ONS Dr. Seth Miller is Featured in WAG

Top shoulder surgeon Dr. Seth Miller is featured in an article titled “A (Medical) Shoulder to Lean On” in the October issue of  the Westchester magazine, WAG. The piece, written by Jane Dove, was released online on September 26, 2017.  Ms. Dove delivers a comprehensive view of Dr. Miller’s distinguished career and founding prinicple of ONS, one of the region’s premier orthopedic and neurosurgical practices.  She is also able to capture the unique formula that sets ONS apart from the competition:  the highest standard of care, the collaborative approach among specialists in the practice and patients, and the compassion for patients’ individual conditions and treatment goals.

The entire article is copied below:

A (MEDICAL) SHOULDER TO LEAN ON  by Jane Dove

“I am personally very proud of our practice — Orthopaedic & Neurosurgery Specialists (ONS) and the way we treat each patient as an individual,” says Seth R. Miller, an orthopedic surgeon who specializes in arthroscopic shoulder surgery and shoulder replacement.

With offices in Greenwich and Stamford and now Harrison, ONS takes a conservative approach to patient care. “We recommend surgery to only about 10 percent of our patients,” says Miller, who is also a clinical assistant professor of orthopedic surgery at the Hospital for Joint Diseases; a staff orthopedic physician at Greenwich Hospital and an assistant attending physician in orthopedic surgery at New York-Presbyterian Hospital. “We want to make sure it is really needed, because we realize that surgery in any of our subspecialties is a traumatic event for our patients. If it can be avoided, so much the better.”

A leading specialist in shoulder replacement surgery with 1,000 total shoulder and reverse shoulder replacements to his credit, Miller helped found ONS in 1998. There he remains committed to providing excellent orthopedic and neurosurgical care through professional cooperation while showing compassion for patients. By setting the highest of standards, ONS can offer patients a wide range of choices that leads to the best possible outcomes.

“For example, if needed, we will have two surgeons involved in a complicated procedure,” he says. “We do everything we can to ensure the results our patients get are the very best possible. And we deliver those results with compassion and understanding along the way.”

SPOTLIGHT ON SHOULDERS

After graduating from Harvard University in 1978, Miller went on to get his M.D. at the Mount Sinai School of Medicine, followed by a residency in general surgery and then a sought-after one-year residency in shoulder surgery at Columbia-Presbyterian Medical Center.

“I studied under the renowned Dr. Charles S. Neer, who offered me this wonderful opportunity,” he says. “I was always interested in the shoulder and had a great year with him, from l988 to 1989. At about the same time, I met another shoulder specialist who invited me to join him at Greenwich Hospital.”

Miller says Greenwich had many orthopedic surgeons on staff but most practiced in the general area. “I did my share of general orthopedic surgery but really wanted to do as much shoulder surgery as possible. I spoke with several other subspecialists who, like me, wanted to improve patient care by combining several of our doctor’s groups into one entity.”

In 1998, the group took the plunge and founded ONS, starting with only eight physicians.

EXPANSION

ONS now has 22 subspecialty physicians trained in orthopedic surgery, sports medicine, physical medicine and rehabilitation.

“Things really took off when patients realized they could get specialty care of the highest quality right in Greenwich. We now have two specialists for every part of the body.”

The successful reception ONS earned from the local patient community there led to its expansion, first to Stamford and then to a new facility in Harrison.

Miller says he believed one of the keys to the success of ONS has been the one-stop approach the practice offers.

“Our patients just love that we can provide so much under one roof,” he says. “Everything is right here and there is no need to trek from outside office to outside office for tests, scans and blood work. We function as a team of doctors and other medical professionals, working closely and seamlessly together.”

If a question about care or a procedure that can best be answered by another specialist comes up, Miller says, “All we have to do is walk down the hall. Patients find this very comforting and we pride ourselves as working as a collaborative team. At ONS you get the best possible care all under one roof. While our practice is large, it is very effective and attuned to the patient, what he or she really needs.”

SATISFIED PATIENTS

He believes ONS is well-served, as are its patients, by not being a part of a larger patient care “network system.” The proof is in the response. “We get positive feedback in the 96 to 97 percent range,” he says.

“As a result, we are not controlled so much by cost-cutting to enhance the bottom line of the network. As a private practice, we control our own destiny and even have our own foundation. We are free and now big enough to control our financial destiny on our own.”

Orthopedic Patients Applaud New Pain-Reducing Procedure

OPIOIDS AFTER ORTHOPEDIC SURGERY COULD BECOME A THING OF THE PAST. 

Recovery from total shoulder replacement surgery usually includes weeks of excruciating pain.  This was not the case for Manhattan, NY resident, Marjorie Purnick, 71, who was out to dinner with surgeryfriends the night after Dr. Paul Sethi performed the procedure using a new, slow release analgesic called Exparel.  Marjorie said she has never taken a single pill for pain in the four months since her shoulder replacement surgery.

“It was incredible. I kept waiting for the pain to hit, but it never did.  Friends who have had the same surgery don’t believe me when I tell them that I had no pain,” she said.   With the help of physical therapy, Marjorie has regained close to 100 percent of her range of motion, a recovery that she said is 4 to 8 months quicker than her friends. “I think I’ve recovered so quickly because I didn’t have pain holding me back.  I could get started with therapy right away.”

As soon as 49 year old Michele Herrera of Rye, NY heard about this new pain treatment, she asked Dr. Sethi to use it during her surgery to correct torn biceps and bone spurs in her right shoulder.  Vivid memories of the agonizing pain she had endured following a similar surgery on her left shoulder five years ago had been preventing her from undergoing the procedure again.

“I was petrified to have the surgery again because of that pain,” she recalled.  This time around, however, it was completely different.  “I am the happiest person in the world.  I had surgery on Thursday and I was out walking the dog that same day.”  When the medication did start to wear off 4 days later, she said she took pain medication because she afraid of how intense the pain would be. She was pleasantly surprised. “I only took one pill instead of two, and once I realized that I only felt a little sore, I switched to Tylenol.”

The search for an alternative to opioids at ONS is borne from a real concern about the increasing national opioid addiction epidemic and the role prescribed opioids like oxycodone and hydrocodone play in addiction. Every day, 78 Americans die from an opioid overdose, according to The Centers for Disease Control and Prevention.  Since the late 1990s, the number of deaths from prescription opioids has quadrupled.

“It is frightening as a surgeon to think that an opioid prescription that is intended to help a patient recover could lead to a lifelong battle with addiction or death,”  said ONS orthopedic surgeon, Paul Sethi, MD.  He has seen college athletes in need of surgery who are willing to suffer great amounts of pain if it means avoiding opioids post-surgery.

Dr. Sethi and ONS colleagues Seth Miller, MD, Katherine Vadasdi, MD and Marc Kowalsky, MD, have been performing shoulder surgeries with the use of  this new analgesic,  that is injected directly into the surgical site and numbs the area for three days or more.  Some patients who have been administered Exparel have not needed any narcotics for pain, or if they did, they’ve needed far fewer than with traditional post-surgical pain control, Sethi said.

“When patients need additional pain relief instead of prescribing 30 narcotic pills post-surgery for instance, there is only a need to prescribe 10,” he said.

Moreover, patients are able to regain movement more quickly because they are not consumed by pain.

Physicians at ONS are optimistic that as more non-narcotic methods of pain relief are made available, the number of prescribed opioids for surgical pain will plummet.  Sethi and others in the practice are conducting a peer-reviewed study about Exparel’s overall effectiveness in reducing pain after other types of surgeries. “The injection has to be specifically tailored to each surgery in order for it to be effective,” Dr. Sethi said.
They plan to expand its use for other surgical procedures such as repairs to ruptured anterior cruciate ligaments (ACL).
Currently, 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.