Explorez tous les épisodes du podcast Your Knee Your Health

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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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.

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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.

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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 2020

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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.

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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.

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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.

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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.

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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=2940161052846

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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/

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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.

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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/

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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/

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Low back pain is the most common disability worldwide.
LBP is the leading cause of missed days of work.

AAOS home exercises - https://orthoinfo.aaos.org/globalassets/pdfs/2017-rehab_spine.pdf

Egoscue - https://www.egoscue.com/

Spine Zone - https://www.spinezone.com/

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I am sure there are other families who have had disagreements about whether or not to get vaccinated. My little brother has yet to get vaccinated. 

If you listen to this episode little brother, these are my thoughts behind why I believe you should get vaccinated against Covid-19.

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Hip fractures occur about 300,000 times per year in the United States.
There is approximately a 5% risk of death in the hospital when you are admitted with a hip fracture.
Many patients may lose a function grade and require a cane or walker even after successful treatment.
You may prevent the risk of a fracture by being checked and treated for osteoporosis, checking your home for things which can increase the chance of a fall. Exercises which focus on balance can help reduce the risk of a fall. And, getting your eyes checked may help vision related issues which can lead to tripping and falling.

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This episode contains a lot. Physician burnout rates of 42% and a physician shortage of 100,000 by 2034 and the forth wave of covid. Sit back and listen in on my opinion of it all.

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Shoulder pain results in two million doctor visits per year in the United States. People can have should pain for many reasons. One common reason is a rotator cuff tear. Here I will go over what the rotator cuff is, what symptoms you may have and what treatment options are available.

Here is the link to the home exercises I spoke about in this episode: https://orthoinfo.aaos.org/globalassets/pdfs/2017-rehab_shoulder.pdf

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A number of employers have travel programs. This is a program where if you need a spine surgery, bariatric surgery or joint replacement you may be sent to a center outside of your home area. I have been involved with a program like this for a few years. I hear a number of misconceptions when I talk to doctors and patients. Here I want to share what I have learned over the past few years caring for a number of patient through a travel program.

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Elbow pain can occur. It is common in tennis players and it typically occurs on the outside part of the elbow. It is called lateral epicondylitis. It can occur on the inside, commonly referred to as golfers elbow. Golfers get medial epicondylitis.

Most people can get better with non-surgical care. Rest, otc medications and stretching helps. Changing your grip can make a difference.

Occasionally your doctor may offer an injection of cortisone or PRP.

Some patients who fail 6 to 12 months of non-op care may benefit from surgery.

AAOS home exercises:

https://orthoinfo.aaos.org/globalassets/pdfs/a00790_therapeutic-exercise-program-for-epicondylitis_final.pdf

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A knee dislocation is a severe traumatic injury. It can tear multiple ligaments and injure blood vessels. It is an emergency.

More commonly people will have the knee cap dislocate. This is a patella dislocation. It can be painful and cause problems. Here I will review the anatomy and the injury to help answer some of the questions you may have about this injury.

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Tai Chi and Qi Gong are  ancient forms of exercise that can improve flexibility, strength, balance and stability.

From the NIH:
https://www.nccih.nih.gov/health/tai-chi-and-qi-gong-in-depth

Tai Chi Wellness Center in San Diego:
http://www.taichimasterhenry.com/

Qi Gong on YouTube:
https://www.youtube.com/watch?v=cwlvTcWR3Gs

Tai Chi on YouTube:
https://www.youtube.com/watch?v=cEOS2zoyQw4

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Insurance companies and health care institutions are commonly non-for-profit yet record earnings in the billions.

You doctor may, in their medical opinion, order or recommend a test, medication or surgery. This treatment may be held up or denied by the health care institution or insurance company.

Here I am going to walk you through the process and more importantly help you with what information I would recommend you put into an appeal letter to your insurance company if you have to fight their denial of care.

The article in the San Diego Union Tribune:
https://www.sandiegouniontribune.com/news/watchdog/story/2020-11-14/scripps-health-executive-compensation-use-of-hospice-donations-called-into-question

Information on Health Insurance Companies Profits:
https://www.nytimes.com/2020/08/05/health/covid-insurance-profits.html

https://www.fiercehealthcare.com/payer/big-name-payers-earned-35-7-billion-2019-here-s-one-common-thread-their-reports

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SIBO or small intestinal bacterial overgrowth is an abnormal amount of bacteria in the small intestine. It can occur after surgery or in patients with celiac disease, crohn's disease, diabetes, scleroderma or simple aging. Symptoms vary and may include a feeling of fullness, bloating, loss of appetite, weight loss and malnutrition. Testing may be needed and your doctor may prescribe an antibiotic to reduce the overgrowth of bacteria.

Please talk with your health care provider if you are having any of these problems.

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The EMR is unfortunately here to stay.
Your information is yours and you should have access to it.
A computer system is at risk of intrusion.
The EMR at one institution does not always talk, or share information, with other institutions.
Make hard copies of your records.
Keep a file of labs, studies and implants.
Regularly update a document with allergies, medication and surgeries.

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So many people I meet are worried about their meniscus tear. Meniscus tears are a normal process of aging and are normally seen in arthritic knees. Meniscus tears in older patients do not heal and can not be repaired. Here I will try to discuss meniscus tears, the treatments and workup. I will also discuss when surgery is performed and its chance of success.

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Neck pain is common. In 2013 1.8% of health care visits were for neck pain, that is over 21 million visits.

Neck pain can be caused by sleeping wrong, poor posture, stress, computer time, and after exercise.

Severe neck problems can be from arthritis or disc problems. Occasionally a heart attack can present as neck pain. Infections such as meningitis can present as neck pain.

If you have severe pain, numbness, weakness, balance issues, fevers you should seek out medical care immediately.

The common home options for your run of the mill stiff neck
1. ice and/or heat
2. OTC medications or ointments
3. Stretches
a. forward bending (flexion)/backward bending (extension)
b. side to side
c. rotation
d. forward and backward
e. hug stretch

Try using a heating pad for a few minutes before your stretches
Try to stretch every hour or two while you are awake.
Try a new pillow.
Adjust your desk or computer to improve your ergonomics
Improve your posture. Check out the UpRightGo.

Always talk to your health provider to make sure that any exercise or treatment is safe and appropriate for you.

Support the show at https://WWW.PATREON.COM/YOURKNEEYOURHEALTH

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I like knees and if I enjoy the complexity of performing total knee replacements.

But, I also do total hip replacements. That surgery has great outcomes. So many patients have questions about what approach is used. Here I will try to explain the similarities and differences between the approaches and briefly go over what a total hip replacement is.

As always, talk to your health provider for specific details on the surgery, your options and a discussion of the risks and benefits of any intervention.

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Dogs and cats. Many people have pet dogs and pet cats. Occasionally those animal bite.

Animal bites can be a big problem and many times people do not think they are a big deal until it is too late and there is a bad infection.

Here I will share the information on animal bites, seeing your healthcare provider or ER, and the importance of washing the wound, the use of antibiotics and the possible need for tetanus or rabies shots.

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Doctors and surgeons are not just created they are trained over time. Friends and family ask me if they should go to a teaching hospital. What is a medical student? An intern? A resident or fellow?

Do they do the surgery or are they just watching?

Here I will try to explain what their roles are and what questions you might want to ask your doctor about who will be involved in your care.

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Sciatica is a common complaint affected roughly 40% of people in their lifetime.

It can be caused by inflammation, irritation, disc problems, arthritis, tumors or more.

Mild symptoms like mild pain, tingling, aching can usually be treated at home.

Anything more severe should be evaluated by your doctor or healthcare provider.

Weakness or loss of bowel or bladder (incontinence) is an emergency and you should go to your local ER.

Ice, heat, OTC meds, stretching and strengthening can help.
Your doctor may send you to PT or orders tests such as an x-ray, MRI or EMG.
Rarely surgery is required.

Here is a link to the stretching book I recommend to many of my patients:
https://www.amazon.com/gp/product/0936070846/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0936070846&linkCode=as2&tag=dradamrosen20-20&linkId=76f92d2cbb506b533cc55cd09af8e2ec

And this is a great stretching strap for the hamstring:
https://www.amazon.com/gp/product/B00065X222/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=B00065X222&linkCode=as2&tag=dradamrosen20-20&linkId=ec63e2bafba991fdcbf2cf1378f9167e

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Sex is a normal human activity. It can improve your health, lower depression and anxiety, boost your immune system even decrease pain.

More than 50% of people have pain with sex due to hip arthritis.

Although the risk of dislocation after total hip replacement is about 2% it is a real fear for many patient after surgery. It is a concern for many as to when it is safe to resume sexual relations with their partner.

Here I will go over what I discuss with my patients to help you better understand returning to sexual relations after surgery.

Here is the link from the American Association of Hip and Knee Surgeons on their 'Guide to returning to sexual activity following Hip or Knee replacement sugery'

https://hipknee.aahks.org/wp-content/uploads/2019/01/sex-after-joint-surgery-AAHKS.pdf

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Please, please, please, if you use these medications check with your health care provider to make sure that based on your health conditions or medications that these drugs are safe for you to take.

NSAIDs or Anti-inflammatories
1. ibuprofen (Motrin, Advil) - 200 mg
2. naproxsyn (Aleve) - 220 mg

These can cause GI upset, bleeding, cardiovascular disease and kidney disease.
AVOID if you are on a blood thinner such as coumadin, plavix, pradaxa, eliquis, xarelto, etc.

Pain Reliever
1. Acetaminophen (Tylenol)
a. regular strength - 325 mg
b. extra strength - 500 mg
c. arthritis strength - 650 mg

AVOID if you have liver disease
Caution if you are taking along with pain pills such as percocet, norco or vicoden as they also contain acetaminophen

Combo Pills
1. Advil 125 mg + acetaminophen 250 mg

Topical 
1. diclofenac gel (Voltaren)

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One of the most common questions people have: it is broken or fractured?

Here I will go into breaks and fractures (they are the same thing) and how we treat them. You will hear more about vitamin D and osteoporosis and ways to prevent falls.

Check out the AOA Own the Bone website:
https://www.ownthebone.org/

You can check out my YouTube channel here:
https://www.youtube.com/channel/UCKcQmqjLERWxmotqLpCh4Lg

https://WWW.DRADAMROSEN.COM

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I love the outdoors, the quiet, the smell and the peacefulness.

The Japanese have a word for this Shinrin-Yoku which roughly translates to forrest bathing. It has been shown to lower blood pressure, improve your immunity and decrease stress.

Use your senses to embrace everything around you - listen with your ears, look with your eyes, smell with your nose, use your mouth to taste the fresh air and feel with your hands and feet.

You can find more in the following books:

Forrest Bathing by Dr. Qing Li

https://www.amazon.com/Forest-Bathing-Trees-Health-Happiness/dp/052555985X

and

Connect with Nature the Norwegian Way by Oliver Delurie

https://www.amazon.com/Friluftsliv-Reconnect-Oliver-Luke-Delorie/dp/0711251428

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Every 3 minutes a person in the United States is diagnosed with a blood cancer.

Every 9 minutes a person in the United States dies from a blood cancer.

Maybe you have been diagnosed or know someone who has been diagnosed with a blood cancer.  I wanted to give a brief overview of lymphoma and leukemia.

The Leukemia and Lymphoma Society raises money to help research to find a cure for these diseases. Consider donating to help their cause.

The Leukemia and Lymphoma Society: https://www.lls.org/

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When I was growing up my family doc was a DO.
I graduated from DO school in 2000.
I still get questions from patients about what a DO is or how it is different from an MD. Here I will answer all of your questions about osteopathic medicine as well as a bit of history lesson on where osteopathic medicine came from.

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I received my second Pfizer Covid-19 vaccine on Friday.  Here I will update you on the statistics which show an exponential rise in cases, especially here in California.

Although my first shot was not bad at all my second shot did affect me for about a day. Listen in and hear more.

Stay safe

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We are in the middle of the worst viral pandemic we may ever see in our lifetime and two vaccines have been approved for use by the FDA.

I have had lots of questions from patients, friends and family members.

Here I am going to very briefly go over the long history of vaccines and then do my best to very simply describe the DNA to RNA to protein pathway and what mRNA is and does.

I will also review the similarities and differences between the two current vaccines available in the US.

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Patients commonly ask "What is the best Total Knee Implant?"

The honest truth is we don't have one. There are differences but no study has proven that one design is superior - otherwise one knee would be used worldwide for every surgery.

Here I go into detail about some of the differences in designs and the thought process a surgeon may have for what they choose to use.

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As a student in medical school I was taught very little about celiac disease. When I was diagnosed with celiac disease I learned a lot.

Here I will discuss celiac disease, non-celiac gluten sensitivity and a gluten free diet.

As I discussed in this episode here are some great resources:

Celiac Disease Foundation - http://WWW.CELIAC.ORG

Alice Bast and Beyond Celiac - https://www.beyondceliac.org/

Peter Bronski - http://nogluten-noproblem.com/

Gluten Dude - https://glutendude.com/

Artisan Bread in 5 - https://artisanbreadinfive.com/2015/03/03/gluten-free-bread-in-five-minutes-a-day-the-video/

My blog which is in need of a big time upgrade - http://ungluten.blogspot.com/

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This is a common question that I get "Am I too old?"

Age is a factor.  There are some healthy 90 year olds and some really sick 60 year olds.  There are risks that we worry about so a screening by your medical doctor is important to make sure that you are optimized for surgery.

Total knee replacement in older individuals can improve pain and quality of life.

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Another common question I am asked is how much pain will someone feel after total knee replacement surgery.  Here I will review some of the common things that I go over with my patients who have this very same question.

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