Trash Talk

Spine Health

May 10, 2012

Scott S. Russo, M.D. of Orthopaedic Associates of Michigan recently spoke at a community seminar on how our spine can change as we age.

He touched on different ways you can minimize the impact of aging as well as some surgical and non-surgical techniques.

The following covers some of the highlights of the seminar.

 

How often does back pain affect the average person?

  • 18.6% are affected annually
  • 26.8% resolve the problem
  • 28.7% have pain that returns
  • 80% experience mild pain
  • 40.2% have persistent back pain

 
Why should you care?

Back pain can cause you to have a poorer quality of life, increased health care costs, loss of work time, and it makes you less productive.

What causes our spine to age?

Dr. Scott Russo often says to his patients, “Control what you can control” because there are some things you can’t prevent such as:

  • Genetics
  • The natural aging process
  • Micro-traumas we experience throughout our life

 
On the other hand, we do have a great amount of control over our lifestyle habits such as:

  • Smoking
  • Nutritional choices
  • Alcohol intake
  • Fitness

 
There are things you can also do when driving long distances. Taking periodic breaks or using a pillow for your lower back will help maintain the normal curvature of your spine. Nonsurgical treatments can relieve most spine pain. Surgery may be necessary for structural problems.

Degenerative Disc Disease

MRI, patient examination, CT scan (in some cases, to rule out other diagnoses), and discography are all used to diagnose degenerative disc disease. Dr. Russo stresses the importance of nonoperative care. You should always look into the nonsurgical approaches before resorting to spine surgery.  Dr. Russo also praised OAM’s physical therapists for their work educating patients in nonoperative spine treatments. Some of the treatments they suggest are regular exercise, walking, low-impact aerobics, and trunk strengthening.

Other nonoperative options include rest for acute, low back pain, and nonsteroidal antiinflammatory drugs (NSAID).

If nonsurgical care is not an option, the following treatments may be:

  • Fusion – removal of the disc and replacement with a bone graft, a cage-filled bone graft, or a bone graft substitute (anterior, posterior, or combined approach)
  • Arthroplasty – articulating disc replacement

 
There were several other spine issues that Dr. Russo covered such as Herniated Nucleus Pulposus (herniated disc), Spinal Stenosis (narrowing of spine), and Spondylolisthesis (fracture or defect in the vertebra).

To Aid in Prevention

  • Great nutrition
  • Superb fitness (1 hour per day: 30 minutes core, 30 minutes aerobics, balance training)
  • Avoid tobacco use
  • Limit alcohol use

 
Who May Need Surgery

If you have:

  • Unremitting pain
  • Poor balance
  • Nerve pressure
  • Progressive curvature

How to Choose a Surgeon

There are many competent and skilled surgeons to choose from but the following may help guide you.

  • Someone who will listen to your concerns
  • Answers all your questions
  • Strong understanding of nonoperative care
  • Experienced in performing the specific procedure needed
  • Willing to share their outcomes

 
To download the full presentation on The Aging Spine, Click here:  http://bit.ly/K67UOD (PowerPoint 14.3MB)

For details on how Orthopaedic Associates of Michigan can help you live pain-free, call us today at 616-459-7101.

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Glucocorticoids and Bone Health

April 27, 2012

Glucocorticoids are often used in the treatment of a variety of inflammatory, autoimmune and neoplastic diseases such as arthritis, asthma and inflammatory bowel diseases. The most common glucocorticoids consist of prednisone, methylprednisolone and dexamethasone. Although these medications have many benefits, they are the number one cause of secondary osteoporosis.[1] Recently, the International Osteoporosis Foundation released a study describing the connection between glucocorticoids and osteoporosis.

Osteoporosis is a condition that results in the thinning of bone tissue and loss of bone density over time. The International Osteoporosis Foundation warns that precautions must be taken to reduce the risk of osteoporosis for individuals on long-term oral glucocorticoid therapy. Glucocorticoids taken orally or intravenously are at a higher risk.

Debra Sietsema, Ph.D., R.N. at Orthopaedic Associates of Michigan states “taking steroids (glucocorticoids) is one of many risk factors for bone loss. Generally, those at risk take 3mg or greater of oral steroids for more than three consecutive months. The higher the dose and longer the treatment leads to a higher risk of broken bones.” Dr. Sietsema recommends that those at risk from taking steroids should ask their health care provider for:

  • Bone health risk assessment, including a FRAX score
  • Height measurements every year
  • Bone density scan (DXA) with spine (vertebral) fracture assessment
  • Review of needed calcium and vitamin D supplements
  • Discuss other ways to improve bone health

 

It is important to speak with your doctor about the risks of long-term glucocorticoid use, and to weigh all options before determining a course of treatment, as each individual situation is different.

If you have concerns about osteoporosis or other medical effects of glucocorticoids and similar medication, please schedule an appointment with your OAM doc to discuss the best option for you. You can reach our office at 616-459-7101.

 

Sources:

[1] Cleveland Clinic Journal of Medicine

International Osteoporosis Foundation

Medical News Today

 

 

 

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Symptoms and Treatments for Charcot Foot

March 5, 2012

Charcot foot is a crippling condition of the foot bones related to diabetes and poor blood flow to the extremities. The condition is caused by a lack of feeling in the foot, often related to neuropathy. When neuropathy is present, the bones of the foot become weakened and can fracture easily. Due to the lack of feeling that neuropathy causes, the patient continues to walk on the foot, causing complications that can lead to deformities.

The symptoms of Charcot foot initially include redness, swelling, warmth in the affected area of the foot, pain, soreness, insensitivity, a strong pulse in the foot and misalignment of the joints, also called subluxation. According to FamilyDoctor.org, the warning signs of nerve damage, which leads to Charcot foot, are numbness, tingling, sharp pain, muscle weakness and difficulty walking. Additional symptoms of calluses and diabetic foot ulcers may occur as a result of bone protrusions due to the deformity that develops.

If the symptoms go undetected and untreated, the muscles become unable to support the foot properly, causing minor trauma such as sprains and fractures. As the condition worsens, the joints become dislocated and collapse, causing deformity.  It is important to regularly check your feet and discuss any symptoms with your doctor, especially if you have diabetes.

Early detection of the condition is imperative to avoid a deformity, disability or possible amputation. Charcot foot can be diagnosed by looking at the patient’s medical history (especially diabetes), discussing symptoms and conducting tests such as xrays and MRIs. The imaging test allows the doctor to detect problems such as fractures, joint subluxation and osteophytes. Additional laboratory tests can be conducted to draw fluid to detect bone and cartilage fragments and blood, which can be present in some cases. Once treatment has begun, xrays will continue to be taken to evaluate the status of the condition.

Patients with Charcot foot have many options for treatment, depending upon how progressed the condition is. Non-surgical treatments consist of:

  • Immobilization of the foot and ankle to protect the weakened bones so they can repair themselves.
  • Custom shoes and braces to be used after the bones have healed. Custom shoes and inserts help prevent the recurrence of the condition and development of ulcers. Braces are used in cases of severe deformity.
  • Activity modification may be needed to avoid continued trauma to the feet.

In severe cases of deformity, surgery may be necessary to reshape the foot and remove bony protrusions. Doctors determine what option is best based on the severity of the deformity.

Patients can play a vital role in preventing Charcot foot. A few preventative measures are:

  • Maintaining blood sugar levels to reduce the progression of nerve damage.
  • Visiting a foot and ankle specialist regularly for check-ups.
  • Checking both feet daily for symptoms. Have someone assist you if you are unable to thoroughly examine your feet.
  • Trying to avoid injury, such as bumping the foot or while doing extensive exercise programs.
  • Following doctor’s instructions for long-term treatment to prevent recurrences, ulcers and amputation.
  • Wearing good, supportive shoes.
  • Wearing seam-free socks that won’t irritate diabetic feet.

 

Charcot foot is a serious condition that if left untreated, could lead to severe deformities of the feet and possible amputation. If you are experiencing any of the symptoms or feel you may be at risk for Charcot foot, please contact Orthopaedic Associates of Michigan at 616-459-7101.

 

Sources: ePodiatry.com, FootSmart.com, FamilyDoctor.org, Foot Health Facts – Charcot Foot

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Raynaud’s Phenomenon Symptoms, Diagnosis and Treatment

February 6, 2012

Raynaud’s phenomenon is a rare condition in which your body does not send enough blood to the fingers, toes and occasionally the tip of nose and ears, causing them to feel cold and numb and turn white or blue. Raynaud’s patients often experience episodes of vasospasm, a narrowing of the blood vessels. Vasospasm reduces the flow of blood to the fingers and toes. Diminished blood supply to the digits causes the tissue to turn white. A prolonged lack of oxygen then causes the digits to turn blue. Once the blood vessels reopen, the fingers and toes often turn red and throb or swell.

There are two types of Raynaud’s phenomena – Primary Raynaud’s, also known as Raynaud’s disease, and Secondary Raynaud’s, known as Raynaud’s syndrome. Research has found substantial evidence that shows both types of Raynaud’s are genetic. The Mayo Clinic describes the difference in the types of Raynaud’s syndromes as:
• Primary Raynaud’s does not have an underlying medical problem that could provoke vasospasm. This is the most common form of Raynaud’s, and is easily treated. The primary causes are changes in temperature and stress.
• Secondary Raynaud’s is caused by an underlying health problem. Although it is less common than Primary Raynaud’s, it tends to be more serious and appear at later ages (40+). Causes of Secondary Raynaud’s include diseases and conditions that damage the arteries or nerves that control the arteries in the hands and feet; injuries to the hands and feet; or exposure to certain chemicals and medicines that narrow the arteries or affect blood pressure.

Because an attack of Primary Raynaud’s can end quickly, a doctor will typically make a diagnosis based upon the patient’s description of their symptoms. WebMD recommends taking color photographs of your hands during an attack that you can show your doctor. A physical examination, discussion of your medical history and blood tests can help diagnose Secondary Raynaud’s.

Various treatment options are available, depending upon the type of Raynaud’s the patient has. General care can be taken to help prevent an attack of Primary Raynaud’s:
• Environmental triggers should be avoided, e.g., cold, vibration, etc.
• Emotional stress is another recognized trigger.
• Extremities should be kept warm,
• Smoking should be avoided.
• Consumption of caffeine and other stimulants and vasoconstrictors must be prevented.
• Raynaud’s may be aggravated by hormones and hormone regulators, such as hormonal contraception. Contraception which is low in estrogen is preferable, and the progesterone only pill is often prescribed for women with Raynaud’s.
Treatments for Secondary Raynaud’s are available to relieve symptoms, but most important, the underlying disease or condition should be the focus of treatment.

The Raynaud’s Association states that approximately 5-10 percent of all Americans suffer from Raynaud’s, but only one out of five sufferers seek treatment. Both men and women suffer from Raynaud’s, but women are nine times more likely to be affected.

The doctors at Orthopaedic Associates of Michigan have treated patients with both types of Raynaud’s. If you are experiencing any of these symptoms, contact OAM at 616-459-7101 to schedule an appointment.

 

Sources: National Institutes of Health,  The Mayo Clinic, The Raynaud’s Association

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Sports Related Wrist Injuries

January 24, 2012

Many of you basketball fans may have heard of Kobe Bryant’s wrist injury back in December. He sustained an injury to the lunotriquetral ligament. This is an injury that the physicians of our Hand and Upper Extremity Center are called upon to treat in a number of athletes.

When the athlete comes in for early treatment, many of these injuries can be successfully treated with a program of sports specific bracing and exercises. This can allow some athletes to participate in their sport quickly. Chronic injuries may need surgery to return to sports.

A different ligament-the scapholunate ligament- behaves differently when injured, and frequently requires surgery in an acute injury situation. An exam and X-ray can detect a number of these injuries but an MRI or wrist arthroscopy may also be necessary.
Learn more about wrist injuries and available treatments.

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OAM Launches “You Want an OAM Doc” TV Campaign

January 16, 2012

At Orthopaedic Associates of Michigan, we have more than 30 highly skilled oprthopaedic subspecialists and eight specialized centers of excellence. We believe that no one provides better bone care in the region, and we are making that known with our new marketing campaign.

Starting today, we have launched a public campaign around the theme “You Want an OAM Doc.” The campaign messaging uses idiomatic expressions – like “We’ve Got Your Back” and “We Know Hand Surgery Like the Back of Our Hands” to highlight the range of subspecialty practices OAM houses.

You can view our campaign spots below, and be sure to watch for them on various TV channels airing in West Michigan. They share our firm belief that if you have a bone, joint or spinal issue – you don’t want just any orthopaedic doctor, you want an OAM doc!

To learn more about OAM and our specialized centers of excellence call us at 616-459-7101.

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Protecting Your Back and Shoulders While Snow Shoveling

January 11, 2012

The onset of winter brings a new form of exercise for many people – snow shoveling! Snow shoveling has to be done by most of us at some time, whether predictably or unexpectedly (such as freeing a stuck vehicle). Snow removing can take a physical toll on your body, particularly your back, shoulders and spine. A spokesperson for the Academy of Orthopaedic Surgeons (AAOS) stated that lower back strain and herniated disks are the most common back injuries sustained while snow shoveling.

Additionally, a study published by Brad Coffiner in Cornell University’s ergonomic department indicated “…when handling heavy snow with a shovel, the L5/S1 disc has been identified as the weakest link in the body segment chain. The most severe injuries and pain are likely to occur in the back region.” Recognizing the lower back is especially susceptible to strain or injury, it would be prudent to review steps to prevent injury. Health.com and MyOptumHealth.com both offer tips you can follow that will help prevent injuries and make show shoveling a bit safer.

  • Warm muscles work better. Warm up inside and incorporate stretches to help prepare your muscles for the upcoming work.
  • Dress appropriately. Wear warm clothing and insulated snow boots or shoes with good traction.
  • Choose a proper shovel. Consider two types of snow shovels: one lifts loads of snow, while the other – with a wide, curved blade – is used as a “plow.” Make sure both types of shovels have curved handles with plastic, lightweight blades. The curved handle helps you keep your back straight when lifting the snow-filled blade off the ground – or when you push snow aside with the plowing shovel. Make sure the handle of your snow shovel reaches your chest.
  • Do not try to shovel all the snow at once. Shovel small amounts at a time, preferably fresh snow. Fresh snow is lighter weight; so clear it as soon as it has fallen if possible.
  • Practice the proper technique. It is advised to push the snow with the shovel as opposed to lifting it.
    • Space your hands apart for leverage. This makes it easier to lift a blade filled with snow.
    • Space your feet shoulder-width apart.
    • Bend at the knees – not the waist. If you do bend at the waist, bring your hands closer to the end of the shovel or get a shovel with a longer handle.
    • Tighten your abdominal muscles every time you lift a load of snow.
    • Keep your head down and in line with a straight back.
    • Keep each shovelful close to the body. Avoid extending your arms.
    • Minimize the distance you carry the snow. Walk each shovelful just a few feet, as close to the ground as you can, then dump it by flipping the handle with your wrists. Avoid throwing loads of snow over your shoulder.
    • Clear deep snow layer by layer.
    • Pace yourself, and stay hydrated.

 

Unfortunately, we see many injuries from snow shoveling each winter. It is necessary that you pace yourself and practice common sense. If you are unable to physically handle the work, you can hire a snow removal company, or even a neighbor to assist you. For those of us who are able-bodied, it is important to remember those who may need assistance. A few minutes to help clear someone’s path and driveway can make a world of difference for them, as well as make you a good neighbor!

For details on how Orthopaedic Associates of Michigan can help you recover from a snow shoveling injury, call us at 616-459-7101.

Sources:  American Academy of Orthopaedic Surgeons,  Cornell University, Health.com,  MyOptumHealth.com

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Patient Success Story: Deuce, Match Point and Ace

December 19, 2011

OAM patient back on the court after a Zimmer total hip replacement

 

Taking a break from a hobby doesn’t sound that hard. But what about taking a break from a sport you’ve loved to compete in for the past 40 years? This was the choice long-time tennis player, Jan B. had to make at a time in her life she never saw coming.

“I just kept telling myself that I was too young for this type of pain,” said Jan. Only 50 years old and on a highly competitive travel tennis league, Jan refused to give in to the pain. “I pretty much denied it was happening for a solid year,” she recalled, laughing. “I even had a surgeon tell me I needed a hip replacement, and yet I still found a way to deny it.”

Jan spent the next year trying everything from acupuncture to general sports massage, with nothing to show for it but more pain. She didn’t understand why the incessant pain in her hip wouldn’t leave, but more importantly, why it was getting worse. A family friend finally spoke up and suggested she visit Dr. Gregory Golladay from Orthopaedic Associates of Michigan. “I was fearful at first, then excited, followed by the dread of post-surgical pain,” Jan admitted. “Dr. Golladay calmed my fears and finally I just told myself that I could do it!”

Soon after her visit with Dr. Golladay, Jan went in for a Zimmer total hip replacement. “The surgery was over before I even knew what happened. I had to rate my pain right after surgery and it was only a four out of 10,” she said. “And to be honest, it was a *zero out of 10 after that!”

Only three short months later, Jan was back on the tennis court and slowly but surely getting back in the groove. “I couldn’t wait for the three-month post-op restrictions to be lifted!”

The smooth recovery has continued to be a blessing that Jan remains thankful for. “I was relieved that it was done and amazed that the pain was gone,” said Jan. “I have no more hip pain and I am beginning the road back to playing tennis! Thank you for giving back such an important part of my life!”

For details on how Orthopaedic Associates of Michigan can help you live pain-free, call us today at 616-459-7101.

 

*The above results are based on an OAM client’s experience. Results may vary.

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Orthopaedic Associates of Michigan to Participate in Extremity Trauma Clinical Research Consortium

December 16, 2011

Orthopaedic Associates of Michigan is one of 12 clinical centers selected to participate in a newly established Extremity Trauma Clinical Research Consortium, funded by the Department of Defense and coordinated by the Research Center at the Johns Hopkins Bloomberg School of Public Health. The Consortium was founded to improve treatment and outcomes for military personnel who have sustained severe orthopaedic trauma on the battlefield.

As a member of the Consortium, Orthopaedic Associates of Michigan will work alongside major military treatment and research centers in conducting clinical research that will help establish treatment guidelines, improve functional and quality of life outcomes, and usher in the use of new and emerging technologies for treating severe lower limb trauma.

According to Dr. Debra Sietsema, clinical research coordinator, Orthopaedic Associates of Michigan was specifically chosen for its unique experience in treating trauma involving lower extremities. “We treat hundreds of injuries to lower extremities a year, most due to automobile accidents, and we look forward to putting that experience to use to benefit injured people across the nation.”

This consortium brings a national team of orthopedic trauma surgery specialists together in a single purpose: to provide the scientific evidence needed to improve the clinical outcomes and quality of life for service members and civilians who sustain major limb trauma. “Without a large, multi-center effort such as this, many of these issues would never be resolved,” says Dr. Clifford Jones, director of orthopaedic research who is among five specialty trained trauma surgeons at Orthopaedic Associates of Michigan participating in the program. Jones also provided surgical care for US soldiers wounded in Iraq and Afghanistan as a volunteer surgeon at the Army’s Landstuhl Regional Medical Center in Germany, part of The Distinguished Visiting Professor Program through the Orthpaedic Trauma Association.

“The work is important and timely. Until now, we have not had sufficient funding or coordination of multiple specialists to appropriately assess and study these complex traumatic injuries,” said Jones. “The results and findings of the Orthopaedic Consortium will be ground breaking and will improve treatment for all those who are faced with these common, but potentially devastating injuries—both military and civilian.”

“The need for such a consortium is evident,” says Ellen MacKenzie, PhD, Director of the Coordinating Center of the consortium. “Eighty-two percent of all service members injured in Operation Iraqi Freedom and Operation Enduring Freedom sustain significant lower limb trauma. Many sustain injuries to multiple limbs. The consortium’s research will help us better understand what works and what doesn’t in treating these injuries and will ensure that our service members are provided with the best care possible.” The Consortium is funded by the Orthopaedic Extremity Trauma Research Program (OETRP) of the Department of Defense for $18.4 million over five years.

Dr. Clifford Jones, MD, FACS, Orthopaedic Traumatologist, is the Director of Orthopaedic Research at Orthopaedic Associates of Michigan.
The twelve core clinical centers currently participating in the Consortium include: Boston University Medical Center, The Florida Orthopaedic Institute, Carolinas Medical Center, Denver Health and Hospital Authority, OrthoIndy and the Indiana Orthopaedic Hospital, Orthopaedic Associates of Michigan, The Orthopaedic Trauma Institute at the University of California at San Francisco, San Francisco General Hospital, The University of Maryland Medical Center’s R Adams Cowley Shock Trauma Center, The University of Mississippi Medical Center, The University of Texas Southwestern Medical Center, The University of Washington Harborview Medical Center, and Vanderbilt University Medical Center.

For more information or comment on this story contact:

Deb Sietsema PhD, RN Clinical Research Coordinator Orthopaedic Associates of Michigan Associate Professor, MSU 230 Michigan St NE, Suite 300 Grand Rapids, MI 49503 Office: (616) 459-7101 ext 417 Fax: (616) 776-2711

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