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Thoughts from an orthopedic surgeon specializing in sports medicine and fracture care, including insight into the practice of medicine.

Medicine's Future...There's an app for that

There’s an app for that….iconic expression trademarked by Apple….thanks to Craig Norquist I came across a cool talk online that dealt with the Future of Medicine. I will not be able to do this justice on the blog, so I urge you to actually go watch the video to see what is happening, what is right around the corner, and what is in store not too long from now.


There may be simple apps like ones that can check your blood sugar and blood pressure and send the results to your doctor. Other advancements include virtual colonoscopies and artificial retinas to help the blind see. What if you are paraplegic? There are now brain controlled exoskeletons that help you walk – absolutely amazing!


Even in surgery there are some amazing new technologies – No incision surgery - essentially a robot enters a cavity of the body through a natural orifice (belly-button for example) to perform something like a gall bladder removal. There is also in the pipeline little robots that can assemble in the body, traveling to places within that a surgeon cannot get to and then treat a problem!


Robotic surgery – the ability for a human surgeon to control a robot (or program it) to have a procedure done, thus potentially making it more accurate, precise, and less likely for human error to play a part. Imagine this in Orthopedic Surgery….for example it is challenging enough to accurately drill tunnels during ACL reconstruction, but perhaps with robotic surgery, this can be more accurate.


We are already communicating in different ways than we did a few years ago - think facebook, twitter, Skype, and Facetime. I am actually thinking about doing virtual office visits – through Skype or Facetime. While this does not allow any “hands-on” interaction, studies have shown that only 20% of visits to the doctor require this sort of interaction, especially in the age of MRI. And patient history will always be the most important element. In fact, virtual visits in the US can be billed to insurance, thus saving people a trip to the doctor’s office (when appropriate), while only having to pay the regular co-pay! Look for this soon on my website.


Definitely some exciting stuff out there – check it out - Daniel Kraft: Medicine’s Future? There’s an app for that Video on TED ( http://goo.gl/vLyY7)

NFL Lockout and Injuries

For those of you into football and the NFL, there MAY be some light at the end of the tunnel…on Mike and Mike this morning, there was a report that both sides are now into negotiating mode, meaning that there has finally been some progress. Early indication is that by sometime in July the lockout may be over – I am not holding my breath, but hopefully it ends soon.


As many of you know my partners and I help take care of the Arizona Cardinals and I have been thinking that with the inability of players to workout at their respective training facilities, rehab with training staff, and get their routine orthopedic evaluations, there will possibly be a higher rate / risk of injury this season, particularly early on.


I doubt there was a sense of urgency for the players, thinking the situation would work itself out soon – unfortunately it has not and I imagine a lot of the guys weigh more than their playing weight, and have possibly not been conditioning in the same manner that they would have been during a routine offseason.

Yahoo Sports (http://goo.gl/ay2xz) wrote about this a few days ago, giving an example of one player being 70 pounds over his playing weight!

I think this is going to lead to more medical and orthopedic problems, from heat exhaustion to ankle sprains, and severely limiting bone contusions to things like ACL tears and meniscus tears, unfortunately.


Lets hope the lockout ends soon and that the injury rate does not increase.

Magnetic Braces & Sleeves

I came across something interesting today – I have a patient that has had shoulder pain for which injections, medications, therapy, and surgery have not helped. He had become quite frustrated with his lack of improvement. Today he reported that his pain is gone! He got a magnetic shoulder sleeve, which he says has taken away his pain completely!


This made me wonder....do these braces work and if so, how? So I did a quick search. Below is what the various companies / websites say about these types of braces / sleeves:

Magnetic sleeves can be used for any type of injury / problem, including arthritis. As far as how they work – supposedly they capture and retain the natural heat that is produced by your body. They also help to relax the capillary walls, which in turn helps to increase blood circulation.

Increased blood circulation can reportedly benefit your knee in several ways. Better circulation helps to reduce swelling, relieve stiffness, and lessen pain. Both warmth and increased blood circulation helps to loosen tightened muscles and promote relaxation. All of this aids in the healing process.


I could not find any scientific study to back what the sites said, only anecdotal proof. So I cannot say whether they truly work and if so, how, BUT I can say that it is helping my shoulder patient. So for those of you with pain from shoulder impingement, tennis elbow, ankle sprains, and even arthritis, maybe this is an option. I don't seen any downside and in the meantime I will continue to look for some scientific evidence.

Foods that fight arthritis

Patients ask me all the time, “What can I do to make sure I don’t get arthritis?” Sadly there is nothing you can do to definitively prevent arthritis from setting in, especially if you have a family history of it – can’t fight genetics. But I recently came across an article which discusses how a few foods seem to help fight arthritis (as well as a few that are bad), so I thought I’d share.


Here are 7 foods that will ease your aching joints.


Good Food #1: Fatty fish (salmon, herring sardines) or any other food with omega-3 fatty acids, such as walnuts, soy beans, flax seeds, canola oil and pumpkin seeds. Omega-3s decrease the production of chemicals that spread inflammation. Get at least one gram of omega-3s a day.


Good Food #2: Extra Virgin Olive Oil. Olive oil contains oleocanthal, which blocks enzymes involved in inflammation. Believe it or not, about 3 tablespoons of extra-virgin olive oil acts like one-tenth of a dose of ibuprofen. Try and get 1 tablespoon per day.


Good Food #3: Sweet peppers, citrus fruits and other vitamin C-rich foods. Vitamin C protects collagen, a major component of cartilage. Like anything else moderation is key. Try for 200-500 milligrams a day. An orange and a cup of broccoli will net you about 200. And do it with foods, not supplements. Foods that are high in Vitamin C have other plant nutrients, which supplements don’t have. For example, broccoli and cauliflower have a chemical – indole-3-carbinol – that may protect us from certain cancers, including breast cancer.


Good Food #4: Brazil Nuts. Brazil nuts contain huge amounts of selenium – 272 micrograms in just three or four nuts, compared to 63 micrograms in 3 ounces of tuna. Low selenium may be linked to rheumatoid arthritis. The mineral helps antioxidants clear out cell-damaging free radicals. Eat 55-200 micrograms a day. If you don’t like Brazil nuts, 1 cup of cooked oatmeal has 12 micrograms.


Good Food #5: Onions & Leeks. These have quercetin, an antioxidant that may inhibit inflammatory chemicals, like ibuprofen, but more research is needed here. Kale, cherry tomatoes and apples are all high in quercetin. Eat One-half cup of a high-quercetin food a day.


Good Food #6: Tart Cherries. The magic ingredient is anthocyanins, the pigments that give cherries – and grapes, black raspberries and eggplant – their color. They’re also powerful antioxidants that cut inflammation. Try to get ½ cup or 8 ounces of juice per day.


Good Food #7: Green Tea. Studies show that certain antioxidant compounds in the brew lessen the incidence and severity of arthritis. How much? Believe it or not, 3-4 cups/day.


And now on to the bad…

Bad Food #1: Shellfish, red meat (if you have gout). Shellfish is high in purines, which are converted to uric acid in the body. When blood levels of uric acid build up, their crystals settle into joints, which can be very painful.


Bad Food #2: Sunflower, Safflower, Corn, & Soybean Oils. They're high in omega-6 fatty acids, which increase inflammation. Watch out: These oils are prevalent in U.S.-made baked goods and snacks.


Bad Food #3: Sugar. Some studies suggest that sugar may increase inflammation. Certainly sugar is high in calories, which leads to weight gain and added pressure on your joints.

Hope this is helpful. Courtesy of Lifescript.com.

Physical Therapy - high costs and limited care

On the way home from work today I heard an interesting story on NPR (http://www.npr.org/2011/06/06/135385837/high-costs-limited-care-a-pain-for-therapy-patients?ps=cprs) about costs for physical therapy (PT) increasing while care seems to be diminishing. 


It seems that Medicare is planning on reducing PT reimbursements by another 5% and if there are any similarities between PT and physician reimbursements, one can expect other insurance companies to follow suit and reduce payments. And while no patient wants to hear that running a PT clinic (or doctor office for that matter) is a business, it in fact is a business. There are monthly overhead costs that are going up every year, while reimbursements continue to go down. Consider how many PT clinics have gone out of business - not because they didn't do a good job, but because their costs exceeded their income - a model that does not work.


Unfortunately this has led to more and more double booking, over-booking, and shorter PT visits, while patients seem to be responsible for more money out of pocket. Not fair, but that seems to be the trend. In fact, much like physicians, more and more therapists are no longer contracting with insurance companies, mostly so they can charge what they feel is appropriate for their time and skill, give patients appropriate one on one time, and help them. Unfortunately this means even more money out of pocket for patients. 


I fear this trend is not going anywhere anytime soon...and I fear it will soon include the commercial carriers, not just Medicare. Amazing that the CEO's of the insurance companies continue to earn a lofty salary and large bonuses, premiums for you and I keep going up, out of pocket costs are going up, but care and one on one time keeps going down....sad state of our current health care system.

Should your daughter / son get their ACL tear fixed?

More and more kids are tearing their Anterior Cruciate Ligaments (ACL) - gone are the days of kids playing a sport and then having a few months of downtime to reat and recover. Nowadays kids seem to playing all year round and unfortunately there is a price to pay for that sometimes. So what are the options for a teenager that tears their ACL?


Managing ACL tears in pediatric patients (defined as anyone whose growth plates are still open) presents unique challenges. The orthopedic literature seems to delinate poor outcomes with nonsurgical treatment, including high risk of long-term knee problems. Patients often get recurrent instability, meniscus tears, and cartilage injuries. But there are risks associated with surgery in this patient population - growth plate injury which can cause leg length discrepancy (one leg shorter than the other), or angular deformity.


There are various ways to determine whether how much growth someone has left - chronological age, skeletal age (using xrays or MRI), and physiologic age using Tanner staging. There are 5 stages in the Tanner classification, with stage 1 essentially being prepubescent and 5 being postpubescent. I tend to rely on chronological age with Tanner staging as my decision making basis for whether to do ACL reconstruction on a pediatric patient or not.


Essentially if the growth plates are wide open, I tend to recommend a growth plate sparing ACL reconstruction using hamstring autograft. For those with little to no growth remaining, I perform a transphyseal (through the growth plate) ACL reconstruction, much like I would do in an adult.



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