Phone: (541) 472-0603 | 702 SW Ramsey Ave. Suite 112 | Grants Pass, OR 97527

Newsletter

Paragon Press – December 2015

07 Dec
by paragondd, posted in Newsletter

Paragon Press
December, 2015
Paragon Orthopedic Center
Grants Pass, Oregon
What is DOMS?The mystery of pain “out of nowhere”
Your goal to work out four to five times a week starting January 1st is made and you head off to the gym to begin Day 1, for a healthier 2016. The first day begins with a moderate upper body lifting regimen. You decide not to work out the next day, but when you wake up on the third day, you can barely lift your arms to get in a spoonful of cereal. What happened? Why didn’t I hurt yesterday if this is from lifting weights? Is it an injury?
The usual answer is: no. You are experiencing DOMS, or Delayed Onset Muscle Soreness. Delayed soreness can develop 12-24 hours after you exercise, with the greatest pains happening in up to 24-72 hours. This pain stems from microscopic damage done when you placed new stresses on the muscles. This damage is not permanent; it is a side effect to the repairs your body is doing, which can lead to stronger muscles and increased mass. There are certain activities known to cause DOMS:

• Step aerobics
• Strength training exercises
• Hill walking
• Jogging
• Jumping

These activities cause muscles to lengthen when force is applied, leading to the microscopic damage, and the delayed pain you will experience. The amount of DOMS pain you have depends on the type and amount of force placed on the muscles. For example, running down a hill places greater force on a muscle than walking down the same hill, resulting in more pain after the downhill run. Doing more repetitions results in more pain than less. This is the reason doctors and exercise experts recommend you start slowly.
I THINK I NEED HELP….
DOMS typically does not require you to seek medical treatment. If the pain becomes debilitating, your arms or legs become swollen, or if your urine becomes dark, then you should seek medical attention.
PREVENTION
Starting slowly into a new exercise routine is the first step to avoid DOMS. Include a cool down period of 10 minutes after exercising, raising your heart rate mildly, such as slow jogging and stretching. Allow enough time for your muscles to recover before using those aching muscles. Schedule your workout routines to cover a variety of muscle groups on different days, so you don’t stress the same group every time. Stretching before and after the exercise can help. Know that everyone can get DOMS, from the exercising newbie to the track Olympian. Let that soreness encourage you that you are working your muscles and creating a healthier body.

The following articles were referenced for this newsletter:
https://www.acsm.org/docs/brochures/delayed-onset-muscle-soreness-(doms).pdf
http://www.webmd.com/fitness-exercise/sore-muscles-dont-stop-exercising?page=2

Paragon Press – June 2015

08 Jun
by cking, posted in Newsletter

Can My Medications Hurt Me During Surgery?

If you have had surgery, you more than likely were told not to eat or drink after midnight the night before surgery, except for one or two medications taken with a small sip of water in the morning.  The surgeon needs to know exactly what you are taking to know what pills are vital to your health and those that cannot be skipped. Wait…there are more reasons to be very thorough when making that list.  Read about these commonly used medications to understand more fully how they impact your body during surgery.When you go in for a healthcare-related appointment, you usually fill out paperwork listing all your medications.  You might not be very careful to list every single last one, but did you know it is crucial to list every prescribed and unprescribed medicine when you go in for orthopedic surgery?  Your surgeon needs to know each drug you take, its dosage, and what it does for you in order for your surgery to have the best outcome possible.  Your primary care physician should be able to give you a complete list of prescription medications to take to your surgeon, and don’t forget about anything bought over the counter that you take.

 DID YOU KNOW?  Nearly 70% of Americans are prescribed at least one medication.

Blood Pressure Medications: These are usually continued the day of surgery to maintain your regulated blood pressure.  If your medication and blood pressure have not been stabilized prior to surgery, it could mean a delay for your procedure.  A stable blood pressure is a must before undergoing any surgical procedure.

Diabetic Medications:  Because the stress of surgery can lead to higher blood glucose levels, your insulin might need to be adjusted for surgery.  Some oral diabetic medications may need to be stopped before you are given anesthesia.

Blood Thinners:  In most case, these need to be stopped 5-7 days prior to surgery.  Your surgeon will let you know how soon to stop taking them and when to resume them.  The reason for this is thinners cause extra bleeding that could cause swelling or an infection at your surgical site.

Steroid Medications:  To maintain your body’s steroid levels, which are important for blood pressure regulation, these are usually continued the day of surgery.  If your steroid level drops, it could lead to low blood pressure problems during surgery.  This is dependent on what levels of steroids you take, so be specific about your dosage with your surgeon.

Heart Medications: These are normally continued the morning of surgery, taken as usual.  A thorough heart history is necessary before surgery.  Sometimes, additional heart medicines, called beta blockers, are added to decrease the risk of any heart problems during surgery.

Dietary Supplements:  Some over-the-counter supplements can interfere with medications necessary for your surgery.  Other over the counter substances can cause surgical bleeding. Taking them can lead to complications, so be thorough about reporting them all.

Immunosuppressant Medications:  If you are a transplant patient, or have an inflammatory condition, such as arthritis, the immunosuppressants you might be taking could significantly slow wound healing after surgery.  Have a discussion with your surgeon about temporarily stopping these.

Understanding the impact of medications on your body’s processes gives more insight into your surgeon’s need to know in advance.  Always be detailed about anything you are taking for the best surgical outcome.

The following articles were referenced in making this newsletter:

Preparing for surgery, medication checklist; why the surgeon needs to know about them

http://www.orthoinfo.org/topic.cfm?topic=A00718

http://www.healthline.com/health-news/policy-seventy-percent-of-americans-take-prescription-drugs-062113

 

Paragon Press May 2015

22 May
by cking, posted in Newsletter

Start off the summer season with a new exercise program

The American College of Sports Medicine’s 10 tips

The warmer days are arriving. Exercise is on many people’s minds, but they lack a trigger to get started, or just don’t know how to begin getting in shape. Paragon Orthopedics sees many patients who have regrets about not being in better shape after a serious injury. To help you, here are a few pointers from the American College of Sports Medicine to create an active exercise plan that gets you excited to begin!

1-Get to know your body.

Without knowing the basics of your muscles and how they work together, you might be putting yourself at risk for injury. The internet is full of information on the basic muscles used in exercising.  Know the difference between good pain, from working your muscles harder, and bad pain, from joint problems or a ligament tear. Rest and stretching are sometimes what is needed, instead of trying to push through pain as you start a new program. Some health clubs have trainers to help you distinguish good pain from bad pain.

2-Understand why you are exercising.

Ask yourself, “Why did I begin to exercise?”  This clarity helps you stay positive and stick with the exercise program.  Mental motivation can act as fuel to experience more positive effects.

3-Assess your current fitness level before starting.

For example, write down your pulse rate before and after walking a mile; count how many push-ups you can do in 30 seconds; and measure your waist circumference.  You can’t know your progress unless you have a starting point.

4-Set mental goals.

Have in your mind a realistic picture of what being in good shape can be for you. These positive thoughts will propel you toward your goals.

5-Identify activities that will help you attain your fitness goals.

Choose activities that interest you, not just what you see others doing. If running is boring, don’t plan on using the treadmill. However, if you enjoy the camaraderie of a spinning class, or prefer the weightlessness of swimming, use these activities to take you to your new fitness level.

6-Develop a comfortable routine.

The ACSM recommends adults have at least 150 minutes of moderate to intense physical activity every week. Build the exercise into your daily routine. Don’t overdo it, especially in the beginning, but don’t do too little. Start out with something that feels comfortable and increase from there. Recognize what has stopped you in the past from sticking with a routine. Listen to your body.

7-Write it down!

Organize your daily and weekly goals on paper. Those who write down their goals can accomplish up to 16% more than those who don’t. Some people have found success using computer programs that monitor your progress, but if the thought of this makes your plan feel more complicated, go with paper and pencil.

8-Have the correct equipment to make exercise enjoyable.

Purchase those water weights or new walking shoes that don’t hurt your big toe. If you are more motivated with music, compile a soundtrack with your favorite songs. Studies show music is a really good motivator for longer and more vigorous exercise.

9-Create incentives.

Develop a reward system before you begin your new plan, and make the rewards realistic.

10-Get started and feel confident.

After all that preparation, you should feel motivated to put your plan into action. Know improvements will take some time and give yourself several months to see an impact. Trust you have developed a great plan and can see it through for success!

All of this might sound like a lot of work, but studies have shown that the clarity of having a plan produces better fitness results. Always consult a therapist or doctor before you begin if you are already being monitored for health conditions. Don’t be afraid to reset your goals to keep your plan realistic, especially if you’ve had a setback. Maybe you set your goals too high and you’ve found the plan to be overwhelming. Reassess and create something you can stick to doing. If an activity has become boring, switch the plan to one that makes you more interested.

Get started today!

The following articles were referenced in making this newsletter:
http://www.paragonortho.net/2015/01/sports-docs-give-tips-on-getting-into-an-exercise-program/
http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/fitness/art-20048269

Paragon Press April 2015

06 Apr
by cking, posted in Newsletter

Overuse injuries once only developed in professional athletes, but today we see it in children, largely as a result of sports specialization and excessive play.  Even weekend warriors who do too much at once are prone to these.  Here are some tips to keep in mind for you, your kids, and your grand-kids:

•  Playing one sport year-around doesn’t allow for a period of rest.  Give those stressed joints a break and take a few weeks off between seasons.

•  Don’t allow a coach to overuse a child during one game or tournament.
STRETCH, STRETCH, STRETCH…like taffy, muscles want to be warm to move easily.

•  Keep a balanced approach.  Playing more than one sport allows different muscles to be used, thus making new muscles be used and others to not feel so much stress.

Name that tuna

Canned tuna is the second most popular seafood product in the U.S. after shrimp.  This protein-packed food, which keeps in the can for 4 years, is a great source of vitamin B-12, vitamin D, calcium, and iron.  If you have been to the grocery store lately, you might wonder which type is best for you.  Is white better than light?  What’s the difference between solid and chunk?  Why are some packed in oil and some in water?  We will try to demystify these terms and help you feel confident you are buying what’s best for you and your family.

Solid or Chunk?

“Solid”, or “Fancy,” is a fish that was packaged as a whole piece, whereas “Chunk” means the piece has been broken into pieces.  It’s a matter of texture preference.

White or Light?

A label that indicates “white” tuna is the albacore variety only.  This fish is a more mild-flavored fish with a firm texture.  Because it is the truest white meat of the 7 tuna varieties, it is more expensive and considered “premium.”  Albacore also contains more omega 3 fatty acids than light tuna, 808mg per serving, versus 239mg in light.  Consider this: Canned albacore is higher in mercury and more expensive than canned chunk light tuna.

Oil packed vs. Water

Fats carry flavor, so tuna packed in oil will have a fuller flavor and more appealing mouth feel.  However, if you’re concerned about fat content, water-packed tuna has only 0.75g of fat per serving, as opposed to 6.9g for oil-packed.  Water-packed tuna is a great, lean protein source.

The following articles were referenced in making this newsletter: http://www.healthytuna.com/about-tuna/tuna-facts http://www.livestrong.com/article/483086-chunk-light-tuna-vs-albacore/ http://www.differencebetween.net/object/comparisons-of-food-items/difference-between-albacore-and-tuna/ http://www.nrdc.org/health/effects/mercury/guide.asp Nanette27, Tiptoe Through the Tuna, Allrecipes, 2015, Feb/Mar, p 15 Johns Hopkins Health Review, Fall, 2014, p.21

Paragon Press February 2015

21 Feb
by cking, posted in Newsletter

THE NEW YOU FOR 2015: Essential information you and your health

Save your money:  Skip the vitamins

The commercials make you think you aren’t as healthy as you could be unless you take them.  However, study after study has shown no ability of vitamins to increase your lifespan, or decrease your chances of fighting a chronic disease.   According to researchers at Johns Hopkins and other institutions, eating a healthy, well-balanced diet gives you all the nutrition you need.  They discovered even more: taking certain supplements can increase your risk of death.  Additional beta carotene, vitamin E, and vitamin A are considered useless and potentially dangerous.  Even though you might be in the habit of taking that vitamin with your orange juice every morning, in light of this news, you’d be better off spending your money on more fruits and vegetables.

Switching to diet soda isn’t a guarantee for weight loss

Regular soda contains many empty calories: about 140 calories per 12oz can.  People automatically think switching to diet soda, with virtually no calories per ounce, will make them lose weight.  Did you know that new research shows overweight adults who drink diet sodas are likely to compensate by eating more food, thus resulting in no weight loss?  A study published in the American Journal of Public Health showed obese/overweight adults drinking diet sodas consumed more calories at mealtimes and when snacking compared to obese/overweight adults who consumed sugary beverages.  If you switch to diet soda for weight loss, you need to also eat less.  It would be smart to look at other areas in the diet where empty calories are consumed, such as candies and gum, and adjust eating habits as well.

How healthy are those freeze-dried snacks?

Freeze-dried fruits and vegetables are a trendy way to sneak in vitamins and minerals these days, but are they really that good for you?  Technically, companies have just taken the only the water out of the food, but unfortunately, they sometimes add sugars to make them taste better.  These hidden calories can add up in a day.  Also, snackers might find some abdominal discomfort because of their concentrated fiber.  It’s easy to eat 20 dried apple slices, but think about how much that would be if it wasn’t dehydrated.  Despite these downsides, the dehydrated snacks are much better for you than candies and sugary snack bars.  Eat with moderation.

More sleep, a better you in 2015?

We’re a nation of sleep cheaters, trying to get more out of the day.  If you’ve made a promise to get more rest this year, here are some tips to get quality zzz’s.

•    Exercise-Moderately, three to four times a week.  Research has shown exercise improves sleep.
•    Limit caffeine-Don’t drink caffeinated drinks after 4pm.  Research shows they disrupt sleep patterns.
•    Relax-Make it a habit to relax one hour before bed.  That includes shutting off electronics, such as televisions and computers.  The light from these can delay your sleep onset.
•    Control light-Keep your bedroom cool and dark, using a sleep mask, if needed.

The following articles were referenced for this newsletter:

http://calorielab.com/brands/soda-pop-and-sport-drinks/47

Pierre, C.(Ed.). (2014). Diet Soda’s Downside. Johns Hopkins Health Review, 1(1).

Pierre, C. (Ed.. (2014). Skip Those Vitamins. Johns Hopkins Health Review, 1(1).

Pierre, C. (Ed.). (2014). Before You Pack Those Freeze Dried Snacks… Johns Hopkins Health Review, 1(1).

Richards, S. (2014). Cheating Sleep. Johns Hopkins Health Review, 1(1).

Paragon Press October 2014

24 Oct
by cking, posted in Newsletter

Two patients have the same knee replacement surgery.  One goes to a state-of-the art medical hospital.  The other goes to a surgery center.  Both are located in the same town, with experienced surgeons.  One costs $15,000 and the other costs $3,000.  Why the difference?

Hospitals Prove More Expensive Than Surgery Centers; Quality up with lower cost facilities

A study this month in the Journal of the American Medical Association (JAMA) set out to see if costs at medical facilities owned by local hospitals, such as the newly built Asante Center for Outpatient Health, are higher than places owned by physician groups, such as Paragon Orthopedic Center and the Grants Pass Surgery Center.  It was determined that the hospital-0wned facilities were charging patients higher rates for outpatient procedures, labs for diagnostic tests, and professional services.

Large hospitals have the negotiating power to raise the prices for their services and negotiate higher fees.  According to a study done by the Urban Institute, insurance companies, whether they are non-profit or for-profit, are not to blame for the high price of medical costs.  Forbes magazine noted, “As hospitals bond together in ever larger networks, their negotiating leverage rises much more quickly than the quality of care.” Smaller can be better, and less expensive.  Patients are urged to be knowledgeable of prices for everything from labs, to diagnostic tests, to surgeries.  Know there are options out there for high-quality, lower-cost care.  The healthcare providers at Paragon are always willing to discuss how to get your healthcare needs met at the best prices.

Americans frequently shop around for the best deals in food and clothing. Why don’t we do the same for our healthcare?

Focus: EBOLA

People are growing in their concerns about the Ebola virus, however, there has been a lot of good information and misinformation about the spread of it.  Educate yourself and others.

Here are the most recent facts on Ebola:

  • Symptoms occur between 2 and 21 days after exposure.  Symptoms include fever, severe headache, muscle pain, diarrhea, vomiting, abdominal pain, and unexplained bleeding.
  • The fatality rate is 50 percent.  A person is immune for 10 years if the person recovers.
  • The disease is spread by direct contact with blood and other body fluids from an Ebola-infected person.  IT IS NOT SPREAD THROUGH THE AIR OR WATER.
  • It has been suggested that dogs can get Ebola, but the chance of a dog in the U.S. contracting it is very small because our dogs aren’t near corpses or eating infected animals.  More studies need to be done for conclusive facts on dogs carrying Ebola.

Don’t let all the media attention on this virus distract you from being concerned about other really important health matters, such as getting your flu vaccination and always washing hands.

The following articles were referenced in making this newsletter:

http://jama.jamanetwork.com/article.aspx?articleid=1917439

http://www.forbes.com/sites/peterubel/2012/10/01/are-insurance-companies-the-key-to-lower-prices/

Miller, Robin. (2014, October 10). Focus on overall health rather than Ebola scare. Daily Courier, Grants Pass, Oregon, p12A

Paragon Press September 2014

04 Sep
by cking, posted in Newsletter

Pills that kill

Pain pill overuse 

Opioids: prescription medications that relieve pain, such as hydrocodone(Vicodin), oxycodone(Percocet), morphine, and codeine.

Facts:

  • •  46 people die every day in our country from legally prescribed pain pills.
  • •  Prescriptions for opioids have climbed 300% over the past decade.
  • •  Opioids are the most commonly prescribed medication in the U.S., with a cholesterol drug coming in second.
  • •  Patients have a 5-25% chance of becoming addicted to pain pills if taken long term.
  • •  60% of opioid overdoses occur in people who got their prescription from a doctor.
  • •  90% of people with chronic pain end up taking opioids.  There is little evidence that opioids work when treating chronic pain.

Myths:

•  It is less likely for women to become addicted than men.

While the numbers for addicted men outnumber that for women, women often become addicted more quickly than men.

•  Opioids are always the best treatment for pain

Over the counter pain relievers, such as Ibuprofen and Tylenol, can relieve a variety of pain issues and are sometimes the best choice for pain relief.  It depends on the pain, so discuss this with your healthcare professional.  Do not discount non-prescription pain relievers just because they aren’t prescription.

•  You cannot become addicted if you take opioids to treat pain

It is easy to become addicted to pain killers when they are not taken exactly according to your doctor’s instructions

•  Extended-release pills are safer

These are definitely stronger than short-acting forms, but there is no evidence that long-acting drugs work better or are safer than short-acting ones.  Doctors have found people dependent on opioids seek out the higher potency of the long-acting varieties.

Avoiding the addiction

Nobody who takes opioids with a prescription expects to become addicted to them.  There are a few things you can do to prevent this from happening you:

  • •  Take pain pills exactly as directed.
  • •  Know how to lower your dose as your body heals and needs less pain
    medication.  Get clear instruction from your healthcare provider.
  • •  If pain and function aren’t improving by 30%, the pain pills likely are not
    working and are not worth the risks.  Talk with your doctor instead of taking
    more and more pills.
  • •  Keep all prescription pain medicine in a locked, secured location.
  • •  Discuss how to transition to nonprescription pain medicines, if your healthcare
    provider is not specific about this.  There should be a plan for weaning off the
    opioids.
  • •  Be responsible for your healthcare by seeing your healthcare provider regularly
    and make sure your pain pill regimen is appropriate for your situation over
    time.  Chronic pain especially requires regular management.

Finally, it is important that you never share your pain medication. Medications are given specifically for the individual, for specific reasons.  Potential interactions with other medications, unforeseen side effects, allergies, inappropriate dosage, and the wrong drug for the treatment regimen, potentially making your medical situation worse are just a few of the reasons sharing is a bad idea.  What is good for you might not be good for another person.  Again, you need to be under a healthcare professional’s care for pain killers.  Take them very seriously so you can have the best medical outcome, best pain control, and avoid complications.

The following articles were referenced for this newsletter:

“Deadly Pain Pills.” Consumer Reports, August, 2014: 19-22.

http://www.consumerreports.org/cro/video-hub/health/drugs/pain-pill-dangers-avoid-deadly-addiction/16601919001/3705124027001/

http://www.forbes.com/2010/05/10/narcotic-painkiller-vicodin-business-healthcare-popular-drugs_slide_3.html

http://www.drugabuse.gov/publications/research-reports/prescription-drugs/opioids/what-are-opioids

http://www.medicinenet.com/script/main/art.asp?articlekey=17186

Paragon Press July 2014

25 Jul
by cking, posted in Newsletter

What You Can Do To Increase Your Chances of Successful Surgery

Firstly, are you a good candidate?
You have an appointment with your surgeon and he tells you your problem requires surgery.  You ask how soon it can be done, and he tells you he can’t do it, or even that he won’t do it. Nobody wants to be told they can’t have what they want, but surgeons realize with some patient choices, the chances of the surgery being successful are slim to none. A surgeon wants your surgery to be successful, just like you do, but did you know certain choices can make you a poor surgical candidate?

Two that are too risky
Statistics show that certain unhealthy behaviors make surgery less successful. Two behaviors which are frequently the cause of poor surgical outcomes are:

•  Smoking
•  Obesity

We would like to think we all heal the same, but studies show this is not the case.  Factors such as age and preexisting health problems can be causes for failed surgeries, but they are beyond our control.  There is a significant body of research that shows smoking and obesity can drastically decrease the chances of a successful surgical outcome and these are behaviors that a patient can change. Smokers and obese patients in England are being denied for in vitro fertilization, breast reconstruction, and new hip/knee surgery unless they slimmed down or stopped smoking.

Smoking
A recent study found in the Journal of Bone and Joint Surgery (JBJS) compared the clinical outcomes of nonsmokers, current smokers, and former smokers following knee surgery.  The researchers concluded smoking had a negative effect on surgery and heavy smokers showed even worse outcomes.  Patients who stopped smoking at least one month prior to surgery had the same outcome as a patient who never smoked.  According to the American Association of Orthopedic Surgeons (AAOS), smoking may be the single most important factor in postoperative complications.  Smoking complications include:

•  Poor wound healing
•  Infection
•  Less satisfaction in the final outcome of surgery

Broken bones take longer to heal in smokers because of the harmful effects of nicotine on the production of bone-forming cells.

Cigarette smoking is recognized as one of the major causes of preventable disease.  Many people are very aware of how smoking affects your lungs, but not many know that it has serious negative effects on bones, muscles, and joints, and that smoking often leads to poorer surgical outcomes, especially in orthopedics.

Obesity
Two-thirds of the American population is considered overweight or obese.  Study after study has shown the deleterious effects of obesity on a person’s health.  Obesity is associated with over 60 medical conditions.  Among the more studied are:

•  Cardiac fitness-Studies show the stress of surgery on the heart might increase the chances of a cardiac event or increase chance of death in an obese person.

•  Diabetes-In one study of diabetics, 28.3% developed post-operative complications after orthopedic surgery as a result of their diabetes.

•  High blood pressure-This can negatively affect cardiac function, as well as many other organs within the body.

•  Sleep apnea-According to Dr. William Mihalko of the Campbell Clinic at the University of Tennessee, obese patients with sleep apnea have higher complication rates after orthopedic procedures.

Obese patients tend to have poorer outcomes and the expense of treating them is much higher than that for non-obese patients.  Complication rates for patients with a BMI over 40 (considered “morbidly obese” is 22%. Children are also included in all these warnings, since nearly one in three children is overweight or obese.  Inactivity and obesity combined can take as many as 7 years off life expectancy.

This should open your eyes to what you can do for your health.  If you struggle with your weight, it’s easier to take off the weight before arthritis occurs and makes it more difficult exercise.  If you can quit smoking even just one month prior to surgery, you have increased chances of surgical success.  Talk to your surgeon to make sure you are in the best position to have a successful surgery.  Both of you want only the best!

The following articles were referenced for this newsletter:
http://jbjs.org/content/96/12/1007
http://orthoinfo.aaos.org/topic.cfm?topic=A00262
http://www.theguardian.com/society/2012/apr/28/doctors-treatment-denial-smokers-obese
http://www.generalsurgerynews.com/ViewArticle.aspx?d=Extended+Hernia+Coverage&d_id=478&i=January+2012&i_id=806&a_id=19990
http://www.aaos.org/news/aaosnow/apr13/cover3.asp
http://www.ncbi.nlm.nih.gov/pubmed/23479424

Paragon Press June 2014

10 Jun
by cking, posted in Newsletter

Ouch, My Elbow Hurts!
Tommy John surgery proves very successful; Why so many

Elbow problems begin at young ages

Many people have elbow issues, especially at older ages, simply from overuse.  Once the elbow discomfort reaches a point when you cannot function, surgery is considered.  In the last 10 years, there has been a sudden increase in elbow surgery mainly in athletes, and of those, mostly baseball players.  Baseball pitchers of every age are throwing harder and starting at younger and younger ages.  These two factors alone add a lot of stress to a very delicate ligament in the elbow, known as the ulnar collateral ligament, or UCL.  The surgery to reconstruct this ligament is called Tommy John surgery, named after the former major league pitcher who was the first to have this surgery.  When the UCL is damaged, there is often pain and instability with throwing, thereby making accurate, fast pitching impossible.  This can be corrected with surgery, where the ulnar collateral ligament is replaced with a tendon from elsewhere in the body.  Many collegiate and professional athletes from many sports have this surgery, but it’s most notable in baseball.

So why the sudden increase in the number of people having Tommy John surgery?  Since 2004, the number of these surgeries has tripled in the major league pitching community, from 12 in 2004, to 36 in 2012.  The surgery has proven to be so successful that pitchers want the surgery done as soon as possible, and the MLB boasts a long list of pitchers who have successfully returned to pitching afterward, earning tens of millions of dollars post-surgery.  There is the lure of believing it’s a guaranteed fix, and for major league pitchers, a lot of money is at stake.

The downside: It’s not fool-proof

There’s no injury that can’t be made worse with surgery.  A study in the American Journal of Sports Medicine showed a 97.2% rate of return to pitching in the pros. The rate of return is much lower in amateur or college athletes. The typical rehabilitation period is a year, but can be longer.  Athletes can spend a long time on the disabled list and some might never see a return to full function.  Pitchers are throwing higher velocity baseballs and something has to give when they keep this up over time.  It seems it’s the elbow that takes the brunt of the force.

Younger and younger ages-A lesson for all kids

Kids these days seem to be forced into choosing a specific sport, which doesn’t allow any period of healing for parts of the body that are stressed.  Well-meaning parents start a child in baseball at 5 or 6 as a pitcher, then a coach might encourage playing on a travel team in the off-season to continue improvement.  As a result, studies show the child becomes three times more likely to end up requiring surgery than those kids who don’t play baseball year-round.  Parents have to be careful about overuse in the body, paying attention to a child’s complaint about soreness and providing rest for that part of the body.  More is not always better.

Myths

#1-The injury happened suddenly or from overuse in a game.

These are myths because tests have shown the ligament becomes torn and frayed over years.  The years of abuse take their toll and the ligament snaps.

#2-Some pitchers have found that they throw harder after the Tommy John surgery.

Indeed, they might, but the results are not from the surgery.  Pitchers throw harder as a result of the rigorous work they did for rehabilitation.

Question: How can you expect a ligament, that doesn’t have as much blood supply as the muscles, to endure repeated wear and tear from excessive, high velocity throwing, such as that which happens in pitching?

The answer: You can’t.

Pitchers have developed their musculature to deliver a pitch that maximizes their potential, but the ligaments and tendons simply can’t keep up with that force.  We can’t expect that major league pitchers will slow down, but we can be aware of the demands we place on the Little Leaguers and other young athletes who compete or pitch in year-round travel teams where a lot of stress is placed on the elbow.  We need to respond to their complaints of elbow pain with ice and rest.

The insights we’ve gained from the studies on Major League pitchers can be applied to many other people with elbow issues.  Any elbow injury is initially treated with rest, nonsteroidal anti-inflammatories (ibuprofen), and ice.  Patients then go through a physical therapy regimen to strengthen surrounding muscles. In some cases the injury will respond well to a cortisone or platelet injection.   There are those candidates who prove to benefit from immediate surgery.  These patients have not responded to non-surgical treatments and they want/need to resume strenuous throwing as soon as possible. In most cases these are elite high school, college or professional athletes who specialize in throwing.  Orthopedic surgeons often recommend a non-surgical approach for weekend athletes as they will likely do just fine without “Tommy John” surgery.

The following articles were referenced for this newsletter:

http://www.usatoday.com/story/sports/mlb/2014/04/11/tommy-john-elbow-surgery-strasburg-parker-corbin/7583413/

http://en.wikipedia.org/wiki/Tommy_John_surgery

http://www.baseball-reference.com/bullpen/Tommy_John_surgery

http://www.webmd.com/fitness-exercise/tommy-john-surgery-ucl-reconstruction

Paragon Press May 2014

15 May
by cking, posted in Newsletter

ORTHOPEDIC NEWS BITES


 Could a Total Hip Replacement help me live longer?

Research has shown that patients who receive Total Hip Replacements (THR) have an improved quality of life and reduced overall pain. Some patients treat the hip pain without surgery, but studies show the replacement surgery:

✓ Prolonged their lifespan
✓ Reduced risk of heart failure
✓ Reduced rate of depression
✓ Lowered the risk of diabetes

Not only did these researchers prove there are added benefits to having a total hip replacement, patients actually save money by having the surgery.  It is fairly expensive to manage disability related to hip arthritis.


 Symptoms You Should NOT Ignore

Have you had something change in your health that made you scratch your head?  Did it come out of the blue?  Are you wondering if it’s worth a trip to the doctor’s office?  Here are some of those issues you shouldn’t keep to yourself because they are indicators of a problem.

◘  Constant canker sores: Can be a sign of celiac disease

◘  Blood in your stool: This can indicate many issues, such as colitis, diverticulitis, hemorrhoids, or even cancer.

◘  Shortness of breath: Causes can range from asthma, to low blood pressure, to a heart attack.

◘  Sudden weight loss/gain: Unexplained weight loss/gain of 5% of your body weight.  Possible reasons: lack of sleep, stress, medication, or a new medical condition.

◘  Sudden hearing loss: Sudden hearing loss is not related to a general wax build-up within the ear. Immediate treatment is very important to preserve hearing.

◘  Confusion or personality changes: Changes in behavior or thinking can be from dehydration or low glucose levels, or from something more serious, such as reaction to a medication.

◘  Flashes of light in your vision: These can result from migraines, or signal a retinal detachment.  Immediate attention is needed for retinal detachments to prevent permanent vision loss.


 Daily Aspirin Not Helpful For Everyone

An analysis of the data from major studies shows that only those who have had a previous heart attack or stroke will benefit from a daily low-dose tablet of aspirin.  There is no evidence that taking aspirin as preventative medicine without a history of a heart attack, stroke, or heart problems is effective.  In this case, a daily aspirin can actually put you at risk for its side effects, such as bleeding in the stomach or brain.  Anyone considering taking low-dose aspirin needs to discuss the risks and benefits with their doctor to determine if it is helpful.  If your doctor does recommend a daily aspirin, be sure to check the dose on the bottle and if there are added ingredients, as some aspirins combine other pain relievers that should not be taken for long-term therapy.

The following articles were referenced for this newsletter:

http://www.amjorthopedics.com/articles/conference-news/article/thr-may-reduce-mortality-heart-failure-and-have-other-benefits/509f00bf83be2c66f5d8396adcc26d3f.html

http://www.costcoconnection.com/connection/201312?pg=56#pg56

http://www.mayoclinic.org/symptoms/unexplained-weight-loss/basics/definition/sym-20050700

http://www.webmd.com/diet/features/5-surprising-reasons-you-are-gaining-weight

http://www.mayoclinic.org/healthy-living/adult-health/in-depth/symptoms-not-to-ignore/art-20045276?pg=1

http://www.rush.edu/rumc/page-1298330129309.html

http://www.webmd.com/heart-disease/news/20140506/daily-aspirin-regimen-not-safe-for-everyone-fda-warns