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WHO DAT?

An Orthopedic Success Story

I along with over 100 million other people watched the triumph of Drew Brees and the New Orleans Saints in the Super Bowl this past Sunday.  I am a long suffering New York Jets fan and usually root for the AFC.  This year I broke with my tradition for two reasons.  First my oldest daughter attends Tulane University in New Orleans; the Saints have really lifted the spirits of that city in ways you must live in NOLA for a while to appreciate. Second, Drew Brees came back from a potentially devastating injury and I always love an Orthopedic Happy Ending.

In December 2005 Mr. Brees dislocated his shoulder while attempting to recover his own fumble in the last game of the regular season.  In the process of that dislocation he tore his labrum and partially tore his rotator cuff.  The shoulder is an amazing joint capable of an extraordinary range of motion.  That flexibility however makes it inherently unstable.  The labrum is a rim of firm tissue that helps hold the shoulder ball in the socket.  When the shoulder dislocates that rim of tissue frequently tears making the joint prone to more dislocations.  The rotator cuff is made of the tendons of four muscles and is also often injured in dislocations.  The cuff muscles and tendons are responsible for maintaining the strength and motion of the arm.  For any throwing athlete stability, motion and strength are essential.

In the general population the incidence of shoulder dislocation is 2%.  This means that at some point in their lives 1 out of 50 people will suffer a shoulder dislocation, usually related to injury.  Even regular people  (i.e. non- professional atheletes) can have problems with their shoulders after a dislocation.  Often the shoulder will “pop out” without significant trauma, sometimes even during sleep.  The younger you are when the first dislocation occurs the more likely you are to have problems with your shoulder in the future. When this happens you may have to consider the treatment that Drew Brees did.

In January 2006 Drew underwent arthroscopic repair of his labrum and rotator cuff.  This surgery involves using an Arthroscope, a small television camera to see inside the joint, as well as specialized anchors and sutures to repair the torn tissues.  Specific instruments are used to perform the repair through 3 or 4 small incisions called portals.  The surgery can take between one to two hours to perform.  At Coney Island Hospital we have the ability and the technology to perform these procedures and do so frequently.  In fact we use the same equipment that is used in specialty hospitals in Manhattan.  The rehab afterwards is just as important as the surgery, and it can take 4 to 6 months to get full mobility and strength back.

The inspiring thing about Drew Brees’s story is his perseverance in the face of adversity.  He was released by the Chargers after his injury.  Several teams declined to hire him because they did not feel a quarterback could recover sufficiently after this type of injury to be competitive.  The Saints, a then ‘down on their luck’ team, hired a then ‘down on his luck’ quarterback.  The rest, as they say, is history.  Modern orthopedic reconstructive surgery enables us to repair and rebuild damaged joints.  To fully recover though, the patient must actively participate in their recovery.   Hopefully the victory of Drew Brees and the Saints will inspire the people of New Orleans to continue to actively participate in their recovery as well.

Jeffrey Passick, M.D.

Dr. Passick is the Director of Orthopedics at Coney Island Hospital. He can be contacted at 718-616-3440

Breakthrough

Keeping pace with change
Hospitals are special places for those of us who have spent the majority of our adult working lives in one, and for those who visit one episodically for care. To those of us who work here in Coney Island Hospital, this is a place where we find fulfillment, where we see our friends, where we get to experience the highs and lows of life on a daily basis. The hospitals of popular culture sensationalize these things. Seattle Grace, the hospital setting of the television show “Gray’s Anatomy” does capture the essence of being part of a hospital community (except with much more promiscuity). Most of us feel blessed to be part of an organization that’s primary purpose is to do good. From what I can tell St. Vincent’s hospital in Greenwich Village is such a place, but unfortunately it may not be around much longer.

For the community that is served by a hospital, that hospital should be an essential part of that neighborhood. Particularly in areas that have an abundance of the poor or disenfranchised the hospital is a place where people go for comfort and care. St. Vincent’s has a long history of caring for some of New York’s poorest and sickest through epidemics from Cholera to HIV. Greenwich Village without St. Vincent’s will be a very different place.

Unfortunately being a ‘caring community’ caring for a community is not enough anymore. A hospital is a business. Whether a voluntary hospital or not, at the end of the day you must be able to make your payroll and pay your bills. In 2010 it is not possible to expect others to make up the difference. Neither the Church nor the State has the resources to subsidize hospitals anymore. It appears St.Vincent’s got caught behind the times. In order to fulfill its mission it had to do more than good work, it had to adapt to a fast changing environment.

At Coney Island Hospital we are lucky. We have an extraordinarily caring community who work and volunteer here. We have a diverse community that we care for as well. In addition, we have seen the future and are actively preparing for it. I have been fortunate to be part of the “Breakthrough” initiative here. This program, launched by our parent, the New York City Health and Hospitals Corporation, has us look at essential processes and reengineer them for greater efficiency and quality. It a system-wide priority and is supported by the entire hospital community. What is unique to this approach is that it involves staff at every level and empowers them to make real changes in areas that they understand because they do the work every day. These changes are immediate and are monitored for efficacy.

We are evolving and adapting to meet the needs of our community and expanding the community we serve. Plans are in place to expand our ER; we are involving community physicians and facilities and connecting them to our information system to allow for better continuity of care. My department, Orthopedic Surgery, is developing a Center of Excellence in Joint Replacement to serve our immediate community as well as surrounding areas.

The story of St. Vincent’s Hospital is truly sad. I feel badly for the hospital staff and people they serve. I hope we will not have to witness the closing of other great institutions that are part of the City’s fabric. Coney Island Hospital is making necessary changes so that we can continue to survive and provide even more services to our community. Stay tuned and see.

Jeffrey Passick, M.D.

Dr. Passick is the Director of Orthopedics at Coney Island Hospital. He can be contacted at 718-616-3440.

Orthopedics and new technology

There was a story reported in this week’s New York Times and elsewhere about a rare disorder called chondrolysis that has been seen to occur after certain surgeries. Chondrolysis is the unexpected deterioration of cartilage in the joint. These particular procedures have employed a “pain pump” – a recently developed device used to slowly inject local anesthetic into the joint after surgery. In theory this technology should decrease post-op pain and increase the patient’s comfort. Unfortunately, it turns out that the anesthetic drugs we routinely use all over the body can actually be toxic to the joint if injected consistently over a period of days. These new devices were never tested for this specific application but were approved for similar uses throughout the body; no one expected these results when the pumps were used directly in joints.

My daughter desperately wants an IPad. It seems soooo cool she has told me on multiple occasions since its announcement 48-hours ago. I told her “it is never a good idea to be the first one to get something new, remember all the problems with the first generation IPhones and Blackberry Storms.” I told her to let someone else be the guinea pig, and once the kinks were worked out we would reassess and consider buying one. The downside of this philosophy is not being the coolest kid in school right away; you can’t tell your friends about your new device and attract the eye of that cute boy or girl before anybody else.

In medicine there are real pressures to be that cool kid. To compete you often have to distinguish yourself from your colleagues. Being the first to offer some new technology that decreases post operative pain can make you more popular, like the kid with the first IPad. I have succumbed to this type of temptation in the past with other new technologies – those devices were approved for my applications. I have not implanted any pain pumps into joints and none of my patients have chondrolysis.

For now my daughter will not be the first in her school to get an IPad. I will also not be the first surgeon to try some new technology. I will watch carefully and when technology is proven safe and offers a real advantage for my patients I will be all over it. I am sure when IPad 2.0 is released I will be all over that too.

Jeffrey Passick, M.D.

Dr. Passick is the Director of Orthopedics at Coney Island Hospital. He can be contacted at 718-616-3440.

Foot pain ruining your golf swing?

The barrier to a perfect golf swing could lie in your big toe. Or your heel. Or on the ball of your foot. These are the three areas of your feet most likely to cause pain that can ruin your golf swing.

Behind these pain-prone spots can lie stiff joints, stretched-out tissues and even nerve damage. But pain relief is possible and frequently does not require surgery.

The three most common painful foot conditions that can ruin your golf swing are heel pain, arthritis and pinched nerves.

• Arthritis can cause pain in the joint of your big toe that makes it difficult to follow-through on your golf swing.

• Heel pain typically results from an inflammation of the band of tissue that extends from your heel to the ball of your foot. People with this condition compare the pain to someone jabbing a knife in their heel. Heel pain can make it uncomfortable for golfers to maintain a solid stance during crucial portions of their golf swing.

• Neuromas are nerves that become thickened, enlarged and painful because they’ve been compressed or irritated. A neuroma in the ball of your foot can cause significant pain as your body transfers its weight from one foot to the other in a golf swing.

Several other painful conditions can also cause instability during your swing. Some athletes and former athletes develop chronic ankle instability from previous ankle sprains that failed to heal properly. Motion-limiting arthritis and Achilles tendonitis can also affect your balance. Ill-fitting golf shoes may cause corns and calluses that make standing uncomfortable.

For the majority of golfers and other patients I recommend simple treatments such as custom orthotic devices (shoe inserts), stretching exercises, changes to your shoes, medications, braces or steroid injections and physical therapy. However, if these conservative measures fail to provide adequate relief, surgery may be required.

Remember foot pain is not normal. With the treatment options available to your foot and ankle surgeon, a pain-free golf swing is clearly in view. When your feet aren’t in top condition, your golf swing won’t be either.

Glen Donovan, D.P.M.

Dr. Donovan is the Chief of Podiatry at Coney Island Hospital.

For more information on  foot problems  please contact Dr. Donovan at 718-616-5509.

Prevent your child from getting this painful foot problem

Parents can prevent a common childhood foot problem by following some simple recommendations.

Ingrown toenails are one of the most frequent conditions I treat in children. Many kids hide their ingrown toenails from their parents, even though the condition can cause significant pain. An ingrown nail can break the skin and lead to dangerous infections.

This condition is caused by tight shoes, tight socks and incorrect nail trimming for most cases. In others, the children may inherit the tendency for nails to curve. American College of Foot and Ankle Surgeons suggests that parents would do the following:

Teach children how to trim their toenails properly. Trim toenails in a fairly straight line, and don’t cut them too short.

Make sure children’s shoes fit. Shoe width is more important than length. Make sure that the widest part of the shoe matches the widest part of your child’s foot.

If a child develops a painful ingrown toenail, reduce the inflammation by soaking the child’s foot in room-temperature water and gently massaging the side of the nail fold.

The only proper way to treat a child’s ingrown toenail is with a minor surgical procedure at a doctor’s office. After the surgery I may also prescribe antibiotics to children with infected ingrown toenails. Parents should never try to dig the nail out or cut it off. These dangerous “bathroom surgeries” carry a high risk for infection.

Glen Donovan, D.P.M.

Dr. Donovan is the Chief of Podiatry at Coney Island Hospital.

For more information on  foot problems  please contact Dr. Donovan at 718-616-5509.