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Better Health D
ADVOCATING FOR PATIENTS: Patient Protective Services, D2 JOINT REPLACEMENT: consider sooner than later, D3 NATURALLY: healthy ways to build muscle, D4
| SUNDAY, DECEMBER 15, 2019
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FITNESS INCLUDES
THREE COMPONENTS GOOD FLEXIBILITY,
GOOD AEROBIC CONDITIONING OR ENDURANCE, AND GOOD STRENGTH.
PHYSIATRISTS OFFER NONSURGICAL APPROACH TO MUSCLE, JOINT, OTHER CONDITIONS THAT IMPEDE FUNCTION By Anne-Gerard Flynn
the United States, Martinez noted, and the broad medical training of physiatrists allows them to diagnose and manage a variety of conditions as well as perform procedures exclusive of surgery to determine what is interfering with a patient’s ability to move and causing pain as well as treat the problem. “We use physical agents like ice, heat, massage, electronic stimulation to help restore the patient’s function,” said Martinez who sees patients for injuries of the muscles
and joints as well as conditions like arthritis at the recently opened Baystate Health and Wellness Center on Dwight Road in Longmeadow and in Springfield. Martinez said many of the injuries he sees are the result of overuse of muscles, joints, ligaments and tendons that attach muscle to bones and that can result in inflammatory conditions like tendinitis
and bursitis. He also treats acute injuries like sports-related concussions. “Ninety to 95 percent of all sports injuries are non-surgical and we are equipped to treat all of them,” Martinez said. He added someone needing surgery for an injury like a fracture would be referred to an orthopedic surgeon. “The philosophy of doing rehabilitation involves identifying three elements,” Martinez said.
“The first is the anatomic dysfunction – what is the type of injury that is causing the athlete pain. The second is which symptoms does the patient have – pain, redness, decreased strength – and then what is the functional limitation, such as the gymnast cannot tumble because they are having shoulder pain.” He said in terms of functional limitation a patient with a sports injury is evaluated on general performance, such as the basic ability to walk without a limp or pivot, and then
Special to The Republican
A back injury as a 17-yearold weight lifter on Puerto Rico’s national team started Baystate Health’s Dr. Julio A. Martinez on a career path that would lead to his specialty – physiatry - that helps restore impaired function in patients who do not need surgery. Also known as physical and rehabilitation doctors, physiatrists treat a variety of conditions affecting the brain, spinal cord, nerves as well as joints and muscles in patients of all ages and may work with a team of other health care professionals, like physical therapists, in overseeing a patient’s treatment. They may have a subspecialty in other fields like brain injury medicine, neuromuscular medicine and spinal cord injury medicine. Martinez is medical director of Baystate Physical Medicine and Rehabilitation that has a number of offices in the area and was the first physiatrist in the Pioneer Valley to become board certified in sports medicine in addition to physical medicine and rehabilitation. The field of rehabilitation became a separate medical specialty after World War II in
Dr. Julio A. Martinez-Silvestrini is medical director of Baystate Physical Medicine and Rehabilitation that has a number of locations in the area. The physiatrist, shown here at Baystate Health and Wellness Center in Longmeadow, is board certified in sports medicine as well as physical medicine and rehabilitation and sees patients in Longmeadow and Springfield for injuries of the muscles and joints as well as conditions like arthritis that do not require surgery. (ANNE-GERARD FLYNN PHOTO)
evaluated on sports-specific performance, such as can they throw their javelin with the correct technique, with the latter helping to determine the causes of the injury. He added once anatomic dysfunction is identified, sometimes through physical examination or tests, like an MRI, and symptoms eased through protective applications such as the use of crutches or bracing, sports performance can be addressed. “An athlete may not be ready to lift weights or run, but they can do posture exercise to make sure their posture is correct,” Martinez said. “They might work on their technique or flexibility. There are a lot of things we can do in the gym as part of the rehabilitation process.” He said it is important for athletes not in the initial phase of recovery to do their rehabilitation exercises twice a day when possible to speed up recovery. Martinez has served as doctor to a number of area high school, college and professional sports teams, like the Springfield Falcons, which played in the American Hockey League until 2016, and the Springfield Armor baseball team when it was based here, and he continues to visit schools and other venues to talk to athletes both about injuries as well as how to avoid them. “I performed with my back injury as a young athlete in an international competition and that was not only painful but it was frustrating emotionally to not be able to perform to the level that I could,” said Martinez of what SEE PHYSIATRIST, PAGE D4
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D2 | SUNDAY, DECEMBER 15, 2019
THE REPUBLICAN | MASSLIVE.COM
Making it easier to see a doctor
Advocating for Patients:
Patient Protection Services
By Tiera N. Wright Special to The Republican When a person is rushed to the hospital, it is seen as a sign of hope in the eyes of the patient and their loved ones; and while lives are saved, not all patients come out with a clean bill of health. “An estimated 2,000,000 people a year contract Healthcare Acquired Infections (HAI), [or as it’s also known], Hospital Associated Infections. 75,000 people die,” says Lonna Carter of Patient Protection Services. “This is more than the leading cause of accidental deaths in the United States, yet it doesn’t spark the call to action like other preventable causes such as plane or auto crashes or food borne illnesses contracted from a restaurant chain.” HAI are infections contracted while patients are treated in healthcare facilities for unrelated medical conditions. While HAI can be spread almost anywhere, they are especially prevalent in hospitals, renal disease facilities, and nursing homes. Explains Carter, “HAIs are caused by bacteria, fungi, [and] viruses; and can cause serious illness or worse, resulting in devastating financial, physical and emotional upheaval.” Common HAIs include Methicillin-resistant Staphylococcus aureus (MRSA), Catheter Acquired Urinary Tract Infections (CAUTI), Pneumonia and bed sores. Adds Carter, “Patients often get these HAI
from Catheters (bloodstream, endotracheal, and urinary), surgery or injections (which introduce pathogens into the blood stream), in settings that aren’t properly cleaned and disinfected.” Should a person contract HAI, in steps Patient Protection Services (PPS), an advocacy organization offering free referral services to victims of HAI. The seeds for PPS were sowed over a decade ago, by a determined and compassionate public health professional and lawyer, who, according to Carter, was inspired by her own father’s terminal illness from HAI. With over ten years in the industry, Carter paired her professional knowledge with her burgeoning personal experience to “help forge a solution to the HAI epidemic” when she launched PPS in the summer of 2019. From healthy moms who contract a life-threatening C Diff or staph infection post-delivery, to healthy athletes who need surgery for broken bones or torn ligaments and contract deadly fungal or staph infections - HAI impacts many people. Says Carter, “the point is we see healthy people contracting illnesses during their treatment and they aren’t told how they got it. This results in unanswered questions, permanently weakened immune systems, loss of bodily functions or worse: death – not to mention overwhelming financial consequences.” Springing into action, PPS’ goal is to stop these prevent-
able diseases as a result of HAI by spreading awareness and providing an array of support to victims. Offering free services such as referrals to patient advocacy or support groups, Carter adds,
“our mission is to help victims of HAI find peace of mind and compensation after being infected at a healthcare institution.”
Therefore, PPS also offers victims of HAI referrals to lawyers with deep experience in the HAI field. Patients who have been hurt by HAIs may be eligible for compensation for their physical and emotional injuries, expenses incurred for medical treatment, loss of income and more. In most cases, PPS’ experts can even identify the cause of transmission of HAI among patients. More than just a legal referral company, PPS believes that awareness can ultimately be a cathartic form of healing in addition to drawing attention to the epidemic. “We are creating a space where victims can safely share their stories and be part of the solution to HAI – while finding peace of mind and compensation,” says Carter, “we recognize that sharing your story, knowing you are not alone, and learning more about how things happened are key ingredients in the healing process, even if legal action is pursued”
For more information on how Patient Protection Services’ can help those harmed by HAI, visit them at: patientprotectionservices.com.
Lonna Carter, Esquire, MPH
is President and General Counsel of Patient Protection Services. She received her Juris Doctorate from Northeastern University School of Law and her Master of Public Health at Tufts School of Medicine. She brings more than a decade of experience in passionate advocacy now to helping victims of HAI get the compensation and answers they deserve.
ATTENTION PATIENTS!
Did you get an infection during a healthcare stay?
Dr. Kevin Snow, Medical Director
Holyoke Medical Group Walk-In Care
Westfield recently gained a convenient new healthcare option that increases the accessibility of quality medical services in the area. Offering same-day treatment for routine illnesses such as sore throat and fever, as well as physicals for work, school and sports, Holyoke Medical Group Walk-In Care makes quality healthcare more convenient than ever. The Westfield location follows just one year after the opening of the Holyoke Medical Group Walk-In Care in Chicopee. So how do you know when to go where for care? This guide explains which choice—your primary care provider, a walk-in clinic or the Emergency Department (ED)—works best for specific medical situations.
CHOOSE PRIMARY CARE Patients should try to get a same-day appointment with their primary care physician, if possible, for non-emergency situations, including minor illness and flu-like symptoms. If an appointment isn’t available, then care through the walk-in clinic is a good option. In addition, explains HMG Walk-In Care Medical Director Dr. Kevin Snow, “Patients should seek care from their primary care physician for chronic issues when symptoms have been building for a while, or when they’re being managed for a condition that requires medication.”
OPT FOR WALK-IN CARE The National Center for Health Statistics found that
48 percent of patients went to the emergency room because their doctor’s office was not open, and they didn’t know there was another option for care. This is where walk-in clinics can help. They’re best for conditions that are not chronic—issues that are out of the mainstream of a patient’s health. “Conditions like bronchitis, flu, cuts that need suturing and abscesses are all examples of things we treat frequently in the walk-in clinic,” says Dr. Snow. “If possible, we always want patients to check with their primary care physicians first in any non-emergent situation.” The purpose of the walk-in clinic is to provide same-day care for minor acute medical issues that can’t be addressed by a patient’s primary care physician at the time care is needed.
Conditions that can be treated at the walk-in clinic include: • Allergies • Acute asthma attacks • Back, knee or joint pain • Cough/cold • Diarrhea • Ear infection • Fever without a rash • Flu-like symptoms • Headaches • Insect bites • Minor burns • Nausea • Physicals for school or sports • Pink eye • Rash or skin irritations • Sinus infection • Sore throat • Sprains and minor injuries • Urinary tract infections • Vomiting
SEEK EMERGENCY CARE Dr. Snow emphasizes that there are times when a trip to the ED is warranted, and even if someone shows up to the walk-in clinic, they’ll be referred to the ED if necessary. “Any heart condition will be sent to the hospital; severe pain, chest pain, rapid heart rate and anyone with a known cardiac condition should go to the ED,” he says.
Other symptoms that should be addressed in the ED: • Any heart condition or severe chest pain • Change in mental status • Choking • Coughing or vomiting blood • Fever with a rash • Head or spinal injury • Loss of consciousness • Major trauma or burn • Risk of poisoning • Seizures • Slurred speech • Stroke symptoms • Sudden dizziness, weakness or change in vision
The Holyoke Medical Group Walk-In Care sites treat patients ages 12 and over.
To learn more, call or visit one of our nearby locations: 1962 Memorial Drive, Chicopee, MA 01020 413.535.4995 140 Southampton Road, Westfield, MA 01085 413.540.5065
Lose Weight. Live Better.
MRSA, C. Diff, Candida Auris, VRE and Acquired Pneumonia may be Healthcare Acquired Infections (HAI). If you or a loved one was harmed by an HAI, Patient Protection Services™ can help.
YOU MAY BE ENTITLED TO COMPENSATION WE HELP YOU ACCESS FREE RESOURCES
Call the Weight Management Program at (413) 535-4757.
With our medical help, you can reach, and maintain, your healthiest body weight. Our team of experts has the experience and technology to help you achieve your weight loss goals. Equally important, we are committed to helping you keep the weight off — for life. Call the Weight Management Program at (413) 535-4757.
helpforHAI@PatientProtectionServices.com • (617) 329-5116 Patient Protections Services™, LLC is a patient advocacy organization and may be affiliated with lawyers and public health advocacy organizations. We are not acting as physicians, financial advisors or lawyers. And, we offer no medical, financial or legal services. Do not stop taking a prescribed medication without first consulting with your doctor. Discontinuing a prescribed medication without your doctor’s advice can result in injury or death.
HolyokeHealth.com
SUNDAY, DECEMBER 15, 2019 | D3
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THE REPUBLICAN | MASSLIVE.COM
Consider joint replacement
surgery sooner than later
Dr Alexander Brothers of New England Orthopedic Surgeons discusses treatment options with a patient. (DON TREEGER / THE REPUBLICAN)
By Alexander Brothers, M.D. One of the most common questions I receive when counseling patients in my clinic is, “when do I need a joint replacement?� The answer to that isn’t quite so straightforward: technically, nobody needs a joint replacement. It is elective surgery, after all – intended to relieve pain from osteoarthritis and improve your quality of life. The real question I want my patients to ask is, “when should I have a joint replacement?� This is much simpler: when injections and anti-inflammatories no longer cut it, and the pain from your arthritis keeps you from leading a full and happy life, then it is time to seriously consider a surgical solution. Most of us have probably known someone who says they wish they’d gotten their joint replaced sooner – it is a very common sentiment, and I think it speaks to the strength of the human spirit to endure, despite the challenges
of chronic pain and discomfort When it comes to hip replacement, I’m often asked about the “anterior approach.� A surgical approach is essentially the pathway by which surgeons navigate through the body to get to the area of interest – in this case, the hip joint. The anterior approach is a more recent development in the technique of performing hip replacement, that is performed with the patient on their back, using a special operating table that is designed specifically for this approach. We enter the body through the front of the thigh and very carefully navigate a pathway between the muscles, after which we are able to access the hip through the front of the joint. Some studies have shown a more rapid short term recovery with the anterior approach – this particular method of navigating between muscles may allow patients to mobilize quicker after surgery.
There is also some evidence that this approach reduces the chance of dislocation of the prosthesis after the surgery is concluded. In addition, because the patient is supine, we’re able to use live x-ray during the procedure to ensure the components are placed in ideal position – on the scale of individual millimeters. I am a perfectionist at heart and these benefits have lead to the anterior approach becoming my preferred method for hip replacement surgery. Not everyone is an ideal candidate for an anterior hip replacement – certain body types and congenital deformities can make the approach prohibitively difficult, and in these patients I would recommend an alternative approach. After all, the Hippocratic oath begins with: “First, do no harm,� and that is something I take incredibly seriously. One thing many patients are surprised to hear is how
much the landscape of joint replacement has changed in even just the last ten years. Many of us have relatives who had joint replacements, spent multiple days in the hospital and thereafter had to go to a rehabilitation facility. Much like having to manually crank a car in order to start the engine, those days are long in the past. With modern day surgical techniques and advanced pain control regimens, the experience of having a joint replacement today is dramatically different. Most patients only spend a single
night in the hospital before being discharged to home. In fact, many of my patients are both comfortable and mobile enough to return home on the same day as their surgery. Your surgery will be done under spinal anesthesia, where your body is fully numbed from the belly down. If you want to remain fully awake during your surgery during the procedure, you are more than welcome to do so – although most patients opt to receive a bit of medication from anesthesia to help them take a little nap while their surgery is being done. Every one of my patients is invited to take a group class at Baystate (where I perform my surgeries), to learn exactly
what to expect both on the day of surgery and in the weeks thereafter. Finally, before your surgery, you’ll return to our clinic for a history and physical, after which you will see me again to ask any and all questions that you may have left over; this could be as short as five minutes or as long as needed. My wish is for you to walk into the hospital on the day of your surgery with your mind fully at peace, confident in the knowledge that you know what to expect, and that you’re going to receive the absolute best care possible. For more information on NEOS, visit: neortho.com or call 413-785-4666.
Alexander Brothers, M.D.
is an Orthopedic Surgeon specializing in adult reconstructive surgery, including both primary and complex revision hip and knee replacements. He is the only fellowship-trained joint replacement surgeon in the region with specialty expertise in the direct anterior approach for hip replacement.
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D4 | SUNDAY, DECEMBER 15, 2019
Physiatrist
chemicals.” He added, “The most common barrier we see for CONTINUED FROM PAGE D1 someone to recover from a motivated him as a teen who concussion is that they do went through a long recovery not say anything and they process to eventually want continue to participate in to work as a physician in the their sport.” area of physical medicine “They are using all that enand rehabilitation and with a ergy that should be used to population that included the heal their brain to play their sports injured. sport,” Martinez said. He added, “The way I see He said the approach his rehabilitation is that for me practice takes is to try to any patient is an athlete.” enable the student patient “Your goal may be to run a to return to classes as soon marathon, but your goal may as possible while getting sufbe to walk without using a ficient rest and limiting the cane or a walker,” Martinez use of any over-the-counter said. pain medication. “So, I approach every Martinez called prevention patient as I would an athlete “the best medicine” when it but with modified goals.” comes to sports injuries. Martinez did his fellowship “We can prevent an injury training in sports medicine easier than we can treat it,” at the Mayo Clinic in Roches- said Martinez, adding he ter, N.Y., which was a pioneer and his staff will do clinics in the development of the at schools in different sports field of physiatry after WW to raise awareness around II, and has been in practice prevention. at Baystate for 17 years. “One of the main things I He oversees a clinic for focus on is the importance patients with musculoskelof being fit in terms of paretal conditions like arthritis ticipating in sports. A lot of as well as the sports medipeople play sports to be fit cine program. He said many when it should be the other patients are referred to his way around. You can exerdepartment through their cise to be fit, but you should primary care provider, but not participate in sports to some with athletic injuries be fit. Sports implies there come through the departis competition and with ment’s educational outreach competition you may push to schools, gyms and vocayourself to a limit that your tional programs. body might not be prepared “We do physical examinafor and you could end up tions for sports participation, with an injury.” evaluation for injury and He added fitness includes prevention of injuries and we three components – good are the only evidence-based flexibility, good aerobic conconcussion program in West- ditioning or endurance, and ern Massachusetts,” said good strength. Martinez who works with “We see a range of protoneuropsychologist Zachary types prone to injury. For exMarowitz in evaluating athample, a football player may letes for concussions and in be very strong but not too helping them return to their flexible. That athlete may sport as soon as possible. have injuries related to musHe said his concussion pa- cle strength, like hamstring tients can be from a variety strain,” said Martinez of a of sports from cheerleading condition that can happen to volleyball, but for girls it is when muscles at the back of most commonly soccer, and the upper leg get stretched football for boys. too far. “Every patient is different, “A gymnast may be very every concussion is differflexible but not as strong and ent,” Martinez said. may be at risk for developing “We tried to avoid over joint instability problems. stressing as one way to look Also, a football player or at a concussion is as an gymnast could get tired very energy crisis in the brain. fast without good endurance You don’t have any tears and so, at the end of the or a bleed. It is a chemical competition, the muscles get reaction. weaker and the athlete loses Chemicals are at the wrong their technique and then level. You want to give the they may be prone to have right environment for your injury as well.” brain to re-regulate those Older active adults he sees
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often have knee arthritis that has flared or a tear of the cartilage called the meniscus that is between the outside and inside of the bones that form the knee joint. “This is a little cushion between your thigh and shin bone, between your femur and the tibia, and a lot of lowering and rotation – like in shoveling snow where you bend and twist – can injure your meniscus,” Martinez said. “When this is happening at the knee instead of at your hip you end up having a meniscus injury. This can also happen when you are doing deep squats.” Martinez said most of the patients he sees visit Baystate’s rehabilitation services two or three times a week to work with therapists and the other days do their exercises at home. “The most common failure for rehabilitation is a patient does not come or they come the days they are supposed to but they do not do the work at home, but also common is that the patient does come to therapy without missing an appointment and does their work at home and as soon as they start feeling better, they stop doing their exercises,” Martinez said. “You should be pain and symptom free before stopping rehabilitation and get cleared by your doctor. If you still have mild pain, you will regress.” Gym equipment available to patients in Baystate Rehabilitation Care, Martinez said, include resistance machines with “levers and pulleys that we change in the direction the athlete is pulling to target specific muscles.” “Sometimes we do exercises that target one muscle and sometimes we do exercises that target multiple muscles,” Martinez said. “For example, for a patient with back pain we may do an exercise where there is pulling not to exercise the shoulders but to provide stability to their trunk.” He said there are also weighted resistance balls that can be used by athletes starting to do plyometric exercises to build stability or power for throwing as their rehabilitation progresses. “We may also have athletes do aerobic exercises, like marching in place or using a recumbent bike, to build endurance,” Martinez said. “We want to be sure their endurance improves. For strengthening, we will be doing resistance training that may be body weight exercises or we may use some pulleys or weights or elastic bands. For flexibility, we will give them specific exercises to stretch and sometimes we may need to use some straps or devices to help the athlete have adequate stretching. We may teach them both static exercises which is stretching a limb or dynamic exercises where you do an exercise to promote flexibility.” “We do not have a cookie-cutter approach in which you are doing this exercise and that is it,” Martinez said. “The exercise rehabilitation process is customized for each athlete.” Martinez said that many of the athletes he sees are on school teams and fall between the ages of 12 and 21. “That said,” he added, “we see athletes younger than 12 and older than 21, with the majority of the older population between 40 and 60, but we also have athletes into their 80’s – often coming in with a golfing injury - and leaving as fit or fitter than some of the younger ones.” Martinez said he feels in treating the sports injured “age is not a number anymore.” “I think that at this moment the reality is that the athlete is an ageless creature and we need to look at them and what is their sport, what they are missing and what we can do to help them out.
THE REPUBLICAN | MASSLIVE.COM
Healthy ways to
BUILD MUSCLE
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· Fatigue the Reshaping one’s · Zero in on the muscles. body takes time eccentric phase of Decrease rest periods between sets to encourage movement. and commitments, Research quick release in muspublished in the cle-building hormones. European Journal of Apthough shortcuts plied Physiology found that can be tempting eccentric workouts are bet- · Have casein ter at triggering hypertroprotein before bed. when trying to get phy, or the increased size Data published in Science muscles. For example, fit. The desire to see of Daily in March 2019 found when doing a squat, lowerthat pre-sleep protein ing into the squat would be instant results can intake increases muscle the eccentric phase of the protein synthesis during lead some people exercise. Increase weight overnight sleep in young to make this adults. Lead author Dr. to make potentially resistance eccentric phase even more Tim Snijders of Maastricht dangerous mistakes effective. University gave 44 healthy young men a 12-week in the name of lifting program. Half were · Hit muscle groups also given a nightly, premore frequently. looking good. sleep protein shake with There are various ways to safely build natural muscle. Novices should always consult their physicians before beginning a fitness regimen. Patience must be part of the equation, as expecting overnight results but not seeing them may derail your fitness efforts or lead you down an unsafe path. The following are some safe ways to build muscle.
· Boost training volume.
According to Ava Fitzgerald, C.S.C.S., C.P.T., a sports performance coach with the Professional Athletic Performance Center in New York, one may need to increase the number of reps and sets, but at an intensity at between 50 and 75 percent of the person’s 1RM (the maximum weight he or she can lift for one rep). For good muscle volume, she recommends three to six sets of 10 to 20 reps.
· Increase caloric intake.
Find the balance between eating enough to gain muscle and gaining too much and body fat percentage creeping up. This can take some trial and error. Try to eat more calories on training days, focusing on plenty of lean protein, whole grain carbohydrates and vegetables.
In the 2016 study, “Effects of Resistance Training Frequency on Measures of Muscle Hypertrophy,” published in Sports Medicine, targeting various muscle groups twice a week, rather than once, helped maximize muscle growth.
about 30 grams of casein, while the others weren’t. The protein-before-bed group gained significantly more muscle strength and size than those who had no protein before bed.
Muscle growth comes from frequent strength training, increasing caloric consumption, taxing muscles, and Working the entire body being consistent and patient several times a week also may help one make gains in with one’s goals. muscle growth. University of Alabama researchers followed a group of men who had been lifting weights for several years. Those who performed a full-body routine three days a week for three months gained almost 10 pounds of muscle over that time.
· Consider a full-body routine.