Panorama Orthopedics's Blog
Staying Active as You Age: Diet, Exercise Can Help
Pablo Picasso once said, “It takes a long time to become young.”It is certainly true that to help defeat the natural effects of aging, it takes time and effort. It also takes understanding.
At a recent educational seminar on helping to prevent and treat joint pain, Dr. Premjit (Pete) Deol began by explaining why aging can contribute to an increased risk of injury and pain. This is increasingly important to understand, given that people are living longer, and looking to stay active later in life.
“The aging process is a process that is not really clearly understood,” said Dr. Deol, who specializes in foot and ankle conditions at Panorama Orthopedics & Spine Center in metro Denver. “It begins at about the age of 30, and from that point on, you start to undergo changes both structurally and functionally.”
After the age of 30, bone density begins to decrease, cartilage proteins become less resilient, connective tissue becomes more rigid, and muscle mass decreases. Problems caused by these changes can be exacerbated by disease, injury and environmental factors.
“All of these things start to accumulate over time and they start to have an impact on how everything works within our bodies,” Dr. Deol said. “A brand new rubber band out of the bag stretches nice and easily. A rubber band that’s been sitting out in the sun, you try to stretch it and it tears. It doesn’t have the same elasticity. That correlates to what is going on in our body as we get older.”
That is why Dr. Deol encourages his patients to take the extra time and effort necessary to practice good health habits every day. Otherwise, the changes associated with aging can more easily lead to other health problems such as high cholesterol, high blood pressure and weight gain.
Dr. Deol recommends a healthy diet and regular exercises, such as those recommended by the National Institutes of Health.
Preventive Measures: Protecting Feet and Ankles
It’s all too easy to neglect and abuse your feet and ankles. However, taking good care of your body is a solid investment that is sure to pay off.Dr. Premjit (Pete) Deol, of Panorama Orthopedics & Spine Center in metro Denver, recently gave tips on preventing foot and ankle pain at an educational seminar.
“It’s not just one thing, it’s a combination of things,” said Dr. Deol.
He advocates that as patients age they follow the recommendations of the National Institutes of Health by consistently doing the following:
• Stay active.
• Do stretching and balance exercises.
• Do strengthening and endurance exercises.
• Eat a balanced, healthy diet.“There are numerous benefits to staying healthy,” Dr. Deol told those in attendance at the seminar. “People who exercise tend to be happier than the people who don’t exercise.”
If a foot or ankle condition makes you nervous about undertaking an exercise program, you may want to discuss special recommendations with your doctor.
“If it’s preventing you from doing the things that you want to do, and the things that you’re doing on your own aren’t making enough of an impact, that’s often times when seeing an orthopedic surgeon can be a benefit,” Dr. Deol said. “They can give you some tips, some exercises to focus on.”
You should also talk to your doctor if at any point exercising becomes painful.
Daily physical activity can help to counter the effects of chronic disease and can even aid in treatment of the disease. It also improves stamina, endurance and mental health.
“The key to doing this is really to find something that you enjoy doing regularly,” Dr. Deol said. “If you stay active, if you’re doing the things we outlined, you’re going to live longer, you’re going to be happier.”
Ouch! Ankle sprains affect almost everyone
Professional basketball players do it. So do contestants on the Amazing Race. In fact, most of us have done it -- running, tripping or perhaps just walking on something uneven. The chances are that at some point you have sprained your ankle.
More than 25,000 ankle sprains occur each day in the United States alone, according to a division of the U.S. Department of Health and Human Services.
“Ankle sprains are very, very common,” Dr. Premjit (Pete) Deol told a group at a recent educational seminar. “There’s probably not a person in the room here who hasn’t sprained their ankle.”
Dr. Deol is an orthopedic foot and ankle surgeon with Panorama Orthopedics & Spine Center in metro Denver.
A sprained ankle occurs when a ligament in the ankle is stretched beyond its limit.
“Usually that happens from a twisting mechanism,” Dr. Deol said. “The foot is kind of fixed to the ground and the body just keeps rotating over that fixed foot.”
Severe strains actually tear the fibers in the ligament.
“It’s like strands in a rope,” Dr. Deol explained. “At some point those strands start to tear, and whether it’s 25 percent torn, or 75 percent torn, there are still fibers that are connected. It’s rare to have a completely torn ligament.”
The treatment for a sprained ankle is usually the “R.I.C.E. therapy:” rest, ice, compression and elevation.
It is important to allow the injured ligament to heal.
“What we tend to see in the office is people who ignore these ankle sprains and they start having repetitive sprains,” said Dr. Deol. “Then they get what we call ankle instability, where that ligament is just not tight enough and the ankle slips in and out. Every time it slips a little bit, every time you turn your ankle, there is a risk of injuring the cartilage in your ankle.”
Most people are able to completely recover from a sprained ankle.Giddy Up: Avoid horseplay when in the saddle
Tomorrow is the first Saturday of May, so that means it's Kentucky Derby Day! It's a great springtime sports party, but at the heart of it is a horse race with lots of speed and talented jockeys.
There are just a few thousand licensed jockeys, but millions of adults and youth in the United States enjoy horseback riding. It can be great fun, as well as great exercise, but if you don't take the right precautions, you can be seriously injured while riding.
According to the National Electronic Injury Surveillance Survey (NEISS), an estimated 78,499 people were treated in hospital emergency rooms for horseback riding injuries in 2009.
Here are some tips from the American Academy of Orthopaedic Surgeons (AAOS) to prevent horseback riding injuries. They are great things to keep in mind for those of us who aren't out to win, place or show:• All riders should always wear horseback riding helmets that meet proper safety standards.
• Wear properly-fitted, sturdy leather boots with a minimal heel. Your clothing should be comfortable and not too loose.
• Inspect all riding equipment to make sure it is not damaged.
• Be sure the saddle and stirrups are appropriate to your size and are properly adjusted.
• Secure all riding equipment properly.
• Children and novice riders should consider using safety stirrups that break away if a rider falls off the horse.
• Novice riders should take lessons from experienced instructors.
• Young horseback riders should always be supervised.
• Amateurs should ride on open, flat terrain or in monitored riding arenas.
• Jumps and stunts require a higher level of riding skill. Do not attempt these without supervision.
• If you feel yourself falling from a horse, try to roll to the side (away from the horse) when you hit the ground.
So celebrate tomorrow, but remember Mint Juleps and riding don't mix. Take care this summer as you saddle up.Pro or weekend warrior, achilles can be crucial
In Greek mythology, Achilles was a hero of incredible strength and skill, as well as a weak spot. It was with good reason that the Achilles tendon got its name.“That Achilles tendon is a pretty important tendon: The thickness, the strength of it, is unmatched by any other tendon in the body,” said Dr. Premjit (Pete) Deol of Panorama Orthopedics & Spine Center in metro Denver. “But it is also susceptible to injury.”
The Achilles tendon attaches the muscles in the calf to the heel bone and is instrumental in walking, running and jumping.
Overuse and degeneration of the tendon can lead to Achilles tendinitis.
“Achilles tendinitis is the inflammation or the swelling around the tendon,“ Dr. Deol explained at a recent seminar.
Surgery is rarely needed to treat the condition. However, it may take as much as six months of treatment using a combination of rest, ice, anti-inflammatory medicine, cortisone injections, exercise and stretches, physical therapy, orthotics or special footwear.
The Achilles tendon is also prone to tears.
“Tears of the Achilles tendon occur slightly above the heel,” said Dr. Deol. “They often feel like being kicked in the back of the heel because that tendon just pops. It tends not to be that painful, but people have trouble pulling their heel off of the ground.”
Patients suffering from a tear may even be able to feel a gap in the tendon. Without surgery, scar tissue will develop to close the gap, but the injury may be prone to reoccurrence. Athletic patients usually consider surgery to more fully repair the injury.
“We try to get things better without surgery,” Dr. Deol said. “Patients who typically do better with surgery are those who are looking to improve their strength.”
It is important to discuss options with your doctor if you suspect that you have an Achilles tendon injury since untreated injuries can become chronic.
Getting to the root of heel pain; plantar fasciitis
If you have pain on the bottom of your foot near your heel, you may have plantar fasciitis. It's a condition for which doctors see two million patients each year.“It’s actually the most common encounter that people come in to the office with when they come to see an orthopedic surgeon, is for pain in their heel,” said Dr. Premjit (Pete) Deol of Panorama Orthopedics & Spine Center in metro Denver.
The plantar fascia is the ligament that runs from the heel across the bottom of the foot.
“It’s almost like a bow and an arrow,” explains Dr. Deol. “You’ve got the arch of the foot, which is the bow, and the bow string that runs across the bottom of the foot that is the plantar fascia. It helps to propel us, it acts as a shock absorber when we’re walking, and it assists us with balance. “
Surprisingly, the treatment for plantar fasciitis can be as simple as regular stretching.
“Some people come in thinking they need surgery because they have plantar fasciitis and that’s absolutely not true,” Dr. Deol said. “Really, we start with stretching.”
Dr. Deol recommends that his patients use the “30-10-3 Protocol,” doing wall push-ups and heel drops for 30 seconds each, 10 times in a row, three times a day.
If stretching isn’t enough, other treatment options include night splints, heel cups, injections, orthotics or surgery.
Many patients suffering from plantar fasciitis will also have bone spurs, which are calcium deposits that the body forms to help stabilize the foot when the plantar fascia tears. However, treatment for the plantar fasciitis may be all that is needed.
“It’s easy to focus on the spur,” said Dr. Deol. “But really, if we treat the plantar fasciitis, a lot of times those symptoms will go away and you’ll still have the spur but you won’t even feel it.”
Aching feet: Shoes can play a role in pain
Are bone spurs getting under your skin? What about bunions? Those aren’t fun ones.When it comes to issues of the foot and ankle, Panorama Orthopedics & Spine Center in metro Denver sees it all.
Panorama surgeons can address fractures, tears and sprains, and many other serious conditions, as well as smaller foot and ankle issues.
“Bunions are probably one of the more common things that we see in the office,” Dr. Premjit (Pete) Deol said at a recent seminar.
Most bunions are the result of wearing shoes that are too small or tight. Bunions can usually be treated without surgery, however in some cases surgery is the best option to provide relief if the bunion is painful.
“For shoewear and function, it tends to be very effective,” Dr. Deol said.
One attendee at the seminar asked about bone spurs, which are calcium deposits that turn into bone.
“Bone spurs can result from a variety of different reasons, but the two most common that we see are either tension or where a joint is arthritic,” Dr. Deol said. “If you’ve got a severely arthritic joint, what the body is trying to do is to protect it. What it does is grow bone spurs to limit how much motion you have.”
Spurs can also form when the ligament on the bottom of your foot tears.
“The body’s natural response is it wants to make it more stable, and the body does that by forming bone,” Dr. Deol said.
In some cases, patients do not need to have the spur removed, but can instead experience relief by treating the underlying problem that caused the spur.
Why stretching should be like brushing your teeth
It isn’t a stretch to say that even small steps taken now can often help to prevent injury in the future.Something as simple as regularly stretching can be an effective preventive and treatment measure. Just ask Dr. Premjit (Pete) Deol, an orthopedic foot and ankle surgeon with Panorama Orthopedics & Spine Center in metro Denver.
“I equate it to brushing your teeth,” Dr. Deol recently told to a group of people suffering from foot and ankle pain. “It’s maintenance.”
Dr. Deol told the group that stretching can help to maintain bone density, to improve muscle strength, and to avoid injury.
“By doing that stretching every day, you’re helping the tissues to stay loose, to avoid getting to the point where they can’t stretch any more and then they start to get injured or torn,” he said.
Dr. Deol also recommends specific stretching exercises to certain patients who suffer from conditions such as plantar fasciitis. Stretching is a conservative treatment method that, when used effectively, can help avoid the need for surgery in some cases.
“Really, we start with stretching,” Dr. Deol said. “Stretching is going to be the most important component to getting better with plantar fasciitis. For 85 percent of people, all they need is stretching.”
Dr. Deol cautioned against bouncing while stretching and tells his patients to be consistent and diligent about doing their stretches. Many of his patients do wall push-ups and heel drops 10 times in a row, three times a day. Each stretch is held for 30 seconds.
You should always use caution when exercising.
“None of these should hurt while you’re doing them,” Dr. Deol explained. “If they’re hurting, then you’re being too aggressive and sometimes that can take you backwards.”
Click here to read some tips that we have available on our web site from the American Academy of Orthopaedic Surgeons.
Back pain? Exercise might still be possible
We know exercise is important, particularly core exercise to strengthen abdominal and back muscles. But how can you exercise if back pain makes almost any activity uncomfortable?The doctors at Panorama Orthopedics & Spine Center in metro Denver look for ways to make patients feel better so they can do more.
Dr. Karen Knight, a board-certified physician specializing in spine disorders, recently held a free educational seminar on strengthening core muscles. Dr. Knight emphasized the importance of core exercise, but cautioned patients with back pain to be careful when choosing their routine.
“Many people do core exercises that they have discovered off of the Internet, and many of those are not safe for individuals with degenerative spine disease,” Dr. Knight said.Some exercises, such as curls and using medicine balls in a twisting fashion, increase the biomechanical stress across the disks in the spine. Extension-based exercises can also narrow the spinal canal in conditions such as spinal stenosis.
Dr. Knight encourages patients who have back pain that is affecting their function or quality of life to be evaluated if they have questions about which exercises to avoid. She recommends exercises to her patients that are spine neutral, some of which are shown here.
“Individuals who see me are already usually in pain so they typically need a structured program,” she said. “All of these exercises are evidence-based. Their goal is to decrease the stress across the disks.”
Even individuals without back pain should use caution when exercising. Dr. Knight says that if an exercise is causing pain, it is possible it is being performed incorrectly, or that there is an underlying medical condition that deserves attention.
You can check out more core strengthening exercises in our photo gallery.
The other hip pain: the 411 on bursitis
If you have ever taken time to consider how the many parts of your body work, you have probably marveled at the phenomenon that is human anatomy.It’s amazing how some of our smallest body parts perform some of our body’s most vital functions. Perhaps that is why seemingly small health complications can become so problematic.
A condition called bursitis occurs when a bursa in your body becomes inflamed. If you’ve never heard of a bursa, you’re not alone! Bursae are small fluid-filled cushion sacs between your bones and soft tissue in such areas as your shoulder, elbow, knee, heel and hip.
Hip bursitis affects the bony part of the hip and can be extremely uncomfortable, often disrupting sleep and making it difficult to move.
At a recent seminar, Dr. Nimesh Patel of the Panorama Orthopedics & Spine Center in metro Denver addressed the difference between hip bursitis and hip arthritis.
“The difference here is that hip arthritis pain is more in the groin,” he said. “If someone complains of pain more in the side, you get something called bursitis.”
Hip arthritis is a serious condition that in many patients eventually results in the need for hip replacement surgery. Dr. Patel said that hip bursitis should also be treated seriously.
“It’s just as important to get it evaluated, because you could have both, but the treatment is different,” he said.
Patients suffering from hip bursitis can benefit from adjusting their activities, using anti-inflammatory drugs such as ibuprofen, and using a walking cane or crutches.
Dr. Patel also suggests physical therapy for many of his patients suffering from hip bursitis.
“What that does is that stretches those muscles out, takes the tension off the tendons, and actually lets that pocket of tissue relax,” Dr. Patel explained.
Surgery to remove the bursa is rare, however it is an option.
Baseball season is here; be sure to rest young arms
It's spring time, and it's time to whip out the bat and glove (and cheer on the Rockies, of course). The doctors at Panorama Orthopedics recommend cheering all you want, but when it comes to young baseball players, it's important to not overdue it.Sports injuries among young athletes (including baseball players) are on the rise. And the numbers are enough to give any parent pause:
• High school athletes, alone, account for an estimated 2 million injuries, 500,000 doctor visits and 30,000 hospitalizations every year. (Centers for Disease Control and Prevention).
• Another 3.5 million kids under age 14 receive medical treatment for sports injuries each year. (Safe Kids USA campaign Web site)
• 62 percent of organized sports-related injuries occur during practice. But one-third of parents do not have their children take the same safety precautions at practice that they would during a game. (Safe Kids USA campaign Web site, 2009.)
The good new is, according to the CDC, more than half of all sports injuries in children are preventable.
Panorama Orthopedics is part of the national STOP Sports Injuries campaign, which highlights teaching proper prevention techniques and discussing the need for open communication between everyone involved in young athletes’ lives. The goal of the campaign is not to stop kids from playing sports, but rather to keep them on the field and out of the training room and operating room.
When it comes to baseball, here are some tips to keep you in the game:
• Warm up properly by stretching, running, and easy, gradual throwing.
• Rotate playing other positions besides pitcher.
• Concentrate on age-appropriate pitching.
• Adhere to pitch count guidelines, such as those established by Little League Baseball.
• Avoid pitching on multiple teams with overlapping seasons.
• Don’t pitch with elbow or shoulder pain, If the pain persists, see a doctor.
• Don’t pitch on consecutive days.Information about how to prevent injuries for 12 different sports is available at the campaign Web site, http://www.STOPSportsInjuries.org.
Suffering from arthritis? You're not alone
Several years ago, one of the leading sources in the nation for information on arthritis issued a staggering projection: By the year 2030, 25 percent of adults will be diagnosed with arthritis.Arthritis is a disease that affects the joints and can progress to the point of becoming a serious and permanent disability.
If you suffer from joint pain, then you know exactly how debilitating it can be.
“It’s a pretty common ailment,” Dr. Nimesh Patel told a group of patients at a recent seminar for the Panorama Orthopedics & Spine Center in metro Denver. “It’s definitely on the rise.”
There are a number of different types of arthritis, and the disease can be caused by normal wear and tear, aging, trauma, or prolonged joint inflammation.
“When that cartilage goes away and you have bone rubbing on bone, that’s what now leads to arthritis,” explained Dr. Patel.
The result is pain, stiffness and limited mobility. Those symptoms can progress until limiting activity no longer provides relief.
The Center for Disease Control and Prevention emphasizes the importance of early detection and management of arthritis, which can help patients maintain their quality of life.
“The thing to keep in mind with arthritis is that it’s a progressive disease,” said Dr. Patel.
Doctors can determine if you have arthritis by conducting a physical examination, taking x-rays and potentially conducting laboratory tests. This also will show your doctor what type of arthritic condition may be causing your discomfort.
Although there is no known cure for arthritis, there are treatment options available that have helped countless individuals manage their pain and improve their function.
If you’re experiencing joint pain, know that you’re not alone.
“When you think that you might be the only one suffering from it, I can guarantee you that’s not the case,” said Dr. Patel.
Less Isn't More: More Experience Means Better Results
Here at Panorama Orthopedics & Spine Center, we have a simple motto: “Feel Better. Do More.”If you suffer from spine or joint pain, those words will mean something to you. When you don’t feel well, it makes it difficult to enjoy fun activities, not to mention just the day-to-day ones.
If you are considering joint replacement surgery, we encourage you to speak to one of our experienced joint replacement specialists. We are proud to be home to some of the best orthopedic surgeons in the business.
Either way, you should do your homework. You may want to consider some of the suggestions from the U.S. Department of Health and Human Services on choosing a doctor.
Not unexpectedly, the Department encourages individuals to look at a doctor’s experience, stating, “Research shows that doctors who have a lot of experience with a condition tend to have better success with it.”
Panorama’s Dr. Nimesh Patel recently addressed a small group of patients who were considering hip replacement surgery. He echoed that advice and encouraged the group to be particularly wary of surgeons who rarely perform the common procedure.
“If they do only a handful, then that should set off a red flag,” he said. “If you’ve done a lot, then you’re going to do better at it.”
If you suffer from joint pain and want to learn more about treatment options, we hope you’ll consider Panorama Orthopedics & Spine Center in metro Denver.
As Dr. Patel told his group, “Here at Panorama we’re rather fortunate, all of our surgeons who focus on joint replacements do a large number. We have a really good system in place.”
Walking the road to recovery after hip replacement
There is a lot to consider if you’re looking into hip replacement surgery.While you’re likely encouraged by the prospect of less pain and greater mobility, the chances are you are less enthusiastic about the more immediate prospect of recovering from major joint surgery.
You may be pleased to learn that hip replacement patients can usually stand and walk, with assistance, the day after surgery. Patients are normally able to perform most of their day-to-day activities within six weeks.
“We want you to stay active, but don’t overdue it,” advises Dr. Nimesh Patel of the Panorama Orthopedics & Spine Center in metro Denver. “Return to your activities, but within reason.”
Physical therapy, both during hospitalization following the surgery and during home care, is important to help patients learn how to use their new prosthesis. Physical therapy also helps to strengthen muscles weakened by joint pain prior to the surgery.
“By the time you have the hip replacement, that muscle is going to be weaker,” Dr. Patel recently told a group of prospective patients at a seminar. “With therapy, with just doing normal activity, those things will help strengthen that muscle.”
For the first few weeks after surgery, patients are encouraged to use assistive devices such as walkers, canes, elevated toilet seats and shower benches to prevent injury. Even after the immediate recovery period, patients are also encouraged to avoid certain positions that might trigger a dislocation of their new hip, at least until six months after surgery.
With more than 300,000 hip replacement surgeries performed each year in the United States, patients around the country are experiencing pain relief and increased mobility.
“The goal is to get you out for your walking, get you started doing the activities that you really enjoy,” said Dr. Patel. “We want you to be able to return to your quality of life and enjoy the things that you want to do.”
(That's what patient Mary Geder is doing in the photo above. Dr. Mark Mills did her surgery.)
For some, hip replacement is key to relieving pain
You used to be able to move with ease, then it took more of an effort to push yourself around. Now, pushing isn’t even enough. In fact, the pain remains even when you’re resting.If you’ve exhausted other treatment options for pain in your hip, it may be time to consider hip replacement surgery.
“If you’re going to get a medical treatment, you want to make sure it is as effective as possible,” said Dr. Nimesh B. Patel of the Panorama Orthopedics & Spine Center in Golden. “The benefit from doing a hip replacement is quite good.”
The surgery involves replacing the bone and cartilage from the damaged hip joint with a prosthetic ball and socket.
According to the Centers for Disease Control and Prevention, 327,000 total hip replacement surgeries were performed in the U.S. in 2009.
Patients choose to have hip replacement surgery for a variety of reasons, and each individual case is unique. However, you may be a good candidate for the procedure if any of these statements apply to you:
• Even when resting and sleeping, you experience hip pain.
• Medical treatment is no longer giving you relief.
• Your x-rays show a severe bony deformity.
• Your pain is chronic or started more recently and is disabling.
• Pain and limited mobility interfere with your daily, work and other desired activities.
“The key is we want to relieve pain,” said Dr. Patel. “The idea is to make you more comfortable and to restore function and mobility. We want you to get active and do things that you want to do.”To read testimonials from Panorama patients who have had hip replacement surgery, click here.
Small steps can help your "twist and shout"
If you’ve lost your “Twist and Shout” due to hip pain, conservative treatment options may help you “work it on out.” Hip pain is a serious issue that has led to more joint replacements than almost any other joint pain. However, smaller steps can be taken to help relieve your pain before you consider hip replacement surgery.
“With all medical treatment, there are different options,” said Dr. Nimesh Patel of the Panorama Orthopedics & Spine Center near Denver. “Even when we talk about hip replacements and hip arthritis. We always try conservative treatment first.”
If you suffer from hip pain, it is likely the result of arthritis in the hip. If that’s the case, it may be possible to minimize your discomfort by trying the following conservative treatment options suggested by the American Academy of Orthopedic Surgeons:
• Avoid certain activities, particularly those that are the most uncomfortable.
• Use over-the-counter anti-inflammatory medicines such as ibuprofen.
• Discuss with your doctor other anti-inflammatory treatments, such as cortisone injections, and other prescription medicine options.
• Use an assistive device such as a walking cane or crutches.Physical therapy may also help to relieve your hip pain and increase your range of motion by strengthening the surrounding muscles.
“Any therapy that we can do to strengthen those muscles is going to be beneficial,” said Dr. Patel. “When your hip doesn’t move, then the muscles that are used to power the hip aren’t used either, so those muscles weaken.”
Dr. Patel said that weight loss can also play an important role in reducing hip pain.
“The extra weight that we carry does put extra strain on the hip joints,” he said. “If there’s an opportunity to lose 10 pounds, 20 pounds, that’s definitely something that’s worth trying.”
Scopes allow for smaller incisions, faster healing
If you were facing major orthopedic surgery even a decade ago, the prospect could seem daunting.
And while surgery is still a serious matter, today’s technology allows for smaller incisions, which translates into quicker healing times for incisions and shorter hospital stays. That, in turn, helps to keep costs down for patients.
“In my practice, it’s probably been the one greatest, most significant change of anything that I’ve seen happen in 17 years,” said Dr. Douglas A. Foulk, with the Panorama Orthopedics & Spine Center in Golden.
Dr. Foulk recently gave a presentation on shoulder replacement surgery to a group of patients who suffer from shoulder pain.
“In today’s world, we’re doing most of these through the scope,” he explained. “We don’t have to make these big shark bites across the top of the shoulder and attach big muscle groups like we had to, even 10 years ago."
Now, tools and instruments allow doctors to go in, watching through a scope, and the results are the same. Of course, that's not how it's always been.
“Those operations took twice as long as the ones we’re doing now through the scope. They required days of hospitalization -- sometimes two or three or four because the pain was so severe," he said. "And they required prolonged use of pain medication.”
While healing time for the incisions has been reduced by the use of medical scopes, Dr. Foulk warned against patients rushing their overall recovery time.
It can take up to six months to fully recovery from shoulder replacement surgery.Panorama's goals: Excellent, cost-effective care
Medical bills aren’t cheap. A group of patients who recently attended a presentation by Dr. Douglas A. Foulk were probably pleasantly surprised to hear the doctor frankly address the issue of cost.
“As an orthopedic surgeon, our main goal is to carry out the surgery in the safest possible environment we can put the patient in, and at the same time recognize that we want to do it in the most cost-effective environment that we can find,” said Dr. Foulk, with the Panorama Orthopedics & Spine Center in Golden. “Those are our two goals, period.”
While health care reform is focused on insuring more people, Panorama has been working to improve the way orthopedic health care is delivered. Panorama’s integrated care model is the key to our success. For more than 55 years, Panorama has improved patient outcomes and improved the patient experience while keeping a handle on rising costs. Patients receive quality care at the best possible value.
“Our group has done a lot to try to work on this process because we know cost containment is going to continue to be a very big issue for us as we move forward as a society in general,” Dr. Foulk said during his presentation. “That’s why we’re working on trying to be able to provide a multitude of different services in environments that we think are specialized.”
Panorama Orthopedics & Spine Center provides specialized care for patients who are suffering from problems related to their spine or joints. Doctors at Panorama specialize in sports medicine, spine injuries, joint replacement, trauma, and problems related to the foot, ankle, hand or elbow.
“That’s really what OrthoColorado is, it’s kind of an extension, or a limb now, into inpatient operative procedures,” Dr. Foulk said. “Again, being done in a safe hospital environment with all of the bells and whistles of a hospital connected with it.”
Ben Franklin's advice applies to rotator cuff tears
It’s never too late for good advice.Even if you’ve already been diagnosed with a rotator cuff tear in your shoulder, you might benefit from heeding the famous words of Benjamin Franklin, who said, “An ounce of prevention is worth a pound of cure.”
Dr. Douglas Foulk with the Panorama Orthopedics & Spine Center in Golden is a big believer in acting quickly to address rotator cuff tears.
“This matters,” he told a group of patients during a recent presentation. “When you can treat smaller tears that are symptomatic, early, then you don’t get forced into having to treat big tears late that, frankly, do poorer.”
Dr. Foulk and his colleagues at Panorama have a variety of tools available to them to help determine the size, depth, and chronicity of rotator cuff tears.
An imaging study such as an MRI might be necessary to determine the severity of the problem and the best treatment approach.
Some tears are small, measuring less than one centimeter, while others can grow to a massive size of more than five centimeters. The larger the tear, the more challenging it is to address.
“Surgery gets more difficult, results are more variable and recovery time can be longer,” said Dr. Foulk. “There is a little bit of urgency to know what you’re dealing with if we feel that a tear is present.”
Patients who suffer from a partial tear, or a small tear, should know that without proper treatment, the tear could become enlarged.
Rotator cuff tears can be the result of trauma, but more often they are the result of slow deterioration resulting from everyday use. Often times, patients don’t realize the extent of the problem until they see the findings of an MRI.
Deliverying hope and a soccer ball to Rwanda
Imagine having to travel miles of hilly terrain, while injured, to see the only physician in the area. You have a broken a leg, or an arm that has healed improperly, but there is no hospital down the street, no orthopedic clinic to which you can drive.
This is a reality for tens of thousands of villagers who live near Mugonero Hospital, a 104-bed general hospital nestled among the small villages overlooking the waters of Lake Kivu in western Rwanda. It is about four hours by car from Kigali, the capital of Rwanda, and the international airport. The hospital provides a range services — including general surgery, maternity and pediatric care, HIV-AIDS treatment and awareness programs and more — but the facilities are unlike any in the United States.
Dr. Pete Deol of Panorama Orthopedics, who specializes in foot and ankle surgery, recently spent a week treating patients there. He and a team completed 12-13 surgeries in facilities he described as “bare bones.”
“They have one OR (operating room), but there is but there is no central heating or central air,” he said. “They don't have the same sterilization standards. … There are rooms where patients will stay but there is no one who will come in and take care of them.” Other than patients’ families, that is. Families cook for patients and will camp out for weeks while a patient is recuperating. The entire hospital faces staffing shortages.
But despite limited facilities and staff, patients are incredibly grateful for the care they receive.
“You are helping people who know that if you weren’t there, there wouldn’t be anyone else to help them,” Dr. Deol said. “It’s the most appreciated I’ve felt in medicine.”
The trip was put together by Centura Global Health Initiatives, which offers short-term medical mission trips for volunteer doctors, medical professionals and non-medical volunteers. Global Health Initiatives provides no-cost surgical, medical and community health programs, education, training and relief in areas where health care is often limited or difficult to obtain. The program has projects in Peru, Belize, Rwanda and Nepal.
“Once you get into an area where they have such limited options, it makes you appreciate everything you can bring to patients,” he said. “It makes you a better physician, it makes you think outside the box.”
Dr. Deol said a touching highlight of the trip was seeing the joy on an eight-year-old’s face after he received an unexpected gift during this trip to the hospital. The boy had broken an ankle falling out of a tree, and after surgery was understandably scared and nervous. That changed after the team, who had brought toys for kids in the hospital, gave him a soccer ball, a highly coveted items among boys in Africa, who often resort to rolled up plastic bags tied up with vines. The boy started to cry because he was so happy.And the rest of the team, seeing how little goes so far, will probably never be the same.
Reverse shoulder replacement can be a step forward
It may seem backwards, and that’s because it is. However, reverse total shoulder replacement is allowing many people to move onward with less pain.
The procedure originated in Europe several decades ago and was approved by the FDA in the U.S. in 2003. You can read more about it online by visiting the American Academy of Orthopedic Surgeons.
In a normal shoulder, the socket is part of your body, and there is a ball at the top of your arm that fits into it. The ball is kept in place by the muscles and tendons in your rotator cuff. In a reverse shoulder replacement, the ball and socket are switched.
The change allows patients to leverage the strength of the large deltoid muscle in their shoulder, instead of relying on the smaller rotator cuff muscles and tendons that may be damaged.
“By repositioning that location of rotation in the shoulder, you can take advantage of that deltoid’s ability to raise the arm, without a rotator cuff keeping the ball in place,” explains Dr. Douglas Straehley with Panorama Orthopedics & Spine Center in Golden.
The procedure is used for select patients who have a completely torn rotator cuff, severe arthritis, or have had unsuccessful conventional shoulder replacement surgery.
“It has really been tremendous in improving the quality of life for people who have that so-called pseudoparalysis. They can’t even raise their arm up,” Dr. Straehley said. “Those people are really benefited by this reverse shoulder replacement. Their function is massively improved.”
The procedure is typically reserved for patients who are 70-years-old or older.
“It doesn’t feel exactly like a normal shoulder,” Dr. Straehley warns. “But it’s certainly nice to be able to get your hand over your head to do activities of daily living. It can really be a tremendous life-changing prosthesis for appropriately selected people.”Wear and tear leads many to battle rotator cuff pain
Doctor’s visits can be overwhelming. Unless you’re an anatomy specialist, it can be hard to follow all the references to different muscles, bones and tendons.
If you’re suffering from shoulder pain, you might be in the market for a simple explanation of a rotator cuff.
In a way, it’s like a wheel with spokes.
There are four muscles that are connected by tendons from your shoulder blade to your upper arm bone, which serves as the hub in our analogy. Each of the muscles, which are like spokes, allow you to pull your arm in a different direction. Together, this “wheel” is the rotator cuff. The large deltoid muscle covers the rotator cuff like a hubcap.
Each muscle and tendon has a unique function, but they work together to stabilize our shoulders and allow us to move our arms.
Like the wheels on our cars, we put a lot of miles on our rotator cuffs. Unfortunately, rotator cuff disease is a common problem, especially on the top part of the shoulder.
“So much of what we do involves lifting, it involves using our arm over our head, it involves pulling and tugging,” explains Dr. Douglas A. Foulk with the Panorama Orthopedics & Spine Center in Golden. “We all do things that have the ability to hurt our rotator cuff.”
In some cases, trauma is the cause of the problem. Often, it’s simply a matter of wear and tear.
As Dr. Foulk told a group of patients at a recent seminar, “You don’t really recognize the tread on the tires of your car getting thin, until you take it into the guy to get some work and they tell you, ‘You know your wear line is at the wear line,’ and you say, ‘Seriously? I didn’t realize I’d driven 25,000 miles.’”
Foulk and his colleagues at Panorama can conduct a series of tests to help determine the cause if you are suffering from shoulder pain.
“This is a topic that we all know very well and we all treat frequently,” he said.Shooting for pain relief; when cortisone can help
The chances are, you’ve heard of cortisone. In fact, you probably have cortisone cream in your medicine cabinet at home.
If you struggle with persistent joint pain in your shoulders, you may also be familiar with cortisone injections. Cortisone is a steroid hormone that acts as an anti-inflammatory and is used to treat many different types of pain.
Dr. Douglas A. Foulk with the Panorama Orthopedics & Spine Center in Golden recently explained the benefits of cortisone injections to a group of patients suffering from shoulder pain.
“Cortisone is a really good drug for this problem because we can deliver cortisone directly to that location,” he said. “Combining that with initially some education, followed by a home exercise program, and modifying activities, can lead to a very successful non-operative treatment program about 90 percent of the time.”
Cortisone can be successfully used to address shoulder impingement, which is basically when different parts of the shoulder are pinching or rubbing together, creating uncomfortable friction. You can read more about shoulder impingement from the American Academy of Orthopedic Surgeons.
Dr. Foulk told the group that occasional cortisone injections can be quite successful in addressing the condition if there is not a tear in the shoulder’s rotator cuff.
“For the most part, patients usually respond very, very well to conservative treatment,” he said. “It’s not that common that the impingement patients will need surgery.”
If you have been told that you do have a tear in your rotator cuff, however, cortisone injections may not be the answer for you. “Cortisone will never heal a tear,” Dr. Foulk explains. “It will put a band aide on your tear and make it feel better, but it will not heal a tear.”
Dr. Foulk also told the group that patients who receive cortisone shots should be prepared for their shoulder to feel worse for a few days, before it starts to feel better. “It can have a bit of a delayed effect,” he said.Shoulder pain? You have options
Note: This is the final post in a three-part series on shoulder replacement surgery.If you’re experiencing severe shoulder pain, don’t shrug it off. You have options, even if you think you’ve tried everything and a total shoulder replacement isn't the right fit.
If you are experiencing pain or have a limited range of motion, there are many possibilities that you can discuss with the doctors at Panorama Orthopedics & Spine Center in metro Denver. There are nonoperative treatments, as well as different types of surgery, including partial shoulder replacement surgery.
Dr. Douglas Straehley said that for every 100 people who have had shoulder replacement, approximately 5 percent have hemiarthroplasties, or limited shoulder replacement surgery.
The goal with any type of shoulder replacement surgery is to improve people’s function and movement, to relieve pain, and for the doctors at Panorama, to conserve bone.
“We really try to be as conservative as possible in terms of preserving bone stock,” said Dr. Straehley. “We always want to conserve bone.”
Partial shoulder replacement, for select patients, can be the perfect fit. It also leaves open the option of a full replacement down the road.
An example of when partial shoulder replacement surgery is used is in cases of Cuff Tear Arthropathy (CTA), which causes a great deal of pain even for patients who still have enough strength to raise their arms.
“This is an answer for that subset of Cuff Arthropathy patients,” said Dr. Straehley. “The vast majority of patients that I do a CTA on, they’re out there doing just fine.”
Shoulder surgery is highly customized to meet the specific needs of individual patients since every case is unique. Discussing your options with a doctor is the first step.With time, doing more after shoulder replacement
Note: This is the second of a three-part series on shoulder replacement surgery.Shoulder replacement surgery can work miracles for addressing shoulder pain and improving your range of motion. But like many things, it takes time.
“It probably takes people anywhere from three to sometimes six months to really get back to 100 percent,” said Dr. Douglas J. Straehley of the Panorama Orthopedics & Spine Center in Golden, Colorado. “Most of my patients after shoulder replacement seem to bounce back quickly.”
Dr. Straehley said that patients can start moving, with certain restrictions, “right off the bat.”
With gentle physical therapy, most patients can perform simple activities after two weeks. However, driving is not permitted until six weeks after surgery and an arm sling is suggested at certain times until the shoulder has recovered.
The American Academy of Orthopedic Surgeons recommends a rehabilitation program to help ensure a successful recovery. Here are some of their recommendations:
• Take it easy. Pain-free motion can tempt you into activities that should wait until you are fully recovered. Avoid heavy lifting and contact sports.
• It’s okay to ask for help. You may need assistance at home for a while.
• Don’t push it. Using your arms to push yourself up can damage healing muscles.
• Physical therapy. Prescribed at-home exercises will help you regain full use of your shoulder.Dr. Straehley also reminds patients to keep their expectations realistic.
“You have to warn people they are not going to have normal strength,” he said. “It doesn’t feel exactly like a normal shoulder. But it’s certainly nice to be able to get your hand over your head to do activities of daily living.”
Patients who have undergone shoulder surgery often get a new lease on life. The procedure is intended for patients who suffer from arthritis and other conditions that make their shoulder joints painful and limit their activities.
“The goal is to improve your pain and therefore your function, improve your range of motion,” said Dr. Straehley.
This New Year, are you motivated?
Every January, it’s not unusual for people to take stock of the last year and make note of what was accomplished and what wasn’t. This sometimes lays the groundwork for a “to-do” list for the following year: hit the gym, clean out a closet, plan a vacation – you know the routine.
The beginning of the year may also be when people start planning for medical procedures that they may have put off due to a hectic schedule or other reasons. You may be bouncing around in your head such questions as: Should I plan to get my knee replaced this year? Can I afford to take the time off work?
The good news is that new research from Case Western Reserve University shows that personal motivation may be the biggest factor in determining the length of time it takes a patient to return to work following a total knee replacement.
Here’s what the study found:
• The median time to return to work was about nine weeks. Patients who reported a sense of urgency about returning to work returned in about half the time taken by other employees.
• Other factors associated with a faster return to work included being female, self-employment and higher mental health scores.
“Although the physical demands of a patient's job have a moderate influence on the patient's ability to return to work following a primary total knee arthroplasty, the patient's characteristics, particularly motivation, play a more important role,” the study author said.
Of course, every patient and situation is different, and you should discuss your situation with your physician. But if lost time is holding you back from a procedure your doctor has advised, know that returning to work can depend more on the patient than on the type of job.
Here’s to a happy, healthy year of feeling better and doing more of what you love!
When others fail, shoulder replacement can succeed
Note: This is the first of a three-part series on shoulder replacement surgery.You surely already know about hip replacements, knee replacements and other popular surgical procedures that have improved the lives of countless people. However, you may not have heard about shoulder replacement surgery. It’s one of medicine’s best kept secrets, but surprisingly it’s been common practice for decades.
“Many times patients somehow think that shoulder replacement is very new, much newer than either hip or knee replacement,” says Dr. Douglas J. Straehley of Panorama Orthopedics & Spine Center in Golden, Colo. “Modern shoulder replacement has been around just as long as hip or knee replacement.”
Since the 1950s, Americans have been using this highly customizable treatment option to bring relief to even the most severe shoulder pain. According to the American Academy of Orthopedic Surgeons, about 23,000 people have shoulder replacement surgery each year.
If buckling your seatbelt makes you blanch, reaching into a cabinet makes you cringe or wiping down your counters makes you wince, then this might be an option worth discussing with a doctor at Panorama Orthopedics & Spine Center.
The best candidates for shoulder replacement are usually patients who suffer from arthritis, particularly osteoarthritis, rheumatoid arthritis or post-traumatic arthritis; have rotator cuff tear arthropathy; or have been diagnosed with avascular necrosis.
However, shoulder surgery is generally a last resort, after patients have already tried other methods of treatments such as rest, physical therapy, medications, cortisone injections and/or partial shoulder replacement surgery.
“We don’t consider doing shoulder replacement unless everything else has failed, the goal being to improve the quality of people’s lives,” said Dr. Straehley. “We can really fine tune the replacement. I’ve had very good long-term success."Ride the powder this season, not the patrol sled
Is hitting the slopes one of your holiday traditions? Snowboarding and skiing can be so much fun that it’s easy to forget these are physically demanding sports.
Panorama Orthopedics treats athletes with injuries all the time, and snowboarders and skiers are no exception. We want to help spread the holiday cheer with some tips to help you stay safe while you’re in the mountains this holiday season.
The first day back on the slopes each winter is often exhilarating … and exhausting. Many injuries happen early in the season when boarders and skiers are still reconditioning their bodies.
“Like anything, no one thinks they are going to be the one that’s going to get hurt,” said Dr. James Johnson, a staff physician for the U.S Ski Team and an orthopedic surgeon with Panorama Orthopedics & Spine Center.
However, being injured on the mountain happens more often than you may realize. According to the U.S. Consumer Product Safety Commission, in 2008 snowboarding was the leading cause of winter sports injuries, and skiing was a close second. Together, these sports accounted for nearly 300,000 injuries in a single year.Skiing and snowboarding both require strength, stability and balance.
Dr. Johnson suggests hitting the gym before hitting the slopes. To fully prepare yourself, six weeks of training leading up to the new season is ideal, with half an hour of conditioning every other day. You should strengthen your quadriceps, hamstrings and hip rotator muscles, and perfect your technique.
It is also important to know when to call it a day since overdoing can be dangerous. Staying alert, even on green runs, can also keep you from becoming a statistic.
We want everyone to be able to enjoy a white Christmas on the slopes, and to stay healthy enough to keep making those runs well into the New Year.In snow shoveling shape? Take care to avoid injury
The snow is falling and we're headed for a white Christmas (unless the Colorado sun melts it before then). But today, take care to avoid injury as you whip out your snow shovel.
Research shows there are many risks to snow shoveling; U.S. hospitals treat on average about 11,500 injuries and medical emergencies a year. You can read more about the Journal of Emergency Medicine study in the Wall Street Journal.
The lower back is the most frequently injured region of the body, followed by arm and hand injuries, and injuries to the head. According to the study, cardiac-related injuries accounted for only 7 percent of the total number of cases, but they are by far the most serious.
Here's some tips for preventing injuries from the Center for Injury Research and Policy and the American Academy of Orthopedic Surgeons:
- Talk to your doctor before shoveling snow. Not everyone is physically fit enough to shovel.
- If shoveling is the only option, then use an ergonomically designed snow shovel.
- Push the snow instead of lifting it up.
- If you must lift, squat with your legs apart, knees bent and back straight. Lift with your legs and don't bend at the waist.
Enjoy your snow day and stay safe!Holiday havoc: How to avoid a "fa la la" off a ladder
Panorama Orthopedics loves seeing our patients, but we’d prefer you spend this holiday season with your loved ones, not in our offices or the emergency room.
Last year, there were a record number of holiday decorating injuries reported nationwide. According to the U.S. Consumer Product Safety Commission, decorating sent 13,000 people to the emergency room.
Even if you were brave enough for Black Friday shopping this year, I’m sure you’ll agree that ER lines are worth avoiding. If you’ll be up on a ladder this holiday season, here are some tips from the Commission:♣ Be picky. Choose a ladder tall enough to reach three feet above the roofline if that’s where you’re headed, and make sure all locks and braces are set.
♣ Make sure you’re on solid ground. The ladder should be on a firm, level surface.
♣ Watch your weight. The maximum load rating should be able to support your weight and what you’re carrying.
♣ No slip sliding. Make a wise shoe choice and check that your ladder has slip-resistant feet.
♣ Set yourself up for success. Ladders should be at a 75–degree angle. Also, make sure your ladder isn’t positioned in front of a door.
♣ Holiday surprises, not holiday shocks. Stay away from live electric wires, and avoid metal ladders if you’ll be near a power source.
♣ Even Santa has helpers. Find someone to hold the bottom of your ladder, but make sure only one person is on the ladder at a time.
♣ It’s a balancing act. Keep your body centered on the ladder and avoid leaning to the sides. Also avoid the top three rungs of a ladder and the bucket shelf.Not all decorating accidents happen on a ladder, but preventing falls will help make sure your next visit to our office is a more pleasant one. From our family to yours, happy holidays!
The information on this site is purely informational and may not pertain to your specific ailment. It should not be taken in lieu of a doctor's advice!
