Cortisone is a naturally occurring hormone that your body secretes every day. It helps you regulate reaction to physical and mental stress, and helps to decrease inflammation.

What is a steroid?

Steroids are groups of hormones that include cortisone. Most of the orthopedic injections given today are different types of steroids, but they are still called “cortisone” injections.

Do cortisone shots cause side effects?

When injected into a joint, soft tissues or spinal area, moderate doses of cortisone are safe and will not give you soft bones, high blood pressure, a round face, or make you gain weight. It can increase glucose levels temporarily in diabetics. Four to six cortisone shots per year can be safely given.

How is cortisone given?

Cortisone can be given by mouth or by injection.

Cortisone is given by mouth for asthma, bronchitis, rheumatoid arthritis and other long-term, severe illnesses. When cortisone is given by mouth over long periods of time, side effects can occur.

Injections of cortisone are used to treat arthritis, tendonitis, bursitis, fascitis, and synovitis. Also, soft tissue inflammations are often successfully treated with a shot in the area.

Cortisone shots are given for inflammation, NOT infection. The inflammation may be secondary to osteoarthritis, rheumatoid arthritis, trauma, torn cartilage or other problems.

What should I do after I get a cortisone shot?

After a cortisone shot it is best to:

• Rest the area of infection for a few days even though you feel much better.
• Apply ice to the affected area three times daily for a few days. Cover the ice pack with a towel to prevent ice burns to your skin. Apply the ice for ten minutes each time.
• If you are not taking anti-inflammatory drugs such as Celebrex, Naproxen or Relafen, take two Ecotrin (coated aspirin) twice a day.

In rare instances, more pain can occur after a cortisone injection. This is called a steroid flare or crystal reaction. The good news is that it will be better in 12 to 18 hours.

Booster Shots: The Express Lane

If you don’t get adequate relief in a week, give our office a call and ask about a booster shot. Very often a second shot can solve the problem.

Activities: Motion is Lotion!

Days of inactivity will increase joint stiffness and make it harder to move around. For your knees and hips, several short walks are better than one long walk. An exercise bicycle is good if tension is off and the seat is high. Swimming is one of the best ways to get the exercise you need. In water you can enjoy a pain-free, full-body workout without stress on your sensitive joints or soft tissues.

Medicines

If you are not already taking an anti-inflammatory prescription, we recommend at least two five-grain Ecotrin tablets (easier on the stomach than plain aspirin) three times a day after.

Tylenol is not as effective for inflammation but is a good pain reliever.

Increase Your Bone Density!

Sure, eating bananas is good for osteoarthritis due to the potassium, but did you know magnesium benefits bones, too? One large study published in the American Journal of Clinical Nutrition and using subjects from the Framingham Heart Study found people who ate diets high in potassium and magnesium had higher bone density readings and stronger bones than those who didn’t.

“Magnesium has been known to help alleviate symptoms of arthritis.  But despite that tens of millions of U.S. adults have arthritis, many people are low in magnesium and other important minerals,” says Michele M. Barrett, Executive Director at The Arthritis Research Institute of America. Increasing magnesium intake isn’t difficult since magnesium is in so many foods.

Foods to Eat:

• Nuts
• Sunflower Seeds
• Tofu
• Dairy Products
• Pineapple
• Raisins
• Artichokes
• Avocados
• Okra
• Kidney Beans
• Lima Beans
• Whole Grains
• Green Vegetables
• Bananas and Plantains
• Potatoes

These foods are also rich in potassium and calcium, two other nutrients that along with magnesium work to strengthen and protect bone.

If you are considering taking a supplement, Web MD states the daily recommended allowance for a woman age 31 and over who is not pregnant or breastfeeding is 320 mg/day. Males are 420 mg/day.

AT THE HOSPITAL FOLLOWING SURGERY

Wear the coach button proudly, and know you are appreciated as an important member of our team.

Head Cheerleader:

• Offer support and encouragement. Let them know you are proud of their progress.
• Keep things fun. Play cards, a board game or practice on the putting green.

AT HOME WHILE RECUPERATING

Foods That Help Healing:

• Serve green leafy vegetables, fruits and juice.
• Chicken, fish or steak are fine if served in the appropriate portion.
• Serving favorite foods, in small portions, often work to wake up appetites.

Taking Medications:

• Patient should take pain medications as ordered or, as needed basis.
• Patient’s blood thinner will be ASA or Coumadin. If Coumadin, blood tests need to be ordered.
• Patients should return to preoperative medications unless otherwise ordered.
• Taking a multivitamin should be fine.

Sleep Patterns:

If patient’s sleep pattern is affected, here are a few hints in trying to remedy.

• Limit daytime naps and stay up as late as possible.
• A quiet chat and warm milk may be helpful.
• Sometimes medications promoting sleep may be needed.

Incision Care:

• Patient should take off outer dressing when they get home.
• The white strips will be on for ten days.
• The patient may get the incision wet in ten days, but be sure to pat dry.
• The incision will appear wet and bumpy the first few days. As the stitches on the inside dissolve, the wound will lie flat again.

Resuming Activities:

• Pace activities during the first few days back at home.
• The patient should use a walker or cane until they are confident they can walk without help.
• Increase activities gradually. Go outside and enjoy the weather—or go to places you always enjoy.

Discomfort Management:

• Patient should take pain medication as ordered.
• Elevate the operated hip/knee on three pillows, 30 minutes, twice per day.
• Have the patient do the exercises demonstrated on the take home DVD.

Low Times:

Patients may have moments of feeling low after surgery. If this happens, try to change the mood.

• Laughter can be the best medicine. Try watching a funny movie or listening to music.
• A little pampering could help. Try a massage or a manicure. Your loved one should be back to their self in due time!

“Technological upgrades like electronic medical records were only natural. Yet it’s greatly increased efficiency and saved countless trees,” she said.

Can switching from paper to electronic health records bring better health for patients? One thing’s for sure: the switch will be good for the health of the planet – at least if you believe the results of a new study by California-based health-care giant Kaiser Permanente.

The study showed that electronic medical records could lower carbon dioxide emissions by up to 1.7 million across the U.S. That’s the equivalent of taking 300,000 cars off of U.S. roads, the New York Times reported.

Besides electronic medical records, Murray has implemented behind-the-scenes initiatives aimed at cutting the amount of waste at the practice. This includes reducing wasted energy by adopting certain habits with technology use. The practice sets computers to go to sleep after a period of inactivity, and shuts them down completely at night. All faxes and waste paper are put in locked containers and then a company comes and shreds the documents. The company then takes the shredded paper to a recycling facility.

The Florida Knee and Orthopedic Centers have also recently moved to using digital X-rays. Digital X-rays are better for the environment.  With digital radiography, no chemicals are used to develop film. She has found that each step is small when measured alone, but that they add up to more significant results environmentally and financially.

The Florida Knee and Orthopedic Centers are doing their part to save the planet! Join them by recycling paper, setting your computers to sleep and powering them down at night.

Eat Right for a Fast Recovery

How you treat your body the weeks before and after surgery has a direct effect on how fast you will heal. Now is the time to take a proactive approach and give your body the building blocks it needs for a fast recovery. A little preparation now will make a big difference in your recuperation later. Don’t wait for the surgery to be over, start the healing now.

• Exercise to increase your muscle tone.
• Stop or at least cut back on your smoking.
• Avoid alcohol usage, especially 48 hours prior to surgery.
• Begin your healthy eating plan at least 10 days prior to surgery and continue 10 days after surgery.
• Eat a well-balanced diet rich in iron, vitamin C and calcium.

Why iron and vitamin C are important

Iron is needed to build healthy red blood cells. Vitamin C improves the absorption of iron, that is, vitamin C makes it easier for the iron to get into the body and work efficiently.

During surgery, you are bound to lose a certain amount of blood. Ample levels of iron and vitamin C in your body prior to surgery will help manufacture strong, iron rich red blood cells to replace those lost during the operation. Your doctor may even prescribe additional iron supplements.

Iron rich foods include lean beef, spinach, lima beans, dried peaches, navy beans, soy beans, bran flakes, prune juice, baked potato, cashews, dark poultry, and eggs. Sources of vitamin C include: green peppers, strawberries, cantaloupe, kiwi, grapefruit, broccoli, Brussels sprouts, tomato juice, spinach, kale, cabbage, and oranges.

Myofascial pain syndrome is a condition of the spine characterized by pain coming from muscles and the connective tissues between the muscles. The connective tissues are called fascia. Myofascial pain syndrome can lead to further back and neck problems if left untreated. If serious the Florida Knee and Orthopedic Center can treat myofascial pain with trigger point injections. Trigger point injections are used to break up the most troublesome areas and to decrease pain. A local anesthetic, such as novocaine, is injected into the trigger points. Pain is quickly relieved, allowing trouble spots to be deactivated and treated more easily with physical therapy. Before you try trigger point injections there are a number of things you can do on your own. However, you want to be sure to avoid these five mistakes.

1.     Not recognizing pain that might be myofascial pain syndrome:

People often think their pain is coming from somewhere else such as arthritis, tendinitis, bursitis, etc. Even if you have one of these, the pain could be coming from your muscles. Back, neck, shoulder pain and headaches can all come from trigger points. Trigger points are the painful areas are often felt as tender “knots” in the muscles. When pressed, these areas are exceptionally painful and may even cause pain to shoot down the arms and legs. The knots are called trigger points and are the most difficult areas to stretch. Trigger points can be relieved with simple pressure techniques and gentle movements.

2.      Not realizing you can do something about myofascial pain syndrome:

Many people believe they have to suffer through myofascial pain syndrome, but that’s not true. Gentle exercises and stretching help decrease pain along with eliminating stress from your life. It has also been found that smoking increases myofascial pain syndrome. Poor sleeping patterns must also be corrected. Studies are additionally being done that show positive results with biofeedback.

3.      Believing the muscle is “weak” and trying to strengthen it:

This is a common misunderstanding about muscles. When a muscle is in pain, yes, it does become “weak”. The muscle becomes painfully contracted, and can’t lengthen to its full capacity. When a muscle can’t lengthen to its full capacity, it can’t fully contract, so it appears “weak.” Strength is demonstrated by how well a muscle can contract. To get strength back in a painful muscle, first you must get the tension (i.e. trigger points) to release. Then you need to lengthen the muscle, by having the muscle go through its range of motion. When range of motion is comfortable, and the length of the muscle is restored, the muscle will have the capacity for contraction again, and strength will return. Then you can add strengthening exercises, if you want to. Don’t do strengthening exercises when the muscle is in pain. It will only add contraction and pain to the already painfully contracted muscle.

4.      Stretching too hard:

You’ve learned all about trigger points and you know you need to stretch, but don’t over-do it! Your muscles have learned to be tight, and now they need to learn how to be loose! Stretch too hard and your muscles will rebound and tighten back up and you will end up in more pain. Only allow your muscles to move in a comfortable range of motion and do it throughout the day. If possible, take a hot shower for 10 minutes prior to stretching to loosen the muscles and then keep the muscles warm afterwards

5.      Overdoing it when they are feeling better

Often when people are feeling better they try to take on the world. They clean the house, mow the lawn, paint the bedroom and wash the cars—only to be miserable the next day. Muscles need time to heal. Pain can go away quickly with the right treatment, but it really takes a few weeks of light activity to give your muscles time to regroup. Pamper yourself and stick to the light stretching while your body takes time to heal!

We have more technical information available on myofascial pain syndrome available here on our Web site.

Growing children and adolescents are treated with braces. Surgery is used if the curvature reaches a certain magnitude or if the scoliosis is progressing rapidly. It’s estimated that one in 30 girls has very minor scoliosis, while one in 100 will need treatment with a brace or surgery. It is not known what causes childhood scoliosis, or why girls are more prone.

Logan McGill, 16, opted to wear a cumbersome plastic body brace for 2 years to correct her 39 degree curvature of the spine, it was either that or surgery. Logan is an active runner and swimmer and had to wear the brace 20 hours a day. She’s making a lot of progress, and actually took it off long enough to participate in a charity marathon to benefit scoliosis treatment.

There’s now a growing number of people over 50 with scoliosis due to the wear and tear on their spines. The discs and joints wear out on one side causing the spine to twist and cause a curve. This causes severe back and leg pain. The discomfort is caused partly by the wear and tear on the joints and discs as well as by slumping, which causes the ribs to dig into the pelvis, putting pressure on nerves in the spinal canal. Leg pain is also common, as the nerves are compressed by the spine collapsing or twisting.

Surgery for adolescents with scoliosis is only recommended when their curves are greater than 40 to 45 degrees and continuing to progress, and for most patients with curves that are greater than 50 degrees. Unlike back braces, which do not correct spinal curves already present, surgery can correct curvature by about 50%. Furthermore, surgery prevents further progression of the curve.

There are several approaches to scoliosis surgery, but all use modern instrumentation systems in which hooks and screws are applied to the spine to anchor long rods. The rods are then used to reduce and hold the spine while bone that is added fuses together with existing bone.

Once the bone fuses, the spine does not move and the curve cannot progress. The rods are used as a temporary splint to hold the spine in place while the bone fuses together, and after the spine is fused, the bone (not the rods) holds the spine in place. However, the rods are generally not removed since this is a large surgery and it is not necessary to remove them. Occasionally a rod can irritate the soft tissue around the spine, and if this happens the rod can be removed.

There are two general approaches to the scoliosis surgery – a posterior approach (from the back of the spine) and an anterior approach (from the front of the spine). Specific surgery is recommended based on the type and location of the curve.

Contact the Florida Knee and Orthopedic Centers with offices in Clearwater and Palm Harbor if you suspect you or someone you love may have scoliosis for treatment options.

While recovering at home after minimally invasive Shoulder Replacement, it is important to remember that recovery will move along more smoothly if the home provides a safe haven for recovery.

Here are several tips to help create a safe environment for Small Incision Shoulder Replacment recovery:

Clear pathways

Paths leading into and out of the home as well as to other rooms inside the home should be as free of furniture, clutter, wires and other potential hazards as possible. Things like throw rugs, phone lines, computer cables, and loose carpeting can all cause patients to fall. That is why it is so important to ensure they are out of the way.

Avoid reaching

While recovering at home, patients will benefit by having their dishes, coffee cups, medication, toiletries, clothing and other necessities organized on a counter or elsewhere where they won’t have to reach to get these items. Several organized areas can be created throughout the various rooms in the home.

Get comfortable

Patients should prepare an area in the home where they can spend the majority of their recovery time. This might be a reclining chair or day bed or sofa. Most important is that the space offers comfort and as few distractions as possible. Within this space patients should have easy access to the items they may need during the day, like the television remote control, a phone, books and magazines, reading glasses, tissues, radio, and a waste basket.

Ask for help

Patients that undergo Small Incision Shoulder Replacement should not feel afraid or ashamed to ask family or friends for help during their recovery period. Although quicker than total shoulder replacement surgery, a full recovery from minimally invasive Shoulder Replacement will still take several weeks. During that time, others can help with meal preparation, light housework and errands. They can help patients with their exercises. They can even offer companionship.

Learn how Small Incision Shoulder Replacement helps patients become pain-free faster than traditional shoulder replacement surgery.

It is not clear who will benefit most from taking bisphosphonates, however bisphosphonates users who took the medication regularly for at least six months before knee or hip replacement surgeries were half as likely as non-users to need repeat surgeries after five years. While this study says that we should use it for primary prevention, in the UK, bisphosphonates are increasingly being used when a knee or hip joint replacement has already started to fail.

The study was conducted as follows:

• A team of researchers, led by Professor Nigel Arden at the University of Oxford, set out to test whether bisphosphonate use is related to improved implant survival time.
• Using data from the General Practice Research Database, which contains anonymized data on three million UK primary care patients, they identified all patients over the age of 40 undergoing hip or knee replacement surgery from 1986-2006 for osteoarthritis.
• Patients who were prescribed bisphosphonates at least six months before revision surgery were defined as bisphosphonate users. Non-users were defined as those who were never prescribed bisphosphonates or who had their first prescription after revision surgery.
• Factors that could affect the results, such as age, sex, body mass index (BMI), smoking status, alcohol intake, use of calcium and vitamin D supplements, and previous fractures were also taken into account.
• Patients were tracked for a maximum of 15 years after their operation to calculate the rate of revision surgery.
• Bisphosphonate users had a lower rate of revision rate at five years than non-users. Bisphosphonate use was associated with an almost twofold increase in implant survival time.
• The researchers estimate that, for every 107 joint replacement patients taking bisphosphonates, one revision operation would be avoided.
• And they suggest that the results could be due to bisphosphonate therapy suppressing the long term inflammatory response around the implant after surgery that often leads to bone loss and loosening of the implant.
• Further studies are needed to confirm these findings, write the authors. However, they say that the protective effect of bisphosphonates seen in this study can be assumed to be valid for the wider population of patients undergoing total hip or knee replacement in the UK.

More than 700,000 hip and knee replacement surgeries are performed each year in the US and this number is projected to double in the next decade, according to the American Academy of Orthopaedic Surgeons (AAOS). More than 9 out of 10 joint replacement surgeries are in patients with osteoarthritis, and age and obesity and major factors for developing severe osteoarthritis. Arden’s study is the first to follow patients over time and record their outcomes; it shows that bone loss drugs may increase the longevity of replaced joints. As more practices adopt this research the number of repeat surgeries will be limited.

While recovering at home after minimally invasive Shoulder Resurfacing, it is important to remember that recovery will move along more smoothly if the home provides a safe haven for recovery.

Here are several tips to help create a safe environment for Small Incision Shoulder Resurfacing recovery:

Clear pathways

Paths leading into and out of the home as well as to other rooms inside the home should be as free of furniture, clutter, wires and other potential hazards as possible. Things like throw rugs, phone lines, computer cables, and loose carpeting can all cause patients to fall. That is why it is so important to ensure they are out of the way.

Avoid reaching

While recovering at home, patients will benefit by having their dishes, coffee cups, medication, toiletries, clothing and other necessities organized on a counter or elsewhere where they won’t have to reach to get these items. Several organized areas can be created throughout the various rooms in the home.

Get comfortable

Patients should prepare an area in the home where they can spend the majority of their recovery time. This might be a reclining chair or day bed or sofa. Most important is that the space offers comfort and as few distractions as possible. Within this space patients should have easy access to the items they may need during the day, like the television remote control, a phone, books and magazines, reading glasses, tissues, radio, and a waste basket.

Ask for help

Patients that undergo Small Incision Shoulder Resurfacing should not feel afraid or ashamed to ask family or friends for help during their recovery period. Although quicker than total shoulder replacement surgery, a full recovery from minimally invasive Shoulder Resurfacing will still take several weeks. During that time, others can help with meal preparation, light housework and errands. They can help patients with their exercises. They can even offer companionship.

Learn how Small Incision Shoulder Resurfacing helps patients become pain-free faster than traditional shoulder replacement surgery.