Category: Dr. Anderson

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What’s New

Our annual meeting of the American Academy of Orthopedic Surgeons (AAOS) was this week in San Francisco.  This meeting brings together almost 30,000 orthopedic surgeons, vendors, and sales people to provide intense education on the “latest and greatest” new technology as well as provide ongoing education for orthopedic surgeons.  It is usually quite a show, taking over all three Moscone Convention Center, with exhibits showing the greatest new plates, screws, biologic materials to help tendon healing, bone graft substitutes, instruments to make our surgeries go more easily, and techniques to implant them. 

One of the reasons I love orthopedic surgery is because there is always something new to learn, innovation has been fostered and through this innovation has brought total knee replacements, total hip replacements, and surgeries to improve the quality of life for millions of Americans.  Today, I am actually taking the day “off” from the Academy and spending time sifting through  what I have been learning and integrating that into some self assessment examinations.  (Yes, at my age, I still have to take tests and questions). 

In the next few blogs, I am going to talk about some of the updates that we learned during this meeting. 

Today, I will just say a few words about smoking.  As you know, smoking is no longer as big an issue that we see in California since laws have restricted ones ability to smoke in most public places and even near public buildings.  So, smoking is much less prevalent here in California, and especially in Bay Area.  So, most of us do not think it as a big issue.

However, it is well established that smoking increases risks of bones not healing (called nonunions), failure of fusions of spine surgery, poor wound healing and increased infections in joint replacement, rotator cuff repair, and has a huge impact on healing.  Many orthopedic surgeons refuse to operate on a patient for a spinal fusion or a cervical spine fusion if they are smokers.  I insist my patients that are smokers to stop before I will perform rotator cuff repair since it has been established that there are higher incidences of failure of healing of these tendons.  In my next blog, I am going to speak about osteoporosis and some of the new controversies surrounding that.  This is one of the current “hot topics” in orthopedics.  So, stay tuned in the next few weeks.

– Lesley J. Anderson, MD

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Our Trains are Up!

 

We welcome you to come by and see our holiday train platform.

 Wishing you health and happiness,

Warm wishes for a Happy Holidays,

Lesley J. Anderson MD, Robert J. Purchase MD, Debby Anziano PA-C, Michelle, Jessica, Pilly, Jennifer, Beleny, and Ericka

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Injury Prevention

Looks like Dr. Purchase had the same idea as I did on a new blog. We wrote this around the same time without discussing it, so I guess we are starting to mind meld. I am very thankful during this Thanksgiving season that he is a caring, personable and excellent surgeon and he is really enhancing the practice.

As the holiday season is approaching, I thought I would talk about injury prevention.  The other day, I did a face plant in my driveway as I was trying to get a large cardboard box broken up for my recycle bin.  It was amazing how fast that one second I am jumping up and down on a box and the next I was falling face down on the driveway after slipping.  Fortunately, all I got out of it was some very sore muscles and few bruises. (I am still not sure about my rotator cuff, though.)

It did remind me, that as we go in to this holiday season, while we are trying to multitask- get that extra chore done, to get those lights up, pick up the kids, make that meeting, get the shopping done, how just an extra second of time may prevent a fall or serious injury.

Such a simple thought. Just take a few seconds, take a deep breathe, focus and center on the task at hand, and not jump to 4 other tasks you have to get to before the current one is done. Even though you are a good driver, and think that “Oh I can send just this one text message while I sit at this light,” no one will see you, and before you know it, you rear end the car in front of you. Or putting up the lights, reaching for that top light on the top of the ladder, or up on the roof, and in a nanosecond, down the ladder goes, and you could fracture your shoulder, hip or worse. Didn’t want to wait for someone to help. So slowing down just a bit and take the extra time can have huge benefits. Check out this link. http://orthoinfo.aaos.org/topic.cfm?topic=A00367.  

In regards to injury prevention, there are a few simple exercises one can do to reduce the risk of falls. And the loss of balance is the number one cause of falls. As a matter of fact,  falls and the injuries that occur have a huge physical, emotional and financial  impact on the quality of life, not only in all people, but more importantly, in those over age 65.  One of the biggest risk factors for death in women over 65 is a fall.  The consequences of a hip fracture is reduced mobility, with complications of reduced mobility such as pneumonia. For some excellent tips, check out the following link for some actual exercises.  http://www.mayoclinic.com/health/balance-exercises/SM00049

Then enjoy the holidays!  Take that extra time, take a deep breath if you are feeling rushed or stressed. We all think it can’t happen to me, but as my face headed toward the pavement, it can!

-Lesley J. Anderson, MD

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Getting Ready for Joint Replacement

I am going to discuss some tips for getting ready for joint replacement surgery.  The surgeons are very astute at discussing the technical aspects of an operation, what kind of installation would be used and what kind of prosthesis, but we are not very good identifying and clarifying what expectations the patient should have both before surgery to get ready and following surgery to have a best outcome and results.  I think many patients do not recognize how much work involves after a joint replacement.  Total knee replacements require a lot more rehabilitation in order to get range of motion than ever admitted whereas a partial knee replacement is a much easier rehabilitation because the incisions are smaller and scar tissue will be less.

Preoperatively, the best thing that patient can do is try to lose 5-10 pounds, and get in some basic shape cardio wise.  If the pain in the joint is too significant to walk then get in a pool and do some deep-water bicycle, running, or walking in the water in order to get your muscles toned and strengthened.  Doing some basic knee exercises (which we do have on our website) including straight leg raises, quadricep, hamstring curls and very importantly practicing the exercises your doctor gives you to do after surgery; practice them preoperatively everyday for the two weeks before your operation.  Learning to use crutches and getting your balance in tiptop shape will also help recovery.  If you are fearful of using crutches or a walker, ask your doctor one or two visits of preoperative physical therapy to not only teach you the exercises also to have you practice how to use crutches.  Make your house safe at home; try to make enough space to move around your downstairs or upstairs in bedroom so that you can get easy access to the bathroom or your favorite couch or chair.  Having pillows available to elevate your leg are important.

I cannot say enough about getting adequate vitamin D preoperatively.  There is an interesting study on total hip replacement that show patients that have a normal vitamin D level do better postoperatively than patients whose vitamin D is low before surgery.  Check into things such as railings for your bathtub or raised toilet seat.  These will make life much easier for bathing.

Many times in the hospital the patients except physical therapists to come around twice a day with their smiling faces and help you do your exercises.  With cost cutting in many hospitals now, the physical therapists may get around to see you but their primary goal is to get you walking, not doing your exercises such as your strengthening exercises or teaching you how to bend your knee at the bedside or sitting in a chair.  So, again practice these before surgery and be ready to do as much as you can on your own.  While the therapists will make sure that you are safe to go home from a walking standpoint or a stair-climbing standpoint, their only focus is now to get the patients out of the hospital sooner, once you are safe but not necessarily as far long as your rehabilitation used to be when you would stay in the hospital five to seven days.  Be your own physical therapy advocate postoperatively.  Ask your therapist what other exercises you can do.

-Lesley J. Anderson, MD

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Robert Purchase MD joining our practice

I am very excited to announce that as of August 1st I will have a new physician, Robert Purchase MD, join me in the practice. He is a wonderful doctor who has been practicing in the Valley for the past 3 years, and is now coming back to the Bay Area. I believe he has many of the same values I have felt are critical for providing care to patients.  He will be able to see you for most all orthopedic problems, not just knee and shoulder problems, (although he does have a subspecialty expertise in these areas.)

After 22 years in solo practice, I am excited to take a vacation longer than a week if I want to and know my practice is in good hands. No, I am NOT retiring or slowing down, although the rumors will fly, I imagine. The workaholic in me won’t let that happen.  I am adding services to the practice, which I have not been able to do in the past.

Dr. Purchase will also be contracted with Blue Cross PPO and Blue Shield PPO (pending) which many of you will appreciate. If you are BTMG, he is not yet contracted, so have your PCP send a referral to me and he will be able to see you.  He is also accepting new Medicare patients.

I appreciate all the loyalty many of you have shown me over the years, and now our “family” is growing and I hope we can enhance your experience in the office.

Please check his bio in the provider section of our web site.

-Lesley J Anderson MD

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Orthopedics and stress and pain! Oh my!

I see patients frequently in my office who work high stress jobs all day, on the computer, on deadlines, demanding bosses, carting the kids all over after school, after work; who come in with pain in the back of their shoulders, or neck.  I have also seen patients come in with pain in their knee after standing a long day at a conference they really did not want to be at.  What these both have in common is that the pain is real.  The tenderness in the muscles, soft tissues, and joint are definitely there, but after a thorough examination there is not really a specific anatomic structure that we can define as the source of the pain. 

We live in a very high stress environment these last few years and I think it is important to remember that our bodies have an amazing ability to tell us that the stress level is getting too high in ways other than what would one normally see such as chest pain, heart attack, and ulcers.  In orthopedics, the body does talk to us when stress levels get too high.  It is always a good idea to have an orthopedic condition checked out by a capable practitioner, but I think it is also important to check in on your own “life pulse”; to check in with yourself about what is going on in your personal life, your work life, your relationship, when the pain started, when it gets better (vacation is always a good barometer). Many reduce stress through exercise, basic walking is probably the best and safest, meditation and yoga (but be careful of the child’s pose and downward dog). But if you hurt, these activities may not be comfortable or possible. So, consider reading or just spending some quiet time with the cellphone, texting, and TV all turned off.  Just enjoy this beautiful area we live in on the bay area. Look at the scenery around you, breathe, and relax.

It is easy for me just to go out in my garden and look at the beautiful flowers and landscape.  I have worked hard to create, although like most people, it only usually last 5 or 10 minutes until I start looking at the tree that needs to be pruned or weeds that need to be pulled. But I try to make the time.

Have you ever heard the term “I feel like I have the weight to the world on my shoulders”, or “so and so is the pain in the neck”, or “I do not feel like I can take another step”.  These phrases would definitely show up in our body when stress gets too high.  The purpose of my blog today is really to remind us all of the value of taking 15 minutes daily to just stop with the texting, turn off the phone, turn off the TV and just find a comfortable place to sit, lie, run, or move to  wherever you body finds a restful place.

-Lesley J. Anderson, MD

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Rotator Cuff Part 4

In April, our annual meeting of the Arthroscopy Association of North America took place in San Francisco. This is the premier society for arthroscopic surgeons (I was the first woman admitted to the Association over 20 years ago). Approximately 2000 surgeons came and there are always new things to learn. 

One of the common themes running through the weekend was that it takes much longer for a patients’ real function to improve than we tell them it will take for rotator repair. In other words, we should help our patients have realistic expectations for when they will be “all better”.  We, as surgeons, tell our patients that after rotator cuff repair surgery, they are going to get better in four months or so. This IS true for day to day activities. I usually tell patients it will take 4-6 months to really feel like you have your shoulder back for day to day activities. This is because some patients get stiff postoperatively (if you are a middle aged female or have diabetes, for example, you have a higher risk for getting stiff- so you should work harder avoiding it) Others’ just sail through their rehab. EveryBODY is different. The consensus at the meeting is that we tell our patients shorter time periods for recovery, because our patients would freak out if they hear that it might be up to a year for all their strength, sporting activities and work function to be as close to normal as possible. I think it is always best to be as honest and clear as you can with a patient in terms of expectations> Although some surgeons act and may even think they ARE the well, ummm, god, we aren’t, and it is our responsibility help you have as realistic expectations as we can. I know I have lost a few patients to other surgeons for just that reason, just because of that, but I do sleep better at night.

In fact, it does take much longer for the shoulder to completely get back to as close to 100% as possible, because the tissues take a long time to mature, the muscles to strengthen and for the whole shoulder to work as a unit again.  So, if you have had rotator cuff surgery, be patient, continue to do exercises, do not be discouraged, and keep in mind that your symptoms will get better up to at least a year if you keep working on your exercises.

-Lesley J. Anderson, MD

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Rotator Cuff Part 3

A few weekends ago, our annual meeting of the Arthroscopy Association of North America took place in San Francisco. This is the premier society for arthroscopic surgery (I was the first woman admitted to the Association many years ago). Approximately 2000 surgeons came and there are always new things to learn.  One of the common themes running through the weekend was that it takes longer for patients’ real function to improve than we tell them.  We as surgeons tell our patients that after rotator cuff repair surgery, they are going to get better in four months or so. Frankly it is because our patients would freak out if they hear that it might be up to a year.  In fact, it does take much longer for the shoulder to completely get back to as close to 100% as possible, because the tissues take a long time to mature, the muscles to strengthen and for the whole shoulder to work as a unit again.  So, if you have had rotator cuff surgery, be patient, continue to do exercises, do not be discouraged, and keep in mind that your symptoms can get better up to at least a year if you keep working on your exercises.

-Lesley J. Anderson, MD

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Rotator Cuff Part 2

The last blog dealt with understanding what the rotator cuff is and basically an overview about rotator cuff.

 How do I know if I have rotator cuff problems?

Contrary to popular belief, history and physical examination is still an incredibly accurate way to diagnose whether you have a rotator cuff problem.  An MRI is not always necessary.  If you have rotator cuff disease, you will have pain during or after an activity.  It will usually be located on the side of your shoulder and occasionally radiates down towards your elbow, but not below it.  Sometimes it will go up towards your neck, but that is usually if it is more severe.  If you have pain which wakens you from a sound sleep, it is much more likely you have a complete full-thickness tear.  Weakness with reaching and overhead work is also a sign of a partial or complete tear. 

Initial treatment of rotator cuff problems, in the acute setting can be use of ice 2-3 times a day and be really careful about your posture, keeping your shoulder blades back and down, and Aleve or Advil on routine schedule for several days, 5-7 days.  These are things that you can do to help at home, but if the pain does not get better, and you need to finally go to the doctor, some of the preliminary treatments have already been done.

Now that you have figured your rotator cuff problem, what is the next step?

As I mentioned, history and physical examination are still the gold standard and are amazingly accurate if done thoroughly for diagnosing rotator cuff pathology. I will next do an office ultrasound to examine the rotator cuff, which is convenient, accurate and less expensive than an MRI. You also do not have to go into a closed tube!

 I personally believe that MRI should be done if:

1.       I cannot figure out what is going on in my history and physical.

2.       If I am considering surgery on a patient, then it will help you in the decision making process.

3.       If there has been 6 weeks of treatment and the pain continues

4.       The ultrasound suggests a tear.

There are lots of variations in the quality of MRI scans as well as those reading them.  Closed MRIs are far superior to open MRIs in terms of quality and accuracy.  If you are claustrophobic, then Valium can also be given before the test to sedate you.  If that is not useful, then we will obtain an open MRI or a test called CT arthrogram could be done.  If it is positive, then the next step will be to discuss surgical options.

– Lesley J. Anderson, MD

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Rotator Cuff Tears

There was a pretty good article in the Wall Street Journal a few weeks back on rotator cuff tears by Laura Londro.  I thought I will explain the next couple of blogs on rotator cuff injuries/problems.  The rotator cuffs are a group of four muscles that come off the shoulder blade or scapula and attach to our humerus/arm and allow us to lift our arm up overhead.  A vast majority of problems occur in the supraspinatus because the blood supply to this particular tendon is the most at risk when you lift your arm away from your body.  The rotator cuff has to glide under the bony archway, the acromion, when you lift your arm to the front and to the side.  Any problems with the attachment of the rotator cuff to the bone can cause pain. 

The rotator cuff will start to degenerate as early as our 20s where pain that develops at that point in time is mostly related to overuse, an aggressive game of tennis, and is rarely seen as a primary problem in someone less than 30.  Shoulder pain in someone under 30 with the diagnosis of rotator cuff is usually due to another cause such as an unstable shoulder with the rotator cuff becoming secondarily inflamed. 

Between 30 and 50, the rotator cuff becomes more degenerated mere replacing the word “tendonitis” (which means inflammation with tendinopathy) which means more related to degeneration.  Over the age of 50, the rotator cuff will further degenerate at a normal process of aging and either develop partial tear which can be small or complete.  Therefore, the cause of rotator cuff problems only depends on one’s age.  Under 30, look at your technique of performing your sporting activities, make sure the diagnosis is correct as instability is also in the cause of “rotator cuff problems under 30.”  Between 30 and 50, the cause of rotator cuff problems is usually due to weakness of the scapular muscles and this is an age group where the training technique, physical therapy, and conservative treatment can often be very valuable. 

Over 50 and only can the rotator cuff be a source of pain but there are other areas that could be the source of pain including the cervical spine, arthritis in the shoulder joint or in the AC joint.  So careful physical examination is important.  Other causes of pain between 30 and 50 are calcium deposits and bone spurs that can cause mechanical pinching of the rotator cuff also which can be treated successfully surgically to prevent progression to cuff repairs.

The next blog will involve discussing how you know if you have a rotator cuff problem.  Then we will discuss the various treatments nonsurgical and finally the surgical treatments of rotator cuff problems.

– Lesley J. Anderson, MD

http://online.wsj.com/article/SB10001424052748703905404576164251084032340.html