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Doc Talk: The downside of toughing it out

By Dr. Mo Brown
Orthopedic surgeon

Mo Brown head shot

Dr. Maurice (Mo) Brown

I love taking care of the tough people who live in beautiful Teton Valley. If you live here, you are “tough”. This is not a sit-and-play-checkers-as-the-sun-goes-down kind of place. Our valley is full of tough people. They ski on torn ACLs, they board with broken tailbones, they sled with ripped rotator cuffs, they drive tractors with broken wrists and they go on with their work and recreation for years with these injuries. Really, I have to marvel at the pain these people must endure and the inventions they create to keep on moving.

If you think I’m writing about you, then please read on.

I admire your high pain threshold and your unwillingness to give up any time for rehabilitation because you’re having too much fun or have too much work to do. Just know this: It’s better for you and your orthopedic surgeon to have something to work with when you decide to get “it” fixed, whatever “it” may be.

Just know this: It’s better for you and your orthopedic surgeon to have something to work with when you decide to get “it” fixed, whatever “it” may be.

Orthopedists see X-rays and MRIs that tell the whole story in a few simple images and sometimes, it isn’t pretty.

A good example of long-term damage being the end product of ignoring an injury is a meniscus tear in a knee joint. It’s very common for me to see patients with a “torn and ignored” meniscus. The meniscus is designed to be a protector of the knee joint. But when torn, it becomes a defector and can destroy the joint’s surface cartilage. I see too many patients that have put off treatment because some days it feels fine and they can live with the popping and occasional pain. It’s a bummer to see the joint surface severely damaged when we finally get around to fixing the problem. If I can offer treatment soon after the injury, there is much less damage to the joint surface resulting in a quicker, better recovery and much better long term outlook.

In modern sports medicine we are generally more aggressive when it comes to early rehab. ACL patients start rehab right away — a big change from casting (eek!) and a year in rehab in the early days of ACL reconstruction. However, recent data regarding ankle sprains has led to a step back in how those injuries are managed. Instead of pushing immediate movement, it’s clear that a period of casting or boot immobilization produces better outcomes.

Again, I see lots of patients who ignore a bad ankle sprain and keep on truckin’. They sprain their ankle over and over and ultimately require surgery to reattach or reconstruct the ligaments.

Now, I’m not throwing stones here. I’m just as guilty of delaying treatment. But take my advice: if you get hurt, have it checked out. If you wait too long, what could have been a little R & R with physical therapy or maybe a minor surgical repair can morph into a more complex procedure such as joint replacement.

If you get hurt, have it checked out.

Orthopedics_Mo Brown

Mo Brown and patient

It’s important to know what the consequences can be if you put off medical help for injuries. You may be mentally able to handle physical pain, but your body is sending that pain signal for a reason.

For all of you die-hards out there, let me put it this way: The toughest thing you can do in these situations is to stop your activities, see your doctor and get “it” fixed before it becomes a bigger problem.

Dr. Mo Brown is an orthopedic surgeon at Driggs Health Clinic.

This article originally appeared in the Teton Valley News.

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The day after … dealing with life after a heart attack

Blake Wachter, M.D. F.A.C.C.

Blake Wachter, M.D. F.A.C.C.

So, you’ve had a heart attack and you lived to tell about it. Great! Now what?

You were probably told about your medications and how important they are when you left the hospital. Yes, they are very important. Most of the medications are ones you’ll need to take for the rest of your life. Your doctor probably put you on an aspirin, a cholesterol medication called a statin, and likely one or two blood pressure medications. These blood pressure medications are not necessarily for your blood pressure; they’re good for remodeling your heart. Think of them as good medications for your heart health.

If you had a stent (a stent is what is used to open up a blockage in your coronary arteries), then you likely were put on a medication to help keep the stent open. You will need to be on this medication for at least one year (after a year, discuss with your doctor whether it is safe to stop it). You may recognize this medication by their brand names Plavix or Effient. These medications are important for your stent, and if you miss even one dose it could be catastrophic and your stent may close up (so don’t mess with this one). It is important that you do not stop any of your medications without consulting your doctor.

Your daily routine

Diet

Now that we have the medications taken care of, there are a couple other items on the agenda including diet and exercise. It’s time to eat healthy! Cut out the fast foods and most restaurant foods. Learn to eat foods with lower cholesterol, lower sodium and less processed foods. Go buy a cook book. Look into the DASH diet – it’s good for high cholesterol, weight loss, heart failure, high blood pressure and diabetes.

Exercise

After you are discharged you were likely referred to cardiac rehab – GO! That’s important. Don’t sit on the couch and feel sorry for yourself. Get out there and exercise. Lose weight, but more importantly, enjoy your second chance at life!

A note to spouses of heart attack survivors: Don’t wait on your loved one hand and foot – that’s the worst thing you could do! Don’t enable. Instead help them work on exercising more and make sure they go to cardiac rehab.

Bad habit

Now, last but not least: smoking. Yep, we had to talk about it sooner or later. You HAVE TO STOP. Please discuss ways to stop with your doctor. No pills or hypnotic therapy will help if you don’t WANT to stop. Find the motivation and do it. I have helped many patients in my clinic stop smoking by exploring the reasons they smoke in the first place and helping them find substitutions for their behaviors.

Having a heart attack is scary. Surviving one means you have another chance at living. Change your life for the better and eat healthy foods, exercise and stop smoking. Make sure you’re around for your loved ones when they need you and work to prevent another cardiac event in your life.

Dr. Blake Wachter, M.D., PhD, F.A.C.C. is a cardiology specialist at Teton Valley Health Care. She sees patients at the Driggs Health Clinic. To make an appointment or for more information call (208) 354-2302 .

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Have a heart to heart, Be Heart Smart

Blake Wachter, M.D. F.A.C.C.

Blake Wachter, M.D. F.A.C.C.

We’re two months into the New Year, and you may have made a resolution to be healthier in 2015.  Or maybe you are looking for ways to feel better. Maybe you’re tired of being tired and out of breath when you attempt simple tasks.

As a cardiologist who specializes in heart failure, I have many patients who come to my clinic with issues such as these. First, I evaluate them for heart disease.  This may include laboratory tests, echocardiograms, or treadmill exercise tests.  The results of these tests may lead to more invasive procedures such as angiograms or cardiothoracic surgery.  Sometimes a serious cardiac or pulmonary condition is not diagnosed, yet the patients continue to have these progressive symptoms.  In all cases, everyone gets the same message from me — Be Heart Smart.

To be heart smart, you have to take a serious look at what you are currently doing with your life. I focus on four areas: Sodium (salt), Calories, Smoking and Exercise. I find that all of these areas are equally hard for patients to gain control of.

 

Be Heart Smart

Smoking

Stop. Smoking causes heart disease, pulmonary disease, and many cancers. However, you must want to stop before you can successfully quit. All the medications, classes and support groups won’t help unless you really want to stop smoking. My patients who have successfully quit have found something personal that motivated them to stop.  I often ask them to name five reasons why they like to smoke, then we discuss ways they can achieve the same feeling they get from smoking with other activities.

Sodium

Cut back. The first step is to educate yourself. Salt does not only come from the shaker; it is a major ingredient in all processed foods. Start reading labels and always remember salt = sodium.

Lowering your sodium intake can reduce your blood pressure, decrease water retention, and help with weight loss.

Find out how much sodium is in your daily diet. You can find just about any food item’s nutritional content online.

Sodium facts:

  • The average American consumes more than 4,000 milligrams of sodium each day.
  • The American Dietary Guideline recommends 2,300 mg per day.
  • I restrict some of my heart failure patients to less than 1,500 mg per day.

Foods high in salt:

  • Fast food anything
  • Gravy
  • Cheese
  • Canned soup
  • Frozen dinners
  • Lunch meats
  • Snack chips
  • Chicken/beef broth
  • Seasoning mixes (steak, grill, etc.)

Of course, you should lose the saltshaker. I instruct many of my patients to avoid going out to restaurants until they know how to cook at home. Go back to the basics and explore a variety of herbs in your cooking: oregano, basil, rosemary, cilantro, chili powder, and many others. If you don’t know what to pick, just smell them in the grocery store; use your nose to choose. Tonight, pick three that you wouldn’t normally have used before and combine them in a chicken dish with a little olive oil and lots of your favorite fresh veggies.

Calories

Eat less. To lose weight you need to understand that it is not just a numbers game but also a metabolism game. Be honest with yourself with how much you are eating. Portion control is very important. There are many free phone-based apps now that can help you count your calories and show your progress. If you’re unsure where to start, try the DASH diet, supported by the American Heart Association. I like it because it is cheap and simple. It is not a fad diet. Rather it teaches you how to eat healthy for the rest of your life.

Exercise

Exercise more. Yes, exercise does help you lose weight but only if you combine it with smart eating habits. Exercise in general is a way make you feel better and become stronger. As you age, your muscles can lose tone and strength, especially if you’ve lived a sedentary life-style. I advise my patients to “sweat” for 20 to 30 minutes a day. Choose an exercise or two you enjoy. For beginners, start out with a modest level of exertion and increase the intensity in 1-minute intervals during your exercise period – interval training.

The Key to Success

My patients who take being heart smart to heart feel better. Once on a routine, they are surprised how much more energy they have. Some have lost weight, a few have stopped smoking, and most have less shortness of breath. They admit it is not easy, but it is worth it.  So talk to your doctor and get busy. Take control of your life. Be Heart Smart.

 

Dr. Blake Wachter, M.D., PhD, F.A.C.C. is a cardiology specialist at Teton Valley Health Care. She sees patients at the Driggs Health Clinic. To make an appointment or for more information call (208) 354-2302 .

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