Orthopedic Health and Vein Care

More Than Just Bones

Many people hear “orthopedic” and think of bones, but orthopedic health spans the entire musculoskeletal system—which includes bones, joints, ligaments, tendons, muscles and nerves. The disease of arthritis is commonly associated with the practice of orthopedic medicine, because osteoarthritis, which is a chronic condition that occurs over time when cartilage between the joints breaks down, is a particularly common diagnosis. And, while it’s true that those nagging tweaks, aches, spasms and clicks could eventually lead you to an orthopedic surgeon’s office, you won’t necessarily end up having surgery.

“There’s a whole range of treatments that I advise before any sort of surgery is recommended,” says Meriter Medical Group’s Dr. Jim Bowers, an orthopedic surgeon who specializes in knee and hip surgery, and who treats many arthritic patients. “I think a lot of people are afraid to come and see the orthopedic surgeon because they’re scared they’re going to have surgery, but rarely do I offer surgery the first time I meet somebody. Generally I want to educate patients: diagnose what type of arthritis they have, where it is, why they have it, what stage it’s in and what non-operative treatments are available.”

Non-surgical treatment options include cortisone treatment or anti-inflammatory medications. Bowers adds that one of the most important things his patients can do for themselves is to get moving and stay moving, especially after diagnosis.

“I’m not a big fan of taking medicine everyday; I think most people aren’t,” says Bowers. “After a thorough evaluation, if we determine they have moderate to even advanced arthritis, I’m going to tell them to keep moving. You’ve already got the arthritis, it’s not going to just reverse itself. The best thing you can do for it is to try to keep it from progressing, and the way that you do that is by keeping the muscles strong with low impact exercise.”

When operating is the best solution, there are a wide range of treatment options. Knee arthroscopy and partial knee replacement are both successful possible alternatives to a full knee replacement. As for hips, Bowers is one of only two surgeons in the area performing anterior approach hip surgery, which is a highly specialized, muscle-sparing procedure involving a special table, upon which the patient lies on his back instead of side.

“It’s less invasive, involves shorter hospital stays, and means a quicker recovery and rehab for my patients,” says Bowers. “For people who are really active and eager to get back to work or normal activities, it’s been very helpful and the way to go.”

Solutions for Spider Veins

Unsightly “spider” veins have plagued humankind for centuries. Documented treatment attempts go back as far as the fourth century BC and even Hippocrates mentioned seeking relief by thrombosis with a metal instrument. Luckily for us, treatment has come a long way. Sclerotherapy is often considered the time-tested treatment of choice for small varicose or (“spider”) veins and visible results are often seen within weeks.

“Sclerotherapy is the treatment of spider veins by injecting a sclerosing agent,” says Renee Knutson, PA-C at Dean Clinic-West Plastic Surgery. “It irritates the lining of these small vessels and causes them to scar shut. Saline solutions have been used in the past but some of the newer agents include Sotradecol, which we use at Dean Clinic.”

Although not appropriate for varicose veins measuring larger than four millimeters in diameter, Knutson says smaller veins scar down in about four to six weeks.

“It’s not an instant remedy for spider veins and more than one treatment may be necessary,” says Knutson. “We hope for a 50-75 percent improvement with each sclerotherapy treatment, and it could be more.”

Kierstyn Block, PA-C, and Knutson’s colleague at Dean Clinic-West Plastic Surgery, says a number of factors may contribute to the development of spider veins in the legs, including pregnancy, hormonal shifts, weight gain, heredity and occupations or activities that require prolonged sitting or standing.

“The sclerotherapy injection may be slightly painful,” says Block. “The chemical that is injected can cause a feeling of burning or cramping for a few minutes in the area where the injection was given.”

After the injection, pressure is applied over the veins and compression stockings must be worn for several days. The sclerotherapy solution causes the vein to scar and collapse, forcing blood to reroute through healthier veins. The collapsed vein is reabsorbed into local tissue and eventually fades.

“Every patient heals at a different rate,” says Block. “Sclerotherapy generally does not require any down time in the recovery period. You will likely be able to walk immediately after the treatment but you should take it easy for a day or two. Bed rest is not recommended but you may need to avoid strenuous exercise for a few days. Avoid exposing your legs to the sun for the first two weeks after the procedure. After about a month of healing, you may be ready for a second vein treatment. With each treatment, you will notice further improvement of your skin’s appearance.”

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