Which is better?...PO Day 236

I went to one of my (seems like many) doctors today.

His office is very low tech. There is no television in the waiting room. There is no pandora radio station playing calming music. There is no keurig coffee maker with assorted coffee and teas in the waiting room. There is no computer in the exam room. If you've had some hospital exam like a cat scan or an x-Ray he cannot show you the pictures, I don't think even he can see them. He is faxed a report from the hospital radiologist who "read" the films and wrote them up in summary. He is not connected to the "grid" so he does not see your electronic health record. There was no  questionnaire asking if I have been to certain African countries, have had a fever of 101 or more, or been exposed to anyone diagnosed with the Ebola virus.

On the other hand, because I was nervous about some test results, yesterday I asked if I could be seen sooner than my appointment next week. He saw me this morning at 9:45. He took the chart from the pocket on the door and spent several minutes reviewing it before he joined me. He looked in my eyes, ears and nose. He listened to my heart and lungs, carefully. He reviewed my test results from six months ago and compared them to the recent tests. He explained things slowly and clearly and reassured me that there was nothing to worry about. He explained why and how we would follow up in six months. Shoot, he even remembered Dear Husband, who was with me, and recalled what he had done for a living. I felt like I had been to a physician, a healer, Marcus Welby, MD!

I just wish you could have it all...the high tech perks and the hands on, old school medicine man. Are the two things mutually exclusive? 

Data breach

I just copied this alert and am posting it here in case any reader is insured through Anthem as administrator of Blue Cross Blue Shield in the affected states of California, New York and "a number of other states," which were not named.



Health insurer Anthem admitted on Wednesday that personal information of customers and employees was stolen by "sophisticated" hackers.

Although Anthem, which offers Blue Cross Blue Shield plans in California, New York and a number of other states, did not say how many customers and employees were affected, the Wall Street Journal reported that the number was around 80 million.

The stolen information includes names, birthdays, medical IDs, social security numbers, street addresses, email addresses and employment information, such as income information. However, neither credit card nor medical information, such as claims, test results or diagnostic codes, was lost.

Anthem contacted the FBI about the breach and hired FireEye's Mandiant unit, the same firm that investigated the Sony breach, to evaluate the insurer's systems and identify security improvements.

Why rTSA?...PO Day 235

Following the same theme, why does someone need a Reverse total shoulder replacement surgery instead of just the more conventional total shoulder replacement surgery?

The shoulder joint is stabilized and held in place by the rotator cuff. The upper arm, the humerus, is not afixed to the socket. They fit together but are held in place by an intact rotator cuff. In the conventional total shoulder replacement surgery the upper humerus is replaced with a prosthetic metal humerus and the socket is replaced with a polyethylene socket but they are positioned in the same arrangement as the natural elements of the joint. They are dependent on an intact rotator cuff to hold the two parts together.

When the rotator cuff is torn such that it will no longer hold the joint together properly, the top of
the head of the humerus tends to drift upward. As the humerus shifts, it allows the deltoid muscle to go slack. A slack muscle is ineffective in moving or raising the limb. With a torn rotator cuff and a slack deltoid muscle the patient is unable to lift their arm. Replacing the humerus and the socket would not change this.

Reversing  the position of the head of the humerus and the shoulder socket allows the muscles of the upper arm and shoulder to squeeze or compress the parts together. They are no longer dependent on the rotator cuff alone. Gravity and time encourage the parts to stay in place. The deltoid muscle is attached to the humerus surgically and becomes the main element in raising the arm. It works!

The road to recovery is a long one. Very conservative physical therapy keeps the joint mobile without risking a dislocation while the muscles recover and knit into the joint. You have to be a patient patient!

Surgery candidate...PO Day 234

The question arose...who is a candidate for reverse Total Shoulder Arthroplasty surgery?

First, the patient should be someone who is pretty much at the end of their rope. I just mean the surgery should not be considered until more conservative treatment has been exhausted. Physical therapy, analgesics and tincture of time should be tried without relief. Persistent and severe disability should be making an extreme impact on the person's lifestyle. The good patient is one in general good health, physically active and knowledgable as to the recovery time involved and have appropriate expectations.

Reverse TSA surgery is indicated when the patient's rotator cuff is fully torn or non functional. An experienced orthopedic surgeon will order x-Rays, cat scans and or MRIs to make the right recommendation for surgery. Surgical experience is a big factor in achieving a good result. Also the patient needs to commit to post operative therapy and physical limitations for quite a while. A sling is worn post op for a good six weeks, day and night. No driving during that time. Very minimal physical activity for six weeks. Long term commitment to gentle use of the operated shoulder is important.

While the age for undergoing this surgery is going down (it used to be performed only on people 70 or older), this is still a surgery for older people. Why? Working people who perform physically demanding jobs like construction are not good candidates. Heavy work puts too much demand on the replaced joint. Also, contact sports and athletic activity where one might fall are contraindicated. Demanding or risky activity is thought to shorten the life of the new joint and hastens the time when a second surgery might be required. Patients must be willing and able to cooperate in their care.

Only the patient can assess their individual disability. Only the surgeon can know his experience and training. When the patient and the surgeon have a meeting of the minds it may be time rTSA. 

Consider the source...PO Day 233

A few weeks ago, maybe a month ago (time flies when you're having fun), I wrote about hand washing in relation to spreading germs in a Hospital setting. Well, there is more to the subject...hand drying!

Researchers in England studied hand drying techniques and equipment. They used three drying systems; a jet air drier,  warm air dryer, and paper towels. They put on latex gloves,,then contaminated their gloved hands with bacteria. Then they dried their hands using each of the three techniques.

Surprising to me, when they measured the levels of airborne bacteria in the area surrounding the jet air drier, they found the germ count was 4.5 times higher than the area around the warm area around the  air dryer. But the germ count was 27 times higher than if paper towels were used and the air around them was tested.

With the jet driers, the bacteria hung in the air for five minutes after the hands were washed and dried.

So these electric air driven hand driers are not only noisy, they can be a sanitary problem. Of course used paper towels overflowing the garbage can is not desirable. Now for the bottom line... The study was paid for by a paper towel Manufacturer. I don't think the outcome is a coincidence. But is it true? Maybe the best thing to do is wash your hands, give them a shake, then wipe them on your pants!

"Old football injury"...PO Day 232

Watching the Superbowl football game started me thinking about how these young athletes get knocked around, fall, tumble and bounce up uninjured. Or are they?

In 2005 the American Orthopedic Society for Sports Medicine published the following findings:

Three hundred thirty six elite college football players were invited to participate in a study of football related injuries. They underwent physical testing and medical evaluation. All had xrays and or MRIs. All shoulder conditions and previous surgeries were recorded. Consideration of playing position was important.

Of the 336 players, 50% had a history of shoulder injury, a total of 226 (1.3 injuries per player). Fifty six players had undergone shoulder surgery (34%), 73 total surgeries. The most common injury was shoulder separation, least common was rotator cuff injury (12%), clavicle fracture (4%) and posterior instability (4%).

Shoulder injuries were more common in quarterbacks and defensive backs. But surgery was more common in linebackers or linemen. A history of anterior instability was more common in defensive players, for whom surgery was required 76% of the time. Linemen had more rotator cuff injuries and posterior instability than other players.

Their conclusion: Shoulder injury is a common injury in college football players, with one third undergoing surgical procedures.

So, knowing this, I am no longer so envious of their ability to take a fall. I will definitely wince a little when I see the quarterback sacked or the lineman run head (and shoulders) into the opponent.

A little late today...PO Day 231

Ah, someone missed me.  What with company, the blahs, and general ennui, I didn't get my post posted like usual. I don't have anything medical to say but with the weather so terrible and me thinking about Dear Son and his family in Wisconsin which is having a veritable blizzard, today's late post is about dealing with the cold.

The magazine The Week offers this Tip of the Week to prepare your house for winter:

Clear the gutters. Be sure water drains at least six feet away from the foundation.

Remove outdoor hoses. If a hose freezes it can break the pipe it is attached to.

Inspect the chimney. If you use your fireplace a lot the chimney may need to be cleaned twice a year.

Check insulation. Look for gaps or weather stripping that needs to be replaced.

Change the furnace filter. You should replace it every two to three months.

Of course, living in the south we seldom have hard freezes. But all those tips still apply to us. And we do like to put on a sweater or a coat once in a while. So I was interested in TheWeek's "The Best of ... Winter Coats." That is until I read the prices! So here's their suggestions...

Carven Old Pink Oversize Coat: wool, full length, pink, classic. $940.00

Voormi AN/FO Jacket: triple layer merino wool, traditional ski shell performance. $549.00

Steven Alan Evening Coat: a down vest inside, detachable hood. Knee length. $625.00

Fjallraven Greenland No. 1 Down: lined with goose down, exterior water resistant fabric suffused with beeswax and paraffin. $500.00

Bottega Venetta Reversible Shetland Wool Coat: an investment, a classic, knee length. $3100.00

Wow, that will buy a lot of t-shirts and shorts! Dear Daughter-in-law, the one trying to adjust to Wisconsin weather, told me she went to a local big box store the other day. Yes, you know the one. She said at the entrance the big main clothing display was bathing suits! I guess those were for the locals who are headed to florida for the winter. :)

Back to normal blogging tomorrow. Sorry for the gap.