Viscosupplementation

What is Viscosupplementation?

Viscosupplementation is a procedure that is often utilized by the doctors at Lake Washington Sports & Spine, mainly for patients who suffer from osteoarthritis of the knee.  Osteoarthritis (also called degenerative joint disease) is mechanical wear of cartilage and bone within a joint and often limits patients’ abilities to remain active.  Since our goal at Lake Washington Sports & Spine is to Keep People Active, any procedure that helps our patients maintain their level of physical function is a great tool in our belt. 

Viscosupplementation (also known as hyaluronic acid injections or hyaluronan injections) involves injecting a lubricating fluid into a joint (most commonly in the knee, which is the only joint that has historically been covered by insurance, but it can be helpful in other joints as well).  Hyaluronic acid is an important component of the joint fluid in healthy joints and is found in lower concentrations in osteoarthritic joints.

What is it like to receive a viscosupplement injection at Lake Washington Sports & Spine?

Both Drs. Hyman and Chimes typically recommend that their patients receive a series of three injections over the course of three weeks (one injection per week).  The patient will come in at their regular check-in time and fill out a follow-up form.  As always, we recommend patients wear athletic clothing to the appointment (shorts are particularly ideal).  The doctor will perform the injection under ultrasound guidance to make sure that the hyaluronan is accurately placed into the joint space.  There is a chance that patients will start feeling benefit after the first injection, but typically, maximum benefit is gained after all three injections have been completed. 

Doctors’ recommendations post-injection:

1.       Ice the injection site if patient is feeling any local tenderness

2.       Continue any mild to moderate cardiovascular exercise routine

3.       Avoid any High Intensity Interval Training (HIIT), weight training or resistance training for the first 48 hours after the injection

4.       Call the office with any other questions/concerns that may arise

The benefits of viscosupplement injections can be felt for between several months and a year, but of course, these numbers vary greatly between patients.  It is possible for the series of injections to be repeated; usually our doctors and insurance companies require at least 3-6 months between the first series and the second.   Additionally, it is important to understand that viscosupplement injections are not substitute for total joint replacement surgery if a patient’s osteoarthritis is severe. 

What if I have osteoarthritis in areas OTHER than the knee?

Currently, the use of viscosupplementation is FDA approved to treat knee arthritis only but it has been shown to be beneficial when used in other arthritic joints such as hips and ankles.  As a practice that focuses on delivering “pure medicine”, our doctors do not want patient care to be restricted by insurance companies, and therefore we offer competitive direct-pay pricing for viscosupplement injections not covered by insurance. The doctors at Lake Washington Sports & Spine will make it clear if they feel viscosupplementation is the best method of treatment, whether or not it is covered by insurance. 

If you are suffering from osteoarthritis that is keeping you from participating in the activities you love, we recommend you call our office and set up a consultation to see if viscosupplementation is the right choice for you!

Graduation Ceremony

Graduation: high school, college, completion of treatment?

The Graduation Wall

Have you ever been to a clinic where they have a ceremony to commemorate your success? Better yet, a clinic that celebrates when you don't have to schedule another appointment?  

Here at Lake Washington Sports and Spine, we believe it’s crucial to recognize our patients' dedication and determination to get back to being active. Our graduation wall represents the collective achievements of every patient who has completed treatment and returned to the activities they love.

The Sights & Sounds of an LWSS Graduation

Our whole office pauses for a moment to recognize your success! At graduation, you write your name on a sticky note, then slap the note on our graduation board while performing an exercise that utilizes your rehabbed body part.  As you post to the board, the LWSS team cheers and shakes maracas in celebration. But wait, it doesn't end there!  Once you walk to the end of our hallway, you press the "Emergency Affirmation" button and are congratulated with a “swag bag”.  Celebration, gifts and a body back-in-motion, who doesn't love that!? 

Why We Believe Graduation Is So Important

LWSS is built on the foundation of "Happiness Based Musculoskeletal Medicine", so we always focus on life's positives!  What could be more positive and happy than returning patients to doing the physical activities they enjoy? We recognize that you put the work in and think you deserve the credit!

For patients who are just beginning their journey with us, we hope the Graduation Wall serves as an inspiration and we look forward to celebrating you and your future success!

5 tips to prevent holiday weight gain & stay active

1) Hydrate
H2Oooooohhh yeah! Drink a large (16 oz.) glass of water 15-30 minutes before every meal, especially before hitting a holiday buffet. Water will help you feel fuller, eat less and aid in the digestion process.

2) Indulge in moderation
Deprivation is a recipe for disaster, but so is unlimited indulgence. Find a happy balance and allow yourself 2 or 3 small portions of your favorite holiday treats. For the rest of the meal, stick to healthier options like veggies, lean meats, low fat cheese and fruit.


3) Weigh in
While it’s tempting to reach for elastic waist pants and hide your bathroom scale for the month of December, neither will help keep you accountable. If you see the number on the scale creeping up or feel your favorite pants getting tighter, you’ll likely pass on that slice of pie.

Think you can take an accountability hiatus and start again in the New Year? Neglecting healthy eating habits and exercise during the holidays will only make your resolutions more difficult.

4) Make exercise appointments
Consistent exercise and protected time to de-stress are more important than holiday shopping and gatherings. To avoid making excuses or falling into the trap of being “too busy”, schedule exercise on your calendar just like you would any other meeting. Bonus, you can even set an event reminder alarm to alert you it’s time to get moving!

5) Share fitness with loved ones
The best part of the holiday season is spending time with friends and family, so connect while staying active! Take an after dinner walk with your kids, go hiking with your cousins, attend a fitness class with your best friend, or register for a fun 5K. Make fitness a new part of of your holiday tradition!

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Healthier Options: Thanksgiving Edition!

I LOVE the fall and winter holidays!  The sights, the sounds and especially the holiday FOOD.  I remember as a kid, the scent of my Mom’s turkey and gravy wafting through the house on Thanksgiving Day.  My family and I would indulge ourselves on the bountiful feast spread before us and celebrate the holiday giving thanks to family, friends and health.

Fast-forward 20 years and I am going to be preparing a Thanksgiving meal for my OWN family now.  I will definitely have Mom’s recipes in mind and will be trying my hand at lightening some Thanksgiving side dishes so I can stay on a healthy path and not fall into the Thanksgiving “coma” from over-eating heavy foods. 

This year I plan to be a more mindful eater. I will prepare some recipes in advance to test out new, healthier side dishes so I know which ones my hubby will enjoy (and which ones he will attempt to feed the dog on the sly).  I have included some lighter side dish recipes below and encourage you to also experiment on your own!  Have fun this Thanksgiving and remember: It’s a holi-DAY not a holi-MONTH so instead of embarking on a month long food fest, take control of the day and kick-start your motivation for a healthy holiday season!

RECIPES

1.   Healthy Potato Gratin with Herbs: Skip the mashed potatoes this year and try a lighter potato dish that loses the heavy cream but keeps the flavor with fresh herbs.

http://www.foodandwine.com/recipes/healthy-potato-gratin-with-herbs 

(recipe courtesy of Food and Wine)

2.   Cider-Glazed Roasted Root Vegetables: Instead of a basic sweet potato/yam dish, try this delicious recipe that brings an added sweetness with apple cider.

http://thescrumptiouspumpkin.com/2014/11/25/cider-glazed-roasted-root-vegetables/ 

(recipe courtesy of the Scrumptious Pumpkin blog)

3.  Cranberry-Pear Wild Rice Stuffing: Take unhealthy “stuff” out of your Stuffing this year with wild rice, whole grain bread and dried cranberries.

    http://www.vegkitchen.com/recipes/cranberry-pear-wild-rice-stuffing/ 

(recipe courtesy of the VegKitchen with Nava Atlas blog)

How to Prepare for Your PRP Visit and What to Do After

Platelet-Rich Plasma (PRP) is an example of proliferative therapy that we’ve discussed on this blog before. The treatment is useful for many musculoskeletal disorders, ranging from lingering tendon, ligament, and muscle injuries (e.g. hamstring and rotator cuff tears) to joint pain (e.g. knees and hips). We at Lake Washington Sports and Spine tend to recommend PRP after other conservative measures, particularly physical therapy or chiropractic care, have not produced meaningful results.

PRP is one of many treatments that we perform in the office, but it is one of the more time-intensive ones. This is due to the nature of the therapy itself. When we perform other injections in our office, medications are drawn from vials then injected into a patient. However, with PRP, the medication comes from the patient! Our blood is not just a homogenous red substance that courses through our veins. There are many types of cells in our blood – which include, but are not limited to – cells that carry oxygen, others that fight off infection, and the ones we are most concerned about: the healing factors.

These healing-inducing cells include platelets, as you probably guessed by the name of the therapy. The portion of plasma containing platelets - as well as other healing factors - is obtained by spinning blood in a centrifuge for 15 minutes, which separates the different aspects of the blood into distinct layers. The platelet-rich concentration is extracted from the resulting vial of separated blood, and injected under ultrasound guidance into the site of injury. This not only concentrates healing factors near the injured area (exactly where it needs to be), but also causes an inflammatory cascade which brings its own set of healing responses.

What can you do to prepare for the procedure itself?

1.     Come early.  Coming in 30 minutes prior to your appointment start time allows us to perform all the steps (draw, centrifuge, and platelet extraction) before the actual injection without making your appointment run late. It also gives us a time buffer in case we run into any issues during the blood collection. Additionally, this time is beneficial to patients as it gives them a time to relax between the blood draw and the injection. If you do not arrive 30 minutes early, there is a chance your procedure will need to be rescheduled. 

2.     Hydrate! Water is an important component of blood, and makes it much easier for any healthcare professional to draw blood from your arm. Your veins are fuller (making it easier to perform the actual blood draw) and your blood moves quicker (less time with a needle in your arm!).

What do you need to do after the procedure?

1.     Rest and get more sleep. Sleep is a wonderful thing, so I feel strange having to recommend it. But many patients do not get enough sleep, and lack of sleep can have a very detrimental effect on your healing rate. Use this procedure as an excuse to get more restful sleep. I recommend using your recovery phase from this procedure as a jumping off point to establish a good sleep routine you can use when you’re back to your fully functional self.

2.     Limit forceful weight bearing and movements with excessive range-of-motion.  Imagine a glob of peanut butter sandwiched between two saltine crackers. Now imagine squeezing the crackers together and spilling the peanut butter onto the floor. You don’t want peanut butter on the floor, just like how you don’t want the Platelet-Rich Plasma anywhere other than where your injury is located. The general idea behind PRP therapy is to concentrate healing factors into a specific, targeted area. An excessive contraction of a muscle, or movement of a joint past normal range-of-motion, can “squeeze” the platelets away from the targeted area. For some cases when the PRP is meant for a lower body part, we may recommend being on crutches for two weeks to really ensure the PRP stays where it should.

3.     NO NSAIDs.

4.     I repeat, NO NSAIDs. Your body’s natural response to injury is to cause inflammation. We typically only associate inflammation with pain, which is why people often take an NSAID (non-steroidal anti-inflammatory drug) like ibuprofen or naproxen (e.g. Advil, Aleve). However, inflammation also triggers a healing response by the body. PRP therapy will cause some inflammation and therefore may increase a patient’s pain level for the first two weeks. This is a completely normal part of the healing cascade, and is temporary. Taking NSAIDs to alleviate the temporary pain will reduce the likelihood of having a more permanent recovery. Do not sabotage your ultimate goal of getting back to fully functional activity for some temporary relief. Keep your end goal in mind!

5.     Ice if necessary, Tylenol if necessary. If you’ve been to our office, you know that we extol the benefits of ice like we’re the ice farmers of Frozen. We recommend ice as our first-line pain reliever, as ice has been shown to reduce pain and inflammation without having to take medication. However, PRP might be the only instance we recommend discretion when icing. As I’ve said previously, forms of proliferative therapy cause inflammation, so icing is counter to what the therapy is trying to accomplish. Therefore, we recommend icing only when completely necessary and the pain in unbearable. You can also try acetaminophen (e.g. Tylenol), as that is a non-NSAID pain reliever.

And that’s it! This is only a general overview, and I’m sure you might have more questions. The doctors here at Lake Washington Sports and Spine always have a consultation with a patient to review the appropriateness of PRP for a given patient, the risks involved, and potential outcomes. They are more than happy to answer any and all questions you may have regarding this procedure at that time.

Stay active!

Meet the Team: Shannon Mack!

-What is your role at LWSS?  What are some responsibilities​ your ​role ​​entails?

My role at LWSS is Dr. Hyman’s Medical Assistant.  Some of my responsibilities include greeting our patients with a smile and getting to know a little bit about them before they meet with Dr. Hyman; throughout the day, I follow up with patients via phone or email (I prefer to call, its more personal), assist Dr. Hyman when necessary during appointments, turnover exam rooms by cleaning and making sure that inventory is stocked, and help my team with some of their tasks. You will also find me petting Wynnie.

-Tell us a little about you ​and your path leading to LWSS: ​​where are you from originally, where did you go to school, and what drew you to Lake Washington Sports & Spine as a place to work?

What drew me to Lake Washington Sport & Spine started with the opportunity to be a part of a team that is focused on healthy, active lifestyles and helping people achieve just that. I was drawn in from the first opportunity I had to meet the LWSS staff and watched how they interacted with one another.

-Give us 5 fun facts about S.Mack!

I think ice cream tastes better during the winter!

Red is my FAVORITE color (although, I only have one red clothing item)

If I could have just one super power, I would definitely time travel

I am beyond thankful for GPS because maps confuse me

Every day, I take a moment to think about what I am thankful for; doing that really helps me to put life in perspective

-What is your favorite form of exercise?  How do you integrate it into your day?

I love running! It frees my mind and also gives clarity. I like to visualize my run throughout the day, especially if it is stressful. During the week, I prefer to run in the evenings as the day begins to cool. On the weekends, I try to hit the road early when it is still quiet and the air is fresh – after a cup of coffee of course!

-When did you become interested in medicine?  In what ways do you think your time at LWSS will impact your future as a nurse practitioner?

I have been interested in medicine ever since I was a child. I had an inspiring Pediatrician and a mom who always encouraged me to dream (she still does). I remember the moment when I decided I wanted to dedicate my life to serving others through medicine and that has motivated me through the years.  I believe LWSS will impact my future as a Nurse Practitioner in many positive ways – I am in an environment that challenges me to think critically, listen patiently, and reply thoroughly. These are skills that I feel are important for being successful as medical professional. The doctors also encourage you to think like a provider by asking questions related to each case and challenge you to consider other reasons for why and how a diagnosis could be obtained. There are so many learning opportunities here that are invaluable!

-Since you've worked in other clinics, can you provide some examples of what sets LWSS apart from other healthcare facilities?

LWSS is truly special. Dreams, goals, visions are not idle here – we all have them, from our staff to our patients, what we do here is “Keep People Active”  and you can see that demonstrated every day. The team here allows you to be yourself and encourages you to set specific goals. Because they are dedicated to seeing patients and staff succeed, they create a supportive and informative culture. From the moment you walk in, you can feel that you are in a place that creates exceptional and is dedicated to seeing patients rehab their injuries to achieve their goals! At LWSS, you are celebrated, encouraged, and set up to succeed.

-Can you give some examples of the types of patient interactions that drive your happiness at work?

I believe that laughter is necessary for healing; whenever I have a chance to laugh with a patient that makes me feel elated!

There is not a better feeling than hearing someone say ‘thank you’ after you have helped them with a need they have, such as, carrying an item or asking how their day is going. Taking one minute to be present with the patient and listen can be transformative in their experience - and mine.

I LOVE that we celebrate our patients who have completed their treatment with a graduation! In the midst of the cheer, I always look for the smile on their faces because you can see they are proud of what they did - and they trusted our team to help them get there!  

Your tendons on cake

My friend and colleague James Crownover recently wrote a wonderful blog post about the relationship between glucose metabolism and tendon injury

http://crownmd.net/your-tendons-on-cake/