Sea Crest Health Care Center

806,000 hip and knee implants were performed in the US in 2007 – that’s double the amount done a decade earlier. However, a 2007 study demonstrates that 7% of Medicare patients who underwent a hip replacement required another replacement hip within seven and a half years.  That number, small as it sounds, translates into thousands of patients who eventually need a “do over”. A joint surgery involves risk, pain, convalescence, rehab and medical expenses; no one wants to go through that more than once if necessary.

A National Joint Replacement Registry helps reduce the rate of failed procedures by keeping a database of information that keys in surgeons to problematic implants, and provides insight as to how to avoid mess ups. According to Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn,  “Every country that has developed a registry has been able to reduce failure rates significantly.”  Sweden is one case in point.

The newly formed American Joint Replacement Registry is still in its nascent stage and has started collecting data. Its goal is to improve the quality, outcomes, and cost-effectiveness of total joint replacement (TJR) surgeries through the achievement of four objectives:

1. Establish an infrastructure and a uniform system for the collecting device information and monitoring outcomes of TJR throughout the U.S.;

2. Identify patients who may need follow-up evaluation thereby increasing patient safety;

3. Create real-time survivorship curve in order to detect poorly performing implants;

4. Establish a uniform system that can be used to define the epidemiology of TJR for outcomes research to improve the quality and outcomes of patient care.

Until we have access to solid facts from the U.S. Registry, there are some proactive steps you can take if you are in the market for a new joint.

– Go with a highly experienced surgeon in a busy hospital; don’t look for the best deal. Ask for recommendations. A 2004 study published in The Journal of Bone and Joint Surgery found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

A similar trend was documented with hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

– A joint replacement is not for everyone. Some arthritic problems are better served with medication, and surgery may be too risky for those who have uncontrolled high blood pressure or another serious chronic condition.

– Research the joint implant that your surgeon recommends. Find out how well it has performed in others and if there are known complications. Some implants are somewhat controversial and may cause tissue and bone damage; newer doesn’t necessarily mean better. If the hospital has its own registry, ask to review the data.

– Educate yourself as to what the surgery entails. The American Academy of Orthopaedic Surgeon’s patient information Web site, orthoinfo.org is very helpful.

– Prepare your recovery in advance. Arrange for the necessary support upon your return home, and make sure you have all the help you need. It is crucial not to overexert yourself during your initial healing period.

As the Baby Boomer generation ages, there is a swelling populaton of people suffering from osteoarthritis. Arthritis pain seems to go hand in hand with insomnia, with joint pain keeping awake 60% of those with osteoarthritis

A new study, reported in the Aug. 15 issue of Journal of Clinical Sleep Medicine, finds that cognitive therapy has a beneficial effect on osteoarthritis patients and insomniacs – assisting them in their quest for a good night’s sleep.

Cognitive behavior therapy for insomnia or CBT-I,was given by an experienced clinical psychologist who taught participants cognitive restructuring techniques that helped change unrealistic beliefs and irrational fears regarding sleep or lack of it.

Handwritten sleep logs kept by participants documented their sleep patterns, and pain level was graded by the Short-Form McGill Pain Questionnaire (MPQ) and the Body Pain Subscale (SF-PAIN) question from the Medical Outcomes Study Short Form-36 Pain.

Results showed that after CBT-I treatement, patients were falling asleep faster than before, and remained sleeping approximately 37 minutes longer. CBT-I seems to be an effective tool for treatment of osteoarthritis in conjunction with other pain management techniques, and may also work well with other chronic pain conditions.

By Nechama Drillick

Will those stinging booster shots be a thing of the past, fading into oblivion together with walkmans, analog TV and Kodak film? With the advent of a new Band-aid-like painless patch lined with microneedles, our grandchildren may never know the ouch of a needle at an annual checkup.

Scientists have developed a patch that can simply be applied to a patient in place of using hypodermic needles, a big boon to diabetics and others suffering from diseases that require frequent pricks. This was presented at the 238th National Meeting of the American Chemical Society in Washington, D.C.

“If you can move to something that’s as easy to apply as a Band-Aid, you’ve now opened the door for people to self-administer their medicine without special training.” said Mark Prausnitz of Georgia Tech, one of the developers.

This development was enabled by advances in the electronics industry, which has microminimized all forms of technology – opening the door for the creation of needles that are only a few hundred microns long, about the width of a few strands of human hair.

Researchers are hopeful that the patch which will initially be used in a clinical setting could ultimately be self applied at home, replacing many other needle injections – even flu shots!

Touch and massage can relieve pain and improve mood in cancer patients.

A study comparing the results of touch therapy and massage therapy found that both relieved pain and improved mood, but massage was twice as effective. Furthermore, there was an increase in pain relief as treatment continued over time.

The results are important, suggesting a non-medical way for cancer patients to receive pain relief.

It’s been long known that touch has a soothing affect on the human body, but there have been few studies supporting it.

Touch therapy consists of a therapist placing their hands on specific spots on the body and applying light pressure for a few moments. The treatment comes out of the holistic healing movement and has not garnered much support among those in the medical field.

Massage therapy is more vigorous, including pressing, rolling, and finger pressure at trigger points. Though not common in the hospital, massage therapy is a commonly offered as part of a physical rehabilitation program. Now, it may become an option for patients receiving painful treatments for debilitating diseases.

Barely half the hospitals in the USA have palliative care programs.

If you aren’t sure what palliative care is, that’s part of the problem.

Palliative care is a care program that includes management of pain and other debilitating symptoms and increased communication and care coordination between physician and family. Palliative care increases the quality of life for patients with complex prognoses . . . Greater palliative care has been linked to lower death rates, fewer intensive care admissions during a patient’s final months, and lower overall expense per patient.

The statistics speak, and palliative care has been increasing around the nation, but it is still almost unavailable in many rural hospitals and the south. The trend is upward, but the problem is still widespread.

The best way to receive palliative care is via hospice care, delivered in specialized institutions, such as nursing or assisted living facilities. Such facilities are smaller, more specialized, and less hectic than hospitals, permitting them greater latitude in customizing the service their patients receive.

Palliative care utilizes a broad range of services for one goal: relieve suffering and increase quality of life. When paired with standard medical treatment, the results is a more comfortable treatment and faster recovery.

By Ruth Folger Weiss

A few months after undergoing routine hip replacements, a number of patients of  a well known LA orthopedic surgeon started suffering from excruciating pains. The surgeon, Dr. Lawrence Dorr, was stymied until he discovered one factor they all had in common; the same replacement joint, manufactured by Zimmer Holdings, was implanted in all of them. Several needed to have their replacement replaced in another bout of surgery. When Zimmer was first contacted about this problem, they just brushed it off. It took a year of more complaints and pressure from doctors until they pulled this device off the market. In the interim many more patients unknowingly had their joints replaced with a faulty Zimmer “Durom Cup” with crippling results.

This upsetting scenario could have been avoided, and many patients could have been spared the agony, if the U.S. would have a Joint Registry in place. A Joint Registry is a national database that tracks the well being of patients with artificial hips and knees. Countries such as Australia, Britain, Norway and Sweden have such a system in place and the benefits are numerous. Tracking the success rates of the different joints available results in the faulty ones being pulled from the market much quicker. The registry data puts pressure on manufacturers to explain why their products perform poorly and the registry alerts surgeon to stop using flawed joints.

Monitoring devices like artificial joints supposedly falls under the domain of the The Food and Drug Administration but they are often overwhelmed by the vast number of products it monitors and because doctors often do not report problems.

Nearly one million hips and knees were replaced in the U.S. alone last year, about half of the world’s total. As the world’s leader in joint replacement, the U.S. should take the initiative and be the leader in follow-up too.  So far all efforts to establish a database here have failed due to the many hurdles, financial and practical, of our fragmented and decentralized health care system, as well as a lack of support from Medicare.

By Neil Bekker

Flip flops, the standard beachwear, are now the hottest form of footwear worn throughout the long hot summer days. They may be stylish, comfortable and cool, but wearing them all the time is a recipe for foot pain.

Since they offer no arch support, heel cushioning, or shock absorption, according to the American Podiatric Medical Association (APMA) they should not be used for extensive walking or for playing sports. Wearers can suffer foot pain, tendinitis, and even sprained ankles if they trip, and are also at greater risk for stubbed toes, glass cuts, puncture wounds, or having a heavy object smash their foot due to their exposed toes.

People with diabetes should choose their footwear with care since any foot injury can become serious, even leading to amputation. They should be vigilant to have a protective covering on their toes and they should stay away from flip-flops and sandals.

Orthopedic surgeons  have treated many people who ran or jumped in flip-flops and suffered sprained ankles, fractures, and severe ligament injuries that required surgery. If you use your flip-flops to play Frisbee or backyard football you’re asking for trouble.

Insect and snake bites are another danger. Emergency room physicians on both sides of the country report seeing adults and children with snake bites to the feet while wearing flip-flops or sandals.

Flip flops are also a driving hazard. If they are loose enough to pop off your feet, you’re in trouble since they get stuck under the brake and gas pedal.

One more thing, when you do wear them – don’t forget to smear sunscreen on your exposed toes.

~ by Jeff Noley

There are some drugs with side effects that are worse than what they treat. Or at the very least, are pretty rotten compared to the alternatives.

Avandia is one example of a drug you might want to rethink taking. Yes, diabetes is a terrible disease. But so is heart disease. And Avandia raises the chance of a heart failure by 109% compared to those taking other diabetes drugs. Exactly why hasn’t been discovered yet, but that’s not the point. Diabetics should steer clear of Avandia if they don’t want to compound their health problems. If there is no alternative to Avandia, ask your doctor about taking heart medications in conjunction with the diabetes drug to lower your risk.

Celebrex is another drug you should treat with care. It’s a pain relieve that causes pain – in the stomach, kidneys, liver, and heart. Just 400 mg of Celebrex a day have twice the risk of dying of cardiovascular disease than those who don’t. 800 mg a day tripled the risk.

Pneumonia and other respiratory tract infections are among the top-ten killers of men, but one of the medicines used to treat it can kill just as effectively. Ketek can affect the heart and damage the liver. It is far better to use one of the alternatives, such as Augmentin,  doxycycline, or Zithromax.

In general, a drug-free life is a healthy one. But if you need medication, don’t blindly accept your doctor’s prescription. Visit the library and look it up in the Physicians’ Desk Reference, and check around online for testimonials or complaints from people taking it. Always ask what the alternative is, and do a search for one yourself. There are more than 4,000 prescription medications out there; your doctor can’t be an expert on all of them. But you can – and should – be an expert on anything you’ll be putting into your system.