Author: D. Bents

Celebrate the freedoms our soldiers fought for you to enjoy: to say what you will on social media, to seek a job that brings you joy, to keep the money you earn, to explore the roads less traveled, to be educated, and to vote for the people crazy enough to run for political offices.  We live in the land of opportunity, so please take a moment to appreciate these privileges that are the glue of our wonderful nation.  Paragon encourages safely observing the day by drinking responsibly and always having water readily at hand if you light fireworks.  We live in a great country, in a gorgeous little corner of this world, and let’s keep it that way.
FUN FACT: The large crack in the Liberty Bell is actually the repair.  They were trying to prevent a small split from spreading further and restore the bell’s tone, but it developed another fissure that resulted in its retirement in 1846.
The Liberty Bell – Independence National Historical Park (U.S. National Park Service) (nps.gov)

The last in our series of blogs covering the subject of pain management after you’ve had orthopedic surgery is: alternative therapies.  Paragon Orthopedic Center is a big advocate of alternatives to opioids because of the dependency that can come with that class of drugs.  In your pre-op discussion with Dr. Bents or Dr. Van Horne, alternatives are recommended according to the most recent research and your individualized surgical plan of care.  Our surgeons stay current on the newest, proven ways to manage your pain and are open to giving those options to you.  Some of the alternatives that have not been previously mentioned in our coverage on this topic are:

• Physical therapy
• Continuous Passive Motion (CPM)
• TENS (transcutaneous electrical nerve stimulation) unit
• Acupuncture
• Meditation/conscious breathing
• Psychological techniques: imagery, hypnosis, relaxation techniques

Putting some time into researching these options is a good idea for anyone who is considering surgery.  Please make sure you discuss alternatives with your surgeon to make sure they will help and not do harm.  Not all of these alternatives will help for all surgeries, which is why this needs to be a conversation with your surgeon before surgery.

Alternative Methods to Help Manage Pain After Orthopaedic Surgery – OrthoInfo – AAOS

After discussing the use of opioids for severe to moderate post-operative orthopedic pain in our last blog, now we will discuss the use of Non-Steroidal Anti-Inflammatory Drugs, or NSAIDS for short.  You might know these as ibuprofen (brand name: Advil/Motrin) or acetaminophen (brand name-Tylenol), or naproxen (brand name: Aleve/Naprosyn).  There are nearly two dozen NSAIDS in use.  These are used alone for mild to moderate post-operative pain and help by reducing swelling and soreness.  They are frequently used in conjunction with opioids to manage immediate post-operative pain and reduce post-operative swelling.  Advantages include: no chance of addiction and fewer side effects than opioids.  Some disadvantages: only for mild to moderate pain, chance of stomach upset/bleeding, and possible cardiac effects.  Studies are ongoing about how best to use these for post-operative pain control.  Unfortunately, there is no one, best way to solve the problem of pain after orthopedic surgery.

Managing Pain With Medications After Orthopaedic Surgery – OrthoInfo – AAOS

This is a huge subject to cover in one blog, so we’ll cover opioids, NSAIDS, and alternative methods of pain management separately.  Dr. Bents recently had a post-operative knee surgery patient complain in the recovery room that she was having pain, saying that she expected not to feel any.  Surgery that involves the cutting of tissues and bones will result in pain, and although the degree to which you feel it varies, Dr. Bents and Dr. Van Horne have protocols to keep you as comfortable as possible.  We will discuss pain management with opioids today, which is what you will typically take right after your surgery when the pain can be moderate to severe.  Top advantages when taking opioids: pain relief is rapid, mobility becomes easier, and increased ability to sleep/rest comfortably.  Most notable disadvantages include: dependency (the biggest concern), constipation, drowsiness, itchiness, nausea, and confusion.  Dependency can happen without you realizing it due to the addictive nature of opioids.  Paragon Orthopedic Center wants you to be on the smallest opioid dose necessary for the fewest days possible to cover your pain to avoid dependency.  You need to follow the instructions from our doctors closely and call Paragon if you have issues outside of your individualized pain protocol.  The doctors act as a team with you and your support system to keep you comfortable, and part of this teamwork is to be honest with the surgeon about whether you use prescription medications before your procedure.  If you use them before your surgery, you might need a higher dose of pain medicine than most people because your body is used to what you are taking, so an honest, open conversation is a must.  Pain coverage is necessary for proper healing, so our surgeons take the time to discuss this for complete clarity before you head into any surgery.  You will get your strength back quicker and get back to your usual activities sooner with good pain control.

Managing Pain With Medications After Orthopaedic Surgery – OrthoInfo – AAOS

Southern Oregon is finally heating up and trying to break some records!  Paragon Orthopedic Center has heard many complaints about how uncomfortable casts can be when the mercury rises.  Sometimes patients forget about how to care for their cast because of high anxiety when the cast is put in place.  Here is an article you might find helpful from the Mayo Clinic about cast care do’s and don’ts.  There are FDA-approved sprays specifically made to help with itching under a cast, if that begins to be a problem.  Just please don’t go putting a cut coat hangar down the cast: it can injure your skin and lead to infection.

Cast care: Do’s and don’ts – Mayo Clinic

We have had some patients become very upset with our clinic staff over the face mask mandate, but having to wear a mask is not our decision.  The Oregon Health Authority never lifted the mandate for healthcare settings.  It is said that because healthcare settings are places where people who are the most vulnerable to serious complications from COVID-19 converge, masking should continue.  All healthcare clinics and hospitals in Oregon, Washington, and California are continuing this practice.  Our doors could be closed if we do not comply.  In order to stay in business, we kindly ask that as we wear them for our entire nine-plus hour day, that you keep them up for the duration of your appointment from entrance to exit.  We will endure the discomfort together and we appreciate you!

Oregon Mask Requirements (egov.com)

The North Pole is at its maximum tilt toward the sun (~23.5 degrees) on this day, giving us the longest period of sunlight time all year.  Along with this comes the longest periods of twilight, both at sunrise and sunset.  What better way to enjoy this than to do a 5K run!  Medford is having a Longest Day Run at 7:30pm TONIGHT.  The run partners with Friends of the Animal Shelter (FOTAS), giving a percentage of the profits to their cause to help animals in need of homes.  You can register for this 3.1-mile race tonight, $25 cash and exact change only.  Get some exercise around Bear Creek Park, celebrate the summer solstice, support a good cause, and they’ll even have Little Caesar’s pizza at the finish line to take care of dinner for you.  Can’t beat that!  Paragon Orthopedic Center encourages you to get moving and support our community.  Read more details and sign up here:

Longest Day Run (runsignup.com)

Here is the June edition of the Paragon Press newsletter.  This month, we take a look at the advice you frequently see on medicines, “Take with food.”  It’s something Dr. Bents and Dr. Van Horne discuss with patients due to the nature of the many anti-inflammatories they prescribe, but how much food, and why?  Read more here:
Paragon Press June 2022

Paragon Orthopedic Center isn’t a comedic hotbed, but in our bone-oriented clinic, we hear our fair share of references to the idiom, “break a leg”.  The patient who broke their leg during a performance, “I literally broke my leg!”  As Dr. Bents is turning to go into surgery, he might hear, “Hey Doc, don’t break a leg!”  The patient who recovered from a broken leg being told as they leave, “Don’t break another leg!”  Nobody is truly wishing a person to have a broken leg, and saying it seems to always elicit a smile.  Typically meaning “good luck,’ the origins of this go back to the theatre.  Superstition says not to wish an actor good luck because that’s bad luck, so instead “break a leg” came about.  It might have been adapted in the early 20th century from a German aviation saying “Hals-und Beinbruch,” meaning “neck or leg break,” or a Hebrew blessing “hatzlakha u-brakha,” meaning “success and blessing,” The German translation is still used today to wish good luck, but it isn’t connected to the theatre.  It is speculated that the saying was brought to America with immigrants after the First World War.  The earliest written usage is in 1939 in an autobiography by Edna Ferber, according to Wikipedia.  So there you have it.  Share your wisdom with others!

Why Do We Say “Break a Leg?” | Reader’s Digest (rd.com)

Before going into the details, it is important to understand the most recent definitions of terminology used in reference to COVID.  Fully vaccinated means you have had the primary series of vaccines.  Up to date means you have had the recommended vaccine boosters.  Quarantine means you are protecting yourself from others by wearing a mask and taking precautions to avoid exposing the virus to others.  Isolation means you are sequestered away from other people.  Exposure means you have come into contact with someone who has the virus, and close contact means you’ve been within 6ft of someone for a total of 15 minutes in 24 hours who has the virus.

Now, according to the CDC, if you have been vaccinated and are exposed to COVID, you do not need to quarantine.  It is recommended that you: wear a mask for 10 days, get tested on day 5, and quarantine immediately if you develop symptoms.

Do you need to quarantine if you have been vaccinated and test positive for COVID?  ALL people who test positive for COVID need to isolate for 5 days, regardless of vaccination status.

How does the vaccine help?  The vaccine aims to reduce the risk of contracting COVID, keep you out of the hospital if you get COVID, and reduce the risk of a hospital stay.

Now that researchers have had time to study the data from the past two years, the CDC has come out with these new guidelines, which could change, based on new data as more studies are completed.   Check out this article by healthline.com for a full explanation of these facts:

Do You Have to Quarantine If You’ve Been Vaccinated for COVID-19? (healthline.com)