“No Pain, No Gain”

Is Not What We Believe In

When New York Yankees’ superstar Alex Rodriguez was diagnosed with a potentially season-ending labral tear in his right hip before the start of the 2009 Major League Baseball season, many fans and sports reporters doubted that the Yankees were a favorite to win another World Series.

Their outlook changed when Yankees team doctors announced that Rodriguez would undergo hip arthroscopy to repair the injury, giving him an "85 to 90 percent chance'' to return to action.  Six weeks after the surgery that was complemented with Platelet Rich Plasma Therapy treatments (PRP, a holistic approach to speed the regeneration and healing of ligament, tendon and muscular injuries), Rodriguez returned to the line-up and led the Yankees to a World Series championship.

Hip arthroscopy is a minimally-invasive procedure that is also used to repair torn tissue, treat some forms of arthritis and possibly prevent future arthritis.  Arthroscopic surgery uses a pen-shaped instrument with a small video camera attached to the end of it that transmits a three-dimensional view of the surgical field on a high definition monitor, giving the surgeon a clear and unobstructed vision of damaged areas of the joint.  According to James Germano, M.D., South Nassau Communities Hospital’s chief of hip service, hip arthroscopy is easier on the patient than the more invasive open approach, which requires larger incisions.

The arthroscope is a pen-shaped instrument with a very small video camera attached to the end of it that transmits a three-dimensional view of the surgical field on a high definition monitor, giving the surgeon a clear and unobstructed vision of the damaged area.  From this visual advantage, South Nassau’s skilled orthopedic surgeons complete each operation in less than two hours with pencil-thin surgical tools, which require approximately a 1/4-inch incision to be inserted in the joint.  This reduces trauma to surrounding tissues, the loss of blood and post-operative pain.  As a result, patients experience a quicker recovery and a return to daily activities of their choice.

PRP is an innovation from the expanding field of medicine known as orthobiologics, which is developing new techniques that combine the body’s natural ability to heal itself and the use of stem cells and advanced medical technologies to repair and heal orthopedic injuries.  In addition to Mr. Rodriguez, it has been widely reported that PRP was used by Tiger Woods and the New York Mets all-star shortstop Jose Reyes.

PRP is blood plasma with a high concentration of platelets with significant bioactive proteins, which are vital to the repair and regeneration of musculoskeletal soft tissue.  It is extracted by drawing a small amount (approximately 10 ccs) of the patient’s blood into a test tube, which is then put in a centrifuge (lab equipment that spins at a high speed to create centrifugal force) to separate the blood into layers with the blood cells collecting at the bottom and the plasma collecting at the top of the tube.

The plasma and platelets are taken from the test tube, put in a syringe and then injected into the patient’s injured or surgically repaired area.  The bioactive proteins activate tissue recovery, new blood vessel formation, bone regeneration and connective tissue repair.  PRP is safe because the platelet rich plasma is taken from the patient’s blood and adheres to the highest standards of patient safety and sterile technique.  Craig Levitz, MD, chief of orthopedics at South Nassau Communities Hospital, along with other sports medicine specialists at South Nassau, is among the few orthopedists on Long Island to offer PRP.  Dr. Levitz says that age is not a factor in determining if PRP would benefit a patient and it may be used on young athletes or older weekend warriors.

Hip Arthroscopy and PRP are two more examples of how orthopedists at South Nassau’s Center for Advanced Orthopedics and the Long Island Joint Replacement Institute™ (LIJRI) are using minimally invasive surgical techniques and technologies to repair common and serious musculoskeletal injuries.  Musculoskeletal injuries repaired at the Center include knee cartilage and ligaments tears; shoulder instability, impingement, recurrent dislocations and rotator cuff or labrum tears; foot and ankle and hand and upper extremity injuries.  In addition to total knee and hip replacement surgery, LIJRI surgeons perform custom-fitted total joint replacements and partial joint replacement techniques, including Birmingham Hip™ resurfacing and the Uni-Knee™ partial knee replacement.  Orthopedic spine surgeons use a range of surgical approaches to fix painful lower back problems. These approaches include lumbar disc replacement, kyphoplasty, and X STOP.

No pain, no gain -- that’s not we believe in.  South Nassau is committed to employing the advantages of modern surgical techniques and technology to eliminate the painful and often debilitating after effects caused by open surgery.  With that as our commitment, we will continue to research and develop approaches and technology to expand our capabilities in minimally invasive orthopedic surgery.

For more information about the Center for Advanced Orthopedics and LIJRI, please call 1-877-SouthNassau. 

Blood Clots: The Quick & Silent Killer

A blood clot can be a quick and silent killer.Ê It can strike any person, physically fit or unfit, young or old.. ÊA blood clot is a clump of blood cells that may form spontaneously in a blood vessel. It may also be caused by injury, invasive medical procedures, medications or cancer. Blood clots that would not dissolve on their own can block blood flow in arteries, capillaries, and veins located anywhere in the body especially those in the brain, neck heart, lungs, intestines, pelvic area, kidneys, legs and arms.Ê Pain caused by blood clots can be excruciating and is often worse at night making sleep difficult. Ê A blood clot formed in a large vein usually in the leg and sometimes in the pelvic area is called deep vein thrombosis.Ê If blood clots in the leg or other original location travel through the blood stream and lodge for example, in the pulmonary artery to the lungs, then it is called a pulmonary embolism. Blockage of a coronary artery could trigger a fatal heart attack. Blockage of an artery in the neck or brain could trigger a fatal stroke. Blockage of a femoral artery or vein in the leg could cause pain, walking difficulty, neuropathy, infection, decaying toes and tissue death. Blood clots can also cause fatal internal hemorrhage. Blood clots kill three times more Americans each year than cancer does: 1.A million Americans die of heart attacks each year, more than half of them women. (Cholesterol does not kill, but blood clot does) 2.Deep vein thrombosis in legs kills about 200,000 Americans a year.Ê (That is more than death from AIDS and breast cancer combined) 3.Pulmonary embolism kills about 60,000 Americans a year. 4.Strokes (brain attacks) kill 200,000 Americans a year. More millions of Americans have sufferings from blood clots than from cancer.Ê Though a blood clot can be a quick and silent killer, it can also be a slow killer.Ê It can inflict suffering for years and incur great medical expenses.Ê Stroke (brain attack) is the leading cause of disability in America.Ê Stroke is more physically and mentally debilitating than recovered heart attack or cancer in remission. ÊÊA 2003 study reported ÒDementia risk linked to silent strokesÓ.Ê 11 million Americans were estimated to have silent strokes in 2003.Ê Silent stroke is a stroke that causes real brain damage, but does not exhibit the classic symptoms of stroke such as vision changes, speech problems, weakness or paralysis on one side of the body.Ê Inadequate blood flow in the brain is an underlying cause of both stroke and AlzheimerÕs disease. ÊÊÊ17 million Americans knowingly or unknowingly have diabetes.Ê More than 55,000 diabetics have feet amputated each year. Why could many years of good control of diabetes with medications life style and protective foot care not prevent debilitating neuropathy, foot ulcers and decaying toes from occurring or getting worse?Ê What is the underlying cause, diabetes as medically known or blood clots in the legs? ÊÊÊBlood thinners neither dissolve existing blood clots nor improve neuropathy suffering. When blood clot broken up into tiny clots by invasive treatment procedures cluster and block again in the blood steam, sudden heart attack or stroke may result.Ê Blood thinners, though good medicine, also can thin or perhaps corrode walls of blood vessels leading to fatal internal bleeding if not caught early. ÊÊÊPainkillers do not relieve excruciating pain from blood clots.Ê Potential internal bleeding is one of painkillersÕ side effects. ÊÊÊDiagnosing and treating blood clots early will improve quality of life and save lives.Ê Pay close attention to health disorders and seek medical help when necessary. ÊÊÊ Ideally, a medical treatment or combination of treatments should offer: 1. To help dissolve blood clots, improve blood circulation and physical mobility 2. To help restore or alleviate memory loss caused by blood clots in the brain. 3.To not produce undesirable side-effects or risks. 4.To be cost effective. 5.To be taken for months not for years or life. 6.To help lower high blood pressure affected by blood clots. 7.To help lower high cholesterol. 8.To help quickly relieve pains or discomforts caused by blood clots. 9.To help heal or reduce occurrence of neuropathy, ulcers and decaying toes in feet so that amputation would not be necessary.

Additional Data Supporting Carotid Artery Stenting

Carotid artery disease accounts for approximately one third of the 500,000 strokes that occur annually in the United States. Carotid surgery (carotid endarterectomy) has been shown to be beneficial in preventing stroke in asymptomatic patients with an 80% or greater carotid blockage or a greater than 50% stenosis in patient with symptoms of stroke or warning stroke called a Transient Ischemic Attack (TIA). However, carotid surgery is generally performed under general anesthesia, has risks of injury to the nerves of the face, and carries with it a risk of stoke and death within 30 days of the procedure of 6-8%. Since 1994, thousands of patients with carotid disease in the United States have been treated with carotid artery stents (metal mesh tubes) as part of many research trials. Carotid artery stents can be placed under local anesthesia of the groin, in a manner similar to a cardiac catheterization or heart angiogram. No general anesthesia is required and the procedure typically takes approximately one hour, with the patient discharged the following day in most cases. A type of filter basket is used during the procedure to lower the risk of stroke by trapping dislodged particles that would otherwise travel to the brain. In the fall of 2004, the FDA approved the first carotid stent for commercial use in the United States. The ACCULINK STENT, manufactured by the Guidant Corporation was approved for use in patients who were at high risk for carotid surgery. In this population of patients the risks of carotid stenting were approximately half of the risk of carotid surgery. At a recent cardiovascular meeting, data from another trial was presented. In the CAPTURE TRIAL, 1600 patients of all levels of risk were treated with the Acculink stent. The stroke rate for the entire group of patients was 4.1% and compares favorably with prior surgical data for carotid disease. As more data has become available, the likelihood that carotid stenting will replace carotid surgery as the primary means of treating carotid disease has increased.