Getting Outdoors? Eight Unexpected Items Doctors Recommend You Take in Your Backpack

Now is a great time to rekindle your love of the outdoors. In fact, record numbers of people flock every year into parks and wilderness to camp, hike, mountain bike or just be at peace. Just remember that when you are remote, your chances for serious injury escalate 50 percent higher simply because you can’t get professional medical attention quickly. Here are eight items Dr. Corey Vande Zandschulp recommends you add to your backpack, along with with advice on what to do if you’re injured in the outdoors.

A 2008 Center for Disease Control study found that nearly 213,000 outdoor recreational injuries were treated in emergency departments annually – more than half of these injuries happened to young people ages 10 to 24. When you’re injured in the outdoors, 911 might not be able to save you.

Many people prepare for a hike by filling up their water bottle, tying a hoodie around their waist and spraying on some bug repellant. Maybe they stick a granola bar or two in their pocket just in case. They’re totally unprepared for an accident. The first aid kit your car is no help if you can’t get to it.

A 2008 Center for Disease Control study found that nearly 213,000 outdoor recreational injuries were treated in emergency departments annually – more than half of these injuries happened to young people ages 10 to 24. Of these injuries, 27.4 percent were fractures and 23.9 percent were sprains. Fifty-two percent of injuries were to the arms or legs while 23.3 percent were to the head or neck.

Dr. Vande Zandschulp, cofounder of Go To Ortho and a specialist in trauma care, suggests bringing a few extra supplies to be prepared for an accident when you go into the outdoors:

  • Gauze
  • Elastic wrap bandage
  • Tourniquet
  • Protein food pouch (popular examples are FitAid or Fuel for Fire)
  • Water purifying tablets
  • Flashlight
  • Emergency blanket (lightweight silver blanket, also known as a space blanket)
  • Instant cold pack

These items are small, lightweight and easy to carry. Put them in a ziplock bag and keep them in your hiking bag and another in your glove compartment when driving.

There are a few other simple precautions you can take before hiking:

  • Let a friend or family member know where you are hiking. Plan on checking in with them when you get home.
  • Consider using a walking stick or hiking pole to maintain your balance while hiking on rough, uneven terrain.
  • If you are heading into the backcountry remember that you will most likely lose cell service. It’s a wise idea to invest in a personal locator beacon or satellite messenger.
  • If you regularly head into the backcountry, consider taking a first aid class at your local community college or a Wilderness First Responder course.

What to do When Injury Happens

Many injuries are not life threatening, but can still cause significant problems if you are alone in the wilderness, no one knows where you are, and you can’t walk out (which is probably why this scenario is used to set up many a horror or suspense movie – just remember that if you are in a haunted forest, your doctor recommends you stay on the path).

A bleeding injury is no laughing matter – it needs to be dealt with immediately. If you or a companion are bleeding, you need to:

1. Stop the bleeding:

  • Apply firm pressure with a clean gauze for at least 15 minutes. If you need to add more gauze, do not remove the original gauze, keep it tight against the wound.
  • While applying pressure, elevate the injury.
  • You may need to wrap a bandage tightly around the wound to hold the gauze in place. This should not be as tight as a tourniquet – you should be able to slide two fingers under the bandage.

2. Use a tourniquet for profuse bleeding:

If you have a minor injury, bleeding will stop with continued firm pressure, but if the wound is large and bleeding profusely or if continued pressure does not stop the bleeding, there is a real risk of death.

If this is the reality of your situation, do not wait to apply a tourniquet. A Wilderness and Environmental Medicine article on tourniquets cites a study conducted in a combat support hospital in Iraq that concluded early tourniquet use before shock had set in was associated with a 90 to 96 percent survival rate. If the tourniquet was applied after the person was in shock, survival rate plunged to just 10 to 4 percent. If a tourniquet was needed but not applied, the survival rate was zero.

Thankfully hiking into the wilderness is not the same as entering a combat zone, but this study sheds light on the need for immediate tourniquet use in cases of profuse uncontrolled bleeding.

3. Prevent or deal with shock:

  • Wrap the injured person in a sleeping bag, jacket or silver emergency blanket.
  • Keep them hydrated.
  • Talk to them to help them stay calm and awake.

Signs of shock include:

  • Rapid pulse
  • Rapid shallow breathing
  • Cool clammy skin
  • Confusion or anxiety
  • Dizziness or lightheadedness
  • Nausea or vomiting

4. Get help:

After the bleeding has stopped and the injured person is wrapped up to help prevent shock, it’s time to seek medical attention. This is a tough situation with no one-size-fits-all solutions. If you are alone, you may have to wait until help finds you. This is the time to use your personal locator beacon or satellite messenger. If your friend is injured and you don’t have one of these devices, you may decide to:

  • flag someone down on the trail.
  • build a travois (a platform between two sticks or branches) that can be used to drag your friend out of the wilderness.
  • leave your friend and go get help.

Dr. Vande Zandschulp is an avid sharpshooter, and he and his family regularly spend time in the outdoors. “It’s up to us,” he said, “The people who enjoy the outdoors, to be smart, to plan ahead, and to do what we can to be responsible for our own wellbeing.”

Learn more about how to treat injuries at home.

Hitting the slopes this winter? Before you do, check out Eight Ways to Prevent Injury and Keep Your Edge Skiing and Snowboarding.


Injured Outdoors or on a Rural Road? 911 may not be Able to Save You

Each year record numbers of people are flocking into Oregon parks and wilderness to enjoy nature. While therapeutic, escaping the city can reduce access to life saving medicine, due to Oregon’s limited trauma and injury support system in rural areas. In fact, your risk of fatality increases nearly 50 percent if seriously injured outside of a major metropolitan area, and accidents are more common than you think. Take Kathryn, for example.

When Kathryn Carter saw the picturesque dead fallen tree just off the trail, she knew it was the perfect place for a #hikingadventures photo. The former gymnast left her golden retriever waiting by the base of the tree and easily climbed into its branches, carefully tested a large branch for safety, and leaned against it, iPhone in hand to snap a pic.

Suddenly, the dead branch broke and Kathryn tumbled eight feet onto the trunk of the fallen tree. “I was laying on this dead tree, with a sharp branch pressed against the side of my neck. … I was sure there would be blood gushing everywhere.” Luckily, the branch hadn’t pierced her skin. Although covered in cuts and scrapes, she was able to limp out of the forest with only a sprained ankle.

This is just one example of what can happen when enthusiasts take to the outdoors. Thankfully, she always hiked with first aid supplies, snacks, and water and an ankle brace; most do not. (Before you head out for your own #hikingadventure, check out our list of Eight Unexpected Items Doctors Recommend You Take in Your Backpack.)

“The highest accident mortality rates in the country are in rural states like Oregon. So this is the challenge from a public health standpoint to try and reverse this and give people a chance who are injured in a rural car accident, farming accident or in the wilderness,” said Dr. Bill Long, co-chair of Oregon Trauma Education Foundation. “Lack of cell phone coverage, inability of medical response teams to get to remote places quickly, and limited trauma training for medical personnel in rural areas all affect how quickly one can get the care needed.”

In Oregon’s mountains and countryside, it’s easy to forget how isolated you are. Treacherous terrain on the coast can slow ambulances. Remote trails may only be accessed by helicopter, which takes time to dispatch and find a location. Even on popular hiking trails that are a short jaunt from popular tourist towns, medical response teams may not be able to quickly get medical equipment up the trail. You’re on your own until help can find you.

Rural Oregon Hospitals and Trauma

If you’ve had an accident in the wilderness and help has arrived – that doesn’t mean your ordeal is over. The fact is, many rural Oregon hospitals are not equipped to deal with traumatic injuries. Appendectomies may be routine at hospitals in rural Oregon, but traumatic injuries in which a patient’s life hangs in the balance are not.

The orthopedic surgeons at Go To Ortho are not just experts in trauma care, they are the on-call trauma surgeons for Legacy Emanuel Hospital and are active in the Oregon Trauma Research and Education Foundation (OTREF), a nonprofit dedicated to addressing the need for additional resources and trauma care training for first responders and rural Oregon hospitals.

The OTREF works to improve trauma education and training at rural hospitals so patients can get the life and limb saving measures they need immediately. The foundation has set in place a system that dramatically improves chances for those who are injured in rural areas. The OTREF continues to raise money so that rural hospitals, surgeons, nurses and emergency medical services personnel can learn and practice critical trauma procedures to stop bleeding and to work together as a team to save lives. This year, Dr. Steven Madey, cofounder of Go To Ortho, is the co-chair of the OTREF annual gala to raise money for training.

The Go To Ortho surgeons, working through Trauma Specialists, have all provided emergency trauma services to patients who have had accidents in remote areas. Sometimes they have provided advice over the phone or have traveled to rural hospitals to perform a surgery.

Dr. Madey wants to help raise awareness about the reality of trauma care in rural Oregon. “Most people don’t know about this issue. We want people to know that planning ahead for an accident is important – it’s not like getting hurt in Portland, Eugene or Corvallis. You can’t be rushed to the ER and have a top notch team of orthopedic surgeons on site to do your emergency surgery. Rural hospitals are doing the very best they can with limited resources.”

Getting outdoors? First check out our list of Eight Unexpected Items Doctors Recommend You Take in Your Backpack.


Workman's Compensation

Q&A With Top Oregon Workers’ Compensation Lawyer, Lauren Oda

The workers’ compensation claim process can be complicated – even experienced HR managers and HR specialists have questions about the nuances of workers’ compensation law. The fact that workers’ compensation rules and regulations differ from state to state doesn’t make the process any easier. Go To Ortho sat down with top Oregon workers’ compensation lawyer Lauren Oda to get all our questions answered.

Lauren OdaLauren Oda joined Sather, Byerly & Holloway, LLP in 2011. She represents Oregon and Washington employers and insurers in workers’ compensation and related employment matters. Prior to her current position, Lauren practiced law in her hometown of Hillsboro, where she handled criminal and plaintiff personal injury matters.

Lauren studied abroad in Santiago, Chile, and is fluent in Spanish. She graduated from the Willamette University College of Law in 2010. She is a member of the Workers’ Compensation Section of the Oregon State Bar, Oregon Women Lawyers Society, Washington County Bar Association, Washington State Bar Association, Washington Self-Insurers Association, Oregon Workers’ Compensation Claims Association, and Risk and Insurance Management Society Oregon Chapter.

Q: What are the first steps an HR manager or specialist should take when a worker says he or she has been injured?

Employers have five days from the date they receive notice of a claim or accident to notify their insurer. There are several pieces of information that must be included on the notice, and it is generally provided on Form 801 “Report of Job Injury or Illness.” Failure to timely notify the insurer may result in civil penalties.

Q: Now that marijuana is legal in Oregon, how does that influence drug testing after an injury at work?

It really hasn’t changed how employer’s test. If the employer has a policy to drug test after any work injury, then they can continue to test. The same standard applies regarding compensability of the work injury. The employer would have the burden of proving the drug use was the major contributing cause of the work injury to avoid compensability.

However, depending on the employer’s drug policy, a positive test for marijuana could result in termination of employment.

Q: What kind of injuries and illnesses are covered by workers’ compensation?

A: When we think of workers’ compensation injuries we often think of a traumatic injury due to a sudden accident at work, resulting in disability or death. Workers’ compensation covers more than just sudden accidents. An injury also can develop over time due to cumulative trauma, such as tendonitis or carpal tunnel syndrome. Additionally, workers’ compensation covers occupational diseases, which are medical conditions caused by work that develop over an indefinite period of time, such as occupational asthma or contact dermatitis.

Q: Does the injury have to happen at the workplace to be eligible for a workers’ compensation claim?

Not necessarily. A compensable injury is an injury arising out of and in the course of employment that results in disability or the need for medical treatment. This must be established by objective findings. There is a two prong test:

  • The time, place, and circumstances of the injury.
  • The causal relationship between the worker’s injury and his or her employment.

Both prongs have to be satisfied for the injury to be compensable under workers’ compensation.

Each case is decided based on the case-specific facts. Some examples of injuries that could be compensable are:

  • If an employee is injured during a commute and the employer provided the vehicle in which the worker traveled to and from the workplace.
  • Special errand: the employer directed an employee to perform a task that took them off the worksite.
  • Parking lot rule: if the employer exercises control over the parking lot, it becomes part of the employment environment and injuries are compensable.
  • Traveling employees: when employees are traveling, they are considered to be continuously in the course and scope of employment, generally even when the worker is injured during personal activities.

Traveling employees can be considered no longer “in the course and scope of employment” when there is a distinct departure or detour. For example, if they travel to Maryland for a work conference, and then take several days to visit family in the area before flying back home.

Q: Are there any kind of work injuries not covered by workers’ compensation?

From a medical standpoint, an injury that was not caused in material part by work activities, or an occupational disease not caused in major part by work activities. For example, if someone has had asthma all their life and they get asthma symptoms at work, that wouldn’t be considered an occupational disease because it wasn’t caused “in major part” by work activities.

From a legal standpoint, there are several situations where an injury or disease would not be compensable. For example:

  • Horseplay: an active participant or instigator of horseplay takes the worker outside the “course and scope of employment” even if the horseplay is happening at work. The exception to this is if the employer knew or should have known about the horseplay, and acquiesced to the behavior.
  • Injuries sustained by an employee who initiated a physical or verbal altercation that invited a physical attack. That means you don’t have to throw the first punch – if you verbally initiated the attack, you’ve taken yourself out of the “course and scope of employment.”
  • Intentional self injury.
  • Lunch break: an injury sustained during a lunch break is generally not compensable, but it’s decided on a case by case basis. Special factors must be evaluated, such as whether the worker was on a special errand, had a dual purpose or was socializing for the employer’s benefit.
  • Recreational and social activities: if social or recreational activities were primarily done for personal pleasure, then they are typically not compensable. For example, a worker plays basketball with co-workers during an afternoon break using a basketball hoop in a courtyard maintained by the employer. The worker jumps up and taps the backboard after the game and injures his knee. The injury would be excluded.
  • Drug and alcohol use: If an employer suspects or knows drugs or alcohol played a role in an employee’s injuries, the burden of proof is on the employer to prove that drugs or alcohol was a major cause of the injury. Additionally, the employer must not have permitted, encouraged or had knowledge of use.

Q: In Oregon, can HR managers and specialists recommend specific medical clinics to an injured worker?

No, they cannot.

SBH logo

An employer is not allowed to direct a worker’s medical care. However, as a service to employees, the employer could provide a list of occupational health providers in the area. The list would need to include more than one provider and could also include a disclaimer that the employer is not directing care but providing a list of local providers as a convenience to employees.

Do you have further questions about workers’ compensation law? Contact Lauren Oda at loda@sbhlegal.com or 503-595-2139.

Thank you, Lauren Oda, for your insight into the workers’ compensation process here in Oregon!

If you are an HR manager or specialist and would like to hear more about how the Go To Ortho’s award-winning orthopedic surgeons can be a good option for your employees, contact Jessica McBurney at info@gotoortho.com to learn more or request an in-person meeting.

Are you an injured worker? Go To Ortho is an immediate injury care clinic, where you can see an orthopedic specialist immediately, no appointment needed. We’re experienced at walking you through the workers’ compensation claim process. Contact us for more information, or just stop by the clinic.


Go To Ortho Collects Four Top Doctor Awards from Portland Monthly

“It’s a testament to the quality of care you get at Go To Ortho that all our physicians made the list,” said Dr. Steve Madey, orthopedic surgeon and partner at Go To Ortho. “The Portland Monthlylist is created by other people working in the medical field, so we’re the surgeons your doctors would go to if they or their family member had an injury.”

Go To Ortho is an immediate injury care clinic, a unique walk-in orthopedic clinic where you can see a top orthopedic physician immediately with no referral and no appointment. It’s the only urgent care in the Portland metro area that treats injuries only.

Each year Portland Monthly announces the city’s best doctors, physician assistants, and complementary medicine providers, according to their peers. Every licensed healthcare provider in the Portland metro area is asked to nominate the doctors “whom they would entrust their own families’ care.” This shortlist is vetted by an independent, anonymous volunteer panel of local medical professionals.

Dr. Amer Mirza, orthopedic surgeon and partner at Go To Ortho, has been named a Portland Monthly Top Doctor five times over the last six years.

“I am honored that my colleagues in the medical community nominate me as a top doctor year after year,” said Dr. Mirza.

Search the Portland Monthly’s database of top doctors to find your next physician!

 

Learn More About Go To Ortho Top Doctors

Dr. Amer Mirza

Dr. Mirza is an award-winning orthopedic surgeon specializing in joint and knee replacement. Besides being named a Top Doctor five times over the last six years, he has received numerous awards through OHSU.

 

Dr. Steve Madey

Dr. Madey is both an orthopedic surgeon and healthcare business innovator. Go To Ortho is his brainchild. He has also helped develop a cutting-edge helmet technology called WaveCel that was recently featured in Oregon Business Magazine.

 

Dr. Britton Frome

Dr. Frome is a trauma specialist focused on hand and microvascular surgery. She is president of the Oregon Association of Orthopaedic Surgeons.

 

Dr. Corey Vande Zandschulp

Dr. Vande Zandschulp focuses on acute care of orthopedic injuries, especially fractures and dislocations, as well as non-healing and poorly healed fractures.


Golf’s Most Common Injuries and How to Prevent Them

One of my favorite ways to unwind is to play a round of golf. I love a challenge, and golf is always a challenge. Just ask Tiger. Yet, if you’re like me, you’re more at risk of throwing out your back swinging than getting a chance at a green jacket. I see several golf injuries each season coming through my clinic Go To Ortho. Everything from sprains and strains to broken ankles or knee injuries. It may not improve your handicap but here’s a little insight from an orthopedic surgeon to keep you on the green.

Golf injuries can be loosely grouped into three categories: pivot and twist injuries; repetitive motion injuries; and slips and falls.

Pivot and Twist Injuries

As you swing your golf club, you are using muscles throughout your entire body to twist and pivot. If you haven’t spent any time recently strengthening or warming up your core or leg muscles, this twist and pivot motion can result in pulled muscles and strains, which causes back pain, neck pain, and even knee and hip injuries.

How to prevent a pivot and twist injury:

  • Warm up: Warming up is an important step. Even physically fit players can get a strained muscle if they don’t warm up properly or if they are swinging incorrectly. I saw this on the Golf Channel and it introduces some great stretching you can do.
  • Strength training: Some training with or without light weights is also a great way to prevent injuries in general. Here’s  how to modify your strength training to prevent back pain while strengthening your core.
  • Moderate your play: Although it’s hard to do,  I’ll say it anyway: avoid a weekend warrior mentality. Slowly work up to longer periods of practice and play rather than going all out at the first sign the sun’s out.

Repetitive Motion Injuries

Swinging a golf club again and again can cause repetitive motion injuries like tendonitis and bursitis in the elbow, hand, shoulder and ankle. Inflammation in the elbow is called tennis elbow or golfer’s elbow, depending on which area is affected. You can also develop tendonitis in your ankles, hands and the rotator cuffs in your shoulders.

How to prevent repetitive motion injuries:

  • Take breaks: Besides warming up before your game, take short breaks while you practice your swing. It gives time for the muscles to rest and recuperate before doing the same motions again.
  • Work on your technique: You can help prevent repetitive motion injuries – and lower your score – by working with a golf instructor on your technique. A proper grip and swing really can help prevent these kinds of injuries.

Slips and Falls

Falls, like Dustin Johnson had before the Masters, are the most common cause of injuries treated in emergency departments across the country. According to a 2016 risk report by the insurance company Travelers, 33 percent of accident claims at golf courses are due to slips, trips and falls.

How to prevent slips and falls:

  • Be aware: Be aware of your surroundings. People trip over uneven ground or by missing a step or two on the stairs. Often times they are not paying attention when getting in an out of the cart because they are preoccupied with their game or socializing. Take a moment to look before you step.
  • Consider your footwear: Golf course rules about footwear vary, but wearing studded golf shoes will help you maintain your footing on the green and prevent some slips and falls when, for example,  climbing out of the sand pit or searching for balls in the rough (or trees).
  • Learn how to fall: You don’t have to be a stuntman to learn how to fall properly. As you fall, bend your knees and elbows. Don’t reach out to catch yourself with your hand – that can result in a broken wrist – instead, turn so you land on the soft part of your body. Your muscles will help absorb the impact. Check out more falling strategies from professional stuntwoman Alexa Marcigliano.

If you are careful to prevent these common golf injuries, and if you forego the golf cart and walk the links, golf can provide wonderful health benefits. Being outside makes you feel better too (as long as you don’t duff your shot, that is).


A Doctor’s Advice: Alternatives to Surgery

As an orthopedic surgeon, I talk to patients about their treatment options all the time. It’s surprising how surgery tends to be first-and-foremost on many patients’ minds. Often it seems some are looking for a quick fix, either a pill to fix the pain or a procedure to fix the injury.  Others are so afraid of surgery – and the cost and recovery time – that they put off medical care and suffer much longer than needed from their injuries, unaware that they could get effective nonsurgical treatment.

In reality, the body has an amazing ability to heal itself. There are lots of effective alternative treatments that I prescribe that help bolster the body’s ability to heal itself naturally, treatments such as chiropractic care, acupuncture or physical therapy.

Chiropractic Care

Chiropractic treatment is helpful for both traumatic injuries – think of the impact of a car accident or a sports injury – and also repetitive motion injuries. Those are injuries that happen over time by doing the same motion over and over – like swinging a golf club – or even slouching all day at your desk. In particular, some minor injuries to the spine, neck, shoulders, or persistant pain can benefit from chiropractic care.

Trauma, injury, repetitive motions and slouching at your desk can move the bones of your spine out of place. When the vertebrae are out of place, they can put pressure on your nerves, causing pain and preventing you from fully recovering from your injury, that is, functioning normally without pain. A chiropractor adjusts your vertebrae to return them to their proper position, removing the pressure from your nerves.

double-blind trial divided patients into two groups: those receiving chiropractic treatment and those receiving “simulated” chiropractic treatment. It concluded that chiropractic treatment is effective for pain relief for acute back pain, sciatica and disc protrusion. In other words, chiropractic care is not providing a placebo effect, it genuinely reduced the pain levels in patients.

Acupuncture

The overprescription of opioids has led to an addiction health crisis. Acupuncture provides a non-addictive way to treat pain. Acupuncture is an ancient practice originating in China thousands of years ago. Although many ancient medical practices have no medical benefit, acupuncture is different: studies have shown that acupuncture is an effective treatment for pain.

Doctors and scientist still don’t fully understand why acupuncture works, but in general terms acupuncture stimulates the nervous system in a way that calms patients’ pain and revitalizes the body’s ability to heal itself. Acupuncture also releases endorphins, which interact with receptors in the brain to reduce pain.

Some patients are afraid the needles will hurt, but the needles used in acupuncture are so thin most people feel only a slight pricking sensation, tingling or pressure. Once the needles are in, those sensations fade. Some patients find the process of acupuncture treatment itself calming.

Physical Therapy

When you have an injury, there’s a good change you’re going to end up doing physical therapy. Sometimes physical therapy is more or as effective as surgery. A recent study concluded that when it comes to rotator cuff surgery, physical therapy on its own was just as effective at treating the injury as surgery and physical therapy combined.

Physical therapy can help patients with traumatic injuries or repetitive motion injuries. The goal of physical therapy is usually to improve range of motion and regain strength. A physical therapist will teach patients specially designed exercises, movements and stretches; and then help track progress and modify movements as necessary to help patients fully recover from their injuries and get back to their normal life, sports and activities.

Be Educated About Your Treatment Options

As a patient, it’s smart to be educated about your options. Not all physicians are going to give you a referral to treatment alternatives like chiropractic or acupuncture. Sometimes you need to ask whether these treatments may be right for your injury. Often your insurance includes coverage for some or all of those treatments, and if you’re in a car accident, Personal Injury Protection (PIP) definitely provides coverage for these treatments, whether or not you’re at fault for the accident. If you’re hurt on the job, in Oregon you have the right to choose your own doctor and your care will be covered by your workers’ compensation claim.

No one plans on getting injured. It’s always stressful and unexpected. Getting educated about your treatment options, and what your insurance will cover, before you or a loved one gets hurt will make that injury a little less stressful.

If you are injured, consider visiting Go To Ortho, the only immediate injury care clinic in the Portland metro area. No appointment needed and no referral needed. You can walk in and be seen by an orthopedic specialist immediately, or contact us for more information.


New Advancements in Knee Surgery Offer Options to Stop Knee Pain

Chronic, severe joint pain affects nearly 30 percent of all Americans, according to the CDC. And in Oregon, nearly 900,000 adults suffer from arthritis and chronic joint pain. One of the most common joint problems reported is knee pain. Those Portland-area patients who need knee surgery have a new option for surgery now available locally and will benefit from the new Oregon Surgical Institute in Beaverton. This outpatient surgery was created through a partnership with Go To Ortho and Regent Surgical Health.

Go To Ortho, which opened this year as an urgent care model for orthopedic injuries, is now one of a handful of clinics that offers the new, partial knee replacement surgery. In the past, if you had arthritis, even if you only had damage in one part of your knee, total knee replacement was your only surgical option. Technological advances such as 3-D magnetic resonance imaging, robotic assistance and computer navigation have changed that – making partial knee replacement surgery a better alternative choice for many patients, especially those suffering from arthritis and osteoarthritis.

“If your knee pain is being caused by damage in only one compartment, you could be a candidate for partial knee replacement surgery,” said Dr. Amer Mirza, orthopedic surgeon and partner at Go To Ortho. “In a partial knee replacement, only the damaged part of the knee is replaced with plastic and metal components. The ligament connecting the thigh and femur bones is left intact, and more nerve pathways are left undamaged.”

Patients who undergo partial knee replacement recover in half the time as those who have full knee replacements. And although nearly one-third of patients who have full knee replacements continue to experience some symptoms like pain and stiffness, less than ten percent of partial knee replacement patients have residual symptoms.

The physicians at Go To Ortho partnered with Regent Surgical Health and other area physicians to open the Oregon Surgical Institute in Beaverton. This outpatient surgery center is designed specifically for performing joint replacement surgeries, meaning large operating room and recovery areas, wide hallways and hospital-scale sterilization areas. An outpatient surgery usually costs less and it reduces the risk of hospital-acquired infections.

“It’s a state-of-the-art facility,” continued Mirza. “It provides a great alternative to having to go to the hospital; less hassle and more personalized service.”

According to Mirza, the facility is proof of an ongoing trend to have direct access to specialists and surgical alternatives instead of what is traditionally available. Typically, one needs a referral to a specialist. However, at Go To Ortho, anyone suffering an immediate injury, or those who have old nagging injuries and want a second opinion, can walk in and get same-day appointments from orthopedic specialists.

Who is a candidate for partial knee surgery?

Patients with arthritis or osteoarthritis are great candidates for a partial knee replacement surgery. Technological advances mean partial knee surgery can be performed on both older patients and young, active patients. This partial knee can last up to 30 years, providing many patients a good long-term solution.


Are Your Tech Habits Causing Carpal Tunnel Syndrome?

In our technology-driven world, if we’re not texting on our smartphones, we’re typing on our laptops. We dash out a quick text – I’m here got us table in the back – or we start playing Candy Crush and time just slips away. We don’t realize that all that tech usage can have a major impact on our wrists, hands, fingers and thumbs.

In the last 25 years, the time that adults and children spend on tech devices has increased rapidly. According to a 2017 Nielsen report, on average in the US, adults spend almost four hours a day on smartphones, tablets and computers.

All that typing and texting can cause wrist pain, numbness in your hands, and aching in your fingers. These symptoms can be annoying, but they are also early signs of carpal tunnel syndrome and the lesser-known, but no less painful, ulnar tunnel syndrome.

How do you know if your tech use or your job is affecting your health?

Symptoms

The symptoms of carpal tunnel syndrome and ulnar tunnel syndrome are similar, but happen in different parts of the hand, wrist and forearm. Both conditions can cause aching pain, shooting pain, burning sensation, numbness, tingling and a weakened grip. Here’s the difference:

Carpal tunnel syndrome: pain, numbness and tingling can occurs in the thumb, pointer finger and middle finger, inside of wrist and forearm. There can also pain in the palm of the hand.

Ulnar tunnel syndrome (also called cubital tunnel syndrome): The symptoms occur in the outer two fingers and run down the outside of the wrist and forearm.

Tech Habits

If you want to prevent developing these syndromes, begin by taking note of your habits. How much time are you spending on your devices? Is there an opportunity to send voice command text messages instead of typing them out? Are your keyboard and mouse in proper alignment with your arms and wrists? Do you schedule “rest” time from work or your device?

And it’s not just adults who can develop these syndromes, we need to evaluate our kids’ habits, too. A recent survey of 1,000 teens and millennials found that a quarter of their respondents between the ages of 16 to 18 text more than 100 times each day. According to a report by the nonprofit Common Sense Media, kids ages 8 to 18 spend on average 1 hour and 20 minutes a day playing video games.

The American Academy of Pediatrics recommends limiting screen time for children 2 to 5 years old to one hour per day. For school age kids and teens, they recommend balancing media use with other healthy behaviors. Parents often associate “screen time” with “TV time” but screen time includes all devices.

My colleagues and I have treated teenagers for carpal and ulnar tunnel syndrome that developed because of texting and video gaming. These teens may go on to jobs that require hand and wrist movements that can exacerbate carpal and ulnar tunnel symptoms. It’s hard seeing teens develop injuries that may cause them pain the rest of their lives.

I would like to note that some people are predisposed to developing these conditions because of factors such as chronic illnesses like diabetes and rheumatoid arthritis, obesity, smaller wrist bones and other factors.

What Can You Do?

Begin with your office.  Small changes can make a huge difference. This video demonstrates this:

You can also be smart about your typing habits at home. You don’t need to buy expensive home office furniture to ergonomically improve your laptop habits:

Factory jobs and other kinds of repetitive motions at work can also cause carpal and ulnar tunnel syndrome. Using a scoop to make dozens of trays of cookies in an industrial kitchen, or using scissors to cut material are repetitive motions that can lead to an injury. Examine your daily work routine and if you realize you are doing repetitive tasks, make a point of building in frequent short breaks for your hands. If you feel like you are developing carpal or ulnar tunnel syndrome at work (or any other repetitive motion injury) it’s important to report it to your supervisor right away and seek treatment.

How To Treat It

If you are feeling the first symptoms of carpal or ulnar tunnel syndrome, it’s a warning that you need to adjust your tech or work habits right away. If the pain does not go away, conservative treatment options can help, such as wrist support braces, massage and exercises. If addressed soon enough, you can prevent surgery and the cost and recovery time of missing work.

Procare is a common brand of wrist support brace that is easy to put on and adjust. This brace can be worn while typing or performing a repetitive task, and/or while sleeping to keep the wrist in a neutral position and relieve pressure on the nerves in the wrist.

Rehabilitation stretches and exercises will also help, including the wrist flexor and extensor stretchesball or sock squeezewrist curls and biceps curls.

To treat the pain caused by these syndromes, you can use over the counter pain medicine or acupuncture. For some, soft tissue massage is also helpful at stimulating the area and reducing pain.

The reality is, these devices are part of our lives. We rely on technology and repetitive tasks to do our work, to play sports and more. So the more we work on prevention and are informed on how to strengthen ours wrists and arms, and treat these injuries, the less pain we’ll feel. And, remember, give yourself some downtime. It can be the best remedy of all.


Can You Prevent Arthritis

You’ve witnessed your grandma or mom dealing with the pain of arthritis. Now you’re crossing your fingers, hoping you’ve missed the genetic lotto that doles out inherited diseases like arthritis. The good news is, it’s not just genetics that influence your chances of developing arthritis: your lifestyle plays a role as well. That means you can actually reduce your chances of getting this debilitating disease by making lifestyle changes today.

Many of the lifestyle changes that can help reduce your chances of developing arthritis also have other health benefits.

What is Arthritis?

When we think of “arthritis” we tend to picture seniors with painful swollen joints. In truth, “arthritis” is an informal way of referring to more than 100 different kinds of diseases that affect both young and old individuals, and can cause pain and debilitation in every joint of the body.

Three common types of arthritis are:

Here are a few surprising facts about arthritis from the Arthritis Foundation:

  • Nearly 53 million adults have arthritis.
  • Almost 300,000 babies, kids and teens have arthritis or a rheumatic condition.
  • In the U.S., arthritis is the number one cause of disability.
  • Arthritis and related conditions account for more than $156 billion annually in lost wages and medical expenses.

How to Prevent Arthritis

Genetic factors that play a role in the development of arthritis are not preventable – you are more likely to develop the disease if you are female and there is a history of arthritis in your family. But there’s good news. Even if you have a genetic predisposition, lifestyle changes can help delay the onset of arthritis or prevent you from developing it at all.

There are three major ways to prevent or delay the onset of arthritis:

  1. Cartilage cushions our joints – you want to reduce the wearing down of this cartilage.
  2. Arthritis involves inflammation – you want to reduce inflammation in your body.
  3. Research has found that arthritis is more common among people who have specific chronic conditions. You want to prevent yourself from developing these conditions.
    • 49 percent of adults with heart disease have arthritis.
    • 47 percent of adults with diabetes have arthritis.
    • 31 percent of adults who are obese have arthritis.

These are the specific lifestyle changes you can make today to protect your joints’ cartilage, reduce inflammation and prevent yourself from developing the other diseases associated with arthritis:

1. Maintain a Healthy Weight

Maintaining a healthy weight by exercising and choosing healthy food reduces your chances of developing heart disease, obesity, diabetes – and arthritis.

Maintaining a healthy weight also reduces the amount of pressure you’re carrying on your knees. The more pressure on your knees, the more pressure on your knees’ cartilage. Once that cartilage breaks down, you face some tough decisions about how to deal with chronic knee pain.

2. Follow an Anti Inflammatory Diet

An anti inflammatory diet can not only reduce inflammation, it can also help you maintain a healthy weight. There are different ways to approach an anti inflammatory diet and differing levels of dietary restrictions. In general you want to:

  • Eat fruits and vegetables
  • Eat whole grains like rice, quinoa, oats, barley and corn
  • Eat lean protein
  • Do not consume processed foods, sugar, alcohol, fast food, TV dinners and bread and bread products

An anti inflammatory diet is a lifestyle change that does not focus on just losing weight. That heavily processed “lean” TV dinner might help you cut calories but is not part of an anti inflammatory diet.

A dietician may be able to help you make better food choices, create healthy habits and stick to them. Let’s be honest: changing your diet is tough. Luckily, with a little practice you can make delicious meals using whole, healthy foods that will make you feel better, give you energy and help prevent arthritis.

3. Control Blood Sugar

When we eat food, our blood sugar rises as our bodies process the food. All food causes an increase in blood sugar, not just dessert, but some foods – like candy, pop and bagels – cause a sudden spike in our blood sugar. We can reduce these spikes by following an anti inflammatory diet.

Another way to prevent spikes in blood sugar is by talking an apple cider vinegar tonic before each meal. Add apple cider vinegar to a glass of water before meals to reduce blood sugar levels. You must use apple cider vinegar with the mother in it. Multiple studies have shown the positive effects of this simple tonic on your blood sugar levels.

4. Reduce Repetitive Tasks

Some jobs, sports and activities – such as factory work, tennis and typing – put repetitive strain on specific joints. They can not only cause a repetitive motion injury, if you are predisposed to arthritis, they can cause the cartilage in the joint to wear down.

Evaluate your job tasks, sports and activities for repetitive motions that could cause pain and injury. Build multiple small breaks into your day to give your joints a rest. If you are playing tennis or a sport that can strain your shoulders make sure you are doing stretches and exercises to prevent injury.

5. Replace High Impact Sports With Low Impact Activities

Some people don’t feel like they’re getting a workout unless they’re gasping for breath, but in reality, low impact exercises and activities can provide a great workout without damaging your joint cartilage. High impact sports like running, basketball and football cause wear and tear of cartilage in our joints. Strength training, brisk walking, swimming and yoga are all excellent low impact exercises.

6. Quit Smoking

If you need another reason to quit smoking – besides lung cancer and emphysema – here it is: smoking can lead to worse arthritis. If you’ve tried to quit on your own and can’t, there are medications that can help you quit.

These lifestyle changes will improve your overall health and wellbeing, with the added benefit of helping to prevent the onset of arthritis. If you’re already experiencing pain and stiffness in your joints, don’t delay seeing a specialist about your symptoms.


Ouch, That Hurts! Time to Decide How to Treat That Injury

Visits to the emergency room can get expensive fast. As deductibles increase, the patient pays out more on those bills. (That’s one reason I co-founded Go To Ortho, the first immediate injury care clinic in the Portland area.) When you or your child is hurt one decision becomes paramount: can I take care of this at home or do we need immediate medical help? Here are some general guidelines for several common injuries, when and how to treat them at home, and when you should see a doctor.

These are general guidelines. If you think you may be experiencing a life-threatening emergency, call 911.

1. Cuts

If you or your child is cut, it can be a scary experience because of the sudden sight of blood. Open wounds are the second most common injury to be treated in an emergency department, but not every cut requires immediate medical attention.

To stop the bleeding:

  • You need to stop or slow the bleeding right away.
  • Apply firm pressure with a clean cloth for at least 15 minutes.
  • While applying pressure, elevate the injury.

Treating at home:

If the bleeding has stopped and the wound is not severe enough to need stitches, you can treat the cut successfully at home:

  • Wash the cut well with soap and water (do not use any other cleansers).
  • After washing the wound, apply antibiotic ointment.
  • Put your band aid or bandage on across the cut, rather than lengthwise.
  • Change the bandage once a day or anytime it gets wet or dirty.

When to seek immediate medical attention:

  • If the bleeding hasn’t stopped after 15 minutes of pressure, it’s time to go to an immediate injury care clinic like Go To Ortho or an urgent care.
  • If the cut is deep: for example, if you see fat, muscle or bone, you definitely want to seek immediate medical attention.
  • Will you need stitches? A good way to tell is to pinch the sides of the wound together – if it looks better that way, you will probably want to get stitches to prevent scarring and help the wound heal. If the cut is on your face, you may be particularly concerned about scars.
  • You will need to get stitches right away – within six to eight hours of the injury – to prevent scarring.
  • If you are seeking medical attention, leave the wound as is – don’t use an antibiotic ointment before stitches.

2. Jammed Finger

If you’ve ever jammed your finger, you aren’t likely to forget it anytime soon – it hurts. Even though the pain stops you in your tracks, jammed fingers can be treated at home using rest, ice, compression and elevation (RICE):

When it comes to a jammed finger, “compression” means gently wrapping it to an adjacent finger to give it stability.

Sometimes your finger isn’t jammed, it’s broken. Here a few warning signs that your finger may be broken and you need to go to the doctor:

  • Finger is deformed.
  • Joint is warm to the touch and you have a fever.
  • Finger becomes numb and pale.
  • Continued persistent pain and swelling that does not lessen after a few days.

If your child has a jammed finger, be sure to monitor his or her injury for less obvious symptoms like swelling that does not lessen. It’s important to set children’s broken fingers to make sure they don’t experience problems with their hands as their bones continue to grow.

3. Bruises

Bruises are common occurrences, especially in active children. Often people will notice a bruise and not remember when they got it. Bruises rarely require a trip to the doctors. However, sometimes bruises form because of a more severe injury.

If your injury includes a painful bruise, you should:

  • Rest the injured area.
  • Use an ice pack ten to fifteen minutes a day several times a day for the first two or three days after the injury.
  • If possible, keep the injury elevated.
  • Ibuprofen will also help.

Some symptoms mean that your injury needs medical treatment, including:

  • Severe pain.
  • Unable to move the injured body part.
  • Signs of infections like streaks coming from the injured area.
  • A fever.

You also need to make an appointment with your doctor if you notice that you suddenly have started to bruise easily or you have a lot of bruises for no clear reason. This could be a sign of a vitamin deficiency or a more serious problem.

4. Blood Under a Nail

Accidentally hitting the end of your finger with a hammer or stubbing your toe can result in not only a swollen, painful toe or finger but also blood gathering under the nail. This trapped blood can cause additional pain and swelling.

If you hurt a finger or toe:

  • Use ice (wrapped in a cloth) or an icepack on the injury to reduce swelling.
  • Take an over the counter pain medication. Ibuprofen is a good choice because it also helps reduce inflammation.

If the pain is severe or throbbing, and you have blood under your fingernail you can treat this injury at home. This procedure shouldn’t hurt because there are no nerve endings in the nail.

To drain blood from under the nail:

  • Clean the toe or finger thoroughly with soap and water.
  • Straighten a paperclip.
  • Heat it in a flame until it is red hot.
  • Place the tip of the clip on the nail and hold it steady – don’t push.
  • The hot metal will slowly melt a small hole in the nail.
  • Repeat until a small hole forms.

Blood will drain out, relieving the pressure and pain. If this does not relieve the pain, you may have a broken bone or a cut under the nail that will require medical attention.

This procedure is not recommended if you have diabetes, a weak immune system, blood flow problems or if there are signs of an infection such as red streaks leading from the nail or pus.

Injuries like cuts, bruises or a smashed finger are always unexpected. Knowing when and how to treat them at home and when to seek medical care reduces guesswork and can help you save money on unnecessary, expensive trips to the ER.

If your injury does need medical attention, consider visiting Go To Ortho, the only urgent care in the greater Portland metro area that specializes in injuries only. Patients are seen by injury specialists and orthopedic surgeons. Contact Go To Ortho or stop by the clinic – walk-in patients are welcome, no doctor referral necessary!