Orthopedic Specialists of Northwest Indiana (OSNI) has been operating in Northwest Indiana for more than 17 years. Dr. Joseph Hecht, OSNI’s senior partner, specializes in arthritis related conditions and treatments, with an emphasis on knee and hip reconstructions. He completed his residency at the University of Chicago Hospitals. Dr. Hecht can be reached by calling his Munster office at (219) 924-3300.
What does an orthopedic specialist do?
In the broadest terms, an orthopedic surgeon takes care of diseases of the musculoskeletal system. That encompasses everything from the spine, extremeties and joints, including hips, knees, hands and feet. A general orthopedist covers everything from traumatic injuries to arthritis. I, myself, focus on things including hip and knee replacement but take care of most any problem considered general orthopedics.
Is there a difference in injuries people sustain when they’re younger or older?
Older people tend to come in with problems such as joints wearing out, or thinning of the skeleton, osteoporosis, which can lead to fractures. Young people tend to have traumatic injuries, such as slipping and falling and twisting an ankle and breaking it. Sports injuries in young people vary based on the sport. Football injuries have a different set of problems than a marathon runner or someone who works out with weights.
How has treatment and technology changed over the last few decades?
Techniques in surgery have moved towards making smaller incisions. Ruptured, torn tendons and other injuries that would have been invasive surgeries in the 1980s or 1990s are can now be fixed much more easily. Even the materials we use have changed. Stainless steel is still popular, but we also use titanium plates, which are lighter and more flexible, depending on where the injury is. Thirty years ago, a wrist break would be put in a cast that would go above the elbow and it would be held into position for six weeks. Now, surgeries can restore alignment of the wrist, and therapy can begin much sooner. That’s true of shoulder and knee tendon and ligament tears and other significant trauma, as well.
How has hip and knee replacement changed over the last few decades?
Techniques have made quite a few advancements in the last decade. There are smaller incisions, newer ceramics, metals and plastics with the trend toward shorter hospitalizations. These practices are gaining more acceptance as time goes along. One hip replacement technique that is gaining acceptance is to perform the hip surgery from an anterior interval (commonly called the direct anterior approach). The advantage of that is you go between the muscle planes rather than cutting through muscles to access the hip joint. This technique can be more difficult and requires additional training and experience, but specialized traction tables have been developed to facilitate the procedure. This causes less limping and within a month, patients are doing much better, much more quickly. Knee replacements are also making improvements. There are techniques to make smaller incisions and have less blood loss. Custom cutting blocks that are made from pre-surgical measurement planning techniques have become readily available. There are many ways to do hip and knee replacement surgeries, and new techniques are gaining popularity when they lead to faster patient recoveries. Is there a best technique that will hold up over the long term? There is no unequivocal proof or what we call level one evidence yet, but consistently good outcomes are always dependent on the skill and experience of the surgeon.
James Murphy, a third generation orthopedic surgeon, has seen firsthand how improvements in technology impact patient care.
Murphy, an orthopedic surgeon out of East Chicago’s St. Catherine Hospital, part of the Community Healthcare System, says his father and grandfather both practiced on the southeast side of Chicago. Between his father’s era and his, there has been a lot of innovation, he says.
In the 1950s and ‘60s, orthopedic surgery meant plastering fractures and putting patients in traction with long hospital stays. The technologies available today have changed all that for the better, he says, so that even patients with complex injuries can be treated as outpatients or have minimal hospital stays.
When his grandfather completed his residency, the program was one of the first orthopedic residencies in the world. He was part of the American Academy of Orthopedic Surgeons started in 1933 at Northwestern University in Chicago. Prior to that, doctors were either general surgeons who did every type of surgery or family physicians.
“We need to appreciate where we came from so was we go forward, we know that we’re part of something bigger than just our clinic or our hospitals. It’s a fellowship of orthopedic surgeons that goes back over a century," Murphy says. "The physicians who came before us really kind of blazed the trail for what we are able to do. A lot of times we forget about that."
The most major advancement is the treatment of arthritis, he says. Growing up in the 1970s, he remembers parties where one room was filled with the older family members who would sit and have food and drinks brought to them. There was also a bucket near every home's front door where seniors would leave their canes.
“That doesn’t exist now,” Murphy says. Nowadays, senior family members are walking around, talking about their golf games and latest travels. Joint replacement has been the greatest advancement as people age. When their knees and hips become arthritic, they can have them replaced to stay active.
Murphy also does ankle replacements, a surgery not many doctors are trained to do. It is an area that is a little underserved, he says. The pain causes sufferers to limit activity in the workplace and recreationally and eventually affects their ability to walk at all.
“It really is a life altering thing where now we can get people active and engaged.”
Arthroscopic surgery has also done a lot to change the way doctors treat patients. They are able to make smaller incisions and use a camera the size of a pencil to see the joint in question. Through a second incision they use instruments to correct whatever problems exist.
"Recovery is such night and day difference," he says, leaving doctors to abandon many of the older protocols.
He compares the shifts in technology to personal computers. "The one you bought five years would never get to market now, the same has happened in arthroscopic surgery."
Some parts of practicing medicine are constant, Murphy says, no matter the generation.
“The main denominator is to have the compassion and care to take the time for patients. They all come to you with a problem and they are looking to you to not only treat the problem but to educate them on the problem so that together you can navigate it and get through it. I’m sure it was rewarding then and it’s very rewarding now."
Gregory McComis, orthopedic surgeon at North Pointe Orthopaedics in Munster, says the anterior total hip replacement is a huge advancement in orthopedic medicine.
“A traditional total hip, which was done for the past 50 years, was done through incision in your buttocks or backside of your hip,” he says. It was more painful and required more rehab. Patients were also at risk for dislocating their hips after surgery.
The anterior hip procedure uses a smaller incision in the groin to remove the ball of the hip joint and replace it with one made of metal and plastic. Doctors do not cut through as many muscles, making it minimally invasive. Patients can get up and walk on day of surgery and go to normal activites in four to six weeks. The muscle sparing means patients will never have an issue with muscle weakness or chance for hip dislocation.
"This can’t be duplicated in any other way," he says.
The procedure was popularized in the United States by a California surgeon around 2005.
McComis started doing the procedure in January 2010 and has done almost 700 of them. Patients come from throughout the Midwest to see him. About 30 percent of patients are in their mid to late 50s.
"A lot of surgeons are not doing this procedure because it is technically more challenging but I think the benefits far outweigh the risks for the patients."
William Biehl, orthopedic surgeon out of St. Anthony Health in Michigan City, uses technology while doing knee replacements. His technique involves having patients get an MRI scan of their knee. A model is then constructed of the knee for which Biehl can “make special jigs that are specific to the patient’s knee.” When he puts those jigs on the knee during surgery, it helps him make better cuts.
Other surgeons utilize computer navigated surgery when making cuts.
Biehl also says availability of vitamins is an important change for orthopedics. Over the last five years, over-the-counter vitamin D3 tablets have become available and they are fairly inexpensive. Although Midwesterners may think they get enough vitamin D, they must have direct sunlight over 80 percent of their body to activate it, something unlikely to happen during the winter months.
“Once it becomes warmer in spring and summer, more people get active and then I see a lot of kids with stress fractures or growth plate injuries. I think a lot of this is due to our vitamin d metabolism around here.” Biehl recommends taking the suggested amounts of calcium with vitamin d3, which for most adults will be 1200 mg calcium with 800 iu of vitamin d3.
Glinda Tufts, of Crown Point, had both knees replaced six weeks apart in 2009 at Rush University Medical Center in Chicago. She had tried steroid injections for the osteoarthritis in her knees but it continued to get worse.
She was most worried about pain and discomfort following surgery but says it went much better than she thought. Anyone considering the surgery should go the minimally invasive route, she says, and avoid methods that open the whole knee.
She was home within 48 hours after the first knee replacement and within 24 hours after the second. The first week post-surgery, she had in-home care but by the second week, she was driving to physical therapy.
Before you can leave the hospital, you have to be complete certain tasks, she says.
“Within 24 hours of having a knee replaced you can climb a flight of stairs. It’s pretty amazing what they can do now.”
Dwight Tyndall, a spine surgeon based in Munster, says that outpatient spine surgery offers many advantages for patients.
“When I first came in practice, the way I was trained, if a patient was having any type of spine procedure, they would be in the hospital three to five days,” he says. “Now we’ve gotten to the point, at least in my practice, where they are going home the same or next day.” With smaller incisions, new techniques and tools, patients can recover faster and can get back to their life sooner, he says. Blood transfusions and large amounts of pain medications are also no longer needed.
“As one of the leaders to move us in that direction, it has been very exciting to see those developments,” he says. Patients don’t want to be in the hospital for multiple days and these advancements mean they no longer have to.
Work related injuries and age related changes are among the top reasons for spine surgery, he says, with patients ranging from their 20s to 70s. Even his young patients often have preconceived or fairly negative ideas about spine surgery and Tyndall educates them about how much has changed.
“We’re still getting the same thing done, with the same objective. The techniques have changed so they have to throw all their preconceptions out the window as far as how long the surgery is going to take, how quickly they get home, how quickly they will recover,” he says.
“The beautiful thing about that is I’ve been able to move my surgeries from hospital based procedures to a surgery center based procedure.” Moving the procedures to outpatient buildings is more cost effective and efficient. Outpatient surgery centers have been used in plastic surgery and sports medicine for some time but the use of them for spine surgery is a fairly recent development.
“It’s the wave of the future since we’re so preoccupied with costs and outcomes. I definitely think it’s the way we’re going to go,” Tyndall says. “I think it will be beneficial for the entire health care system and especially for our patients.”
Women with a faulty breast cancer gene might face a greater chance of rare but deadly uterine tumors despite having their ovaries removed to lower their main cancer risks, doctors reported at a conference last month.
A study of nearly 300 women with bad BRCA1 genes found four cases of aggressive uterine cancers years after they had preventive surgery to remove their ovaries. That rate is 26 times greater than expected.
"One can happen. Two all of a sudden raises eyebrows," and four is highly suspicious, according to the physician who did the study, Dr. Noah Kauff of Memorial Sloan Kettering Cancer Center in New York.
His study, reported at a cancer conference in March in Florida, is the first to make this link. Although it's not enough evidence to change practice now, doctors say women with these gene mutations should be told of the results and consider having their uterus removed along with their ovaries.
"It's important for women to have that information ... but I think it's too early to strongly recommend to patients that they undergo a hysterectomy" until more research confirms the finding, said Dr. Karen Lu, a specialist in women's cancers at MD Anderson Cancer Center in Houston. She plans to study similar patients at her own hospital, the nation's largest cancer center, to see if they, too, have higher uterine cancer risks.
About 1 in 400 women in the U.S., and more of eastern European descent, have faulty BRCA1 or BRCA2 genes that greatly raise their risks for breast and ovarian cancer. Doctors advise them to be screened early and often for breast cancer, and to have their ovaries out as soon as they have finished having children to help prevent ovarian and breast cancer, because ovarian hormones affect breast cancer as well.
But the role of BRCA genes in uterine cancer isn't known, as Kauff says. His study looked at 1,200 women diagnosed with BRCA gene mutations since 1995 at Sloan Kettering. Doctors were able to track 525 of them for many years after they had surgery that removed their ovaries but left the uterus intact.
The vast majority of uterine cancers are low-risk types usually cured with surgery alone. Aggressive forms account for only 10 to 15 percent of cases but more than half of uterine cancer deaths.
Researchers were alarmed to see four of these cases among the 296 women with BRCA1 mutations. None were seen in women with BRCA2 mutations. Last year, the actress Angelina Jolie revealed she had preventive surgery to remove both breasts because of a BRCA1 mutation. Her mother had breast cancer and died of ovarian cancer, and her maternal grandmother also had ovarian cancer.
“Ultimately whether a person wants to lost weight with or without bariatric surgery,” says General and Bariatric Surgeon, Dr. Paul Stanish, M.D., F.A.C.S., who is the Medical Director for the Healthy4Life program at Community Hospital in Munster and St. Mary Medical Center in Hobart, “they will need to make lifestyle changes.”
Stanish, the co-founder of Healthy4Life, a program designed as a comprehensive team approach to weight loss. To accomplish this, group’s team of professionals, each with specialized skills and expertise in a multitude of areas including nutrition, exercise physiology, diet, internal medicine, surgery and psychology, are able to work with each patient and address their individual needs.
According to Stanish, even those who are prime candidates for weight loss surgery still need to be in good shape before proceeding to surgery. That’s why the team approach emphasizing education and lasting lifestyle changes is so important.
“Changing eating habits is the most important step,” says Stanish. “We live in an extremely toxic food environment where there’s food everywhere. Much of our fast food is easier to get and cheaper to buy and not good at all for you.”
While most people can county food calories, they aren’t always aware of liquid calories—the amount of sugar in what we drink. Consider this, the largest size Starbucks Caramel Flan Latte with whipped cream has 450 calories; a 16-ounce Coca Cola classic at McDonald’s has 410. And those are empty calories, they don’t fill you up so you’re still hungry. Pile that on with a cinnamon roll at Starbucks (420 calories) or a Big Mac at 540 calories and you have half your 2000 calorie allotment for the day.
But there’s further bad news. Forget about working it off.
“You have to be a highly trained athlete to exercise you way out of a bad diet,” says Stanish. “That’s why education and food journaling where we keep track of what we eat are so important.”
Weight loss surgery is a life-changing procedure requiring many changes before and after surgery says Lori Granich, Registered Dietitian at the Midwest Bariatric Institute at Franciscan St. Margaret Health in Dyer.
“Not only will the surgery center that you choose require you to make changes, but your insurance company also has requirements that must be completed before they approve your surgery,” she continues. “With the help of your bariatric team, you will be asked to start making changes before surgery.”
According to Granich this may include starting a vitamin regimen, increasing fluid intake, quitting smoking and regularly exercising.
“One of the best ways to improve health before surgery is to lose weight,” she says. “Even a small amount of weight loss will decrease the risk of surgery, improve breathing and increase ambulation.”
Kristal Markovich, a registered dietitian at Methodist Hospitals, suggests that prior to surgery it’s important to start a diet that includes low fat or fat free dairy options, lean cuts of meat, whole grains as well as consuming more fruits and vegetables.
“Bariatric support groups allow you to meet people who have had surgery or are preparing to have surgery just like you,” says Markovich. “They are great places to practice your new healthy lifestyle in a positive and supportive environment.”
There’s also a psychological component to why we eat.
“When we do the surgeries, they’re very measured,” says Stanish noting that it’s the patients not the surgeries which vary, making it important to get to the underlying food pathology.
“Meeting with a psychologist is also a prerequisite for most programs,” says Granich. “The psychologist can evaluate if you are ready to make the changes necessary for weight loss surgery and can also help you deal with other issues you may have related to food, stress or family. Most bariatric centers have information seminars and support groups that can educate you and your family on bariatric surgery.”
Often patients are asked to keep a food journal.
“People think of it as a chore,” says Stanish, “but I want people to think when they’re about to eat and ask themselves, why am I eating? Am I eating because I’m hungry? Depressed? As well as the time of the day and what they’re eating”
Bariatric isn’t the end of healthy lifestyle changes.
“It is extremely important to continually stay in touch with your bariatric team,” says Granich, “and attend all preoperative and postoperative appointments.”
When they recognize the signs of patients who aren’t fully committed, Stanish and his team work with them.
“We know what phases they are in and whether they are or are not following the diet and exercising,” he says. I tell them I’m like Santa, I know if they’ve been good or bad.”
There comes a point in an alcoholic’s life when drinking takes over. When opportunities to self-medicate outweigh everything else.
For 60-year-old south suburban Stella, a nightly dose of alcohol helped dull the pain of her husband’s passing. Several days a week, she bought a pint and nursed it in front of the TV. Then she passed out.
For five years, this was Stella’s pattern. She drank alone, and when she ran out, she had a network of 20 liquor stores she bought from.
“I didn’t want them to know I had a drinking problem,” she said. “So I’d switch things up and go to different stores. As if someone who buys a pint of vodka at a time doesn’t have a problem!”
Like many alcoholics, Stella was a private drinker. On rare occasions when she ventured out with friends, she kept her addiction under control.
And unlike the stereotypes often associated with an alcoholic, Stella wasn’t a destitute drinker. On the contrary, she was a doctor’s wife.
“I just wasn’t dealing with life as it was coming at me, and I knew it,” she said. Eventually nighttime drinking became daytime drinking too.
Stella made appointments to see her doctor; she even attended Alcoholics Anonymous meetings. But it wasn’t until she got a DUI that Stella made the decision to get sober for good.
“It was the worst day of my life,” she says of her DUI arrest. “I had never felt so humiliated. Yet it was the best day of my life too. It forced me to do something about my problem. Thankfully, I didn’t hurt anyone else. I had such a sense of grace. Someone was looking out for me, and I wasn’t going to blow it.”
Urged by her doctor, psychiatrist and addictions specialist Joseph Beck, M.D., she voluntarily admitted herself to the four-week program at the Illinois Institute for Addictions Recovery at Ingalls (IIAR). The IIAR is a 16-bed adult addiction treatment facility providing care for a wide range of addictions, including alcohol and drugs; gambling; the internet; video-gaming; sex; spending/ shopping; food; and chronic pain with addiction.
Since her treatment four years ago, she’s never touched a drop of alcohol again.
“The first Saturday night that I was in treatment, a group of us were eating popcorn and watching a movie about addictions,” she recalls. “I was surrounded by people dealing with similar issues, some worse than mine, and it suddenly hit me that this was the best Saturday night I’d had in five years.”
Though she had to conquer the addiction herself, Stella says the IIAR counselors gave her the tools she needed to be successful.
“And for that,” she adds, “I’m forever grateful.”
“What many people don’t realize is that coming to treatment is the first step in a lifelong journey of recovery,” Dr. Beck explains. “Your life (the people, places, and things you’re associated with) has to dramatically change after treatment. That’s really where the rubber meets the road for so many of our clients.”
After her discharge, Stella reconnected with old friends and began volunteering in the community. She repaired fractured family relationships and rediscovered her love of traveling. She even hired a personal trainer and lost 83 pounds in the process.
With the help of the IIAR, Stella emerged from the darkness of her addiction and rebuilt a life that now brings her joy.
To others facing the uncomfortable truth of addiction, Stella advises, “The most important thing is to be honest with yourself. Are you the person you want to be? If the answer is no, you don’t have to do it alone. Help is closer than you think.”
If you or someone you love is ready to reach out for help, call 708.915.4090, available 24 hours a day.
Athletes, with their need for a competitive edge, enhanced speed and being able to play through pain, are at a greater risk of becoming addicted to drugs in general but prescription drugs specifically because of injuries and the rising pressure to keep playing even when injured says Peter Bradley, a therapist at Illinois Institute for Addiction Recovery which has a unit at Ingalls Hospital in Harvey, Illinois. Bradley is certified in working with dual diagnoses involving substance abuse and mental health issues, as well as Professional Compulsive Gambling Counselor and is nationally certified to work in Illinois as well as other states.
Professional sports figures are often afraid if they don’t play because of an injury someone else will take their place while high school and college athletes worry about losing scholarships and prestige.
“And there’s the fan level,” says Bradley. “You want to please them and that feeling just adds to the pressure.”
At times, that’s apparent even to those watching the game. An athlete withers in pain on the floor, is helped back to the bench, he or she is talked to sternly and then suddenly they’re back on the floor.
“Some of the medications they prescribe for injuries can be doozies,” says Bradley. “The opioids used in pain killers are very strong , very potent and they’re meant for short term use because they are highly addictive. Therein lies the problem, a lot of people get addicted who wouldn’t normally have the profile of someone who would become addict.”
“Sports figures are high arousal people says Larry Brewerton, a psychology professor at Indiana University Northwest. In the past Brewerton has set up alcohol and substance addiction programs in Chicago like the Cook County Dept of Corrections and Mt. Sinai Hospital as well as working as a director of a C.A.R.E. unit in the city specializing in alcohol and substance abuse.
By using the term high arousal, Brewerton is referring to the need for extreme physical and emotional stimulation.
“They’re used to high arousal when they’re playing with a lot of adrenaline going on and they really thrive on that,” he says. “When they’re not off, they still need it. They thrive on it and so many use amphetamines, cocaine, things that keep up that arousal. It makes them feel very good as well as omnipotent.”
College and high school athletes like pro stars use for various reasons—steroids for bulking up, diuretics to lose weight (common among wrestlers who have to fit in a specific class) and amphetamines to speed up.
“It puts you in a no win situation,” says Bradley. “If you don’t use them and compete with those who are using, then they have the edge. But you have to look at it as an integrity thing, about what’s right and what is good for you and your body.”
Bradley believes painkillers are the number one misused prescription drug.
“If you use them too many days you develop tolerance and withdrawal symptoms where you try to stop and these are symptoms of drug addictions,” he says. “Pain patients’ withdrawal from opiate use is like having the flu a hundred times over and addicts know in order to stop these dramatically painful withdrawals is to take the drug. I’m a firm believer that certain people need prescription medicines for certain things, but the potential for misuse is pretty amazing”
Brewerton, who used biofeedback when working with sports stars in order to train them to relax, says that there are many people who are addicted who are not aware of it mainly because of self medicating.
“They look at medicine that is prescribed as being okay compared to drugs on the street,” he says. “Unfortunately general practitioners write a lot of prescription and don’t send patients to specialists to figure out why they’re anxious, can’t sleep and instead of just writing prescriptions…many people out there self medicating.”
There isn’t a clear cut profile of who becomes an addict and who doesn’t.
“There are many different reasons,” says Brewerton. “Most people in their lives have experimented with alcohol or drugs but what makes people go into addiction is another subject in itself. Most people stop but others just keep going. That’s why a therapist needs to find the trigger. Why can two people go out and have a glass of wine or two at dinner and another have a half gallon?”
Treatment can make a difference but Brewerton offers some caveats.
“Many times treatment programs for alcohol and substance abuse ask someone to give something up but you also have to replace it with something to give the patient a way to put themselves in a place that’s very awarding but satisfying and healthy as well,” says Brewerton. “Therapists need to make sure the patient has been seen medically in order to ensure there are no medical issues that need to be dealt with. Then it’s important to do a really good history looking for factors that may have caused their use and continuation of use-- traumatic abuse, car accidents, post traumatic stress disorder, to get an idea what that person is about and why they may be using in the first place and why they continue to use.”
Both Bradley and Brewerton agree that the best chance for recovery is when a patient is committed. If not, when confronted by loved ones, the addict withdraws from them and becomes angry as denial is part of the addiction process.
“That’s an important part of recovery,” says Brewerton.
When has the economic impact of healthcare not been front page news lately? Insurance companies, provider systems and state and federal governments, which have been working for years to towards becoming more efficient as well as complaint, are now seeing fruits of that labor. On the other side, the individual customer is embarking on a new world, where research and decision-making will be an obvious and defining factor in the family budget. Just anecdotally, many people I know are making choices that will change their wellness plan for this year anyway, as part of a large social experiment with an unknown (and unknow-able) result.
And while it is difficult to be 100 percent comfortable with trying to predict how healthy we will be in the year to come --- especially when the weather has been an extremely volatile factor in everyday living and working --- there are a items that everyone is relieved to have off the table like pre-existing conditions, or the million dollar insurance caps that have been gone so long that they are almost forgotten. By the way, I don’t mind giving up the old routine of filling out a new set of forms for every doctor visit. Remembering the dates of any past surgeries, illnesses, prescription drugs---generic vs. trademark names, dosage, duration, are you kidding me?---had gotten to be way more than a minor annoyance. Kind of like taking a standardized test before every office appointment; I won’t miss that. I like that a specialist I haven’t seen for 13 years knows exactly what took place that long ago and will gladly show me the report, because I sure don’t remember the details.
Last week I went to the wake of a high school friend’s mother who died at the age of 91, leaving a very sad, but very large group of people including spouse, children, grandchildren, spouses of children and grandchildren, and many great grandchildren, even a few with spouses of their own. While it was obviously very painful for family to lose someone so close and so beloved, it was plain to see what a joy every day of her life had been for all concerned. Living longer and having an improved quality of life is the big benefit of efficient and affordable healthcare, that’s the benefit we sometimes forget about as we study fees-per-paycheck and coverage subsidies.
Communicating, informing and educating readers about what’s going on with healthcare in Northwest Indiana are our mission. The economics that go with supporting healthy life plans are certainly an important part of our work, but we should never forget the point of staying alive. Our common goal of living longer, happier and healthier lives is the reason these things matter so much and commerce, in spite of all the attention it gets, is just a side note.
Next issue we will look at innovative treatments, aching bones and our tired, cold feet.
Associate Publisher and Editor
Negatively charged microparticles potentially could reduce damage from heart attacks, a Chicago-Australia team reported in a study on mice has published.
Researchers from Northwestern University and the University of Sydney in Australia found that injecting mice with the microparticles within 24 hours of a heart attack reduced tissue damage by 40-50 percent. The study, published in Science Translational Medicine, showed similar results for West Nile virus, multiple sclerosis, inflammatory bowel disease and other issues.
“We’re pretty optimistic because of the very potent anti-inflammatory effects we’ve seen,” said Stephen Miller, a researcher and professor of immunobiology from Northwestern University.
The Centers for Disease Control and Prevention reported that heart disease is the No. 1 cause of death in the U.S. In 2009, nearly 25,000 people in Illinois died from heart disease.
One of the researchers, Daniel Getts, a visiting scholar in microbiology-immunology at Northwestern, compared a heart attack to frozen pipes in the winter. “There’s no water getting through and on the other side of the blockage the heart starts to die,” he said.
The blockage causes tissue to die and the body responds by sending white blood cells to clean up the dead tissue cells. However, the white blood cells become inflamed and can cause damage.
In the study, the charged microparticles were injected into the bloodstream and bonded with the inflammatory cells.
“Instead of going to the heart or the brain, they were diverted to the spleen by the cells that ingested them,” Miller said. “A good proportion of those cells end up dying.”
By injecting people with microparticles soon after a heart attack, researchers hope they can minimize damage caused by inflammatory cells.
The microparticles are made from a biodegradable polymer known as poly (lactic-co-glycolic) acid. The Food and Drug Administration already has approved the particles, which are used to make some medical sutures. Scientists do not yet understand what causes the particles to redirect the inflammatory cells to the spleen, or how they signal the cells to die.
“There needs to be future work on how these particles are manipulating the immune system,” said Eric Bachelder, a researcher in drug delivery at Ohio State University in Columbus. He called the treatment both innovative and promising.
“If you told me someone injected it into these animal models…I would have thought that nothing would have happened,” Bachelder said of the microparticles
The study was conducted on thousands of mice in labs in Chicago and Sydney, and Miller said much of its promise lies in the successful replication of the experiments.
“The cool thing I think about the study is that this was a collaboration between labs in Australia and at Northwestern, and the various models were carried out at different places,” he said.
According to Miller, a biotech company called Cour Pharmaceutical Development Co. has been spun off of the experiment to raise capital for a clinical trial focusing on heart attack treatment. Getts is Cour's chief scientific officer and Miller has an interest in the company. The therapy will need to go to the FDA for approval of a phase one trial in humans, which could happen within the next two years.
“The bottom line is this seems to be a very potent protective therapy for different inflammatory disease models,” Miller said.
It may start with a feeling as if the heart is skipping a beat or beating too hard or fast.
Those heart palpitations may lead to shortness of breath, or even fatigue or chest pain.
While these symptoms can mean many different medical conditions, they also may lead doctors to suspect atrial fibrillation - the most common type of heart arrhythmia.
While catching any long-term health condition early is important, Dr. Adarsh Bhan, a cardiologist on staff at Advocate South Suburban Hospital, said diagnosing atrial fibrillation early in patients reduces the risk of stroke and heart failure - two major complications of AF.
And as age goes up, so does the risk.
"The incidence rate is pretty high," Bhan said. "At 60 years old, the incidence rate is 4 percent, and at 80, it's 10 percent."
Diagnosing AF can be challenging, however, at times. While an electrocardiogram test is often the tool for catching it, Bhan said not everyone exhibits signs and symptoms often associated with the heart problem.
"Not every atrial fibrillation stays all the time, either," he said. "It can come and go."
According to the National Heart, Lung and Blood Institute, AF is more common in people who have high blood pressure, coronary heart disease, heart failure, rheumatic heart disease, structural heart defects and congenital heart defects. It's also more common in those who are having heart attacks or who have just had surgery.
To understand AF, Bhan points to the heart's electrical system, which controls the rate and rhythm of the heartbeat. In a healthy adult heart at rest, an electrical signal begins a new heartbeat 60 to 100 times a minute. If a person is suffering from an arrhythmia, the heart may beat too fast, too slow or with an irregular rhythm.
Once a physician diagnoses a patient with AF, the next course of action involves preventing further damage, Bhan said.
"Once we diagnose, our treatment involves preventing a stroke and relieving the symptoms," he said.
Because blood can pool in the heart's upper chambers, a blood clot may form, he said. If that clot breaks off and travels to the brain, it can cause a stroke.
"Doctors will prescribe a blood thinner, such as Coumadin," Bhan said.
Bhan said once patients are prescribed blood thinners for AF, they likely will be required to take them for the duration of their lives.
"Over the last couple of years, however, blood thinners have been more effective and have simplified patients' lives because no monitoring is needed," he said.
Other courses of treatment include medications, procedures to restore a normal heart rhythm and surgery.
Following a healthy lifestyle, however, can lower a person's risk for heart disease that may then help prevent atrial fibrillation.
The National Heart, Lung and Blood Institute recommends following a heart healthy diet that's low in saturated fat, trans fat and cholesterol, as well as not smoking, being physically active and maintaining a healthy weight.
The year 2013 saw some promising advances in cardiovascular drugs and treatments — good news for doctors and their patients. According to northwest Indiana-area cardiologists, this year should offer patients more comfort and hope and doctors a bigger arsenal to combat the threats of heart disease and stroke.
New medicines to prevent dangerous blood clots are “A big deal,” said Dr. Sabrina Akrami, cardiologist and cardiovascular physician at Ingalls Health System in Harvey, Ill., said, “New anticoagulant medicines are very exciting. People with heart issues like atrial fibrillation have risk for a blood clot and stroke. Benefits include fewer blood tests than for Coumadin or warfarin and patients don’t need to avoid certain foods that have a negative effect with the older drugs,” Akrami said.
Dr. Michael Wheat, director of the Advanced Heart Failure Program at Porter Regional Hospital in Valparaiso, Ind., agreed. “Newer drugs are very promising for treating atrial fibrillation. They don’t require monthly blood tests because they’re working better and are more stable.”
Coumadin and warfarin are still good medicines for most people who have been on them a long time and do well, but for most of my newer patients I’ll use the newer drugs,” said Akrami. Another benefit is a shorter hospital stay. “The newer ones usually will kick in with 24 hours, so you can give one or two doses and usually send the patient home the same day.”
Wheat said one problem is “The newer drugs cost quite a bit and many patients can’t even afford the co-pays.”
Another drawback: “If patients develop a life-threatening bleeding issue, we can reverse that quickly with warfarin or Coumadin, but the newer ones don’t have an antidote,” said Akrami
Mechanical devices are helping cardiologists discover trouble spots.
“The infrared catheter we’re using identifies vulnerable plaque,” said Dr. Andre Artis, Methodist Hospital Director of cardiology for the Northlake campus, and co-director of Methodist Hospital Cardiology Service Live. “It allows us to look at the inside of the blood vessel wall, and that’s good for the patient who is likely to develop heart disease. It identifies the most vulnerable area” of fatty deposits, which eventually irritate and erode the inside of the vessel and fat is released into the bloodstream. The body tries to defend against it by sending a blood clot that can cause a heart attack.
“We are also able to perform better procedures to remove blood clots in patients,” said Dr. Sammi Dali, heart specialist and director of cardiovascular medicine at Franciscan Alliance St. Anthony Hospital in Michigan City, Ind. “A catheter is put in and medicine is infused and spread to the clot to dissolve it more.
“Other procedures include placing a stent for a clogged carotid artery. St. Anthony’s also does ablation for atrial fibrillation, which destroys where the arrhythmia may be coming from.”
What’s in, what’s out
For some patients it’s best to start all over with an LVAD -- an artificial heart. “That’s one of the most exciting things,” said Wheat. Originally connected to a large external apparatus, “Artificial hearts are becoming quite small and battery operated.”
Sometimes what’s new is what’s not being used. “I have not been using a lot of niacin in the past year or so,” said Wheat. “Just a few years ago it was thought to be wonderful for reducing plaque, but we’re finding patients aren’t at less risk with it.”
“It’s the side effects, like flushing,” that patients don’t like, said Artis. “Statin (drugs) are better, good at raising the good cholesterol and lowering the bad cholesterol like triglycerides.”
Said Dali, “When you reach a point where the medicines are working well, adding new medicine (like niacin) isn’t helping and you might have more side effects.”
Understanding genetic heart disease can guide treatment. We perform genetic testing after coronary angioplasty,” said Community Hospital’s Dr. Samer Abbas. The interventional cardiologist explained the testing is “to make sure that patients will response in an appropriate way to anti-platelet therapy,” a regimen of powerful anticlotting drugs.
“Determining medications depends on genetic variations,” said Dali. “The genetics of heart disease is still a work in progress. It will help us understand treatment depending on those variations.”
Other points to ponder:
• “We’re learning that even a low-level inflammation can trigger the buildup of plaque leading to heart attacks,” said Wheat.
• “We know heart disease is an inflammatory process, so the presence of intestinal microbes (found in red meat) can contribute to developing heart disease.” -- Dali
• “They’re coming out with newer and better stents; they last longer and have medicine in them.” -- Akrami
• “The future holds hope for better blood pressure control. Current trials will likely lead to making a new device available in close to two years that will cause damage to the nerve that sends the message to constrict vessels, which raises blood pressure.” -- Artis
“It’s exciting, because it’s better for patients to have more options,” said Akrami.
A few years ago, a very well-respected Northwest Indiana CEO-physician predicted with certainty that in the future, for routine medical check-ups, monitoring medication, screening tests and other wellness care, most people would not be visiting doctors. The great majority of patients would be seeing healthcare professionals specializing in a particular service or treatment. In theory, not too far into the future, a typical healthy person could go for years without ever seeing a doctor.
This was not very surprising to most people in the room including me. I had already had plenty of experience with highly trained nurse practitioners, mammography technologists, physicians’ assistants, midwives, physical therapists, audiologists and personal trainers.
The first time I had a routine annual exam by a physician’s assistant happened by accident---my regular obstetrician was at the hospital delivering a baby. This had probably happened a half dozen times over the years I had been a patient of that group. And, though I had usually re-scheduled the appointment hoping for better luck, this time I was offered the opportunity to have an assistant do the exam. I was delighted.
The next time was an emergency on my side of the scheduling matrix. I had the option to see an assistant physician immediately even though my regular doctor was unavailable. I began a course of treatment for the problem that was holding up a surgery and within a few days and the surgery was scheduled.
The world of routine health and wellness maintenance started evolving a long time ago by adapting new models to fit patient’s needs. While we were out leading healthy lives and having busy careers, training of health care professionals had split into thousands of sub-specialties. Hospitals were replaced by health systems and in-patient treatment, with a few rare exceptions, became out-patient treatment. Nurses are now routinely complete continuing education units or get specialized training, but their career options have never been better.
A couple of months ago, another Northwest Indiana CEO said that health care consumers would soon be scrolling through prices for medical procedures and treatments similar to the way we search in real time for airfares and hotel rooms. Though that seems hard to imagine, anyone who has ever looked at an explanation of benefits would welcome a quick search tool to use before the doctor visit or procedure, wouldn't they?
This issue of Get Healthy, as usual, contains a handful of miracles large and small, but don’t forget the rapid transition into the new world of wellness where even the patients can have something to say about decisions about the care we get.
Associate Publisher and Editor
Pain and scarring is often a reality of surgery that is difficult to avoid.
However, physicians say certain actions before and after surgery can help minimize the discomfort and scarring a patient experiences.
Here are some tips from local doctors about what you can do to minimize scarring and best prepare for the discomforts of surgery.
Dr. Jay Dutton, a plastic surgeon and otolaryngologist on staff at Adovcate South Suburban Hospital, says it's important to make sure a patient is getting the proper nutrients prior to surgery.
"You should make sure your vitamins aren't deficient because they are important for the wound healing process," he says.
Dr. Mubarak Mirjat, founder and president of Maximum Rehabilitation Services in Munster, says patients should also spend time in advance preparing for the weeks immediately following surgery. These preparations can help minimize pain that could be experienced during the process of adapting afterward, and can be made with the help of physicians and physical therapists.
"If they need crutches to walk or have any needs where they must have proper training beforehand, a few visits with us beforehand will help them," he says.
Even practicing exercises that will be performed in physical therapy or at home following surgery can minimize discomfort, as well as figuring out a plan on how to best move up and down stairs in multi-level homes.
"Communication is so important," Mubarek says. "Surgery is hard, but post surgery is the mother of harder."
Dr. Adam Conn, a member of Porter Physician Group and part of Associates in Surgery, says talking with a doctor about minimally invasive procedures, which are available for a number of surgical diseases, can produce a game plan that results in less discomfort post surgery.
"We always try to choose the least painful, and the best procedure for the patient," he says.
Laparoscopic and robotic are all options for major abdominal operations, and doctors can perform minimally invasive procedures on hernias, gallbladders and colons, for example, as well.
"The smaller incisions lead to less pain, quicker recoveries and lower risk of post operative infection in most cases," Conn says.
Other options to minimize pain after surgery include using a long-acting local anesthetic that improves pain control for up to three days and using endoscopy to perform anti-reflux surgery for heartburn, he says.
One of the most important things patients should do post surgery is to protect themselves from sun exposure to minimize scarring.
"It can affect the pigmentation of the wound," Dutton says. "You want to have maximum sun block for at least six months after surgery."
Wounds also heal better in a moist environment, so keep it covered with a dressing and moist with a topical treatment, he says.
While Neosporin can speed the healing process, Dutton says he cautions patients to watch out for topical allergic reactions.
"So if you have redness, make sure you stop," he says.
Avoid alcohol early on after surgery, and choose acetaminophen like Tylenol over ibuprofen like Motrin and Aleve.
"Those promote bleeding and will make you bruise more," Dutton says.
If acetaminophen is not strong enough to help with pain, Dutton advises talking with the patient's physician about a controlled substance prescription.
"Continue taking a multivitamin as well," he says. "Make sure you don't have a vitamin deficiency."
Parents with young children know immunizations is a common topic at the pediatrician's office. However, doctors warn vaccinations aren't only for kids. Here are some vaccinations doctors recommend for adults.
All adults should get the influenza vaccination each year, says Dr. Geraldine Feria, a member of the Porter Physician Group and a physician with Wanatah Primary Care.
This is especially important for new parents if their babies will not have reached the 6 month mark yet during the winter period, she says.
"We cannot give the flu shot to babies younger than 6 months," she says.
Those with high risk of serious complications if they catch the flu, such as the elderly or people with chronic illnesses and weakened immune systems, also are advised to get vaccinated.
While some vaccinations last several years - even decades - the flu vaccine only protects for one year because it is based on what experts believe will be the top three or four virus strains that year.
"The flu shot should be given yearly, as the formulation within the vaccine changes every year based on existing circulating strains," says Dr. Kamo Sidhwa, who is part of Metro Infectious Disease Consultants and on staff at Advocate South Suburban Hospital.
"Pertussis (Tdap) vaccine is certainly one of the very important vaccines for adults," says Dr. Charlene Graves, chairman of the Immunization Committee of the Indiana Chapter of the American Academy of Pediatrics.
More commonly known as whooping cough, pertussis cases or outbreaks were reported in a majority of states in 2012, with 49 states and Washington, D.C. seeing increases in cases compared to 2011, according to the Centers for Disease Control and Prevention.
While pertussis can have a mild effect on adults, it can be deadly to young children.
"Influenze and pertussis in particular can cause mild upper respiratory illnesses in adults, but in babies, can cause severe respiratory distress and occasionally death," Sidhwa says.
The Tdap is a 3-in-1 vaccine that offers protection against diphtheria, tetanus and pertussis. The Centers for Disease Control recommends getting a Tdap vaccine once, and then a Td (tetanus and diphtheria) booster every 10 years.
Feria says it's especially important to get immunized if routine contact will be made with a young child.
"The OB community is doing a good job in advising parents to get it and advising grandma and grandpa to get a booster, so when new baby comes along, they won't give pertussis to the baby," she says.
The shingles vaccination, called the Varicella Zoster vaccine, should be considered for older adults because the virus can be especially debilitating in this patient population, Sidhwa says.
Shingles is a painful localized skin rash caused by the same virus that causes the chickenpox. Anyone who has had the chickenpox can develop shingles because the virus remains in a person's nerve cells even after the infection clears. The virus can reappear several years later - causing shingles.
The vaccination protects a person's body from a reactivation of the virus.
Though the CDC recommends the vaccine be given to those 60 and older, the vaccination has been licensed and approved for those 50 and older.
Like the flu, contracting pneumonia at an older age can be a serious health threat, Graves says.
"The pneumonia vaccine is recommended for seniors and for other people of all ages who have medical conditions that make them high-risk for pneumococcal infections," she says.
The CDC recommends those with certain risks related to their health, job or lifestyles that put them at higher risk for contracting pneumonia receive the vaccination in one to three doses throughout adulthood. However, doctors also recommend every adult over 60 to 65 receive the immunization.
"Sixty and over we want them to get the pneumonia shot, especially if they're diabetic, asthmatic or have bad COPD," Feria says. "Those are really the ones you want to target, along with those whose immune systems are compromised."
"A potential new vaccine that adults should be aware of is the HPV, which is indicated for young adults age 19 to 26," Sidhwa says.
Human Papillomavirus - or HPV - is a common virus spread through sexual contract. Most who have HPV have no symptoms, and there are about 40 types of the virus - including some that can cause cervical cancer in women and other types of cancer in both men and women.
The HPV vaccine prevents the most common types of HPV that cause cervical cancer and genital warts, and it's given in three doses.
Though babies are given Hepatitis B vaccinations as part of their routine schedule of immunizations, doctors say adults who haven't been vaccinated, should.
A virus causes Hepatitis B, a disease that attacks the liver. It can cause infection, cirrhosis of the liver, cancer, liver failure and even death.
"This is one of few vaccines that can prevent liver cancer," Feria says.
Forty-year-old John Babista, of Woodridge, is a nurse. However after crossing the finish line at a Hammond triathlon, he suffered a heart attack and became the patient.
“What had happened to me is shocking but I am very thankful to everybody and especially to our good Lord that I am still here to tell our story,” says John.
John, who for the past four years has trained year round for races, was competing in Wolf Lake’s Leon’s Triathlon back in June.
John’s wife Alma, who is also a nurse, was with their two sons, ages 15 and 8, at the finish line cheering John on.
“As I saw him coming to the finish line, I was relieved. I was standing by the arch and he gave his sons his signature airplane run before he crossed the finish line - I even took pictures of him. Then we walked and as I tried to find him, my brother-in-law, yelled, 'Kuya (big brother) is on the ground,'" says Alma, who still gets emotional
when speaking about the experience. “I called out his name, but he was losing consciousness and gasping for air. I cried for help and yelled, ‘check his pulse’. People all around were helping: doing CPR, hugging me and hugging my kids. It was the longest minute of my life.”
Karen Callahan, R.N. at Franciscan St. Margaret Health-Hammond Emergency Department, says the team in the Emergency Department were prepared to deal with John’s grave condition when he arrived due to a phone call the department’s Emergency Medical Services had made to them.
“The staff in the ED that day work every other weekend together for years and we just ‘click’ when it comes to critical situations. We know what each other does best and we flow in a methodical, systematic way. John was our focus from the minute we received the EMS call,” says Callahan.
Once John arrived he received a therapeutic hypothermia treatment from the hospital staff that is new to Northwest Indiana. The treatment is performed by covering a patient’s back, chest and legs in cooling pads. Cooling the body helps to preserve the brain and heart. The process decreases the body’s metabolic rate, which protects the brain from neurotoxins that usually attack 24 to 48 hours after cardiac arrest.
“Therapeutic hypothermia is fairly new to the staff at Franciscan St. Margaret Health. We were in-serviced approximately 6 months prior and John was the first patient I personally had to start it on,” says Callahan.
John was hospitalized at Franciscan St. Margaret Health-Hammond hospital for nearly 3 weeks.
After undergoing a slew of tests back home it was discovered that John’s right artery was 100% blocked, the left artery was almost 100% blocked and the posterior artery was more than 25% blocked.
“It sounds strange because I have an active lifestyle and live healthy and still got those blockages in my heart. We are convinced that it is genetics since a few of my family members have had heart bypass surgery in the past.”
Fortunately, John was able to resolve his heart problems without open-heart surgery. After five and half months of rehabilitation, John successfully completed his Cardiac Rehabilitation Exercise Program on Nov. 21 and returned to work Nov 25.
Alma says there were countless people who provided support and made John’s recovery possible including visits from Leon’s Triathlon founder, Leon Wolek.
“Our family is very thankful to all first responders, paramedics, co-cyclists, co-workers, staff at St. Margaret Hospital, Catholic Charities, Chicago Asian Running Endurance, family and friends. They all became our immediate family, who provided us with everything to make our life easier while John was in the hospital,” says Alma. “Of course the whole hospital staff - we are so glad we ended up at St. Margaret. They are all God’s instruments.”
Callahan says as an ER nurse she rarely sees the outcomes of critical patients, due to most times they are not good outcomes.
“I have been an ER Nurse here for 27 years and John, his story, his family and the true spirit of how the whole hospital pulled together is something I will never forget,” says Callahan. “John is a miracle and I am so blessed to have been a part of that miracle.”
Dr. Cherukuri, a leader in Northwest Indiana for minimally-invasive cosmetic procedures for the face and neck, has helped thousands of patients since 2003. Dr. Cherukuri, a member of Carepointe Ear Nose and Throat Sinus Center, has offices in Munster, Merrillville and St. John. For more information, visit his website at theweekendlift.com or call (219) 836-2201.
How are you different from other plastic surgeons?
Facial plastic surgery is a sub-specialty of plastic surgery and ear, nose and thoat (ENT) surgery. If you go to the Yellow Pages to find a plastic surgeon, most of the plastic surgeons in Chicago and the Midwest spend three-quarters of their time doing breast augmentations and tummy tucks and other non-facial procedures. We spend 100 percent of our time on the face and neck. We have the most experience in reconstructive and aesthetic procedures, including face lifts, eyelid lifts, nose jobs, Botox and other facial fillers.
Why is it important to go to a plastic surgeon who specializes in the face?
When you have the most experience, you have the most natural-appearing results. What’s unique about the face is you can’t really hide it under clothing. Everything is out there for everyone to see, so it’s important to do it right.
What are some trends in facial plastic surgery? What’s the difference between visiting you versus a medical spa?
The trend over the last 10 years has moved from extreme makeovers to minimally-invasive “no down time” procedures. People are becoming more accepting of improving body image. We perform eyelid lifts, which helps your eyes look less puffy and tired-looking. We also do Botox and facial fillers. It’s very important that the person doing your procedure be a surgeon. When it comes to these procedures, cheaper is not better. You want someone who has done this for 15 years, not learned how to do it during a weekend-long course. We offer free consultations so people can learn what will and won’t work for them, and so they know what to expect. We want well-educated, happy patients.
What is “The Weekend Lift?“
In 2003 we pioneered a minimal-incision procedure called “The Weekend Lift.” A normal facelift takes four to six hours, requires general anesthesia, has extensive recuperation time and can cost up to $20,000. The Weekend Lift is designed for active people who don’t want much down-time. The Weekend Lift can get similar results, but relies on local anesthesia. It takes about an hour, recovery is many times the length of a weekend, and gets excellent results. It generally costs under $5,000. We aim for natural-looking results, making people look like they did five to 10 years ago. We have done more than 600 of these, and have more than 99 percent patient satisfaction.
What kinds of skin cancer treatments do you do?
We also work with dermatologists to treat facial lesions and skin cancer. Many dermatologists don’t want to cut on the face and neck because they want their patients to have the least visible scar. We have extensive training in skin cancers and other lesions, and most patients have almost scar-free healing. If they have a suspicious lesion or mark on their face or neck, they can come see us directly. When it comes to lesions that are itching, bleeding or not healing right, we urge them to come see us immediately. Depending on the type of lesion, patients here are treated with local anesthesia in the office and in most cases can drive themselves home afterward. This saves time and money compared with going to a hospital setting.
What are the things we can do to help prevent signs of aging and skin cancers?
Avoid tanning beds, don’t smoke and stay out of the sun whenever possible. Always use sun block, even if it’s cloudy or if there’s snow on the ground. We recommend using SPF 30 or higher, but any SPF is better than none. It helps prevent aging from UV rays and it helps prevent skin cancer.
All patients want a pain-free answer to their problems and new technologies and knowledge are helping doctors provide that. Whether it is an implantable pain blocker, a new technique for spinal surgery or advancements in anesthesia, local doctors are helping their patients alleviate pain.
Blocking pain signals
Minimally invasive technology like spinal cord stimulation helps Ramesh Kanuru, MD, lessen back pain for his patients.
Kanuru is an interventional pain management specialist at Kanuru Interventional Spine with locations in Highland, Valparaiso and Merrillville. He says the stimulator treats back pain by blocking the pain signals traveling to the brain. It’s an implantable system, which is entirely inside the body.
One of the advantages of this system is that patients do a trial run with an external version of the device to see if spinal cord stimulation works for them. The trial can be easily done in the office, Kanuru says. During the one-week trial, the system is connected to an outside battery.
“If they get a minimum of 50 percent relief and are able to sleep better and are able to do daily activities better, then we’ll do the permanent implant,” Kanuru says. The permanent procedure involves implanting electrodes in the spine connected to a generator, which is the size of a pacemaker in the body. The battery for the generator is rechargeable with a remote control.
Most patients get at least 75 percent pain relief and are able to be off of narcotics or significantly cut down their pain medications, Kanuru says.
The stimulator is indicated for people who had failed back surgery and continue to have pain, patients with sciatica who are not candidates for surgery for other medical reasons and patients with diabetic neuropathy, diabetes with tingling and numbness in the feet that is not controlled by medication. It is also used to treat complex regional pain syndrome, post herpetic neuralgia and intractable abdominal pain.
“It’s a simple system patients can manage themselves,” Kanuru says. Patients can turn it on or off any time they like. “This helps to reduce their pain medications significantly. Because they’re not under the influence of narcotics, the alertness of their brain is not compromised. This is especially important in the elderly who under narcotics may sustain injuries secondary to falls. If they can control the pain without pain medication, they can be really sharp.”
If major spinal surgery is needed in the future, the system does not get in the way, Kanuru says. Some patients, like plumbers and construction workers, elect the stimulator over surgery because their occupations require a lot of twisting and bending .
“If they have spinal fusion, they may not be able to do their jobs, he says. With the spinal cord stimulator, they can keep working and have the surgery done at a later time. For more information, visit controlyourpain.com and painkanuru.com or call 219.838.1100.
State of the art spinal surgery
An advanced surgical technique has revolutionized a Northwest Indiana doctor’s ability to take care of his patients.
Nitin Khanna is an orthopedic spine surgeon and founder of Spine Care Specialists in Munster, a division of Orthopedic Specialists of Northwest Indiana. He co-developed a minimally invasive approach to back surgery, known as MAS PLIF.
“The area where patients can be helped the most with surgical intervention is in the face of neurologic compression. By that I mean something pinching or pressing on a nerve,” Khanna says. The new technique allows doctors to free those nerves with minimal disruption to the surrounding tissue, allowing patients a more consistent and quick recovery.
The fusion operations are performed through incisions that are typically 1.5 inches in length and patients typically go home within 23 hours of their procedure, Khanna says. There’s minimal blood loss and most patients are off all pain medication within two weeks.
Historically, it would take months and years for patients to recover due to significant damage to surrounding tissues that were otherwise healthy and normal. Scar tissue, consistent pain and blood loss would lead to prolonged hospital stays for many patients.
“The concept of being able to move those patients to typically overnight stays is a major, major step forward for both patients and for medicine in general,” says Khanna, who teaches this technique around the country.
“Everybody is wanting to learn how to do this because it’s so revolutionary … I’m as blown away by it as my patients are and my colleagues are.” Ninety-seven percent of his patients have a positive outcome, Khanna says.
He encourages everyone in the Region to get a second opinion before having surgery to make sure it is the right choice for them. By seeing a specialist, they can insure that their particular issue is being properly addressed. They should also see if there’s a good minimally invasive surgical option available.
“I’ve done spinal surgery 11 years, all day, every day with 400-plus cases a year. That anatomy, you know better than you know anything else.”
For information, visit spinecarespecialists.com or call 219.924.3300. For information on the MAS PLIF technique, visit nuvasive.com.
Post-op pain advancements
How pain is treated before and after surgery is an important part of a patient’s recovery and a hot topics among doctors.
Joseph Hecht, an orthopedic surgeon specializing in joint replacement with Orthopaedic Specialists of Northwest Indiana in Munster, says, “there are different protocols to make post-op pain more tolerable. Almost every surgery we do, there’s a certain amount of forethought in terms of trying to make the patient comfortable.”
Hecht’s most common operations are hip and knee replacements.
“There is a lot of discussion in meetings nowadays about controlling the pain around the surgery and different protocols.”
Those protocols may include giving pre-medications or anti-inflammatory meds during the surgery. There are also options of using general anesthesia or a spinal.
“We inject an anesthetic mixture of medicines in the knees during the surgery,” Hecht says. “It has become more popular in last five years or so and helps to control some of the post op pain.”
The actual medicines used during a joint replacement are fairly wide ranging, he says. In the last year or two, an intravenous Tylenol has been used that is effective up to 24 hours after a surgery.
Hecht, who does 150 to 200 knee replacements in a year, says not everything works on every patient and that balance is key. Sometimes a second medication is needed to counter side effects from medications.
“When they have a really good pain experience it’s gratifying but it’s a wide range. If their pain is higher, we have other things in protocol to control pain. There are layers. If one thing isn’t working as well, we go to something else. You have to have a lot of tools in the toolbox to make it work for everybody.”
A new twist on the traditional ice pack also helps treat pain. Polar Care is a sleeve that can be wrapped like a brace around the knee. It’s connected to a cable, which connects to a small cooler. An electric motor in the cooler circulates the cold water produced by ice. The technology is portable so patients can take it home.
“The cooling effect also has pain killing effect and keeps swelling down,” Hecht says. “Swelling is a problem in itself, creating stiffness and more discomfort.”
For information, visit osni.org or call 219.924.3300.