Physician Assistants

At Direct Orthopedic Care (DOC), located in Boise, Meridian, and Nampa, we have adopted a new innovative orthopedic urgent care model staffed by experienced physician assistants (PA) and sports medicine physicians. DOC is the first adopter of this efficient care model in the Treasure Valley. Direct Orthopedic Care is locally owned and operated by a group of physicians and physician assistants.

Here at Direct Orthopedic Care, there are nine PA’s with a combined 35 years of orthopedic experience. With their surgical and nonsurgical orthopedic experience, they can treat nonsurgical orthopedic injuries. When a patient has a surgical problem, PA’s have direct access to the orthopedic surgeons and sports medicine physicians to schedule the patient within a week of their initial visit. This is the most rapid orthopedic referral system in the Treasure Valley. DOC patients avoid the usual wait time associated with scheduling with an orthopedic surgeon because of this model. Additionally, the PA always has a surgeon available on call to examine the patient if needed. In our orthopedic urgent care model, the PA serves as the primary provider in the practice, while providing the accessibility to a specialist that is not provided in any other clinic in the Boise area.

Another advantage to this model is monetary savings by avoiding and emergency room visit or unnecessary visits from a traditional urgent care. The PA’s are more cost effective for a practice to employ, so they can work extended hours, weekends, and holidays, to provide the greatest access for our patients.

Instead of waiting for a specialist appointment next time you have an orthopedic injury or even chronic pain walk-in to DOC. We are open until 8 PM, 7 days a week with four locations throughout Boise, Meridian, and Nampa.

Smoking and Healing

All our providers at Direct Orthopedic Care recommend patients quit smoking to aid in the healing process. Most patients know about the more talked about effects of smoking such as heart disease and lung cancer, but few know about the significant effects smoking has on their bone health.

There has been significant research supporting superior and earlier healing frequencies in non-smokers. One study showed 95% of non-smokers healed completely where only 68% of smokers healed completely after arthroscopic shoulder surgery. Additionally, the healing time was 2 months longer in the smoking group. Some of the injuries and surgeries that were studied with these outcomes were rotator cuff repairs and tibia fractures. It is also important to note, even after someone quits smoking their outcomes are better than a current smoker but still not as good as someone who has never smoked.

Why does smoking reduce healing?

The primary reason smoking slows healing is because it reduces the blood flow. Nicotine constricts blood vessels by 25%. Blood carries nutrients, minerals, and oxygen throughout the body, because of the constriction caused by nicotine limited amounts of nutrients are delivered to injured areas leading to a slower healing time.

Here at Direct Orthopedic Care, we encourage all patients to quit smoking as soon as possible in order to help with the healing process. Whether a patient has a surgery or is trying to recover after a fracture, patients will have better outcomes if they do not smoke.

Preparing to quit?

Sometimes the hardest part about quitting is making the decision to quit. It is important to pick a quit date, then make sure you purchase any smoking aids you might need as well as disposing of all smoking paraphernalia. Another helpful tool is to make a journal with reasons you want to quit smoking and carry it with you for when you have an urge to smoke. If you have questions about resources to assist in quitting, talk to your primary care provider as soon as possible. 

Arthritis

Background

Arthritis is a condition affecting over 3 million new patients each year, and approximately 23% of adults in Idaho are affected by arthritis.  A common misconception about this condition is that arthritis is one disease when in fact, arthritis is a common symptom of a group of diseases called rheumatic diseases. Arthritis directly means inflammation of the joint. Additional symptoms in the joint include pain, stiffness, and swelling. In some cases, joints are not the only thing affected by these rheumatic diseases, sometimes tendons, muscle or skin are affected.

There are 100’s of types of arthritis that can occur in patients, although only a few are seen by physicians’ day to day. Osteoarthritis also is known as degenerative joint disease is the most commonly seen form of arthritis. It often develops from wear and tear on a joint, and cartilage damage occurs leading to poor function of the joint. Another common type of arthritis is rheumatoid arthritis with is an autoimmune disease where the immune system attacks the synovium in multiple joints.

Arthritis affects people of all ages. In fact, 2/3 of people affected with arthritis are under 65. Even more surprising one in 250 children suffers from an arthritic disorder. Additionally, arthritis is more common in women. Affecting 22.7 million people, arthritis is the leading causes of disability. Unfortunately, there is no cure for arthritis only treatment for symptoms. Early diagnosis is key to helping patients deal with arthritis. A significant number of people confuse arthritis for an injury when they first experience pain, deciding to wait it out before going to see a doctor.

Learning to live with Arthritis

Arthritis has a large impact on a patient’s lifestyle. Individuals will struggle with emotions as people find their new normal because they may need help doing everyday tasks they could do independently before. Generally, patients will slowly adjust to the challenges presented with arthritis.

Due to the lack of a cure for arthritis, it is imperative that patients eat a balanced diet, get adequate sleep, exercise regularly, avoid stress, and stay at a healthy weight. Eventually, most people may need assistive devices or products to help with mobility. Patients should make sure they have access to all resources to help make their lifestyle as enjoyable as possible.

If you are struggling with joint pain, walk-in to DOC to be evaluated!

Sources:

Arthritis. At-a-Glance. Centers for Disease Control and Prevention. Updated 07/22/15.

Viscosupplementation

Here at Direct Orthopedic Care (DOC), many patients come to us as an attempt to avoid surgical intervention. One of the common treatments our providers will suggest before recommending surgery to a patient is viscosupplementation. Many of our patients have never heard of this treatment before having an injection at one of our four locations in the Boise area.  

What is viscosupplementation?

Viscosupplementation often referred to chicken shots or hyaluronate injections are used to treat osteoarthritis in the knee. This gel-like substance is injected into the knee joint; the purpose is the mimic synovial fluid in the knee. When a knee is affected with osteoarthritis the cartilage is damaged and the synovial fluid can’t lubricate the joint.  The viscosupplementation injections contain hyaluronic acid which occurs naturally in synovial fluid, it helps lubricate and reduce friction in the joint.

These injections were first approved for use by the US FDA in 1997. They are to be used after other conservative treatment options are unsuccessful, such as physical therapy, heat and ice applications, anti-inflammatories, or use of steroid injections such as Kenalog. There are multiple makers of these hyaluronic acid treatments. Hyalgan was one of the first injections to be approved, in 1997, it is a series of 5 injections. Euflexxa is a series of 3 injections, approved by the FDA in 2004. One of the newest treatments is one injection approved in 2011, Gel-One.

Will it help my knee pain?

Patients who report success with these injections generally have the greatest relief between two and three months. Most insurance companies allow patients to repeat these injections after six months. Additionally, some insurance companies prefer patients to try a 3 or 5 series before trying a single dose such as Gel-One. But like any course of treatment they do not work for everyone. Research has shown these injections to be most successful when patients are just developing osteoarthritis. Patients who have advanced osteoarthritis may have to look at other options such as knee replacement for relief.

Patients can expect some mild pain, and an uncomfortable feeling once the fluid is injection into the joint. Although some patients experience pain at the injection site, swelling, redness, heat, rash, itching, bruising, or fluid in the injection join. Other rarer side effects include infection, bleeding, or even and allergic reaction.

If you have osteoarthritis and would like to learn more about viscosupplementation come into DOC any day of the week.  

Sources:

Viscosupplementation Treatment for Knee Arthritis. OrthoInfo. American Academy of Orthopaedic Surgeons (AAOS). June 2015.
http://orthoinfo.aaos.org/topic.cfm?topic=a00217

Pain Management

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The largest consumer in the world

Narcotics are not the best or only way to manage pain. Narcotic consumption is exponentially growing in the United States. The US consumes more narcotics than any other county in the world, roughly 99% of the narcotic supply. This alarming statistic contributes to overdose being the leading cause of death for young adults ages 25-45. Most of these users are not buying narcotics on the street but rather obtaining them from family, friends, or physicians.

How can we fix it?

Recent studies show increasing narcotic dosages do not necessarily correlate with pain relief. Although physicians are still caught between the need to help control pain and the risk of over-prescribing narcotics.

More than ever physicians are having to catch on to red flags for narcotic users, such as inordinate quantities, inconsistent intervals, no physical exam, use of street slang, and no logical relationship to the underlying condition. Additionally, it is imperative that physicians document narcotic abuse in chart notes. In Idaho, our physicians have access to the Board of Pharmacy reporting tool. With this tool, physicians can see a complete report on a patients’ medication history. Our physician’s use this tool frequently before prescribing pain medications.

Above all physicians want patients to have adequate pain relief. For this reason, they prescribe pain medications in the postoperative period. To protect patients and their families our providers have strict medication guidelines. It is much harder to control pain after surgery when someone is taking narcotics before surgery because they can have a tolerance built up. If patients continue to have pain after the post-operative period, we will consider a referral to a pain management specialist.

Doing your part

There are multiple tactics patients can use to help with pain relief aside from taking narcotics. Patients must maintain a positive attitude, and partake in relaxation and distraction techniques to calm anxiety. Additionally, patients should continue to do daily exercises in addition to physical therapy appointments. Furthermore, elevating the extremity can help decrease discomfort and swelling.

Most of the information for this blog was from Dr. Travis J. Kemp’s website, tjkempmd.com. 

How To Manage Your Bunion

What is a Bunion?

Bunions are one of the most common disorders of the foot. The symptoms include pain when wearing shoes, a large protruding bone on the inside of the foot, and sometimes numbness in the big toe. A common misconception about bunions is they are a boney growth on the inside of the foot but, instead bunions are a malalignment of the metatarsal in the foot. The x-rays below show a normal foot compared to a bunion malalignment. 

Why do they develop?

There are a couple theories on why bunions form. In most cases, it is due to poor footwear, referred to as an acquired bunion. Approximately 90% of bunion surgeries are in women because of their affinity for heels and tight fitting footwear.

The second formation of bunions is hereditary bunions. Individuals with low arches and flat feet are more prone to bunion formation. Hereditary bunions run in families, and usually become present in teenage years and worsen throughout adulthood.

Treating my bunion

The treatment of a bunion is to relieve pain, not for a cosmetic deformity. If a bunion is not painful there is no reason to have a surgery to correct it. First, someone should try wearing shoes with a wide toe base to minimize pressure over the bunion. Then only if this doesn’t help, surgery could be considered.

Bunion surgery is performed by making an incision through the skin and muscle tissue to the metatarsal bone. Then the tendons are divided, and the protruding edge of the bone resected. After the bone is separated the metatarsal is realigned to the big toe and secured with a screw.

After surgery, follow-up appointments are the key to a successful surgery. At the follow-up appointments the surgeon will inspect the incisions and re-wrap the foot. The most important aspect of a follow up is to make sure the toe and metatarsal are kept in proper alignment. The surgeon will place the patient in a bunion shoe for walking during the eight-week healing period to help protect the progress made from the surgery.

If you are having pain from a bunion. Come into Direct Orthopedic Care (DOC) seven days a week until 8 PM.

PRP

A cheater?


Just before making a re-appearance at The Masters in 2010, Tiger Woods admitted in a press conference that he had undergone Platelet-rich Plasma (PRP) therapy in order to facilitate the healing process and aid with recovery for overuse injuries he had sustained throughout his preparation and career as a golfer. Woods had previously denied ever utilizing “any illegal drug” or human growth hormone throughout his career, but many skeptics still raised their brows at his admittance to this mystery “PRP” therapy he had received. After taking a closer look at what PRP therapy entails, as well as its benefits and indications, we’ll let you be the judge of whether one’s own body can be utilized as a therapeutic method to heal itself.

 

Platelet-rich, what?

Platelet-rich Plasma (PRP) is a new treatment method for a variety of musculoskeletal problems. Originally, PRP was used in maxilla-facial and plastic surgery in the 1990’s to aid with healing after surgery, although it wasn’t widely used because the equipment could cost up to $40,000.  PRP didn’t transition into the realm of orthopedics until the early 2000’s and has since become more affordable for physicians and patients. It has continued to increase in popularity with the above-mentioned athlete, Tiger Woods, as well as Takashi Saito sharing their success stories.

 

Human blood contains a liquid called plasma, as well as solid matter including red cells, white cells, and platelets. The purpose of the platelets in blood is for clotting wounds. Platelets also contain growth factors which also help with recovery and aid in the healing process for wounds and injuries. To create a PRP injection, blood is drawn from the patient and put into a centrifuge so the platelets can be separated and stored. Once the platelets have been removed, the mixture is then injected back into the patient. Some physicians use ultrasound to guide the injection into the site as well as at follow ups to monitor progress and tissue regeneration.

 

So, why does it work?

The theory behind PRP is the concentrated amount of growth factor can potentially increase the healing time. Growth factors are concentrated 3-5 times more in PRP than in a normal blood injection. It is recommended that patients do not use anti-inflammatories while having PRP treatment because medications like Advil decrease the inflammatory response and, in turn, inhibit healing. A mixture of PRP and local anesthetic is injected into an injured area (such as Tiger Wood’s elbow after an overuse injury occurs). It is often noted that the pain to the area may increase initially before tissue generation and healing begins.

 

Where can I use it?

There are a variety of conditions treated with PRP. PRP is the most effective treatment of chronic tendon injuries such as tennis elbow or chronic Achilles tendonitis. Additionally, PRP is used to treat acute ligament and muscle injuries, especially in athletes, arthritis, and recovery after surgery. There is still limited research on the effectiveness of PRP injections, resulting in few insurance companies willing to cover the experimental procedure. Most physicians that use PRP as treatment charge between $500-$1000. Because the treatment is developed from a patient’s own blood the treatment is considered low-risk for a treatment option.