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Texas Orthopedics, Sports & Rehabilitation Associates

Wednesday, August 20, 2014

Often Misdiagnosed, Underdiagnosed... The 411 on Psoriatic Arthritis



Written by Dr. Robert Koval, Rheumatologist

Psoriatic arthritis is a potentially debilitating disease that can present in a variety of forms. Unfortunately, there is no single lab test that can definitively diagnose this disease. Instead, physicians rely on clinical symptoms and exam findings, supported by inflammation levels and other markers. The most characteristic exam finding are psoriasis (red, scaly patches), joint/tendon inflammation, finger/toe swelling (dactylitis or "sausage digits"), and occasional hip, spine or ocular inflammation. 

In the past, physicians were limited in their treatment of this disease. NSAIDS (Non-Steroidal Anti-Inflammatory Drugs, such as Advil/Aleve and other prescriptions) help to relieve some of the symptoms of Psoriatic Arthritis. Traditionally, DMARDS (disease modifying anti-rheumatic drugs) have been used to slow down the underlying inflammatory response. Drugs such as methotrexate, sulfasalazine, or leflunomide have been around for many years.

New Treatments, Biologics
An exciting time in the treatment of Psoriatic Arthritis occurred with the development of "biologic medications." Simply put, biologics are medications manufactured or extracted from living (biological) sources. Examples of these include etanercept (Enbrel), adalimumab (Humira), golimumab (Simponi), infliximab (Remicade), certolizumab (Cimzia), and ustekinumab (Stelara). Current guidelines suggest using these drugs after failures or side effects with more traditional DMARDS (per above), or in those with very active disease including spinal/hip involvement or documented functional impairment. 

These drugs have revolutionized the treatment of the disease, enabling many with severe disease activity to achieve remission. These drugs are very expensive, and the pros and cons, including some rare side effects, should always be discussed with the patients Rheumatologist. Generally, insurance covers these drugs as long as certain pre-requisites are satisfied, although this varies from one plan to another. Long term safety date recently made available proves that these are reasonable options for long term treatment of the disease. 

More data is needed to decide when it is safe or prudent to begin withdrawing these drugs after remission is attained.

Monday, August 18, 2014

6 Tips for Getting a Better Night's Sleep (infographic)




 Most of us have a hard time getting to sleep. Yet, not getting good quality sleep can lead to significant health problems.

According to the National Institute of Health, sleep plays a vital role in good health and well-being throughout your life. Getting enough quality sleep at the right time can help protect your mental health, physical health, quality of life, and safety.

Whether you're a student heading back to school or an adult in search of some Z's, here are some tips to help you get a better night's sleep.


1. Try to go to bed at the same time every night - even on weekends. Variations in your sleep pattern can disrupt your body's sleep-wake clock. 

2. Stop drinking caffeine at least 6 hours before bed. Coffee is a stimulant and its effects can last as much as 8 hours!

3. Don't eat or drink alcohol 3 hours before bed. Eating too much or drinking alcohol can worsen the effects of insomnia.

4. Finish exercising at least 2 hours before hitting the sack. Exercise in the mornings to give yourself a nice boost of energy for the day.

5. Turn off all your electronics 1 hour before going to sleep. The light tells your brain that it's time to be awake. 

6. Use the hour before bed for quiet time and relaxation instead of working or studying.

Keep up with Texas Orthopedics' news by following us on Facebook and Twitter (@TexasOrthopedic).

Thursday, August 14, 2014

Dr. Loeb on Time Warner Cable News: Total Shoulder Replacements on the Rise



Most people have heard of total knee or total hip replacement surgery. But Dr. Michael Loeb says total shoulder replacements are catching up to their counterparts.

"In 2006, about 35,000 to 40,000 shoulder replacements were done, and that number in 2011was 65,000 to 70,000, so it's going up," Dr. Loeb told Time Warner Cable News.

Patient, Pete Bishop, underwent total shoulder replacement after years of arthritis pain took its toll. He was sidelined from his great passion of rock climbing.

But one year after total shoulder replacement surgery at Texas Orthopedics, he's back doing what he loves most.

To hear more about shoulder replacement surgery and Pete's story, click here.

Keep up with Texas Orthopedics news by following us on Facebook and Twitter (@TexasOrthopedic). 


Tuesday, August 12, 2014

Treating Football Sprains and Strains with R.I.C.E



Football season is around the corner! But with that comes frequently occurring injuries like strains and sprains. The very nature of football as a high-impact sport where players are constantly moving in all directions put a player at high risk. And whether you are a star high school player or just getting together with friends in the park for a game, it's important to know how to treat a strain or sprain.

Treat Strains and Sprains with R.I.C.E

When playing football, your wrists, knees, ankles, hamstrings, groin, neck and back are susceptible to sprains and strains. The best way to treat them is with R.I.C.E.: Rest, Ice, Compression and Elevation.

Rest: Reduce or stop using the injured area for at least 48 hours. If you have a leg injury, you may need to stay off of it completely.

Ice: Put an ice pack on the injured area for 20 minutes at a time, four to eight times per day. Use a cold pack, ice bag, or a plastic bag filled with crushed ice that has been wrapped in a towel.

Compression: Ask your doctor about elastics wraps, air casts, special boots, or splints that can be used to compress an injured ankle, knee, or wrist to reduce swelling.

Elevation: Keep the injured area elevated above the level of the heart to help decrease swelling. Use a pillow to help elevate an injured limb.

If the pain persists, contact us!

Have a question? Ask us on Facebook or Twitter (@TexasOrthopedic).

Tuesday, August 5, 2014

4 Tips for Getting a Better Workout at the Gym



You're diligently working out at the gym every day, but you're still not seeing the results you want. This happens more often than not.  Here are 4 tips to help you get a better workout. 

1. Switch it Up!

Most of us tend to do the same things over and over at the gym. If you're running on the treadmill every day, not only does it get boring, but you're not challenging yourself. Next time, try lifting weights or taking a yoga class. This will use different muscles and hopefully turn you on to a different activity you'll actually enjoy. 

2. Get Of Your Phone!

As much as we don't want to admit it, your phone can be a big distraction when you're trying to work out. If you listen to music, set-up your playlist before you hit the gym. Otherwise, leave it in the car. Your blogs, forums and social media will still be there when you're finished. 

3. Use Proper Form

When you're lifting weights, it's essential that you can control the weight for the entire movement. If it's too heavy and you're swinging your body to help, you won't actually be working the muscle. Try lowering the weight or asking for some assistance to get the right form. 

4. Watch Your Diet

Unfortunately, working out is only part of a healthy lifestyle. You also have to eat right in order to get results. That doesn't mean you can never eat a cheeseburger again; it means you can't just work out to compensate for eating unhealthy every day. 

For more workout tips, follow us on Facebook and Twitter (@TexasOrthopedic).

Monday, August 4, 2014

Dr. Loeb on KXAN: From Shoulder Replacement to Rock Climbing




When Pete Bishop arrived for his one-year appointment with Dr. Michael Loeb, following his total shoulder replacement surgery, he brought a picture that left him in awe.

Pete was hanging upside down from a cave wall.

Prior to his surgery, the pain in Pete's left shoulder was so excruciating that he could barely hold a glass of water. He was an avid rock climber and he knew surgery may keep him from his favorite sport. But the pain was too much to bear and surgery was a must. 

Yet, one year later, Pete was not only pain-free in his left shoulder... he was also back rock climbing. 

Click here to check out Pete's story on KXAN-TV.

Thursday, July 31, 2014

What's a Jones Fracture? More on Longhorn QB David Ash's Injury



It's official... David Ash will be the starting quarterback for the University of Texas Longhorns, announced by new coach Charlie Strong last week. 

Just before the announcement, David Ash was given medical clearance for the broken foot injury he suffered during spring season training. The injury he suffered to his left foot is known as a Jones Fracture.

What is a Jones Fracture and how is it treated?

This foot fracture occurs near the base of the bone. It's a more serious injury because if often disrupts the blood supply to the bone which can slow down recovery. Because of this, more regimented therapy may be recommended. In Ash's case, treatment required surgery as well as therapy, however, not all Jones Fractures require surgery. In some cases, a physician may recommend a below knee fiberglass cast and may prescribe the patient to bear no weight on the injured foot. 

We're hoping QB David Ash is healed and ready to go in September. Hook 'em horns. 

Click here to learn more about foot fractures.