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Posts by Britt Natalia

Dr. Alexander and Dr. Cywinski raise money for youth centers during a 2,500 mile bike trip

Dr. Daniel Alexander and Dr. David Cywinski, childhood friends and partners at the Finger Lakes Bone and Joint Center, set out to bicycle the perimeter of the United States, raising money to build a new community center in their old neighborhood of Babcock, a suburb of Buffalo.

Their first trip was cut short in 1986 in Seguin, Texas, outside of San Antonio, when Cywinski and Tony Glosek were hit from behind by a driver who dozed off behind the wheel of a pickup truck hauling a horse trailer. Cywinski broke one leg; Glosek broke two and his jaw.

A quarter of a century later, the trio returned to Seguin, Texas, where the accident happened and resumed the ride. They covered 2,500 miles from Seguin, Texas to Buffalo in 25 days.

“We wanted to finish what we started,” said Alexander. “And that was raising money to build a youth center.”

“Dave, Tony and I grew up extremely poor, and the Boys Club, the Babcock Boys Club, at the time, was a home away from home. It was a safe haven for three poor kids to go and grow. And what the boys club did, it gave us the tools that we needed to succeed in life.”

“We played sports there, we played games there. We learned a lot of things about life at the Boys Club, not to mention skills, hands-on skills but also life skills. Without the Boys Club I certainly wouldn’t be a physician today,” said Dr. Cywinski.

The money raised went to improving the Boys and Girls Club of Geneva and will go into building the Seneca Babcock Community Center of Buffalo.

 

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Personally tailored exercises offer relief for patients with lower back pain

Impaired movement control may result in chronic lower back pain. A new study from the University of Eastern Finland shows that the combination of manual therapy and exercise is an excellent way to combat movement control impairment in the lower back.

This combination reduced the disability experienced by patients and significantly improved their functional ability. A personally tailored exercise program was more beneficial for patients than a generic one, and the treatment results also persisted at a 12-month follow-up.

Movement control impairment is a common cause of lower back pain

Only 15% of patients suffering from lower back pain get a specific diagnosis, meaning that up to 85% of patients have to settle for a non-specific one.. Many international care guidelines call for further research addressing the different subgroups of patients with lower back pain.

Patients with movement control impairment constitute one such subgroup. These patients have difficulties in controlling the position of their back when sitting down, standing or doing back bending. Impaired movement control is often caused by an earlier episode of back pain. The situation is problematic because patients don’t realize that their incorrect back position is provoking pain.

So far, it has been unclear which specific exercises should be recommended to which patient groups. The study analyzed which form of treatment better alleviates non-specific lower back disability: a personally tailored exercise program targeting movement control impairment, or a generic exercise program. Patients’ situation was analyzed after a three-month physical therapy period, and again after 12 months. Patients had five physical therapy sessions, including either personally tailored or generic exercises. Each session also included a brief manual therapy. After the physical therapy sessions, patients filled out a questionnaire charting the level of disability caused by their back pain.

Combination of manual therapy and exercise works

A total of 70 patients with diagnosed movement control impairment participated in the study. The results indicate that a three-month physical therapy period significantly improved the functional ability of both groups, and the results persisted at a 12-month follow-up. Compared to the onset of the study, the results of the group doing personally tailored exercises were statistically and clinically better than the results of the group doing generic exercises both with regard to the level of disability and improvement of functional ability.

 

The findings were originally published in European Journal of Physiotherapy and BMC Musculoskeletal Disorders

Article Published by the University of Eastern Finland 

 

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Besides FLBJC, who and what is included in the RRH network?

Finger Lakes Bone & Joint Center is now part of the larger, Rochester Regional Health network. This includes several hospitals, all-inclusive care programs for the elderly, surgical centers, skilled nursing facilities, and more, across Western New York and the Finger Lakes region.

To learn more about the Rochester Regional Health network, visit: https://www.rochesterregional.org/about/

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Advances in Research on Bone Regeneration Using Stem Cells

Researchers at the University of Wisconsin (UW)-Madison have just published new work on bone regeneration. The research, published online February 2, 2017 in Stem Cell Reports, contains information on two proteins found in bone marrow that are key regulators of the master cells responsible for making new bone. The study is entitled, “Identification of Bone Marrow-Derived Soluble Factors Regulating Human Mesenchymal Stem Cells for Bone Regeneration.”

“These are pretty interesting molecules,” explained Wan-Ju Li, Ph.D. a UW-Madison professor of orthopedics and biomedical engineering, in the February 2, 2017 news release. “We found that they are critical in regulating the fate of mesenchymal stem cells.”

Dr. Li worked with Tsung-Lin Tsai, a UW-Madison postdoctoral researcher, and, according to the news release, found “that exposing mesenchymal stem cells to a combination of lipocalin-2 and prolactin in culture reduces and slows senescence, the natural process that robs cells of their power to divide and grow. Li says keeping the cells happy and primed outside the body, but reining in their power to grow and make bone tissue until after they are implanted in a patient, is key.”

“To engineer the growth of new bone in the body through regenerative medicine first requires generating large amounts of good quality cells in the lab, notes Li. In the body stem cells are rare. But if cell growth, differentiation and quality can be controlled in the lab dish, it may be possible to create stocks of cells for therapeutic applications and prime them for bone regeneration once implanted in a patient.”

Professor Wan-Ju Li told OTW, “In this study, we have demonstrated a systematic approach to identify soluble factors of interest extracted from human bone marrow and used them in bone marrow-derived mesenchymal stem cell (BMSC) culture for tissue regeneration. We have found that lipocalin-2 and prolactin are key factors in bone marrow, involved in regulating BMSC activities. Treating the cell with lipocalin-2 and prolactin delays cellular senescence of BMSCs and primes the cell for osteogenesis and chondrogenesis. We have also demonstrated that BMSCs pretreated with lipocalin-2 and prolactin can enhance the repair of calvarial defects in mice.”

“Mesenchymal stem cells, which are bone forming cells, can maintain their properties in culture after isolated from the body by simply being exposed to the proteins extracted from bone marrow their native microenvironment. Our study provides research evidence that is in support of a potential clinical procedure by which orthopedic surgeons can use the two molecules identified in our study to treat a critical-sized bone defect.”

 

Originally Published in Ry Ortho

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How well does calcium intake really protect your bones?

Ask anyone how to prevent bone fractures and they’re likely to answer, “Get more calcium.” Medical experts have tended to agree. For example, the Institute of Medicine advises a calcium intake of 1,000 to 1,200 milligrams (mg) a day for most adults. But in the last five years, we’ve also learned that calcium — at least, in the form of supplements — isn’t risk-free. An intake of 1,000 mg from supplements has been associated with an increased risk of heart attack, stroke, kidney stones, and gastrointestinal symptoms.

Now an analysis of reams of research concludes that consuming calcium at that level doesn’t even reduce fractures in people over 50. And a related analysis indicates that increasing calcium intake has only a modest effect on bone density in people that age. Both were published online this week in the medical journal BMJ.

These results may seem startling, but they aren’t a surprise to Dr. David Slovik, associate professor of medicine at Harvard Medical School and author of our Special Health Report Osteoporosis: A guide to prevention and treatment. “I don’t believe that we’ve ever thought that calcium per se reduces fractures; it’s one part of a larger picture,” he says. You really can’t say ‘Take enough calcium and you’ll be fine.’”

What the analyses found

The analyses were conducted by a team of New Zealand researchers led by Mark Bolland, who first identified the cardiovascular risk associated with calcium supplements. For the first analysis, they looked at more than 70 studies on the effects of dietary calcium and calcium supplements in preventing fractures. They considered both randomized clinical trials and observational studies, and the studies varied widely in terms of numbers of participants, calcium intake, vitamin D intake, and how fractures were reported. The researchers found that, over all, neither dietary calcium nor calcium supplements were associated with a reduction in fractures.

In the second analysis, the team reviewed 59 randomized controlled clinical trials that evaluated calcium intake and bone density. Fifteen of those studies involved dietary calcium, and 44 looked at calcium supplements. Over all, getting at least 800 mg of calcium a day from the diet or taking at least 1,000 mg of supplemental calcium a day increased bone density. But bone density only increased by about 0.6% to 1.8% — an amount too low to affect fracture risk.

It’s important to note that these studies included very few men. (Many people think that osteoporosis only affects women, but men can develop osteoporosis too.)

The study that started it all?

Bolland and colleagues pointed to one study that they think may be responsible for today’s calcium recommendations. This study was a randomized controlled trial conducted among 3,800 elderly French women (average age 84) in assisted living. The women initially had a low calcium intake (around 500 mg a day), low vitamin D levels, and low bone density. Those who received 1,200 mg of calcium and 800 international units (IU) of vitamin D supplements daily for three years had a 23% lower risk of hip fracture, and a 17% lower risk of fractures over all, than those taking placebos. The women who took calcium also built bone, while those on placebos continued to lose it. Those results — reported in 1992 and 1994 — are often cited by experts when drafting calcium recommendations for the general population. But Bolland argues that healthy, active people who don’t have a calcium or vitamin D deficiency aren’t likely to get the same protection from taking that much calcium.

What to do?

“The takeaway is that you shouldn’t be taking calcium with the idea that it will prevent bone fractures,” Dr. Slovik says. But he notes that adequate calcium and vitamin D intake is still essential for healthy bone. A deficiency of either can increase the risk of diseases like osteomalacia and rickets.

It’s impossible to determine how much calcium each of us, individually, needs. Try to get as much calcium as you can from food. If your doctor advises you to get 1,000 to 1,200 mg of calcium a day, you can safely add a daily calcium supplement of 500 or 600 mg without increasing your risk of heart attack or kidney stones. And don’t forget vitamin D. No one is challenging the recommendation for vitamin D — 600 to 800 IU a day from either food or supplements.

 

Originally published in Harvard Health 

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Joint Commission National Quality Approval Seal

Dr. Alexander Awarded the Joint Commission’s Gold Seal of Approval

Joint Commission National Quality Approval SealA big thank you and congratulations to Dr. Daniel Alexander and the surgical team & staff at FLBJC for achieving the Joint Commission’s Gold Seal of Approval for its Orthopedic Knee and Hip Replacement program.

Newark-Wayne Community Hospital was officially named an Orthopedic Joint Center of Excellence by the Joint Commission, becoming Rochester Regional Health’s 4th accredited Orthopedic Joint Center of Excellence.

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Obesity Affects Knee Implant Survival

While it is known that high BMI (body mass index) can increase a patient’s risk for complications after total knee arthroplasty, researchers from the Mayo Clinic in Rochester, Minnesota, recently took a closer look at implant survival and discovered that rates of reoperation and implant revision or removal after total knee arthroplasty were linked to increased BMI. The study was published in December in The Journal of Bone & Joint Surgery.

Daniel J. Berry, M.D., of the department of orthopedic surgery and biostatistics and health sciences research at the Mayo Clinic in Rochester, and colleagues used data from the clinic’s total joint registry to analyze 16, 136 patients who underwent primary total knee arthroplasty from 1985 to 2012. The mean BMI of these patients was 31.3 kg/m2.

According to the results, the higher a patient’s BMI after total knee arthroplasty, the higher the rates of reoperation (p < 0.001) and implant revision or removal (p < 0.001). Patients with a BMI over 35 kg/m2 also had a higher risk for infection.

Berry told OTW that the increased risk of infection for patients with high BMI is likely related to three factors:

  1. Doing surgery in patients with high BMI is more difficult and surgical times often are longer.
  2. The thick adipose tissue layer in patients with high BMI often doesn’t heal as well as muscle tissue and creates a higher infection rate.
  3. Patients with high BMI often have medical comorbidities, such as diabetes mellitus and some may also have nutritional protein deficiencies, which put them at higher risk for infection.

“Increased risk of implant revision or removal in high BMI patients is partly driven by increased infection risk (which often leads to implant removal) and partly driven by increased risk of aseptic loosening, ” Berry explained.

“We believe it is important to consider the patient’s entire medical situation when making a decision about if/when to perform a total knee arthroplasty. The potential benefits of surgery need to be weighed against the risks for the individual patient. High BMI is considered a potentially modifiable risk factor for surgery, so for a number of patients optimizing this risk factor ahead of surgery makes sense.”

He added though that “to date there are limited data on how much one reduces risk by weight reduction before surgery for patients that start with a high BMI and lose weight before surgery.”

 

Originally published in RY Ortho

by Tracey Romero

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Can Radio Frequency Energy Kill Low Back Pain?

Back pain is the most common reason people go to their doctors. According to the National Institutes of Health, 80% of adults will experience low back pain at some time in their lives. Chronic low back pain, lasting 12 weeks or longer, is believed to affect nearly one-third of the U.S. population.

Now a minimally invasive, nerve ablating procedure that was recently cleared by the Food and Drug Administration, may give relief to some people with chronic low back pain.

“In 25 years of practicing orthopedics, this is the most important clinical study I’ve ever done, ” said spine expert Jeffrey Fischgrund, M.D., chairman, orthopedics, Beaumont Hospital, Royal Oak and principal investigator of the Relievant SMART trial. “The system is proven to be safe and effective in clinical trials. It is much less invasive than typical surgical procedures to treat low back pain.”

For the study, research teams in the United States and Germany recruited 225 participants. One hundred fifty received the minimally invasive, ablation treatment and 75 received the placebo. The treatment used radio frequency energy to disable the nerve responsible for low back pain. Under local anesthesia, through a small opening in the patient’s back, an access tube was inserted into a vertebral body of the spine. Radio frequency energy was transmitted through the device, creating heat, which disabled the nerve. The access tube was then removed. The minimally invasive, implant-free procedure takes less than one hour.

“This is a new way to treat back pain. This type of treatment has never been done before, ” said Fischgrund. “It’s revolutionary. Compared to more traditional therapies; the odds of success are much greater.”

Patients eligible for this new procedure typically have been candidates for more invasive back surgeries and take strong pain medications, like opioids. Those research participants that had the radio frequency ablation procedure noticed significant improvement in their back pain within two weeks of surgery.

Relievant Medsystems Inc., a California-based medical device company, developed the nerve ablation procedure and technology.

 

Originally published in RY Ortho 

by Biloine W. Young

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Anti-Inflammatory Diet Reduces Bone Loss & Hip Fracture Risk In Women

With age, people tend to lose bone mass, and postmenopausal women in particular are at a higher risk of osteoporosis and bone fracture. However, there are things we can do to prevent this. A new study suggests that a diet rich in anti-inflammatory nutrients may reduce bone loss in some women.

A new study suggests that an anti-inflammatory diet – which tends to be rich in healthy fats, plants, and whole grains – benefits bone density among postmenopausal women.

The National Institutes of Health (NIH) estimate that in the United States, more than 53 million people have osteoporosis already or are at an increased risk of developing it because they have low bone density.

Osteoporosis is a condition in which the bone strength is reduced, leading to a higher risk of bone fractures – in fact, the disease is the leading cause of bone fractures in postmenopausal women and the elderly.

Most bone fractures occur in the hip, wrist, and spine. Of these, hip fractures tend to be the most serious, as they require hospitalization and surgery.

It used to be believed that osteoporosis was a natural part of aging, but most medical experts now agree that the condition can and should be prevented.

New research from the Ohio State University found a link between nutrition and osteoporosis. The study was led by Tonya Orchard, an assistant professor of human nutrition at the Ohio State University, and the findings were published in the Journal of Bone and Mineral Density.

Analyzing the link between diet and bone loss

Orchard and team investigated data from the Women’s Health Initiative (WIH) study and compared levels of inflammatory nutrients in the diet with bone mineral density (BMD) levels and fracture incidence.

The WIH is the largest health study of postmenopausal women ever conducted in the U.S. Women were enrolled in the study between 1993 and 1998.

The researchers used the dietary inflammatory index (DII) and correlated the measurements with the risk of hip, lower-arm and total fracture using data from the longitudinal study.

They then assessed the changes in BMD and DII scores. The researchers distributed food frequency questionnaires to 160,191 women aged 63 on average, who had not reported a history of hip fracture at the beginning of the study.

Researchers used BMD data from 10,290 of these women and collected fracture data from the entire group. The women were clinically followed for 6 years.

Orchard and team used Cox models to calculate fracture hazard ratios and adjust for age, race, ethnicity, and other variables.

Low-inflammatory diets benefit younger white Caucasian women

The scientists found an association between highly inflammatory diets and fracture – but only in younger Caucasian women.

Specificallly, higher scores on the DII correlated with an almost 50 percent higher risk of hip fracture in white women younger than 63 years old. By contrast, women with the least inflammatory diets lost less bone density during the 6-year period than their high DII counterparts, even though they had overall lower bone mass when they enrolled in the study.

As the authors note, these findings suggest that a high-quality, anti-inflammatory diet – which is typically rich in fruit, vegetables, fish, whole grains, and nuts – may be especially important for younger white women.

“[Our study] suggests that as women age, healthy diets are impacting their bones. I think this gives us yet another reason to support the recommendations for a healthy diet in the Dietary Guidelines for Americans.”

Tonya Orchard

Rebecca Jackson, the study’s senior author and director of Ohio State’s Center for Clinical and Translational Science, adds that their findings confirm previous studies, which have shown inflammatory factors to increase osteoporosis risk.

“By looking at the full diet rather than individual nutrients, these data provide a foundation for studying how components of the diet might interact to provide benefit and better inform women’s health and lifestyle choices,” Jackson says.

However, it is worth noting that the study did not associate a more inflammatory diet with a higher risk of fracture overall. On the contrary, lower-arm and total fracture risk were found to be slightly lower among women with higher DII scores.

Although the study was observational and could not establish causality, a possible explanation ventured by the authors is that women with lower inflammatory diets may exercise more and have a higher risk of falls as a consequence.

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6 Arthritis Fighters You Should be Eating

Research has found that the treatment of the most destructive form of arthritis may receive a boost with the consumption of a diet high in anti-inflammatory compounds.

Arthritis is a common, but often misunderstood, disease of the joints. There are 100 different types of arthritis, according to the Arthritis Foundation. The two most common are osteoarthritis, which comes with an aging body, and inflammatory arthritis such as rheumatoid arthritis. Inflammatory arthritis is one of the most destructive forms of arthritis because the joint’s cartilage is actually being attacked and destroyed, said Mark Williams, M.D., a family physician with Beavercreek Family Medicine.

“Inflammatory arthritis can severely affect a person’s ability to be mobile, get up and down,” said Dr. Williams, who practices with Premier HealthNet. “They often have chronic pain as well, which significantly affects their quality of life.”

There is no specific diet prescribed for those suffering from inflammatory arthritis such as rheumatoid arthritis — however, recent research suggest those who suffer from the disease might benefit from modeling their eating habits after the Mediterranean diet, according to the Arthritis Foundation. Many of the foods in this diet have been found to help control inflammation, the key culprit of arthritis pain.

“The Mediterranean diet is rich in whole foods, fruits, vegetables, lean meats and fish,” Dr. Williams said. “These types of food items can decrease inflammation, which in turn, decreases the pain and stiffness of arthritis and may help improve the quality of a person’s life.”

Dr. Williams said it is important for those who suspect they may be suffering from arthritis to see a health care provider who can diagnose which kind they may have. That will then help form a course of treatment, including the type of diet that will best help counteract symptoms. The most common symptoms of arthritis include joint stiffness and swelling. Inflammatory arthritis can also cause a person’s joints to become red and swollen.

The Arthritis Foundation suggests the following guidelines when choosing anti-inflammatory foods:

Think seaside: Fish such as salmon, tuna, sardines and anchovies are rich in inflammation-fighting omega-3 fatty acids. Eat up to four ounces a week.

Go a shade darker: Fruits and vegetables dark in color usually boast a high concentration of antioxidants. Try your hand at dark berries such as blueberries and blackberries and throw kale or a purple squash in the mix. Eat up to two cups of fruit and three cups of veggies with each meal.

Get nutty about it: Walnuts, pine nuts, pistachios and almonds contain monosaturated fat that fights inflammation. Grab a handful a day.

Add in beans: Look for ways to include beans into your meals. These small items are packed full of anti-inflammatory compounds that also deliver fiber, protein, folic acid and minerals.

Pour on the oil: Olive oil contains monosaturated fat, antioxidants and oleocanthal, a compound that can lower inflammation and pain. The foundation suggests three tablespoons a day in cooking or salad dressings.

Fill up on fiber: Fiber lowers C-reactive protein, a substance in the blood that indicates the presence of inflammation. And Dr. Williams said fiber works best when consumed through whole grain foods.

Originally published in Day to Daily News 

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