Watch the panel presentation, The Well-Balanced Athlete, delivered by ONS physicians at Byram Hills High School in Armonk, NY on February 13, 2018. Sports medicine experts Dr. Marc Kowalsky and Dr. Demetris Delos were joined by sports psychologist Dr. Alex Diaz, to address such issues as injury prevention, the dangers of sports specialization, sleep and nutritional requirements, and the importance of mindfulness training. The school’s television station recorded the 90-minute program. If you would like to see the presentation live, the panel will be addressing the Briarcliff Manor school district coaches, parents and students at the Briarcliff Middle School Auditorium on Tuesday, March 13 beginning at 7:00 pm. There will be time for Q & A at the end of the presentation. You can also view the PowerPoint presentations given by Dr. Delos and Dr. Kowalsky.
GREENWICH ORTHOPEDIC SURGEON DR. PAUL SETHI AND THE ONS PRACTICE WERE FEATURED IN AN ARTICLE IN GREENWICH PATCH FOR USING A NEW PAIN-REDUCING PROCEDURE THAT CAN REDUCE OR ELIMINATE THE NEED FOR NARCOTICS.
In the article, Greenwich Surgeon Strives to Combat Opioid Epidemic with New Procedure, Greenwich Patch staff writer, Rich Scinto, wrote that oftentimes opioid addiction begins after surgery.
A group of orthopedic surgeons based in Greenwich are using a new pain-relieving method that helps reduce a patient’s reliance on opioids.
Dr. Paul Sethi with Orthopaedic and Neurosurgery Specialists recently has seen collegiate athletes in need of surgery who are willing to suffer great amounts of pain if it means staying off of opioids post-surgery.
“Young people are becoming more aware of how dangerous of a problem it is,” Sethi said about opioid addiction.
It is also frightening as a surgeon to think that an opioid prescription that is intended to help a patient recover could lead to death or a lifelong battle with addiction, he said.
Sethi has been performing shoulder replacement surgeries with the use of Exparel, which is an injection of long-lasting liposomal bupivacaine that can last for three days post-surgery. Some patients have used no narcotics or a greatly reduced amount after the surgery, Sethi said.
Instead of prescribing 30 narcotic pills post-surgery generally there is only a need to prescribe 10, he said. That translates to less pills that could fall into an addict’s hands.
The prescription of opioid pain relievers has skyrocketed. In 2013 health-care providers wrote 259 million prescriptions, enough for every American adult to have a bottle of pills, according to the CDC.
About 70 percent of opioids used for non-medical reasons are obtained through family or friends and 18 percent through a prescribing doctor, according to the Substance Abuse and Mental Health Services Administration.
Sethi and others are conducting a peer-reviewed study about Exparel’s effectiveness in reducing pain after surgery.
Sethi and others at the practice plan to expand the use of Exparel to other types of shoulder surgery and there is potential to use it in operations such as ACL repairs. The injection has to be specifically tailored to each surgery in order for it to be effective, he said.
Surgeons should spend a good amount of time educating their patients about pain management and the potential for opioid abuse.
“In medicine we are pressed for time, but I think this is one of the most important things we teach our patients about,” he said.
The injection costs about $300 extra, which is a bargain if it can save a person from an overdose death or a long struggle with addiction, Sethi said.
For now narcotics still are prescribed in case pain comes back after Exparel wears off.
SUMMER SPORTS SAFETY ADVICE FROM ONS SPORTS MEDICINE SPECIALIST, KATHERINE VADASDI, MD.
With Memorial Day upon us, summer is a great time for outdoor sports as long as you take certain precautions to avoid injury and illness. With the increase in temperatures, proper hydration is a must. Intense exercise that causes you to sweat is usually a good reminder to drink water, but you can become dehydrated simply taking a walk or playing ball with your child during hot weather. Swimmers, who don’t notice their perspiration and tend to feel cooler because they are exercising in water, need to remember to replace fluids on a regular basis, too.
Generally, it takes the body about 10 days to adapt to the heat. Even if you’ve stayed conditioned throughout the winter, it’s important to start your outdoor exercise slowly, gradually increasing in time and intensity until your body has fully acclimated. Whenever possible, exercise in the cooler parts of the day such as morning and evening.
Similarly, if you haven’t played a sport since the fall, such as golf and tennis, don’t expect to just pick up your game where you left off. Back sprains, tennis or golfers elbow and wrist problems can pop up if you haven’t taken the time to develop the muscles that are important for your specific sport. Knee injuries such as meniscus tears and anterior cruciate ligament (ACL) ruptures are common when the knee is unstable and if there is an imbalance in the hip and leg muscles. A sudden pivot or twist while running or jumping could derail your active summer by requiring surgery and rehabilitation. Relatively short strengthening programs can have a significant impact on reducing the risk of ACL injuries and anterior knee pain.
It’s also important to protect your skin from the sun. At the very least, use a waterproof sunscreen with a minimum SPF of 30 – 45 that is designed for sports. Be sure to apply the sunscreen at least 30 minutes before you go outside, even if the day is overcast, and reapply every two to three hours.
THE ORTHO ACCESS PROGRAM AT ONS OFFERS AN ADDED LEVEL OF SAFETY TO YOUNG ATHLETES WHO ARE INJURED ON THE FIELD.
If you missed yesterday’s Well column in The New York Times, it focused on the lack of national safety standards to protect student athletes from crippling or fatal injuries. Individual states and the schools within them, for the most part, haven’t yet adopted injury prevention and treatment policies or procedures for children who play organized or league sports either. The responsibility is all too often left to coaches and parents to assess what measures to take when a young athlete is injured and when they can return to play. 500 student athletes died last year due to poor decisions made immediately following injury, according to the article. The ORTHO ACCESS program at ONS is designed to add an extra layer of medical support and injury prevention education for coaches, athletes, and parents. During the first critical moments after a player is hurt, ONS ORTHO ACCESS sports medicine physicians helps to determine the best immediate course of action to take. Read more.
NEW ACL REPAIR STUDY IS PROMISING BUT LIMITED, SAID ONS KNEE SURGEON DEMETRIS DELOS, MD.
Today’s New York Times reports that using a patient’s own blood to help heal an ACL tear has shown promising results in a small study conducted by the Boston Children’s Hospital. While having a torn ligament heal itself could be the holy grail of ligament surgery, ONS knee surgeon, Demetris Delos, MD, cautions that more thorough research is needed. The trial involved only 10 patients and recovery was tracked just a few months after surgery. “These early results are exciting,” Dr. Delos said, “but it is important to see how these patients do in the medium and long term (several years after surgery) especially when it comes to returning to active lifestyles and the trials need to be expanded to much larger groups of people to see how it translates to the population at large.” Until the long term safety and efficacy can be determined, he said, current ACL reconstruction surgery, which replaces the injured ligament with a tendon from other areas of the body such as the hamstring or patellar tendon, will remain the standard as it has proven successful with predictable results and allows the majority of patients to return to their pre-injury activities.
DID YOU KNOW THAT FEMALE ATHLETES ARE AS MUCH AS TEN TIMES MORE LIKELY TO SUFFER AN ACL INJURY THAN THEIR MALE COUNTERPARTS?
Differences in pelvis width, the size of the ACL and the intercondylar notch (where the ACL crosses the knee joint), are all thought to play a role. What’s more, the upper part of a female’s shin bone at the joint is much shorter and more rounded than a male’s, which creates a greater laxity in the joint. Women also tend to have an inward angle to their knees, otherwise known as knocked knees, which places more stress across the outer knee joint and ligaments, particularly when it comes to sudden or extreme movements, such as an abrupt change in direction or pivot. Women also move differently than men. For instance, they tend to land from a jump with their knees in a somewhat straight position, pulling on the quadriceps rather than the hamstrings. Because of this, the force of the impact is transferred to the knee, creating a high risk for an ACL rupture. Men, on the other hand, are better able to absorb the impact because they tend to land with bent knees.
For these reasons, it is crucial for female athletes of all ages to modify their natural biomechanics through neuromuscular training programs that can teach them better ways to move their bodies and protect their knees, said orthopedic surgeon Katie Vadasdi, MD, who heads the Women’s Sports Medicine Center at ONS. “Through neuromuscular training programs, we can help female athletes significantly reduce the risk of ACL ruptures by developing balance between the quadriceps and hamstrings and improving the landing biomechanics with more bent knees and hips to avoid a knock-kneed position on impact.”
Preventing ACL injuries has both near and long term benefits so the sooner you get started with this kind of a conditioning program the better. Studies indicate that there is a tenfold increase in the incidence of osteoarthritis in the knees of women who suffered an ACL injury at some point in their lives. Moreover, injuries that were incurred during youth seem to result in the onset of osteoarthritic symptoms at a much earlier age in adulthood.