Staying Safe on the Slopes

Skiing is a safe and fun endeavor that the whole family can enjoy.  Nobody wants to get injured while skiing and taking a few precautions can mean the difference between a great day on the slopes and the end of your ski season. Follow the tips below, in addition to the recommendations of the National Ski Patrol to stay safe.

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Wear Proper Dress

Proper dress is critical for having a day on the mountain that is both enjoyable and safe.  A day that may look sunny can turn cold and cloudy quickly. For this reason it is always useful be prepared for both weather extremes. Sunscreen, sunglasses and lip balm are a must if the sun is shining. Conversely, if it is windy, cold and cloudy, then good gloves, a hat, goggles and a neck gaiter can keep you more comfortable and decrease the risk of frostbite. Avoid wearing cotton as it absorbs moisture and acts as a poor insulator when wet. Instead chose layers that wick moisture from your body.

Utilize Correct Equipment

Using the correct equipment is absolutely essential for a safe ski day.  Many of the injuries I see are as a result of using equipment incorrectly or incorrect equipment. Always make sure that ski bindings are set appropriately for your ski level as well as your size.  This is especially true if you are borrowing skis or other equipment from a friend. When in doubt have a professional look at your skis and boots to make sure they are appropriately sized and set for your skill level.

Wear a Helmet

It should go without saying that a helmet may save your life in the event of an accident while skiing. Always make sure that the helmet you are wearing fits appropriately, is buckled up and is designed for skiing. According to the National Ski Areas Association, in the 2017/2018 season at US Ski Resorts, 84% of skiers and snowboarders wore helmets.  100% of children under the age of 9 wore helmets.  Helmets, in addition to functioning as a safety item, also keep your head surprisingly warm.

Observe Trail Markings

Understand what different signage means out on the mountain. Some trails may be closed, while others have hazards that can lead to accident. Importantly, know that where you are skiing is within your skill level. Skiing above of ones level is a common source of injuries and accident.

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Understand the Responsibility Code of the National Ski Areas Association

  1. Always stay in control, and be able to stop or avoid other people or objects.
  2. People ahead of you have the right of way. It is your responsibility to avoid them.
  3. You must not stop where you obstruct a trail, or are not visible from above.
  4. Whenever starting downhill or merging into a trail, look uphill and yield to others.
  5. Always use devices to help prevent runaway equipment.
  6. Observe all posted signs and warnings. Keep off closed trails and out of closed areas.
  7. Prior to using any lift, you must have the knowledge and ability to load, ride and unload safely

When would I consider a PRP injection for myself?

By Daniel Gibbs, MD

Patients often ask me about PRP. PRP stands for platelet rich plasma.  It is a liquid that is obtained from a patients’ blood. The blood is drawn from a patient’s vein. A centrifuge is then used to separate out the parts of the blood. The main parts of blood include the red blood cells which carry oxygen, the white blood cells which monitor and address infection, platelets which help with healing and the plasma which carries proteins and other substances important for healing and regular bodily functions. In PRP, the red blood cells are removed.  The platelets and plasma are retained.  Depending on the potential site of injection, varying levels of white blood cells are removed.

PRP can be both pro-inflammatory (meaning it increases inflammation) or anti-inflammatory (meaning it decreases inflammation) depending on the formulation of the injection.  Both formulations can be useful depending on if more inflammation or less inflammation is what the problem calls for.  Much of this determination is based on the location and type of pathology being addressed.

The anti-inflammatory effects of PRP are most useful when dealing with arthritic and degenerative conditions. PRP has evidence in the treatment of arthritis.  The strongest evidence is from a very high quality study out of Rush in Chicago. It is a randomized, prospective, double blind, controlled trial. They found that PRP is more effective at managing pain from knee osteoarthritis and improving function than injections of lubricating hyaluronic acid.  I would consider an anti-inflammatory PRP injection for the treatment of knee arthritis, especially if I had tried cortisone (steroid) and hyaluronic acid without significant relief and was trying to avoid a knee replacement.

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The second place that I would consider a PRP injection is in the treatment of an acute sprain or strain. The pro-inflammatory formulation of PRP is especially useful in this setting. The goal is to increase inflammation with the secondary effect of speeding healing time.  To go down this pro-inflammatory road, the patient must make a conscious decision to avoid anti-inflammatory modalities including ice and NSAIDs (like ibuprofen and naproxen).  These medications and modalities counteract the effect of the pro-inflammatory PRP. Specific locations that I would consider include an ankle sprain, patellar tendonitis, MCL sprain, and other ligament sprains/tendon strains.

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PRP can be a useful adjunct to the other mainstays of orthopaedic treatment; medication, physical therapy, activity adjustments and R.I.C.E. PRP injections are generally not covered by insurance companies so patients (and the doctors who care for them) must be mindful of the financial side effect of the treatment; especially in cases where it used without significant scientific evidence. I would not consider PRP for myself for all orthopaedic maladies but I would certainly consider it to treat the two general problems mentioned above.


The content found herein is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.


 

Acute Management of Sprains and Strains

By Daniel Gibbs, MD

As summer approaches, and we change our activities from skiing, snowboarding and snowshoeing to hiking, running, swimming and biking, the risks of acute (sudden) sprains (ligament tear) and strains (muscle/tendon tear) rises. A ligament connects a bone to a bone. A tendon connects a muscle to a bone.  Both a sprain and strain can be either microscopic tearing (Grade I) or full thickness tearing (Grade III).  The initial approach to self-treatment, regardless if you are dealing with a Grade I sprain or a Grade III strain, is the same.

If you do sustain a sprain or a strain, there a couple of early interventions that you can employ to accelerate and improve your recovery.  The old acronym of R.I.C.E. still applies. At the highest levels of sports (NFL, NHL, NBA, MLB, MLS, NCAA), this what the professionals do.

Rest. It is important to dial back your activities while still being ambulatory. Take the stress off of the injured ligament or tendon for a brief period. This does not mean being sedentary. Use crutches if your injury is to your lower extremity to get around without stressing the injured ligament or tendon further. Keep the blood flowing while allowing your body to heal itself.  A brace, at the direction of a physician, can be helpful in augmenting stability.

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Ice. Apply ice to the injured area.  Three times a day for 20 minutes is a good place to start. Twenty minutes on and then twenty minutes off can also be effective. This reduces swelling and inflammation. Caution must be taken to avoid a skin burn. Place a layer of fabric between the ice and the skin. Monitor closely. 

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Compression. Apply compression to address swelling. This will accelerate recovery and improve pain. I prefer sleeves to wraps. Sleeves provide more uniform compression without the risk of cutting off blood flow.  These can be picked up at most pharmacies or sporting good stores.

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Finally, elevation. Elevate the injured body part to decrease swelling. The injured body part must be above the heart in order for the fluid in the area to drain back to the body.

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An additional treatment that reduces pain and accelerates recovery is the use of anti-inflammatory medications. These medications are available over-the-counter. They can be taken as instructed on the bottle unless otherwise directed by a physician.

If you think that you have a sprain or strain, it is a good idea to be evaluated by a physician to rule out a broken bone or a complete rupture of a ligament, tendon or muscle that might require advanced diagnostics or treatment. If you have been diagnosed with a sprain or strain, make sure to R.I.C.E. to improve your chance at a successful and expedient outcome.


The content found herein is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.


 

How to pick an orthopaedic surgeon?

A decade of medical training (4 years of medical school, 5 years of residency and 1 year of fellowship) has put me in contact with hundreds, if not thousands, of medical doctors, including surgeons. This training has been across the United States from Washington, DC to Chicago to Los Angeles. I have learned from and observed doctors from all parts of this country and all walks of life. Throughout that time, I have witnessed countless good surgeons.  What made them good?

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As a medical professional, assessing whether a doctor would be a good doctor for a family member is a difficult task.  I don’t have first hand knowledge of my child’s pediatrician’s skills. I don’t have access to my parent’s surgeon’s records or interactions with other patients. I am essentially, in these encounters, like any other patient.  I often find myself in these situations asking myself… “Is the person treating my loved one a good doctor?”

Technology has obviously tried to help us narrow this information gap.  We have access to a physician’s educational background and website rankings, easily via the internet.  Some of this information is useful, such as, “Did my physician attend reputable educational institutions?” I believe there is credibility afforded by academic centers that are known for producing quality doctors.  But I also believe that some of this information, particularly rankings, can be harmful to the doctor-patient relationship.  Do you want the same organization who determines if you had a good experience purchasing your car also determining if you had a good encounter with your doctor? While it might be nice if the car salesman told you about the risks of the car you were purchasing, you don’t expect him or her to.  If your doctor didn’t tell you about the risks of a medical decision you were making, he or she would be negligent. Does hearing about the bad things that could happen if you underwent surgery change how you feel about the experience? Is this honest discussion often accurately reflected in physician rankings? I am not so sure about that.

This all leads me to ask a simple question. What makes a good surgeon? It is probably too difficult of a question to address in one blog post but I would like to highlight one area that I believe makes the biggest difference in the identification of a good surgeon.  I think in order to assess the quality of an orthopaedic surgeon (and I will keep it specific to that specialty) a person must ask themselves, “Does this doctor understand what I want?”

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Medicine is very much a science. We have good scientific data for a lot of what we do. I know that a knee replacement works well for the treatment of arthritis of the knee.  The art of medicine is deciding which patient is at the point that they are ready to undergo a total knee arthroplasty (knee replacement).  In order to figure out which patients are ready, I must ask myself, “What does this patient want?”  Is the person in front of me having knee pain from arthritis but about to go on a hike to Machu Picchu? If this were the case, and I were to discuss a knee replacement, I would not be understanding what the patient wants.

Ultimately, when a patient sits down with their orthopaedic surgeon, they have something that they want. It may not be explicit. Most people don’t come into the office knowing they want surgery or physical therapy or an injection. But often patients do know that they want to be pain free or to be able to return to playing tennis or hiking. Does your orthopaedic surgeon take the time to figure out what you want and then discussion treatment options that fall in line with your goals? If they do, then they are more likely than not going to be, in my opinion, a good surgeon. If they don’t understand your goals and what your needs and wants are, then it might be a good opportunity to get a second opinion?  As a surgeon, my goal is never to talk a patient into a treatment. My job is to help them understand that my treatment recommendation will help them achieve their goals and get back to doing the things that they love.

Tommy John Surgery

Tommy John Surgery

Tommy John Surgery, also know as elbow ulnar collateral ligament (UCL) reconstruction, was invented in 1974 by Dr. Frank Jobe.  Prior to the invention of the surgery, pitchers were often left with no options when they tore their UCL. The main function of the native UCL is to resist valgus forces (forearm moving away from the body relative to the arm). In pitchers, it is under the most stress when the pitcher cocks back his arm to throw and begins accelerating into the throw.

In 1974, Tommy John began having medial elbow pain and an inability to pitch. He asked Dr. Jobe to brainstorm a way to try and reconstruct his ulnar collateral ligament.  Dr. Jobe channeled his experience with tendon transfers in polio patients to develop an approach to reconstruction.  Tommy John played for 13 additional years after his return in 1976.

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UCL reconstruction is highly effective in elite baseball players at returning them to baseball.  All athletes who undergo surgery understand that the recovery and rehab is long and arduous. Almost 25% of major league baseball pitchers have had the surgery.

The reconstruction consists of taking a graft (usually a tendon from the leg or forearm) and anchoring it into the arm (humerus) and forearm (ulna). If the athletes is having symptoms of ulnar nerve irritation, then often the nerve is moved during the same operation.

If you are a baseball player with elbow pain, call Dr. Gibbs for an appointment to discuss treatment options to get you back on the field.