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illustration: Silvia Cabib

Orthopedics and Pain

A Special Supplement for

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Pain: How to Cope Three Things You Should Do for

Chronic Pain B

aptist Health Louisville physical therapist Mary Plunkett knows a thing or two about pain relief. Not only does she instruct patients on how to cope with discomfort, but she does this while managing her own chronic pain as well. “I do take some medication, but I do other things in order to help cope, and those are the exact same ways I try and teach my patients,” Plunkett says. “I tell them you need a bag of tricks you can go to to learn how to manage your pain. And you need several of them.” What type of coping mechanisms does Plunkett pull out of her physical therapist’s hat? First, she reminds patients to breathe. Deep breaths from the diaphragm work best, almost like the techniques expectant mothers learn to deal with the pain of contractions. A patient concentrates on the rise and fall of her stomach, and this simple act calms her neurological systems and, over time, allows her to refocus her mind away from the pain. Meditation, with its strong breathing element, also aids in calming the body and mind. Plunkett says she’s excited about recent studies demonstrating the benefits of meditation and introduces her patients to basic techniques. Above all, Plunkett recommends

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By Amanda Beam

chronic pain sufferers exercise, even though the movement might cause discomfort at first. “Your body is meant to move,” she says. “With any pain patient, what tends to happen is that they want to shut down and not move at all. But that is not what the body is made to do.” Released endorphins are one of the many benefits of working out. Easiest in its approach, the gentle stretches of Hatha yoga provide both a workout and the benefits of relaxation. Aquatic physical therapy can also help. Many chronic pain patients associate any touch with unpleasantness; even water touching the body can have a negative connotation. But after a time, people begin to understand that touch is a normal sensation and not one necessarily related to suffering, Plunkett says. Overcoming chronic pain isn’t a walk in the park. Most of these methods take time to be effective. But Plunkett thinks their effects are well worth the wait. “It’s not a fast journey,” she says. “It’s slow and plodding, and it takes a lot of different help between your physician and maybe your physical therapist and you to come up with the right type of prescription.[But] there is a light at the end of the tunnel.”

Percentage of participants surveyed in a 2010 study who said they had suffered from chronic, recurrent, or long-lasting pain enduring for at least six months.

Source: The Prevalence of Chronic Pain in United States Adults: Results of an Internet-Based Survey in The Journal Pain.

Use Opioids Safely: Three Key Steps one Keep your doctor informed. Inform your health care professional about

any history of substance abuse. All patients treated with opioids for pain require careful monitoring by a health care professional for signs of abuse and addiction, as well as to determine when these analgesics are no longer needed.

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Follow directions carefully. Opioids are associated with significant side effects, including drowsiness, constipation, and depressed breathing, depending on the amount taken. Taking too much could cause severe respiratory depression or death. Do not crush or break pills. This can alter the rate at which the medication is absorbed and lead to overdose and death.

“Turn your wounds into wisdom.” — Oprah Winfrey

three Reduce the risk of drug interactions. Don’t mix opioids with alcohol,

antihistamines, barbiturates, or benzodiazepines. All these substances slow breathing, and the combined effects could lead to life-threatening respiratory depression. Sources: Mary Plunkett through Andy McLeroy of Baptist Health Louisville

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Not Your Gramma’s Surgeon…

Orthopedic Surgery is Changing by Amanda Beam

From post-op to pain relief, the field of orthopedic medicine has seen numerous advances in the past decade. Innovations in materials and surgical techniques have decreased patients’ hospital recovery time while allowing them to return to an active lifestyle more quickly and safely. Experiencing these improvements firsthand, five Kentuckiana specialists in orthopedic surgery share their views on recent advancements as well as other changes on the horizon. 4

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Dr. Patrick Bauer, M.D., board-certified orthopedic surgeon with Orthopedic Surgeons of Southern Indiana, a Clark Physician Group Since 1996, Bauer has been treating patients with various types of bone and joint difficulties. Shorter hospital stays and quicker mobilization after surgery, he says, are two advancements in surgery he has seen since he started practicing. Dr. Stephen P. Makk , M.D., board-certified orthopedic surgeon with Louisville Bone and Joint Specialists Makk says he has seen younger, more active people of the baby boomer generation searching for ways to continue their energetic lifestyles despite joint pain. In the era of Internet information, Makk cautions that not all procedures or operations are appropriate for all patients, no matter what you read online. Dr. Arthur Malkani, M.D., board-certified orthopedic surgeon with Jewish Physician Group, part of KentuckyOne Health In his 19 years of practice, Malkani has particularly noticed the rise in obesity among Americans, as well as the associated health effects excessive weight can cause on the joints and the whole body. Dr. Ani Uyoe, M.D., board-certified orthopedic surgeon with Floyd Memorial Medical Groups Orthopedics In the field of orthopedic surgery overall, Uyoe credits both minimally invasive procedures and more aggressive rehab as two major improvements he has seen since he began practicing medicine. New technologies, such as instruments that shrink blood vessels so less blood is lost during surgery, have also increased the odds of successful procedures. Dr. Kittie George, MD, a board-certified orthopedic surgeon at Louisville Bone and Joint Specialists and Medical Director of Women’s Bone Health at Norton Healthcare While dealing with both standard orthopedic issues as well as bone health in women, George has noticed that, from a surgical standpoint, operations are being performed in a much less invasive way. Smaller incisions and the greater use of scopes allow for less pain and a reduced recovery time for patients. For other treatment options, she also spoke highly of the recent advancements using Platelet Rich Plasma (PRP) and Autologous Conditioned Plasma (ACP) as injections.

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What significant advances have you seen in the field of orthopedic surgery both overall and with joint issues in particular? Dr. Bauer: “I think the most progressive thing has been time in the hospital and rapidness of recovery. It’s not been so much with the specifics of the surgical procedures, just getting patients up quickly and into rehab quickly. When I was first in training, patients would stay overnight in the hospital to have ACL surgery [or] to have rotator cuff surgery. Those patients go home now the same day. Patients would spend a week in the hospital after total replacement surgery. Those patients are going home two or three days after surgery.” Dr. George: “The biggest thing that is going on right now is that everyone is being more proactive. And I think that’s from a physicians’ standpoint and a patients’ standpoint. People are getting smarter about what they are doing. They’re staying healthier. They’re staying more flexible. They’re staying fit. They are also taking a much more proactive stance in regards to osteoporosis.” Dr. Makk: “The major things driving orthopedic surgery are the baby boomer generation and ‘boomeritis’. Boomers are overall an active generation, and they want to remain active. So we’re doing more and more hip, knee, and shoulder replacements and more and more procedures to try and keep people active into older ages.” Dr. Malkani: “Orthopedic surgery has had a tremendous impact over the past five or six years, especially with joint replacements. Patients are now living longer. I can’t believe that I’m doing hip and knee replacements in patients who are in their 80s and 90s on a regular basis. It’s mind-boggling. Joint replacement allows our senior citizens to maintain their independence and get rid of their pain for a better quality of life.” Dr. Uyoe: “I think one of the big advances in orthopedics is probably the development of the anterior approach hip replacement procedure. Hip replacements in general have really revolutionized the world of orthopedics. It’s one of those major advances in orthopedics. And recently, there has been new interest in the anterior approach, which even makes it a little bit more revolutionary.”

What progress have you seen in other areas such as imaging techniques or pain relief? Dr. Bauer: “There was a lot of use of ‘pain pumps’ at the first part of the 21st century, and that sort of went by the wayside. We do a lot more surgery now with regional anesthesia. We can inject around the surgical site, so patients can get up and move more quickly. “In planning for certain types of knee replacement surgery, there is MRI imaging that is used to sort of custom design cutting guides that will accurately reproduce the patient’s own anatomy as opposed to just using end marks we would make standard cuts with. I’m not sure that the specifics of the CT Scan or MRIs have changed, but the way we’re using them has improved.” Dr. George: “With pain relief, I would still say the PRP and ACP. Those are providing healing and pain relief. With imaging, you are definitely seeing the use of more ultrasound with injections and assistance with identifying injuries such as tendon tears. Whether it’s rotator cuff, patella tendon, quad tendon-using ultrasound in the office to define these injuries and for treatment as far as injecting things in an exact area.” Dr. Makk: “There have been a lot of advances in pain relief. We have better medication that can provide relief without sedation or other side effects. We’re using more and more regional blocks or

numbing medicine injected in the nerves in the area of surgery to relieve pain longer after surgery, and basically they wear off more slowly. Where you once might have woken up in the recovery room with severe pain that has to be controlled, we’re able to better manage a kind of smooth landing with the pain.” Dr. Malkani: “Another advancement we’ve had that is really nice is post-op pain management. We have medications that are long-acting for pain relief. I’m talking about the stuff we do in surgery — the regional anesthesia and blocks. These new drugs that have come out, we inject locally into the tissues, and it gives long-acting pain relief for that patient.” Dr. Uyoe: “It used to be, in the old days, we’d just give you a little button to push, and the machine gave you pain medicine. But we’ve come a long way since then, and we now know that attacking pain from multiple sources is a better option. So, we are using techniques like local infiltration of anesthetics and using regional anesthetics such as epidural or spinals and then using non-narcotic oral medication. And, of course, we still have our traditional methods of pain control, such as narcotic medicines through an IV or orally. That’s another big advancement in orthopedics overall — trying to control pain better through a multimodal pathway.”

What medical advancements do you expect to see in orthopedic medicine in the next five years? Dr. Bauer: “Probably at some point, we’ll be able to do a much better job in restoring cartilage as opposed to replacing it. In other words, someone now who has an arthritic knee gets diseased bone and cartilage removed and it’s replaced by metals and plastics, whereas at some point we may be able, through genetic manipulation, to actually regrow normal cartilage.” Dr. George: “I keep hitting on the PRP and ACP, but I think in the near future that (treatment) will no longer be considered experimental by insurance companies. I think once you have those prospective studies that show the benefits of PRP are there, I think it will be approved by insurance companies. I think that will be a huge, huge advance in the treatment of various things. I think you’re going to see the further use of stem cells. That is used in other countries. I think you’ll see it used more and more here in the United States.” Dr. Makk: “I say, kind of tongue-in-cheek, that what’s new in orthopedics is advertising. People hear more and more from companies trying to get directly to the consumer with the Internet. People are doing research, which is good, but oftentimes they’re coming in with volumes of unfiltered information from the Internet that may have been written by marketing departments rather than scientific departments. The job of the patient is to find a physician that you trust and have him or her filter the information for you to find techniques that are A) proven and B) most effective for your condition.” Dr. Malkani: “I think we’re going to see a lot of deficiencies in our health care systems. You are going to see, for example, that Medicare and our health care system are really underfunded. The fact is that we have so many people who need health care and there’s not enough funding to go around. We have to do a better job with every dollar we get for health care and make better use of it. And that means hospitals will have to do more with less and still maintain great quality and efficiency.” Dr. Uyoe: “ I think technology is really helping orthopedic surgeons. It doesn’t matter what specialty you are: sports medicine, foot and ankles, pediatrics. I think that with advancements such as using smart phones and smart pads, it just allows us to deliver information quicker to the patient.” todayswomannow.com / todaystransitions.com

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Arthritis Pain By Amanda Beam

The message of massage… As a term, arthritis encompasses more than 100 different diseases and conditions within the family of musculoskeletal disorders. Affecting more than 27 million Americans, this chronic ailment is typified by a breakdown of cartilage that cushions bones in joints. Despite the prevalence of the disease, scientists have yet to find a cure. Merchelle Stokley, massage therapist with Anderson Physical Therapy/Back Pain Relief Center, would like to get her hands on those suffering from arthritis. “I can’t fix arthritis, but I can help reduce the pain that goes along with arthritis,” she says. Research has shown that regular massage can alleviate some of the pain and stiffness associated with arthritis and may actually increase patients’ range of motion. In a 2012 Duke University study, participants diagnosed with osteoarthritis were treated to either Swedish massage several times a week or traditional therapies. Patients in the massage group, on average, achieved greater pain relief and more improved function over the traditional treatment plans. Stokley uses deep tissue massage to soothe the discomfort of arthritic patients. She also stretches their legs and bodies in ways they might not be able to do at home. Techniques such as electrostimulation or moist heat may be applied to troublesome areas to increase blood flow and enhance Stokley’s ability to give a deeper massage. Results do take some time. In the aforementioned Duke study, the researchers found that 60 minutes of massage once or twice a week for eight weeks gave the greatest benefits. “It doesn’t happen overnight, obviously,” Stokley says. “It didn’t take us a day to get in this shape, so it’s definitely going to take more than one treatment to get us out of it.”

“Any of the studies that have actually done a really true, blind randomized trial [show that] the relief is about the equivalent of taking an aspirin a day, and there have been no studies that have shown that it has actually helped to rebuild cartilage. Unfortunately, our body isn’t very good at doing that.” — Dr. Patrick Bauer, board-certified orthopedic surgeon with Orthopedic Surgeons of Southern Indiana, a Clark Physician Group, on whether or not the supplement glucosamine provides relief from different forms of arthritis.

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Number of people age 18 and over projected to have doctor-diagnosed arthritis by the year 2030. Source: cdc.gov

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Sports Pain By Amanda Beam

Biofreeze Do you need the benefits of cold compression on an injury without the icy mess? You might want to learn more about BioFreeze, a topical pain relief ointment. Using menthol as its active ingredient, this analgesic works by providing a “counterirritant” to the pain. According to the makers of BioFreeze, the treatment utilizes Gate Control Theory, “where nerve impulses from one stimulus block the nerves containing pain signals to the brain.” In recent years, races such as the Disney World Marathon have provided pumps of the pain reliever to runners in need at medical tents.

Put your Best Foot Forward According to the American Academy of Physical Medicine and Rehabilitation, up to 70 percent of runners will be injured every year. Get a leg up on those statistics by making sure your current footwear is the right fit for your foot type. Craig Vanderoef, category manager of running apparel at Adidas, offers a few suggestions. First, he says, make sure the shoes you wear fit. Feet swell during running. Ensure your shoe accommodates this by buying shoes with a thumb-width space between the end of the shoe and your longest toe. Also, footwear should be roomy enough that you can pinch a fourth of an inch of fabric from the widest portion of your foot. And then there’s the question of support and foot shape. “Everyone’s body is a little different, so there’s a perfect running shoe for each body, but no one shoe is perfect for all,” Vanderoef says. “Some people need very little support, and so they need a good fit and very little correction from the shoe.

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sure “up.Make to warm I always

recommend foam rolling because that’s a real effective way to warm tissue up before you put it through a repetitive motion.

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The maximum amount by which athletes should increase their weekly training time, distance, weight, or intensity. Anything more might push the body too hard and lead to injury.

— Dr. Kyle Bowling, owner of Kentucky Sports Chiropractic, on how to help reduce overuse injuries.

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Other folks have biomechanical problems and need a shoe that enhances their foot strike from impact to toe-off.” Runners, especially those new to the sport, should pay a visit to a specialty running shop so an expert can help them find a shoe that fits their feet and their needs. Buyers need to actually run for a bit in the shoe to get a true feel of its fit. “The best fit is the shoe you don’t have to think about and don’t even notice,” Vanderoef says. As a collegiate runner, Vanderoef learned firsthand the value of a good shoe. Even now, the 38-year-old hasn’t missed his daily run for more than 4,800 days. He accredits proper footwear, a good massage therapist, and core strength and conditioning as the keys to this impressive feat. “Running shouldn’t hurt,” he says. “Starting can be rough, but eventually it should feel natural and pain-free. The right shoes and apparel will help in this.”

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Don’t Want Surgery? You have options…

by Amanda Beam

Needle a little help?

In the past few years, Dr. Jessica Stumbo, a University of Louisville/Jewish Hospital Sports Medicine physician, has seen nonsurgical advances become more common in the field, some of which deal with stimulating damaged tendons and muscles in order to help them heal. Although not particularly new in its discovery, prolotherapy continues to gain mainstream acceptance in doctors’ offices across the nation. The treatment’s premise is simple: A physician injects a non-pharmaceutical agent such as sugar water into the area affected by pain or weakness. Researchers think this type of stimulation by introducing an irritant will reinitiate the body’s natural restorative process. “The body sort of forgets that there’s a problem, and we go in and do various things to irritate the area to make the body go, ‘Oh, there’s a problem here. I need to come and send all the growth factors and healing factors to help heal this chronic issue,’” Stumbo explains. Similar to prolotherapy, dry needling has become more prominently used among physical therapists. Small, solid needles are inserted in trigger points around the afflicted area. But unlike prolotherapy, no liquids are injected. “[Practitioners] basically go in to the trigger point areas with the needle, and it helps the muscle relax,” Stumbo says. “They’ll usually follow it up with physical therapy or rehab to help stretch the muscle. They even use it sometimes for chronic headaches.” In addition to these techniques, doctors have been using platelet-rich plasma (PRP) injections to decrease joint and muscle pain by promoting natural healing. In this procedure, whole blood is collected from a patient and then processed through a centrifuge to filter out the nutrient-rich PRP cells. The physician then injects the PRP cells back into the injured area. While insurance does cover dry needling, PRP injections and prolotherapy generally are not included in most plans. Stumbo believes this is likely to change as more study results become available. At present, research has been mixed on whether the injection solutions themselves promote healing or if the irritation by the needle is the only thing required. “Some people think the act of sticking a needle in there is what helps it,” Stumbo says. “Other people argue that it’s what you put in there that helps it. We just don’t have the high-quality studies yet.”

Work out scar tissue

As owner of Kentucky Sports Chiropractic, Dr. Kyle Boling also uses some noninvasive approaches to orthopedic pain. The former collegiate runner sees a lot of sports injuries caused by overuse. “Our musculoskeletal systems work a lot like an assembly line,” he says. “If one thing stops doing its job — one muscle, one tendon, 10

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one ligament, one joint — then something else nearby has to come in and work harder. That’s when we get the overuse injuries.” Many times, Boling says, built-up scar tissue may be the cause of pain after damaged or overused tissue heals irregularly. “One of the culprits of an overuse injury is a buildup of scar tissue or adhesion that limits the muscle’s range of motion and ability to heal itself and really get a good blood flow and oxygen supply,” Boling says. “[The techniques we use] break it apart and allow the body to heal on its own.” Boling performs two separate procedures to loosen such built-up scar tissue. In the Graston technique, he uses a series of handheld stainless steel instruments to identify and break down scar tissue through calculated rubbing and massage techniques. Only providers trained and accredited in the Graston technique can practice it by name. Boling also employs the Active Release technique. A complex series of patient movements are paired with precise tension applied to points on the body. Practitioners learn more than 500 different moves when training for this technique. Learn more: grastontechnique.com, activerelease.com

Powerful physical therapy

Mary Plunkett, physical therapist with Baptist Health Louisville, treats a wide variety of orthopedic injuries. “I always say to my patients every single time when they come to physical therapy, you’re basically looking at some choices: surgery, medicines, or physical therapy,” Plunkett says. “And they all have risks and benefits. I think everyone has to look at that.” A March 2013 study in the New England Journal of Medicine recently examined whether surgery or physical therapy had better success rates in treating meniscal cartilage tears. The study showed no significant difference after six months between patients who had surgery and post-op physical therapy compared with those who had no surgery and only traditional physical therapy. Plunkett says the study points to the power of physical therapy, which often has fewer risks and side effects than surgery, as well as costs much less than most operations. Still, patients must understand that physical therapy takes time to produce results. “The beauty of physical therapy is that the only risk you have is the time you put in to it,” Plunkett says. “That’s really the only negative.”

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illustration: Silvia Cabib

Despite recent advancements in orthopedics, most surgeries still present their own set of risks, such as complications with sedatives or post-op infections. But before deciding to go under the knife, patients today can consider many non-surgical avenues that may provide proper healing and pain relief. And much like innovations in surgery, this field of non-surgical orthopedic treatments continues to grow with each newly discovered technique.


Choose Your Attitude by Bob Mueller

We have the power to support our experiences and interactions by having an open, flexible, and loving attitude. The attitude with which we approach life is a choice every day. We have the power to choose the position or perspective we will assume toward specific events and people in our lives. This orientation influences our actions and responses to the challenges we encounter each day. We can make the choice to frame our view of the world and its daily details positively and optimistically or negatively and pessimistically. The challenge of life is certain; our choice of attitude is not. Too often we fail to accept ourselves as imperfect human beings on a difficult path. Choosing our attitude is one area where we can enjoy real personal power. Amazingly, grumbling can turn into gratitude, arrows into gifts, and mistakes into learning when we adjust our attitude to positive instead of negative. The attitude we choose determines whether we scowl at each perceived flaw or welcome the challenge of the moment, prepared to transform even the toughest conflict into an opportunity for growth. If we believe we are inadequate, unvalued failures, undeserving of joy and happiness, then this is the negative reality we can expect to manifest and experience. Alternatively, when we see ourselves as adequate, valued and deserving, we are more likely to realize joy and fulfillment. Adopting a positive attitude in advance helps us weather lifeâ&#x20AC;&#x2122;s storms. Adequacy is a perception of our relative state of being. There are situations in life that cause us to experience a physical, mental, emotional, or spiritual sense of lacking. Ultimately, attitude can influence these perceptions of scarcity or abundance. So, we can choose between the perception of ourselves as not smart enough, not likeable or good enough to deserve love and happiness, or we can see ourselves as intelligent, capable, and worthy of all the love and fulfillment we desire. Rarely do we get to make all the choices regarding a situation. However, we invariably have an opportunity to play a role, make a contribution or influence the outcome. Our attitude affects the quality

of that contribution. We have the power to support our experiences and interactions by having an open, flexible, and loving attitude. The search for our inner self is deep and we may encounter painful secrets and what we perceive as ugly flaws. When we adjust our attitude to positive, we are more likely to look at these discoveries as healing revelations and beautiful gifts. Somewhere along the way, it is possible to lose sight of our own value and become stuck in the perception that we are not good enough. Only through the realization that we each possess unique talents, abilities, and gifts are we able to reclaim our significance. A smile is the earliest form of communication and filled with positive attitude. An infant smiles in the first few weeks of life. As the child grow, it learns how to turn the smile into a laugh â&#x20AC;&#x201C; a joyous response reflecting pleasure. A sense of humor, a feeling of fun, and an ability to laugh are all signs of emotional maturity. Healthy laughter frees us; it is the sunshine that makes lifeâ&#x20AC;&#x2122;s shadows interesting. When we develop the ability to see the humor in a situation, we gain the ability to handle it. We were born with smiles. They are as much a part of us as our teeth and hair. Polished and cared for, our smiles can grow into a sense of humor that will help us through the painful times. As a fundraiser for Hosparus I spend countless hours thanking people for their contributions to our non-profit cause that compassionately serves those at the end of life. It is such a joy to thank people for their good deeds and make their day by applauding their positive attitude of giving back. Rather than view these calls as an endless ritual, I use them to spread an attitude of gratitude. It is our attitude that we discover strength or weakness, hope or anxiety, determination or frustration. Alone, we determine whether our attitude will be loving or jaundiced. Today is mine to make. Let me choose my attitude with care.

Bob Mueller is the assistant vice president of Mission & Stewardship at Hopsarus www.bobmueller.org

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osteoporosis Pain

By Amanda Beam

Are you at risk for brittle bones later in life? Although osteoporosis affects people of every sex, color, and ethnicity, the Center for Disease Control and Prevention warns of several risk factors that increase a person’s chance of developing the disease.

Sources of calcium Although it’s the most abundant mineral in our bodies, calcium must be ingested. We can’t actually physically produce it, and we need it for strong bones and teeth. That’s where eating calcium-rich foods such as dark green leafy vegetables comes in. Dairy products, nuts, and foods fortified with calcium can also provide the recommended daily dose shown below.

• Female • White/Caucasian • Post-menopausal women • Over age 50 • Small in body size • Eating a diet low in calcium • Physically inactive

Catching a break: minimally invasive surgery treats spinal fractures caused by osteoporosis Osteoporosis isn’t the type of disease that likes to make a casual entrance. Many people don’t even realize they have the condition until pain sends them to the doctor and a broken bone is discovered. “One of the main issues we are facing is osteoporosis and compression fractures, especially in elderly females,” says orthopedic surgeon Mohammad E. Majd with Floyd Memorial Orthopedic Group. “The good news is about two-thirds of those compression fractures basically get better with passing time and without any medical intervention. But one-third of them don’t get better.” When conservative techniques and time don’t work, Majd uses a procedure called kyphoplasty to repair osteoporosis-related spinal fractures. The surgeon begins the minimally invasive procedure by cutting a small incision near the break and inserting a small tube. Using an imaging device, a small balloon is inserted through the tube and gently inflated, lifting the misplaced bone fragments back to their proper position. Once the balloon is removed, the surgeon uses a type of cement to stabilize the bone. In his 20 years of practice, Majd has performed more than 3,500 of these procedures. Ninety to 95 percent of his patients who undergo the procedure wake up afterward with immediate pain improvement. Time is of the essence when broken bones are involved. If a person experiences discomfort in her back, she should make an appointment to see her physician. The quicker a doctor catches the break, the better the outcome of treatment and the faster the patient can get back to her everyday life. “My recommendation is if they have pain, then come to the hospital and see us as soon as possible,” Majd says. “It has been my experience that if you do that procedure sooner, the result is much, much better.”

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1 2 1 4 in

women and

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men over the age of 50 will have an osteoporosisrelated fracture in his or her remaining lifetime — from The Bone and Joint Decade’s publication The Burden of Musculoskeletal Diseases in the United States.


Orthopedics and Pain Supplement 2013  

Our Annual Orthopedics and Pain Supplement, as seen in Today's Woman May issue and Today's Transitions Summer issue.