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Posts by Britt Natalia

Dr. Alexander Helps National Ski Instructor after 35 Years of Pain

Larry is a 73 year old national ski instructor who had debilitating pain in his knees for 35 years until he met Dr. Daniel Alexander. He was unable to walk without pain, much less ski, but after Dr. Alexander performed two knee replacement surgeries Larry says: “My peers said that’s the best they’ve ever seen me ski…I ski all day, walk fine. I’ll be here as long as I possibly can ski, which will hopefully be until my 80s.” Watch the video here!

Thank you to Dr. Alexander and all the talented doctors from Rochester Regional Health who continue to improve the lives of those in our community!

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Unstable Knees May Contribute to Recurrent Falls and Injuries

Unstable knees may contribute to recurrent falls and injuries

A study found that knee buckling was associated with a higher risk of recurrent falls and significant injuries.

Knee buckling, caused by weakened muscles, is common in people who have osteoarthritis in their knees. To determine whether knee buckling leads to falls, researchers at the University of California, San Francisco, studied 1,842 participants enrolled in the Multicenter Osteoarthritis Study (MOST), 59% of whom were women. At a visit five years into the study, the researchers asked the participants if their knees had buckled in the past three months and whether they had fallen as a result. About 17% of participants said their knees had buckled, 20% of whom reported falling as their knees gave way.

Two years later, the researchers queried participants again. They calculated that people whose knees buckled at year five were 1.6 to 2.5 times more likely than those with stable knees to fall during the next two years. Moreover, those who said they fell when a knee buckled at the five-year visit had 4.5-times the risk of recurrent falls and double the risk of sustaining significant injuries in a fall over the next two years.

The researchers noted that physical therapy and joint replacement can improve knee stability and balance. If you have arthritis and your knees feel a little wobbly, you might want to explore physical therapy before you have a fall. The report was published online Feb. 8, 2016, by Arthritis Care & Research.

https://www.health.harvard.edu/knees/research-were-watching-unstable-knees-may-contribute-to-recurrent-falls-and-injuries

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Dr. Christopher Brown’s success with MACI Procedure, Patient Testimonial

“Life without pain in my knees was something I never thought would happen, but now I’m starting to see that with Dr. Brown’s help, that can be a possibility.” – patient Courtney Johnson.
Thanks to a diagnosis and surgery from Dr. Christopher Brown, Courtney Johnson was able to move without pain again after years of not knowing the cause. After concluding her condition was a result of cartilage delamination syndrome, a disorder that normally causes the breakdown of cartilage in older patients, Dr. Brown recommended the MACI procedure, which uses the patient’s own cartilage cells to repair the damage.
In August 2017, Dr. Christopher Brown became the first surgeon in Upstate New York to implement this new knee cartilage treatment. The procedure, conducted at Newark-Wayne Community Hospital, allows the patient to be part of their own pain solution by using their own healthy cells to help repair damaged ones.
For the first time in her life, Courtney was able to envision a pain free future thanks to Dr. Brown, stating, ” Before I met Dr. Brown, I didn’t have much hope that I would be able to do anything active without pain in my knees. Once I met him and got a diagnosis, he gave me reassurance that I’d be able to have a normal life.”

 

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2018 Health Care Achievement Award Goes to Dr. Christopher Brown

2018 Health Care Achievement Award Goes to Dr. Brown

We congratulate Dr. Christopher Brown on his 2018 Health Care Achievement Award! Dr. Brown is the medical director of Rochester Regional Health Sports Medicine and currently practices sports medicine at Rochester Regional Health, Finger Lakes Bone and Joint Center. The Rochester Business Journal created this achievement award program, ” to recognize excellence, promote innovation and honor the efforts of organizations and individuals making a significant impact on the quality of health care in our area.”

Dr. Brown was awarded this honor in the category of Healthcare Innovation, which recognizes medical care providers responsible for developments of new procedures, devices, or treatments that can save lives or improve the quality of life for a large number of people.

MACI®: The Game-Changing Alternative

In August 2017, Dr. Christopher Brown became the first surgeon in Upstate New York to implement a new knee cartilage treatment that uses the patient’s own cartilage cells to repair the damage.  Surgery was conducted at Newark-Wayne Community Hospital.

This procedure allows the patient to be part of their own pain solution by using their own healthy cells to help repair damaged ones. This could help dozens of people who live in constant pain because of bone-on-bone friction, due to the loss of cushion that cartilage provides.

The MACI procedure is used to treat defects in the cartilage that cover the surface of the joints, so that movement is smooth and pain-free. 

Innovation on the Operating Table

Besides his MACI procedures, Dr. Brown is recognized as an innovative surgeon who is always willing to adapt and learn new cutting-edge techniques that benefit his patients. He has employed several advanced procedures for shoulder and knee repair including: superior capsule reconstruction (a special procedure for irreparable rotator cuff tears where he uses a graft to replace the rotator cuff); allograft osteochondral transplant (for which he procures a size-matched cadaverous donor and then transplants a fresh graft within 21 days); and autograft osteochondral transplant (uses small plugs of bone and cartilage from patient’s knee and moves it to the problem area).

Finger Lakes Bone and Joint Center is proud to have an innovative physician like Dr. Brown serving our community and region! Congratulations again Dr. Brown, for winning the 2018 Health Care Achievement Award!

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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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