ONS: Fairfield’s Top Doctors

ONS is proud to announce that 16 physicians from the practice have been named

2020 Top Doctors in Fairfield County by Castle Connolly Medical Ltd., a respected national medical data research company. Fifteen of the designees have received this accolade for several consecutive years.  However, physiatrist Christopher Sahler, MD, joins the elite roster after becoming eligible for nomination in 2019.  David Nocek, MD, who retired last year, received the designation as well.

WHAT IT TAKES TO BE TOPS

The Castle Connolly Top Doctors are nominated by their peers for talent and expertise in their medical specialties.  A Castle Connolly physician-directed research team then reviews the credentials of each nominee. They give special scrutiny to medical education, training, board certification, hospital appointments, administrative posts, professional achievements, years in practice and reputation, according to the organization’s website.

Moffly Media published the results of the annual survey in the January issues of Greenwich Magazine, Stamford Magazine and New Canaan/Darien Magazine. As in past years, ONS has the most physicians ranked than any other practice.

ONS TOP DOCTORS IN FAIRFIELD

In the field of Orthopedic Surgery, the following physicians and Dr. Nocek were singled out as the best in Fairfield:

Elsewhere, Mark Vitale, MD was recognized as Fairfield’s Top Hand Surgeon.

The entire ONS Spine Center team was identified as the best in neurosurgery: Paul Apostolides, MD; Mark Camel, MD; Amory Fiore, MD, and Scott Simon, MD.

Along with Dr. Sahler, Jeffrey Heftler, MD, at the ONS Interventional Sports and Spine Center, was ranked on top in the category of Physical Medicine and Rehabilitation.

 

Tips for Safe Skiing

Skiing can be one of the most enjoyable winter activities and is a great sport the entire family can enjoy.  But nothing can ruin a great day outdoors (or even the next 6-12 months) like a serious Ski Injury Prevention injury such as the dreaded anterior cruciate ligament (ACL) tear.

Skiers are at greatest risk to strain the ACL to the point of tearing in several ways: when they try to recover from a fall with their body weight in back of the skis; if they don’t land a jump correctly; or if improperly set ski bindings don’t release during a critical moment. ACL tears usually require surgery and a lengthy recuperation to repair.  In short, it’s an injury you want to avoid at all cost.

It almost goes without saying that proper fitting equipment, adequate rest, hydration, sleep and weather-appropriate, moisture-wicking attire are essential elements of injury prevention.

Physical preparation is also key.  Ideally, you started a conditioning program at least two or three months before your ski trip to build strength and stability in your core and lower body.  If you didn’t get around to it, or if this is your first trip of the season, it’s worth considering the following safety tips from ONS Sports Medicine Specialist, Dr. Demetris Delos.

  1. Warm up: Some light stretching slope-side before you step into your skis can be helpful to stimulate the muscles that will play an important role in a day of skiing.  For example, try a few simple leg exercises such as leg circles and leg lifts to the sides, back and front of your body while engaging your core.  Mini squats, trunk twists and 30 seconds of quad and hip flexor stretches will also help with flexibility.
  2. Acclimate: Take a few runs on an easy trail to put your mind and body rhythm in sync before you attempt more difficult terrain.
  3. Cool down: When you break for lunch and at the end of the day, stretching (preferably by maintaining a certain pose for 15-20 seconds at a time, and repeating that for 3-5 repetitions) can loosen up the muscles and prepare them for the necessary recovery process.
  4. Know Your Limits: Ski at your level. Don’t think about tackling a mogul-filled Double Black Diamond if blue runs are the height of your comfort zone. Ignore pressure from more accomplished friends or significant others.
  5. Know When to Quit: Most skiers know that the risk of injury increases in the afternoon or early evening as fatigue sets in. So, if you’re feeling fatigued but want to do one last run, DON’T.
  6. Respect Nature: The risk of injury increases when visibility is decreased by late afternoon shadows, during snowfall, and when ski conditions become very icy or very soft. When these factors are present, consider easier runs or call it a day.

 

Your ONS Visit

A visit to the doctor can be stressful for many people, with forms to fill out, questions to ask, diagnostic tests to undergo and information to absorb. The staff at ONS is committed to providing a seamless, comfortable experience for every patient.  You can make it even easier and the time spent with your physician more productive by taking a few simple steps to prepare ahead of time.

 GET THE MOST FROM YOUR ONS VISIT

  • Complete Forms in Advance of Your Appointment.Medical forms

    Your medical history provides important information to your doctor about your overall health. After making an appointment, you will receive an email or text with a secure link to all the necessary forms online. Filling out the required forms prior to your office visit will reduce the amount of time you will be sitting in our reception area.

    • If you prefer to complete the forms at ONS, plan to arrive 30 minutes before your appointment. You cannot be taken to an exam room until all forms have been completed. You will need to bring the following information with you:
      • The name of your primary care physician and referring physician, if you have come by referral.
      • A list of all your medications, dosages and frequency, including vitamins and herbal supplements.
  • Bring Important Medical Reports to Your Appointment.

    If you have previously had diagnostic testing related to your symptoms, such as X-rays or MRIs, bring copies of the reports to your appointment. This may help your physician diagnose your problem and develop your individual treatment plan.

  • Create a Symptom Log.

    To the best of your ability, create a timeline starting with the onset of symptoms and any activity that may have contributed to your condition. Your physician will want to know of the progression of symptoms and any activities that worsen or improve them.  Be sure to include treatments you have previously tried.

  • Make a List and Take Notes.

    Compile a list of all your questions about your condition and treatment options, so your physician can address your concerns.  Be sure to take notes during the appointment. They will be useful as reference when you get home.

  • Call if You Will Be Late.

    Please give us a call if you know you will be late for your appointment. We may be able to hold your appointment or will reschedule for another time or day.

    NOTE: 24 HOURS CANCELLATION NOTICE IS REQUIRED 

Dr. Berliner Appointed Director

ONS Appoints Joint Replacement Specialist to Head the ONS Outpatient Joint Replacement CenterDr. Berliner

Orthopaedic & Neurosurgery Specialists (ONS) announced today the appointment of orthopedic surgeon and joint replacement specialist, Jonathan Berliner, MD, to the new position of Director of the ONS Outpatient Joint Replacement Center.

Dr. Berliner joined ONS in 2017. He is a fellowship-trained specialist in hip and knee joint replacement and revision surgeries, with an expertise in muscle-sparing anterior hip replacement, minimally invasive total knee and partial knee replacement, complex revision total hip and total knee replacement, computer-assisted surgery, and trauma of the lower extremity.

With a medical degree from the New York University School of Medicine, Dr. Berliner completed his residency in orthopedic surgery at the University of California, San Francisco (UCSF), followed by a fellowship in hip and knee replacement at Hospital for Special Surgery in New York City.

“ONS has been in the forefront of the trend toward outpatient joint procedures,” said ONS Medical Director, James Cunningham, MD. “Dr. Berliner has been an integral part of that effort. Under his leadership, patients can trust ONS to stay ahead of the curve in providing the best research-based options available. “

ONS makes this appointment at a time when the national trend for outpatient joint procedures is growing exponentially.  Currently, more than one million ambulatory joint replacement surgeries are performed annually in the United States.  That number is predicted to jump by 90 percent in the next decade.

At Home Recovery Gains Favor

The movement toward ambulatory joint replacement surgery is fueled by advances in minimally invasive surgical techniques and pain management protocols, and a younger demographic of patients who prefer to recover in the comfort of home.

There are many benefits to outpatient joint replacements versus similar inpatient surgeries as well. Research data indicates that patients have a more comfortable and quicker recovery at home with the support of family and friends.  Patients who recover at home are at reduced risk of infection and newer, long lasting intra-operative anesthetics help to limit the severity of post-operative pain.  The procedure is also less costly, as patients don’t incur charges for tests and services associated with one or two nights in a hospital. ###

About Orthopaedic & Neurosurgery Specialists

ONS has been one of the most advanced practices of its kind in the region for more than 20 years. Headquartered in Greenwich, Connecticut, ONS is a multi-specialty orthopedic and neurosurgery physician group with locations in Greenwich, Stamford, and Harrison. All offices feature fellowship-trained experts in orthopedics, sports medicine, joint replacement and physical medicine and rehabilitation, urgent ortho care services, physical therapy centers, digital imaging and, in Greenwich and Stamford, MRI. For more information visit www.onsmd.com.

About Stamford Ambulatory Surgery Center (ASC)

The Stamford ASC is an advanced outpatient surgical center owned and operated by the ONS partners.

ONS Doctors Speak to Sell Out Crowd

Dr. Paul Sethi and Dr. Marc Kowalsky were presenters at the prestigious American Shoulder and Elbow Surgeons 2019 Resident Course: Essentials of Shoulder and Elbow Surgery. The sold out event took place on November 22 and 23 at the Orthopaedic Learning Center in Rosemont, Illinois.  The course consisted of lectures and surgical exposure to arthroscopic and open procedures.  It is offered annually to 55 residents and fellows planning careers in shoulder and elbow surgery.

As one of three event chairs, Dr.  Sethi opened with a review of the principles of shoulder and elbow anatomy to help the attendees further their skills and mastery of surgical approaches and procedures of the shoulder and elbow.  Dr. Sethi also gave a presentation called, 10 Technical Tips: Arthroscopic Bankart/Posterior Repair.

Dr. Kowalsky’s presented the following day on How to Take an Elbow Apart and Put it Back Together! Posterior Family of Approaches – Sparing, Trap, Osteotomy.

Do You Have Text Neck?

TEXT NECK IS A REAL PAIN, SAYS SPINE SPECIALIST, HEEREN MAKANJI, MD.

It seems like everywhere you look, people of all ages are looking down at their phones.  They do it at home. At work. In school. In restaurants.  While waiting for a train. Even while walking, driving and riding a bike.  Concern about the pervasiveness of handheld devices exists for a variety of reasons, not the least of which is the detrimental affect they have on the cervical spines of children, teens and adults.  Some call it Text Neck.

By some estimates, adults spend an average of 5 hours a day using a mobile phone or tablet, while teens report using their devices almost constantly throughout the day.  As a result, more and more people are developing neck pain caused primarily by holding their heads in an abnormal way.

WHAT HAPPENS TO YOUR NECK?

Consider this. A quick glance down at your phone adds about 20 pounds of unnatural force to the discs in your neck. That weight more than doubles when you are fully engaged with your device.  Putting that stress on your cervical spine for hours a day, every day can accelerate the natural wear and tear on the cervical bones and discs.

Leaning your head forward also compresses and tightens the muscles in the front of your neck and lengthens the tendons, ligaments and muscles in the back of the neck. Over time, this can cause inflammation and weakness. Abnormal flexion also can be responsible for headaches, neck pain, shoulder pain and nerve-related symptoms such as radiating pain, tingling, numbness and/or burning in one or both arms. Your chances for disc herniation and early arthritis are also increased.

Neck pain from textingGrowing children and teens can develop those problems too, but they have the additional risk for skeletal deformity. Studies have shown that overtime, younger people who strain their neck muscles by holding their heads in a forward tilt for prolonged periods can develop an abnormal curvature in the upper back and neck.  In one study, researchers in Australia noted the development of bone protrusions similar to horns in the connecting tendons at the back of the neck in young teens who had used phones and tablets since childhood. There’s a name for that too. Phone Bone.

CAN TEXT NECK BE TREATED?

Physical therapy and in some cases, surgery can help alleviate the symptoms brought on by the overuse of these devices, but there are other steps you can try before it gets to that point.  Youngsters should be encouraged to partake in physical activities that help develop musculoskeletal strength and reduce time spent gaming and texting.  People of all ages can engage in activities that promote good posture, such as yoga or Pilates. When possible, use a desktop or laptop with the screen at the ergonomically correct angle. Or try lifting your phone so you are holding your head properly on top of the spine.  Long term, however, the solution is easier said than done. Look up from your device and notice what’s around you. The text can wait.

Contact Sports and Shoulder Injuries

PAIN AND TRAUMA ARE THE COMMON DENOMINATOR WITH THESE THREE SHOULDER INJURIES.

Anyone can suffer a shoulder injury, but athletes involved in contact sports such as rugby, football and hockey are particularly vulnerable to fractures, separations and dislocations caused by the parts of the shouldercombination of speed and contact force to the shoulder upon impact, according to ONS Sports Medicine Specialist, Dr. Marc Kowalsky.

“The three most common injuries I see in athletes playing contact sports are clavicle fractures, AC joint separations and shoulder dislocations,” Dr. Kowalsky said.

WHAT HAPPENS TO THE SHOULDER?

Clavicle, or collarbone, fractures can occur along the bone anywhere between its attachment to the shoulder and the sternum. Direct trauma, and falling on an outstretched arm, are both common causes of a collarbone fracture.

A shoulder separation is the result of trauma at the acromioclavicular joint (AC joint), where the collarbone and the highest point of the shoulder blade, known as the acromion, meet. With this injury, the ligaments that hold the the joint together become stretched or torn from the force of the impact to the area.

A shoulder dislocation occurs when the head of the arm bone (humerus), or the ball of the shoulder joint, is driven out of the glenoid socket.  The injury is considered a complete, or locked, dislocation when the ball remains out of socket and requires manipulation in order to be put back in place.  A partial dislocation, a condition known as subluxation, occurs when the ball is forced out of its natural position in the socket, but is able to slip back in place on its own.

SYMPTOMS OF COLLARBONE FRACTURES, SHOULDER SEPARATIONS AND DISLOCATIONS

Trauma is the common denominator in these injuries, and they all can produce significant pain. Along with pain, these injuries typically cause an obvious deformity, including squaring of the shoulder with a dislocation, or a prominent bump or prominence with AC separations.  Injured athletes will also notice difficulty raising the arm, as well as tenderness, swelling, and eventual bruising.  In the case of a shoulder dislocation, the pain usually improves significantly when a physician performs a closed reduction, during which he or she puts the shoulder back in place.

DIAGNOSIS AND TREATMENT

Diagnosis is made initially by physical examination of the shoulder and an X-ray.

Early conservative treatment for mild injuries usually includes sling immobilization to protect the shoulder and minimize pain, along with ice, rest and Nsaids.  X-rays are used to assess alignment and the presence of a fracture.  An MRI will be considered, particularly for shoulder dislocations, if a soft tissue injury such as a labrum tear or injury to the rotator cuff tendons, is suspected.

Depending on the severity of the injury and the complexity of the treatment, physical therapy is usually prescribed to help patients gradually regain strength and mobility.  Surgery is typically considered only for significant injury with wide displacement, or for certain athletes at high risk for recurrent injury.

SHOULDER PROTECTION

Of course, some injuries are unavoidable, but having proper fitting upper body gear can go a long way to dissipate the impact.  Balanced strength and conditioning in the muscles that support the shoulder is also key to help prevent an injury, minimize the extent of the injury if one should occur. Additionally, studies have shown that pre-injury strength and conditioning is also your best shot at a fast return to play.

The shoulder has several muscles that attach the shoulder blade (scapula), humerus and clavicle.  While it is important to have balanced strength in all muscles in the shoulder, the muscles and connecting tendons that make up the rotator cuff are the front line for shoulder stabilization.

STRENGTH AND CONDITIONING TIPS

As with any new exercise, it’s important to consult with a professional therapist or trainer, particularly if you have a prior injury or limitation. Strength and conditioning programs are suitable even for our youngest athletes, but the program should be age-appropriate and supervised.  Start slowly, and gradually increase repetitions, sets and level of resistance. And it is particularly important to focus on proper form.  Exercises done improperly can put unintended stress on other parts of the shoulder or even elsewhere in the body.

Trainers and physical therapists can help develop a shoulder strengthening program that’s right for you.  Many exercises to strengthen the rotator cuff can be done using a resistance band, particularly for strengthening your internal and external shoulder rotation, and the muscles in your scapula. Your posture alignment and range of motion will also benefit.

Planks are good to strengthen the core, back and shoulders, as long you maintain proper alignment. You can challenge yourself with a variation on a push up, where you start at a low plank and push up to a high plank one arm at a time.

 

Stamford ASC Wins Apex Award

Stamford Ambulatory Surgery Center (ASC) has received a 2018 National APEX Quality Award for Excellence in Healthcare.

“ONS is honored to receive the 2018 National Apex Quality Award because it reflects our practice-wide commitment to the highest standards of quality care and patient satisfaction,” said Seth Miller, MD, a founding partner at ONS.

This national distinction recognizes outstanding healthcare providers who have demonstrated excellence in patient satisfaction and overall care during the previous calendar year, according to a statement from SPH Analytics, the national healthcare analytics firm behind the awards.

Apex winners represent the top 10% of SPH clients with the highest satisfaction scores for measures tied directly to care and are based solely on patient feedback and evidence-based success.

For eligibility, a minimum of 300 patient surveys from each SPH client were collected and analyzed from January 1, 2018 – December 31, 2018. In all, more than 633 healthcare facilities in the United States were eligible for the award; 96 were selected as winners.  The Stamford ASC was one of only three facilities selected from the state of Connecticut.

“We applaud all recipients of this year’s award for their exceptional impact in driving satisfaction for their patients,” said Amy Amick, President and CEO of SPH Analytics.

Youth Sports and Hydration

HOW MUCH IS ENOUGH?

Did you know that the majority of young athletes are already dehydrated with they show up for practice or a game?

According to ONS Sports Medicine Specialist, Dr. Marc Kowalsky, improper hydration impacts mental alertness, physical performance and increases the risk of injuries.

“As little as 2 % dehydration can cause muscle fatigue and affect a young athlete’s aerobic performance, strength, stamina, and reaction time,” he said. “It can also put undue strain on the heart.”

Adequate hydration is vital to maintain normal blood pressure and improve blood flow and circulation, which affects the levels of oxygen and nutrients that are delivered to the muscles.

SYMPTOMS OF DEHYDRATION

When anyone exercises, the core body temperature increases. Sweating dissipates excess heat in response.  “Hydration replaces the water lost through sweat and helps prevent cramps, heat exhaustion and heat stroke,” Dr. Kowalsky said.

Decreased athletic performance is just one sign that an athlete is fluid deficient.  He or she may demonstrate such symptoms as irritability, fatigue, nausea, headache, muscle cramping and difficulty paying attention.

SIMPLE HYDRATION GUIDELINES

So how much does a young athlete need to drink to stay properly hydrated?  The exact amount depends on a variety of factors, including the youth’s body size and the level of training and exertion expended during practice and games.

“In general, young athletes should drink ½ – 1 ounce of water per pound of body weight and minimize his or her water weight loss to no more that 2 percent of that body weight,” Dr. Kowalsky advised.  In other words, a 100- pound child should lose no more than 2 pounds during exercise. The easiest way to establish a general guideline is to weigh your child before and after intensive athletics.

General hydration levels can also be checked by looking at the color of the player’s urine.  The goal is for a clear, water-like appearance; from there changes toward a more concentrated color and density indicates dehydration.

Parents can help by encouraging their athletic children to drink plenty of water during the day, particularly an hour or two leading up to exercise, when they should have at least 16 ounces. Ideally, while playing, they should shoot for half a dozen big gulps of water every 15 – 20 minutes. After activity, 16- ounces for every pound lost through sweat should be replenished.  However, over hydration has its own set of problems, so don’t let them go overboard with the fluids.

WATER AND SPORTS DRINKS

In general, water is best for sports sessions of an hour or less.  Sports drinks can help to replenish the fluid, electrolytes and carbohydrates that are lost during more physically taxing conditions such as sports participation that exceeds 60 minutes, if there is extreme heat and humidity and/or if the young athlete is prone to excessive sweating.  In these circumstances, experts recommend a sports drink with at least 110 – 240 mg of sodium per 8 ounce serving.

WHEN TO GET HELP

In general, mild symptoms of dehydration should go away shortly after the child has started hydrating.  However, consult with a doctor right away if the symptoms persist, worsen or if the child  faints, or seems disoriented.

ONS Named Official Medical Team

NEW PARTNERSHIP IN SUPPORT OF WOMEN’S PROFESSIONAL HOCKEY

The Connecticut Whale of the National Women’s Hockey League (NWHL) announced that ONS will serve as the team’s official medical practice. The new partnership provides the CT Whale with access to one of the leading specialty orthopedic and spine practices in the region. The Whale has officially named ONS Sports Medicine Specialist, Marc S. Kowalsky, MD, as their team physician and medical director.

“The Connecticut Whale are thrilled to announce our partnership with Dr. Kowalsky and the exceptional ONS team,” said Whale general manager, Bray Ketchum. “Our priority with the NWHL and with the Whale is to provide our players with the best professional care. There is no doubt we have that with ONS.”

Dr. Kowalsky is a renowned orthopedic surgeon with expertise in surgical and nonsurgical management of sports injuries. He has cared for professionals and amateur athletes at every level of competition. Dr. Kowalsky is currently a team physician for the US Rugby National Team, Iona Prep Rugby, and other local sports teams He has previously served as an assistant team physician for the New York Islanders and New York Jets.

“With the growth of the women’s and girls’ hockey in the US, we are proud to be affiliated with the CT Whale, who have been trailblazers in the National Women’s Hockey League,” said Dr. Kowalsky. “ONS is a natural fit for the team because we share a commitment to quality, player safety and a completely healthy return to play if an injury does occur.”

The ONS Sports Medicine and Women’s Sports Medicine Centers have been providing the highest standard of orthopedic and spine care to athletes in Fairfield and Westchester counties for more than 20 years. They are experts in advanced surgical and non-surgical techniques and have been pioneers in non-opioid pain management.  The ONS team of 26 sub-specialty trained physicians are recognized for their expertise and exceptional brand of patient-centered care.

ABOUT THE NWHL

Established in 2015, the NWHL was the first professional women’s hockey league in North America to pay its players. The mission of the the league is to fuel the continued growth of the sport and brand of pro women’s hockey. The league is made up of the Boston Pride, Buffalo Beauts, Connecticut Whale, Metropolitan Riveters, and Minnesota Whitecaps. Visit NWHL.zone and follow on Twitter and Facebook @NWHL and Instagram @NWHL.zone

Make it to the Marathon

Sports Medicine Specialist and marathon runner, Marc Kowalsky, MD, provides tips to stay the course leading up to a big race day.

How do you handle the last few weeks leading up to a big race?  You have dedicated months to training. You’ve re-arranged your schedule to fit it all in. You’ve plunged into cold waters time after time, spent hours on the bike and covered countless miles running.  Chances are most of this training has taken place before sunrise, or after dark, while others are sleeping or relaxing at home. Congratulations for getting to this point. Now, in the final stretch, it’s important to to keep the following advice in mind.

DON’T OVER TRAIN

The lion’s share of your training has already occurred. Now is not the time to radically ramp up your training, or try to make up for past lapses in your training program.  Too much training in the final stages before a big race only increases your chance for an injury that could put you on the sidelines instead of the starting gate. Have confidence in the incredible amount of work you have done, and maintain your momentum during the home stretch.

FOCUS ON FUEL

It’s extremely important for endurance athletes, particularly those new to the sport, to focus on fuel in these final days of training.  Proper hydration, nutrition, and sleep are as important as training and will give you the energy reserves you’ll need to safely reach your goal.

INSPIRATION AND GRATITUDE

Regardless of what inspired you to take part in this Triathlon, now is the time to remind yourself of the reason you began this process and the progress you’ve made.  You are about to accomplish an amazing feat of athleticism.  Congratulate yourself for that and remember to thank everyone else who helped get you to the finish line.

ONS Welcomes Two New Physicians

Heeren Makanji, MC Dr. K. Choo

HEEREN MAKANJI, MD

 

KEVIN CHOO, MD

We are pleased to welcome two new physicians, Heeren Makanji, MD, an orthopedic spine surgeon, and Kevin J. Choo, MD, an adult reconstruction and joint replacement surgeon, to our growing team of top tier specialists.

Dr. Choo will see patients at the ONS offices in Greenwich and Stamford, CT.  He specializes in primary hip and knee replacement for the treatment of degenerative osteoarthritis, inflammatory arthritis, avascular necrosis, hip dysplasia, and post-traumatic arthrosis.

Dr. Makanji will treat patients with spine disorders at the ONS offices in Greenwich, CT and Harrison, NY.  His expertise includes complex cervical and lumbar reconstruction and minimally invasive and robotic navigation-assisted spine surgery. He is experienced in treating degenerative conditions as well as tumors, trauma and infections.

“Dr. Choo and Dr. Makanji were hand-picked for their elite level of training and demonstrated commitment to delivering the highest standard of care to patients,” said Seth Miller, MD, president of ONS.  “Their contributions to ONS will further our mission to provide the highest standard of musculoskeletal treatment with compassion and convenience to our growing community in Fairfield and Westchester Counties.”

Dr. Choo earned his medical degree from the University of Chicago and completed his internship and residency at UCSF (University of California- San Francisco). He was fellowship-trained at Rothman Institute, Thomas Jefferson University in Philadelphia, PA, in direct anterior hip replacement, use of computer- and robotic-assisted technology, and partial knee replacement. Dr. Choo has presented and published on such topics as the biology of bone healing, the reduction of opioid use after orthopedic surgery, periprosthetic joint infection management, and partial joint replacement. Dr. Choo was named an Emerging Leader by the American Orthopaedic Association (AOA) and is a reviewer for the Journal of the American Association of Orthopaedic Surgeons (JAAOS).

Dr. Makanji earned his medical degree Harvard Medical School and completed his residency through the Harvard Combined Orthopaedic Residency Program at Massachusetts General Hospital/Brigham & Young Women’s Hospital/Beth Israel Deaconess Medical Center. Dr. Makanji was fellowship-trained in orthopaedic spine surgery at Rothman Institute, where he also served as a clinical instructor in orthopaedic surgery.

A Road to Recovery

DETERMINATION AND A SURGEON’S SKILL PUT ONE PATIENT BACK IN THE RACE.

How can a 54-year old man come back from knee replacement surgery to complete a 100-mile bike race just 18 weeks post-op and an Ironman competition four months after that?

Ken Harris Story
Ken at the Gran Fondo

According to Greenwich resident Ken Harris, the answer is determination to be physically fit before surgery, setting goals to achieve after surgery, and selecting the joint replacement surgeon he could trust to do the best job.  That surgeon was Frank Ennis, MD, of ONS.

“Dr. Ennis understood that I wanted to achieve certain things and we worked together to get me there. I learned that losing weight and getting fit before surgery would make the entire process so much easier, so I did what I had to do,” Ken said.

Indeed, studies have shown that people who are in good physical condition prior to surgery are much more likely to have an easier, faster and successful recovery than those who are in poor shape.  Ken, for one, reinforces those findings.

AN UPHILL BATTLE WITH PHYSICAL CHALLENGES

However, Ken’s road to pre-surgical fitness wasn’t an easy one.  Over the past 25 years, Ken’s athletic pursuits were moved to the back burner while he raised a family and built a residential contracting business.  At the same time, Ken began to experience pain in both knees that interfered with his ability to exercise. In 2014, the former Ironman and triathlon competitor contracted a MRSA virus in his right knee after seeking treatment for pain. That episode took a grueling six months to overcome.

Traumatized by the experience, Ken put off seeking any further pain treatment, even as it worsened over the years.  By 2018, Ken was so debilitated by pain, he couldn’t perform  many of the tasks required in his line of work or simply climb a flight of stairs. He knew he had to do something. That’s when he went searching for a joint replacement surgeon who would give him confidence that his previous medical nightmare would not be repeated. Friends recommended ONS and Dr. Ennis.

LIGHT AT THE END OF THE TUNNEL

“Dr. Ennis immediately put me at ease. He genuinely listened to my concerns and was cautious and sensitive to what I had been through,” Ken said, “He gave me faith that I could get my life back and he was there guiding me every step of the way.”

With confidence in Dr. Ennis’s surgical expertise, Ken didn’t feel any angst or fear going into the procedure.  After, he was amazed that he didn’t need narcotics for pain.

“I took one painkiller after leaving the hospital but once I realized that I only felt discomfort, I threw out the rest.  There wasn’t really any pain,” he said.

Ken’s exceptional recovery was helped along through 12 weeks of rehabilitation at the ONS Physical Therapy Center at the Harrison office.  By the time therapy was finished, Ken was ready to rebuild his strength and endurance on a bike so he could participate in the New York Gran Fondo six weeks later.

While Ken may never run a 2:43 marathon again, he is motivated by what he can do, as long as Dr. Ennis gives him the okay.  On August 18, Ken completed an Ironman competition at Mont Tremblant in Canada. It was just 7 months and 7 days from the date of his surgery.

“When I asked Dr. Ennis about doing the Ironman, his main concern was whether I felt up to it. And he advised me to walk during the part of the race the involves running.  I could live with that,” he said.

Watch Your Step With A Twisted Ankle

TIPS FOR SAFELY TREATING A TWISTED ANKLE

photo: AAOS

DO YOU NEED A DOCTOR?

Many people delay seeking medical attention for a twisted ankle. For mild cases, that’s okay. Rest, NSAIDs and ice can usually take care of the problem within a week or two. But if it takes longer than that to get better, or if you have strained your ankle to the degree that it becomes tender, bruised and swollen, you should see a doctor, according to Mark Yakavonis, MD, orthopedic foot and ankle surgeon at ONS.

“Without proper treatment and rehabilitation, severe sprains can weaken the ankle and increase the likelihood of re-injury. Repeated ankle sprains can lead to long-term problems, including chronic ankle pain, arthritis, and instability,” he said. Moreover, severe pain and swelling that extends from the foot to the knee or higher is usually a symptom of a fractured ankle. That condition should be treated as soon as possible.

Children, in particular, should see a doctor right away if an ankle fracture is suspected, said Dr. Yakavonis. “A child’s ankle fractures typically involve growth plates.  If it’s not treated properly, the natural growth and development of the child’s leg may be compromised,” he warned.

ANKLE SPRAINS

An ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. This is a common injury that occurs among people of all ages as a result of the foot rolling or twisting to one side. Sprains range from mild to severe, depending upon how much damage there is to the tissues.

You can treat most ankle sprains without surgery. Even a complete ligament tear can heal without surgical repair if it is immobilized properly.  Depending on the severity of the sprain, your physician may wrap the ankle in a bandage or recommend a device for protection and support, such as a boot or an air brace. Mild sprains usually resolve within two weeks. Severe ankle sprains can take as long as 12 weeks to recover.

ANKLE FRACTURES

Similar to ankle sprains, ankle fractures are most commonly caused when a person trips and twists or rolls the ankle in the process, or if there is impact from an accident.

Ankle fractures involve two joints: the ankle joint where the tibia, fibula and talus meet, and the syndesmosis joint, which is the joint between the tibia and fibula. A fracture can range from a simple break in one bone to multiple fractures. Some fractures may coincide with injuries to the ankle ligaments that keep the ankle bones and joint in its normal position.

Absent of a physical deformity such as a bone protruding from the ankle, an X-ray may be required to determine which bones, if any, are broken and the extent of bone separation or displacement.

Children’s ankle fractures, on the other hand, typically involve the tibia, fibula and growth plates. Growth plate ankle fractures require immediate attention because the long-term consequences of an improperly healed fracture can cause the leg to grow crooked or of unequal length to the other. For this reason, a child who has broken an ankle should have regular follow-up check-ups for as long as two years after the injury to make sure that growth proceeds properly.

TREATMENT FOR FRACTURE

Of course, the complexity of the treatment depends on the severity of the fracture, the bones involved and whether there is displacement or dislocation. Most fractures require elevation to reduce the swelling and decrease the risk of damage to the surrounding tissue. Splints are usually positioned to support the ankle until the swelling has gone down, at which point a cast or fracture boot will be put in place.  Your physician will determine the length of time you’ll need to use crutches, a walker or wheelchair to avoid weight bearing.  This can range from a several days to several months.  Severe breaks will require surgery to re-position bone fragments to their normal alignment and the insertion of special screws, metal plates and rods to keep everything in alignment.

Dr. Yakavonis and Michael Clain, MD, are fellowship-trained orthopedic surgeons who are experts in the surgical and non-surgical treatment of all foot and ankle conditions.

Call 203-869-1145 for to make an appointment or request an appointment online.

 

ONS’ New Partnership

Orthopaedic & Neurosurgery Specialists (ONS), the leading provider of multi-specialty orthopedic and neurosurgery services in Connecticut and Westchester, announced today a growth capital investment from Kohlberg & Company, L.L.C. (“Kohlberg”), a leading private equity firm headquartered in New York. Kohlberg is partnering with ONS to continue expanding its extensive offering of clinical care capabilities and ancillary services while serving a broader base of patients in the Tri-State area.

ONS, headquartered in Greenwich, Connecticut, is a multi-specialty physician group with three locations in Greenwich, Stamford, and Harrison. The Company’s clinical offering covers a wide range of sub-specialties including orthopedic, sports medicine, joint replacement, neurosurgery, physiatry and ancillary services such as physical therapy and MRI. ONS partners operate an ambulatory surgery center and an urgent care center, providing the highest quality of care through a full continuum of care.

Seth Miller, MD, Co-Founder and Executive Committee member of ONS, remarked, “We are incredibly excited to partner with Kohlberg and to pursue the next chapter of the Company’s growth. Kohlberg brings extensive industry experience and financial resources with a proven track record of investing in leading healthcare services companies.” Mark Camel, MD, Co-Founder and Executive Committee member of ONS, stated, “We believe Kohlberg will be the ideal partner to help implement our plans for strategic growth and to expand our clinical model to better serve our patients today and going forward.”

“ONS is a clear market leader in orthopedic services with an unparalleled reputation for providing best-in-class patient care and delivering industry-leading clinical outcomes,” commented Robert A. Cucuel, Operating Partner of Kohlberg. “We are thrilled to partner with ONS, and we look forward to supporting ONS’ continued expansion as well as their unwavering commitment to delivering the highest-quality patient care.”

About Kohlberg & Company, L.L.C.

Kohlberg & Company, LLC (“Kohlberg”) is a leading private equity firm headquartered in Mount Kisco, New York. Since its inception in 1987, Kohlberg has organized eight private equity funds, through which it has raised over $7.5 billion of committed equity capital. Over its 32-year history, Kohlberg has completed 76 platform investments and nearly 200 add-on acquisitions, with an aggregate transaction value of over $15 billion.

For more information visit: www.kohlberg.com.

Jumping for Joy with New Knees

CRIPPLING KNEE ARTHRITIS AT A YOUNG AGE. 

No one expects the pain of arthritis to affect a thirty-something adult, but that’s what Westchester middle school teacher, Mallory Chinn, was faced with.  For 5 years, Mallory tried every non-operative treatment available to ease the worsening pain in her knees. Some treatments would work for a while. Others did not work at all. By the time Mallory turned 40, her pain was debilitating. She had trouble walking and climbing stairs, and missed out on family activities such as bike rides and hikes in the woods.

“I was pretty much immobilized,” recalled Mallory, now 43.  The defining moment came one day when her youngest child, then 7 years old, ran ahead of her.  “When I tried to chase up the hill after him, I was stopped in my tracks by an excruciating stab in my knee.  I thought ‘this is ridiculous. How can I be so young and not mobile?”

By this time, Mallory’s arthritis was severe, often referred to as bone-on-bone. She looked ahead to the life she wanted to have going forward and it didn’t include constant pain and physical limitations.

“I wanted to be able to live an active life and keep up with my kids, so I decided to go for it,” she said of her decision to undergo a double knee replacement procedure.

ONE GIANT LEAP FOR MALLORY: DOUBLE KNEE REPLACEMENT

On August 11, 2017, Dr. Demetris Delos of ONS performed the surgery at Greenwich Hospital. The procedure went according to plan. However, as anyone who has recovered from a knee replacement can attest, the road to recovery is a slow, challenging process that requires months of rehabilitation.

Following surgery, Mallory recuperated for a few weeks at an in-patient rehabilitation facility.  Upon release, she went to a number of local physical therapy centers to continue her rehab program. Time after time, she was disappointed by the therapists’ indifference to her concerns and pain. As soon as Mallory learned that ONS had a state-of-the-art physical therapy center at the Harrison office, she made an appointment. At ONS, she found the physical therapists were kind and highly-skilled at helping joint replacement patients get moving again.

THE ONS ADVANTAGE

“Everyone made it a happy, safe place to heal. I actually looked forward to going to therapy because it felt like I was a part of a big family,” she said. Mallory praised the therapists and PT Techs and the integrated care she received.  Once when there was a concern about one of her wounds, the therapist, Robert Spatz, PT, reached out to Dr. Delos and received a reply within a minute.

“Dr. Delos and the Physician Assistants were always there if I had questions or needed a prescription refill.  Whenever Dr. Delos was at the Harrison office, he always came over to PT to see how I was doing,” she said.  When it came time to come off the narcotics, Dr. Alex Levchenko, an ONS physiatrist, introduced Mallory to alternative pain management strategies.  “I didn’t even know ONS had doctors that could do that,” she said.

Mallory was particularly impressed by the amount of time Spatz, who is also the director of PT at that office, spent working with her.

“In other places, I’d see the therapist for a minute and then I’d be handed over to a tech for the rest of the hour.  Robert always gave me a big chunk of his time,” she said.  “He was respectful of my tolerance and goals. He went out of his way to educate me about each step of the recovery process.”

Mallory went to PT three times a week until she “graduated” in December of that year. She was strong and stable enough to continue her strengthening using a tailor-made workout she could do at the gym.

REGAINING INDEPENDENCE WITH NEW KNEES

Since then, Mallory has fully reclaimed mobility in her life and enjoys activities with her friends and family.  She has hiked in the mountains of Colorado, and can spend an entire day walking around New York City.  At a summer camp last year, Mallory led a group of 30 girls through a physically challenging Ninja Race course.  In May, Mallory picked up a jump rope during her school’s Wellness Week, and got hopping.  “I wasn’t the bounciest person out there, but I could never have done it before my knee replacements.”

Although Mallory is completely recovered, she has had occasions to visit ONS.  She brought her husband to the Harrison office when he needed treatment for back pain. She was back again when her daughter sustained an athletic injury. Each time, she has been welcomed with the same kindness she first experienced during her time there. “I tell everyone that ONS is the best.  I’ve sent family members and friends there. I wouldn’t even think of going anywhere else,” she said.

Take your first step toward an active life.   Schedule an appointment online with an ONS total joint replacement specialist or call 203-869-1145.