Study examines patient modesty concerns and a novel approach to solving them

Comfort in Care

Study examines patient modesty concerns and a novel approach to solving them

By Brian Sodoma For as long as most of us can probably remember, it’s been standard practice to remove all street clothes, including underwear, before surgery. Patients are then asked to wear a loose-fitting gown into surgery with an open back that allows a surgeon easy access to all surgical regions. The removal of street clothes is one of the ways hospitals and surgery centers help reduce infection risk during procedures.

However, this long-time practice has created anxiety in some patients who would prefer to wear their underwear into surgery for privacy and dignity.

Some even forego care. In a British Journal of Anesthesia-published study, gown use induced preoperative anxiety in 45.2% of inpatients and 38.3% of outpatients. In another study at

Samara State University, anxiety around potential exposure even had an adverse effect on outcomes.

ARIZONA STUDY SEEKS SOLUTIONS This spring, the MORE Foundation, in cooperation with The CORE Institute, will conduct a study involving 200 orthopedic surgery patients to gather more perspective on the subject of patient modesty and to test a potential solution: surgical underpants that are manufactured to medical equipment grade hygiene and quality standards.

“Some of the reasons for this anxiety can be gender bias —a female patient, for example, with a male surgeon. Some of it might be religious in nature, or the belief you should only expose yourself to your spouse or to parents. We know this is important for a growing number of people, and we want to learn more and explore a possible solution,” said Marc Jacofsky, Ph.D., the study’s lead investigator and Executive Director for Research and Education at the MORE Foundation.

Dr. Marc Jacofsky says the research is randomized and single-blinded, so patients won’t know ahead of time if they will be offered the underpants or not. The study will evaluate responses from pre- and postsurgery patient surveys about the topic of patient modesty in general, as well as the impact of the coverings offered on the entire surgery experience.

“We may be surprised by the number of people who actually want the garment when it’s offered to them,” Dr. Marc Jacofsky added. “Some may turn it down, too.”

PATIENT ADVOCACY Dr. Jacofsky said that while the issue of patient modesty might not be top of mind for everyone, the growing discussion warrants research. The subject has spurred patient advocacy organizations into action. “Because we have the partnership with The CORE Institute Specialty Hospital, where it’s a very controlled environment, it’s easy for us to run a study like this,” he added. “This used to be a very topdown ‘surgeon says’ issue, but as people push back from that norm and feel more empowered, we want to explore the best alternatives and not be resistant to change.”

Marc Jacofsky, Ph.D.

Go! on theBack

Bilateral shoulder surgery transforms life for auto industry engineer

By Brian Sodoma Photos by Michelle Massey Barnes

For many people who require a joint replacement surgery, nagging pains start slowly. For Mark Messer, they arrived quickly and were debilitating. In early 2018, the active 64-year-old Michigan-based automotive engineer who loves riding jet skis, snowskiing and tossing around a baseball with his grandkids began feeling pain in his right shoulder.

“It got to the point where it started to ache all the time. I couldn’t sleep lying down. I had to sleep in a Lazy Boy [recliner] with pillows all around me,” he recalled. “I’d be sleeping, then wake up in the middle of the night and it felt like a car ran over my shoulder.”

Messer relied on pain medication for pain relief at first, but he eventually went to see his primary care physician for guidance.

NEW SHOULDERS ON THE HORIZON Messer tried cortisone shots for about six months and even spent time in the gym to see if he could regain his shoulder’s strength and mobility. Ultimately, his primary care physician referred him to The CORE Institute. There, Dr. William Kesto, a Fellowship Trained Sports Medicine Surgeon, quickly saw that osteoarthritis had fully deteriorated Messer’s right shoulder socket. The shoulder would need to be replaced. Messer was stunned by the news initially: “I thought, ‘what do you mean I need a new shoulder? People don’t do that.’” The total shoulder replacement procedure Messer needed involves replacing the humeral head, or the top part of the arm (humerus), as well as the socket (glenoid) that attaches the humerus to the shoulder blade. Messer was impressed with Dr. Kesto’s ability to explain the procedure and why it works so well.

“I always walk patients through their x-rays, so they understand the pathology,” Dr. Kesto said. “I have an anatomic model of the shoulder in my office, so I can show them what the implant looks like and how we perform the surgery. That visual aid helps patients understand why it works and why they’re going to eventually feel a lot better.”

Typically, patients with osteoarthritis who need a total shoulder replacement have difficulty reaching their arms above their head and using their hands behind their back. The simple act of

William Kesto, MD

“After the right shoulder was done, I realized how bad the left one really was. Now, my range of motion for both arms is above 90%. Now I can change lightbulbs up in the ceiling and I’m going to ride my WaveRunners again this summer and do some kayaking.”— Mark Messer

threading a belt through belt loops can be challenging.

“Technology has improved tremendously in the last five to ten years, so many more patients can get this procedure now,” Dr. Kesto added. “The sockets last longer, and you don’t have to put a long stem on the humeral side, just the humeral head which may result in less pain and surgical time.”

AFTER CARE, RECOVERY Depending on your goals, shoulder replacement surgery recovery can take between three and six months to get all the muscles working together again and to fully regain motion. Messer spent six months in physical therapy, three sessions per week, after his right shoulder replacement. After the success of the first surgery in October of 2018, Messer opted for a left shoulder replacement in May of 2020 and had twice-a-week physical therapy for six months for that procedure.

“After the right shoulder was done, I realized how bad the left one really was,” Messer said. “Now, my range of motion for both arms is above 90%. Now I can change lightbulbs up in the ceiling and I’m going to ride my WaveRunners again this summer and do some kayaking.”

Like Messer, many of Dr. Kesto’s patients are still surprised to learn a total shoulder replacement is even possible today.

“I think that’s one of the things people don’t know. They can regain a lot of their function and get back to doing the things they like to do with these operations,” Dr. Kesto explained. “I think the message is to inquire about these procedures and not just accept the functional limits you have in life.”

FOR MORE INFORMATION

For more information about shoulder or other joint replacement procedures, visit TheCOREInstitute.com.

After a slip-and-fall accident that tore her hamstring, Sue Gaines is back to participating in group exercise classes

By Elise Riley

Track Back on

Sue Gaines prided herself on being active. A SERIOUS INJURY resident of Sun City West, Gaines, 66, is an avid Gaines hit her head in the fall, suffered a black eye, and hiker and walker. She grew up riding horses. tore her left hamstring. While the immediate concern Her favorite hobby —riding a Peloton indoor was a possible head injury, Gaines said she knew the bike —kept her healthy and engaged with friends damage to her left leg was more serious. across the country who enjoyed group “I tolerate pain pretty well,” she said. cycling classes. “And I kept saying that my leg just wasn’t

But it wasn’t an injury on the bike or a moving correctly.” slip on a hiking trail that sidelined Gaines Gaines called The CORE Institute, and threatened her mobility. Instead, it where she’d previously had a successful was an everyday accident at work. shoulder surgery. This time, she saw

“It was just a slip and fall,” she said. Dr. Michael Rose, a Fellowship Trained “They had just gotten done mopping Orthopedic Surgeon specializing in the floors, and my legs just went out Sports Medicine. from under me. I did the splits without Michael Rose, MD “I was very adamant with him: I ride my meaning to —I’ve never been able to do bike five, six times a week and wanted to the splits, but I did on that day. I couldn’t get up. I knew continue to do that,” she said. “He reassured me that it was pretty serious.” with my surgery, I’d be able to get back on the bike.”

TORN HAMSTRING Ten days after the fall, Dr. Rose surgically repaired Gaines’ torn hamstring.

“She tore the tendon of the hamstring off the lower part of the pelvis,” he said. “It was completely torn off. What we do for people who do a lot of activity like (Gaines) is repair the hamstring tendons.”

Hamstring injuries like Gaines’ aren’t especially common as everyday injuries. Still, athletes such as hurdlers or running backs often suffer hamstring injuries because their skills involve explosive pushing from the legs.

Gaines’ hamstring tear was likely the result of years of activity and wear and tear. Dr. Rose likened it to the degradation of fabrics that are washed and worn over and over.

“You get small tears in the tendon, and then the tendon doesn’t have a great blood supply, so it doesn’t have a great way to repair itself,” Dr. Rose said. “It’s the same process as with the rotator cuff in the shoulder. It’s like when you have a pair of jeans that you wear a lot, and at the knee it kind of wears out, and then it gets small tears, and the tears become bigger over time.”

RECOVERY TIME Immediately after the surgery, Gaines had to immobilize her leg so it wasn’t bearing any weight and couldn’t be extended.

“Once Dr. Rose fixed my leg and the surgery happened, I felt so much better,” she said. “Once he went in there and reattached it, as soon as he did that, my pain level was very low. I didn’t even take pain pills.

GET BACK IN ACTION To learn more about how The CORE Institute can help with your injuries, visit TheCOREInstitute.com.

It was amazing.”

Three weeks after the surgery, Dr. Rose permitted Gaines to return to her bike without any weight/resistance on the pedals. She also went to physical therapy for six weeks.

“Every time I’d go into physical therapy, they’d allow me to have more mobility in the leg,” she said. “It was 8-12 weeks before the brace came off completely, and I was able to do what I was supposed to do. I was still weak, but I could do normal activity.”

At her 12-week checkup, Dr. Rose cleared her to resume normal activity. She was back on her Peloton and connecting with her virtual friends who’d missed her. Now after her successful procedure she found she was riding with the same vigor as before the accident.

“My left leg is actually stronger than my right,” Gaines said. “There’s nothing I can’t do now.”

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