Joint Replacement Symposium at Greenwich Hospital

hip replacementOn Wednesday, April 22nd, at 6:00 p.m., orthopedic surgeon/ joint replacement specialists from ONS and Greenwich Hospital will present a joint replacement symposium in the Noble Conference Center at Greenwich Hospital located at 5 Perryridge Road. Knee and hip specialists Frank Ennis, MD and Brian Kavanagh, MD; and shoulder specialist Seth Miller, MD will present information about the latest advances in joint replacement, including computer-assisted and minimal incision, muscle sparing techniques. Information about preparing for joint replacement, pain management and what to expect from the recovery process will be addressed by hospital anesthesiology, nursing and physical therapy department staff.

Many people suffer from severe pain caused by arthritis, a fracture or other conditions that make common activities such as walking, putting on shoes and socks or getting in and out of a car, extremely difficult. Today, over 900,000 hip and knee replacement surgeries are performed each year in the United States. An additional 53,000 shoulder replacements are performed. Deciding if- and when- it’s time to consider joint replacement surgery are important decisions.  This educational symposium is designed to provide anyone who is considering joint replacement with pertinent information to assist them in making the right decision for them.

Frank Ennis, MD specializes in hip and knee replacement and is fellowship trained in adult reconstructive surgery. Dr. Ennis is among the first orthopedic surgeons in the New York area to perform computer-assisted joint replacement. He completed undergraduate studies at Yale University and post-baccalaureate pre-medical studies at Harvard University. He graduated from Duke University School of Medicine and completed a residency at Yale University Department of Orthopaedic Surgery. He received his fellowship training at New England Baptist Hospital in Boston.

Dr. Kavanagh

Dr. Kavanagh

Brian Kavanagh, MD has performed over 6500 joint replacement surgeries in the past 25 years. He graduated Princeton University and earned a medical degree at University of Connecticut School of Medicine. He did his internship and residency at the Mayo Clinic, Mayo Graduate School of Medicine in Rochester, Minnesota, and served on the faculty at the Mayo Graduate School of Medicine for seven years. Dr. Kavanagh was on the teaching staff at Yale University School of Medicine in New Haven for five years. Dr. Kavanagh was also an instructor in the hip and knee total joint fellowship program.

Seth Miller, MD is a graduate of Mount Sinai School of Medicine in New York. After his residency at New York Columbia-Presbyterian Medical Center, he completed a research fellowship at the Hospital for Special Surgery in New York and a shoulder surgery fellowship at Columbia-Presbyterian Medical Center. He served as an orthopaedic consultant to the New York Mets for more than eight years.  He is the current President of ONS.

All three surgeons are on staff at Greenwich Hospital, a recipient of The Joint Commission’s “Gold Seal of Approval™” for total hip and knee replacement surgery and spinal fusion. The certification for hip and knee replacement procedures recognizes the hospital’s commitment to maintain clinical excellence and patient satisfaction, while continuously working to improve patient care.  Greenwich Hospital’s total joint replacement program offers a level of continuity that sets it apart from other facilities. A clinical resource nurse helps patients every step of the way – before, during and after surgery and throughout rehabilitation and recovery. Patients receive the practical information, emotional support and follow-up care they need to guide them through the entire process.

You will have the opportunity to ask questions at the conclusion of the talk.  The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.

Posted in Greenwich Community, Greenwich Hospital, Health Seminar, Joint Replacement, Management, Medical, Medical Expertise, News and Announcements, ONS Surgical Team, Orthopaedic Conditions, Orthopaedic Research, Seminars, Treatment, Uncategorized | Leave a comment

Staying in the Game: Q&A

Waveny Low Back Pain Seminar

The Staying in the Game: Non-Operative Treatment of Low Back Pain was a success. Dr. Heftler and Alicia Hirscht did an astounding job educating attendees about the common causes of low back pain and non-surgical treatment options including, physical therapy, medicines, and injections. They reinforced the fact that when there are back problems, other mechanics of the body compensate for it in order to protect the area; therefore, you have to know where the pain is resonating from in order to diagnose it correctly. And even though they covered good amount of content, there were still some questions to be answered. The following are excerpts from the Q&A:

Q: My doctor told me that being active in the early morning is bad for me, is this true?
Well, in the morning the body is stiffer, dehydrated, and more prone to injury from being immobile all night. Joints and disks produce fluid by moving so if you are active in the early morning, listen to your body and do not overdo it.

Q: I wake up at night with muscle cramps, what could I do to help reduce it?
A: Easiest solution is to take a shot of tonic water before bedtime.

Q: Is there a way to tell the difference between whether it is a back problem or a blood vessel problem causing leg pain?
A: If you are in a weight bearing position and you have to sit down, it is your back; if you have to stand against a wall, it is most likely the vessels.

Q: … what about pain cause by blood clots?
A: Blood clot pain bothers a patient all the time.

Q: What is your opinion on glucosamine chondroitin?
A: There was a study that said that it does not work in restoring cartilage but a significant amount of patients still reported a reduction in pain, possibly alluding to a placebo effect. Nonetheless there is no medical downside, just stop taking it if it does not help.

To ask some of your own questions, come to the Joint Replacement Symposium on April 22nd at Greenwich Hospital; Dr. Ennis, Dr. Miller, and Dr. Kavanagh will be speaking and Dr. Delos will also be giving a seminar on May 7th about Solutions for Knee PainThe programs are free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.

 

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Congratulations Matt Camel!

Congratulations to Dr. Camel and his talented son Mathew on Matt’s impressive performance in the Boys 14-15 division at the PGA Junior Tour Drive, Chip, and Putt Championship at Augusta National in Georgia over the weekend.

Boys 14-15 winner Matt Camel, 14, hit his first drive outside the boundaries, then pumped a 281.5 yarder to take the lead after the driving.

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Who is Tommy John and why did he have surgery?

Putting On White GlovesWhat are Tommy John surgeries? Dr. Sethi and Yu Darvish of the Texas Rangers know. It is when an individual undergoes the reconstruction of a torn ulnar collateral ligament. Dr. Paul Sethi of ONS is a disciple of Dr. Frank Jobe, the man who did an ulnar collateral graft in Tommy John’s elbow in ’74 and so created the most famous baseball-medical connection since Lou Gehrig’s disease (also known as, ALS).

Another person to know in this field is Dr.Glenn Fleisig, a man who is well versed in this topic and has made a career out of arm injuries. He was recently interviewed in an article about the Tommy John surgery after a presentation at MIT Sloan Sports Analytics Conference about his collaborative study with Stan Conte of the Los Angeles Dodgers.

The research in the study noted that the Tommy John surgery is becoming more common, as more pitchers had the surgery in 2014 than in the 90’s combined. Although the success rate of the surgery is high, 20 percent of pitchers never regain a full level of performance even after PT. Other topics covered in the interview include:

  • What causes tears and the surgeries that follow
  • Whether it is the arm speed or the pitcher has his forearm cocked that far back
  • How long should we expect a pitcher to be out after TJ nowadays
  • Overuse of the ligament
  • Risk Factors and more

Read the Grantland article in order to enjoy the full interview about the Tommy John surgery.

Posted in Greenwich Community, Medical Expertise, Orthopaedic Conditions, Sports Injury, Sports Medicine, Surgery, Throwing Injuries, Uncategorized | Leave a comment

Greenwich Hospital Announces New Chief of Staff, ONS Neurosurgeon Paul Apostolides, MD

Paul Apostolides, MD Neurosurgeon

Paul Apostolides, MD
Neurosurgeon

Dr. Paul Apostolides, Section Head of the division of Neurosurgery at Greenwich Hospital, has been appointed hospital Chief of Staff as of January 1. Dr. Apostolides joined Greenwich Hospital’s medical staff in 1998 and has served on many committees including the credentialing committee, executive committee and peer review committee. For three years prior to his current appointment, he was Assistant Chief of Staff. He has served on the Greenwich Hospital Board since 2012.

A graduate of Stanford University and University of Massachusetts Medical School, Dr. Apostolides completed his residency and fellowship training at the Barrow Neurological Institute. He is board certified by the American Board of Neurological Surgery, and is in practice with Orthopaedic & Neurosurgery Specialists (ONS) in Greenwich. He specializes in minimally invasive as well as complex reconstructive spinal surgeries.

ONS is an advanced multi-specialty orthopedic and neurosurgery practice serving patients throughout Fairfield and Westchester Counties and the New York Metropolitan area. ONS physicians provide expertise in the full spectrum of musculoskeletal conditions and injuries, sports medicine, minimally invasive orthopedic, spine and brain surgery, joint replacement and trauma. For more information, visit www.onsmd.com, or call (203) 869-1145.

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Mark your calendar for the Joint Replacement Symposium!

Joint_Replacement_SymposiumOn Wednesday, April 22 at 6 p.m., orthopedic surgeons from ONS and Greenwich Hospital’s anesthesiology, nursing and physical therapy staff will present an informative and comprehensive seminar about joint replacement surgery; including Frank Ennis, MD; Seth Miller, MD and Brian Kavanagh, MD.

Topics will range from the latest advances in joint replacement, computer-assisted surgery, minimally invasive & muscle sparing techniques, preparing for joint replacement surgery, pain management, and even what to expect from the recovery process.

You will have the opportunity to ask questions at the conclusion of the talk.  The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.

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MRI versus the Stress Test: Which one do you need?

Sean C. Peden, MD

Sean C. Peden, MD

Sean Peden, MD is an orthopedic surgeon who specializes in foot and ankle surgery. Dr. Peden has expertise in treating a variety of foot pain and deformity related conditions including Achilles tendonitis, ankle instability, cartilage injuries, bunions and hammer toes and keeps up to date with the latest breakthroughs in the field. Most recently, the unnecessary reliance on the MRI compared to conducting a simple stress test has caught his attention. The following is what he wants you to know:

Nowadays orthopaedic surgeons will frequently order Magnetic Resonance Imaging (MRI) studies for patients suffering from acute or chronic musculoskeletal injuries. Radiographs, also known as plain films, show a two dimensional projection or shadow of bone. It is useful for diagnosing obvious displaced fractures, but subtle findings are often missed.

MRI is an advanced technology that provides information in three dimensions about bone, tendon, muscle, ligament, fat, swelling, fluid, etc etc (unlike plain films, which just show bone). Basically it shows us just about everything we need to know, short of nerves and other subtle dynamic findings. It uses no radiation and is incredibly safe.

But in the setting of an ankle fracture – where either the fibula or tibia is broken near the ankle and our job as surgeons is to determine which ankles will be fine with a cast and which need a surgical correction – MRI IS OF NO ADDED BENEFIT. What I want to determine is this setting is whether the fracture is “stable.”

An unstable fracture will shift with time, even with a good cast, and certainly once a patient begins walking. Shifting is a very bad thing, especially in the ankle. It leads to abnormal pressures on the joint, cartilage wearing, degenerative changes, and stiffness, also known as post traumatic arthritis. In an active and healthy patient that is unacceptable. A significantly better outcome is achieved with a one hour surgery to fix the fracture and restore anatomic alignment and stability.

The main problem with MRI is that it is a static test. The images are taken with the patient lying flat on a table. There is no weight or force across the ankle joint. While MRI can image the ligaments, in the setting of an ankle fracture these ligaments are always injured, but whether they are injured to the point of instability is indeterminable.

A simple test that costs very little and takes about 5 minutes is a stress radiograph. Using either gravity or the hands of a surgeon, and mild stress is placed across the ankle joint. If the joint widens or shifts I know that it will do the same in the future. The most up to date orthopaedic literature supports stress x-rays, not MRI, as the best way to decide between surgical and non-surgical treatment.

The other problem with MRI is cost and time. It is a 30-45 minute test and carries with it a significant cost. The burden of the cost is shared by the patient, the insurance company, and society as a whole. With the skyrocketing costs of healthcare in our country we should reject the notion of ordering tests when they should have no effect on our decision.

A 2014 article supports this from the Journal of Bone and Joint Surgery, the official scientific journal of the American Academy of Orthopaedic Surgeons.

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Accomplished Orthopedic Surgeon joins ONS Sports Medicine Team

Marc Kowalsky MDOrthopedic surgeon and fellowship trained sports medicine specialist Marc Kowalsky, MD has joined the ONS team. Dr. Kowalsky has expertise in conservative and operative treatments of upper and lower extremity sports injury, as well as complex shoulder and elbow pathology including degenerative disease, and trauma.  He has a particular interest in the management of shoulder and elbow arthritis, instability, rotator cuff tears, labral injury, and cartilage disorders.

Dr. Kowalsky looks for rehab-focused, non-operative solutions whenever possible, recommending surgery when it will be most effective. His goal is to return patients quickly, safely and fully to their best function and performance.

Dr. Kowalsky earned his medical degree at Tufts University School of Medicine, Boston, MA where he also earned an MBA in Health Management. He did his residency in orthopedic surgery at Columbia University Medical Center, New York Orthopaedic Hospital in New York, NY. He also completed fellowship training in shoulder and elbow surgery at Washington University School of Medicine, Saint Louis, MO and in sports medicine at Lenox Hill Hospital, Nicholas Institute of Sports Medicine & Athletic Trauma, New York, NY.

He has authored original research manuscripts, review articles, and textbook chapters focusing on AC joint reconstruction, rotator cuff repair, and shoulder replacement. He currently serves as a reviewer for the Journal of the American Academy of Orthopaedic Surgery and the Journal of Shoulder and Elbow Surgery.

“Dr. Kowalsky will be a great asset to our practice as we meet the growing demand for musculoskeletal care in Fairfield and Westchester counties,” said Dr. Seth Miller. “His high level of training and accomplishments reflect the ONS standard of offering the highest level of care possible to our patients.” He is in network with Aetna and Oxford/United Healthcare.

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Shoulder Pain? (Part II)

Shoulder_Pain_blogRemember last week’s post? Dr. Kowalsky ended the last installment with listing a multiple options one could take to repair a rotator cuff tear due to the fact that it is very unlikely for the condition to heal on its own. The following is a more in depth description of what makes up this part of the body and what to do after the symptoms of arthritis of the shoulder appear.

The glenohumeral joint of the shoulder includes the humeral head, or ball, and the glenoid, or shallow socket.  Both joint surfaces are coated with articular cartilage, the pearly-white, smooth surface that allows near friction-free, painless movement of one surface on another.  Typical wear-and-tear osteoarthritis occurs due to the degeneration of the joint surface.  As the articular cartilage erodes, the underlying bone can become exposed, change in shape, and create symptoms.  Patients typically present with pain deep within the joint.  The pain can be associated with mechanical symptoms, such as catching, clicking, or grinding, as well as loss of motion.  For some patients, typically those with mild or moderate arthritis, there is a role for conservative management.

However, the most reliable means for pain relief, improved motion and function for patients with moderate or severe arthritis is shoulder replacement.  This procedure is performed by removing and replacing the arthritic ball with a metal implant, and by resurfacing the socket with a plastic implant, restoring low-friction, pain-free motion. Implant design and surgical technique for the treatment of both rotator cuff tears and shoulder arthritis continue to evolve.   These innovations empower shoulder and elbow surgeons to individualize the treatment plan to a specific patient and problem.

Tonight, March 12 at 6:30 pm at Greenwich Hospital,  Dr. Kowalsky will give a health talk on “Common Causes and Solutions to Chronic Shoulder Pain” will discuss the causes, symptoms, and treatment of rotator cuff tears and shoulder arthritis.  The event will highlight important recent advances in the management of these conditions that have been associated with improved long-term outcomes.

The program is free and open to the public.
Registration Requested. Call (203) 863-4277, or register online at www.greenhosp.org.

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Staying in the Game: Non-operative Treatment of Low Back Pain

On Wednesday, April 8th at 6:00 PM, Jeffrey Heftler, MD of ONS (Orthopaedic and Neurosurgery Specialists, PC) and Greenwich Hospital, and Alicia Hirscht, DPT, SCS, CSCS, of ONS Physical Therapy, will present a free health seminar, Staying in the Game: Non-operative Treatment of Low Back Pain. The seminar will focus on common causes of low back pain and non-surgical treatment options including, physical therapy, medicines, and injections and will be held Waveny Life Care Network, 3 Farm Road, New Canaan, CT.

Doctor Photos_HeftlerDr. Heftler is an interventional physiatrist who specializes in spinal injections and other non-operative treatments for spinal and musculoskeletal disorders. “Many Americans experience low back pain over the course of their lifetime” said Dr. Heftler. “The vast majority of people with low back pain are able to achieve and maintain relief without requiring surgery.”

Physical-Therapy_Alicia-Hirscht-221x300Alicia Hirscht, DPT, SCS, is board certified by the American Physical Therapy Association in Sports Physical Therapy where she is the Senior Clinical Specialist. Alicia lectures regularly in the community on injury prevention, adolescent sports medicine and women’s health.

The program is free and open to the public. Registration is requested. To register call, 203-594-5310 or register online at www.waveny.org. For more information on topics related to orthopedics, sports medicine and neurosurgery, visit the calendar page.

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