Monday, February 24, 2014

Eickhoff’s Extras: New in the News

Great news for patients with sulfa allergies!  New research demonstrates that those with sulfa allergies can take Celebrex.   Research has found that the structure between sulfa drugs and Celebrex is different enough that cross sensitivity is rare.   Patients who had life threatening reactions to sulfa medications should not take the medication though.

Jennifer Eickhoff, FNP-BC, MSN, ATC, LAT

Prescriber's Letter: February 2014; Vol: 21, No. 2

There is a fine line between blogging and giving medical advice. The content of this blog is for informational purposes only and should not be construed as medical advice.  Nothing contained in this blog is intended to replace the medical advice of a trained, licensed physician.
In all matters relating to your health, you are urged to consult a physician. You can contact Advanced Bone & Joint to set up a formal consultation appointment with Dr. W. Anthony Frisella, Dr. Dane Glueck, Dr. Brandon Larkin, Dr. Anthony Lombardo, Dr. John McAllister, II, Dr. Brian Meek, Dr. Paul Spezia, Jennifer Eickhoff, FNP-BC, or Matt Pliske, PA-C

Wednesday, February 19, 2014

Wellness Wednesday / "Delia's Dose"

This week’s blog is inspired by the fact I have started to make my own toothpaste. Yes, I am officially a Hippy.

You know how I encourage everyone to read the ingredients on anything you eat or drink, well I started reading the ingredients on EVERYTHING, like my toothpaste, mouthwash, and even my lotion.

YIKES! In my attempt to find a “healthy” toothpaste at the store, I read things like… Carbomer 956, Carrageenan, Carboxymethlycellulose sodium, coamidopropyl betaine, glycerin, hydrated silica,
mica, peg 8, poloxamer 407, propylene glycol, sodium benzoate, sodium fluoride, sodium hydroxide, sodium lauryl sulfate, sodium saccharin, sorbitol, titanium dioxide, triclosan….What is all this stuff??!?  The ingredients that I really zeroed in on were  Yellow #10, Red #3 and Blue #1. I have noticed that soooo many of the things we eat and drink have these food dyes in them. Those can’t be good for fact one of my New Year’s Resolutions was that I gave up eating peanut M&M’s because of the many food dyes they contained. No longer are they allowed in my house!

Apparently Americans are eating 5 times more food dye now than we were in 1955. Why? Well, because apparently we like our chewy “rubber” fruit snacks and our maraschino cherries to be really RED! Studies show that how a food looks is just as important to us as how it tastes. Without food coloring, many processed foods(key word is PROCESSED) would have an unpleasant, uneven, plain
color…and since we apparently eat with our eyes, the big food companies add coloring. What’s in that frosted berry(flavored) processed pop tart you gave your daughter for breakfast?? Red 40, Blue 2, Yellow 6 and Blue 1, I bet. How about a glass of strawberry milk to wash that nutritious breakfast down…believe me there are no strawberries in that milk!!

So what’s the big deal…why are these bad for us? Many studies say that years of us ingesting these food dyes have lead to the rise of ADHD-Attention Deficit Hyperactivity Disorder-among other things like…
Chromosomal damage
Brain tumors
Bladder tumors
Thyroid tumors
Neurochemical and behavioral effects
Aggression, violent behavior
Eczema, hives

You are probably thinking…oh a little of those dyes won’t hurt me…wellll, how many things are you eating and drinking every day that have those dyes in them?? Bbq sauces, flavored popcorns, cold medicine, cereals like Fruit Loops, Lucky Charms, and Apple Jacks,  gum, jello, beef jerky, salad dressings, many many candies, crackers, frozen pizzas, sports drinks, cereal bars, jellies, popsicles, to name a few!

This is what bothers me the most…countries like Norway and the United Kingdom have banned almost all food dyes! Some have been banned from use in the US, but 7 still remain on the FDA’s approved list. For example, Kraft, the company that makes macaroni and cheese, in the UK they use paprika and beta carotene to make it that famous yellow orange color. Here in the US we still get to eat it with Yellow #5 and Yellow #6..YUMMY!

Blue #1 is banned in France and Finland
Blue #2 is banned in Norway
Red #3 the FDA tried to ban it and it failed
Yellow #5 is banned in Norway
Yellow #6 is banned in Norway and Sweden
GEEZE ! that’s it, I am moving to Norway.

For a healthier alternative, look for these all natural dyes….the ones we used for centuries!
Annatto extract (made from ground up seed pods of the annatto tree, which grows in South America)
Beta-carotene (red-orange pigment found in plants and fruits)
Beet Powder (red beets are dehydrated then ground into a powder, no additives)
Paprika (a red powder made from grinding sweet red peppers)
Saffron (a red orange spice made from the stigma of a flower called Crocus, native to Greece)  
Turmeric (deep orange colored spice from the root of the Curcuma longa plant, native to India)
Fruit & Vegetable juice

Have a Healthy Week!

Ohhh by the way,  here’s my new favorite toothpaste recipe:
6 tsp baking soda
¼ tsp hydrogen peroxide
2 tbsp coconut oil (melted)
12 drops peppermint essential oil

Put the baking soda in a bowl, add all the other ingredients and mix until you get a paste texture. If it’s too runny add more baking soda, if it’s too dry add more coconut oil. Store it in a dark container to protect the hydrogen peroxide.

Monday, February 17, 2014

Eickhoff's Extras: Shoulder Dislocations in the Young and “Old”

Shoulder Dislocations in the Young and “Old”

Shoulder dislocations are more common in young active athletes than in older individuals.  This is because a young person has more laxity or stretching of the ligaments around the shoulder.  Anterior (or front) shoulder dislocations account for 96% of all shoulder dislocations.  Posterior (or back) dislocations are rare and generally only happen during seizures or electrical shock.  
Most true dislocations are diagnosed by xray in an emergency room.  After the dislocation is reduced, or the joint is back in the correct position, another xray is taken for confirmation.  It is important to follow up with Orthopedics for treatment after a dislocation.

In all dislocations, structural damage must occur to allow the joint to “come out of socket”.    In younger individuals there is a possibility of a Bankart tear or a Hills-Sachs lesion.  A Bankart tear is a small tear in the labrum.  A Hills-Sachs lesion is an indention on the humeral head, from the humeral head hitting the glenoid during the dislocation.   In patients over the age of 30 rotator cuff tears are more likely to occur.

For patients under 20, a MR Arthrogram is ordered.  This is a special type of MRI that involves injecting contrast or dye into the joint prior to the MRI.  The dye allows the radiologist and the provider to see the structures in the shoulder better then a regular, non contrast MRI.   The MR Arthrogram will show the extent of the Bankart tear and if a Hill Sachs lesion is present. 
 In general, patients under 25 with a true dislocation will need surgery.  This is because once a young patient has a dislocation, the structures around the shoulder are stretched making it easier for the shoulder to dislocate again.  Multiple dislocations can cause further damage in the shoulder, lead to an unstable shoulder, and eventually arthritis.

For patients between the ages of 20-30, a MR Arthrogram is normally ordered.   The decision for surgical or conservative treatment is determined based on the results of the MR Arthrogram, the patient’s exam, and medical history.  
For patients older then 30, a MRI will be ordered to evaluate the rotator cuff.   If there is a substantial tear in the rotator cuff, surgery to repair the tendon may be needed.   If surgery is not required, most patients do well with six weeks of physical therapy.  They go on to live normal lives with no pain and no further dislocations. 

The surgery to fix a Bankart Repair is about 60 minutes in length.  The patient is under general anesthesia, so they will be asleep during the procedure.  Anchors are used to secure the labrum to the bone.  This is an arthroscopic procedure, meaning the entire procedure is done through small incisions around the shoulder.  There can be anywhere from 4-6 small incisions ranging in size from 0.5-1.5 inches in length.   Sutures are used to close the incisions. 

You can watch Dr. Frisella perform this surgery below:

After surgery for a Bankart repair, the patient can expect to be in a sling for 6 weeks.  During that time the sling can be removed while in a seated position for typing, writing, eating, and while sleeping.  Physical therapy will also be started to work on passive range of motion.  This means the shoulder is stretched to prevent the patient from getting a stiff shoulder.  After 6 weeks, physical therapy will advance to active range of motion, allowing the patient to start lifting their arm themselves.  Strengthening begins at 12 weeks post-op.   Generally the last post-op visit is somewhere between 3-4 months.  There will be lifting and/or range of motion limitations until at least three months after surgery.  There should be no contact sports until 6 months post-op.

Monday, February 10, 2014

Eickhoff’s Extras: New in the News

In a large Canadian study, patients who had rheumatoid arthritis (RA) had higher complication rates after undergoing a hip or knee replacement. The reasoning is unclear, but it could be related to RA medications, use of smaller implants, and the affect of the disease on the bone. 

Jennifer Eickhoff, FNP-BC, MSN, ATC, LAT

Ravi B, et al "Patients with rheumatoid arthritis are at increased risk for complications following total joint arthroplasty" Arthritis Rheum 2013; DOIi: 10.1002/art.38231.

Monday, February 3, 2014

Eickhoff’s Extras: New in the News

New research shows that in patients with hip arthritis, exercise can help them avoid having a total joint replacement.  For those that ended up still needing a total hip replacement, by exercising they were able to postpone the surgery by almost two years.

Jennifer Eickhoff, FNP-BC, MSN, ATC, LAT