Episodes
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Most people have no idea what SPD is - its the sterile processing department. The place in the hospital that cleans all of the human body stuff off instruments so they are clean and sterile for your surgery.
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I will share with you what we talk about in the operating room.
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Missing episodes?
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A mini-podcast series on the operating room - what really happens
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Dr. DeCook wrote "The general public would be aghast if they knew that often surgeons and staff who had never worked together before start doing cases together for the first time."
Here I share my thoughts on team, inattention blindness, turnover times and more.Support the Show.
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I wanted to share some statistics and personal experience with suicide and other stress factors.
If you need help please ask for help over and over if you have to.
If you notice someone is in trouble do everything you can to get them the help they need.Support the Show.
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Supplementing with essential amino acids (EAA) after total knee replacement may be helpful. Two studies have shown that supplementing with EAA for one week before and two weeks after surgery, patients had less atrophy of their muscle and it improved outcomes.
Check with your doctor to see if these might be beneficial for you.
The two brands I recommend to my patients are:
Thorne - https://amzn.to/3EiFTWA
Pure Encapsulations - https://amzn.to/38JnI0q
The two articles:
Essential amino acid supplementation in patients following total knee arthroplasty by Hans Dreyer in The Journal of Clinical Investigation in 2013
and
Perioperative essential amino acid supplementation suppresses rectus femoris muscle atrophy and accelerates early functional recovery following total knee arthroplasty by Hideki Ueyama in The Bone and Joint Journal 2020Support the Show.
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Here I will discuss how knee pain treatment can be similar to the treatment of back pain and how knee surgery recovery is not like the recovery from back surgery.
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Pete Egoscue is a Vietnam vet who had suffered from chronic pain. In the 1970s he devised a method to change postural imbalances with "E-cises" and this has helped many people reduce their chronic pain. He has a number of books where you can read about his method.
There are over 30 Egoscue Clinics in the United States so you may be able to find a trained specialist in your area if you think this method may be helpful for you.Support the Show.
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This is a common question many patients have - can I do too much?
It depends. It is rare to do so much that you harm yourself. On average you should see less pain, less swelling and better function.
If you are ahead of schedule and have more symptoms back off 10%. But if you are behind, even though you are having more pain, you may need to push harder.
This is where your therapist and care team come in handy. By working with you they can guide you on how to balance your symptoms and your recovery.Support the Show.
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So many patients are coming in with the same story. Due to covid they have gained weight and stopped exercising. We are now seeing patients with pain and it got worse when they tried to go back to the gym. Others are struggling with losing the weight they gained during the past two years.
Here I will share what I am seeing and the things I have discussed with my patients.Support the Show.
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I have been reading and learning more and more about CBD lately. I am excited for all of the research that is beginning to come out. The ACES (Advancing Cannabinoid Education & Science) Trial is scheduled to be released in a few months. I have talked with the founders at Corganics who produce CBD in three forms with a very stringent process with third party testing. A quarter of products on the market have no purity testing and almost a quarter contain THC. You need to be cautious and aware of what you use and what you buy to make sure that it is safe for you.
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Covid is once again ravaging the world and the healthcare systems that people depend on. The United States spends more per person than any other country in the world yet the US does not have the best health metrics.
Covid has not helped. Hospitals are overwhelmed. Doctors, nurses and other hospital workers are at the breaking point. PPE is still limited. Elective surgeries are cancelled. Wait times are longer than ever.
The future is bleak. Many have left the profession of healthcare. I doubt many people will look eagerly to enter medical school, nursing school or some other hospital based profession. Patients will still need care. The ability to access care will be compromised. Wait times will be longer. Patients will suffer. The future is coming but it will be different and the effects of covid will leave a stain on healthcare systems for a long time.Support the Show.
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I am happy to share with you my new book THE KNEE BOOK - A GUIDE TO THE AGING KNEE
In the book you will find answers to all of the questions you may have about your knee symptoms.
Chapters cover knee symptoms and imaging, exercise and weight loss, over the counter treatments and surgical treatments such as arthroscopy and knee replacement.
You can find the paperback book on Amazon or through this link:
https://www.amazon.com/Knee-Book-Guide-Aging/dp/B09NKWMYFN/ref=sr_1_2?crid=3BSKDJRI44D9G&keywords=the+knee+book&qid=1639946441&sprefix=the+knee+book%2Caps%2C144&sr=8-2
And an ebook version is available here:
https://www.amazon.com/Knee-Book-Guide-Aging-ebook/dp/B09NLL58LG/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=1639946441&sr=8-2
Available at Barnes & Noble as a Nook here:
https://www.barnesandnoble.com/w/the-knee-book-a-guide-to-the-aging-knee-adam-rosen/1140795276?ean=2940161052846Support the Show.
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Total knee rehab is a long journey for many. It can be scary if you do not know what to expect. Here I will share what is common at one month and three months on your road to recovery after a total knee replacement.
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Some people are born with a leg length discrepancy. Some have an injury, like a fracture, which can lead to the limb being short or long. Many patients with arthritis will have the leg shorten, even if they are not aware of it. At the time of surgery the goal is to fix the knee or hip and make it stable. Patients may feel long after surgery. For many this resolves in a number of weeks. Some may continue to feel long, especially if they have spine issues. Sometimes to make the hip or knee stable the leg may have to be lengthened on purpose otherwise the knee or hip would be unstable which could lead to problems such as a dislocation
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Antibiotics before the dentist is a debate that has gone back and forth for decades between the AAOS and the ADA. Listen in on my take on antibiotic prophylaxis for joint replacement patients.
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Here is my summary of the AAOS (American Academy of Orthopedic Surgeons) Clinical Practice Guidelines on Management of Osteoarthritis of the Knee (Non-Arthroplasty) 3rd
1. Not Recommended
a. narcotic medication
b. viscosupplements (hyaluronic acid)
c. arthroscopic washout
d. orthotics
e. interposistional devices
2. Should Help
a. oral or topical Nsaids
b. acetaminophen
c. patient education
d. self management / supervised exercise
3. May Help
a. cane
b. brace
c. oral supplements (tumeric, ginger, glucosamine, chondrotin, vit D)
d. weight loss
e. neuromuscular training, manual therapy, massage
f. cortisone injections
g. PRP injections
h. denervation
i. menisectomy if other conservative options have failed
j. osteotomy
you can read the full guidelines here:
https://www.aaos.org/quality/quality-programs/lower-extremity-programs/osteoarthritis-of-the-knee/Support the Show.
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The Female Athlete Triad
First described in 1992
1. Amenorrhea
2. Osteoporosis
3. Disordered Eating
It is really important to make athletes, parents, trainers and coaches aware of this triad. Usually a stress fracture may be the first presentation of these disease pattern.Support the Show.
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When you have elective or scheduled surgery it is important to be as healthy as you can to reduce the chance of a complication. We call this process optimizing a patient for surgery. Here I will talk to you about what we look for and why it is important.
There is a great risk tool you can use to look at your risk at the time of total joint replacement from the National Joint Registry in the UK: https://jointcalc.shef.ac.uk/Support the Show.
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Carpal tunnel syndrome is a condition where the median nerve is compressed at the wrist. This can lead to pain, numbness and weakness.
Find more information at AAOS: https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/Support the Show.
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