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Examining Jabari Parker’s ACL Injury

Jabari Parker ACLThe Milwaukee Bucks will have to hold onto their playoff hopes for the rest of the season without star rookie Jabari Parker, who tore his left ACL on Monday against the Phoenix Suns.

The Bucks initially thought the number two pick in this year’s draft only suffered a knee sprain, but an MRI showed the true damage to the knee. The team announced that Parker would undergo surgery to address the tear, but they have not yet announced when that will occur. The injury will cost him the remainder of his rookie season.

Parker suffered the knee injury during a drive to the basket against the Suns. As he drove towards the hoop he collided with P.J. Tucker, and his knee appeared to buckle. Parker fell to the floor in pain, but he did not appear to be in as much discomfort as Derrick Rose when he tore his ACL in a game in 2012, so the Bucks hoped they avoided a costly injury. Unfortunately, that was not case.

Parker got off to a hot start during his rookie season, averaging 12.3 points and 5.5 rebounds through 25 games. Most importantly, the Bucks started the season 13-12, a huge improvement from last season when they went 15-67.

Dr. Silverman comments

This is a truly unfortunate injury. ACL injuries are problematic in any sport, but basketball players have it rough because they play on a hardwood floor. This will cause the leg to absorb more force as players run up and down the court.

As for Parker’s surgery, you can’t just sew a ligament like the ACL back together, because it will never fully heal. Instead, a doctor is going to take an allograft or autograft – human donor tissue or the patient’s own tissue – and use it to recreate the major function of the ACL to prevent abnormal forces on the knee joint.

The procedure is typically preformed arthroscopically, where the doctor will insert a small camera and other instruments through small incisions in the skin in order to correct the tear. Screws will be placed in the bone tunnel to securely hold the grafts in place.

Post-Op

Weight bearing and rehabilitation can start immediately after surgery, in conjunction with strong narcotic medications to control pain.

The good news is that Parker is young, but he’ll need to undergo intensive physical therapy to return to his high level of play. He’ll need about 6 months to recover, but it can take anywhere from 18-24 months for the knee to completely heal, as the ligament needs to strengthen through the development of new tissue, which can take up to two years. I don’t mean to say that Parker will be out for two years, but similar to the Rose situation, Rose noted that even though he’s healthy enough to play, it takes longer for an athlete to regain that trust in their knees. Even though they aren’t experiencing pain in the knee, they can still “feel” the injury and that can impact their willingness to explode towards the hoop, as there is potential for a re-tear.

Just look at this quote from Rose. “I think I’m way more explosive now. Like getting to the rim. I think I can take contact a little bit better. And as far as jumping-wise, I think I can jump even higher. They tested my vertical — I increased it by 5 inches.” How long after his injury do you think he said that? 6 months? 12 months? Nope, that quote came in October 2013, 18 months and a half months after he initially injured his ACL.

Parker will return to the Bucks in time for the 2015-16 season, but he’s still going to be feeling the effects of the injury. As long as he stays healthy next year, expect big things in 2016-17 when he has put all shades of the injury behind him.

Related source: ESPN.

Study Says You’re Only As Old As You Feel

Happy seniorsConquistador Juan Ponce de León spent his life looking for the Fountain of Youth, but new research suggests the key to feeling youthful may all be in our heads.

Researchers from the University College in London and the International Longevity Centre-UK said individuals who feel older than their age are more likely to die than those who feel younger than their true age.

For their study, researchers asked 6,500 English older adults one simple question: How old do you feel? They then compared their perceived age to their actual age and tracked the participants for more than a decade. The average actual participant age was 65. At the end of the study they found:

  • Participants who felt at least one year older than their actual age were 41 percent more likely to die within eight years than those who felt at least three years younger than their actual age.
  • Adults who felt younger had a 14 percent death rate during the study, those who felt the same age had an 18.5 percent death rate, and those who felt older than their actual age had a 25 percent death rate.
  • Overall, study participants had a youthful mindset. 69.6 percent of respondents said they felt three or more years younger than their actual age, 25.6 percent felt their actual age, and only 4.8 percent felt older than their actual age.

Researcher Andrew Steptoe said the main factors in feeling older include illnesses, smoking, alcohol intake, physical activity, education and wealth.

“Someone who feels younger is possibly healthier than someone who feels older — they have fewer diseases, they may be more mobile,” said Steptoe. “People who felt younger than their real age were more likely to survive over the next eight years or so compared to those who felt older.”

Since researchers hypothesized that those who felt older than their age may already be suffering from serious conditions, they threw out any cases where a patient died within one year of the beginning of the study. Researchers found that their results held true. They said their findings can help doctors push for a youthful mindset as well as physical treatment.

“Individuals who feel older than their actual age could be targeted with health messages promoting positive health behaviors and attitudes toward aging.”

Marian Armitage, who took part in the study, said she’s not letting her actual age slow her down.

“I just became 60 this year, and I certainly don’t feel 60.”

Dr. Silverman comments

This is an interesting study as it shows the importance of keeping both your body and mind in good shape. Stay active, because you’ll feel younger, and according to these findings, live longer.

Thousands Injured in Tanning Beds Each Year

Tanning Bed InjuriesYou’ve likely heard that tanning beds have been cited as a reason for inflating skin cancer rates, but researchers also suggest the booths cause thousands of immediate injuries every year.

Tanning bed injuries have significantly decreased from a decade ago, but nearly 2,000 people were injured in tanning beds in 2012. 1,957 tanners visited emergency rooms as a result of burns, fainting or other related injuries in 2012, which is down from 2003 when hospitals treated 6,487 patients ailing from tanning bed injuries. Overall, an average of 3,200 people have been injured by tanning beds each year since 2003.

“We’ve seen several studies showing indoor tanning increases the risk of skin cancer, both melanoma and non-melanoma,” contributing to about 400,000 cancers a year in the United States, said CDC researcher Gery Guy. “We’re looking at more acute injuries.”

Researchers say they aren’t exactly sure why acute tanning injuries have fallen so drastically over the course of a decade, but they hope it’s because people aren’t using the machines as frequently. John Overstreet, executive director of the Indoor Tanning Association, said the drop in injuries has not coincided with any large drop in tanners.

“These businesses take the welfare of the customers seriously,” said Overstreet. “Injured customers are unhappy customers, and staff is trained to show the customer how to use the equipment properly and make sure people are not overexposed or sunburned.”

Tanning Injuries

As you might have guessed, burns top the list of most common tanning bed injuries. Some findings from the report include:

  • Nearly 80 percent of injuries requiring an ER visit were for skin burns.
  • 6 percent were for eye injuries.
  • 9.5 percent were from people who got dizzy or passed out due to overheating.
  • The rest of the injuries were cuts or similar injuries.
  • The majority of people who suffered a tanning injury were young white women.
  • 13 percent were under the age of 18.

Dermatologist Darrel Rigel said he’s not surprised by the findings.

“The burns I’ve seen have been pretty intense, the kind that can leave a scar. It’s a serious problem,” said Rigel. “The earlier you start, the worse it is, but like with cigarette smoking, it always pays to stop.”

Dr. Silverman comments

I’m always amazed at how many people are willing to cook themselves and increase their risk of skin cancer in order to achieve what they believe is a more beautiful look. If you want to do something regularly to enhance your appearance, opt for a run instead of frying yourself like a lobster.

Related source: USA Today

Americans: Waistlines Up, Exercise Down

Fat AmericansAmericans saw their waistlines increase last year due in large part to the fact that people are exercising less, according to a report by the United Health Foundation. The concerning data is a reversal from 2012 data that suggested Americans we’re starting to fight back against obesity.

The nationwide results show that Americans are becoming fatter, but as a state, Minnesota fared pretty well in the report. Minnesota is ranked as the #6 healthiest state in the country. The states that edged Minnesota out of the Top 5 are Hawaii, Vermont, Massachusetts, Connecticut and Utah.

On the flip side, the least healthy states are primarily located in the south. The least healthy state is Mississippi, followed closely by Arkansas, Louisiana, Kentucky and Oklahoma.

Nationally, the obesity rate rose from 27.6 percent to 29.4 percent in 2013. Additionally, nearly 25 percent of people reported doing no physical activity or exercise in the past 30 days. That’s up about one percent from last year. More findings from the report include:

  • Obesity rates have doubled over the last 25 years.
  • Nearly 10 percent of adults have diabetes.
  • Diabetes rates have doubled over the last 20 years.
  • Optimistically, smoking rates have dropped 3%, adolescent immunization is up 5 percent, and infant mortality rates are down 4 percent from 2013.

“What people are not focusing enough on is that we are producing an extraordinary number of people who are unnecessarily sick,” says Reed Tuckson, a senior medical adviser to United Health Foundation. “They are pouring into medical system; it’s a total crisis.”

Anthony Wall, director of professional education for the group, said people need to be more conscious about what they put into their body.

“Obesity is a condition people suffer from, so one of the areas we’re trying to spend a lot more time on is trying to understand the behaviors and why people make certain choices” when it comes to food, says Wall. “They need tools to make a change themselves.”

Dr. Silverman comments

I couldn’t agree more with Mr. Tuckson. Change isn’t going to happen overnight and it’s not going to be easy, but people need make conscious decisions to be healthier. When you’re at the grocery store, pass on the potato chips and pick up a few more leafy greens.

Sure, it’s easy to grab a Big Mac on your way home from a long day at work, but eating healthy isn’t easy. Same goes for your exercise regimen. You might have to wake up early or DVR your favorite TV show in order to get your workout in, but it will be worth it.

Hopefully we heed the recommendations in this report and can improve on our numbers in 2015.

Related source: USA Today

Knee Surgery Could Increase Arthritis Risk

Knee ArthritisA new study claims that undergoing surgery to repair a meniscal tear in the knee could increase a person’s risk of developing arthritis.

The findings, presented at the Radiological Society of North America’s annual meeting, say that meniscus surgery could contribute to cartilage loss and an elevated risk of developing osteoarthritis in the knee. For their study, researchers examined MRI scans of the knees of 355 patients with arthritis. They then compared the images to a similar numbers of knee scans in patients without arthritis. The median patient age was 60 years old, and most of the subjects were overweight.

After analyzing the data, researchers found:

  • All 31 individuals who had their knee operated on to repair a meniscal tear developed arthritis within a year, while only 59 percent of those who opted for non-surgical treatment developed the same condition.
  • 81 percent of patients who underwent surgery to repair a meniscus tear suffered cartilage loss in their knees. Only about 40 percent of individuals who did not have surgery suffered cartilage loss.

“We found that patients without knee osteoarthritis who underwent meniscal surgery had a highly increased risk for developing osteoarthritis and cartilage loss in the following year compared to those that did not have surgery, regardless of presence or absence of a meniscal tear in the year before,” says study author Frank Roemer, MD, from Boston University School of Medicine and the University of Erlangen-Nuremberg in Germany.

Dr. Roemer added that although surgery is an option for individuals with meniscal tears, “increasing evidence is emerging that suggests meniscal surgery may be detrimental to the knee joint.”

He concluded by saying other options “need to be discussed more carefully in order to avoid accelerated knee joint degeneration.”

Dr. Silverman comments

This isn’t the first time we’ve heard that some knee operations may be unnecessary. I think there are certainly other factors that have led to osteoarthritic degeneration of the knee, and 31 isn’t a huge sample size, but that doesn’t mean we should dismiss the findings.

We owe it to our patients to provide them with the best care and not just temporary solutions that lead to other problems down the road. Each and every day we are making advancements in healthcare and surgical techniques. These studies help bring our shortcomings to light, and now it’s our turn to do everything in our power to improve on those shortcomings.

Related source: OutPatientSurgery.net

5 Ways to Stay Healthy During the Holidays

Holiday HealthThe holidays are often a time to celebrate the season with friends and family, but it’s also a time when it’s easy to fall into poor health habits. Below, I share five ways to stay healthy as 2014 comes to a close.

1. Eat Right – From turkey and pumpkin pie to candy canes and gingerbread cookies, the time between Thanksgiving and New Year’s is often filled with tempting food choices. Nobody is saying you need to completely avoid indulging in some holiday sweets, but you don’t need to wash down three Kit Kats with two glasses of egg nog. Holiday treats are often loaded with calories, so be careful not to overindulge, or your waistline may soon resemble Santa’s belly!

2. Plan Ahead – Playing off the first tip, holiday travel can make it tough for you to eat healthy. If you’re stuck in an airport or taking a long road trip, it can be easy to grab an unhealthy option from a fast food joint. If possible, plan ahead and pack a healthier option so you don’t have to spend $10 on the #3 combo at an airport Arby’s.

3. Exercise – Getting your workouts in during a normal week can be tough enough, and now you need to plan around a Christmas pageant at Billy’s school, Clara’s holiday orchestra concert and the annual office party. But you can’t let exercise fall by the wayside simply because you’re busy. Carve out some time – even if it’s only 20 minutes – to get a workout in. Wake up a little earlier, or walk up and down your office’s stairs during your lunch hour to get your daily exercise. Once you’re out of your routine, it can be hard to get back in the groove.

4. Help From Santa – We’re not saying you should buy a treadmill for your significant other, but getting them a gift that enhances their workout routine is a win-win. Whether it’s a new pair of headphones, a smartphone exercise armband or new running shoes, a gift that aids their workout routine is a great idea.

5. New Year’s Resolution – Picking a resolution and sticking to it is another great way to keep yourself healthy all through 2015. Pick one or more resolutions that are feasible, and write them down in a place you’ll see every day to remind yourself to stick to your resolution. Better yet, find a buddy who has similar resolutions and help one another keep to your resolutions!

Scooters Leading Cause For Child Holiday Injuries

Scooter injuriesAlthough they may not be able to ride them until the spring, the Consumer Product Safety Commission suggests parents should refrain from purchasing scooters for their children this holiday season, as they are the toy that produces the most hospital visits each year.

According to a report published in Clinical Pediatrics, kick scooters popularized by Razor and other companies in the early 2000s have led to a 40 percent increase in injury rates between 1990 and 2011. Injuries from other holiday favorites like toy food, plastic guns and remote controlled devices continued at a steady pace, but hospitals saw a significant increase in scooter-related accidents over the past two decades.

“They continue to be very common injuries,” said Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus.

Very common indeed. According to hospital records, 195,363 children were hospitalized for toy-related injuries in 2011, up from 121,249 in 1990. That means the injury rate for every 10,000 kids has jumped from 18.9 in 1990 to 26.9 in 2011.

The Consumer Product Safety Commission says the scooter boom is to blame. The commission cited 52,500 scooter-related injuries and one death in 2013. The report also noted that falls from scooters are the most common type of scooter injury.

The Razor company website suggests that children should wear elbow and knee pads while riding, but Smith said there’s one other precaution every scootering child should take.

“Wear a helmet, wear a helmet, wear a helmet, said Smith.

Smith added that while toy companies and taking more precautions and “are doing a lot more to prevent injuries….. we can do more.”

Dr. Silverman comments

Scooters are fun toys for children, but I’ve seen my fair share of kids who have suffered a sprain or fracture because they fell off their Razor. Foot injuries will heal over time, but head trauma can linger or cause problems for years.

If Santa is going to leave your child a scooter under the tree this year, make sure he also brings knee pads, elbow pads and a helmet. Also, supervise your children while riding, and make sure they stick to the driveway and sidewalk.

Related source: USA TODAY

Putting a Bow on Our Hearts To Your Soles 2014

OHTYS 2014Once again the annual Our Hearts To Your Soles event was a rousing success! Thank you to everyone who participated in this wonderful event.

After a night of fun and foot exams I can once again say that this year’s event was one of the best. All of the attendees received a new pair of Red Wing shoes, and they also received fresh socks courtesy of Dignity U Wear.

It was great to see some many thankful individuals and smiling faces throughout the night. Every year it warms my heart to see so many caring people give back to those in need, and the guests are always so appreciative of the care and supplies they receive. I’d like to quickly give shout out to everyone else who made the event a success, including Catholic Charities of Minneapolis and St. Paul, Soles4Soles, Interstate Parking, the doctors, therapists and lawyers who attended, and especially the volunteers.

I’d also like to thank those who took pictures for the event, which can be seen in the Our Hearts To Your Soles 2014 album on Facebook. I’ve also included some of the photos below!

The holidays are often a time when we reflect on all the things we are thankful for in our lives, and it was wonderful to see our community come together to support those in need this season. I am blessed to be surrounded by so many people who want to give back to others in the community. Thank you so much for your support of Our Hearts To Your Soles 2014, and we’re already looking forward to another great event in 2015!

OHTYS 2014


OHTYS 2014

OHTYS 2014

Photos courtesy Catholic Charities of the Twin Cities

Medical Errors Down Significantly Over Last Three Years

Medical errorsImproved standards and patient handling techniques have led to a significant reduction in the number of patients killed due to avoidable errors over the last three years, according to a new report by the Department of Health and Human Services.

The report suggests that an estimated 50,000 fewer patients have died over the past three years due to a variety of factors. Some of the changes that led to fewer avoidable errors include:

  • New financial incentives for keeping patients healthier.
  • Penalties for hospitals who experience excessive remissions.
  • Some health insurers have stopped paying for hospitals’ mistakes.

Another key aspect in reducing preventable errors is through improved sterilization and quarantining techniques. Hospitals reported 1.3 million fewer hospital-acquired infections between 2011-2013. The rate of infection during that period was a 17 percent drop from the rate in 2010. Still though, the numbers are too high, as about 12 percent of all hospitalized patients still experience an “adverse event” during their stay.

The HHS also noted there have been fewer adverse drug events, pressure ulcers and falls over the past four years. The reduction in adverse events saved the healthcare industry $12 billion between 2011 and 2013.

“We made major investments in quality improvements,” said a Centers for Medicare and Medicaid Services senior official on Monday. “We made investments in the research and understanding of patient safety.”

The three-year analysis shows that the healthcare industry is heading in the right direction, as 2013 was safer than the previous two years. About $8 billion of the $12 billion in savings came in 2013 alone. A senior HHS official called the improvements “unprecedented.”

“The improvements we’ve seen in the last two years seem much larger than anything that’s been published by any researchers” during earlier years.

Dr. Silverman comments

Just yesterday I shared a story about confirmation and cognitive bias. Avoidable mistakes occur, but it’s great to hear they are happening at a significantly reduced rate. Doctors and nurses are triple and quadruple checking patient charts, and patient handoffs during shift changes are also improving.

I hope we can continue to build on these positive changes in 2015.

Related source: Washington Post

Preventing Surgical Errors and Cognitive Bias

Medical ErrorsA short while ago the Boston Globe ran a story about Carolina Carcerano, a 74-year-old who went into Tuffs Medical Center for a routine back pain procedure. The operating neurosurgeon requested a special dye to test the location of a tube that had been placed in her spine. The pharmacy didn’t have the specific dye, so they provided a different one.

The neurosurgeon checked the label and saw the name of the dye he expected to see – one that was safe for spine injection – but because of the pharmacy swap, he missed a dye’s label that said it shouldn’t be injected into the spine.

“A mistake was made,” said neurosurgeon Dr. Steven Hwang. “We gave her the wrong dye.’’

Carcerano died the next day.

Cognitive Bias

Thousands of patients are injured each year by “cognitive bias,” defined as when physicians see what they expect to see on medical charts and medication labels, instead of what they actually show.

“[The surgeon] saw what he expected to see and proceeded,” said Dr. Saul Weingart. He said it’s an example of cognitive or “confirmation bias.”

Even more troubling is the fact the some malpractice insurers don’t offer compensation even when an indisputable medical error has occurred.

That was the case in Carcerano’s death, as the malpractice insurer denied that the surgeons and pharmacists were responsible for her death.

“A mistake was admitted, and now they’re saying it’s not their fault,’’ said Carolina’s son Stephen.

Stephen and his brother Michael filed a lawsuit against the hospital, and the insurance company settled after the Boston Globe began asking about the case.

Preventing Errors

After the error Tuffs implemented a variety of hospitalwide improvements to cut down on errors, including requiring caregivers to submit detailed written medication orders to pharmacists and proper patient positioning during intravenous line removal. State investigators said a follow-up investigation showed vast improvements in care.

In addition to hospital improvements, six hospitals have started a pilot program to offer patients and their families who have been harmed by medical errors a swift apology and earlier financial settlements. The program is hoping to determine how earlier resolution impacts patient and family satisfaction.

“You should be able to work out compensation even if there are multiple defendants if there is a clear-cut avoidable injury,’’ said Dr. Alan Woodward, one of the leaders of the pilot program. “It’s morally and ethically the right thing to do.’’

Dr. Silverman comments

This is a sobering take on a challenging problem. Confirmation bias, meaning you see what you expect to see, is unfortunately present in our everyday behavior.

Ascertainment bias is also present and strongly being reinforced in this “teamwork” approach. But this also highlights another problem of the law of unintended consequences. These checks and re-checks in a teamwork approach often lead to a diminution of individual responsibility into collective responsibility.

In collective responsibility, people can become inhibited from speaking up despite all encouragement to do so. For example, in this situation at least three people said this was the right dye to use. How many of the people really read the label before handing the bottle to the nurse who showed the bottle to the doctor?

Related source: Boston Globe