This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.
It would be very unlikely to find a person whose life has not been affected by someone with Alzheimer’s disease (AD). AD is one form of dementia. Currently, more than 4 million people in the USA have AD. One in ten people (10 percent) age 65 and older has Alzheimer's disease. About one-third of people age 85 and older (32 percent) have Alzheimer's disease. The risk increases with age and family history for the disease.
Important new research has shown that there is another potential cause for AD and treatment trials have been very promising. There is a growing body of scientific evidence that the bacteria (P. gingivalis) most commonly associated with chronic gum (periodontal) disease, can infect the brain and may have a role as a cause of Alzheimer’s.
The Greater Boston Physicians for Social Responsibility and the Science and Environmental Health Network offer the following guidelines to reduce the Risk of Developing AD:
Medical Contributor: Mario Cornacchione, MD is the Assistant Chair of Family Medicine, Associate Professor of Family Medicine at Geisinger Commonwealth School of Medicine. Dr. Cornacchione is the Research Director at the NEPA Memory & Alzheimer’s Center where he is the principal investigator on the clinical trials studying new medications for the treatment of Alzheimer’s disease.
NEPA Memory & Alzheimer’s Center is recruiting subjects who are 55 to 80 years old with a documented diagnosis of mild to moderate Alzheimer’s, among other criteria to participate in the GAIN (GingipAIN Inhibitor for Treatment of Alzheimer’s Disease) Trial.
To learn more, contact: NEPA Memory & Alzheimer’s Center 220 S. River St. Plains, PA 18705, 570-262-0664 or visit www.GainTrial.com.
Sources: The HealthCentralNetwork, Inc; GainTrial; NEPA Memory & Alzheimer’s Center
Read Dr. Mackarey’s Health & Exercise Forum – Every Monday : .This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.
Medical Contributor: Mario Cornacchione, MD is the Assistant Chair of Family Medicine, Associate Professor of Family Medicine at Geisinger Commonwealth School of Medicine. Dr. Cornacchione is the Research Director at the NEPA Memory & Alzheimer’s Center where he is the principal investigator on the clinical trials studying new medications for the treatment of Alzheimer’s disease.
It would be very unlikely to find a person whose life has not been affected by someone with Alzheimer’s disease (AD). AD is one form of dementia. Currently, more than 4 million people in the USA have AD. One in ten people (10 percent) age 65 and older has Alzheimer's disease. About one-third of people age 85 and older (32 percent) have Alzheimer's disease. The risk increases with age and family history for the disease.
Important new research has shown that there is another potential cause for AD and treatment trials have been very promising. There is a growing body of scientific evidence that the bacteria (P. gingivalis) most commonly associated with chronic gum (periodontal) disease, can infect the brain and may have a role as a cause of Alzheimer’s.
The study is evaluating whether an oral investigational medicine, (COR388) can slow or halt the progression of Alzheimer’s by inactivating the toxic proteins, (gingipains released by P. gingivalis) that have been shown in animal studies to damage and destroy brain cells.
Dr. Cornacchione is the Research Director at the NEPA Memory & Alzheimer’s Center where he is the principal investigator on the clinical trials studying new medications for the treatment of Alzheimer’s disease. The center has been selected as 1 of 100 research sites participating in this large international clinical trial to test a dramatically new way of understanding and treating Alzheimer’s disease.
The study drug, COR388, was designed by pharmaceutical company Cortexyme to inactivate the toxic gingipains created by the P. gingivalis bacteria, reduce inflammation, reduce the bacterial infection and slow or halt progression of Alzheimer’s disease. An earlier small clinical study showed COR388 was well-tolerated, with a promising trend of average improvement in the memory test performance for the Alzheimer’s patients in the study who took the drug compared to placebo.
Alzheimer’s Disease (AD) is a progressive degenerative disease of the brain that affects memory and thought process. Memory impairment is the hallmark of this disease. Also, those suffering from AD present changes with the following: language, decision-making, judgment, attention, and other personality or aspects of mental function. AD progresses differently in each case.
Two types of AD have been identified, early onset and late onset. In early onset, symptoms appear before the age of 60 and progresses very rapidly. It accounts for 5-10% of all cases. Autosomal dominant inherited mutations have been found in early onset AD.
The cause of AD is not completely understood, however, most experts agree that both genetic and environmental factors are involved. It is important to rule out other medical causes before a final diagnosis of AD can be made. Only a post-mortem microscopic examination of brain tissue can confirm the diagnosis. Structural and chemical parts of the brain disconnect as the brain tissue shows twisted fragments of protein that clogs up the nerve. Clusters of dead and dying nerve cells block the transmission of information and communication from one nerve cell to the next. AD causes a disconnection of areas of the brain that normally work together.
Consider Participating in the GAIN Trial
GAIN is a clinical trial evaluating whether an investigational oral drug is safe and can halt the progression of Alzheimer’s disease by reducing the damage caused by bacteria in the brain. Eligible study participants are being recruited at study sites around the country.
A Revolutionary New Approach to Understanding Alzheimer’s
The GAIN Trial is based on the growing body of scientific evidence that the bacteria P. gingivalis, commonly associated with gum disease, can infect the brain and cause Alzheimer’s disease. COR388 is an investigational drug designed to inactivate toxic proteins released by the bacteria and stop or slow further damage to healthy brain cells. A study of COR388 in a small group of Alzheimer’s patients has shown promise in improving memory.
You or a loved one may be eligible for the study if you:
The GAIN (GingipAIN Inhibitor for Treatment of Alzheimer’s Disease) Trial is based on a growing body of scientific evidence that the bacteria P. gingivalis, most commonly associated with degenerative gum disease, can infect the brain and cause Alzheimer’s disease.
This clinical trial will evaluate whether the investigational oral drug COR388 is safe and can slow or halt the progression of Alzheimer’s disease by inactivating the toxic proteins, called gingipains, released by the bacteria and stop or slow further damage to healthy brain cells.
The GAIN Trial is looking to enroll more than 500 participants with mild to moderate Alzheimer’s disease at more than 90 clinical trial centers in the United States and Europe.
With a lack of effective long-term treatments, researchers are working hard to find new and better approaches for slowing the progression of Alzheimer’s disease. Advances in treatment are only possible through clinical research and trials like GAIN. A clinical trial is a medical research study to explore whether an investigational drug is safe and effective for humans. These trials follow strict scientific standards and regulatory requirements to protect patients and help produce reliable results.
A clinical trial may find that a new intervention improves patient outcomes, offers no benefit or causes unexpected harm. All of these results are important because they advance medical knowledge and help improve patient care. Study physicians will review risks and potential benefits with patients and their caregivers before patients are enrolled in the GAIN Trial. All new drug candidates like COR388 are studied in clinical trials to generate data that can be evaluated by the US Food and Drug Administration (FDA) and other regulators for safety and effectiveness before being approved for common use.
NEPA Memory & Alzheimer’s Center is recruiting subjects who are 55 to 80 years old with a documented diagnosis of mild to moderate Alzheimer’s, among other criteria to participate in the GAIN (GingipAIN Inhibitor for Treatment of Alzheimer’s Disease) Trial.
To learn more, contact: NEPA Memory & Alzheimer’s Center 220 S. River St. Plains, PA 18705, 570-262-0664 or visit www.GainTrial.com.
Sources: The HealthCentralNetwork, Inc; GainTrial; NEPA Memory & Alzheimer’s Center
Read Dr. Mackarey’s Health & Exercise Forum – Every Monday : Next Week Read Alzheimer’s Part II of II – “Reducing the Risk of Alzheimer’s Disease.” This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
…and is the framework for positive social evolution!
As many of you may know, I love to travel. Also, I am a Charles Darwin enthusiast, as it provides for me, a logical framework for life…physically and socially. My wife, Esther, and I just returned from a trip to the Galapagos Islands in January. In addition to the beauty of the people, islands, plants, animals and birds, it was inspiring!
For 100 years Darwin’s THEORY of evolution was the source of great controversy and dissention. However it is important to remember, in 1959, upon the discovery of DNA by Watson and Crick, the THEORY has been proven to be scientific FACT…as much as we have come to accept Galileo’s scientific principles, that the earth is not the center of the universe.
Last year, the scientific community proudly marks the 160th anniversary of the publication of The Origin of Species. Born on February 12, 1809, in the small town of Shrewsbury, England, Charles Darwin circumnavigated the globe on the HMS Beagle at the young age of 22to make keen observations and document findings in unparalleled detail. He spent the next three decades analyzing his data to support a thesis and published his findings in arguably the most controversial book ever written.
In medicine, the possibilities are unlimited. “His central idea, the simplicity of which is exceeded only byits stunning profundity, would shake social convention.His insights and clear unassuming prose would bringorder to the chaos of biology, expose the mechanisms that underpinlife's diversity, and illuminate the origins of our species,” according to James Evans, MD, PhD, The Journal of the American Medical Association, 2009 on the 150th anniversary.
The growing field of genetics supports this claim. According to geneticist Theodosius Dobzhansky, "Nothing in biology makes sense except in the light of evolution." He purports that if evolutionary biology is the foundation for biology and biology is the foundation of medicine, than the two must coexist if one is to discover the true cause of a disease. Darwin’s impact on contemporary medicine is far reaching and is predicted to have an even more powerful impact in the future.
Social evolution has also demonstrated similar profound enlightenments based on the scientific evidence for evolution and DNA. In simple terms, we must adapt to change in order to survive and thrive. This is just as true socially as it is physically. Two, there is only ONE race…the human race. Evolution and DNA have proven this to be fact. Regardless of the color of your skin (which adapted to change over time based on environmental need), the god or gods you worship, the food you eat or the place you live, we all share the same DNA. Remember, to be different is not bad, in fact, it may allow you to thrive and survive!
Others in medicine offer another perspective to support Dawin’s influence in patient care. William Meller, MD, author of Evolution Rx, states that in spite of our anxiety about healthy foods, toxins in the environment and prolific diseases such as cancer, human beings were designed to heal. He feels that this is supported by a million years of evolution and natural selection that has influenced us to be powerful, healthy and self-healing. In spite of germs, toxins, and pollution we continue to thrive. Today, there are 80,000 centenarians in the United States and it is expected that by 2050 there will be 800,000.
However, if your gene pool is questionable like most of us, don’t use that as an excuse. There are things you can do to live longer and healthier.
10 Healthy Habits to Improve Your Chances of Living to be 100 Years Old
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well!
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
Ankle swelling is a common symptom that occurs when your body retains fluid in the lower legs, ankles and feet. Most people have experienced it at some point in their lives and it often resolves on its own with elevation and muscle movement. While it is usually benign and occurs on both sides of the body, in some instances immediate medical attention is required. The most common causes of ankle swelling are:
Prolonged Positions – you have probably noticed swelling in your ankles and feet after a long trip by plane or car. Some may also experience symptoms after a long day at work sitting or standing in one position for an extended period of time. It may be the most common cause of lower leg swelling and easiest to resolve.
Diet- excessive salt in your diet is associated with swelling in the lower legs, especially when associated with other risk factors for swelling such as organ function or obesity.
Varicose Veins – when the valves in the blood vessels which carry blood from the legs back to the heart are damaged, blood and fluid can collect in the lower legs. Prolonged standing or sitting without intermittent movement will worsen the condition.
Pregnancy – during pregnancy, the body retains more fluids than usual and most women experience some form of swelling in the lower legs, ankles and feet.
Medications – certain drugs can cause fluid retention in the lower legs such as: anti-inflammatory medications, steroids, diabetes medications, antidepressants and cardiac medications.
Blood Clots – blockages in the blood vessels of the lower leg can limit the movement of fluid from the legs back to the heart. It is often present in only one leg and associated with warmth, pain, and cramping. It is a serious condition and requires immediate medical attention.
Trauma/Infection – after a trauma or injury such as an ankle sprain, bruise or fracture, the damaged tissue leaks fluid surrounding the affected area. Also, when a specific area of the lower leg becomes infected, as in the case of a cut or splinter in the ankle or foot that has not healed properly, swelling occurs in the surrounding tissues. These situations are often associated with warmth, pain and limited to the side of the injury. Treatment to injured tissues and the infection is required.
Lymphedema – swelling in the lower leg can occur when there is a blockage in the lymphatic system or when lymph nodes are removed in surgery for cancer. Medications, massage, compression garments, and elevation, can address the symptoms.
Diseases – such as those of the kidney, heart, and liver are associated with swelling in the lower legs.
Obesity – swelling in the tissues of the legs, ankles and feet occurs due to excessive weight placed on these tissues and adipose tissue in the abdomen compressing blood vessels which enter the lower body. Obesity is one of the most common causes of lower leg swelling and it complicates all of the aforementioned conditions associated with swelling in the legs.
Change Positions – on a long plane ride or sitting all day at school or work – get up and walk around every 30-45 minutes. Set a timer on your phone to remind you.
Exercise – regular exercise keeps the muscles and blood vessels in your lower extremities healthier. Also, intermittent movement of the leg muscles throughout the day, even when sitting, serve to prevent swelling. Try ankle pumps and toe curls.
Elevation – when sitting or lying down, try elevating your ankles and feet on a pillow to allow gravity to assist fluid movement in your legs.
Low-Sodium Diet – read the labels on your food and you will be shocked by how much sodium is in most foods, especially canned soups and vegetables. But, there are low-sodium options and don’t add more salt to your food.
Weight Loss – maintaining a healthy BMI is the single best thing you can do, not only for lower leg swelling, but for your overall health and wellness.
Compression Socks – for most people, over-the-counter compression socks will adequately prevent fluid retention in the lower legs. For comfort, begin with the lightest compression possible. 12-15 or 15-20 mm of mercury is a good start and put them on as soon as you get up in the morning, before swelling begins.
Sources: WebMD and Cleveland Clinic
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.
THE MAKO ROBOTIC ASSISTED DEVICE
This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.
GUEST AUTHOR: JOHN MERCURI, MD, MA; Orthopedic Surgery - Adult Reconstruction; Geisinger Orthopaedics and Sports Medicine; Clinical Assistant Professor at Geisinger Commonwealth School of Medicine
According to John Mercuri, MD, a local orthopedic surgeon specializing in joint replacement and certified MAKO Robotic Assisted Hip & Knee Replacement surgeon, there are new advances in hip & knee replacement surgery which offers significant benefits to the patients of Northeastern Pennsylvania
WHAT IS ROBOTIC ASSISTED JOINT REPLACEMENT SURGERY?
In the past few years you may have heard or read about the relatively new concept of “robotic surgery.” Often, people get the wrong impression and think that the surgery is performed by a robot in place of a surgeon. But in fact, a surgeon performs the procedure, with the assistance of a robot.
In 2000, the Food and Drug Administration approved the da Vinci Surgical System, the first widely used surgical robot in the United States. Named after the famous inventor who tirelessly studied human anatomy, the device is designed to facilitate surgery using a minimally invasive approach while the surgeon operates from a console. The da Vinci has been successfully used on prostate, cardiac and gynecological surgeries and continues to offer many advantages to surgery.
In 2006, another robotic system was launched specifically for orthopedic surgery. It is called the MAKO Robotic Arm Interactive Orthopaedic System, and it is currently owned by Stryker Corporation. It was initially used to perform a partial knee replacement, but has since been used for more than 83,000 total hip and knee replacements with 980 active surgeon users.
The MAKO system involves the use of a CT scan before surgery to create a 3-D virtual model of the unique anatomy of the joint. The model is programmed into the MAKO system software and used by the surgeon to help customize a joint replacement specifically designed for the patient’s unique anatomy.
During surgery, the surgeon uses the MAKO system to tweak the plan and perform the surgery. Using the predefined area set by the CT scan, the surgeon guides the robotic arm to remove the arthritic portions of bone and cartilage and then the surgeon uses the robot to insert a custom-fit and aligned partial or total implant. The robotic system helps the surgeon stay inside the planned boundaries to provide 99 percent accuracy and alignment of the new joint.
Locally, John J. Mercuri, MD, orthopedic surgeon at Geisinger Orthopedics and Sports Medicine, is trained and certified to use the MAKO system. He performs hip and knee replacements at Geisinger Community Medical Center and uses the MAKO system whenever appropriate. He feels that robotic technology can help eliminate some of the common problems associated with joint replacements including dislocations, instability, and implant failures. It can also help the surgeon perform a more efficient, faster, and less invasive surgery.
Last week, we interviewed Bob from West Mountain who shared his MAKO success story. His second knee was replaced using MAKO 6 months ago and he boasts that he is functioning at 90%.
TRADITIONAL VS. ROBOTIC ASSISTED JOINT ARTHROPLASTY (REPLACEMENT)
Traditional Joint Replacement
By surgically replacing the arthritic ends of bones with metal and plastic components, a hip or knee replacement creates new surfaces to allow a joint to function like a natural joint without the pain and restriction of a damaged, degenerative arthritic hip or knee.
A total hip or knee replacement (THR or TKR), also called a total hip or knee arthroplasty (THA or TKA), resurfaces the compartments of the hip or knee joint while attempting to preserve most of the surrounding supporting soft tissues. In the knee, a total joint replacement is required if cartilage (thick cushion covering ends of bones) in all three compartments is damaged/worn away resulting in arthritis. For those with arthritis and degeneration in only one compartment, usually the medial or inside compartment, a partial knee replacement, also called a unicompartment knee arthroplasy (UKA) may be a better choice, especially for those who are relatively young and active.
Traditional joint replacements have held up to the test of time. Copious amounts of research support their effectiveness, and many studies show that 80-90% of total knee replacements last at least 20 years (and even longer for hip replacements).
However, there are a variety of reasons that a joint replacement may not last as planned. Revision surgery to correct the problem can be complicated and have a lengthy recovery process. Fortunately, new robotic technologies can help eliminate some of the problems that lead to early revision surgery.
Robotic Joint Replacement
Robotic assisted joint replacement begins with a CT scan of the effected joint. Using the predefined area set by the scan, the surgeon guides the robotic arm to remove the arthritic portions of bone and cartilage, and then the surgeon uses the robot to insert the implants in a very precise position. The robotic system helps the surgeon stay inside the planned boundaries to provide 99 percent accuracy and alignment of the new joint.
Historically, some of the leading experts in knee replacement surgery realized that misalignment or instability of a knee replacement can lead to early failure rates. More recent research on hip replacement has shown that incorrectly placed components can lead to dislocation of the hip and early failure of the joint. It is based on this premise that robotic assisted joint replacements have been developed. They use technology to assist in better implant placement to minimize complications and increase implant longevity.
According to American Academy of Orthopaedic Surgeons (AAOS), “preliminary data show robotic-arm assisted TKA is safe and effective, with outcomes comparable to, if not better than, those of manually-instrumented TKA.”
Qualifications for a Robotic Assist
The qualifications for a robotic are the same as a traditional TKA in terms of pain with loss of function. However, robotic surgery may be especially beneficial for patients with congenital joint problems, someone who has had prior surgery in the joint, patients who have had a traumatic injury to the joint, or patients who have spine arthritis but also need joint replacement. Regardless of whether you have a joint replacement with or without a robot, there are multiple factors that are used to determine whether surgery is safe for you including your medical history and your current overall health.
Advantages of a Robotic Assist
When appropriate patients are selected and proper surgical technique performed, several studies have determined that the robotic assist is a viable and successful option. One study found as many as 92% of robotic assist patients had excellent or good outcomes. Additionally, the study found a 96% implant longevity rate with patients reporting a more natural and quieter knee, especially in those patients suffering from bone deformities or previous traumas to the joint. Other studies found that the potential advantages are many:
Complications of Robotic joint replacement surgery
While less frequent, robotic complications are similar to those found in traditional joint replacements. Those complications most commonly include infections, blood clots, and fractures. However, robotic surgery is unique in that there is the possibility of a complication related to the placement of metal pins into your bone during the surgery. These metal pins are necessary for the robot to “see” where your bones are during the surgical procedure.
In summary, while the idea of getting a joint replacement (robotic or traditional) is intimidating, it is one of the safest and most effective medical procedures! The fact that the robotic technology can further advance an already successful operation is very exciting! Discuss which option is best for you with your orthopaedic surgeon. NEPA is fortunate to have many highly skilled and experienced board- certified orthopedic surgeons successfully performing joint replacements daily. For more information, and to find out who is performing robotic assisted joint replacements in your area, visit our source for this column, the American Academy of Orthopaedic Surgeons website: www.aaos.org
SOURCES: Rothman Institute, Philadelphia, PA; American Academy of Orthopaedic Surgeons, Stryker Corporation, Geisinger Orthopedics and Sports Medicine
For More Information: aaos.com; stryker.com; YouTube MAKO Robotic Joint Replacement
Medical Contributor: John J Mercuri, MD, MA; Orthopedic Surgery - Adult Reconstruction; Geisinger Orthopaedics and Sports Medicine; Clinical Assistant Professor at Geisinger Commonwealth School of Medicine
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
DO YOU NEED A NEW HIP OR KNEE?
This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.
There is good news for those in need of a hip or knee replacement today! Recent advances have ushered in a new era of joint replacement for patients in Northeastern Pennsylvania.
Recent studies conclude that hip and knee replacement surgery has had a very positive impact on lifestyle and overall health benefits for more than 7 million people in the United States that have had a hip or knee joint replaced. In view of this, it is predicted that this number will increase substantially with the aging baby boomer population.
Health & Exercise Forum has dedicated three weeks to the topic of “Hip and Knee Replacement Updates.” Last week, Part I discussed hip and knee arthritis and treatment options, including knee replacement. This week, Part II will offer a self-assessment to determine if you are ready or eligible for a new hip or knee. Next week, Part III will present the benefits and complications of a new hip or knee and will specifically discuss a new option in hip and knee replacement surgery – MAKO Robotic Assisted Joint Replacement.
I had the opportunity to meet with a local man named Bob, who had MAKO Robotic Assisted Knee Replacement. The interview, along with more detailed information from an in-house article from geisinger.org provided sage insight from a patient’s perspective.
Bob, from West Mountain, is a “poster child” for MAKO. He is 67 years old engineer and suffered from pain, stiffness and weakness in both knees from advanced arthritis. He had difficulty walking around his work facility as well as leisurely activities with his friends and family. He relied on nonsteroidal anti-inflammatory drugs and other conservative measures while he researched his best surgical option. Ultimately, he decided to see Dr. John Mercuri, a fellowship-trained orthopaedic surgeon specializing in hip and knee replacements and is certified in MAKO robotic assisted joint replacement.
Bob had one knee replaced and three months later the other using MAKO. Bob credits the same-day-surgery and robotic approach for his ability to accelerate his rehab and return to normal activities such as returning to the gym in 10 days. Bob says, “I have a lot to do in life…hunt fish, get out in nature and enjoy the world!
Bob used the Lower Extremity Functional Score (LEFS) to indicate his functional levels:
WHO IS ELIGIBLE FOR A NEW HIP OR KNEE?
Hip and Knee joint replacement is recommended for chronic, disabling arthritic joint pain not responding to conservative management such as: non-steroidal anti-inflammatories, Tylenol, physical therapy, weight loss, activity modification, assistive devices, steroid injections, or tramadol. Most surgical patients are between the ages of 50 and 80, but joint replacements have been performed successfully in patients of all ages. Common physical activities such as bicycling, swimming, golfing & walking are almost always allowed following surgery. Today, with recent advances, the options continue to improve.
NEW RESEARCH – FINDS THOSE WHO WAIT TOO LONG FOR NEW HIP OR KNEE SUFFER OTHER HEALTH PROBLEMS
New research shows that those who suffer from hip or knee pain due to arthritis for an extended period of time may be doing a great disservice to their overall health and well-being. The results showed that over time those suffering from advanced arthritis of the hip or knee lose their ability to walk more than 1-2 blocks or climb stairs without severe pain. Also, they are unable to use a treadmill, bike, elliptical or stepper for aerobic exercise. As a result of this inactivity, they gain a significant amount of weight and are unable to enjoy traveling or doing things with their family due to the inability to walk. In addition to weight gain, a sedentary lifestyle leads to high blood pressure and sleep apnea. Over time, it is likely to lead to coronary artery disease and adult onset diabetes. Consequently, the arthritic pain in the knee can contribute to many health issues.
While surgery should never be taken lightly and is always the last option, sometimes it is the best choice.
How Do You Know if You’re Ready For A New Hip or Knee? Take the Test!
Score each question below as follows:
| POINT SCALE | |
| Extreme Difficulty or Unable to Perform = | 0 points |
| Quite a Bit of Difficulty = | 1 point |
| Moderate Difficulty = | 2 points |
| A Little Bit of Difficulty = | 3 points |
| No Difficulty = | 4 points |
| ACTIVITIES | |
| Usual work, housework, daily activities | Score _______ |
| Hobbies, recreational activities, sports | Score _______ |
| Safely get in and out of a bathtub | Score _______ |
| Walking between rooms | Score _______ |
| Putting on shoes and socks | Score _______ |
| Squatting | Score _______ |
| Lifting objects (like a bag of groceries) from the floor | Score _______ |
| Performing light daily activities at home | Score _______ |
| Performing heavy activities at home | Score _______ |
| Getting in or out of a car | Score _______ |
| Walking 2 blocks | Score _______ |
| Walking a mile | Score _______ |
| Going up or down 10 stairs | Score _______ |
| Standing for one hour | Score _______ |
| Sitting for one hour | Score _______ |
| Running or walking fast on even ground | Score _______ |
| Running or walking fast on uneven ground | Score _______ |
| Making sharp turns while walking fast | Score _______ |
| Hopping or a skip step | Score _______ |
| Rolling or turning in bed | Score _______ |
| TOTAL SCORE: | __________/80 |
Scoring: The higher the score the more functional you are and less likely to need surgery for a new knee. For example, 80 out of 80 total points is normal. 60 and above is fairly functional. 40 to 50 points is a danger zone and below 40 you might start talking to your doctor about a surgery. Your orthopedic surgeon will help you decide if a hip or knee replacement is best for you. Next week in “Health & Exercise Forum” read about the MAKO robotic assisted hip and knee replacement.
SOURCES: Rothman Institute, Philadelphia, PA; American Academy of Orthopaedic Surgeons, Stryker Corporation, Geisinger Orthopedics and Sports Medicine
For More Information: aaos.com; stryker.com; YouTube MAKO Robotic Joint Replacement
Medical Contributor: John J Mercuri, MD, MA; Orthopedic Surgery - Adult Reconstruction; Geisinger Orthopaedics and Sports Medicine; Clinical Assistant Professor at Geisinger Commonwealth School of Medicine.
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: Part II of III on “Hip & Knee Replacement Updates.”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM..
HIP & KNEE REPLACEMENT UPDATES: IMPORTANT NEW OPTIONS AVAILABLE
This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.
There is good news for those in need of a hip or knee replacement today! Recent advances have ushered in a new era of joint replacement for patients in Northeastern Pennsylvania.
Recent studies conclude that hip and knee replacement surgery has had a very positive impact on lifestyle and overall health benefits for more than 7 million people in the United States that have had a hip or knee joint replaced. In view of this, it is predicted that this number will increase substantially with the aging baby boomer population.
Health & Exercise Forum will dedicate the next three weeks to the topic of “Hip and Knee Replacement Updates.” Part I will discuss hip and knee arthritis and treatment options, including knee replacement. Part II will offer a self-assessment to determine if you are ready or eligible for a new hip or knee. Part III will present the benefits and complications of a new hip or knee and will specifically discuss a new option in hip and knee replacement surgery – MAKO Robotic Assisted Joint Replacement.
ARTHRITIS OF THE HIP OR KNEE
I have been advising my patients to exercise, keep active, and walk as long as they can in order to stay mobile and healthy. However, seniors often tell me activities that require prolonged walking are limited by hip or knee pain from arthritis. They often ask, “What is arthritis?” How does it happen? What can I do about it? I will attempt to answer these questions, however, keep in mind that having hip or knee joint arthritis is not a death sentence to an active lifestyle.
Your family physician will examine your knee to determine if you have arthritis. In more advanced cases you may be referred to an orthopedic surgeon or rheumatologist for further examination and treatment. X-rays will show if the joint space between the bones in the joint is getting narrow from wear and tear arthritis. If rheumatoid arthritis is suspected, blood tests and an MRI may be ordered. The diagnosis will determine if your problem is mild, moderate or severe.
In the early stages, your treatment will be a conservative, nonsurgical approach, which may include; anti-inflammatory medication, orthopedic physical therapy, exercise, activity modifications, supplements, bracing, etc. You along with your family physician, orthopedic surgeon or rheumatologist will decide which choices are best.
John J Mercuri, MD, MA; Orthopedic Surgeon at Geisinger Orthopedics and Sports Medicine in Scranton, recommends the Clinical Practice Guidelines from the American Academy of Orthopedic Surgeons (AAOS) for interventions based on the supporting literature for treatment efficacy:
The following interventions, while often used and may not be harmful, are NOT supported in the literature for treatment efficacy:
When conservative measures no longer succeed in controlling pain and deformity or improving strength and function, then more aggressive treatment may be necessary.
SOURCES: Rothman Institute, Philadelphia, PA; American Academy of Orthopaedic Surgeons (AAOS), Stryker Corporation, Geisinger Orthopedics and Sports Medicine
For More Information: aaos.com; stryker.com; YouTube: “MAKO Robotic Joint Replacement.”
Medical Contributor: John J Mercuri, MD, MA; Orthopedic Surgery - Adult Reconstruction; Geisinger Orthopaedics and Sports Medicine; Clinical Assistant Professor at Geisinger Commonwealth School of Medicine
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: Part II of III on “Hip & Knee Replacement Updates.”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
A Clear Vision For 2020!
New Year’s Resolutions are very predictable. While most are health oriented, I purport that a healthy mind, body and spirit requires a healthy lifestyle. Interestingly, the ten most popular resolutions listed below, all have an impact on a healthy life.
Polls repeatedly show that one of the most consistent resolutions for the New Year is to make more time to spend with family and friends. Moreover, research shows that the comfort and camaraderie of these people whom we love is important to our health and well-being.
2. Begin or Improve a Fitness Program
The benefits of regular exercise is no longer anecdotal, it is factual. Daily exercise, even in small doses, has been associated with more health benefits than anything else known to man. Studies clearly demonstrate that it reduces cholesterol and coronary artery disease and the risk of some cancers. Also, it increases longevity, helps achieve and maintain weight loss, enhances mood, lowers blood pressure, and even improves arthritis. In short, exercise keeps you healthy and makes you look and feel better. If done properly, there is no down side. So, make this year the year to do it!
3. Adhere to a Weight Loss Plan
Recent studies report that more than 66 percent of adult Americans are considered overweight or obese. As a result, weight loss is one of the most popular New Year's resolutions. However, adhering to a weight loss program is not easy. It requires many things, including, setting reasonable goals and staying focused. Often, professional help is required. While this may be one of the most difficult goals to attain, the ultimate reward and value is well worth the effort.
4. Stop Smoking
Second only to losing weight, this resolution, while extremely difficult, is another life-saving goal that must be attempted. Studies report that smokers try and fail four times on average before they are successful. SO, KEEP TRYING! Get help. Talk to your physician about using over-the-counter or prescription nicotine replacement therapy and proven quit-smoking aids. Consider smoking cessation classes, support groups and hotlines in addition to the meds. This is one goal that is worth the effort.
5. Find Your Smile
Due in great part to our hectic and stressful work and family demands, the United States is home to millions of people requiring the use of mood elevators and antidepressants. As a result, it is important to learn what really makes you happy in order to FIND YOUR SMILE. It requires the balance of a healthy mind, body and spirit. It might be a walk in the snow, taking dance classes or a trip to the spa. One hint, it is often something simple and inexpensive.
6. Moderate Drinking
This is one tip for a healthier New Year that I expect to receive plenty of flack about! But, I would be remise if I did not mention this potentially harmful habit. While many people use the New Year as an incentive to finally stop drinking, most are unable to adhere to such a rigid goal. Studies show that moderate drinking can offer many health benefits such as lowering cholesterol and coronary artery disease but that is defined as one or two 8 ounce drinks per day and red wine is preferred. However, many heavy drinkers would do well to taper off to a moderate level. For those with a problem and have decided that you want to stop drinking, there is a world of help and support available such as Alcoholics Anonymous. There are also a number of treatment-based programs, as well as support groups for families of alcoholics.
7. Get Finances in Order
This is one tip that few consider being health related. However, serious stress from financial problems affects millions of Americans every day. This cumulative stress can be very harmful to your health and can be lessened by initiating a plan. Get professional help and learn how to downsize and reevaluate your real needs…less toys with less stress for a longer life!
8. Try Something New
There may be no one thing more important to gaining a new perspective on life that to have learned something new. It could be as drastic as returning to school to prepare for a career change or as simple as learning to play bridge. Have you vowed to make this year the year to learn something new? Take a course at local college or read a new book. Visit the Everhart Museum or take the free tour of the Scranton Cultural Center. It will enrich your life and make you a more interesting person. Most local colleges and universities offer distance and adult education programs.
9. Service To Others
Service to others is service to you! There may not be anything more gratifying than providing a service to others in need. Volunteerism makes you a better and healthier person. It fits into any schedule. Donate clothes, time or resources. Locally, we have many charitable causes in need of help: Be a “Friend of the Poor,” or serve lunch at St. Frances Soup Kitchen.
10. Get Organized
The goal of organization, like the goal of financial order, has similar health implications because it eliminates tremendous stress. There are many books and websites that offer suggestions on how to organize just about anything in your life. For this reason, I love my iPhone – there’s an App for that!
SOURCE: A. Powell, About.com Guide
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
I am sure that many of you feel as I do…it is beyond my comprehension that in two days I will be living in the year two thousand and TWENTY! Moreover, I hope you share my sentiments that each year, each month, week, day, and minute is a gift, not to be taken for granted. And that is why we resolve at this time each year to make a concerted effort to improve ourselves; mentally, physically and spiritually, so that we may live a longer and healthier life, in order to spend more time with the friends and family we love.
Not surprisingly, getting physically fit and losing weight are the top resolutions to begin each New Year. According to the University of Pittsburgh Medical Center, 10 million Americans choose to join one of the 45,000 health clubs and hope to get fit and healthy for life. Unfortunately, if starting an exercise program is the hard part, than sticking to it is the hardest part.
Once the initial excitement and enthusiasm wears off, so too does the discipline and determination necessary to overcome the many distractions in our lives to make exercise a priority for life. Diane Klein, PhD polled long-term exercisers (those exercising at least 3 times per week for more than 13 years) what motivated them to “stick with the program.” The answers are in order of importance. Please note that “appearance” was NOT at the top of the list.
10 Motivators to Stick to an Exercise Program
10 Tips to Stick to an Exercise Program
Lastly, if nothing else motivates you to continue your exercise routine, remember that researchers have found that the benefits of regular physical activity are numerous:
Source: WebMD
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well!
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
Happy Holidays! My gift to readers this holiday season is to offer some health tips. However, before I get accused of being a “Scrooge” about enjoying the food and drink associated with the season, please know that I was raised in an Italian kitchen. As such, it is fair to say that I have and will eat my fair share of the Italian Christmas Eve food celebration consisting of, but not limited to: Chianti wine, seafood antipasti, calamari, baccala, pasta with anchovies, seafood ravioli, cannoli, Italian cheesecake and Baci Perugina Dark Chocolate Hazelnut candy, cappuccino, espresso, sambuca and limoncello.
Overindulgence during the holidays causes many, including seniors, to make New Year's resolutions related to diet and exercise. But, this year, I propose that you incorporate healthy habits during the holiday season, and you may find that your resolutions are not as hard to keep.
According to American Association of Retired Persons (AARP), seniors are considered those 50 years old and older. I will never forget how humbled I felt when I received my application to join AARP a few years ago. With this in mind, this year I offer healthy holiday resolutions for seniors, who are especially vulnerable to unhealthy holiday habits.
Every day, get out of the house for a walk to view the outdoor Christmas lights and decorations. Dress for the weather, walk with a companion, and take along a flashlight if necessary to illuminate your path and use caution to avoid falls on slippery sidewalks.
2. Combine shopping and walking.
In inclement weather, combine holiday shopping with your exercise. Indoor malls are great places to walk. Inquire with the mall management about walking clubs. Plan to shop early or late to avoid crowds. If you are planning on shopping in a particular store, park at the opposite end of the mall -- even if time is short, you will still get some exercise.
3. Remember to take your medications.
Routines are disrupted during the holidays and you may forget important medications. Make a special reminder to take your medications or order re-fills. If you are traveling, be sure to take enough medications with you in case of delays and have a copy of your prescriptions in case of loss. Be sure to bring a phone number for your doctor along with your health insurance cards, in case of emergency. Carry your medications in your carry-on luggage if you are flying.
4. Eat your vegetables and salad first.
Beginning your meal with healthy vegetables and salads will fill you up and reduce the temptation to over-indulge on high-fat, high-calorie foods. Taste your holiday favorites in small amounts to satisfy your palate.
5. Be aware of drug interactions.
According to Dr. Amy Anderson, internal medicine physician on the medical staff at Baylor University Medical Center," says holiday spices like cloves, thyme and sage can interfere by as much as 50 percent with the body's natural ability to utilize common drugs." Talk with your doctor or pharmacist about your medications and find out if there are any foods you should avoid while taking them.
6. Know your food ingredients.
If you have food allergies, ask about ingredients before you indulge. Be especially careful of home-baked goods if you have an allergy to tree nuts or peanuts. Those ingredients can be deadly if you are affected by these types of allergies.
7. Practice allergy-free decorating.
If you suffer from allergic rhinitis, holiday decorations stored in the attic and basement can build up a coating of dust and mold that can trigger allergies. Some people may also need to rethink Christmas tradition and substitute an artificial tree.
The holiday season includes plenty of kissing and hand shaking. Getting a yearly flu shot and frequent hand washing are your best defense for avoiding the flu. If you are sick with a cold or flu, limit contact with others until you are well so you don’t infect others.
Holiday preparations and helping Santa means less sleep. Do your best to get to get at least 6-7 hours of sleep every night and avoid heavy foods, chocolate, caffeine and alcoholic beverages before bedtime. If you need to recharge, take a nap during the day.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
