happened to them. Therefore, I truly believe we need to make a scale like this available in orthopedic offices to provide the best resources for patients.
For example, if this scale is administered and the results are high, then the next step should be to provide the patient with mental health resources on therapy options. Currently, this is NOT the standard of care, which translates to your surgeon is not mandated to provide any mental health resources to you, nor is your physical therapist.
Therefore, as the patient, you are left to become your biggest advocate. Therefore, I want to provide the information on this scale in the hopes that you as the reader can become educated on your options. Please use this scale as a reference with your own circumstance and reflect on your answers. Talk to your healthcare provider about this scale and your answers and see what services may be available to assist you at this time. One of the most important things that you can do for yourself is to become your biggest advocate, and I truly believe that is being one with the mind and body.
Interested in more?
You can check out her site here: https://linktr.ee/Lifeisajourknee
Or her IG here: @lifeisajourknee
And she will be speaking at ACL Study Day 2020 and can be heard in person or on livestream
KERRY MORRIS, BS, MPA, is a former patient of ACL surgery and Massachusetts native. She tore her ACL in May of 2018 and underwent surgery in June of 2018. As a non athlete, she found herself with an infamous sports injury in the world of orthopedics. Her world was turned upside down. Through pain and persistence she learned that the mental and emotional health was just as paramount as the recovery process. After months of physical therapy; ignorance was no longer bliss. Throughout her recovery, it became a profound goal of hers to help others through the use of her Instagram handle @lifeisajourknee. Through this digital avenue, she has reached out to thousands of knee surgery patients from all over the world. She believes that it is not enough to suggest that physical therapy and "at-home" rehab will cure the invisible scars that are left as a heavy burden on the minds of patients. Her goal is to support igniting the change that is needed to respect mental health therapy in the same way physical therapy is regarded for recovery.
Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Back pain is the most common reason for doctor’s visits in the U.S. It’s no wonder that it’s a topic on many patient’s minds and misinformation abounds. We are privileged to have back pain/movement specialist, Nathan Kadlecek, DPT, founder of Kadalyst Wellness and Physical Therapy, join us for …
Back pain is the most common reason for doctor’s visits in the U.S. It’s no wonder that it’s a topic on many patient’s minds and misinformation abounds. We are privileged to have back pain/movement specialist, Nathan Kadlecek, DPT, founder of Kadalyst Wellness and Physical Therapy, join us for the newest, back pain blog series!
Have questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Intro and Overview
POP. Sweet relief.
I love getting my back cracked. It feels amazing and causes me to just want to lay there for a few moments and soak it in.
When I was applying to physical therapy programs, my idea of helping and healing people from musculoskeletal issues was that I would be able to diagnose and then treat people based on their specific dysfunction. This could have been a slight positional change in the spine where one segment was rotated more than another, or a pelvis that was rotated too far forward (anterior tilt) or even one of the innominate (hip) bones being rotated more than the other on the sacrum.
I thought I was going to be going to school to fix people and that I, and only I, with my hands could determine what the true dysfunction was.
I was wrong. I had an existential crisis.
** Disclaimer: I am not a manual therapy hater and I use it from time to time.**
Tl;dr
We all have biases and beliefs that aren’t very strong if you dive in just past the surface. It’s uncomfortable to question deep seated beliefs.
Don’t confuse usefulness or effectiveness of a technique or treatment plan with the “why it works,” i.e. the mechanism. These are common errors in reasoning I see from patients and practitioners, alike... A few examples:
a. It rained and then the sun came out. The rain causes the sun to come out.
b. I got an adjustment/manipulation and now I feel better (true, many people feel better). Adjustments/manipulations put things back into place (is this true? Nope). I feel better, therefore, adjustments definitely put things back into place.
i. If the second supporting reason given is false, the conclusion cannot be true. Therefore although someone feels better, this doesn’t mean the REASONING for why it happened is correct.
3. Joints, unless dislocated by trauma, don’t go out of place, especially the spine or pelvis. They certainly can feel off or weird, but this does not correspond to an actual reliably testable positional shift. Ten different healthcare providers will see and feel ten different things when it comes to spine or pelvic position. #unreliable
Why is this important??
False beliefs can be incredibly negative, fear inducing, and self-limiting. I’ve worked with dozens of people who stopped doing incredibly meaningful activities due to the fear that was put into them by well intentioned people saying that “oh, you shouldn’t do that, it’s bad for your back, you’ll throw your back out and be damaged forever.” This is completely avoidable and it’s up to the healthcare providers AND general public to be honest with our own biases and beliefs and to be skeptical of absolutes. Here’s a quick and great read about the relationship between beliefs, self-efficacy, and chronic low back pain in references [1].
I CAN FIX YOU WITH MY HANDS!
Upon taking my first class in my physical therapy program at Columbia University, I was bright eyed, bushy tailed, and ready to learn exactly how to fix people. This started with in-depth anatomy classes with a lab section for cadaver dissection, physiology to further solidify our undergrad knowledge of each of the bodies internal processes, and various classes specific to neurological conditions, orthopedic conditions (muscle, bone, tendon, ligaments, etc.), pediatrics, geriatrics.
Each of these classes were interesting, however none piqued my curiosity more than the orthopedics courses. These were the courses that would talk about exercise, manual or manipulative therapy, soft tissue mobilization (i.e. massage), and various modalities. In these courses, particularly the spine course, I was fully engaged and soaking all of the information up like a wet sponge.
But, there was a problem. When it came time to start practicing and learning about spinal palpation (feeling spinal segments) and we were asked to perform special tests to determine the difference in rotation of various segments, or the height differences of one innominate bone (hip) from the other, I couldn’t do it. I sucked.
I’ve sucked at things before, I mean, really terrible. I was so bad at field goals my freshman year of high school that I didn’t even get the kicker position (I went on to get a scholarship in college as a punter/kicker). I barely passed neuro in PT school. And wrapping presents… yea it looks like a child did it (although there have been improvements ;) )
This spinal palpation and diagnosis thing though, I couldn’t get it. No matter how much I worked at it or practiced it, I couldn’t feel what the highly experienced professors could feel.
I remember one day I asked, “I really can’t feel the difference, and really, won’t everyone feel something differently, anyways? Isn’t this based on our own perception and confidence?” The response from the instructor was “you just need to practice more and eventually your hands will get more sensitive to the motions.” What’s funny is that I ran into this instructor a few years down the road and found that he doesn’t even believe that, go figure. The educational system is weird.
With the help of some highly skeptical friends, who were older and a bit wiser than I, they helped me build up a healthy set of skepticism towards the palpation of “segmental dysfunction,” and the idea that something was either “out of alignment,” or “mispositioned,” and that it needed to be “corrected,” and that this was somehow the cause of pain. In addition to my skeptical bros, our final ortho class was extremely insightful.
For the entirety of the past two years of PT school I had been under the impression that pain was largely caused by biomechanical faults that could be palpated and corrected by manual therapy. At the beginning of my third year, this paradigm was absolutely crushed and I was left wondering why the hell I even went to school and paid hundreds of thousands of dollars. I was left feeling disillusioned and angry that so much of what we had learned was based on old and outdated evidence. It was exhausting and defeating.
Thankfully, as time went on, and we continued to learn and push through the final third year, things started to look up. I found that instead of feeling disillusioned from my bias being challenged and destroyed, that I now had more freedom and that many of the patients suffering with chronic pain that I had worked with in the past (who didn’t respond to manual therapy at all) might have some hope after all, to suffer less, that it wasn’t about me ‘fixing’ them.
LAW OF THE ARTERY AND LAW OF THE NERVE
I love reading and studying about beliefs, behavior, bias, fallacies, and many other areas of behavioral economics. This has spurred me on to read numerous different books on the topic, one of my favorites being Thinking Fast and Slow by Daniel Kahneman. If you haven’t read this book, you need to, as you’ll realize you aren’t nearly as smart or bias free as you think.
Due to this love of learning about biases, beliefs, and becoming more skeptical, a curiosity arose. Just like I had wanted to fix people with my hands, many people before me also wanted to do the same; not only Physical Therapists, but Osteopaths and Chiropractors, too. I became curious about how each of these professions started and where in the world did the term “out of alignment,” crop up from. I’d learned and read about the origins before but never as in depth as now.
Before osteopaths, chiropractors, or physical therapists, there were “bone setters”. These bone setters were present in Indonesia, China, Japan, Russia, Hawaii, Nepal, Mexico, and other parts of the world. They performed various techniques of manual manipulation including “adjustments,” “high velocity low amplitude thrusts,” “osteopathic manipulations,” or whatever you’d like to call it. They also reduced actual dislocations of the hip, knee, and shoulders, although they had no formal medical training [2].
The first Osteopathic Medicine college: 1892, in Kirksville Missouri, Andrew Taylor Still the father of Osteopathic Medicine opened the American Osteopathic College.
Founding belief: Law of the Artery: “He based his theories of disease and dysfunction on the “disturbed artery” in which obstructed blood flow could lead to disease or deformity. This would become known in Osteopathy as the Law of the Artery.”
The first Chiropractic College: 1897, in Davenport, Iowa, Palmer opened The Palmer College of Cure, now known as the Palmer College of Chiropractic.
Founding belief: “...Palmer began to reason that when a vertebra was out of alignment, it caused pressure on nerves. He further reasoned that decreasing nerve impulses would surely affect visceral function leading to disease (the Law of the Nerve).”
The first physical therapy college: 1913, in Otago, New Zealand. The School of Physiotherapy at the University of Otago, NZ.
Founding belief: No particular “founding belief,” as this profession developed organically out of close relationships with orthopedic surgeons. PT’s were originally known as “reconstruction aides,” for injured soldiers during and after World War I (WWI). Mary McMillan was the first and most prominent reconstruction aide, as she was taught by the pre-eminent Sir Robert Jones, a physician in England who co-authored the treatise “Orthopedic Surgery.” Use of massage, corrective exercise, and other modalities were originally utilized.
Prior to the 20th century, much of medicine was still following the motto of “observe and use what helps, avoid what does harm,” which sounds good in theory, but doesn’t always work. This can be evidenced by a procedure to treat fevers back in 1796 and into the 1800's, “bleeding,” using a tool called a lancet (scalpel). It was assumed that if you get rid of the symptom, fever, you solve the problem. So… why not just make people bleed enough to where they become cold. Clearly this wasn’t a great approach and in my mind emphasizes why it’s important to also understand the mechanisms as to why things work so we don’t continue to do incredibly stupid and counterproductive things.
We shouldn’t judge professions based on their beliefs 100 years ago, and we also shouldn’t judge individual people just because they are part of a certain profession. I think this is counterproductive and does not take into account individual beliefs of practitioners and the evolution of professions over time. However we should absolutely hold people accountable when the narratives given to people about pain are incorrect as these can cause serious chronic issues down the road.
FALSE BELIEFS DO CAUSE HARM
“Why should I care about how it works or what they’re telling me, I just want to feel better.” Feeling better at the expense of possibly developing chronic pain down the road is not a healthy trade-off. Like I stated before, manual therapy and adjustments/manipulations/mobilizations all have a positive effect for many people, however the ‘why’ behind it working is also important.
Here is where I have some qualms. Over the past three years of practicing as a physical therapist, i’ve had multiple people, nearly every day, tell me either, “my back is out,” or “my hip popped out,” or “my PT said my hips were WAY off,” and I need to go get it adjusted to get it put back into place. I’ve had more people than I can count, get an adjustment to “put it back in place,” and then who are deathly afraid of exercise because it might “pop it out.” These conversations are frustrating for a few reasons. Disclaimer: * This applies to PTs, Chiros, and Osteopaths. I’m not singling one one profession, so don’t get all bent out of shape ;). *
Joints popping out... DOES. NOT. EXIST... unless you dislocate a joint in which you’ll likely need to get it reduced at the hospital. If people can’t agree on where a joint is out, then how can you know it’s a problem [3,4,5]?
Practitioners who continue to tell people their hips are “off,” or their spine is “out of alignment,” have not taken the time to analyze the evidence. They have not grown as an evidence informed clinician over their time in practice, and they are doing their patients/clients a huge disservice. Yes, these practitioners will likely help many people who were likely to find symptom resolution anyway, BUT, there is also a second order consequence that many of these people now believe that their body is fragile.
Informed opinion incoming. Based on various clients I've had who believe these statements due to healthcare providers misinformation, I posit that we have a MUCH greater % of the population that is now suffering from chronic pain. Yep, I said it. I believe, and again, this is my opinion, that if we are providing this misinformation to the public that makes them feel feeble, weak, fragile, and out of control, requiring an external force to save them, that we are in fact feeding the chronic pain epidemic [6].
There are approximately 50 million people with chronic pain in this country and millions more living with what’s defined as “high-impact chronic pain,” which is defined as chronic disabling pain that prevents one from working and highly impacts their social life and well-being.
Clearly, we have a problem. The amount of individuals suffering with chronic pain continues to increase, and seemingly, the amount of people who still believe outdated information from the 1800’s is HUGE. I will state it again, just because something has been around for 100’s or thousands of years, and has some positive effects, does not explain WHY.
This “why” is important because it’s now understood that this is a huge contributing component of who will suffer from a chronic musculoskeletal pain condition, and who will not.
SO… IF MY BACK AND HIPS DON’T GO OUT, WHAT’S GOING ON?
There is no doubt that oftentimes our back or hip feels a bit or very ‘off.’ If you really dig deep into your first experience of this feeling and who was the first few people to give you advice on it, it’s likely you’ll remember somebody who said “oh, you need to be careful,” or “you should go get adjusted,” or “wow, your hips are WAY out,” or “your L5 vertebra is way out of place by 2mm.”
Oftentimes we feel and experience pain, and immediately we tap into our memory to see if this is something similar. If it’s not something familiar that we’ve experienced before we’ll go search it up and see if we can figure it out. This is typically when someone will get told that “oh, it’s because your back is out of place,” lemme just pop it back in…
Back pain itself, especially the kind where we feel something is off, that nasty muscle spasm and grabbing feeling, or sciatica, are multifactorial. The irritated structure could be a nerve, muscle, tendon, ligament, disc, or something else, but, there may be a better way to think about this. Rather than trying to find an exact diagnosis (when there typically is not one), what if you thought about pain as what it’s NOT vs. what it is.
If you can rule out that the pain is not due to a fracture, kidney stone, infection, cancer, gall stone, and some other rare conditions, then chances are, with a program to stay moving, and working on your self-efficacy and healthy body beliefs, that things are going to be okay.
Perception is reality, however reality can be warped. If your perception is that your back hurts, therefore your back is out, then your reality that you’ve created is (likely) that every time your back hurts, it’s because your back is out. When really, this is not happening, for reasons cited above. Our perception of situations and events is usually horribly flawed. We are incredibly irrational actors, and the sooner we can accept that and become a little more skeptical and use a few more sources, the sooner we will be able to make a dent in this massive problem that is chronic and persistent pain.
Check out Part 2 to see when imaging is needed and tips on working that pain away!
What do YOU think? As always, please leave your wonderful comments below or respond directly to me via email with your love mail or hate mail :). Email me
AND for a much more in depth review of this topic please visit https://www.painscience.com/articles/structuralism.php -- it's really an epic document! VERY detailed and rational.
Some extra reading:
You can take his Overcoming Back Pain course by clicking here:
https://kadalyst-digital-wellness.thinkific.com/courses/overcoming-back-pain
You can join his free back pain facebook community here:
https://www.facebook.com/groups/BackPainSupportGroup55/
Subscribe to his youtube channel:
https://www.youtube.com/channel/UCkgXLFgOA9l9lynt35Rw5aw?view_as=subscriber
Connect on LinkedIn:
https://www.linkedin.com/in/nathan-kadlecek-dpt/
Nathan is a powerlifter and physical therapist who’s helped hundreds of people recover from injury and get strong, including iron man competitors, ultra-marathoners, weekend warriors, and high level baseball players. He completed his B.Sc degree of Exercise Science in Arkansas at Harding University and Doctor of Physical Therapy education at Columbia University in New York City.
Nathan thrives on solving large, complex problems and is on a mission to fix America’s broken healthcare system by educating people about pain, self-efficacy, and self-determination.
He’s a movement optimist
A health resiliency evangelist
References
Baird A, Sheffield D. The Relationship between Pain Beliefs and Physical and Mental Health Outcome Measures in Chronic Low Back Pain: Direct and Indirect Effects. Healthcare (Basel). 2016;4(3) https://www.ncbi.nlm.nih.gov/pubmed/27548244
Pettman, E. (2007). A history of manipulative therapy. Retrieved May 12, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565620/
Seffinger MA, Najm WI, Mishra SI, et al. Reliability of spinal palpation for diagnosis of back and neck pain: a systematic review of the literature. Spine. 2004;29(19):E413-25. https://www.ncbi.nlm.nih.gov/pubmed/15454722
French SD, Green S, Forbes A. Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain. J Manipulative Physiol Ther. 2000;23(4):231-8.
Walker BF, Koppenhaver SL, Stomski NJ, Hebert JJ. Interrater Reliability of Motion Palpation in the Thoracic Spine. Evid Based Complement Alternat Med. 2015;2015:815407.
Baird A, Sheffield D. The Relationship between Pain Beliefs and Physical and Mental Health Outcome Measures in Chronic Low Back Pain: Direct and Indirect Effects. Healthcare (Basel). 2016;4(3)
Back pain is the most common reason for doctor’s visits in the U.S. It’s no wonder that it’s a topic on many patient’s minds and misinformation abounds. We are privileged to have back pain/movement specialist, Nathan Kadlecek, DPT, founder of Kadalyst Wellness and Physical Therapy, join us.
…
Back pain is the most common reason for doctor’s visits in the U.S. It’s no wonder that it’s a topic on many patient’s minds and misinformation abounds. We are privileged to have back pain/movement specialist, Nathan Kadlecek, DPT, founder of Kadalyst Wellness and Physical Therapy, join us.
In Part 2, he goes over when imaging is needed for a back injury and 11 tips to help your back pain!
Missed Part 1? Check it out here!
Have questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Overview
Weekly, almost daily, someone shares with me that they hurt their back doing some activity that they “shouldn’t have been doing.” They'll attribute this to a herniated disc, slipped disc, sciatica, or some other malady. Or, they attribute it to some random motion they did the day prior or the fact that they sit at a desk most of the day. Oftentimes, they share that this back pain is severe, know someone who’s had this type of pain before, and ended up having to get surgery. Well… that escalated quickly. Talk about a self-fulfilling prophecy. It's amazing to me that no-one told them how beneficial physical therapy can be for back pain. This is the point in the conversation where I politely ask to put the brakes on and then slowly we back up to what actually happened.
I want to start this off with a question. If you are experiencing severe back pain try asking yourself, have I undergone a serious injury? (car accident, hard fall, etc.)? Keep your "yes" or "no" answer in mind as you continue reading the example scenario.
Jim's Scenario
Jim is cleaning up his backyard of his newly purchased home. What he didn’t realize when he made the purchase is that there were so many large rocks that he would have to move in order to put in a lawn and sprinkler system. He was going to hire a gardener to do this, but hey, he just finished watching “Rocky,” he’s feeling strong, and he doesn’t find the sense in paying someone to move some puny rocks if he can do it himself. So Jim goes and throws rocks around for a few hours. By the time he’s done, he’s developed a sharp pain on the mid to lower left side of his back. It’s debilitating. He can now barely bend over to put his socks on. He needs to lie on his bed just to get his pants on. Two days go by and it’s really not much better. He starts to become concerned and remembers that bending, twisting, and lifting is “bad.” He remembers that his own father had back pain and that it NEVER went away. He starts to think about his job, “what if I can’t stand sitting for > 1 hour, how am I going to drive to work?” This then causes him to question “what if I lose my job!” All of these thoughts are permeating through Jim’s mind. He wonders if he needs an x-ray or an MRI.
Ok, let’s pause again. Does Jim need the x-ray or MRI? Yes or no?
The answer is…..
Most likely not. Jim does have the occasional jolt that goes down his leg, but this is pretty normal in the instance of back pain. In the absence of progressive numbness, tingling, weakness, pain, loss of bowel and bladder, loss of reflexes, or a dangerous (fall, car accident) mechanism of injury, imaging is likely not necessary.
This excerpt is from the American Academy of Family Physicians going into more detail of when something is a “red” flag, please read it carefully!
When Do You Need Imaging?
Don't do imaging for low back pain within the first six weeks, unless red flags are present. (Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected.)
Low back pain is the fifth most common reason for all physician visits. Imaging of the lower spine before six weeks does not improve outcomes, but does increase costs.
Supporting Information
Low back pain is one of the most common reasons for an outpatient visit. The evaluation for low back pain should include a complete, focused medical history looking for red flags, which include, but are not limited to: severe or progressive neurologic deficits (e.g., bowel or bladder function), fever, sudden back pain with spinal tenderness, trauma, and indications of a serious underlying condition (e.g., osteomyelitis, malignancy). It is also important to rule out non-spinal causes of back pain, such as pyelonephritis, pancreatitis, penetrating ulcer disease or other gastrointestinal causes, and pelvic disease. Fractures are an uncommon cause of back pain; they are associated with risk factors such as osteoporosis and steroid use.
Most patients with radicular symptoms will recover within several weeks of onset. The majority of disc herniations will regress or reabsorb within eight weeks of onset. In the absence of progressive neurologic deficits or other red flags, there is strong evidence to avoid CT/MRI imaging in patients with non-specific low back pain [1].”
So What Do I Do About My Back Pain?
You’re probably thinking, “well that’s nice to know, what do I do then if my back hurts?” Well, you’re in luck, because the answer is pretty simple. I would tell Jim to keep moving. While it is tempting to “rest” our backs when they hurt, this is actually the opposite of what we should be doing in many cases. If you are the rare bird who deadlifts 5 times per week, then a bit of rest might do you well. If you are everyone else, then rest is probably the opposite of what you need.
In 2011, it was estimated based on a survey of 49,000 individuals in the US that only 20.6% of people get the recommended minimum of exercise per week. This includes aerobic activity which includes walking, biking, running, swimming, etc, and strength training such as lifting weights and various gym regimens [2].
If you do fall into the category of people who have back pain and don’t get the recommended levels of exercise here is a sample of what you can do to help make you feel a bit better while your back pain resolves.
Go to work. Individuals who take time off of work for lower back pain are more likely to develop persistent pain problems.
Go for daily walks, 20-30 mins.
Modify your gym routine. If you were doing a certain exercise and it hurt too much to complete, change it up a bit. There are infinite ways to modify exercises so you can complete your workouts!
Recognize that most people will experience back pain at some point in their life and that in most cases it will go away.
There are plenty of other things that are also very important to living a healthy and fulfilling life. These are equally as important than the above recommendations for lower back pain:
a. Nutrition — eating healthfully and thoughtfully
b. Sleep — getting enough of it
c. Stress — developing stress management skills — we cannot eliminate all stress but we can learn how to manage it well
d. Spirituality — religious practices, meditative practices, and other types of spirituality is important for our overall well-being
e. Healthy relationships
f. Self-reflection and personal development
The above list will be developed further in future articles. I hope that the information in this article was valuable to you, and, if you’d like more information please shoot me an email or leave a comment below.
See Part 3 for 11 exercises to get started on today!
You can take his Overcoming Back Pain course by clicking here:
https://kadalyst-digital-wellness.thinkific.com/courses/overcoming-back-pain
You can join his free back pain facebook community here:
https://www.facebook.com/groups/BackPainSupportGroup55/
Subscribe to his youtube channel:
https://www.youtube.com/channel/UCkgXLFgOA9l9lynt35Rw5aw?view_as=subscriber
Connect on LinkedIn:
https://www.linkedin.com/in/nathan-kadlecek-dpt/
Nathan is a powerlifter and physical therapist who’s helped hundreds of people recover from injury and get strong, including iron man competitors, ultra-marathoners, weekend warriors, and high level baseball players. He completed his B.Sc degree of Exercise Science in Arkansas at Harding University and Doctor of Physical Therapy education at Columbia University in New York City.
Nathan thrives on solving large, complex problems and is on a mission to fix America’s broken healthcare system by educating people about pain, self-efficacy, and self-determination.
He’s a movement optimist
A health resiliency evangelist
References
American Academy of Family Physicians. Imaging For Low Back Pain. Choosing wisely campaign. Received from:https://www.aafp.org/patient-care/clinical-recommendations/all/cw-back-pain.html
Centers for Disease Control (May 3, 2013). Adult Participation in Aerobic and Muscle-Strengthening Physical Activities — United States, 2011. Morbidity and Mortality Weekly. Report. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6217a2.htm?s_cid=mm6217a2_w
Back pain is the most common reason for doctor’s visits in the U.S. It’s no wonder that it’s a topic on many patient’s minds and misinformation abounds. We are privileged to have back pain/movement specialist, Nathan Kadlecek, DPT, founder of Kadalyst Wellness and Physical Therapy, join us.
…
Back pain is the most common reason for doctor’s visits in the U.S. It’s no wonder that it’s a topic on many patient’s minds and misinformation abounds. We are privileged to have back pain/movement specialist, Nathan Kadlecek, DPT, founder of Kadalyst Wellness and Physical Therapy, join us.
The common misconception is that when a non-fracture injury such as a muscle spasm or strain occurs, we should stop moving and only rest. It may seem counter-intuitive but after an injury occurs it is important to begin the rehab process right away.
In Part 3, Nathan goes over 11 exercises that you can do today to start strengthening your back and start that rehab process!
Start from the beginning and check out Part 1 here!
Have questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
You can take his Overcoming Back Pain course by clicking here:
https://kadalyst-digital-wellness.thinkific.com/courses/overcoming-back-pain
You can join his free back pain facebook community here:
https://www.facebook.com/groups/BackPainSupportGroup55/
Subscribe to his youtube channel:
https://www.youtube.com/channel/UCkgXLFgOA9l9lynt35Rw5aw?view_as=subscriber
Connect on LinkedIn:
https://www.linkedin.com/in/nathan-kadlecek-dpt/
Nathan is a powerlifter and physical therapist who’s helped hundreds of people recover from injury and get strong, including iron man competitors, ultra-marathoners, weekend warriors, and high level baseball players. He completed his B.Sc degree of Exercise Science in Arkansas at Harding University and Doctor of Physical Therapy education at Columbia University in New York City.
Nathan thrives on solving large, complex problems and is on a mission to fix America’s broken healthcare system by educating people about pain, self-efficacy, and self-determination.
He’s a movement optimist
A health resiliency evangelist
An often overlooked part of surgery is the nutrition factor. Eating correctly will help your body recover faster and fuel it for the increased metabolic demand. This series we have Kylie Gearhart MS, RD-AP, CDN, CNSC to give expert advice on what to eat before and after surgery!
Have …
An often overlooked part of surgery is the nutrition factor. Eating correctly will help your body recover faster and fuel it for the increased metabolic demand. This series we have Kylie Gearhart MS, RD-AP, CDN, CNSC to give expert advice on what to eat before and after surgery!
Have questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Gearing up for a surgical procedure means you have likely put in your fair share of time, research, and doctor appointments - but have you thought about your nutritional status? The way you eat and drink prior to your surgery may have a significant impact on your outcomes and rate of healing, making pre-operative nutrition therapy a vital (but sometimes overlooked) component of surgical care. Working as a registered dietitian (RD) at a primarily orthopedic surgical hospital, I have witnessed first-hand the importance of adequate nutrition prior to surgery. In fact, rare situations have occurred in which surgeons/physicians delay or refuse to perform surgery on patients who are deemed inadequately nourished. I recommend to focus on the following nutrition checklist for the months, weeks, or even days leading up to your surgery to set your body up for success:
Emphasis on protein. Surgery puts your body into a catabolic state, therefore it is important to focus on maintaining or building lean body mass with adequate protein intake and exercise (if able) to increase ease of recovery. Ensure each meal contains a protein-rich source such as eggs/egg whites, chicken, fish/seafood, turkey, lean beef, pork, Greek yogurt, cottage cheese, low fat milk or cheese, tofu, soy, farro, quinoa, beans, nuts, and seeds.
Consume a well-balanced diet. Aim to consume three meals per day (with the addition of snacks as needed) incorporating all the food groups and macronutrients. Each meal should consist of a carbohydrate (especially whole grain sources which are rich in B vitamins to combat stress), a lean protein, a healthy fat, and a variety of colorful vegetables. Fruit and dairy can be incorporated into meals or as snacks between meals.
Prevent/correct possible malnutrition. Have you experience recent weight loss, decreased appetite, or are you underweight? Unless recommended by your physician or surgeon, weight loss prior to surgery is not ideal as it increases your risk of malnutrition. Avoiding pre-operative malnutrition is of utmost importance as malnutrition is associated with negative outcomes including increased infection rates, poor wound healing and increased risk of decubitus ulcers, overgrowth of harmful bacteria in the gastrointestinal tract, abnormal nutrient losses, even mortality. Aim to incorporate healthy high calorie/high protein foods to maintain your weight and lean body mass. These foods may include: meat, dairy, beans, nuts/nut butter, seeds, avocado, fish, milkshakes or smoothies, oats, brown rice, sweet potatoes, whole grain/lentil/chickpea pasta. Protein powder and oral nutritional supplements may be recommended if you are unable to meet your calorie and protein needs via food alone.
Avoid added sugar. I am not talking about the natural sugar found in fruit, dairy, grains, or certain vegetables. I am talking about the added sugar in soda, juice, candy, cake, cookies, baked goods, syrups, and condiments which can spike your blood glucose levels. Controlling blood sugar is important for circulation, immune system function, and preventing post-op infections, especially if you are diabetic or prediabetic.
Hydrate! Studies have shown that patients who are well hydrated report less pain and nausea post-surgery. As a general rule of thumb, divide your weight in pounds in half to calculate the amount of fluid you should be ingesting daily. You may want to consider eliminating caffeine and alcohol from the diet as these act as diuretics and can remove essential nutrients from the body. Follow your surgeon’s recommendations regarding when to discontinue oral water intake prior to surgery.
Support your immune system. I suggest consuming foods rich in vitamin C and zinc to support a healthy immune system and prevent post-surgical infections. Vitamin C is found in citrus fruit, broccoli, cauliflower, kale, bell peppers, sweet potatoes, and strawberries. Zinc-rich foods include meat, shellfish, legumes, seeds, nuts, dairy, eggs, and whole grains.
Run a vitamin panel. If you have time prior to surgery, I recommend having your vitamin levels checked to correct any deficiencies. Supplements may be recommended by your physician if necessary, but I try to promote a “food first” approach.
If you are anticipating an upcoming surgery, it may be in your best interest to meet with a registered dietitian to be sure your nutritional status is optimized, shorten post-op hospital stays, and reduce complications. Not all patients fit under the same medical picture, proving individualized nutrition support to be paramount.
Final Tips
Consider setting up an appointment with an RD prior to your surgery, especially if you have experienced signs of protein calorie malnutrition including: significant weight loss, decreased appetite, a body mass index of less than 18.5 kg/m2, decreased strength, muscle wasting, and subcutaneous fat loss.
It would also be a good idea to consult with an RD if your surgeon recommends you lose weight prior to your surgery in a healthy manner, or if you take steroids/experience elevated blood glucose levels, have multiple food allergies or preferences which eliminate food groups, or exhibit poor wound healing.
Bonus: insurance typically covers these outpatient dietitian visits! We prepare for all types of major life events: races, exams, weddings, and presentations – why not prepare and nourish our bodies for surgery?
Ready to see how to eat for after surgery? Check out Part 2 here!
References:
Elwyn DH, Bryan-Brown CW, Shoemaker WC. Nutritional aspects of body water dislocations in postoperative and depleted patients. Ann Surg 1975; 182:76.
Kinney JM, Weissman C. Forms of malnutrition in stressed and unstressed patients. Clin Chest Med 1986; 7:19.
Santos JI. Nutrition, infection, and immunocompetence. Infect Dis Clin North Am 1994; 8:243.
Mainous MR, Deitch EA. Nutrition and infection. Surg Clin North Am 1994; 74:659.
Hayhurst C, Durieux ME. Enteral hydration prior to surgery: the benefits are clear. Anesth Analg. 2014; 118(6):1163-1164.
Kylie Gearhart MS, RD-AP, CDN, CNSC is a registered dietitian nutritionist based in New York City.
Associate Dietitian – New York Nutrition Group (accepting most insurance coverage and available for in person or virtual nutrition consultations): https://www.nynutritiongroup.com/
Contact Kylie for a nutrition evaluation: kyliegearhart@gmail.com
Follow Kylie on social media @kylie.nutrition
Check out her personal website: https://kylierd.com/
An often overlooked part of surgery is the nutrition factor. Eating correctly will help your body recover faster and fuel it for the increased metabolic demand. This series we have Kylie Gearhart MS, RD-AP, CDN, CNSC to give expert advice on what to eat before and after surgery!
Miss Part 1 on …
An often overlooked part of surgery is the nutrition factor. Eating correctly will help your body recover faster and fuel it for the increased metabolic demand. This series we have Kylie Gearhart MS, RD-AP, CDN, CNSC to give expert advice on what to eat before and after surgery!
Miss Part 1 on what to eat before surgery? Check it out here!
Have questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Congratulations, you made it through your surgery and are now in the recovery phase. As discussed in the previous blog post, the way you eat and drink prior to your surgery is very important, but the nutrition checklist has not ended just yet. Your diet after surgery is equally if not more important to improve rate of healing and surgical outcomes. Working as a registered dietitian (RD) at a primarily orthopedic surgical hospital, I dedicate the majority of my time to ensuring my patients are meeting their post-op estimated energy needs and recommending the ideal menu selections to alleviate any side effects of anesthesia, surgery, or pain medication. Utilize the following guidelines to be sure you are optimizing your healing and recovery through nutrition:
Emphasis on protein. Protein remains number one from the pre-operative checking to the post-operative checklist because adequate protein intake continues to be extremely important during the recovery phase. Your body just went through some trauma and is in a catabolic state, so focus on high biological value protein sources to achieve optimal wound healing and maintain your lean body mass given the likelihood of muscle atrophy in a more sedentary state. Ensure each meal contains a protein-rich source such as eggs/egg whites, chicken, fish/seafood, turkey, lean beef, pork, Greek yogurt, cottage cheese, low fat milk or cheese, tofu, soy, farro, quinoa, beans, nuts, and seeds. If patients are unable to meet their nutritional needs via diet alone, dietitians will sometimes recommend oral protein supplements such as powders or shakes.
Fiber, fiber, fiber. One of the most common patient complaints post-surgery is constipation, whether it be opioid-induced or related to lack of oral intake or movement. Fiber is an indigestible carbohydrate that helps promote bowel regularity and comes in two forms – soluble which softens stools and insoluble which bulks stools – both imperative for regular bowel movements. I encourage patients to consume prunes, prune juice, and plenty of fruits, legumes, vegetables, nuts, seeds and whole grains as tolerated.
Hydrate! Fiber and hydration go hand in hand in while combating constipation. If you are increasing your fiber intake, you definitely want to ensure you are adequately hydrated to help move the fiber along the gastrointestinal tract. Not only does water play a key factor in preventing constipation, it also is important to avoid post-surgical complications such as blood clots and infections.
Eat small, frequent, balanced meals. Your appetite may not be the greatest post-surgery as you may be in pain, fatigued, or nauseous from the anesthesia; eating may become more of a chore than a pleasure. Try have small, frequent, balanced meals and consume your fluid between meals to avoid a heavy volume of food/fluid in your stomach at once, and slowly increase your intake as tolerated. If you can only tolerate small volumes of food, aim for items packed with calories and protein such as shakes/smoothies, avocado, nut butter, and Greek yogurt. This is not the time to skimp out on calories and experience drastic rapid weight loss – even if that is a long-term goal.
Choose calcium and vitamin D rich foods. This one is especially important for bone fracture surgeries as calcium and vitamin D work together to promote bone health and formation. Calcium rich foods include all dairy products, but if you are lactose intolerant or avoid dairy for any reason, obtain calcium from dark leafy vegetables or fortified foods such as orange juice, tofu, oatmeal, or cereal. The best source of vitamin D is the sun, but it is also obtained from dietary sources such as fatty fish, eggs yolks, cheese, or fortified milk. Your dietitian and/or doctor may recommend a supplement if you are deficient or your diet lacks calcium or vitamin D.
Keep your blood sugar stabilized. Just as it is recommend you avoid added sugar pre-surgery, avoid sugar post-operatively as well (and really always!) Soda, juice, candy, cake, cookies, baked goods, syrups, and condiments which can spike your blood glucose levels disrupting circulation and immune system function, and increase your chance of infection.
Choose vitamin C rich foods. Not only does vitamin C support a healthy immune system to fight off post-surgical infections, it also helps with wound healing and bone formation. Choose foods such as citrus fruits, green and red bell peppers, collard greens, broccoli, spinach, strawberries and tomatoes.
Choose zinc rich foods. Alongside its role in immune support, zinc has also been shown to support wound healing, unite bone fractures and prevent osteoporosis due to its role in collagen synthesis. Zinc is abundant in oysters, meat, dark poultry fortified cereals, dairy, beans, and nuts.
Limit alcohol. Alcohol consumption impacts the body’s ability to absorb calcium and other nutrients and disrupts vitamin D metabolism. Alcohol intake of three or more alcoholic drinks per day can be detrimental to bone health and healing. Not saying you cannot drink again, but moderation is key and there is nothing wrong with a glass of wine daily paired with a nutritious, active lifestyle.
If you just had surgery, it may be in your best interest to meet with a registered dietitian to confirm you are eating for optimal healing, lean body mass retention, complication reduction, malnutrition prevention and to alleviate any uncomfortable nutrition-related side effects. Consult with an RD if your surgeon recommends weight loss after surgery, if you take steroids/experience elevated blood glucose levels, have multiple food allergies or preferences which eliminate food groups, or exhibit poor wound healing. As mentioned in part one of this blog series, insurance typically covers these outpatient dietitian visits and dietitians want to support and optimally fuel your body at all stages of recovery: immediately post-op, throughout the rehabilitation period, and beyond!
Check out Part 3 on nutritional supplements here!
References:
Berg KM, Kunins HV, Jackson JL, et al. Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med. 2008;121(5):406‐418. doi:10.1016/j.amjmed.2007.12.012
Elwyn DH, Bryan-Brown CW, Shoemaker WC. Nutritional aspects of body water dislocations in postoperative and depleted patients. Ann Surg 1975; 182:76.
Jensen JE, Jensen TG, Smith TK, Johnston DA, Dudrick SJ. Nutrition in orthopaedic surgery. J Bone Joint Surg Am. 1982;64(9):1263‐1272.
Mainous MR, Deitch EA. Nutrition and infection. Surg Clin North Am 1994; 74:659.
Santos JI. Nutrition, infection, and immunocompetence. Infect Dis Clin North Am 1994; 8:243.
Smith TK. Nutrition: its relationship to orthopedic infections. Orthop Clin North Am. 1991;22(3):373‐377.
Smith TK. Prevention of complications in orthopedic surgery secondary to nutritional depletion. Clin Orthop Relat Res. 1987;(222):91‐97.
Kylie Gearhart MS, RD-AP, CDN, CNSC is a registered dietitian nutritionist based in New York City.
Associate Dietitian – New York Nutrition Group (accepting most insurance coverage and available for in person or virtual nutrition consultations): https://www.nynutritiongroup.com/
Contact Kylie for a nutrition evaluation: kyliegearhart@gmail.com
Follow Kylie on social media @kylie.nutrition
Check out her personal website: https://kylierd.com/
An often overlooked part of surgery is the nutrition factor. Eating correctly will help your body recover faster and fuel it for the increased metabolic demand. This series we have Kylie Gearhart MS, RD-AP, CDN, CNSC to give expert advice on some common supplements for orthopedic patients and …
An often overlooked part of surgery is the nutrition factor. Eating correctly will help your body recover faster and fuel it for the increased metabolic demand. This series we have Kylie Gearhart MS, RD-AP, CDN, CNSC to give expert advice on some common supplements for orthopedic patients and what to watch out for when shopping for supplements!
Miss Part 1 on what to eat before surgery? Check it out here!
Part 2 on what to after surgery can be seen here!
Have questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Patients are often seeking herbal/nutritional supplements to optimize their nutritional
status and healing, however internet searches mixed with exceptional brand marketing
strategies can lead to misinformation. The job of a registered dietitian is quite often myth busting the results of those internet searches by applying evidence based research applied with the overall patient clinical picture in order to provide appropriate patient-centered advice.
This post will serve as a guide to frequently inquired about herbal and nutritional supplements by orthopedic patients.
Turmeric: This popular spice has been used for centuries, not just to flavor or color food, but for anti-inflammatory effects of the phytochemical curcumin. Research has shown that on top of curcumin’s anti-inflammatory properties, evidence exists for cholesterol-lowering, antidiabetic, antioxidant, and anticancer properties. Specific to orthopedic patients, curcumin has been shown in studies to reduce arthritis pain and swelling. There is currently no recommended dosage, however studies have suggested 1 to 3 grams of dried, powdered turmeric root per day is needed to achieve benefits. Add to coffee, tea, rice, lentils, vegetables, soups, stews, or dressings and consume with high fat foods such as olive oil, avocado, fish, and seeds to optimize absorption.
Red Algae: For thousands of years, different forms of algae have been used to help lower blood glucose levels, detoxify heavy metals, and improve gastrointestinal health. Research shows red algae may increase blood circulation, control hypertension, act as an antioxidant, regulate glucose levels, lower LDL or “bad” cholesterol, and improve the immune system. In its natural form, red algae is a sea vegetable which is rich in protein, fiber, and vitamins. If you are a sushi-lover, chances are you consume red algae in the nori sheets which are typically used to roll sushi. Red algae comes in a supplement form for those looking to achieve glucose control, lower cholesterol, or improve their immune system, however use caution with dosage as there is a risk of iodine toxicity side effects and drug/nutrient interaction, especially with blood-thinning medications due to the high vitamin K content. Consult with a doctor before beginning supplementation.
Green Tea: Green tea has been studied for decades and is strongly associated with metabolism and fat burning properties. Green tea contains catechins which are flavanoids (also found in red wine) and provide strong antioxidant activity, therefore exhibiting protection against many chronic diseases including cardiovascular disease, cancer, type 2 diabetes, and neurodegenerative disease. However, research shows that usually three to four 8-oz cups of green tea per day are needed to achieve the beneficial effects on weight loss, metabolic syndrome and type 2 diabetes, which is why some people opt for a dietary supplement form of green tea extract. Beware that excess consumption of green tea extract has been linked to liver toxicity and should only be given under direction and supervision of a physician. Green tea has beneficial effects and is healthier than many other beverages, but the capsulated form would not be something I would personally recommend as it is not worth the risk of liver injury.
Picking the Right Supplements
As a general rule of thumb, avoid products with over the top marketing and over-zealous benefit claims, ie. boasting maximized energy, rapid healing, high-performance brain power, elevated mood, ultimate relaxation, etc. These claims are likely not backed by research and more-so subjective statements used by marketers and social media experts to grasp consumers’ attention (and money). However, if patients tried a product and felt it was effective (and not just placebo effect), and their physician/dietitian feel the product is safe for consumption – by all means, continue consuming the product. It is also important to keep in mind any drug/nutrient interactions and to consult with a licensed practitioner before relying on any nutritional supplement for desired health outcomes, especially if anticipating a surgery as some dietary supplements impact the viscosity of blood. Another concept to consider is that purchasing costly functional beverages doesn’t seem to be necessary when many food sources contain the same nutrients or functional ingredients.
Food should always come first!
References:
Kylie Gearhart MS, RD-AP, CDN, CNSC is a registered dietitian nutritionist based in New York City.
Associate Dietitian – New York Nutrition Group (accepting most insurance coverage and available for in person or virtual nutrition consultations): https://www.nynutritiongroup.com/
Contact Kylie for a nutrition evaluation: kyliegearhart@gmail.com
Follow Kylie on social media @kylie.nutrition
Check out her personal website: https://kylierd.com/
An often overlooked part of surgery is the nutrition factor. Eating correctly will help your body recover faster and fuel it for the increased metabolic demand. This series we have Kylie Gearhart MS, RD-AP, CDN, CNSC to give expert advice on some common supplements for orthopedic patients and …
An often overlooked part of surgery is the nutrition factor. Eating correctly will help your body recover faster and fuel it for the increased metabolic demand. This series we have Kylie Gearhart MS, RD-AP, CDN, CNSC to give expert advice on some common supplements for orthopedic patients and what to watch out for when shopping for supplements!
Miss Part 1 on what to eat before surgery? Check it out here!
Part 2 on what to after surgery can be seen here!
Have questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!
Patients are often seeking herbal/nutritional supplements to optimize their nutritional status and healing, however internet searches mixed with exceptional brand marketing strategies can lead to misinformation. The job of a registered dietitian is quite often myth busting the results of those internet searches by applying evidence based research applied with the overall patient clinical picture in order to provide appropriate patient-centered advice.
This post will serve as a guide to frequently inquired about herbal and nutritional supplements by orthopedic patients.
Turmeric: This popular spice has been used for centuries, not just to flavor or color food, but for anti-inflammatory effects of the phytochemical curcumin. Research has shown that on top of curcumin’s anti-inflammatory properties, evidence exists for cholesterol-lowering, antidiabetic, antioxidant, and anticancer properties. Specific to orthopedic patients, curcumin has been shown in studies to reduce arthritis pain and swelling. There is currently no recommended dosage, however studies have suggested 1 to 3 grams of dried, powdered turmeric root per day is needed to achieve benefits. Add to coffee, tea, rice, lentils, vegetables, soups, stews, or dressings and consume with high fat foods such as olive oil, avocado, fish, and seeds to optimize absorption.
Red Algae: For thousands of years, different forms of algae have been used to help lower blood glucose levels, detoxify heavy metals, and improve gastrointestinal health. Research shows red algae may increase blood circulation, control hypertension, act as an antioxidant, regulate glucose levels, lower LDL or “bad” cholesterol, and improve the immune system. In its natural form, red algae is a sea vegetable which is rich in protein, fiber, and vitamins. If you are a sushi-lover, chances are you consume red algae in the nori sheets which are typically used to roll sushi. Red algae comes in a supplement form for those looking to achieve glucose control, lower cholesterol, or improve their immune system, however use caution with dosage as there is a risk of iodine toxicity side effects and drug/nutrient interaction, especially with blood-thinning medications due to the high vitamin K content. Consult with a doctor before beginning supplementation.
Green Tea: Green tea has been studied for decades and is strongly associated with metabolism and fat burning properties. Green tea contains catechins which are flavanoids (also found in red wine) and provide strong antioxidant activity, therefore exhibiting protection against many chronic diseases including cardiovascular disease, cancer, type 2 diabetes, and neurodegenerative disease. However, research shows that usually three to four 8-oz cups of green tea per day are needed to achieve the beneficial effects on weight loss, metabolic syndrome and type 2 diabetes, which is why some people opt for a dietary supplement form of green tea extract. Beware that excess consumption of green tea extract has been linked to liver toxicity and should only be given under direction and supervision of a physician. Green tea has beneficial effects and is healthier than many other beverages, but the capsulated form would not be something I would personally recommend as it is not worth the risk of liver injury.
As a general rule of thumb, avoid products with over the top marketing and over-zealous benefit claims, ie. boasting maximized energy, rapid healing, high-performance brain power, elevated mood, ultimate relaxation, etc. These claims are likely not backed by research and more-so subjective statements used by marketers and social media experts to grasp consumers’ attention (and money). However, if patients tried a product and felt it was effective (and not just placebo effect), and their physician/dietitian feel the product is safe for consumption – by all means, continue consuming the product. It is also important to keep in mind any drug/nutrient interactions and to consult with a licensed practitioner before relying on any nutritional supplement for desired health outcomes, especially if anticipating a surgery as some dietary supplements impact the viscosity of blood. Another concept to consider is that purchasing costly functional beverages doesn’t seem to be necessary when many food sources contain the same nutrients or functional ingredients.
Food should always come first!
References:
2013;39(1):69-77.
Shishodia S, Sethi G, Aggarwal BB. Curcumin: getting back to the roots. Ann N Y Acad Sci. 2005;1056:206-217.
Aggarwal BB, Harikumar KB. Potential therapeutic effects of curcumin, the anti-inflammatory agent, against neurodegenerative, cardiovascular, pulmonary, metabolic, autoimmune and neoplastic diseases. Int J Biochem Cell Biol. 2009;41(1):40-59.
Menon VP, Sudheer AR. Antioxidant and anti-inflammatory properties of curcumin. Adv Exp Med Biol. 2007;595:105-125.
Turmeric. University of Maryland Medical Center website. Last reviewed May 4, 2011. Accessed April 23, 2014.
Frenkel M, Abrams DI, Ladas EJ, et al. Integrating dietary supplements into cancer care. Integr Cancer Ther. 2013;12(5):369-384.
Seon-Heui Cha, et al. Screening of Extracts From Red Algae in jeju for Potentials Marine Angiotension-1 Converting Enzyme (ACE) Inhibitory Acitvity. Algae. 2006:21(3): 343-348.
Dennett, C. Green Tea Catechins. Today’s Dietitian. 2019: 21(8): 18.
Yang CS, Wang H, Sheridan ZP. Studies on prevention of obesity, metabolic syndrome, diabetes, cardiovascular diseases and cancer by tea. J Food Drug Anal. 2018;26(1):1-13.
Kylie Gearhart MS, RD-AP, CDN, CNSC is a registered dietitian nutritionist based in New York City.
Associate Dietitian – New York Nutrition Group (accepting most insurance coverage and available for in person or virtual nutrition consultations): https://www.nynutritiongroup.com/
Contact Kylie for a nutrition evaluation: kyliegearhart@gmail.com
Follow Kylie on social media @kylie.nutrition
Check out her personal website: https://kylierd.com/