Patient Education

We believe all patients should be fully informed about their condition.

Rather than doing a random websearch and getting unrealiable information, we have provided you with some of the information below on some of the more common conditions we treat.

ARTHRITIS DIET FOR LIFE”

The arthritis diet targets certain “food groups” that fight inflammation and other foods that set off the inflammatory response within the body.  It is best to approach this diet with optimism and approach it with a thorough understanding that it is a diet “…for life.” 

To begin, in order to identify food groups that you may be sensitive to, foods that may be producing painful inflammation every time you eat them, you must first purge your system of them.  These are foods listed in the lower half of the “Arthritis Diet for Life.”  Avoid these for one month.  During this time, educate yourself by looking at the labels of everything you put into your grocery cart.  After one month, you may actually find yourself feeling more comfortable and, while not the objective, a few pounds lighter!  Next, slowly start adding each food group back into your diet one at a time.  If you are sensitive to any of these foods, you might start noticing joint pain/aching usually within an hour of eating them.  If so, this should be your warning to avoid that “food group” in the future.  Why?  Every time you eat of it, you are flaring-up your joint or other body part without realizing it.  Remember, this is “a diet for life.”  If you eat it, know that it can cause pain.  At the same time, the resulting inflammation can result in “joint degeneration,” which is another term for “osteoarthritis.”

Regarding the foods contained in the upper half of the diet, you will want to consume these on a daily basis, unless contraindicated for other health reasons (…diabetes, medications, allergies, etc.).  These food groups/supplements actually help to decrease inflammation from joints & other body tissues (…heart, lungs, blood vessels, etc.).  Try to substitute these foods for the others that “flare-you-up!”  (For example, drink soy milk instead of cow’s milk; eat Ezekiel Bread in the freezer section of Publix, instead of whole wheat breads, etc.).  The goal is to live your life pain free.  Bon Appetite!   (Regarding the Tart Cherry Juice Concentrate, it can be purchased from most Health Food stores or visit:  fruitfast.com and/or other “like” websites.)

What are the choices? If non-surgical treatment is not effective, surgery may be recommended.  The role of surgery is to relieve the pressure on the nerve at the wrist.  This may be done with an incision down the middle of the palm, known as an open carpal tunnel release, or with the endoscopic or arthroscopic carpal tunnel release that uses 2 small incisions in the palm.

What are the differences between the techniques?  Both techniques involve the use of a tourniquet to temporarily stop the circulation to the hand and are outpatient procedures.  The ligament is cut from the topside with the open carpal tunnel release and from the underneath side with the endoscopic carpal tunnel release.  The open carpal tunnel release is more common, but the recovery may be longer.  Dr. Gardner prefers the endoscopic carpal tunnel release, as it may allow you to return to work and recover more quickly, with less pain and no splinting.  If there is any difficulty with the endoscopic technique, it will be converted to an open technique.

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What can I expect?  The results of both techniques are excellent with >90% satisfaction.  Both procedures have been done on thousands of patients.  The complications with carpal tunnel release are rare with either technique but may include:  Nerve damage leading to numbness, weakness or pain, damage to the circulation or tendons, and failure to relieve all of your preoperative symptoms.  The pain in the fingers, especially the symptoms you have at night are usually the first symptoms to improve after surgery.  The numbness and weakness will take longer to improve, often as long as six months.  While unusual, you may require hand therapy to regain full use of your hand.

How is it treated?  Your hand will be placed in a splint following surgery only if an open carpal tunnel release is performed.  You are encouraged to move your fingers after surgery and keep your hand elevated; this will reduce the pain and swelling in your hand.  You should not lift objects weighing more than 2 or 3 pounds, or do any forceful gripping until allowed by Dr. Gardner, who will discuss with you timing for going back to work, and any restrictions you may have.

What is it?  Carpal tunnel syndrome (CTS) is a common condition that affects the hand.  The symptoms result from pressure on the median nerve at the wrist.  The carpal tunnel is a space in the wrist through which 9 tendons and the median nerve travel from the forearm into the hand.  Symptoms include numbness and tingling in the fingers and hand, and pain in the arm, hand, and fingers.  Unless treated, the symptoms tend to progress, eventually leading to constant numbness and occasionally to loss of muscle strength in the hand.

Screenshot 2016-02-15 06.37.54What causes it?  The symptoms are caused from pressure on the nerve.  Tendinitis may lead to swelling within the carpal tunnel and then to increased pressure on the nerve.  Conditions with an increased incident of carpal tunnel syndrome include diabetes, hypothyroidism, and arthritis.  Carpal tunnel can also be seen after fractures or dislocation of the wrist and with pregnancy, but in this case it usually resolves after delivery.

What are the symptoms?  Numbness and tingling involving the thumb, index, and middle finger are the most common symptoms seen with carpal tunnel syndrome.  The symptoms are often most severe at night.  There can be a tendency to drop things because of the hand feeling clumsy.  Occasionally the numbness or pain may involve the other fingers or move up into the forearm or arm.  Some people notice the numbness more when using a computer mouse, keyboard, tablet, or when talking on a phone.

WHAT IS IT?

Glucosamine is a naturally occurring nutrient in the body necessary for the production of key components in connective tissue that replenish and maintain healthy articular cartilage.

It has been widely used in Europe for the past 40 years as a nutritional supplement to treat osteoarthritis.  Dr. Gardner has been using/recommending it for over 10 years without problems.

WHAT DOES IT DO?

Glucosamine frequently provides pain relief to arthritic patients.  It may reduce inflammation in the joint and help restore pain-free range of motion.  Popular claims that Glucosamine prevents the breakdown of cartilage or reverses the degeneration of cartilage are unproven, as yet.

The use of Glucosamine is beneficial, and may be compared to low doses of non-steroidal anti-inflammatory drugs.  This is also ideal because of the very few side effects and the excellent safety profile.

HOW IS IT TAKEN?

Glucosamine comes in different forms – Glucosamine sulfate or Glucosamine hydrochloride are the most common.  Some forms come with Chondroitin compounds, and while the additional benefits of this combination are inconsistent, they appear to be real.

Regardless of the form chosen, Glucosamine should be dosed about 500mg 3 times a day for the 1st month, then twice a day following that.  The Chondroitin dose should be about 400mg 3 times a day for the 1st month, then twice a day after that.  If there is no improvement after 3 months, there is no perceived benefit and discontinuation is appropriate.

ICE MASSAGE INSTRUCTIONS

Ice massage is a useful technique to treat pain and swelling. The following technique is a simple, low-cost, but effective technique to use ice:

  1. Fill a small paper “Dixie” cup with water and place it in your freezer. 
  2. Once frozen, remove the cup of ice and peel a small amount of paper off the top to expose the ice surface. 
  3. Gently massage the surface against the area to be treated. 
  4. As the ice melts, peel the paper as needed.  You will be left with a small piece of ice after about 10-15 minutes, the recommended duration of icing. 
  5. This can be repeated the next morning and evening, and then when desired if it was effective in relieving pain.

KNEE ANATOMY

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MENISCAL TEARS

Anatomy:  Menisci are the cartilages in the knee joint, between the femur (thigh bone) and the tibia (shin bone).  There are two menisci in the knee.  One is medial and the other is lateral.  The menisci serve three purposes in the knee:

  • They serve as shock absorbers to the knee.
  • They give some minor stability to the joint.
  • They assist in lubricating the knee joint.

After they stop growing, the menisci slowly lose their blood supply and therefore cannot heal themselves.  Also, by soaking up the joint fluid, they also soak up mineral deposits from the knee, making them brittle.  It is partly for these reasons that the menisci are so commonly torn, especially in older people.

Screenshot 2016-02-15 06.55.17Mechanism of Injury:  There are several different types of meniscal tears with different mechanisms of injury.  Commonly, a sudden twisting of the knee when the foot is planted and the knee is slightly bent, compresses the meniscus and causes it to tear.

Diagnosis:  From the history, symptoms, and examination, a tentative diagnosis is often possible.  To support this diagnosis, an MRI is usually ordered (a meniscus tear cannot be identified on an x-ray).  An MRI (Magnetic Resonance Image) produces pictures of your knee, frequently identifying the problem.

Treatment:  Having a torn meniscus in your knee is uncomfortable and can damage surrounding structures.  For these reasons, Dr. Gardner’s usual treatment of choice for certain types of meniscus tears is knee arthroscopy, which is an outpatient procedure typically involving 2 little puncture holes through which the damaged portion of the meniscus is removed (or repaired).  But, not all meniscus tears require surgery.  Some are fairly “benign” and can be treated with “healing therapies” such as prolotherapy, PRP, or bone marrow extracted cellular therapies among a growing list of “regenerative” options.

Recovery:  Most people will require 2-6 weeks of physical therapy after surgery.  Most people will walk within a day or two of surgery but may need crutches or a walker for a short time.  Pain medication needs are quite variable.  Within 2 months, you should be near your pre-injury level of activity.

Outcome:  For most people, the arthroscopic procedure alleviates the pain and their outcome is excellent.  However, if there are arthritic changes in the knee or extensive damage to the joint surface, you may still experience weather-change or activity-related pain, but it is typically improved.

WHAT IS OSTEOPOROSIS?  It is the most common bone disease and is characterized by compromised, that is DECREASED, bone strength leading to an increased risk of fracture. This disease does not cause any symptoms, and because of this, people do not know they have it until they unexpectedly fracture a bone or

are diagnosed by a bone density scan, or DEXA. 

The bone density test is indicated to measure how “solid” your bones are—it can alert you to problems with your bones before you have a fracture.  The “Z-score” represents numbers that compare your bones with others your age.  The “T-score” compares the condition of your bones with those of an average young person with healthy bones—those of a 25-30 year-old. * The lower your bone density score, the greater the risk you have of fracture.

HOW IS OSTEOPOROSIS TREATED

  1.  We recommend adequate amounts of Calcium and Vitamin D3 in the foods you eat and/or the supplements you take every day.  When you don’t take in enough calcium from your diet, supplements may become essential or the calcium will be taken from your bones.  Vitamin D is necessary because it promotes the absorption of the calcium in your gut and maintains adequate serum calcium and phosphate concentrations in the blood to enable normal mineralization of the bone. 

*Unless you are instructed not to take either of these supplements or you are being treated by another provider, the recommended dosing for Calcium with Vitamin D3 is one 600mg tablet, two times a day.  Add a daily multivitamin with minerals.  In addition, include a separate Vitamin D3 tablet, 2,000 IU daily.  Taken this way, you’ll receive 1,200 mg of Calcium and >2000 IU’s of Vitamin D3 each day. 

2. If being treated with medications specifically for osteoporosis/osteopenia, take them as prescribed.

3. EXERCISE!  This will help to prevent falls and fall-related fractures by strengthening your bones and muscles which improve your balance, coordination, and flexibility.  The best exercises are weight-bearing activities and any movement that makes you work against gravity. 

4. Finally, find out everything you can about this disease process.  It will help you “turn it around!”  Go to nof.org or your local library to find out more.  Questions?

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