Wasatch Front/Inaugural Edition

The Emotional Road

to Family Life
What's
The Rush?
Repairing Joints
Without Surgery
Colonoscopy:
Out of Pocket
Expenses
Eliminated
Know the Signs
of Skin Cancer
Special thanks to Mike Farr and the
staff of Farr's ice cream for their
help and the use of their nostalgic
Ice Cream Shoppe in Ogden,
Utah for the cover photography.
Special thanks to our "Cover Girls"
pictured left to right, front row,
Katie Berry, Andrea Chavez and
Nelida Navarro. Back row, left to
right, Jane Porter and Taylor Nefcy.
Photographer.
Doug Reinhart, MD
Jed Naisbitt, MD, RPhS
Board Certified in Phlebology
Memeber of the American
College of Phlebology
Specializing in Vein Care
John Whitehead, MPAS, PA-C
Member of the American
College of Phlebology
15 Years experience in Phlebology
1525 East 6000 South Lower Level Ogden, Utah 84405 801-337-5854
Superifical Venous
Reflux Disease
2 times more prevalent than Coronary Heart
Disease/(CHD), 5 times more prevalent than
Peripheral Arterial Disease (PAD)
Estimated 25 million people with symptomatic
superficial venous reflux: only 1.7 million seek
treatment, over 2.3 million go untreated.
Practice
Highlights
- Full Service Vein Center
- Open M-F, 8-5
- Accept all Insurances
- Up-to-date Ultrasound Technology
- Diagnostics by Registered Vascular
Technicians (RVT)
Only Comprehensive Vein Center
offering a full range of services in the
Midwest.
Comprehensive
Services Include
- Vein Closure with Laser
- Vein Closure with RF Technology
- Ambulatory Phlebectomy
- Wound Care
- Full Line of Medical Grade
Compression Stockings
- Spider Vein Treatments Sclerotherapy,
YAG Laser and IPL
- Coagulopathy Management
Your
Healthy Legs
Begin Here!
whatdoctorsknow.com
On Call with Dr. Porter
I
am forgoing the traditional publishers letter to
introduce some major changes in our magazine
changes that will make your reading experience
more enjoyable and more informative.
Welcome to What Doctors Know formerly Local Healthcare
Today magazine. We are changing our name for the obvious
reason we are no longer a local magazine. We are national
and available on the Nook, the PC, the iPad, or any android
based tablet. We are officially part of the digital future.
The name changes, but the mission does not. While we continue to provide local
healthcare information along the Wasatch front, we will be expanding to a monthly
national journal. Over the course of the next several months you will see a broader
range of physicians from around the country and even from around the world.
Frankly, I dont want to waste the space here with another history lesson or
philosophical rant. Instead, I would rather make you aware of these changes
and invite you our valued readers to take advantage of our online version
exclusively available through the Barnes and Noble bookstore website.
Download the app, click on What Doctors Know and get ready to read. The
cost is reasonable a dollar a month but the information is invaluable.
Very shortly we will be offering a greatest hits national print
version which will be available in the more than 700 Barnes and Noble
bookstores across the nation. The local issues will compliment our
national efforts and we would encourage you to explore both.
We are growing, but we want you to grow with us and most of all, we want to hear
from you. We know you have questions, suggestions and more. If you have a health
question you want answered, drop us a line or send us an e-mail. We will match your
question with the best medical expert so you get the same kind of information you
expect from a leading healthcare magazine. What Doctors Know, and you should, too!
Steve Porter, MD
Publisher and Chairman
Send us your questions or a topic and we will have one of our
knowledgeable doctors give you the answers...simplified.
We want to hear from YOU!
editor@whatdoctorsknow.com or write us at, What Doctors
Know,585 West 500 South, Ste. 200, Bountiful, UT 84010
whatdoctorsknow.com
contents
Wasatch Front/Inaugural Edition
Published by
What Doctors Know, LLC
Publisher and Chairman
Steve Porter, MD
Medical Advisory Board
Vicki J. Lyons, MD, Chairman
Timothy J. Sullivan, MD, Medical Content Director
Editorial and Design Director
Bonnie Jean Myers
Senior Designer
Suki Xiao
Design Associate
Cayden Chan
Executive Director, Marketing
Larry Myers
Executive Director, Production
Kai Xiao
IT Director
Eric Lu
Director of Operations
Allen Nunn
Copyright 2011 by What Doctors
Know, LLC. All rights reserved.
Reproduction of this magazine,
in whole, or in part is prohibited
unless authorized by the
publisher or its advertisers. The
advertising space provided in
What Doctors Know is purchased
and paid for by the advertisers.
Products and services are
not necessarily endorsed by
What Doctors Know, LLC.
For more information on ad placement or contributing an article, please
email submit@whatdoctorsknow.com, or call (801) 299 -1122.
For information on subscriptions, please visit www.whatdoctorsknow.com
Corporate Office
What Doctors Know
585 West 500 South, Ste. 200 Bountiful, UT 84010 (801) 299-1122
Contributing Writers:
Dann C. Byck, MD
Russell A. Foulk, MD
Megan Wolthius Grunander, MD
Darrin F. Hansen, MD, FACS
Aaron Hofmann, MD
Phillip C. Hoopes, MD
Kenneth M. Hurwitz, MD
Christopher Y. Kim, MD
Vicki Lyons, MD
Stephen L. Miller, MD, FACC
Jed P. Naisbitt, MD
Mark Newey, DDS
Steve Porter, MD
Robert P. Rivera, MD
Jeffrey J. Rocco, MD
Mark F. Rogers, DPM, FACFAS
Thomas G. Rogers, DPM, FACFAS
Scott F. Rogers, DPM
Timothy J. Sullivan, MD
Chad W. Tingey, MD
Scott K. Thompson, MD
Michael Van Bibber, MD
Robert Wayment, MD
Raul Weston, MD
Brent Williams, MD
The American Heart Association
Utah Association of Oral and Maxillofacial Surgeons
On Call With Dr. Porter ..................................................................................................................1
Flu Season is Here ............................................................................................................................3
Colonoscopy: Out of Pocket Expenses Eliminated ...............................................................4
Whats The Rush? A New Approach to Fast Allergy Relief .................................................6
Oral and Maxillofacial Surgeons-Specialized Training...Specialized Care......................8
New Hip Replacements for Active Lifestyles ...........................................................................9
Controlling Your Risk for Vascular Disease ...........................................................................10
Ankle Pain Could Be More Than a Minor Sprain ............................................................... 11
The Emotional Road To Family Life ........................................................................................12
Implantable Contact Lens............................................................................................................ 14
Know The Signs of Skin Cancer ................................................................................................15
Get A Leg Up On Varicose Veins .............................................................................................. 17
Wrinkles...Now You See Them, Now You Dont ...................................................................18
Exploring Vision Correction Options ...................................................................................... 19
Prostate Surgery Enters the Robotic Age ................................................................................20
Why Does My Heel Hurt So Much? ......................................................................................... 21
Colon Cancer: The Silent Killer ................................................................................................22
Pain Management-There Are No Easy Answers or Cures .................................................23
Repairing Joints Without Surgery .............................................................................................24
An Undercover KillerPeripheral Vascular Disease ..........................................................25
Lap Band Surgery ..........................................................................................................................26
Missing Teeth: More Than Aesthetics, Its A Matter Of Health .......................................27
ED (Erectile Dysfunction) Could be Early Warning Sign for Cardiovascular Disease ....................28
The 411 on Shoulder Pain ............................................................................................................30
Sensible Solutions for Obesity ....................................................................................................32
whatdoctorsknow.com
Flu Season Is Here
S
easonal flu vaccines
protect against the three
influenza viruses that
research indicates will be most
common during the upcoming
season including the Swine
Flu. The viruses in the vaccine
can change each year based
on international surveillance
and scientists estimations
about which types and strains
of viruses will circulate in a
given year. About 2 weeks
after vaccination, antibodies
that provide protection against
the influenza viruses in the
vaccine, develop in the body.
The CDC makes the following
recomendations for influenza
immunization this year.
When to Get Vaccinated
The CDC recommends that
people get their seasonal flu
vaccine as soon as vaccine
becomes available. The vaccine
is available at all Smiths
Pharmacies from Logan to St.
George. Vaccination before
December is best since this
timing ensures that protective antibodies are in place before
flu activity is typically at its highest. The CDC continues to
encourage people to get vaccinated throughout the flu season,
which can begin as early as October and last as late as May.
Vaccine Effectiveness
The ability of a flu vaccine to protect a person depends
on the age and health status of the person getting the
vaccine, and the similarity or match between the
viruses or virus in the vaccine and those in circulation.
Vaccine Side Effects (What to Expect)
The viruses in the flu shot are killed (inactivated), so you cannot get
the flu from a flu shot. Some minor side effects that could occur are:
Soreness, redness, or swelling where the shot was given
Fever (low grade)
Aches
If these problems occur, they begin soon after the shot
and usually last 1 to 2 days. Almost all people who
receive influenza vaccine have no serious problems from
it. However, on rare occasions, flu vaccination can cause
serious problems, such as severe allergic reactions.
Who Should Get Vaccinated
Everyone 6 months and older
should get a flu vaccine each
year at the start of the influenza
season. While everyone should
get a flu vaccine each flu season,
its especially important that the
following groups get vaccinated
either because they are at high
risk of having serious flu-related
complications or because they
live with or care for people
at high risk for developing
flu-related complications:
1. Pregnant women
2. Children younger
than 5, but especially
children ages 6 months
to 2 years old
3. People 50 years of
age and older
4. People of any age
with certain chronic
medical conditions
5. People who live in
nursing homes and other
long-term care facilities
6. People who live with or
care for those at high
risk for complications
from flu, including:
Health care workers
Household contacts of persons at high
risk for complications from the flu
Household contacts and out of home caregivers
of children less than 6 months of age (these
children are too young to be vaccinated).
Who Should Not Be Vaccinated
There are some people who should not get a flu vaccine
without first consulting a physician. These include:
People who have a severe allergy to chicken eggs
People who have had a severe reaction
to an influenza vaccination
People who developed Guillain-Barre syndrome (GBS)
within 6 weeks of getting an influenza vaccine
Children younger than 6 months of age (influenza
vaccine is not approved for this age group)
People who have a moderate-to-severe
illness with a fever (they should wait until
they recover to get vaccinated)
As of July 2011, 920 cases of the Swine
Flu had been reported in Utah along with
14 deaths and nearly 300 hospitalizations
from the virus. The start of the traditional
flu season is fast approaching and
Utah Health Officials as well as the
CDC (Center for Disease Control) are
concerned about this year. They don't
know how forceful or violent the virus will
become. To be safe, both departments are
recommending seasonal flu vaccines.
For more information and store locations go to www.
smithsfoodandrug.com and www.cdc.gov//flu/protect/keyfacts.htm
whatdoctorsknow.com
M
ost colon cancers are preventable through early detection. Recently I scoped a
patient in his 60s who had a complaint of rectal bleeding. This patient had been
avoiding the test because of his fear of discomfort and the possible diagnosis
of cancer. The result was, unfortunately, exactly what he feared. His reluctance to get
the test delayed the diagnosis and made the prognosis worse. He told me that if he had
known how easy and painless the procedure was, he would have done it years ago.
Cancer screening is much of what I do. Since moving to Utah nine years ago, I have
performed thousands of colonoscopies. I, myself, have a family history of colon cancer and
About 130,000 Americans will be diagnosed with
colon cancer this year and 50,000 of those will
diethats roughly the same number of people
killed in automobile accidents each year.
Colonoscopy: Out of
Pocket Expenses Eliminated
Dont let colon cancer cut
short your retirement.
Health Insurance companies have eliminated the out of pocket expenses
related to colonoscopies. The industry just eliminated one more excuse.
whatdoctorsknow.com
had my first colonoscopy at the age of 40 with a follow-up
examination every five years. Ironically, most complaints
regarding colonoscopies have little to do with being
uncomfortable. In our practice, the largest single complaint
after the procedure is that we havent even started yet.
The purpose of screening is to find polyps, which are the
precursors of cancer. These are small tissue growths on the wall
of the bowel that may over time grow into cancer. With early
detection and removal, polyps are generally not a problem.
Many physicians have their own opinions regarding the timing
of exams, but we follow the guidelines of the American Society
for Gastrointestinal Endoscopy, also known as the ASGE.
The recommended age to start colon cancer screening in an
otherwise healthy male or female is 50. If the initial exam
shows no polyps, the exam is usually repeated in 10 years.
If there are polyps present, they are removed and a repeat
exam is performed anywhere between one and three years
later, depending on the type, size and number of polyps.
Patients with a history of colon cancer in the family should
undergo a colonoscopy at 10 years younger than the age at which
the relative was diagnosed. For instance, if a relative had colon
cancer diagnosed at the age of 35, family members should have
their first colonoscopies at the age of 25. If the patient was over the
age of 50, the national recommendation is to start screening at the
age of 40. Patients with a family history of colon cancer should have
repeat examinations every five years, even if the results are normal.
Patients should also undergo more frequent examination if
they have a personal history of colon, breast or ovarian cancer,
or inflammatory bowel disease such as ulcerative colitis or
Crohns disease. They should also have more frequent exams
if they had polyps previously. Some individuals may require
an annual examination, depending upon the situation.
Polyp and colon cancer development can also occur in young
individuals. The youngest person that I have seen with cancer
was just 18 years old. For that reason, we take rectal bleeding,
significant lower abdominal pain or weight loss associated with
symptoms seriously. However, most people with bleeding or
lower abdominal discomfort do not have colon cancer or even
colon polyps. The problem is distinguishing between minor
and potentially serious problems based solely upon the history
and physical exam. If you are in doubt about your symptoms,
arrange a consult with a qualified gastroenterologist.
About the Author:
Steve Porter, MD, is the Medical
Director of the Endoscopy Lab at a
leading Hospital in Utah. He has
been practicing Gastroenterology
for more than years. For more
information, contact Dr. Porter at
(801)387-2550.
...Only about half the people
that should be screened
are getting it done.
Some things can be done to
decrease colon cancer risk.
These include:
A diet high in fiber and low in red meat and fat.
Proper weight maintenance.
A daily dose of calcium and aspirin
(as directed by your physician).
The use of antioxidants.
A recent study from Canada shows that only 60% to 70%
of colon cancers are picked up on screening. Most of the
missed cancers were on the far right side of the six-foot-
long colon. In Canada, much of the screening is done
by primary care doctors, and studies have shown that
they often dont reach the difficult far right side.
I recently scoped the mother of a friend from Manhattan
who had been scoped in hospitals there several times
(including one quite recently). When I scoped her I
found a long and twisty colon with a cancer at the very
end. It is likely that the other doctors did not reach
that far. When having a colon cancer screening, find
someone with experience and a good track record.
It is our hope that with adequate preventive care and screening
examinations, we will eventually make colon cancer a thing
of the past. Unfortunately, only about half the people that
should be screened are getting it done. Because cases of
colon cancer equal the number of automobile-related deaths
every year, I would recommend that if you bother to buckle
up, you should probably also get a colon cancer screening.
whatdoctorsknow.com
What's The Rush?
A new approach to fast allergy relief.
R
ush Immunotherapy is a method for
providing rapid relief from allergies. What
is this new procedure and where does
this fit into the treatments we already have?
Seasonal or persistent nasal itching, sneezing, runny nose,
nasal congestion, sinus headaches, postnasal drainage,
sleep disturbance because of nasal obstruction, as well as
itching and burning of the eyes (allergic conjunctivitis)
affects 10-25% of people in Western countries. Pollen and
airborne substances arising from molds, animals, mites
and other insects are common causes of these problems.
Allergic reactions in the lungs result in asthma in
approximately 5% of the worlds population. Tightness in
the chest, shortness of breath, wheezing, and coughing are
common asthma symptoms. Asthma can limit activities,
disrupt sleep, and have a very negative effect on quality of
life. Acute respiratory tract infections or exposure to allergic
triggers can cause severe or even fatal worsening of asthma.
The goals of therapy for upper airway allergic reactions
(allergic rhinitis, hay fever) include relief from annoying
symptoms, relief from disturbed sleep, and avoidance
of complications such as middle ear infections or sinus
infections. Antihistamines, decongestants, nasal steroid
sprays, and other nasal allergy sprays often provide relief.
The goals for asthma are control of the symptoms,
prevention of limitations on activities, and protection from
severe worsening during respiratory tract infections or
exposures to allergic triggers. Bronchodilators, inhaled
steroids, oral asthma medications, and other medications
can provide symptomatic relief for some patients.
Allergic rhinitis, allergic conjuctivitis, and allergic
asthma, often need immunotherapy (allergy shots). These
injections provide control of symptoms and then resolution
of the allergies. Currently this is the only therapy that
can actually reduce or eliminate the body's unwanted
allergic reactions to environmental substances.
Rush Immunotherapy is a new injection procedure
that is revolutionizing how we treat allergies.
Traditional immunotherapy typically involves injections
twice a week with increasing amounts of antigens (the
whatdoctorsknow.com
substances that cause the allergies). This process usually takes
16 weeks to reach full treatment doses (maintenance doses).
The Rush Immunotherapy revolution has centered on the
recently acquired knowledge that relief from allergy symptoms
requires lower doses of antigens than are required to make
the allergies go away entirely over time. Research in United
States and Europe has led to Rush Immunotherapy procedures
that allow us to reach levels of antigens that begin to relieve
symptoms in one day rather than over a period of 2-3 months.
Patients are given high doses of allergy suppressing
medication to minimize reactions at the sites of injections, or
in the rest of the body. Typically 8 injections are given over
a period of 5 hours and the patients are then observed for 2
more hours as the materials are absorbed into the body.
Rush immunotherapy can be a great convenience for patients
with demanding work or school schedules. While the
procedure requires a full day in the office, we avoid nearly 3/4
of the visits needed to build up to maintenance doses. A day in
the office also affords time for the patient to ask questions about
allergic disease and treatment. There is time to discuss and
demonstrate how to deal with unexpected late allergic reactions.
As allergy symptoms improve after Rush Immunotherapy,
patients are much more likely to return for the final doses to
build up to maintenance. These higher doses are required
not to relieve symptoms, but rather to gradually eliminate
or markedly decrease the severity of the allergy itself.
Not everyone is a good candidate for Rush
Immunotherapy. If asthma control is not
stable, if lung functions are not near normal,
Rush Immunotherapy may not be safe.
Preschool children may be good candidates from the point of
view of clinical improvement, but being kept in a relatively
Advantages of Rush Immunotherapy
Convenience for patients with limited time.
Doses of immunotherapy that begin giving
relief of symptoms can be reached in one
day, rather than over 2-3 months.
The time required to reach full treatment
maintenance doses is markedly reduced.
Both the patient and the doctor can
quickly determine whether or not this
form of therapy will be successful.
small space can be very difficult for them. For many patients,
Rush Immunotherapy is an alternative with several advantages
over medications alone, or traditional immunotherapy.
Any form of immunotherapy carries a risk that the patient
may have a troublesome reaction at the injection site, or that
a more severe reaction involving the whole body may occur.
This could include hives (urticaria), swelling of the eyes, lips,
or other structures (angioedema), even anaphylaxis (reactions
that cause trouble breathing or decreases in blood pressure).
The possibility of an allergic reaction is why allergists
rely upon patient education, observation in the office after
injections, and having an emergency plan for dealing
with rare severe reactions. Rush Immunotherapy patients
are taught about the characteristics of the late allergic
reactions, are given medications to use in case of a reaction,
and are taught the use of self-injectable epinephrine.
Rush Immunotherapy provides a method for achieving clinical
improvement very rapidly and greatly reduces the number of
visits required to achieve long lasting freedom from allergy.
About the Author:
Vicki Lyons, MD, is a board-
certified and fellowship-trained
Allergist and Immunologist.
She has been practicing for 0
years. For more information,
contact Dr. Lyons at
(801)387-4850
About the Author:
Timothy J. Sullivan, MD, completed
training in Internal Medicine and
Allergy & Immunology at Washington
University in Saint Louis, Missouri. After
years in full-time academic medicine
at Washington University, University of
Texas Southwestern Medical School,
and Emory Univeristy, he entered
full-time patient care. Dr. Sullivan
practices Allergy and Immunology in Atalnta, Georgia and is a
Clinical Professor at the Medical College of Georgia. For more
information, contact Dr. Sullivan at (404) 255-2918
Optimize your time to allergy relief,
schedule a Rush Immunotherapy
evaluation with Dr. Lyons today!
Visit www.vicki-lyonsmd.com
for more information.
whatdoctorsknow.com
ORAL AND MAXILLOFACIAL SURGEONS
Specialized trainingspecialized care
S
cience, experience, and the
ingenuity of humankind have
advanced the fields of medicine
and dentistry. Doctors interested
in a specific niche choose to spend
extra years, between 4-7 beyond
medical/dental school, fine-tuning
their expertise and knowledge. The
culmination of this additional training
defines specialties and specialists.
Most Utahns know that cleanings,
fillings, gum problems and simple
tooth extraction fall under the
category of basic dental care.
However, many are not aware
that procedures such as complex
or impacted tooth removal, IV
anesthesia and sedation, grafting, or
dental implant procedures comprise
a large portion of an oral surgeons
4-6 years of specialty training.
These hospital-based programs
expose the oral surgeon to ill and
complex patient populations,
About the Author:
The Utah Association of Oral and Maxillofacial Surgeons
(UAOMS) is the professional organization representing
all oral and maxillofacial surgeons in Utah. UAOMS
supports its members ability to practice their specialty
through education, research and advocacy. UAOMS
members comply with rigorous continuing education
requirements and submit to periodic office examinations,
ensuring the public that all office procedures and
personnel are prepared to meet a patients needs.
For more information about the Utah Association of Oral
and Maxillofacial Surgeons, please visit www.uaoms.org
to find an Oral Surgeon near you.
providing invaluable experience
with diagnosis and treatment.
Patients often receive this type of
specialty care from their family dentist.
However, any unexpected outcomes
or complications have to be managed
by a specialist. While an education
from dental school exposes a dentist
to certain specialized procedures, new
graduates may have different levels
of exposure or hands-on experience.
Oral surgeons,
receiving advanced
training beyond
dental school,
have maximized
exposure to
specialized
procedures such
as wisdom tooth
removal, anesthesia,
grafting, jaw
surgery, trauma, and
dental implants.
When contemplating oral
surgery, consider the following:
Removal of impacted wisdom
teeth will take an average of 15-20
minutes in an oral surgery office.
Oral surgeons place hundreds
of implants in residency, often
in conjunction with advanced
bone and soft tissue grafting.
The American Association of
Oral and Maxillofacial Surgeons
certifies all oral surgery offices in
Utah as safe to administer general
and IV anesthesia. Peer reviews
are conducted every 3 years.
Every oral surgery office is
required to have emergency
airway kits, defibrillators, oxygen,
and emergency drugs to handle
severe medical emergencies.
Every oral surgeon in Utah has
Advanced Cardiac Life Support
certification, in addition to Basic
Life Support (BLS). All staff
members are BLS certified.
Oral surgery residency training
exposes every oral surgeon to
medically compromised patients,
enhancing an oral surgeon's
skill and training with both
dental and medical knowledge.
Oral surgeons spend nearly 18
months learning to manage
pulmonary, cardiac, ICU, trauma,
and general medicine patients.
In an effort to help educate those seeking
oral surgery care and treatment, the
Utah Association of Oral Surgeons has
launched a public education program
to help patients make an informed
decision about their dental care. More
information can be found at: UAOMS.ORG
whatdoctorsknow.com
New Hip Replacements
for Active Lifestyles
I
n todays world where 50 is the
new 30, people are pursuing
their recreational passions even
later in life. And as generations age,
that increased activity coupled with
the nations overweight population
leads to more and more people
experiencing increased wear and tear
on their joints and grappling with the
fear of losing the activities they love.
But thanks to advances in material
and surgical technologies in recent
years, hip replacement is now an
option for patients of various ages,
opening the door for continued
recreation from leisurely walks to
cycling, tennis, even downhill skiing.
Simple design,
advanced solutions
The hip joint is a ball and socket joint.
A protrusion at the top of the femur
fits neatly inside the pelvic bone, where
a wide range of smooth motion is
provided by the surrounding cartilage,
which acts as a lubricant for the joint.
As people age and tens of millions of
rotations accumulate on the joint over a
lifetime, problems can set in and have
profound effects on an individuals range
of motion and comfort. This breakdown,
which to some extent is a natural part of
aging, can reach a point where a patients
quality of life is severely impacted
and a hip replacement procedure is
identified as the best course of action.
A lifelong solution for any age
As recently as a decade ago, patients
undergoing a hip replacement were
told they would have to come back
approximately 10 years after the surgery
to have a new liner installed in the
artificial joint as the man-made materials
would succumb to the same wear cycles
that impacted the original joint.
But today, advances in materials
technology are making it easy for
patients as young as 50 to reasonably
expect the high-tech artificial
cartilage polymer to last a lifetime.
The advanced materials also permit
the rigors of most athletic activities,
allowing for a high quality of life so
patients can pursue the things they love.
For many people,
having a hip
replacement is not an
end, but a beginning.
Using Pre-Hab
to minimize
recovery time
With any surgical
procedure, theres
plenty of focus on
About the Author:
Aaron Hofmann, MD, is a board-
certified orthopedic surgeon and implant
designer of hip and knees at The Center
for Precision Joint Replacement on the
campus of Salt Lake Regional Medical
Center. He is also the founder of the
Hofmann Arthritis Institute. For more
information, contact Dr. Hofmann at
866-431-WELL (9355).
rehabilitation during the weeks and
months after going home from the
hospital. But to maximize the bodys
ability to recover, patients should
also engage in pre-habilitation to
get ready for a hip replacement.
Depending on the length of time before
the procedure is scheduled, pre-hab can
include everything from weight loss to
conditioning of the upper extremities (for
handling crutches afterward). Patients
may even spend time learning to use
a walker or crutches in a comfortable
environment prior to surgery.
In addition to preparing themselves
physically, pre-operative education
gives patients and their family members
access to valuable information about
what to expect and how to best
accommodate the recovery period.
Walk in, Walk out
When the big day finally arrives,
patients can expect a procedure that
is very different from the original hip
replacements of 50 years ago. Advanced
even robotic surgical procedures
allow for quick and precise installation
of the artificial joint, making it easy to
for patients to get back on their feet.
After arriving at the hospital for a
hip replacement, most patients leave
within 48-72 hours, having walked
with assistance and navigated stairs
before being discharged. Just six weeks
after the procedure, patients can expect
to have 80 percent of their recovery
behind them. Within six months
they can be back to enjoying their
hobbies and activities at 100 percent.
Insurance
Though each insurance provider varies,
insurers, including Medicare, cover
most joint replacement procedures.
Scheduling a consultation with a
joint replacement specialist can help
determine a patients eligibility.
whatdoctorsknow.com 0
W
e have all heard it more
times than we care to admit:
preventing vascular disease
is a matter of the right lifestyle choices. I
see patients too often who have ignored
the potential for heart issues by living
a lifestyle most cardiologists would
call dangerous. As a cardiologist, it
is my job to try to repair the damage,
but so many of these heart problems
could have been prevented.
I am concerned with the number of
people who are literally heart attacks
waiting to happen. These people dont
see the signs or realize how their lifestyle
is increasing their potential dramatically
for vascular disease. I try to educate my
patients about heart care and help those
at risk make the right lifestyle choices.
But what are those choices? What
changes should be made to become
healthier and live longer?
The choices and changes start by
looking at a number of lifestyle
habits including what you eat; your
weight; your physical activity; your
stress level and of course, smoking.
How and what patients eat is a constant
battle we cardiologists fight with our patients.
After all, the United States is infamous for
our overweight population. Its sad, because
simple changes can make us healthier,
look better, feel better and live longer.
The most recent guidelines for healthy
eating from the American Heart Association
includes at least 4.5 cups of fruits and
vegetables per day along with at least two
servings of oily fish a week. The regime also
includes three ounces of fiber rich whole
grains, no more than 1,500 mg of sodium
per day and no more than 36 ounces of
sugar sweetened beverages per week.
Also, the AHA recommends four
servings of nuts and seeds per week, no
more than two servings of processed
meats per week and limited saturated
fats for the total energy intake.
Then theres the weight issue. Weight has a
tremendous effect on the potential for heart
disease. When the belly starts to grow, the
risk of high blood pressure, high cholesterol
and diabetes goes up remarkably. There
has been a lot of talk about our BMI (body
mass index) and if you have no clue what
this is, it certainly is time to learn.
To determine your BMI, you simply
multiply your weight in pounds
by 703 and divide the result by the
square of your height in inches. The
AHA suggests a BMI below 25.
If your BMI is below 25, keep up the
good work. If your BMI is above 25,
it should be a wake up call for you
to change your lifestyle, change
the way you eat and get active.
Along with the potential for added body
fat, an inactive lifestyle is a risk factor for
coronary heart disease. Regular, moderate-to-
vigorous physical activity helps prevent heart
and blood vessel disease. The more vigorous
the activity, the greater your benefits. Even
moderate intensity activities help if done
regularly and long term. Physical activity can
help control blood cholesterol, diabetes and
obesity, as well as help lower blood pressure
in some people.
Keep in mind that
not only will physical
activity help in the
weight category, it
also reduces blood
pressure, increases
HDL and improves
the body's sensitivity
to insulin, which helps
control blood sugar. I
advise 30 minutes of moderate exercise 5x/
week. Patients should exercise to a perceived
moderate level - meaning sweaty and
breathless, not able to speak in a full sentence
without talking a breath -- but not gasping.
As a general rule, I advise a physical
conditioning program focusing
on 4 targets: endurance (cardio),
strength, flexibility, and agility.
Smokers' risk of developing coronary heart
disease is 2-4 times that of nonsmokers.
People who smoke a pack of cigarettes
a day have more than twice the risk of
heart attack than people whove never
smoked. Cigarette smoking is a powerful
independent risk factor for sudden cardiac
death in patients with coronary heart
disease. Cigarette smoking also acts with
other risk factors to greatly increase the
risk for coronary heart disease. People
who smoke cigars or pipes seem to have a
higher risk of death from coronary heart
disease (and possibly stroke) but their risk
isn't as great as cigarette smokers. Exposure
to other people's smoke increases the risk
of heart disease, even for nonsmokers.
High blood pressure increases the heart's
workload, causing the heart to thicken and
become stiffer. This stiffening of the heart
muscle is not normal, and causes the heart to
work improperly. It also increases your risk
of stroke, heart attack, kidney failure and
congestive heart failure. When high blood
pressure exists with obesity, smoking, high
blood cholesterol levels or diabetes, the risk of
heart attack or stroke increases several times.
Finally, diabetes seriously increases your
risk of developing cardiovascular disease.
Even when glucose levels are under control,
diabetes increases the risk of heart disease
and stroke, but the risks are even greater if
blood sugar is not well controlled. At least
65% of people with diabetes die of some
form of heart or blood vessel disease. If
you have diabetes, it's extremely important
to work with your healthcare provider to
manage it and control any other risk factors.
Of course, if there is any doubt about
your risk for heart disease, see your
doctor for a check up. Youll find out
how healthy you heart is and receive
lifestyle advice based on your check-up.
Controlling Your Risk
for Vascular Disease
About the Author:
Stephen L. Miller, MD, FACC,
received his fellowship in cardiology
at the University of Wisconsin. He is
the founder of a leading cardiology
center in Salt Lake City, UT. For
more information, contact Dr.
Miller at (866)885-4278.
whatdoctorsknow.com
A
nkles support five times the body weight
when you walk. If your ankle ligaments or
tendons are stretched, worn or damaged, even
basic joint movement can be extremely painful.
Anyone suffering from chronic ankle sprains and anyone
who avoids certain activities in fear of another sprain, could
be suffering from such damage but it is easily repaired.
The ankle is a bridge of muscle and tendons connecting the
leg and foot. The body asks a great deal of this bridge,
demanding it not only provide a sturdy foundation for
standing but that it also offer amazing flexibility. With
all the stretching and pulling on any given day, the
ankle is literally under a great deal of constant stress.
The solution for chronic ankle pain for
many is a highly successful surgical
procedure many podiatrists today use.
About the Author:
Scott F. Rogers, DPM, graduated from
Brigham Young University and received
his doctorate from the Scholl College of
Podiatric Medicine. He then completed
a residency at Loyola University Medical
Center. Dr. Rogers is a member of both the
American Podiatric Medical Association
and the Utah Podiatric Medical
Association. He is Board Certified in foot
and reconstructive rear foot/ankle surgery.
About the Author:
Mark F. Rogers, DPM, FACFAS, graduated
from the Illinois College of Podiatric
Medicine in Chicago, Illinois and is board
certified in foot and ankle surgery. Dr.
Rogers has lectured on aspects of podiatry.
He is a member of both the American
Podiatric Medical Association and the
Utah Podiatric Medical Association.
About the Author:
Thomas G. Rogers, DPM, FACFAS,
graduated from Brigham Young University
and received his doctor of podiatric
medicine degree from the Illinois College
of Podiatric Medicine in Chicago, Illinois.
Dr. Rogers is board certified in foot and
ankle surgery and is a fellow of the
American College of Foot and Ankle
Surgeons. He is the chief of the podiatry
department at Utah Valley Regional Medical Center. Dr. Rogers
is a member of both the American Podiatric Medical Association
and the Utah Podiatric Medical Association.
For more information, contact Dr. Rogers at (801) 763-9049.
Ankle Pain Could Be
More Than a Minor Sprain
Surgical techniques to
repair damaged ankles have
been improved and perfected
with more than 50 years of
procedures. The surgery restores
the ankles form and function
by giving it more strength and
stability and helps avoid those
pesky re-occurring ankle injuries.
With ankle surgery, the doctor
shortens the problem ligaments
as well as tendons, making it
stronger than before. We add
extra support by wrapping an
artificial support material
around the ankle in order
to add extra protection
against injury. One of the
materials we use in ankle
reconstructive surgery is a strip of
material taken from a cadavers pericardial
sac. Pericardial means around the heart.
The benefit of using the pericardial material in surgery is its
unique make-up, which provides the ankle more strength and
stability. Nature created the pericardial sac with a tough exterior
coat and an inner double coat. The outer and inner layers
simulate a three-dimensional woven fabric to create a stronger
than original support material for a long-term ankle repair.
The results of this reconstructive method are amazing.
We have had patients come back and ask for their other
ankles to be worked on since the surgically repaired ankle
worked so much better. Of course, the answer is always
no. While we are amazed at the success we have enjoyed,
no surgery should be undertaken without a need.
Post-operative recovery is fairly standard for what you might
expect of a surgery of this kind. There is physical therapy
programs but in most cases, a patient can start playing
basketball in eight weeks after surgery. For the first week
after surgery the patient should try to avoid putting any
strain on the foot. The patient should keep an eye out for
any complications such as sudden spikes in pain or signs of
infection (like a high fever or discharge). After ankle surgery,
the patient should slowly ease back into normal routines but
avoid any intense exercise. Most of those undergoing the
surgery report having slightly more tightness in the ankle
but are able to return to a full state of activity in six months.
If you find you are suffering from these chronic
symptoms, this may be an answer for you.
As always, consulting with a qualified doctor
is an important step to pain free living.
whatdoctorsknow.com
The Emotional Road To Family Life
I
nfertility is a common, yet complex, problem affecting
approximately 15 percent of couples trying to have a
baby. Too often, blame for the inability to conceive is
placed on the women when in reality, men and women
share the burden equally. In up to 50 percent of infertile
couples, the problem is partly related to male reproductive
issues. Fortunately, with today's high-tech procedures and
powerful medications, a diagnosis of infertility means the
road to parenthood will be challenging but not impossible.
Infertility clinics in the United States using
Assisted Reproductive Technology (ART) reported
the success of 61,426 infants in 2008. This is
about 1% of all babies born each year nationally.
Many of those who suffer from infertility describe overcoming
the disease is like riding an emotional roller coaster. Cassee
and Patrick McClearys story exemplifies this well.
Cassee and Patrick decided to have a baby in 2002, but after a
year of trying and no luck, they began the emotional trek of
exploring infertility options. The first stop was their family
OB/GYN. Under his care, Patrick had surgery and Cassee
had a few procedures. After another non-productive year,
their OB/GYN referred the couple to an Infertility Specialist.
The McClearys OB/GYN is a very good physician, but
recognized he didnt have the proper training nor equipment
necessary to help the couple. He knew all about womens
health and delivering babies, but making babies was an
entirely different discipline. He did the right thing in
referring the couple to someone he thought could help.
While their hopes were high, the results were not.
Unfortunately, they then spent another 3 years visiting
several other specialists who could not provide the
care they needed. Insurance hassles and continued
unsuccessful treatments led to much disappointment.
There were so many roadblocks at almost
every turn, Cassee said. But we werent going
to give up. We werent going to back down.
In Patricks mind the worst frustration was the suboptimal
quality of care they received. Patrick works for a major
pharmaceutical company and knows the practice of
medicine well. They were looking for a physician and
clinic that would demonstrate the same care and passion
that they have in their quest to become parents.
Patrick said, We often talk about medical care,
but the element of care was noticeably absent
in most practices. We want to feel good about
our doctor. We even visited a major University
and walked away. The lack of individualized
care and concern was a major turnoff.
Cassee and Patrick felt they lost five valuable years. They
were determined to experience the joy of bringing a new
life into the world, but they also realized they had to be
whatdoctorsknow.com
The Emotional Road To Family Life
more cautious and do a little more homework. They didnt
give up. After talking to friends, other doctors and anyone
who listen, they somehow found information about my
clinics in Boise, Idaho and Pleasant Grove, Utah.
I met the McClearys in 2007 and it was obvious from the
start that they were determined, yet cautious. They were
educated, patient and had gone through a great deal in their
quest for pregnancy. I learned they had been thorough in
their research and had been to a number of treatment centers.
Having suffered personally from infertility, I believe that
infertility puts a couple in an emotional state that, quite
frankly, requires an emotional connection with their doctor.
Patrick was obvious in his frustration when he said: Dr. Foulks
office was different. It seemed he and the staff were passionate
about what they did and we felt like we were their only patients.
I give a lot of credit to Patrick who recognized, through
testing, that he was a major part of the problem. Looking
back on the issue, he explains the problem with a smile,
most sperm are active little swimmers looking for an egg
to impregnate, and my swimmers ended up being the
lazy kind who simply laid at the bottom of the pool.
Infertility is treatable--virtually every cause can be overcome
to help every couple have a baby of their own. The most
common cause of infertility problems are ovulation
defects and male factors. Couples must understand why
they can not get pregnant and have a plan to overcome it.
They should begin with the easiest step and understand
exactly why any treatment is not successful. It is crucial
to identify the problem, then treat it proactively
each month. Many people become frustrated and
quit if they dont get the right kind of help.
We are meant to have children; there is
always a reason why we can not. The key
is to know the reason and overcome it.
Infertility treatment is affordable. Most couples can
achieve pregnancy with minimal and affordable
treatments. Too often, unwary couples get pushed into
treatments that are not best for them or do ineffective
treatments that waste their time and money.
Less than 10% of infertile couples need the
expensive high tech treatments like IVF.
Infertility is an emotional burden. The best way
to cope is to understand the dysfunction, know all
the options and then develop a plan that is realistic
and based on the ones history and needs. After five
years of frustration, the McClearys took a pragmatic
approach and the roller coaster eased into a smoother road.
For the McClearys, after we identified the problem, the
solution was easy and effective. They were undaunted in their
quest and the results were beautiful. Cassee gave birth to the
couples first baby in 2008. Recently, the couple came to me
again and we were able to produce a second pregnancy. This
time, Cassee gave birth to twins at the end of April this year.
Happily, Cassee and Patrick will tell you that
marriage and kids go together. In spite of all the trials
and tribulations the couple went through, the end
result has been three healthy children. They will tell
you it was a fun, yet often trying, experience.
Evidently the journey with my staff was more enjoyable
than I had realized. Cassee referred her 40-year-old
sister and another cousin to me, both who are now
pregnant and happily expecting their first children.
About the Author:
Russell A. Foulk, MD, is board
certified in Reproductive
Endocrinology, Obstetrics &
Gynecology. He has served on the
Pacific Coast Reproductive Society
Board of Directors for years.
For more information, contact Dr.
Foulk at (801)492-9200
Contact lensesyou either
love them, or hate them.
If you are a hater, there is an alternative to contacts called
Implantable Contact Lens, or ICL. ICLs have already been
used to correct the vision of more than 200,000 eyes worldwide.
Implantable contact lenses (ICLs) correct vision in much the
same way as external contact lenses, except ICLs are placed
inside the eye where they permanently improve vision. These
thin, pliable lenses are inserted through a small incision
in the cornea and placed behind the iris and in front of the
natural lenses. The natural lens is kept in the eye and works
with the implanted lens to correct vision. The ICL procedure
is virtually pain free and has a 95 percent success rate.
As a pioneering ICL implant surgeon, I have seen the amazing
way this procedure corrects vision. The first ICLs were
implanted in 1993, however, my introduction to ICL surgery
dates back to the days of an FDA clinical study in 1998.
Over the years, as study patients returned for
follow-up visits, they would often describe their
vision as spectacular, amazing, and more.
Oddly enough, the majority of these patients were not candidates
for any other refractive procedure, including LASIK or PRK, due
to a number of reasons including extremely high prescriptions,
thin or irregular corneas, or dry eye syndrome. For the most
part, ICL exceeded expectations in these challenging patients.
In 2005, the FDA approved STAAR Surgicals Visian ICL for
the treatment of myopia. We are expecting FDA approval for
the Visian Toric ICL, which in addition to treating myopia,
corrects astigmatism with very impressive results.
Patients I have treated with ICL surgery include pilots,
sharpshooters, military service men and women, local and
federal law enforcement officers, professional photographers,
surgeons, scuba divers, race car drivers, radiologists, and
stay-at-home-moms. Patients who want the best out of their
vision are candidates for the ICL as well as those patients who
are not candidates for LASIK or PRK or other techniques.
One of my latest ICL patients was a 30-year-old male who
was functionally blind from nearsightedness. His vision
was so poor that he had to wear -18.00 prescription glasses
everywhere (-18.0 means his eye focuses clearly at just over
5 centimeters while everything beyond is out of focus!)
Whenever he would set his glasses down on the counter, he
literally could not see them. He couldnt wear contact lenses,
and clearly was out of the treatment range for laser vision
correction. His eyeglasses were so thick that it was difficult
to find an optical store capable of making a pair of glasses
for his prescription. Even though he lived in Alaska, his
family realized the need to fly him here for ICL surgery.
Today, the young man is on Facebook and his photo
tells it all. Looking straight at the camera for his picture,
his smile is amazing! Affected by Downs syndrome,
he will never need to find his glasses again and he will
wake up every morning to a bright and clear world.
It has been particularly rewarding to treat so many
patients and see the look of joy on their face after surgery.
As a surgeon, there is no better feeling of satisfaction
when you have dramatically changed someones life.
There is nothing as precious as vision, and
nothing as valuable as the ability to see the
world around us in its clearest form.
About the Author:
Robert P. Rivera, MD, is Director of Clinical
Research at Hoopes Vision. He has lectured,
conducted formal physician training courses,
and taught eye surgery at numerous
hospitals throughout the world. He routinely
travels to developing nations as a volunteer
eye surgeon for patients who would
otherwise not have access to vision-restoring
medical care. For more information, contact
Dr. Rivera at (877) 305-2745
Implantable
Contact Lens
The Permanent Solution
To Every Day Contacts
whatdoctorsknow.com
whatdoctorsknow.com
Know The Signs of Skin Cancer
B
y the third quarter of 2011, there were more than
70,000 reported cases of melanoma and nearly 9,000
deaths in the United States. For that same period,
there were nearly 1 million cases of other non-melanoma
cancers reported with less than one thousand deaths.
There are many forms of skin cancer and just
like virtually every other cancer, the sooner the
diagnosis, the higher the chance of survival.
Skin cancer mostly develops on the sun-exposed areas of
the skin, including the scalp, face, lips, ears, neck, chest,
arms and hands, and on the legs in women. But it can
also form on areas that rarely see the light of day your
palms, beneath your fingernails, the spaces between your
toes or under your toenails, and your genital area.
What could be misunderstood as a pimple that just wont heal or
a dark spot on the skin could be a form of skin cancer in its early
stages. If you have any skin changes that worry you, see a doctor.
Not all changes in skin are cancer, but considering with early
diagnosis, the better chance for cure, its best to seen by a doctor.
Skin cancer affects people of all skin tones, including
those with darker complexions. When melanoma occurs
in those with dark skin tones, it's more likely to occur in
areas not normally considered to be sun-exposed.
Sun spots, called actinic keratosis, are early warning signs of
cancer that are still very close to the top of the skin. These can
be frozen and drop off. In more advanced cases when skin
cancer is diagnosed, the patient may be faced with the need
to have it surgically removed. In these cases, your doctor most
likely will be using Mohs Surgery to remove the cancer.
I prefer Mohs because it is one of the most effective and
advanced treatments for most types of skin cancer today.
It offers the highest potential for cure - nearly 100 percent
in some studies. It is the treatment of choice when the skin
cancer has been previously treated by another method.
In the days before Mohs, the surgeon would
remove the tumor and even though it was
given the all clear by pathology 10-15% would
grow back and need further surgery.
About the Author:
Chad W. Tingey, MD, is a Fellowship
trained skin cancer and reconstructive
surgeon and Dermatologist. After
graduating from Dartmouth Medical
School with Honors, he recently
completed his Dermatology residency
at Loma Linda University Medical
Center and and ACGME Procedural
Dermatology Fellowship in Mohs and
laser surgery at Scripps in San Diego. For more information,
contact Dr. Tingey at (801) 475-3000
Preventing Skin Cancer:
When ultra violet light comes down from the sun, it
scrambles your DNA. Your body works hard at fixing the
damage all day long. When it becomes too much and
the body cant fix it anymore, the result is skin cancer.
The first step in preventing skin cancer, of course, is
to avoid overexposure to the sun including tanning
beds. Always use a good SPF sunscreen and a hat or
long sleeves can help a lot. Recent research, however,
has also demonstrated that people avoiding the sun
can become low in Vitamin D, therefore getting healthy
amounts of Vitamin D from your diet is important too.
Not acceptable if its your nose the tumor is growing on! The
problem is that most skin cancers have growths like river
tributaries that grow below the surface without any specific
pattern so the surgeon had to take a wide area to try and
remove everything. Often, to avoid the regrowth problem,
more tissue than necessary was removed causing a larger
wound. Mohs makes the entire process more accurate.
The main reason Mohs surgery is so effective is because
the removed tissue is microscopically examined, carefully
mapped out and evaluated by the surgeon at the time of
the surgery. The patient doesnt have to wait days for the
slides to be read and face the return of another surgery.
Mohs nearly eliminates the chance of the cancer growing
back and minimizes the amount of healthy tissue lost.
Surgeons usually perform Mohs surgery as an
outpatient procedure in their office, which will have an
on-site surgical suite and a laboratory for immediate
preparation and microscopic examination of tissue.
Local anesthesia is administered around the area of the tumor
and the patient is awake during the entire procedure. The use
of local anesthesia in Mohs surgery versus general anesthesia
provides numerous benefits, including the prevention of lengthy
recovery and possible side effects from general anesthesia.
When the surgery is complete, the physician will assess the
wound and discuss options for cosmetic reconstruction and
repair of the affected area. Most often, the surgery starts early
in the morning and in most cases is completed the same day.
Take care of your skin and if you are
unsure, see your dermatologist.
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Get A Leg Up
On Varicose Veins
I
n the United States, it is estimated that 25 percent of women
and 18 percent of men will suffer from varicose veins. The
odds are stacked against you, by 90 percent, if both your
parents have varicose veins. Ironically, if only one parent is
affected, their daughter has a 60 percent chance of being affected
while the son only has a 25 percent chance. As we age, the
percentage of women and men with venous disease increases.
It is also estimated that 60 percent of all leg ulcers result from
varicose veins. Exercise can help, but 12 percent of varicose
vein patients will end up with long-term support stockings
and fewer than 10 percent will require surgical treatments.
Whether the initial cause is genetics, pregnancy,
prolonged standing or sitting, excess weight,
inadequate exercise or a damaged saphenous vein (the
larger, superficial veins in the leg), the physiology of
venous insufficiency is nearly always the same.
Your arteries pump oxygen-rich blood from your heart
throughout your body and your veins return oxygen-
poor blood back to your heart. Venous insufficiency,
commonly known as venous reflux, occurs when your
leg's veins cannot pump enough blood back to your heart.
Because your blood doesnt move through your veins
properly, it begins to pool, causing varicose veins.
There are three types of veins: superficial veins, that lie
close to your skin, deep veins, that lie within your muscles,
and perforating veins, that connect your superficial veins to
your deep veins. When these veins function properly, your
blood is pumped efficiently through your system. However,
when you stand or sit for prolonged periods of time, the
blood in your legs can pool and increase your venous blood
pressure. This can stretch the vein walls and with time it can
weaken the walls of the veins and damage the vein valves.
Varicose veins are often an indicator of venous
reflux. Smaller varicose veins near the surface
generally arent a serious problem and can be
managed with simple home measures. As the
larger deep veins fall victim to this progressive
disease, significant circulatory complications
can occur, such as bleeding under the skin, deep
vein blood clots, edema, and venous ulcers.
General symptoms of venous
reflux can often include:
Varicose veins
Leg pain, restless, aching, tired
or weak legs, especially after long
periods of standing or sitting
Itching or burning of the skin
Edema or swollen legs and/or swollen ankles
Color and texture changes of the skin
Wounds that wont heal (skin ulcers)
Most mild cases of venous insufficiency can be treated
with compression stockings while more serious
cases may be treated with surgical procedures.
One surgical method is a minimally invasive office
procedure called radiofrequency ablation has been highly
successful in treating superficial venous reflux. This
technology uses a very small catheter and radiofrequency
energy to occlude, or seal shut the saphenous vein.
A single small incision is made near the knee where a
slender catheter is inserted into the saphenous vein. The
catheter is positioned near the groin, and in a series of
steps, energy is applied to heat the vein, which destroys the
vein. Because blood no longer flows through this vein, over
time it is absorbed by your body. Radiofrequency ablation
may also be used to seal shut incompetent perforator veins
that are often associated with venous stasis ulcers.
This short procedure, usually 30 to 45 minutes, requires
only a local anesthetic used to minimize pain and
discomfort. There are no stiches, and most patients
return to normal activity within a day or two.
While venous insufficiency is not usually considered
a serious health risk, it can be a source of serious pain
and discomfort, and even disability. It is important to
discuss all your medical conditions with your doctor so
they can explore the best treatment options for you.
About the Author:
Jed P. Naisbitt, MD, is board certified by
the American Board of Obstetrics and
Gynecology and is a board eligible member
of the American Board of Phlebology. He
is also a member of the American Institute
of Ultrasound in Medicine. He has treated
venous disease for the past years and
is considered one of the leaders in the
treatment of venous disease.
For more information, contact Dr. Naisbitt at (801)337-5854
whatdoctorsknow.com
whatdoctorsknow.com
F
ine lines, wrinkles, and folds in the skin develop with age but
are not necessarily a welcome badge of honor we are readily
willing to display. As our skin loses collagen and elasticity,
the lines and folds develop and our youth begins to slip away.
Thanks to an increasingly popular non-surgical treatment called
injectables, slowing down the visible aging process can be achieved.
Fillers
The term filler refers to a substance injected into the
faces soft tissues to add volume. These substances literally
restore lost volume thereby reducing the appearance and
visibility of lines, folds, and wrinkles in the skin.
Wrinkles...Now You See Them, Now You Dont
About the Author:
Scott K. Thompson, MD, focuses
exclusively on conditions of the face, head
and neck. He is board certified in both
facial plastic and reconstructive surgery, as
well as otolaryngology. He specializes in all
reconstructive and cosmetic aspects of the
face. He has offices in Layton, Bountiful,
and Draper. For more information,
contact Dr. Thompson at (801)776-2220
or www.utahfacialplastics.com
Treatment of the lines around the
nose and mouth with filler significantly
decreases their visibility and diminishes
the aged appearance of the mouth.
Fillers can also be used to
effectively add volume to the
lips, giving them a more youthful
and feminine appearance.
Following treatment with Botox Cosmetic,
the visibility of the frown lines and
crows feet are dramatically reduced.
How long do fillers last?
Although the above fillers are broken down by the body,
the metabolism rate varies by product and from patient to
patient. Generally, studies have shown fillers to last anywhere
from 6 to 18 months. In some cases fillers can stimulate new
collagen growth resulting in more permanent improvement.
Are fillers safe?
The fillers listed above have been extensively studied, are FDA
approved, and have been used to treat millions of patients
worldwide. They are biocompatible with the human body and
eventually break down naturally. Most patients can expect
some temporary swelling, bruising, redness, or tenderness
following treatment - usually lasting less than seven days.
Neurotoxins
For those unfamiliar with these products, the idea of deliberate
injection of a neurotoxin raises eyebrows. However, the two most
commonly used and well known of these prescription medications,
Botox Cosmetic and Dysport have been extensively studied. Botox
Cosmetic, has a longer track record and has been used in close to 12
million cosmetic procedures. As with other medications and vaccines,
a medication potentially harmful in large quantities can be therapeutic
when used in smaller concentrations directed at specific targets.
Neurotoxins at work
Botox Cosmetic and Dysport work by temporarily blocking
nerve impulses to specific muscles. This results in decreased
muscle activity and consequent reduction of lines. The
most commonly treated areas include the lines between the
brows (frown lines), lines at the corners of the eyes (crows
feet), and the horizontal frown lines (Figures and ).
Fillers at work
Commonly used examples include Restylane, Juvederm, Radiesse
, and Sculptra. In general, the areas around the nose and mouth,
including the lines extending from the nose to the corners of the
mouth (nasolabial folds), the folds extending downward from the
corners of the mouth (melolabial folds), and the fine lines that develop
around the mouth (lipstick lines) are most effectively treated with fillers
(Figure ). Fillers can also be great volumizers for the lips (Figure )
How long do Neurotoxins last?
Injections are made with a fine gauge needle and last between
3 and 6 months. With repeated injections, the muscle gradually
becomes weaker and injections can often be spaced further apart.
Are they safe?
When used in correct doses, proper location, and when
administered by a physician trained in facial structure and anatomy,
neurotoxins effectively reduce fine lines and wrinkles. The most
common side effects include temporary bruising and swelling.
More safety information can be found at botoxcosmetic.com.
Are treatments painful?
Cosmetic injectables are administered through a very small, fine
gauge needle, not unlike a typical shot or IV. The use of topical
anesthetic creams, can significantly reduce injection discomfort. Ice
is also recommended to minimize pain, swelling, and bruising.
Injectables treat these lines at their source and
achieve powerful results while allowing patients to
immediately return to normal daily activities.
Creams and other topical agents which promise to reduce lines,
are simply moisturizers that plump the skin and mask fine
lines. Injectables offer a new and exciting non-surgical method
of effectively treating fine lines and wrinkles in the face.
Because these substances are injected beneath the skin
near important nerves, muscles, and blood vessels: seeking
treatment from a physician who is thoroughly trained
in the anatomy and physiology of the face is critical.
whatdoctorsknow.com
Exploring Vision
Correction Options
T
he first experimental studies about
refractive surgery were published
nearly one hundred fifteen years
ago by an ophthalmologist in Holland.
Today, many options are available to
surgically correct ones vision. Those
looking to rid themselves of glasses or
contact lenses may be confused as to
which option, if any, is best for them.
When investigating vision correction
surgery, it is important to visit a facility
with surgeons who are experienced
and comfortable with a wide range
of surgical vision correction options.
When determining which form of vision
correction surgery is best for an individual,
a surgeon must consider the age and
health of the patient, degree of refractive
prescription to be treated, the patients
individual vision requirements, and the
physiology of the patients eye. Laser
vision correction is a popular choice, but
some people will be better off with a lens
implant. In some cases no current form of
vision correction surgery is appropriate.
Current vision correction options
can be classified into three main
groups: first, surgery that changes
the shape of the cornea (the clear
dome that covers the front of the
eye) such as LASIK or PRK; second,
implantable lenses that are inserted
between the cornea and the natural
lens inside the eye (ICLs); and third,
intraocular lenses that replace
the eyes natural crystalline lens
after it has been removed (IOLs).
The first group (changing the shape of the
cornea) includes LASIK, IntraLASIK, PRK,
CK and many similar variations. This is
often the first type of surgery that patients
consider when thinking of correcting
their vision. FDA approved in 1995,
PRK was the first laser vision correction
procedure that removes tissue to correct
vision. LASIK and then IntraLASIK were
approved soon after, and have become
the most popular choice. PRK is still a
good choice for patients with thinner
corneas or higher prescriptions. Generally
speaking, laser vision correction is the
first choice for patients in their 20s and
30s with nearsightedness, farsightedness
or astigmatism. People in their 40s, 50s
or even 60s may also find laser vision
correction to be the best choice for their
needs. These patients may consider
options such as monovision or blended
vision, where the laser corrects one eye to
distance and the other for near vision, as
a solution to presbyopia (difficulty with
near vision that starts around age 40).
Some people find that their cornea is too
thin, or their prescription too strong for
laser vision correction. These patients may
still be excellent candidates for implantable
collamer lenses (ICLs). Think of these
like contact lenses that can be implanted
either just in front of or just behind the iris
(the colored part of the eye). These lenses
can correct higher prescriptions than
lasers are able. They cannot be felt, and
generally cannot be seen. These lenses are
commonly appropriate for nearsighted
patients that are in their 20s, 30s, and 40s.
As with LASIK, patients that can naturally
change focus from near to far should still
be able to do so after this procedure.
The third common option for vision
correction is to remove the natural
crystalline lens and replace it with an
artificial implanted
lens. This is sometimes
recommended to
patients in their 50s, 60s
and beyond. This type
of vision correction
surgery includes
cataract surgery,
where the lens must
be removed because
it has become cloudy.
About the Author:
Phillip C. Hoopes, MD, is a pioneer
in Lasik surgery. He has performed
more than ,000 Lasik and refractive
surgeries, and over 0,000 vision
correction procedures. For more
information, contact Dr. Hoopes at
(877)305-2745
1 2 3
Procedures include PRK,
LASIK IntraLASIK, CK, and
others. Can correct nearsight-
edness, Farsightedness and
astigmatism.
Changing the shape
of the cornea.
Intraocular lens implants
(IOLs)
Implantable lenses
(ICLs)
A thin lens implanted just
in front of or just behind
the iris. Used to correct
nearsightedness in patients
with thin corneas or
extremely high prescriptions
Replacing the natural lens
with an artifcial lens implant.
New lenses provide both near
and distance vision correction.
Cataract surgery is one form,
but many select this option
before cataracts form.
This is the most commonly performed
vision surgery in the world. New multifocal
and accommodating lenses are now able
to correct both distance and near vision
allowing some patients to function without
either distance or reading glasses. Patients
may opt to have these lenses implanted
even if they do not have cataracts with a
procedure known as clear lens exchange.
The surgeons at Hoopes Vision are
experienced with each of these current
surgical options and have access to
the newest technology associated with
each form of vision correction. They
have an on-site laser surgical suite for
LASIK, PRK and IntraLASIK surgery, as
well as an on-site, Medicare-approved,
ambulatory surgical center where ICL
and IOL surgeries are performed. If you
would like to know which type of vision
correction is best for your needs, please
schedule a complimentary evaluation
with one of the doctors at Hoopes Vision.
0 whatdoctorsknow.com
M
inimally Invasive and Robotic surgery have
become the medical communitys new buzz-
words. Robotic surgery is becoming the standard
in some areas and almost every day physicians are finding
new ways to apply minimally invasive and robotic surgery.
The fight against prostate cancer is no exception. The use of
robotics to perform an operation known as radical prostatectomy
is one of the best applications for this new robotic technology.
As a urologist, I am excited about the benefits of using robotics
in the fight against prostate cancer, but realize, as physicians
we must remember patients facing a cancer diagnosis need
more than technology. They also need comfort and education.
What is Robotic and Minimally Invasive Surgery?
Robotic surgery is laparoscopic surgery performed with the
assistance of a high tech robot under the control of the surgeon.
The surgeon is at a panel with monitors and controllers not
unlike a powerful video gaming console performing the
procedure. Imagine major surgery performed through the
smallest of incisions (minimally invasive), with improved
optics (3-D vision and easy magnification and zoom) and small,
precise, wristed instruments that can work in tight places.
Imagine having the benefits of a definitive
treatment but with the potential for significantly
less pain, less blood loss, shorter hospital stay
and faster return to normal daily activities.
We are also seeing anecdotal evidence that robotic prostatectomy
is resulting in faster return of urinary continence and higher
level of recovery of sexual function following surgery.
Thanks to this breakthrough surgical technology, the Ogden Clinic
is now using the da Vinci Robotic-Assisted Prostatectomy as a
tool in the fight against prostate cancer in the Weber County area.
Three of our staff urologists have been extensively trained in this
amazing robotic surgical system. Always remember, the robotic
surgical system does not replace your surgeon at the controls.
Prostate
Surgery
Enters the
Robotic Age
Your surgeon is always in control of every aspect of the surgery
with the assistance of the da Vinci robotic surgical system.
In prostate cancer treatment, millimeters matter. Nerve fibers and
blood vessels are attached to the prostate gland. To spare these nerves,
they must be delicately and precisely separated from the prostate
before its removal. Surgeons use the precision, vision and control
provided by the da Vinci to assist them in removal of the cancerous
prostate while preserving important nerves and blood vessels.
Prostate Cancer Facts
One in six American men will develop prostate cancer sometime
in their lifetime. According to the Center for Disease Control and
Prevention prostate cancer is the most common cancer in men.
The American Cancer Society noted that more
than 203,415 men were diagnosed with prostate
cancer in 2006 (the most recent data) and
28,372 men died from the disease that year.
There are no warning signs or symptoms of early prostate
cancer. Screening is based on examination of the prostate with
a digital exam and the use of screening blood and urine tests
most commonly the blood test known as a PSA. Your doctor
will examine your prostate gland to determine whether it is
enlarged, inflamed with an infection, or may have cancer.
About the Author:
Michael Van Bibber, MD, is a graduate
from the University of Utah and received
his MD from the University of Utah School
of Medicine. He also received extensive
training in General Surgery and completed
his Urology Residency at Dartmouth-
Hitchcock Medical Center in Lebanon, New
Hampshire. For more information, contact
Dr. Van Bibber at (801) 475-3000
Call Your Doctor About Prostate Cancer If:
You have a painful or burning sensation during
urination or ejaculation or have abnormal
symptoms such as blood in the urine or semen.
You have dull, incessant deep pain or stiffness
in your lower back, pelvis, upper thighbones, or
other bones in that area. Ongoing pain without
explanation always merits medical attention. Pain
in these areas can have various causes but may
be from the spread of advanced prostate cancer.
You experience unexplained weight loss or loss of
appetite, as well as fatigue, nausea or vomiting.
You have swelling of the lower extremities.
You experience weakness or paralysis in
your legs and/or difficulty walking.
2011 Intuitive Surgical, Inc.
whatdoctorsknow.com
local healthcare today www.localhealthcaretoday.com 20
Plantar
achilles tendon
,QDPPDWLRQRIWKH
Plantar Fascia can
cause heel pain
A
lmost 100% of the time, plantar fasciitis (fash-eye-tis) is
caused by a tightness in the calf muscle known as the
gastrocnemius, or gastroc for short. The gastroc crosses
the ankle through the plantar fascia. Plantar fasciitis is simply
inflammation of the plantar fascia, a dense, fibrous structure
along the sole of the foot and just beneath the skin that starts on
the bottom of the heel bone (or calcaneus) and extends toward
the ball of the foot. The plantar fascia acts as a tension band that
helps to maintain the arch of the foot when your weight is on it.
The pain of plantar fasciitis tends to be at its worst with the first
step out of bed in the morning and also following high-impact
activities. Typically this pain will subside somewhat after that first
step, and then may be more painful again by the end of the day.
Symptoms of plantar fasciitis can be severe enough to interfere
with everything from basic daily activities to intense athletic
training. In athletes, heel pain will most often increase during
phases of higher-intensity and higher-volume training.
Some common risk factors for heel pain are overuse, pregnancy
and obesity. Patients with a body mass index (BMI) greater
than 30 are 5.6 times more likely to have plantar fasciitis than
patients with a BMI less than 25. Overweight women are six times
more likely to have plantar fasciitis than overweight men. Of
course, weight loss is extremely difficult without exercise, and
exercise is even harder with heel pain from plantar fasciitis.
What can I do if I have plantar fasciitis?
There are a number of recommendations for non-operative treatment
of plantar fasciitis. Night splints, physical therapy to stretch the calf
muscles and foot, over-the-counter antiinflammatory medications
and massage can also provide some relief. Modifications to footwear
can also help alleviate plantar fasciitis. Cushioned running shoes
are best for support and absorbing shock. Many running shoe
specialty stores have an experienced fitter to make sure you get
the best shoe fit and type for your foot. Its important to remember
that the shock absorption of running shoes decreases dramatically
after about six months or 500 miles, so be sure to replace your
running shoes in accordance with these guidelines. Custom or
prefabricated shoe inserts, called foot orthotics, have also been
used to treat plantar fasciitis. However, recent studies have shown
limited benefits of orthotics used specifically for plantar fasciitis.
* The Gastroc Slide for Chronic Plantar Fasciitis, presented to American
Orthopaedic Foot and Ankle Society by M. Chilvers, J. Rocco and A. Manoli in
July 2007. Read the entire presentation online at www.utahorthopaedics.com.
More aggressive treatments of plantar fasciitis include cortisone
injections and extracorporeal shockwave therapy, like that used
to break up kidney stones. The results of these treatments have
been mixed. Traditionally, surgical treatment has focused on heel
spur surgery or plantar fascia release, which involves cutting a
portion of the plantar fascia to relieve pressure and inflammation.
Some providers have reported success with these treatments,
but plantar fascia release has been implicated in painful arches,
increased and new foot pain and even continued heel pain.
Surgical lengthening of the gastroc muscle has been effective
in treating resistant, chronic plantar fasciitis, and in improving
and maintaining ankle flexibility. In fact, a recent study has
shown that 93.6% of patients experienced good or excellent
results, which were relief of pain and return to sports, including
running.* This procedure is called the gastroc slide because the
gastroc muscle slides apart as it is lengthened. The gastroc slide is
performed as an outpatient procedure through a small incision.
The procedure can be performed in about 10 minutes. Following
surgery, patients are allowed to walk with full weight-bearing
in a walking boot. The boot is worn during sleep for one month
following surgery. The boot can be removed for walking as soon
as the patient feels comfortable doing so. Most patients are able to
walk in a regular shoe three to seven days after the procedure.
Greater than 80% of heel pain gets better with non-operative
treatment. The gastroc slide procedure, however, has
been successful where other treatments have failed.
Heel pain is a common problem. There are a number of potential causes
of heel pain, but the most common culprit is plantar fasciitis.
Why Does my Heel Hurt So Much?
If you have heel pain:
Stretch regularlyespecially the calf muscles.
Replace your running shoes regularly.
Seek medical treatment if necessary.
About the Author:
Jeffrey J. Rocco, MD, is an Orthopedic
Surgeon specializing in foot and ankle
reconstruction and lower extremity
trauma. He is fellowship-trained by the
Michigan International Foot and Ankle
Center. Dr. Rocco is also on the research
review board for First Endurance
and writes sports nutrition articles
for the company blog at http://blog.
firstendurance.com. For more information, contact Dr. Rocco
at (801)917-8000 or visit www.utahorthopaedics.com
whatdoctorsknow.com
Colon
Cancer:
The
Silent
Killer
C
olon cancer can grow for years
without any symptoms. Thats
why there is such a push from the
medical community for colonoscopies.
Merely being age 50 or older is the number
one risk factor for colon cancer. However,
if you have a family history, you should
be aware of the ten-year rule. That means
if colon cancer has shown up in one of
your family members at age 50, you
should get tested at 40 ten years before
the first family member was diagnosed.
Colon cancer has no bias. It affects
women equally as it does men.
Even though we highly recommend
patients at age 50 or more get a
colonoscopy, I have seen patients
as early as age 20 and as old as
age 80 with colon cancer.
Because colon cancer can silently grow
without any warning signs, there are
some early body indications we all
need to be aware of just in case there
is a presence of cancer growing. Colon
cancer symptoms come in two general
varieties: Local and Systemic.
About the Author:
Megan Wolthius Grunander, MD, recieved her Doctor of
Medicine at the University of Utah. After completing her
General Surgery internship at the Universtiy of California San
Francisco and Gerneral Surgery residency at Harbor-UCLA
Medical Center, she then completed her fellowship training
in Trauma/Surgical Critical Care at Cedars-Sinai Medical
Center in Los Angeles. For more information, contact Dr.
Grunander at (801) 475-3000
Local Colon Cancer
Symptoms
Local colon cancer symptoms
affect your bathroom habits and
the colon itself. Some of the
more common local symptoms
of colon cancer include:
Changes in your bowel habits,
such as bowel movements
that are either more or less
frequent than normal
Constipation (difficulty having
a bowel movement or straining
to have a bowel movement)
Diarrhea (loose or watery stools)
Intermittent (alternating)
constipation and diarrhea
Bright red or dark red blood
in your stools or black, dark
colored, "tarry" stools
Stools that are thinner than
normal ("pencil stools") or
feeling as if you cannot empty
your bowels completely
Abdominal (midsection)
discomfort, bloating, frequent
gas pains, or cramps
Systemic Colon
Cancer Symptoms
Systemic colon cancer
symptoms are those that
affect your whole body, such
as weight loss, and include:
Unintentional weight loss
(losing weight when not dieting
or trying to lose weight)
Loss of appetite
Unexplained fatigue
(extreme tiredness)
Nausea or vomiting
Anemia (low red blood cell count
or low iron in your red blood cells)
Jaundice (yellow color to the
skin and whites of the eyes).
If you experience any of these
for two or more weeks, call
your doctor right away to
discuss your concerns and
arrange for tests to get to the
bottom of your symptoms.
Living With a Colon
Cancer Diagnosis
Colon cancer is categorized in four stages.
Stage I is when the tumor has spread
just beyond the lining of the inside of
the colon. During this stage, treatment
consits of removing the colon segment
affected by the turmor. The five
year survival rate is 95 percent.
Stage II is when the tumor cells have spread
deeper into the colon wall and possible
through the outer lining of the colon and
into nearby tissues or organs. Treatment
is surgical removal of all tissues affected.
Survival rate for five years is 60 percent.
Stage III is the cancer has spread into
the surrounding lymph nodes. The
five year survivial rate is 35 percent.
Stage IV is when the cancer has
spread to distant organs such as the
liver, lungs or bone. The five year
survival rate is about five percent.
Most patients diagnosed with
colon cancer will require surgery.
Surgery may then be followed
with chemotherapy treatment.
Rectal cancer, however, may be
treated with radiation therapy and
chemotherapy followed by surgery
and then more chemotherapy.
Surgery for early colon cancer may be the
removal of the polyp with the aid of a thin,
lighted tube called a laparoscope. Three or
four tiny cuts are made into the abdomen
and the tumor and part of the healthy
colon are removed. Nearby lymph nodes
are also removed during the surgery and
examined for possible spread of the cancer.
The success of colon cancer surgery
depends upon the stage of the disease
and how it has affected the other tissues
in the body. Early detection, as with
any cancer, increases survival rates.
Growing and spreading silently with no
signs, is colon cancers greatest danger.
Public education and awareness of
colon cancer has helped dramatically
drop the incidence of this deadly cancer
and as a result we are saving lives.
whatdoctorsknow.com
Pain Management:
Searching for Answers
C
hronic pain frequently pushes
people to make irrational choices.
Desperate to relieve pain, the
distressed can be convinced to endeavor
in just about anything. However, making
the wrong choice can delay appropriate
treatment, cause further damage, or
intensify ones pain. If they are lucky, they
may only do damage to their pocket book.
Constant pain can be a never ending
agony and there is rarely a quick
cure. Every person reacts differently
to stimuli, medications, and therapy.
Medicine is no exact science and
there is no one size fits all fix.
The prudent way to get relief is to begin
with a physician who is fully trained and
focused strictly on pain management.
Unfortunately, there are many facilities
and so-called practitioners in the world
today who make claims of miracle cures
with ornate, elaborate, and sometimes,
harmful methods. Only therapies that
have been properly tested through
accepted medical research and review can
be relied upon to provide relief. Without
proper research neither the safety not
effectiveness of pain therapies are known.
I tell my patients legitimate, medically
trained and licensed physicians base
their practice on evidence based
medicine. This means the procedures,
methodologies, medications and
treatments we use have been tested,
analyzed, and reviewed under controlled
and medically accepted conditions.
Proper pain management
starts with a thorough
examination by a qualified
pain management specialist.
Just as with any bona fide medical
specialty, a physician dedicating his or
her efforts to pain management must
go through years of additional training
to understand, identify and learn how
to treat the complexities of pain.
Pain management requires exhaustive
training in anatomy, physiology,
pharmacology, neurological and many other
complex factors that can trigger or stop pain.
Be wary of fad medicine or miracle
therapies. At best, these experimental
techniques merely temporarily mask
the pain and then it returns. The result
with those techniques is usually another
treatment or another adjustment.
It reminds me of the old anecdote about
the man who hit his thumb with a
hammer so he wouldnt think about his
migraine headache. He may have forgotten
about the migraine for a short time, but
eventually his situation became worse. He
now had a broken thumb and a migraine.
While in medical school, we had to treat a
number of cases that had gone the miracle
cure route resulting in more damage.
Its unfortunate
to see how pain
can drive people
to unconventional
and potentially
dangerous measures.
If you are one
who suffers from
chronic pain,
there are things
you should know
and expect from
your doctor.
First and foremost, you should expect a
thorough examination to isolate the pain
and its source. Our nervous system and
physiology are very complex. Once the
pain has been isolated and identified,
the next step is to devise a program to
provide as much relief as possible. Every
body is not the same and the source of
every bodys pain is different. We try our
best to alleviate pain many times we
succeed, and sometimes we dont. There
are cases where all we can do is make
the patient as comfortable as possible.
Going to a true pain management
physician means you have a full palette of
evidence based medicine no magic bullet
or experimental treatment. I use multiple
modalities to customize treatment to
each individual patient instead of one
single method for every patient. I call it
A to Z pain management. The solutions
could be as simple as prescribing or
changing medication or it could involve a
minimally invasive procedure performed
in our office. Overall, we try to minimize
medication and maximize cure. For
more advanced cases the solution may
require treatments in a hospital setting.
A word of advice I offer my
patients; avoid waiting for the
pain to become unbearable.
Just like so many medical conditions,
getting to a qualified physician before the
pain progresses is the smart choice. So
many conditions caught early are minor.
Caught too late they become serious.
Finally, when you make the choice to see
a physician for pain management, check
credentials. Qualified physicians in any
specialty are proud of the extra years they
spent in medical training to offer patients
the best possible care. Never be afraid to ask
what makes your doctor qualified to treat
you for your condition. A qualified physician
will be glad you asked. And so will you.
About the Author:
Raul Weston, MD, is a fellowship trained
specialist in internventional pain medicine,
receiving his training at the University
of Utah Medical Center and Huntsman
Cancer Institute. After completing his
medical degree from the historic Medical
School at Virginia Commonwealth
University in Richmond, Virginia, he
completed his Anesthesiology residency
from the University of Utah. For more information, contact Dr.
Weston at (801) 294-7246
whatdoctorsknow.com
U
sing your own blood to speed
the healing process for damaged
joints is quickly gaining interest
from the medical community, professional
athletes and the general public. Platelet
Rich Plasma Therapy, as the procedure is
called, already has an impressive following.
Among those who have used the treatment
to heal their injuries faster include
Tiger Woods, Andrei Kirilenko, Peyton
Manning, Kobe Bryant, Hines Ward, Cliff
Lee, Troy Polamalu, Bartolo Colon, at
least 20 of the worlds professional soccer
players, a major league pitcher and more.
Troy Polamalu and a teammate used
Platelet Rich Therapy to heal in time to
play in a winning Super Bowl effort. Its
performed right in the doctors office and
you dont have to be a professional athlete
to be a candidate for the procedure.
Weekend athletes and soccer moms
can also benefit from this procedure.
I am one of the few Utah physicians
offering Platelet Rich Plasma Therapy
in my Park City office. Because its
an in-office procedure theres no
hospital stay or other inconvenience.
Platelet Rich Plasma (PRP) has been
around for more than 20 years. PRP
involves using a persons own platelets to
stimulate healing of damaged connective
tissue. First used by dentists and wound
care specialists in the early 1990s, PRP
can repair joint trauma or degeneration
that would otherwise be chronic.
It was once thought that platelets were
only important for their ability to clot
blood. Its now recognized that platelets
contain numerous tissue growth factors
that can generate new blood vessels
and collagen to repair damaged tissue.
Additionally, platelets attract other cells
such as stem cells to an injured area,
which can further stimulate and accelerate
the bodys natural healing capacity.
The process of PRP therapy involves
accurate identification of the injured
structure, which sometimes includes
the use of ultrasound at the bedside, in
addition to a careful physical exam. The
physician then draws a small amount of
blood from an arm vein, just like getting
your cholesterol checked. Next, the blood
is centrifuged (spun) for 12-15 minutes
to separate the platelets from the red
blood cells and plasma. Then the platelets
and plasma are injected into the injured
area, which has first been anesthetized
to make the procedure as painless as
possible. Over the next few days the
patient will experience some soreness
at the injection site as the bodys natural
responses are mobilized. Initially, there
will be mild inflammation that will attract
specialized cells called fibroblasts to the
area. Fibroblasts spin new collagen, the
building block of cartilage, ligaments,
tendons, menisci and joint capsules. Over
the following weeks, the new collagen
will remodel itself to take on the form
and function of
the structure that
needs repair.
Although patients
who have had chronic
pain for some time
usually notice pain
relief in the first week
after treatment, the
actual repair process
can go on for several
months. Sometimes
only one treatment is
needed. Injuries that
are very old, extensive or severe may need
several treatments for satisfactory healing.
There is generally no down time for this
therapy. The patient can resume normal
activities immediately, although strenuous
or heavy load activity is discouraged for
1-2 weeks. Risks are negligible in that no
one is allergic to their own platelets. The
whole process may take less than an hour.
Conditions that can benefit from PRP
include sports injuries, backache, neck
pain and whiplash, shoulder, elbow
and wrist problems, hip, knee and
ankle disorders, plantar fasciitis, TMJ,
osteoarthritis and similar conditions.
PRP has taken away pain, and allowed
patients to return to skiing, cycling, tennis,
golf, or other sports, and even facilitated
improvement of their performance.
Hines Ward, who attributed his 2009
super bowl win to PRP therapy for
a sprained MCL, was injured just a
few weeks before the big game.
PRP and Prolotherapy
PRP is actually an advanced form
of prolotherapy, the injection of
other solutions to stimulate healing.
Prolotherapy has been practiced all
over the world for decades and has been
endorsed by as prominent a physician
as Everett C. Koop, US Surgeon General
under Ronald Reagan. Prolo is short
for proliferation (of new tissue) and has
also been called Regenerative Injection
Therapy (RIT.) You can learn more about
it on the website: www.getprolo.com.
Stem Cell Prolotherapy
The latest advance in prolotherapy
involves the addition of mesenchymal
stem cells to the injection solution. These
are cells that can be easily harvested
from your own body fat and when
injected into an area of injury, will
evolve into new tissue that can further
enhance the bodys recuperative power.
About the Author:
Kenneth M. Hurwitz, MD, is Board Certified
in Pain Management and has been a
physician since and practicing
prolotherapy for the past years. He
completed his internship at Beth Israel
Medical Center in New York City and
residency at Albany Medical Center in New
York. He studied prolotherapy at the Medical
School of the University of Wisconsin.
For more information, contact Dr. Hurwitz at (435)901-2232 or
visit www.biologicregeneration.com or www.getprolo.com
Repairing Joints
Without Surgery
whatdoctorsknow.com
An Undercover Killer...
Peripheral Vascular Disease
A
n estimated ten million adults in the United
States are affected by peripheral vascular disease
and they dont even know. Even worse, patients
who have relatively minor peripheral vascular disease
symptoms face a five-year mortality rate of up to 30%
from primarily cardiovascular causes (stroke, heart
attack). Almost one-third of patients with peripheral
vascular disease die within a five-year period.
What is peripheral vascular disease?
Peripheral vascular disease (PVD) is a disease of the blood
vessels (arteries and veins) located outside the heart and brain.
Peripheral vascular disease refers to blockages in the arteries and
veins forming the circulatory pathways between the heart and
the rest of the body. When one of these arteries becomes blocked
with plaque, the results can be disastrous. The proper term for
narrowing of an artery is stenosis; and the disease process causing
stenosis, or even complete obstruction, is called atherosclerosis.
What is atherosclerosis?
Atherosclerosis is a gradual process of hard cholesterol
substances (plaques) that build-up on arterial walls. These
plaques narrow openings, making it more difficult for proper
blood flow. The clogging can start in the teen years from poor
diet, smoking and lack of exercise. As we get older and the
blockages become more severe, the real problems start.
In milder atherosclerosis cases, arteries are not substantially
narrowed and there are no symptoms. We all have millions
of plaque-like substances sticking to artery walls every
day. Proper blood flow and a healthy vessel lining (the
endothelium) help cleanse these toxic substances from
the walls. When the endothelium becomes damaged as a
result of high blood pressure, smoking and diabetes, the
plaques begin to accumulate, leading to blockages.
What Are the Signs and Symptoms?
Symptoms and signs depend on the diseases progress. In milder
cases, symptoms could be aches and pains in the legs or arms just
from walking or mild exercise. One common symptom in milder
cases is called Restless Leg. The patient usually complains about
one or both legs aching, burning or just feeling uncomfortable
at night. In order to sleep, the patient may drop the leg over the
side of the bed for comfort, not knowing they are simply using
gravity to help blood flow through a partially blocked artery.
Another manifestation of PVD is wounds that wont heal. When the
body isnt doing its job, such as healing a wound, its a sign something
is wrong. Advanced cases of the disease can cause gangrene, death
of tissue, and if left untreated can lead to the need for amputation.
More dramatic consequences of atherosclerotic disease are strokes
and heart attacks. However, peripheral vascular disease is under-
diagnosed and under-treated. I want to emphasize that atherosclerosis
is a systemic disease; if you have blockages in one part of your body,
chances are extremely high you have blockages in other parts.
Patients often write off many symptoms as old age. Young
or old, when you dont take care of your body, bad things
happen. Just like an automobile, if you use the wrong fuel
or dont perform proper maintenance, it will break down.
When you see your doctor for any medical problem, and if you
have any symptoms of PVD, discuss them with your doctor.
Many patients have come to me after ignoring the early warning
signs as a last gasp effort before amputation. I want to catch
this disease early and prevent it from ever getting too far.
There are risk groups - such as diabetics - we assume already have
the disease, but there are other groups who are potential candidates
for the disease because of their lifestyle choices. These include:
Smoking. The arterial wall lining (endothelium)
constantly fights the good fight. The poisons in smoke
actually stun the endothelium and break down an
important line of defense against atherosclerosis.
Hypertension. Higher blood pressures mean stiffer
blood vessels and more turbulent blood flow that can
damage the vessels and contribute to blockages.
Sedentary lifestyle. Contributes to obesity and leads
to diabetes, hypertension and high cholesterol.
Poor Diet. Goes hand-in-hand with a sedentary lifestyle.
Age. We cant do anything about age, but we certainly can
keep the body healthy through proper diet, exercise and
treatment of risk factors. Dont use age as an excuse. The
older we get, the more aggressive we need to be about upkeep.
Caught early, treatment for peripheral vascular disease is relatively
simple. It could be a prescription of diet, exercise and/or medication.
Initial screening is simple, quick and non-invasive. The more
advanced the disease, the more involved the treatment and screening.
About the Author:
Christopher Y. Kim, MD, completed
his residency in Internal Medicine at
the Univerisity of Texas medical school
in Houston. He also completed his
fellowship in Inverventional Cardiology
at the University of Texas. He is board
certified in Cardiovascular Disease and
Internal Medicine. For more information,
contact Dr. Kim at (801) 776-0174
whatdoctorsknow.com
S
ometimes diets just dont work.
The heavier you are, the more
difficult it is, especially when you
are extremely overweight. Your health
and your life are at serious risk.
There are many reasons a person can
become significantly overweight or
obese, including genetic, metabolic,
social and environmental issues.
A person is considered morbidly obese if
he or she is about 100 pounds overweight
or 80 pounds overweight with other severe
medical conditions such as diabetes,
hypertension, acid reflux, sleep apnea or joint
pain. The more excess weight, the higher
the risks of developing these conditions.
Its like driving down the freeway with
your brakes on. You may be okay for a
while but eventually the extra weight will
wear out joints, causing pain, wear down
the pancreas, causing diabetes and wear
out your heart, leading to a number of
conditions that can shorten your life.
Obesity is the second leading
cause of preventable premature
death. Only smoking is worse.
If youre one of those who have tried to
lose the weight and are looking for other
options, the safest weight-loss surgery is
a laparoscopic adjustable gastric band.
How lap band surgery works
The surgery works by installing a solid
silicone ring around the top part or your
stomach. It is adjustable, reversible, safe,
effective and unlike other surgeries,
does not involve cutting or stapling the
stomach. It is much safer than other
common weight-loss procedures.
Most operations are done in an hour
and patients go home the same
day after just one or two hours.
The Procedure
The operation is performed
laparoscopically with five small
incisions under general anesthesia. Thin
instruments are inserted through the
tiny incisions and the lap band is placed
around the upper part of the stomach like
a collar creating an hourglass shape. Next,
a tube is connected from the lap band to a
small access port beneath the patients skin
just on top of the muscles of the abdomen.
After the first four to
six weeks, adjustments
to the lap band can
be made through
the access port if
needed. The majority
of adjustments are
usually made during
the first year and
then less frequently
to maintain weight
loss. Regular
follow-up visits are
critical to success. Recovery is shorter
than with other procedures, with
most individuals being able to return
to desk work in five to seven days.
Am I a Lap Band Candidate?
If you think you could be a candidate for
lap band surgery (see box above), you
should request a thorough consultation
with your doctor. In the meantime,
here are some things to consider:
Check with your physician and see if
lap band surgery is for you. For more
information see www.utahlapband.net or
call us to attend a free informational seminar.
Lap Band Surgery
Make life easier by getting rid of that extra weight
Utah Lap-Band & General Surgery has moved to a state of the art medical facility in Draper,
Utah. Conveniently located just off I-15 and south of the 11400 South exit. Our patients can
now enjoy convenience of location while being treated in a modern, comfortable setting. The
same great care in a more convenient location. Call today for an appointment. 801-523-6177
11762 S. State St. Suite 220, Draper, UT 84020
About the Author:
Darrin F. Hansen, MD, FACS, is certified by
the American Board of Surgery and is also
a certified member of the American Society
for Metabolic and Bariatric Surgery. As a
Center of Excellence surgeon, his other
credentials include membership in the
American Medical Association, the Utah
Medical Association, and Salt Lake Medical
Association. For more information, contact
Dr. Hansen at (801) 523-6177 or visit www.utahlapband.net
Lap Band Surgery
could be for you if:
Your body mass index (BMI)
is at least 40, which is about
100 pounds overweight. Or,
your BMI is 30 or higher
with one or more obesity-
related health conditions.
You are at least 18 years old.
You have been overweight
for more than five years.
Your serious weight-loss
attempts have had only
short-term success.
You are not currently suffering
from any other treatable
disease that may have
caused you excess weight.
You are prepared to make
major changes in our eating
habits and lifestyle.
You do not drink
alcohol in excess.
You are not currently pregnant.
(Note: If you do become
pregnant after having this
procedure, the band can be
adjusted for the duration
of your pregnancy).
Missing Teeth:
More Than Aesthetics.
Its A Matter Of Health
T
oo many people think living with
a lost tooth is no big deal.
Knowing the long-term effects can quickly make
people realize, it is a big deal. Not replacing a missing tooth
increases the risk of loosing the adjacent tooth and the gap
left from the lost tooth takes away stability and increases the
possibility for this adjacent tooth to loosen and fall out.
It gets worse. There is a vast amount of bone loss that can follow
tooth loss, which can progress rapidly over time. Bone loss can
affect the shape of the jaw, the bite, and the future of your teeth.
You may find it difficult to chew food properly and this can
contribute to your health and diet since you will be limited in what
you can eat. In turn, you may find yourself fighting obesity and
perhaps diabetes because of a poor diet caused by lost teeth.
If you wear dentures, you may develop the inability to use full or
partial dentures and you may even find denture wearing painful
due to bone structure changes caused by a simple missing tooth.
Then theres the matter of facial muscles becoming out of
shape or deformed. Your teeth and jaw act as a foundation for
your facial muscles and bones. When the foundation starts to
crumble, the shape of the remaining teeth, muscles and bone
begin to change. In some cases it can cause social embarrassment
because the face becomes distorted or older looking.
Finally, bone loss beneath conventional bridges can cause food to
become impacted, increase the incidence of gum disease and believe it
or not, tooth loss can increase the possibility of heart disease and stroke.
Missing a tooth is a big deal.
Replacing a missing tooth can be done in several ways.
Among the methods are a tooth supported bridge, a
removable partial denture or a dental implant.
Dental Implants have quickly gained preference from oral
surgeons and patients because of the long-term benefits. The up
front cost of a dental implant may be a little
more, but over time, the implant becomes the
better value. With normal care, implants can last
for years without any worry about failure. Along
with longevity, dental implants can be installed
without destroying or sacrificing adjacent teeth.
Other methods may require taking out an
adjacent tooth for a bridge. Be it one tooth or
several teeth, dental implants are definitely the
preferred method of replacing missing teeth.
What are dental implants?
Dental implants are a dental restoration
system composed of a titanium screw and a
crown. The dental implant process includes
a small-diameter hole (pilot hole) is drilled
for the titanium screw. Once in place, this
titanium screw holds the dental implant in
place. Surgeons often use surgical guides
when placing the dental implants.
After the pilot hole has been drilled, the implant screw is
placed. Once in place, the surrounding gum tissue is secured
over the implant and a protective cover screw is placed on
top to allow the site to heal. After the healing is complete, the
surgeon will attach an abutment, which attaches a crown to
the implant. With the abutment in place, the surgeon will then
create a temporary crown. The process is completed when
the temporary crown is replaced with a permanent crown.
Dental Implants Care and Longevity
Once an implant has been placed, maintaining diligent oral
hygiene habits is required to ensure proper fusing of the
implant and bone structure. If cared for properly, an implant
restoration can remain in place for more than 40 years.
Healing from the surgical procedure to place the dental
implant(s) takes up to six months, while the fitting and
seating of the crown(s) can take up to two months.
Again, this timeframe depends on individual cases and
treatments. Follow-up appointments with your treatment
coordinators are essential for monitoring your progress.
Implant Surgery Follow-up and Aftercare
For five to seven days after surgery, your diet should be
restricted to soft foods. If stitches are present, they may need
to be removed by your surgeon; however, self-dissolving
stitches that do not require removal are typically used.
Failure to floss and brush is the leading cause of implant
failure. Infection can also occur if the implant and
surrounding areas are not cleaned properly. Smoking has
been shown to cause high failure rates with dental implants
and should be avoided following implant procedures.
For more information, contact your Oral Surgeon.
About the Author:
Mark Newey, DDS, started his private
practice in 00. He belongs to a number
of organizations including, American
Oral & Maxillofacial Society, American
Society of Dental Anesthesiologist, and
Weber District Dental Association. For
more information, contact Dr. Newey at
(801)825-1116
whatdoctorsknow.com
ED (Erectile Dysfunction)
Could Be Early Warning Sign
for Cardiovascular Disease
U
tah is a great place to live,
and not just because of the
mountains or the snow. Utah is
so appealing because of its great people.
Family oriented and conservative, the
attitudes and thinking of Utah people for
the most part, are remarkably different
from other more liberal environments.
Its no secret Utah is a
conservative state.
This conservative attitude can make it
difficult - even embarrasing - for men
to discuss their sexual health. Erectile
dysfunction often has a negative impact
on a man's quality-of-life and may be
an early sign of cariovascular disease,
especially for men under the age of 45.
Talking to your doctor about ED is the
right thing to do; it may take a load off
your mind, lead to successful treatment of
ED and may even discover cardiovascular
disease in time to do something about it.
Age Is Not The Issue
ED is not a natural part of the aging
process. There are multiple causes for the
disease and individual treatments are
directed to correct them. In some cases a
change in lifestyle and use of a medication
may be the answer. Whereas other cases
may involve more invasive treatments,
and even placement of a prosthesis.
Each treatment is targeted at the cause
and designed to help men feel whole
again and find more enjoyment in life.
According to the American Heart
Association, results of a recent study
suggest that erectile dysfunction
(ED) is a reliable predictor of death
in men with heart disease.
Men with both conditions are twice
as likely to die as males without
erectile dysfunction. They're also
at significantly elevated risk for
cardiovascular death, heart attack, stroke
and hospitalization for heart failure.
These studies have shown the age of a
man at the onset of ED is an important
consideration for cardiovascular
problems. The younger the man with
ED, the higher the risk of cardiovascular
disease. The onset of ED in men under
50 is a particularly strong predictor
of a cardiovascular event during the
ensuing 5 years. By
age 70, however, the
onset of ED is only
a minor risk factor
for cardiac disease.
ED Could Be a
Sign Of Serious
Health Issues
The same studies
strongly suggest that
ED is often a vascular disease, probably
caused by the same health issues that
cause coronary artery disease. Therefore,
the risk factors for coronary artery disease
are the same as the risk factors for ED.
Atherosclerosis (ath-ur-o-skluh-
RO-sis) or hardening of
the arteries is the buildup
of plaque in the arteries in
different parts of your body.
It causes the arteries to narrow and
harden, limiting blood flow. Because
the arteries supplying your penis are
smaller than those supplying your
heart, symptoms of atherosclerosis may
first show up as erectile dysfunction.
Heart disease occurs when you have
atherosclerosis in the arteries that supply
your heart with blood. Atherosclerosis
can also increase your risk of other
problems, including aneurysm, stroke
and peripheral artery disease.
Healthy Lifestyle Choices
Are Necessary
This means the same healthy lifestyle
choices necessary to remain sexually
active in our later years are the same
lifestyle choices necessary for a healthy
heart. The second thing these studies
tell us is that doctors cant always just
prescribe medication or use other
forms of treatment without looking
closely into the causes of ED which,
in some patients, may include a full
cardiovascular evaluation, and advice
on how to reduce the patients risk
factors by leading a healthy lifestyle.
Men have a much higher
prevalence of ED if they are obese,
hypertensive, diabetic or smokers.
The same factors that can clog up the
arteries leading to heart attacks and
strokes may also damage the blood
vessels that supply blood to the penis. It
can be a precursor for heart problems that
may come to fruition in four or five years.
Don't be embarrassed to see your
doctor and talk about the problem.
About the Author:
Robert Wayment, MD, received his
MD from the University of Utah
School of Medicine. He completed
his Urology residency at Southern
Illinois University School of Medicine
in Springfield, Illinois. For more
information, contact Dr. Wayment at
(801)475-3000
whatdoctorsknow.com
0 whatdoctorsknow.com
Have you ever experienced shoulder pain?
Most of us have. In fact, shoulder pain is one
of the most common complaints seen in the
orthopedists office. And many of your primary
care physicians will see shoulder pain on a weekly
basis. Of those complaints, most are related to
the rotator cuff. Other causes of shoulder pain
include arthritis, tendonitis, pinched nerve, frozen
shoulder, muscle spasms and fibromyalgia.
W
hat is the rotator cuff?
The rotator cuff is actually four muscles and their
tendons which run from the scapula, or shoulder
blade, to the humerusthe upper arm bone. (The top of the
humerus is a ball shape and rests on the glenoid, or socket,
to make the two parts of the shoulder joint.) These muscles
perform the duty of lifting and rotating your arm as well
as helping to keep the shoulder joint in place or stable.
The main rotator cuff muscle is the supraspinatus. This
muscle is by far the most commonly affected by injuries
and impingement. The supraspinatus is the rotator cuff
muscle and tendon that lies directly under the acromion,
or the bone on the top of the shoulder. When the arm is
lifted out to the side or to the front, the supraspinatus may
be pinched between the humerus and the acromion. This
is known as impingement or impingement syndrome.
Between the rotator cuff and the acromion lies the bursa-a
slippery sack that lubricates those two structures.
Impingement also occurs when the supraspinatus weakens
and the humerus can shift upwards towards the acromion.
Some of us have a curved or hooked acromion known as a
spur. This will reduce the space for the rotator cuff and bursa
even more. Activities associated with impingement include
overhead-motion sports-such as tennis, volleyball and baseball-
repetitive job-related activities or just the duties of daily life.
Combine the lack of adequate space with a naturally poor
blood supply to the supraspinatus and over time the rotator
cuff can simply degenerate and give way or tear. Often referred
to as wear and tear, this represents a vicious cycle that leads
to rotator cuff tears. Rotator cuff tears can also occur with
trauma. This is often a fall onto the shoulder or outstretched
hand. Other common ways to tear your rotator cuff are
car accidents, throwing injuries or lifting heavy objects.
How do you know when you have impingement
syndrome versus a rotator cuff tear?
Thats the $64 million question. Both can be extremely painful.
Both can be debilitating. Both will be painful with use of the
arm, particularly lifting objects overhead. The pain is often
on the outside of the upper arm and radiates downwards to
the middle of the upper arm. Impingement will not lead to
significant weakness, whereas those with a rotator cuff tear
will be weak and wont be able to overcome the weakness.
The 411 on
Shoulder Pain
whatdoctorsknow.com
11 www.localhealthcaretoday.com LOCAL HEALTHCARE TODAY
Clavicle
Coracoid
Process
Bursa
Humerus
Acromion
Torn Rotator
Cuff Tendon
Night pain usually means there is a rotator cuff tear as
well. If pain persists longer than two weeks you will
benefit from an examination. Waiting too long often leads
to other complications. The examination to differentiate a
rotator cuff tear and impingement is difficult and is best
performed by an experienced shoulder specialist. Most
importantly, the exam should test your strength. Pain may
come and go, but strength loss due to a rotator cuff tear
does not improve. MRI studies can also be helpful. X-rays
will show the acromial spur, but not rotator cuff injuries.
What do I do when shoulder pain occurs?
If you have a fall or a trauma, see your doctor or an
orthopedic surgeon. The treatment of shoulder pain depends
entirely on the cause of the pain. If you have impingement
syndrome, nonsteroidal anti-inflammatories (NSAIDs) such
as Advil or ibuprofen and waist-level exercises or physical
therapy will often help you resolve the symptoms. The
physical therapy will lower the humerus and decrease the
intensity of the impingement. Occasionally, the pain just does
not decrease. In this case, injections are very helpful. If your
symptoms persist, smoothing the spur and shaving the bursa
may be necessary to alleviate your symptoms. Although
this is surgery, it is easily tolerated and recovery is swift.
If you have the more serious rotator cuff tear, the
treatment often requires surgery. Physical therapy can
help keep your range of motion, but lifting overhead
will only damage your tear further. Also, time is not
on your side. The longer you live with your rotator cuff
tear, the larger the tear will become and the more your
rotator cuff muscle will shrink or atrophy. In addition,
if you have had more than two injections for bursitis
(inflammation of the bursa) you should see an orthopedic
surgeon because you likely will have a rotator cuff tear.
So, your rotator cuff tear means a visit to the orthopedic
surgeon. Your surgeon will discuss options, which will include
surgery if you wish to have your problem fixed. There are
different ways to fix rotator cuff tears. Historically, an open
incision was required to perform your repair. Now the gold
standard has shifted to repairs that are performed entirely
through the arthroscope. The scope is used to see the tear
better because it is magnified and a more anatomic repair may
be possible. In addition, arthroscopic repairs do not violate the
deltoid muscle, which is an important assistant to the rotator
cuff. With all arthroscopic repairs there are also fewer infections
and many believe it is a less painful recoveryalthough this is
difficult to prove. Arthroscopic rotator cuff repair is technically
difficult and only few surgeons are able to perform it routinely,
especially in cases where the tear is large or massive.
The bottom line?
If you have a rotator cuff injury, see your physician. Seek
an orthopedic surgeon who is willing and able to offer
you the state-of-the-art arthroscopic rotator cuff repair.
About the Author:
Dann C. Byck, MD, is currently
practicing in Ogden, Utah. He instructs
orthopedic surgeons throughout
the country on how to perform and
perfect arthroscopic procedures of
the shoulder, elbow and knee. Dr.
Byck has been selected as one of the
few Arthroscopy Association of North
America's Master Instructors. He has been practicing in Utah
for eight years. For more information, contact Dr. Byck at
(801)917-8000 or visit www.utahorthopaedics.com
The rotator cuff is actually four
muscles and their tendons which run
from the scapula, or shoulder blade,
to the humerusthe upper arm bone.
Impingement or Rotator
Cuff Tear = Pain and/or
ache outside of shoulder
to mid-upper arm
Rotator Cuff Tear =
Weakness and pain
Impingement =
No weakness
whatdoctorsknow.com
Sensible Solutions for Obesity
O
besity is a major threat to the
health of many people in America.
Obesity is as serious a threat
to health as smoking and more serious
than other known lifestyle risks. In spite
of continued awareness programs and
warnings of the known serious problems,
obesity is increasing in the United States.
According to a recent article published
in the Journal of the American Medical
Association (JAMA January 13,
2010,) about one-third of U.S. adults
(33.8%) are obese, and another third
are overweight. No state has met the
nations Healthy People 2010 initiative
to lower the obesity prevalence to 15%.
Obesity related health conditions include
heart disease, stroke, type 2 diabetes,
hypertension, metabolic syndrome, and at
least nine types of cancer. In 2008 it was
estimated that medical costs associated
with obesity were over $147 billion.
Fat is considered the largest endocrine
organ in the body and emits over 100
biochemicals into the body. Only two of
these substances are beneficial to health.
The American Society of Bariatric Physicians
(ASBP) is a professional association of
physicians, nurse practitioners and physician
assistants who treat patients who are
overweight or obese. It is also the primary
source for clinical education and training
for non-surgical medical management of
obesity. They have established guidelines
for weight management that are evidence
based and have proven to assist patients
to reduce weight, improve overall health,
and prevent future metabolic diseases.
By restructuring the diet to increase
protein and reduce carbohydrate intake,
TimeLess Medical Spa & Weight Loss Clinic
has created a diet plan that is effective,
sustainable and easy to maintain.
There are many benefits of a
high protein diet including:
Protects muscle
o Increases protein
synthesis in muscle
o Decreases body fat
o Increases burning of calories
thermogenesis
Treats or prevents: Obesity,
Metabolic Syndrome, Type
2 Diabetes, Sarcopenia (loss
of muscle), Osteoporosis,
Hypertension, and Heart Disease
Stabilizes blood sugar
Increases satiety resulting
in long term compliance
Meal replacements can be a very effective
part of a weight management program.
Using meal replacements that are
nutritionally sound and high in protein help
patients by controlling calories, restricting
serving sizes and making sure adequate
protein is consumed. Once a goal is
reached, patients who use at least one meal
replacement a day have been successful in
keeping the weight off according to data
from the National Weight Loss Registry.
At TimeLess, we have implemented the
recommendations of the ASBP to create
weight management programs that work.
Patients are evaluated by Brent Williams,
MD, who has been trained in bariatric
medicine. Patients are given an initial
work-up including a short history and
physical. This is important because some
medical treatments can contribute to or
cause weight gain. Frequently, alternatives
are available to aid in weight loss.
Patients are placed on a personalized diet
program to meet their specific needs.
Weekly counseling and body compositions
are provided by trained bariatric assistants
to ensure that fat is being lost while
preserving muscle. When weight goals are
met, we help fashion a plan for maintaining
weight loss. Meal
replacements are
available at TimeLess
that are high in good
quality protein,
nutritionally sound
and delicious.
Losing weight and
keeping it off is a
journey, but a journey
worth taking to keep
you healthy, active
and looking great.
About the Author:
Brent Williams, MD, has been a family
physician for over years and is certified in
bariatric medicine and is a member of the
American Society of Bariatric Physicians,
American Medical Association and the Utah
State Medical Association. Debbie Williams
attended Weber State University with a
major in Communications, Psychology, and
Nutrition. She is a member of the American
Society of Bariatric Physicians and is a Certified Bariatric Assistant.
For more information, please call (801)528-9078
Photos used with permission.
Before
After
6112 S. 1550 E. #3, South Ogden, UT
Raul Weston, MD
Board Certifed Anesthesiologist
& Interventional Pain Specialist
801-294-PAIN
801-294-7246
1551 S Renaissance Towne Dr #460
Bountiful, UT 84010
Interventional Pain Physicians
Treating
t Back Pain
t Neck Pain
t Shingles Pain
t Headaches & Migraines
Comprehensive Pain Treatments
www.crpainrelief.com
Compassionate & Individualized Care
Pain Relief Specialists
Dr. Mindy Boehm, MD
Pediatrics
Quality Care
from Neighbors
you Trust
LOCATIONS
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Ogden
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10am 8pm SatSun
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Ogden
8am 8pm MonFri
10am 8pm SatSun
Mountain View
1100 West 2700 North
Pleasant View
8am 8pm MonFri
10am 5pm Sat
Grand View
3485 W 5200 S
Roy
8am 8pm MonFri
10am 5pm Sat
Skyline
6112 South 1550 East
South Ogden
8am 8pm MonFri
10am 5pm Sat
Call today for an appointment!
801 475 3000
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ogdenclinic.com