Vitamin D & Surgery Healing
I just read an interesting article in a surgical journal. The vast majority of studies in my scientific journals tend to focus on biomechanics, surgical techniques and implant methods. This caught my attention as it instead focused on health. More specifically, the researchers were asking whether Vitamin D deficiency is associated with failure to heal after surgery. They were looking specifically at rotator cuff tears that were surgically reattached. It turns out that more tendon repairs had to have surgery again in the group of people with low Vitamin D. We have known for a while that those over age 70 have less potential to heal repairs, possibly from diminished blood flow to the tendon. This information about Vitamin D may give people another method of maximizing healing potential in advanced age.Read the article
What is PRP?
PRP stands for ‘Platelet Rich Plasma’. In short, it is taking a sample of your blood and separating out the components of the blood that can stimulate a healing response. That concentrated part of the blood is then injected into the injured part of the body.
The procedure itself involves an outpatient office visit that lasts up to 30 minutes. Just like a regular blood draw, the blood is taken from a vein in the arm. That blood is then placed into a centrifuge and spun down for 5 minutes. This separates the blood into two distinct layers. The lower layer is dark red and where the red blood cells are. The upper layer is yellow and more clear, and that is where the platelets and other healing factors reside.
The upper ‘platelet’ layer is then separated off within a self-contained sterile device. The fluid is then contained in a syringe, allowing it to be injected into the injured joint or tendon. I use ultrasound guidance to accurately target the site of injury and guide the injection.Read the article
Gratitude and Relationship to Surgery Rehab
After you have taken care of enough people, you start to notice patterns in how some people bounce back quite quickly after a repair/reconstruction, and others have a very difficult time. As someone who is trying to improve outcomes and happiness among patients, I try to figure out what the differences are among these people, and how those differences may tie into how they recover. If I perform a couple hundred arthroscopic shoulder repairs in a year, there are usually enough people I see with a very similar problem and it becomes easier to then compare amongst them.
One of the factors that has stood out for me is gratitude. Time and again I see patients who are generally appreciative of the world around them and the opportunity to interact with people. These are people who are thankful for what they have, and tend not to rue what they are missing or wanting. They discuss issues in terms of where they are heading, not where they are stuck at. It seems obvious that a “happy” person would feel better, but it seems to be more than just a smile on a face. It is the attitude of really knowing that things will go well; if they don’t go well for a time, then there must be a reason for the bump in the road and it will be bypassed soon enough. It reminds me of actualization. That is to say, visualizing positive outcomes and general appreciation of those around you, and then the realization of that positivity becoming real in future experiences.Read the article
Hip/Knee Joint Replacement: What are the major risks?
There are different risks associated with different types of surgery. Each person has an individually different risk profile and many of the risks are worsened by overall medical issues. Hip and knee replacement tend to have a higher risk of blood clot due, in part, to the decrease in activity after the procedure. If the clot stays in the leg, then it is usually treated with anticoagulant medication for 3-6 months. If the clot travels into the lungs, then there are more involved treatments. Most surgeons use some form of blood thinner in the first few weeks after surgery to help reduce the chance of clotting. Read the article
Joint replacement: When should I do it?
It is a big decision when you are faced with a major joint (shoulder, hip or knee) that hurts on a daily and nightly basis. It gets to the point where the pain and stiffness affects many of your daily decisions and can significantly erode your overall health. Health problems result not only from the lack of activity, but also from the effects of various over the counter treatments that can cause their own problems.
It is important that you exhaust all of the non-surgical means to alleviate your pain and improve function. I will go into more depth on non-surgical treatment options for arthritis in another segment.
Your surgeon cannot tell you if you should get surgery, but merely can tell you whether you are a candidate based upon your story, your examination, and your imaging (x-rays most commonly).
Read the article