Vitamin D Deficiency Common Among Orthopaedic Surgery Patients

Post provided by American Academy of Orthopaedic Surgeons

New Study Finds Nearly Half of Patients Have Low Vitamin D Levels Authors Recommend Screening, Supplementation to Improve Post-Surgical Healing

Forty-three percent of patients scheduled to undergo orthopaedic surgery have insufficient levels of vitamin D and two out of five of those patients had levels low enough to place them at risk for metabolic bone disease, according to a study published this month in the October 6th issue of the Journal of Bone and Joint Surgery (JBJS).

According to the National Institutes of Health (NIH) , vitamin D helps the body absorb calcium and is essential for bone growth and bone remodeling. Without sufficient vitamin D, bones can become thin, brittle or misshapen. People can obtain vitamin D in three ways:

• by eating certain types of food (including fish, dairy products, eggs and mushrooms);
• receiving sun exposure; and
• taking supplements

All 723 patients in the study had been cleared by a specialist in internal medicine for elective orthopedic surgery. The researchers found that, of the 723 patients studied,

• 411 (57 percent) had normal Vitamin D levels,
• 202 (28 percent) had insufficient levels; and
• 110 (15 percent) were vitamin D deficient.

“We found that nearly half of the patients who were considered ‘healthy’ enough for surgery had significantly low levels of vitamin D, placing them at risk for poor bone healing, osteomalacia (bone and muscle weakness),” said Dr. Lane, who is also a professor of orthopedic surgery at Weill Cornell Medical College in New York. “This was very disconcerting since vitamin D levels can be determined with a simple blood test and low levels can be easily treated with supplements in just a few weeks.”

“Patients who are planning to undergo any orthopaedic procedure can request a screening (specifically, a blood test called the 25 hydroxy Vitamin D test) or ask to be placed on a medically supervised Vitamin D supplement regimen prior to surgery,” said Dr. Lane.

How much Vitamin D is enough? The American Academy of Orthopaedic Surgeons (AAOS) and recent research support that the body needs at least 1000 IU per day for good health — depending on age, weight, and growth. Indeed, many people need much more than 1000 IU to keep Vitamin D levels in a good range.

Pain Pills- part 5

Post provided by Barbara Bergin, MD

Here’s the story of two fictitious young men. They are not actually my patients, but I see these two scenarios played out over and over in my practice. These are two teens, both of whom tore their anterior cruciate ligaments.

Hank asks for no pain pills following his injury, even though they were offered. He thinks he’ll do fine on Tylenol. Following the MRI, which confirmed the presence of an ACL tear, he wants to make plans for surgery as soon as possible. He’s in high school and knows he’ll probably have to miss a couple of days. He asks if it’s possible to get a handicap parking permit. That way he’ll be able to park a little closer to his school. He asks if the doctor can estimate when he’ll be able to go back to school so he can make arrangements with his teachers. He has his surgery and is encouraged to go ahead and take his pain pills as needed, but after a couple of days he discontinues them and takes Tylenol instead. He doesn’t like the way the pills make him feel and he can’t study while he’s on them. He goes back to classes even before his sutures are out. He quickly regains his muscle strength and range of motion and within a few weeks has stopped using crutches.

After his injury Alex got a bottle of narcotic pain pills from the emergency room. He’s been taking them every 4-6 hours, just like the directions on the bottle. They don’t really work that well anyway. Following the MRI, which confirmed the presence of an ACL tear, he wants to make plans to have surgery. He’s a freshman in college and so he’s going to let his parents know that he’s going to have to take off the rest of the semester and needs a note to take to the registrar’s office. His knee is killing him even before surgery so he figures it’s going to be even worse afterward. He has very little swelling but is having difficulty moving his knee. At the end of the visit he reminds the doctor that he will probably need another prescription for pain pills. He’s not out yet but he doesn’t want to get caught over the weekend without them and so he may as well stock up ahead of time. And he reminds the doctor that the Vicodin is not even touching the pain, so could the doctor make sure he gives him something stronger.

After surgery, he struggles with his rehabilitation. He takes the stronger pain pills every 4-6 hours, like it says on the bottle. He takes them before he goes to physical therapy so that he can tolerate it. He takes two before bed at night, just to be able to sleep. Sometimes he takes another one if he wakes up in the middle of the night. Six weeks after the surgery he is still requesting pain pills weekly and the doctor has to start a program of weaning him off the pills. The doctor gets a call from the pharmacy saying that Alex is also getting pain pills from his primary care physician.

Hank and Alex represent the whole spectrum of responses to pain. Alex isn’t a bad person. He’s not taking illegal drugs. He’s not selling drugs. Hank and Alex just respond differently to pain. But sometimes patients like Alex get into serious trouble taking prescription narcotics without even recognizing that there is a potential problem. Physicians don’t want to see patients suffer. So they’re reluctant to deny the pain pills when the patient is complaining. This can inadvertently lead to a pattern of prescribing narcotics that eventually contributes to addiction. Then drug seeking behaviors develop, which can last a lifetime.

The most important things to remember are:
1) Use narcotic pain pills only when absolutely necessary.

2) Use them sparingly and not necessarily “as directed” on the bottle. It’s not like taking an anti-biotic, which must be taken at regular intervals around the clock in order be effective. Take them less if possible. The prescription dose of a medication that is prescribed “as needed” means that you can take them less if a smaller dose works sufficiently.

3) Have a healthy respect for prescription narcotics. They are not benign medications.

4) Once you’ve transitioned from the narcotic to over-the-counter medications, such as Tylenol or Advil, then get rid of them by following the FDA recommendations on this website: http://www.fda.gov/forconsumers/consumerupdates/ucm101653.htm

New South Austin office opens Wednesday, December 1st

Texas Orthopedics new South Austin office is located at:

3755 South Capital of Texas Highway, Ste. 160

Austin, TX 78704

The office is conveniently located just east of the Mopac/360 intersection and shares the parking lot with the Barton Creek greenbelt entrance.

This location will replace Texas Orthopedics Westlake office at 5656 Bee Caves Road. In addition to orthopedic care and MRI services, we will offer physical therapy in Suite 150.

9 Texas Orthopedics Physicians Named Super Doctors by Texas Monthly

Congratulations to our nine physicians who were voted Super Doctors by Texas Monthly magazine!

- Bradley Adams, DO
- Barbara Bergin, MD
- Donald Davis, MD
- Robert Foster, MD
- Peter Garcia, Jr., MD
- Tyler Goldberg, MD
- Richard Lutz, DO
- Scott Smith, MD
- Archie Whittemore, MD

Texas Orthopedics Employees Pick a Christmas Charity

Each year Texas Orthopedics employees donate to a local Austin charity during the holidays. This year, we are collecting donations for the Center for Child Protection. The Center for Child Protection is the first stop for children who are suspected victims of abuse and for children who have witnessed a violent crime. An accredited children's advocacy center serving Travis County, children are referred to the Center exclusively by law enforcement and Child Protective Services, and each child is brought to the Center by a caregiver for a recorded interview, forensic medical exam, counseling, and crisis intervention. All services are provided at no charge.

Each Texas Orthopedics office has a piggy bank to collect spare change. At the end of December, we will count the change and purchase items off the Center for Child Protection wish list with the money we have raised. Many of the items needed are safety related items, such as car seats, baby gates, outlet covers and cabinet locks.

Pain Pills- part 4

Post provided by Barbara Bergin, MD

So why do some people use a ton of pain pills and other’s don’t? Umm, it’s complicated.

1) Some people have a low tolerance for pain. It’s that simple and yet it’s that complicated. It’s hard to know whether it’s something psychological or physiological. No one wants to feel pain but everyone is different in their ability to tolerate it. And there is no pain pill out there that is going to keep you from feeling pain altogether, unless it also makes you stop breathing. Right…if you’re not breathing you’re not feeling pain. But there is some level of narcotization which will leave you not caring about the pain.

2) Some people have a high tolerance to the pain pills. That’s another enigma. I can’t explain that one in a few paragraphs. It’s also multi-factorial. Suffice it to say that it’s something genetic or physiological, or metabolic. It’s really not that important to know. The outcome with these folks is not any different than the folks who have no tolerance for pain. They end up needing a lot of pain pills.

3) Some patients get into the habit of taking a lot of pain pills. It just sneaks up on them and on their docs. They have a painful injury or surgery and they get plenty of pain meds when they ask for them. It seems reasonable to the doctor because their patient has a legitimate reason to take pain meds. After an extended period of using them, they just become habituated to their use and then it’s really hard to back down. Many patients have chronic conditions. It’s almost impossible to back down on pain pills in the face of persistent pain or worse; progressively escalating pain. It takes a tremendous amount of patience on the part of the doctor, along with willpower and newfound tolerance for pain on the part of the patient. It’s really one of the hardest problems I deal with.

4) Some patients are sharing their pain meds with friends and family. They’re very good hearted and really hate to see loved ones in discomfort. I’m sorry, but that’s against the law. And it’s probably the reason why some patients use up 40 narcotic pills in two days.

5) Some folks are selling their pain pills. It’s one of the other reasons patients use up 40 pain pills in 2 days. It’s also against the law. These patients get really good at fooling us docs. They’ve got it down to a science and it sometimes takes us awhile to figure it out. They know that and so they just keep doctor shopping, thereby staying under the radar.

The bottom line is that there are huge numbers of patients who begin to abuse prescription pain relievers, muscle relaxers and stimulants. It causes a lot of disability and costs the system a tremendous amount of money.

Texas Orthopedics volunteers at Race for the Cure

Texas Orthopedics employees, friends and family passed out water to the Komen Austin Race for the Cure participants Sunday, November 7th!