Temple Health Jeanes Hospital
health matters Summer 2014
Our Get-Fit Guide:
Shape Up Your Fitness Routine
Also inside 6 Nutrition Buzzwords: Understanding Whatâ€™s Healthy and Whatâ€™s Hype 7 Are You Taking Your Cardiac Medications Properly? jeanes.com
Orthopaedics and Sports Medicine
Our Get-Fit Guide:
Shape Up Your Fitness Routine
“Start off slow, set small goals, and increase your activity and intensity with each exercise session.” – Todd Chertow, MD
ice weather can bring on the urge to get back into an exercise routine or embark on a new fitness challenge. That might mean training for a 5K race or trying a trendy fitness class, such as high-intensity interval training (HIIT), which involves bursts of cardio activity followed by short rest periods, in 30 minutes or less. This renewed motivation, however, can result in sports- and exercise-related injuries, such as tendinitis, stress fractures, pulled muscles, and torn ligaments. “In the warm weather, we see a lot more people who are trying to get in shape for their
health matters Summer 2014
summer attire,” said William J. Markmann, MD, an orthopaedic surgeon at Jeanes Hospital. These common maladies can sideline you just when you’re hitting your stride. “If you have an exercise-related injury, you have to stop what you’re doing until your pain is gone, swelling is down, and you’ve regained your full range of motion,” Dr. Markmann said. Don’t let injury derail your best intentions. Our get-fit training guide, which is geared for every fitness level, can help you exercise safely and stay in the game.
The Exercise specialists
Physicians at The Orthopaedic Center at Jeanes Hospital are skilled at treating exercise-related injuries—and can offer advice on how to help prevent them from coming back. Call 215-728-CARE (2273) for an appointment. Free total joint replacement education classes are also offered at Jeanes Hospital. For more information, including a schedule of upcoming classes, visit jeanes.com.
Fitness Level: Newbie/Lapsed Exerciser
Exercise Type: Regular Gym Goer
Fit Tips: Get the all clear from your primary care doctor. It’s important to check with your physician before starting a new fitness program, especially if you have a health issue, such as a heart condition or joint pain, or you’re training for something rigorous, such as a marathon. Don’t overdo it. “Start off slow, set small goals, and increase your activity and intensity with each exercise session,” said Todd Chertow, MD, an orthopaedic surgeon at Jeanes Hospital who is fellowship-trained and board-certified in sports medicine. Dr. Chertow is also the team physician for LaSalle University in Philadelphia. You might begin, for example, by walking at a regular pace for five minutes twice a day, five days per week, then slowly increasing your walking time and pace, and working up to jogging. Or, try interval training, which involves jogging and walking for a minute or two, and alternating the pattern throughout the duration of your workout, even if it’s just for 15 minutes initially. “The one-minute recovery periods allow you to work out longer because you won’t fatigue as quickly,” Dr. Chertow said.
Fit Tips: Set goals to your training level. Even if you think you’re in great shape, don’t push yourself too hard to reach the next level. “Start from where you are now and pace yourself,” Dr. Chertow advised. To track your progress, keep a log of your activity. Seeing increases in the frequency, intensity, and amount of time you’re working out can motivate you to keep up the good work. Prepare for new To track your activities. Just because progress, keep you’re in shape for one activity doesn’t mean a log of your you’re conditioned for activity. another. If you’d like to get out on the tennis court after jogging on the treadmill at the gym all winter, for example, be sure you’re up for the task. “There are strengthening exercises you can do for your elbow and rotator cuff to help you avoid common tennis injuries like tendinitis in the elbow and a torn rotator cuff,” said Pekka
You know you’re one if: You’re just getting started on or back into a fitness routine after taking some time off.
You know you’re one if: You visit the gym or engage in other physical activities, such as bike riding, walking, running, or yoga, a couple of times a week.
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William J. Markmann, MD Orthopaedic Surgeon, Jeanes Hospital
Todd Chertow, MD Orthopaedic Surgeon, Jeanes Hospital
Pekka Mooar, MD Professor and Interim Chair, Orthopaedic Surgery & Sports Medicine, Temple University School of Medicine jeanes.com
Orthopaedics and Sports Medicine
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Mooar, MD, Professor and Interim Chair, Orthopaedic Surgery & Sports Medicine, Temple University School of Medicine. Certified personal trainers, such as those who work with the orthopaedic surgeons at Jeanes Hospital, can show you specific exercises targeting the muscles you’ll use for your chosen fitness activity. These fitness professionals can also show you how to do the exercises Gary W. Muller, MD correctly to avoid misuse injuries.
Exercise Type: Serious Fitness Buff
Orthopaedic Surgeon, Jeanes Hospital
You know you’re one if: You make exercise a daily, or at least frequent, part of your routine. You may also take part in more intense workouts, such as marathons or half-marathons, HIIT, kickboxing, or spin classes. Fit Tips: Mix it up. If you’re an avid exerciser, you probably have your favorite activities. But repetitive activity can lead
Women: Protect Your Knees
to overuse injuries, such as stress fractures, which have the hallmark symptom of point tenderness—persistent pain in one specific spot. Protect yourself. “If you vary your workouts, you’re less likely to get injured,” Dr. Mooar said. If you’re a runner, for example, take alternate days off for rest or strength training, such as lifting weights. Likewise, if you favor strength training, alternate with aerobic activity, such as walking or jogging. Pay attention to pain. Exercisers at all levels who push themselves beyond their fitness level will feel some degree of pain, signaling the muscle breakdown and repair that leads to muscle growth. “When you’re training, a little soreness is fine,” said Gary W. Muller, MD, an orthopaedic surgeon at Jeanes Hospital. If you’re stiff when you get out of bed in the morning but it’s gone by noon, that’s okay. But if discomfort lingers or interferes with your ability to train or go about your day, see a doctor. “Treatment for an exercise injury can be straightforward, such as RICE (rest, ice, compression—wrapping in an elastic bandage—and elevation), but unless you know why it occurred, you’re doomed to repeat it,” said Dr. Muller.
To keep your knees healthy: There’s no question exercise is beneficial for your body. But • W atch your alignment. When if it’s executed with sloppy style, it can increase your risk of jumping, land with your knees and hips injury. This is especially true for women who participate in slightly bent. Also, when doing deep activities that require jumping and pivoting, such as volleyball, knee bends, don’t bend your knees soccer, basketball—or even a step class at the gym. past 90 degrees. When you’re doing “Women tend to not absorb the impact of landing through a lunge, for example, don’t get down their knees as well as men do,” said Emily Abramson-Chen, MD, so low that your knee (and your body a sports medicine physician at Jeanes Hospital. weight) extends past your toes, which can overstretch In fact, according to the American Academy of Orthopaedic and weaken tendons and ligaments. You should be able Surgeons, women who to see your toes when you look down. participate in jumping and • Don’t go it alone. From power yoga to kickboxing, a variety pivoting sports are two to ten of group classes are available that can help you times more likely to sustain a get fit with others. And because they’re led by an knee ligament injury, such as instructor, they’re also a great way to make sure you’re an anterior cruciate ligament exercising with proper body mechanics. “Put yourself at (ACL) injury, than male athletes the front of the class and ask the instructor to watch that participating in the same sports. your form is correct,” Dr. Abramson-Chen said. The ACL is one of our major knee • Strive for a total body workout. “Mix up your exercises so ligaments, which connects the Emily Abramsonyou use different muscles,” Dr. Abramson-Chen advised. thigh bone (femur) to the lower Chen, MD Cross-training reduces the risk of knee and other exercise leg bone (tibia). ACL injuries can Sports Medicine injuries while promoting total body fitness. Beyond strength lead to osteoarthritis of the knee Physician, training and cardio, try adding Pilates, yoga, or tai chi. decades later. Jeanes Hospital
health matters Summer 2014
Small Incisions, Big Benefits:
houlder arthroscopy has made treatment of shoulder problems safer, easier, and faster than ever for a number of patients. J. Milo Sewards, MD, Assistant Professor, Orthopaedic Surgery & Sports Medicine, Temple University School of Medicine, answers some common questions about this procedure.
What is Shoulder Arthroscopy?
Shoulder arthroscopy is a procedure used by surgeons to diagnose and repair problems in the shoulder joint. During the procedure, your surgeon makes a small cut in your shoulder, about the size of a buttonhole. Through it, he or she inserts a small camera—about the width of a pencil—that is connected to a video monitor in the operating room. This allows the surgeon to see the inside of your shoulder. If your shoulder needs to be repaired, your surgeon may insert other small instruments through one to three more small cuts in your shoulder. After surgery, the cuts will be closed with stitches and covered with bandages. Most people receive a regional nerve block to numb their arm and shoulder during the procedure. You may also receive light sedation to keep you comfortable. The procedure usually lasts less than an hour, but you’ll need someone to drive you home and stay with you for at least one night.
How Is Arthroscopy Different From Traditional Surgery?
Arthroscopy uses small incisions to access your shoulder joint. In traditional open surgery, large incisions are made
to completely expose the joint. Smaller cuts generally mean less pain, fewer complications, shorter hospital stays, and faster recovery.
What Shoulder Problems Can Arthroscopy Repair?
Shoulder arthroscopy is used to repair many shoulder conditions, including: • Torn ligaments—ligaments help stabilize the shoulder • Shoulder instability—when your shoulder partly or fully dislocates • Torn rotator cuff—a tear in the muscles or tendons that attach your upper arm to your shoulder blade • Inflammation or damaged lining of the joint—often caused by an illness such as rheumatoid arthritis • Shoulder impingement syndrome— when the shoulder needs more room to move around
J. Milo Sewards, MD Assistant Professor, Orthopaedic Surgery & Sports Medicine, Temple University School of Medicine
Who Can Have Shoulder Arthroscopy?
You might be a candidate for shoulder arthroscopy if you have shoulder problems that persist despite nonsurgical treatment, including rest, physical therapy, and medicine and injections to reduce inflammation.
How Long is the Recovery?
After a simple arthroscopic repair, you’ll probably wear a sling for about four weeks. You might feel some pain and discomfort for this long, too. Recovery from more complicated procedures takes more time. But if the surgery is successful, once healed, most people resume their favorite activities, with less shoulder pain and better quality of life than before.
Convenient Orthopaedic Care, Right Where You Live
Temple Orthopaedics & Sports Medicine has five locations throughout Philadelphia and the surrounding suburbs. Each site offers some of the most respected orthopaedic surgeons and rehabilitation specialists in the region. To schedule an appointment, call 800-TEMPLE-MED (800-836-7536). jeanes.com
Nutrition Buzzwords: Understanding What’s Healthy and What’s Hype
rocery shopping isn’t so easy anymore. Store shelves are packed with products featuring trendy buzzwords—from “gluten-free” to “natural”—promising all sorts of health benefits. With so many choices, how do you know what’s merely marketing hype and what’s truly beneficial? “It can be overwhelming,” said Heather Rudalavage, RDN, a registered dietitian and nutritionist at Temple Health Women’s Care at Elkins Park. If you’re unsure of what to buy, steer clear of fads or claims that seem too good to be true, advised Howard Bronstein, MD, an internal medicine physician at Jeanes Hospital. “You can’t go wrong by simply eating a balanced diet, with plenty of fresh fruits and vegetables, some protein, some fat, and whole grains,” he said. In the meantime, use this handy guide to help you make sense of some top nutrition buzzwords and decide which items to add to your shopping list and which to skip: Gluten-free. Gluten is a protein found in wheat, barley, rye, and most oats. Both gluten allergy and gluten intolerance can cause stomach pain, diarrhea, fatigue, and bloating. For those with celiac disease (gluten allergy), following a gluten-free diet is a must. Natural. This overused term means a product is free of artificial flavors, color, and synthetic substances. However, the FDA and USDA do not have a formal definition for "natural" to be used on food labels. Rudalavage cautioned that just because something is “all natural,” it doesn’t mean it’s healthy. “It could be made with butter, salt, cream, and/or sugar,”
health matters Summer 2014
she said. “Use common sense and look more closely at the food label.” Organic. Organic foods are grown without the use of pesticides and synthetic fertilizers. Foods with the highest pesticide residue because of their thin skin—known as “the dirty dozen”—may be worth the added cost to buy organic. These include peaches, apples, sweet bell peppers, celery, nectarines, strawberries, cherry tomatoes, hot peppers, grapes, spinach, cucumbers, and potatoes. Probiotic. These “friendly bacteria,” or yeast, help improve digestive health. You can add good bacteria through certain foods or probiotic supplements. Look for live active cultures in yogurt or dairy items with added probiotics. Whole grains. These grains include the entire seed of the plant in its natural state. In contrast, when grains are refined, they lose some of their protein and nutrients. Look for products that say “100 percent whole grain” or “100 percent whole wheat flour.”
Howard Bronstein, MD Internal Medicine Physician, Jeanes Hospital
Talk with your doctor about nutrition as part of your ongoing preventive care. Need a family doctor? Use the Find a Doctor tool at jeanes.com or call 215-728-CARE (2273). Appointments with a nutritionist are available at Temple Health Women’s Care at Elkins Park. For more information, visit templehealthwomens.org or call 215-517-5000.
Heather Rudalavage, RDN Registered Dietitian and Nutritionist, Temple Health Women's Care at Elkins Park
Don’t Miss a Beat:
Take Care with Your Heart Medications
f you’re one of the millions of Americans who takes heart medications, you probably fall into one of two categories. Perhaps you had never taken any kind of medication, apart from a daily vitamin, before your doctor told you during a routine checkup that your cholesterol level was high. You now take a statin to lower your LDL (“bad cholesterol”) and raise your HDL (“good cholesterol”). In your case, the medication lowers a key heart disease risk factor but may not make you feel any differently. Or perhaps you’ve had a heart attack or have been diagnosed with chronic heart disease. In your case, medications such as vasodilators, which ease chest pain, or beta-blockers, which control a racing heartbeat, might be critical for managing symptoms and helping you live fully. No matter what heart medications you’re on, it’s important to take them exactly as prescribed. This might be easier said than done, however. We’ve asked two noted health care providers from Jeanes Hospital and Temple Cardiology to weigh in on four potential problems you might encounter—and offer some advice on how to possibly solve them.
1 Mycostmedications too much.
Ask your physician if a generic equivalent is available. “Many heart medications, including statins, which are some of the most commonly prescribed drugs, are available as generic medications that may work just as well but cost much less,” noted Michael O’Connor, CRNP, a nurse practitioner with Temple Cardiology at Jeanes Hospital.
y medications 2 Mmake me feel dizzy or nauseated.
Don’t ignore any unusual reactions to medications. “If you start experiencing side effects, don’t just stop taking your medications—call your doctor immediately,” said Steven Mattleman, MD, a cardiologist at Jeanes Hospital. “There’s probably another medication that will treat your condition in a different way, or perhaps the dosage or frequency needs to be adjusted. The key to finding the regimen that works for you is communicating with your doctor.”
can’t keep all my 3 Imedications straight. Ask your doctor or pharmacist for a list of all your medications, along with explanations of what
they do and how and when to take them. Keep that list with you, and bring it to all of your medical appointments. Also, tell your health care providers about any homeopathic remedies, vitamins, or supplements that you are taking so they know to check for possible negative interactions.
feel fine, so I 4 Isometimes skip
Steven Mattleman, MD Cardiologist, Jeanes Hospital
taking my medications.
This is a common problem for people who take medications to reduce their risk factors. But skipping cardiac medications is dangerous. “If you don’t develop a routine for taking your medications, conditions such as high blood pressure and cholesterol—which often have no symptoms— can quickly get worse,” Dr. Mattleman said. “By taking your medications as prescribed, you’re protecting yourself against developing more debilitating problems.”
Michael O’Connor, CRNP Nurse Practitioner, Temple Cardiology at Jeanes Hospital
To learn more about our cardiology services or make an appointment, contact Jeanes Hospital on the web at jeanes.com or call 215-728-CARE (2273).
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health matters Jeanes Hospital, the only Quaker-founded acute care hospital in the United States, is part of Temple Health. The hospital provides communities in Northeast Philadelphia, Montgomery County, and Bucks County with advanced medical, surgical, and emergency services. Health Matters is published quarterly by Jeanes Hospital to provide its community with health, wellness, and safety information; however, it does not replace the advice of your physicians. You should always consult your physician regarding any medical concerns and before making any changes in your lifestyle, physical activities, or treatment plan. Jeanes Hospital does not exclude participation in, and no one is denied the benefits of, delivery of quality medical care on the basis of race, religious creed, sex, sexual orientation, gender identity, disability, age, ancestry, color, national origin, physical ability, or source of payment. Temple Health refers to the health, education, and research activities carried out by the affiliates of Temple University Health System (TUHS) and by Temple University School of Medicine. TUHS neither provides nor controls the provision of health care. All health care is provided by its member organizations or independent health care providers affiliated with TUHS member organizations. Each TUHS member organization is owned and operated pursuant to its governing documents.
Published on Jun 9, 2014