Recover from these hot summer days with this refreshing spinach and strawberry salad. Flavors of sweet and citrus are deliciously juxtaposed in this incredibly easy-to-make recipe. You’ll love it!
More than 450,000 hip replacement procedures are done every year in the United States, to restore mobility and resolve chronic pain in patients with debilitating hip problems. While these procedures are generally very safe and effective, problems with hip replacement implants have caused quite a stir lately. Recalls and high rates of complications have drawn the attention of regulatory agencies in both the United States and the UK, as concerns about the safety of an entire category of hip implants have been raised. If you are planning to have a hip replacement or have already had a procedure, there are some things you need to know about the dangers associated with hip implants.
Hip replacement removes a damaged hip joint and replaces it with an artificial joint. Total replacement removes the natural femoral head, or ball, and the acetabulum, or socket, of the hip joint. Partial replacement replaces just the femoral head. Joint resurfacing generally replaces the acetabulum with an artificial cup,
Hip replacement implants are made with materials that include plastics, metals and ceramics. The most commonly used implants are composed of a metal ball and a socket that is made of plastic or lined with it. Implants are also made with ceramic femoral heads, paired with plastic, metal or ceramic sockets. In metal-on-metal implants, both the ball and socket have metal surfaces.
All implants have some risk of complications. Most common is implant dislocation, an issue that most often occurs during the weeks following surgery as the hip is healing. Bone fractures can occur, due to pressure from the implant, as can infection. Osteolysis, or bone loss, can happen as the body’s immune system attempts to clear away implant debris, destroying bone cells in the process. Nerve damage, hardening of soft tissues around the hip, implant loosening or breakage, and uneven leg lengths are other possible complications.
Metal-on-metal hip replacement systems have been more problematic than other types of hip implants, due to minute particles of metallic debris that wear off of their components over time. These particles collect in the soft tissues around the hip and can cause a condition called metallosis. Metallosis happens when those particles cause the tissues to become inflamed, leading to intense pain and swelling in the hip and in some cases, tissue death and bone loss at the implant site.
Metal ions can also be absorbed into the bloodstream, circulating throughout the body. Although the long-term consequences of elevated levels of these ions in the blood are largely unknown, medical experts have expressed concern that they may affect immune function and increase cancer risk.
Several metal-on-metal products have been recalled by manufacturers. There have been several DePuy hip replacement recalls, including their ASR XL Acetabular System and ASR Hip Resurfacing SystemStryker. Products made by Zimmer Holdings and Smith & Nephew have also been recalled. Thousands of patients have been affected by these faulty implants, leading to thousands of revision surgeries and hundreds of lawsuits.
This article was written by Elizabeth Carrollton who writes to inform the general public about defective medical devices and dangerous drugs for Drugwatch.com.
I love sharing what I know with others and discussing my patient care philosophy. I recently had such an opportunity with Jennylyn Gleave on The Jennylyn Show. We sat down together and discussed everything from the humble beginnings of my career as a 14-year-old hospital volunteer, to how the lifestyle of a professional athlete can impact overall health. I describe how the prescription drug abuse epidemic affects the doctor-patient relationship, and we discuss the issue of “biofeedback” and how emotional barriers can prevent effective treatment. Join us for an in-depth one-on-one.
Your health is important, and after a long winter of reduced activity or inactivity you might be tempted to ditch those old winter habits, go outside, and train as soon as the weather improves.
According to Moshe Lewis, MD, chief of physical medicine and rehabilitation at California Pacific Center, St. Luke’s Campus in the Department of Orthopedics, although you may be tempted to exercise at the same level you did at the end of the last season, such enthusiasm often leads to early season injuries.
If you changed your routine for the winter, you need to get back into shape slowly. The following are some tips from Dr. Lewis for avoiding injuries as you increase your exercise this summer.
Try to exercise three to four times per week on alternate days. One of the best ways to get injured or sore is to go hard all weekend and do nothing during the week. Don’t succumb to the weekend warrior syndrome. You will also have higher risk of damage to your ligaments if you overexert yourself. Remember to pace yourself and increase your training gradually over the weeks. Adding one hundred steps to your daily routine will add a tiny bit to your fitness level, if you keep it up. Your body will adapt.
Alternating your workouts can improve your performance and reduce the risk of injuries. By participating in a variety of different activities such as running, weight training, hiking, or biking, you limit the stress on one specific muscle group because different activities use muscles in slightly different ways. Muscles are easy. They adapt and get stronger fast. And that is why you get injured.
As you ease back into training you may experience some minor muscle aches and soreness. But if you have any sharp, unusual pain, or soreness that doesn’t go away, pay close attention. You may be on the way to an injury. Listen to the early warning signs of an injury, otherwise you increase your chances of tissue and muscle tear, which can often lead to permanent long-term damage.
If you can find a few people with the same fitness level and goals as you it can help keep you progressing at a good pace. Working out in a group provides support, accountability, and structure. You are more likely to complete a well-rounded exercise routine and stay on track with your fitness regimen.
Getting back into shape is often slow and difficult, and you have to ramp up your intensity level and exercise routines gradually. Remember you have to pace yourself, and if you took the winter off don’t expect to be back at your peak fitness in a week or two.
Take your time and keep in mind that summer training is a time for fun, light-hearted exercise. You aren’t competing so just relax, enjoy your activity, and enjoy the summer.
Doctor visits typically increase as the year comes to an end. How many times have you been to the doctor’s office, been poked and prodded, leaving with a prescription, only to recall all of the things you didn’t ask? Or maybe there was something the doctor said you didn’t quite understand? Since many people are going to the doctor’s office to improve their overall health, the next time you go, make the most of the visit with a few strategic tips.
Interview length: 56 minutes — Interview date: November 21st, 2011
In this interview with Dr. Michael A. Lenoir on KPFA Radio's About Health, we touched on acute vs. chronic pain, Michael Jackson and dietary considerations. We answered many listener questions regarding increased sensitivity to pain, acupuncture, avoiding surgery, chiropractors, arthritis, the stress caused by pain, and more.
In light of the following article, I have always strongly encouraged my patients to actively involve their family by bringing them to visits. In addition, I strongly recommend participation in the California Neuropathy Support Group and to openly discuss their feelings with our healthcare team:
Abuse of narcotic pain relievers, insomnia drugs and anxiety drugs by women is landing a growing number of them in emergency rooms for drug-related suicide attempts.
A recent report by the federal Substance Abuse and Mental Health Services Administration shows a 49 percent rise in emergency department visits for drug-related suicide attempts by women aged 50 and older between 2005 and 2009.
While some of the increase can be attributed to population growth of women in this age group, the study found stark increases in emergency department visits for drug-related suicide attempts involving drugs that treat anxiety, insomnia and pain, such as hydrocodone and oxycodone products.
Michael Dulle, clinical director of the Salt Lake substance abuse treatment center Odyssey House, said he is personally aware of five to eight female patients, ages 50 and up, who have been hospitalized for accidental overdoses or suicide attempts from prescription drugs in the past 18 months.
Ken McCoy recently interviewed me on his radio show. We had a great time discussing what pain management is, what pain management specialists do, and my philosophy regarding pain management in general. Click the play button on the audio player above to listen to our segment. Here’s an overview of what we talked about:
Trying to get patients to understand their medication: Medication is extremely important to many, but some forget what their medicine is supposed to be doing for them. Sometimes they no longer need to be taking it.
Ken McCoy and I also discuss how I got started as a pain management, physical medicine, and rehabilitation specialist. * We discuss how the holistic approach to treating patients and the future of medicine/health.
Alice Francis and her husband Alan had always been a dynamic and evenly-matched couple. They both worked in high-energy careers that they loved; they traveled the world together; they exercised together regularly, and led extremely active lives. When Alan’s first flares of chronic back pain prevented him from keeping up with their fast-paced lifestyle, Alice quickly realized that their relationship was about to undergo some drastic adjustments.
“This transition has been life-changing,” she admitted, “and although I wouldn’t want anyone to have chronic pain, I have learned a lot of lessons regarding pain care and advocating for my spouse in this ‘adventure’ ”.
Alice does not like referring to herself as her husband’s “caregiver”, but it is an apt description of the role she has had to fill in Alan’s health care management. As her husband’s treatment progressed through office visits, complex pain regimens, and four corrective surgeries, Alice has taken on an active role in helping her Alan to manage his chronic pain. In the six years since Alan’s degenerative disc disease was first diagnosed, Alice has learned to be an effective champion of her husband’s medical care while maintaining her own positive outlook on life.
Thousands of spouses and children of pain sufferers find themselves in Alice’s position every year. Becoming involved in the care and treatment of a suffering loved one is a natural and loving gesture, but it can easily take its toll on even the most patient caregiver. Here are some of Alice’s tips for others who are caring for loved ones suffering from chronic pain.
- How long has the doctor provided pain management?
- Does the doctor give injections, and if so, where were they trained and what is their general outlook on patient injection needs? (In our experience, doctors who were trained via Mayo Clinic will give only 3 injections per year. Doctors trained in other programs are sometime more open to assessing the number of injections based on the need of the patient.)
- What is the doctor’s general philosophy on pain management? If they don’t have one, that’s a red flag.
- How many doctors are in the practice? Will patients generally see the doctor or the physician’s assistant?
- How far in advance do you need to make an appointment?
- Who is the contact when you are unable to reach the doctor?
- Will you be able to get copies of all medical records and appointment notes? (I always request this on a monthly or quarterly basis. It’s important to see what the doctor’s interpretation of the appointment was, which can be quite different than yours or the patient’s.)
- Has the doctor ever experienced long-term or chronic pain? Although this isn’t a deal-breaker, the doctor’s firsthand experience is a plus. They will most certainly have a high level of compassion and understanding for what the patient is going through.
Alice stresses that finding the right rapport between a doctor and the patient is extremely important, since this doctor-patient relationship could potentially last for years. She found that helping Alan to be proactive about his own emotional needs made it easier to find doctors who were a good match for Alan. “At the beginning of our pain journey, it was very important for my husband to explain to a doctor who he was before pain. He wanted them to have a glimpse of what his life was like before this happened. He was struggling to deal with all the changes going on, and needed people to know that he hadn’t always been the ‘patient’.
“Some doctors were very attentive during this dialogue. Others were very dismissive and condescending. Their reaction was almost always a sign of the care and compassion to come. I suggest the patient or caretaker come up with some brief summary of activities and interests prior to the pain and see what kind of reaction you elicit.”
Alice offers further perspective on the changing relationship of chronic pain patients and their caregiver companions. “My husband went through not only a huge physical adjustment to dealing with chronic pain, but an equally large psychological adjustment. Without work or exercise or the ability to live an active lifestyle, he just didn’t know who he was anymore. I went through a similar adjustment, I’m sure.
“Acknowledging this transition, and how hard it must be, was very important for both of us. Be patient during this time, because your loved one really needs to feel vital and normal. Strongly suggest to your loved one they go see a therapist or psychologist to work through these issues. It can be a huge help to you both.”
“Of all the things I have done in my life,” says Alice, “taking care of or being in a relationship with someone you love who is in chronic pain is by far the most difficult. In the beginning I felt like my good days were completely dependent on his good days. That’s no way to live.
“You do need to provide love, compassion, sometimes some physical and mental support. But you also have to realize that you CANNOT fix or change the situation. You can’t make the person take meds or not take meds. You can’t do physical therapy for them. You can’t take the pain away so you just have to let it go. “I developed a sense of normalcy around all of this. I have a career that I love-- it keeps me very busy. I go shopping and traveling some with girlfriends. I exercise on my own, and do things just for me. This new ‘normal’ life really helps provide Alan with a sense of ‘normal’ as well. I strongly encourage you not to forget about you in this process.”
This article is summary and companion article to Taboo Talk's April 6th (2011) radio show/podcast.
The San Francisco Chronicle recently interviewed one of my patients and myself to gain a perspective on how many doctors are "scared to death to prescribe [medicine] stronger than ibuprofen 800mg", given concerns about drug misuse. The article discusses the balancing act between the lack of access to pain physicians and the way most patients can be functional despite pain medication. Here is an excerpt of one of my quotes:
"I have colleagues who are board certified in pain who will not write significant pain medication for treatment. Many of them are feeling overwhelmed and scared," said Dr. Moshe Lewis, a pain management specialist with California Pacific Medical Center who has treated Reia. "Most of the patients I see, probably 90 percent, have legitimate pain. The challenge is figuring out who's who."
Do you have a muscle, tendon or part of your body that is recurrently tight or painful and does not respond well to stretching? You may be a candidate for Active Release Techniques® (ART). ART is a fast-acting, highly effective soft tissue technique that breaks up adhesions or scar tissue, whether from trauma or repetitive strain, and helps return tissue to its normal flexibility and function.
Scar tissue can form with any type of repetitive motion that limits relaxation of the tissue thus restricting sufficient blood flow and oxygen to the area. An injured area where there is a chronic inflammation and insufficient flow of oxygen may trigger a series of chemical reactions called chemotaxis that increases the recruitment of macrophages and fibroblasts that eventually build fibrosis or scar formation. As an area becomes tighter and more fibrotic, the cycle is perpetuated and more scar formation occurs.
Acutely injured tissue tends to feel boggy and swollen, such as experienced with a sprain, strain or spasm. After a couple of weeks, tissue under the stress of sustained tightness or decreased mobility begins to change, becoming stringy, then lumpy, and eventually fibrotic. Fibrosis is what causes tendonitis to become chronic tendinosis. It is what can entrap nerves and cause someone to experience nerve pain with movement.
Whether scar tissue formed by repetitive motions working at the computer or by repetitive training for an elite musical or athletic performance or somewhere in between, an ART practitioner can identify where the adhesions are and then release them. Fibrotic tissue can be broken down, reabsorbed by the body, and with correct exercise and movement re-education, the tissue will remodel to do what it was designed to do, without recurrent pain or tightness.
Prior to the Vancouver Winter Olympics, I was working with Chuck Berkeley, a member of the USA Bobsled Team. He was experiencing recurrent calf pain and tightness that was keeping him from sprinting and jumping, two must-dos for his sport. Through specific palpation, adhesions were identified deep in his lateral calf, between the soleus and the peroneus longus. With significant tension placed on the adhesions and Chuck moving his ankle through motion first to stretch soleus and then peroneus longus, tension increased where my hand was and the adhesions were released. Within 3 treatments, his calf was no longer painful or tight. To restore the tissue to its normal function, Chuck was given specific exercises to strengthen his gluteal muscles, and avoid overuse of his calf muscles for stabilizing and push-off through his running stride and with jumping. His symptoms did not return, and Chuck was able to continue his training and compete in the Olympics.
P.R. “Nina” Patterson, PT, OCS, ART
Sports + Orthopedic Leaders Physical Therapy, Inc
By Moshe Lewis
Co-written by Mikel Davenport LAc
In Chinese medicine, there is a saying: where there is blockage there is pain, but where there is no blockage there is no pain. We know this to be true in western medicine, as well. When we are hurt, inflammation effectively blocks and redirects our body’s healing resources to the site of an injury or infection.
As a result, we often manipulate inflammation as a tool to bring about healing. For example, the orthopedic technique of prolotherapy requires injection of an irritant such as a sugar solution into a weak joint. This irritant induces inflammation, thus increasing the healing of nearby tendons and ligaments.
The traditional Chinese practice of acupuncture works in much the same way: it creates minute traumas along the skin’s surface to bring a beneficial inflammatory response. Acupuncture does more than simply irritate local tissue, though. By directing inflammation to areas that stimulate orthopedic trigger points and our neural pain sensors, the effect of each needle can bring widespread and lasting relief. In my own practice I’ve found acupuncture to be a boon to chronic pain sufferers.
Our health care system isn't always easy to navigate or understand. As a doctor, I have to deal with insurance companies on a daily basis. Here are a couple of tips on how to get the most out of your health care insurance company.
1. Collaborate with your doctor about alternative approaches and complementary medicine
2. Ask for lower cost options, including generics and sample prescriptions
3. Negotiate for lower charges when paying cash, especially while trying to meet deductibles
4. Use the money in your Flexible spending account for complementary medicine and alternative treatments
5. Use a third party to order prescription refills
6. Stay Healthy
7. Stay in your Network
8. Use the ER for emergencies
9. Visit your insurance company's website to understand your benefits
10. Analyze your health plan at open enrollment to see if your needs are being met