July/August 2017

Ask the Orthopedist

By REUBEN GOBEZIE, MD

QUESTION

Is it possible to have shoulder replacement surgery as an outpatient procedure?

ANSWER

Yes. Orthopedic surgeons who specialize in shoulder surgery are now providing patients with the outpatient option when it applies to their condition. People love the outpatient experience and recover better when they are at home.

When provided by a specialist, the surgery may only take 35 minutes in a highly controlled environment and results in little blood loss. The less time that you are under anesthesia, the better the recovery. There is less risk of infection, increased patient satisfaction and higher quality outcomes based on function and pain with a home recovery. Patients walk out with their arm in a sling and are home the same day.

In the weeks leading up to surgery, each patient and their caregiver should be provided with educational information and a prescription for physical therapy. For example, our practice offers a series of physical therapy videos that patients study before the surgery and work on at home post-surgery. The videos illustrate the exercises, and the education offers very specific goals that each patient needs to meet to recover faster.

The outpatient surgery and home rehabilitation option saves patients considerable time and money. Most patients are able to use their arm enough to care for themselves within a week after the procedure. After three months of follow-up appointments, the patient no longer requires office visits, but the atrophy from the initial injury could take up to a year to fully improve.

While a large percentage of patients are candidates for outpatient shoulder surgery, it’s not for everyone. Patients with complicated medical histories may not qualify. Each patient should be carefully examined to determine the procedure that will work best for them.

All shoulder conditions should be evaluated by a shoulder specialist with a thorough history and physical examination including imaging studies.

Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues. It also can affect other organs.

The cause of RA is unknown. It is an autoimmune disease, which means the body’s immune system mistakenly attacks healthy tissue. RA can occur at any age but is more common in middle age. Women get RA more often than men.

Infection, vaccination, genes, a refined food diet and hormone changes may be linked to the disease.

RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet and ankles are the most commonly affected. The disease often begins slowly, usually with only minor joint pain, stiffness and fatigue.

Do I Have RA?

RA symptoms include morning stiffness that lasts more than one hour. Joints may feel warm, tender and stiff when not used for an hour. Joint pain is often felt on the same joint on both sides of the body.

Over time, joints may lose their range of motion and become deformed.

The usual medical advice given to people with RA is to exercise to decrease pain and to feel more energetic, although this hardly seems possible to someone suffering wfromRA.

It is true that inactivity decreases joint motion and flexibility. Inactivity also can lead to weak muscles and deformed joints. Regular exercise helps reverse joint stiffness, builds muscle and boosts overall fitness.

With regular exercise, you can be stronger with less fatigue despite this disease. Here is the key: RA patients need to do the right type of exercise, not simply more exercise.

Exercise Know-How

Exercise should be discussed as a dosage, just like medicine. The right amount of exercise for someone with RA can be life changing. The wrong dose could easily leave the sufferer worse off.

For many people, the exercise that provides the most benefit is machine-based strength training done with extreme control.

If you’ve turned 65 or are getting close to it, you’re likely swamped with information about Medicare plan options such as prescription drug plans, supplemental health insurance policies and Medicare Advantage plans.

Some folks may enjoy the challenge of figuring out the process of choosing health insurance coverage. After all, it’s important to choose the right coverage for your needs. However, if you’re not one of them, consider an appointment with a licensed sales agent who can help you navigate through the various options and help you get the right coverage for your health care needs.

Finding a Fit

Brokers (or agents) are licensed by the state and undergo annual required training and testing by the plans they sell.

There’s no cost for the service offered by a licensed sales agent because the agent is paid a commission by the private insurance carrier based on your enrollment in the plan.

 Consider meeting with an agent before you turn 65 so you can anticipate costs and coverage. Caregivers or family members who are helping make these decisions can participate in the meeting, too.

A licensed sales agent assures that your enrollment application gets properly completed, follows up with the carrier to ensure timely processing, and provides notification of your enrollment status.

The agent also will research prescription drug plans (PDP) because each has a list of covered drugs. An agent can help determine if your drugs are covered,  the co-pays associated with a plan and which plans to offer the best benefits for your situation.

In addition, the sales agent also verifies that your doctors, hospitals and other medical providers are in-network. This is an important step before selecting a plan because many Medicare plans have a network of doctors that they use.

An agent follows up annually to discuss changes to your medical needs, to discuss any upcoming changes to your current policy, and to provide updates on the health insurance industry.

Farm Market Fresh

Summertime in a Basket

You can keep your chlorinated pools, air-conditioned resorts and jammed amusement parks.

For our money, the best place to spend a few hours in the summertime is at one of Northeast Ohio’s farmers markets.

Summer’s slog through our humid, hot weeks is almost perfectly measured through the colorful fruits and vegetables that show up in vendor booths each week.

The season starts with crisp greens, fresh flowers and strawberries in June, then moves to squash, raspberries and blueberries in July. August’s bounty comes in quick succession: tomatoes in odd and expected colors, zucchini, sweet corn, melons. Did I mention zucchini?

By September, we’re a bit jaded by summer’s plenty. That’s why it’s a perfect time for the season’s heavy hitters: fragrant, sweet grapes, bushels of apples and the look-at-me pumpkins and gourds with their crazy shapes and colors.

Careful observers, mindful of the season’s rainfall and temperatures, can guess within a week or so how far into summer we’ve gone and how close to autumn’s chill we’re getting.

If you’re not a seasoned farmers market shopper, we’ve got a few hints to get you started. An old hand? Consider checking out a different market or two in another community.

Despite its sprawling suburbs, network of highways and big time sports teams, Northeast Ohio remains, at its heart, farm country. Why not eat like it?

Your Guide for a Fruitful Farmers Market Visit

By Breanna Mona

Do you just squeeze the produce and hope for the best?

Wait, can you even touch the items at all? How do you know you’re picking the best? Is the professional shopper in the straw hat and yoga pants rushing you along?

Take a breather and take in these tips straight from the horse’s mouth — or should we say farmer’s?

Let Freedom Ring

Define Your Time

By Estelle Rodis-Brown

Ahh, freedom.

From the page of our nation’s Declaration of Independence to the pages of our lives, nothing’s quite so sweet as the intoxicating ring of freedom — the certain unalienable rights of life, liberty and pursuit of happiness.

Yet, if you really think about it (or read the full Declaration), you must accept freedom from something before you can pursue freedom to something better.

Stretching Limits

After midlife, we experience a cascade of new freedoms, if we can see change in a positive light. Whether it’s a newly empty nest, the absence of a partner, retirement or downsizing, each change represents a freedom from old obligations and expectations. This opens up new possibilities: freedom.

Suddenly, you find yourself with time and space that you didn’t have before. Don’t fritter them away on daytime TV and falling into the same old ruts left over from that previous life. Instead, satisfy old longings you never gave yourself permission to pursue before. Join that class you were afraid someone else would think was silly. Take that trip you talked yourself out of before. Paint your living room that bold color you always wished you could. Reach out for better relationships. Because guess what? Now you can.

Big Changes, A Life Redefined

Perhaps no one better illustrates the dramatic before-and-after equation of life than Brenda Formberg of Ravenna.

When midlife hit Formberg, so did a slew of unwelcome changes: She divorced. Her daughter left for college. There was a second cancer diagnosis, job loss, and the resulting need to find a new home.

Her outlook seemed hopeless as pieces of her once-stable life fell apart. Eventually, Brenda emerged with renewed vigor for the pursuit of life, liberty and, yes, happiness.