Total Joint Replacement Surgery: Q&A with an Expert

Wednesday, February 12, 2014 10:48 AM comments (0)

Have medications and physical therapy done little to relieve your joint pain? Are you hoping to find a way to get back to the things you love without having to worry about pain? Total joint replacement might be the next step, but it’s a step you shouldn’t take without asking some important questions first.

Ravi Bashyal, MD, Orthopaedic Surgeon, specializing in minimally invasive hip and knee replacement surgery at NorthShore, answers questions on total joint replacement surgery, from what makes someone a good candidate to recovery, rehabilitation and beyond: 

Who is a good candidate for joint replacement surgery?
Total joint replacement surgery is an excellent option for patients who have "worn out" their hip or knee joint, found little relief from conservative management options such as injections or medications, and who feel that their worn-out joint is significantly impacting their ability to enjoy their daily activities and life.

Are there minimally invasive options for total joint replacement?
Yes. There are many new techniques and implants that allow total joint replacements to be done now in a much less-invasive fashion than in the past.  These innovations can allow for shorter surgical times, lower complication rates and faster recovery. Talk to your surgeon about his/her personal approach, and how you might fit into this as an individual patient.

What should a total joint replacement patient do prior to surgery?
There are numerous steps one should complete prior to a joint replacement surgery:

First and foremost, meet with an orthopaedic surgeon to make sure you are a good candidate for this type of surgery. He or she can talk to you about possible risks, recovery times and patient outcomes. Also make an appointment with your medical doctor and any other specialists (i.e. cardiologist) to make sure you are medically cleared to safely proceed with surgery.

Attend a class regarding joint replacement at the NorthShore Total Joint Replacement Center. This is an excellent opportunity to participate in a program focused on hip and knee replacement. You'll have a chance to meet with nurses, physical therapists, social workers, and other team members that will explain the ins and outs of what to expect before, during and after your surgery and during your hospital stay.

Make a pre-operative appointment with your surgeon and his/her team. This will give you a chance to review what you have learned during the pre-operative process, discuss any questions/concerns that may have come up, and to feel comfortable and confident going into your surgery.

What can a patient do to help to ensure the best possible outcome?
Become a partner in your care. The Total Joint Replacement Center at NorthShore is there to guide patients from beginning to end, from pre-op to rehabilitation. Patients are encouraged to communicate with their surgeon but also with our highly trained orthopaedic nurses and staff throughout the process. We feel that it’s important for our patients to have a thorough understanding of what to expect before, during and after surgery.

How long should you expect to be in the hospital after a total joint replacement?
Most of our hip-replacement and knee-replacement patients are ready to be discharged 2-3 days after their operation. Some patients are even ready to go home the day after. Many of our patients go directly home after surgery with in-home nursing and therapy arranged by our social work team, while others elect to go to an inpatient rehab center prior to going home. Ask your surgeon what to expect, and discuss with him/her what would work best for your individual situation and preference.

While recovery time varies case by case, what timeframe for recovery should a patient of total joint replacement expect?
Recovery is different for everyone. With our use of minimally invasive techniques and advanced post-operative care, many patients are recovering at a much quicker pace than 10 or 15 years ago. We have many patients back to work and activities within a few weeks. Of course, this is subject to individual recovery times, and the specific activities that each patient will return to after surgery. A discussion with your surgeon about your recovery is an important part of the pre-operative process.

What about long-term? How long should someone expect an implant to last?
Innovations in joint replacement technology have dramatically increased the longevity of many types of implants. Many currently available implants can survive for 20 or more years, and even if these devices "wear out," currently technology allows us to replace only the worn-out part without having to re-do the entire operation or replace all the parts.

The Rewards and Challenges of Treating Elite Athletes

Friday, February 07, 2014 3:33 PM comments (0)

Dr. DunlapBradley Dunlap, MD, Orthopaedic Surgeon and Sports Medicine specialist at NorthShore, has been treating elite-level hockey players since 2009. He has worked with USA Hockey as a team physician during tournaments in the United States and Europe. As a former college hockey player, his own personal athletic experience provides insight into the way athletes think, both in injury and health.

Here, he tells us what inspired his pursuit of sports medicine and why getting an athlete back in the game is the biggest reward of all:

Were you a hockey player yourself?
I grew up playing hockey starting at the age of five and played through college at Yale University. I still play occasionally in adult hockey leagues and am on the ice several times a week helping coach my nine-year-old son’s team. My daughters, ages four and five, are also on the ice, learning to skate.

What made you choose sports medicine/orthopaedics as a specialty? 
I sustained a knee injury that required surgery while playing hockey my freshman year in college. My surgeon was a former Yale football player and he did a great job taking care of me. He got me back on the ice without missing a beat. That’s what sparked my interest in orthopaedics and, in particular, sports medicine. I love working with motivated athletes, helping them to get back to the best of their abilities. I feel that as a former athlete, I have some insight into how athletes think and take great joy in seeing them get back into the game.

What is the day-to-day like for a team physician, particularly as a physician of hockey players?
There is actually a lot of down time covering these tournaments.  I love being around hockey, talking hockey with the players, coaches and training staff so I get to be around that during these tournaments.  Typically, I consult with the training staff and evaluate players before and after practice and am obviously ready should there be any injuries that occur during game play. While there are the more significant injuries to tend to (lacerations, dislocations, concussions), many times it’s just as important to make sure that things such as pink eye don’t spread throughout the team or that a player with the flu has a separate water bottle from the rest of the team. Hockey players in general are great to deal with. The perception is that hockey players are rough and tough, but they actually tend to be good-natured, down to earth, and appreciative of the help we can provide.

What challenges have you encountered as a hockey team physician? 
As with any elite athletes, the players we work with are incredible competitors.  They love hockey and they love to be on the ice.  However, it can be difficult at times as they can minimize the significance of injuries, especially those that require subjective complaints and feedback such as concussions.  It is my job to make sure we look out for the athlete’s best interest and health, both short-term and long-term.  It can be unpopular to pull a player off the ice, but if it’s the right thing to do then that is ultimately my job and that is why I’m there with the team.

What are the rewards of working with elite athletes?
The biggest reward is seeing the players succeed. The team physician is just one cog in the wheel to maximize and optimize the players’ abilities. There is also personal satisfaction for me in being able to combine two of my passions: hockey and medicine.

How does your work with USA Hockey inform your treatment of other patients?
I think working with athletes of any level is fundamentally the same. Is there a difference between working with the elite young athletes at USA Hockey who will someday make hockey their profession and a weekend warrior who just needs to be able to be on the ice or court Saturday afternoon? Absolutely. But my goal is the same: to keep them in the action and maximize their ability to compete and be at their best. 

Undergoing and Recovering from ACL Surgery

Wednesday, February 05, 2014 10:55 AM comments (0)

skiierFor an athlete there is nothing worse than suffering a sports injury that takes him/her out of competition. While some injuries require more rest and rehabilitation than others, those who undergo surgery for an anterior cruciate ligament (ACL) injury need to take it slow before heading  back into play.

In most cases, ACL surgery is done through small incisions, or arthroscopic surgery, rather than open surgery. Not only does this help reduce scarring and decrease recovery time but it can also help reduce complications and risks. Often the surgery is performed on an outpatient basis, meaning the patient won’t have to spend even a night in the hospital. Outpatient surgery doesn’t make recovery any less serious, however. 

Patrick Birmingham, MD, Orthopaedic Surgery and Sports Medicine at NorthShore, shares his tips for ensuring a safe and speedy recovery from ACL surgery:

  • Follow your doctor's orders. The last thing you want after you’ve undergone surgery is to suffer from an infection. Make sure your incision stays properly dressed, clean and dry to reduce this risk.  Don’t submerge under water until your doctor says it’s OK.
  • Be vigilant about your physical rehabilitation schedule or routine. It may take months or up to a year to return to some of the same activities you were involved in prior to your surgery. Be sure to stay in close contact with your physical therapist and don’t forget to do any recommended exercises at home, too.
  • Don’t be afraid to rest. If you are sore, remember to ice and elevate. Don’t push yourself beyond your comfort level. You should be able to manage your pain, and when you can’t, rest.  It’s also very important to get restful sleep because this will aid your recovery as well.
  • Follow instructions carefully. The tendon graft can take from six to twelve weeks to heal, so all of the post-operative instructions should be followed to protect the graft.

Have you had ACL surgery or know someone who has? 

 

Taking on Trans Fats

Friday, January 31, 2014 11:59 AM comments (0)

trans fatThe Food and Drug Administration (FDA) announced in 2013 that it plans to label partially hydrogenated oils (PHO’s), which are the primary dietary source of trans fats, as not generally recognized as safe for use in food. This relabeling of trans fats is just the first move in a process that will likely lead to a ban on trans fats in the U.S. food supply. 

Trans fat first entered the American food supply in 1911 in the form of Crisco shortening. Fairly early in its history, preliminary studies show that trans fats could be more harmful than other fats. Later studies confirmed this finding, indicating that trans fat contributed to heart disease.  While their presence has already been greatly reduced in the food supply, trans fats can still be found in many processed foods, like frozen pizzas, microwave popcorn, baked goods, margarine and store-bought icings. 

Philip Krause, MD, Director for the Section of Cardiology at NorthShore Skokie Hospital, explains why doctors have long urged their patients to stay away from trans fats:

  • Increases LDL cholesterol. High levels of low-density lipoprotein (LDL), or “bad” cholesterol, build up the walls of your arteries and can make them hard and narrow. Elevated LDL cholesterol levels are a significant risk factor for heart disease, heart attack and stroke. Consumption of trans fats can raise the bad LDL cholesterol in the body.
  • Lowers HDL cholesterol. High-density lipoprotein (HDL) is your cholesterol friend. It’s responsible for cleaning up your bloodstream, picking up excess cholesterol from where it doesn’t belong and bringing it back to your liver.
  • Increases triglycerides. A type of fat found in blood, triglycerides are also partly responsible for the hardening of arteries. When combined with high LDL cholesterol, elevated triglycerides put you at high risk for stroke, heart attack, heart disease and even diabetes. 
  • Causes inflammation. Inflammation is the body’s response to injury. Trans fats can increase inflammation by damaging the lining of the blood vessels. Inflammation may also be a cause of fatty blockages in the heart’s blood vessels. 

Notably, manufacturers have made steps to reduce fat levels in many foods and products. Since 2006, after which food labels reported trans fat content, intake of this substance has dropped significantly.

It is hoped, after the FDA finalizes its preliminary determination, PHO’s would be considered as “food additives” and could only be used with prior authorization. The primary goal and hope is that with better consumer education and these changes in product and food manufacturing, Americans can look forward to much healthier life ahead.

 

It's a Lifesaver: Blood Donation Facts & Stats [Infographic]

Monday, January 27, 2014 10:57 AM comments (0)

National Blood Donor Month is a time to celebrate both the generosity of current volunteer blood donors and encourage others to register as donors and start making regular lifesaving donations of their own. In recognition of National Blood Donor Month, NorthShore University HealthSystem has created an infographic that highlights important facts and statistics of blood donation, from the time it takes to make a donation, to a breakdown of blood types and more. 

Share our infographic with your friends and family and encourage them to consider donating to our own NorthShore Evanston Hospital Blood Bank. Click on the image below to view our full National Blood Donor Month infographic.  

donation infographic

A Gluten-Free Diet: Is It Right for You?

Thursday, January 23, 2014 11:55 AM comments (0)

Gluten chatAre you contemplating going gluten-free? Gluten-free products now line the aisles of the grocery store, and it seems more and more people are adopting the gluten-free lifestyle. But is it right for you?

Geeta Maker-Clark, MD, Integrative Medicine at NorthShore, answers questions on all things gluten, from the difference between gluten sensitivity and celiac disease to going gluten-free for weight loss.

What is the difference between celiac disease and gluten sensitivity? If it isn't an allergy issue why would some people's bodies react to it?
Celiac disease and gluten sensitivity involve two different responses to the gluten protein, which is found in wheat, barley and rye. The symptoms of both conditions can be very similar, which makes it difficult to determine which one you might have (if either) without the use of a lab test. We can check for celiac but not for gluten sensitivity with a lab test. 

Celiac disease occurs when gluten triggers your immune system to attack the lining of your small intestine. The condition is autoimmune in nature, which means gluten doesn't cause the damage directly; instead, your immune system's reaction to the gluten protein triggers the cells to mistakenly attack the lining of your small intestine. 

The theory around gluten sensitivity or intolerance is that a person experiences a direct reaction to gluten, or, in other words, the body views the protein as an invader and fights it with inflammation both inside and outside your digestive tract.

Is there a test for gluten sensitivity?
There are no good lab indicators for gluten sensitivity. You can be tested for celiac disease. But, if this is negative, it does not mean that you are not gluten sensitive. The best indicator is to try an elimination diet and see if your symptoms improve. This is the gold standard.

What are the drawbacks of a gluten-free diet? 
The main drawback to a gluten-free diet is the effort. One needs to prepare in advance by looking through the pantry and refrigerator, reading ingredients on labels, and understanding what contains gluten so it’s not consumed. It’s very helpful to have a cookbook or some recipes in place so that you have what you need to make the trial successful. Some foods labeled as gluten-free are high in fat and sugar, so this needs to be considered when purchasing. That being said, I have scores of patients who have done this successfully, felt much better and then were motivated to continue.

What is the best basic way to begin gluten-free lifestyle?
I think that the best way to begin is to clean out your kitchen and pantry of things you can no longer eat. Removing the temptations will make this lifestyle shift easier for you. Next you can focus on fresh, whole foods such as produce, grains and fish. Become a label reader and familiarize yourself with the hiding places of gluten. There are some great supportive gluten-free living blogs online, gluten-free smartphone apps that will tell you what you can buy in the grocery store, and excellent cookbooks too. There is a lot out there to support you on your path!

Some people go gluten-free to control their weight. Is there any risk in that?
A gluten-free diet is not a good way to approach weight loss, if that is the goal. Some people who are gluten-free do lose weight, but usually because they are consuming fewer calories overall when they eliminate baked goods, bread, etc. 

The gluten-free diet can lead to weight gain if one is consuming enough gluten-free food, or processed foods high in fat and sugar. I would not recommend a gluten-free diet for those looking to lose weight. A balanced diet high in fresh, whole foods and low in processed food, as well as an active lifestyle would be a more effective method.

If a gluten-free diet has improved digestive symptoms of celiac disease, should you still be tested for celiac disease? 
It is very important that you do find out if you have celiac disease, as this information can help guide your lifestyle as well as help your family understand their risks because there is a genetic component to celiac disease. This can be accomplished with a blood test ordered by your doctor.

Is there a relationship between ulcerative colitis and gluten?"
While there is no evidence that gluten causes ulcerative colitis, it may trigger symptoms in some people who are sensitive to it; thus, it may be useful to try a gluten elimination diet for three weeks to see if symptoms improve. There is no risk in doing it, so it is a reasonable option.

Can a gluten-free diet help treat Barrett's esophagus?
Whenever I’m considering an inflammatory disease process, especially when related to the GI tract, I always discuss an anti-inflammatory plant-based diet. Of course this is most helpful to prevent disease, but it does have a role in treatment as well. Barrett's esophagus occurs after chronic insult to the esophageal lining over time. Losing weight and eating a diet high in anti-oxidants, like colorful fruits and veggies, are an important part of the treatment. A gluten-free diet is a reasonable step as well to see if acid reflux symptoms improve. Since Barrett's is diagnosed by upper GI endoscopy and biopsy, the only way to know if a gluten-free diet is helping would be to repeat these same tests later with your gastroenterologist.

Could a gluten-free diet help with the symptoms of hypothyroidism?
People with celiac disease or gluten sensitivity often have gastrointestinal symptoms like gas, bloating, diarrhea and abdominal pain after eating. There are people with autoimmune thyroid disease and other autoimmune diseases who also do much better with a gluten-free diet, so I do utilize the elimination diet for 3-4 weeks as a trial. There is no risk in trying, but it does take some preparation to successfully eliminate the gluten from your diet.

Get Fit: Great Exercises Your Family Can Enjoy Together

Friday, January 17, 2014 10:00 AM comments (0)

family fitnessGet them when they’re young! Exercise is important for every single member of the family, even the small ones. Physically active kids are more likely to grow up into physically active adults, which could ultimately reduce their risk for heart disease, obesity and many other health issues. In addition to the long-term and obvious physical benefits, children that are physically active have better concentration at school, higher self esteem, improved ability to handle stress and greater social acceptance than those who are not active.

Help your kids make a lifetime commitment to health and fitness by making that commitment as a family. Show your kids the way it’s done and you could set them on a path for a healthier future. 

Ideally, all children over the age of two should be physically active for at least one hour per day.  For toddlers and preschoolers, much of that will be unstructured play, but it’s important, nonetheless.  If a child or family is not currently active at all and one hour per day seems intimidating or unrealistic, it’s perfectly fine to set smaller goals (i.e., 15-20 minutes per day) and build from there.

Leslie Deitch Noble, MD, Pediatrician at NorthShore, shares some ideas for family fitness that will get everyone moving and, most importantly, having fun:

Hiking. A moderately difficult hike can burn approximately 400 calories per hour.  If you don’t happen to be near a hike-friendly area, simply go for a brisk walk as a family. It’s a great safe way for the family to catch up, explore the outdoors and get fit together. 

Ice-Skating. Cold weather doesn’t mean the entire family should hibernate. There are many calorie-burning activities that embrace the season and feel more like fun than exercise, including ice-skating, which can burn over 400 calories per hour. Make sure everyone stays safe by keeping ice-skating confined to skating rinks and not lakes or ponds.

Yoga. The family that does yoga together reduces stress levels together. There is a yoga type for every age and every fitness level. When introducing beginners and children to yoga, help prevent injury by using a certified yoga instructor.

Biking. When roads aren’t icy or snowy, break out the helmets and hit the road. Make sure everyone is up-to-date on safety and the rules of the road before heading out. Biking is a great way to explore as a family, and, it could potentially awaken a lifetime passion for fitness for your kids.

Dancing. Nothing could be simpler or more fun than turning on some tunes and dancing as a family. If a fitness craze like Zumba can work magic for adults, a little dancing could do wonders for kids too. Dance games for the Wii, Xbox or other gaming consoles are also a great way to get the family dancing at home during the cold months.  Parents and kids, alike, love a little bit of friendly competition when everyone is laughing and grooving together.

How do you stay fit as a family?

 

The Height of the Season: Flu Myths vs. Facts

Monday, January 13, 2014 2:30 PM comments (0)

flu seasonWorried about catching the flu this season? There are many things you can do to prevent the spread of the flu—washing your hands regularly, getting adequate sleep, maintaining a healthy diet and exercise routine—but one of the best is to make sure you get vaccinated. 

Kenneth Fox, MD, Pediatrician at NorthShore, addresses some of the pervasive myths surrounding the flu and the flu shot to give you your best shot for dodging the bug this season:

Myth: I got the flu shot and got the flu right away.
Fact: The flu shot is not 100 percent effective but it is effective. The vaccine reduces a person’s risk of developing significant symptoms by 60%.

Myth: The flu shot is effective immediately.
Fact: It takes a period of two weeks for the flu shot to take effect.

Myth: Only the elderly and young children are affected by the flu.
Fact: The elderly and children younger than two (as well as people with other underlying medical conditions such as asthma, heart disease, cerebral palsy, COPD, diabetes, kidney or liver disease) are at highest risk for flu complications. Those with compromised immune systems are also at especially high risk. But, the flu can strike anyone.  Some of the most serious cases can occur in people who were previously healthy.

Myth: People suffering from the flu should always go to the hospital.
Fact: Healthy people should take care of themselves at home: get plenty of rest, drink lots of fluids and take Tylenol or Advil. Be watchful of other health issues though. If you are suffering from labored breathing or dehydration, you should go to the emergency room.

Myth: You should feed a cold and starve a fever.
Fact: Maintaining nutrition and staying hydrated is important when you are sick with the flu, so the answer is feed and feed.

Myth: Getting the flu shot once per season is always adequate.
Fact: One flu shot per season is adequate for almost everyone, with the exception of children under nine years old who should get two doses of flu vaccine (separated by  four weeks) during the first flu season they are immunized.

Myth: Flu and cold symptoms are the same.
Fact: Flu symptoms include a fever, cough, congestion, chills, fatigue, body aches, and often sore throat and headache. Cold symptoms are fewer in number, much milder and last just a few days.

Myth: The flu lasts 24 hours.
Fact: Children are typically ill 7-10 days but can shed the virus a few days before their symptoms begin and up to 2 weeks after the start of symptoms. Adults are typically ill 5-7 days but shed the virus 1 day before symptoms begin and usually up to 5 days after the start of symptoms. Some symptoms like fatigue may last for several weeks in kids and adults. 

Myth: There is no way to protect yourself from the flu.
Fact: The flu vaccine is a safe and effective way to prevent the flu and to reduce the risk of its complications. Also, thorough and frequent hand washing, avoiding contact with contaminated surfaces, getting adequate sleep, nutrition and hydration all reduce a person’s flu risks. Being watchful of complications and seeing your doctor if serious symptoms arise (like difficulty breathing and dehydration) reduce your risks of harm. Staying home when ill with the flu and covering your mouth when coughing also reduces the risks of spread in the community. 

It’s not too late to get vaccinated this flu season. Have you had your flu shot?

Winter Safety Tips

Tuesday, January 07, 2014 1:20 PM comments (0)

Winter SaferyWinter has arrived--with a venegence. Shovels and snow plows are out of storage for the season, and there's probably a layer of frost covering the windows. Winter can be quite beautiful from the safety of your home, but it can be dangerous as soon as you step out the front door, from an increased risk of frostbite and slip-and-fall injuries to impaired road conditions.

With proper preparation and attentiveness to potential hazardous seasonal conditions, many of the risks of winter can be greatly reduced or avoided altogether.

Timothy Sanborn, MD, Cardiologist at NorthShore, offers the following winter safety tips:

  • Take your time when shoveling. While you may want to get the job done fast, it’s important not to overexert yourself. If you start to feel pressure in your chest or experience shortness of breath, take a break and slow down. If symptoms last more than five minutes, you may need to seek medical attention.
  • Be careful of icy sidewalks. Common winter injuries, especially to the ankles and wrists, can be the result of slipping or falling on slick surfaces. For minor injuries, be sure to stretch the area and maintain flexibility for 2-3 days. If you fall and are in severe pain, and notice swelling around the joints, be sure to go to the hospital. You should also go to the hospital if you’ve hit your head and are suffering from a severe headache, vomiting or confusion.
  • Use salt on sidewalks and driveways. The more steps you can employ to reduce your risk of injury, the better. Before a big storm, try to salt heavily trafficked area to help limit your chances of accidents.
  • Stay inside in inclement weather. If you know a big storm is coming, postpone going out to run errands. Stay off the roads as much as possible. If you are elderly or have problems with your balance, get help with shoveling and daily routines.
  • Watch for signs of frostbite. Keep skin covered at all times. Signs of frostbite include: pain (stinging, throbbing, burning), numbness, blistering of the skin or discoloration.

How do you prepare for winter weather?

New Year and New You: Clean Eating

Monday, January 06, 2014 2:03 PM comments (0)

clean eating

Jeni Panicko, RD, LDN at NorthShore, shares her tips and suggestions for making clean eating part of your 2014.

Have you made a New Year's resolution to lose weight each year for as long as you can remember? Make a change this year. Instead of vowing to lose weight and beating yourself up when you come up short, change the way you think about food by changing the way you eat. This year, practice clean eating.

When you eat “clean,” it means you focus on consuming whole, unprocessed foods, such as fruits, vegetables, beans and legumes, dairy, whole grains and heart healthy fats like avocados and olive oil. Clean eating also involves avoiding many of the pitfalls of dieting, like skipping meals and replacing healthy whole, unprocessed foods with diet foods that may contain high levels of sodium and sugar.

Do you try to eat "clean" in your family?

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