Phrenic Nerve Reconstruction

Health Vantis recently visited a facility that addresses one of the less common yet very difficult to treat conditions. It is phrenic nerve damage. We connected with the administration of the medical facility and are now proud to say that we are happy to help those that may need this type of surgery. There are only a few surgeons in the world that are qualified and experienced to perform phrenic nerve reconstruction.

What is phrenic nerve?

Phrenic nerve is not a household name and many people probably have not heard of it. Yet it keeps us alive as we breathe. The nerve controls the diaphragm muscle, which controls the breathing process. It is in charge of voluntary and involuntary breathing, such as during sleep, by transmitting signals from the brain and spinal cord to the esophagus. We breathe without making much effort and it is all due to the phrenic nerve. Its primary function is to carry out our breathing without us having to think about it or tell our body to do so.

Phrenic nerve is a twin nerve. It begins in the brain and continues down to the first few vertebrae of the spine. Then it splits. The two nerves go down through each side of the body. The right side comes in contact with the windpipe and heart while passing the lungs. The left side also comes in close contact with the heart, with both sides eventually ending up in the diaphragm. Because of its location and proximity to both the lungs and the heart, the nerve can be impacted if there are specific conditions in either of these organs. If either of the nerves is damaged and signals between the brain and diaphragm are interrupted, normal breathing may be prevented.

What are the symptoms of phrenic nerve damage?

People with phrenic nerve injury experience difficulty breathing.  Depending on the severity of the injury, they may become winded after climbing a flight of stairs or even tying their shoes. For some, difficulty in breathing while lying down can interfere with sleep, causing insomnia. Symptoms can include lethargy, headaches and blue-tinged lips or fingers.

The most severe impact of phrenic nerve damage is diaphragm paralysis, which prevents the patient from being able to regulate breathing on his or her own.

Why does it get damaged?

The most common causes of phrenic nerve injury are surgical complications and trauma. Phrenic nerve damage may occur after a major operation such as neck dissection for head and neck cancer, lung surgery, coronary bypass surgery, heart valve or other vascular surgery and thymus gland surgery. After the surgery, sometimes scar tissue forms in the neck, which compresses the nerve. Injuries can also result from epidural injections or other types of nerve blocks, as well as chiropractic manipulation of the neck, which can disturb the roots of the spinal nerves.

What can be done?

There has been little hope for individuals suffering from this condition until recently. Treatment options for phrenic nerve injury have been limited to either nonsurgical therapy or diaphragm plication, neither of which attempts to restore normal function to the paralyzed diaphragm.

Advances in nerve decompression and transplant allow reconstructive plastic surgeons to reverse diaphragm paralysis.  The techniques used are derived from the procedures commonly used to treat arm or leg paralysis, which have allowed surgeons to restore function to previously paralyzed muscle groups. The doctor either corrects or transplants the nerve in order to restore function.

The rarity of the condition makes it difficult for patients with a phrenic nerve injury to find treatment.  The condition is often misdiagnosed or viewed as insufficiently severe enough to require corrective surgery.

Patients who have undergone phrenic nerve surgery report improvements in their physical and respiratory function, and a reversal of the sleeping difficulties related to diaphragm paralysis.

If you or a loved one suffers from phrenic nerve injury, it is likely you have been told by your physician that you must learn to live with this deficit. Well, that is simply not true. Contact Health Vantis to get connected to the world-class board certified surgeon who will help you or your loved one.

MAKOplasty and Your Total Hip Replacement

In our last blog we talked about three major approaches to hip replacement. We also mentioned the words minimally invasive when describing surgical techniques procedures. But what does that really mean though? Through the years, the surgeons improved on their techniques and are able to make shorter incisions and less tendon cutting. All that means less invasive when it comes to any surgery. Some of those techniques differ in name depending on what country you have your operation. What matters though is that the doctors are using these minimally invasive techniques to improve the outcomes, patient experience and shorten the recovery time.

Robotic Assistance In Operating Rooms

In our world of technology and race to develop Artificial Intelligence, robotic assistance can be found in many places. Operating rooms are not an exception. When the surgeons combine the improved techniques with a much more precise and individualized robotic assistance, the joint replacement surgeries leave less room for human error. When a surgeon makes an incision and opens up your hip, he only has an approximation of your individualized hip socket size and bone damage.

The scientific data does tell us that poor component positions and impingement are the sources of increasing mechanical complications in total hip replacement. Robotic guided navigation attempts to improve the surgeon’s performance by precise quantitative knowledge in the operating room. This technology provides predictable and reproducible results.

MAKOplasty and Hip Replacement

In 2010 the first MAKOplasty Total Hip Replacement was performed. MAKOplasty utilizes RIO Robotic Arm Interoperative Interactive Orthopedic System and RESTORIS Family of Implants for partial knee and total hip arthroplasty. MAKOplasty increases accuracy in aligning and placing implants. The RIO system assists surgeons by creating a 3-D model of the patients’ anatomy. It enables surgeons to develop a pre-surgical plan that customizes implant size, positioning and alignment specifically for each patient. During the procedure, real-time visual, tactile, and auditory feedback enforces a safety-zone and facilitates ideal implant positioning and placement.  Thus it reduces the potential for complications.

As a patient, you will be required to get a CT scan first. The information from the CT scan will be loaded into MAKO software system.  Then it is used to create your personalized pre-operative plan. During surgery, the surgeon guides the robotic-arm while preparing the hip socket and positioning the implant based on your personalized pre-operative plan. The Mako system also allows your surgeon to make adjustments to your plan during surgery as needed. When the surgeon prepares the bone for the implant, the Mako system guides the surgeon within the pre-defined area and helps prevent the surgeon from moving outside the planned boundaries. This helps provide more accurate placement and alignment of your implant.

The use of the robotic arm is a valuable innovation for Total Hip Replacement. Contact Health Vantis to learn more about your individualized options in hip replacement.

Common Approaches to Hip Replacement: Which One Is Right For You?

If you are heading for a total hip replacement procedure you may be wondering about the details of the operation and your recovery – will the incision heal fast, will you be able to walk without a cane and go up and down the stairs.  We wrote about preparation for a hip replacement in our prior blog. In this one, we wanted to talk about different approaches that surgeons may take for your hip replacement.

Hip replacement is one of the most successful operations in all medicine. The first metallic hip replacement was performed in 1940 by an American surgeon, Dr. Austin Moore. In 2016-2017 in Canada a total number of 55,981 hip replacements were performed. That is quite an increase from 47,541 done in 2012-2013.

Different approaches and techniques exist when it comes to replacing your hip. The two things that often are asked about are how big is the incision and what muscles, tendons or fascia are cut to get to the diseased joint.

Posterior Approach

By far the most common approach is the posterior approach. It is done on a traditional operating room table. You will be laying on your side.  The incision curves backward into the buttock area. The size of the incision is about 10 to 12 inches long. The hip is reached by cutting several tendons that come out of the pelvis called short external rotator muscles. This allows for an excellent exposure and visualization of the femur and the socket of the hipbone, which in turn allows for precise component (new hip parts) positioning. A common risk to this method cited in the medical literature is increased dislocation rates and risk of a sciatic nerve injury.

A variation of this approach is called mini-posterior approach. It does not cut the muscles but instead separates them and the incision is smaller. This is considered a minimally invasive approach.

Lateral Approach

This is the second most common approach. The incision is made directly on the side, over the bony prominence that is against the mattress if you are a side sleeper. You can be laying on your side or on your back. A standard operating room table can be used or depending if operative imaging is needed, radiolucent (transparent to X- rays) table is used. A large muscle called gluteus medius is then split in order to access the hip joint from the front side.

This method allows for good exposure femur and hip bone socket, minimizes the risk of dislocation and sciatic nerve injury. The risk here is damage to abductor mechanism. Medical studies suggest that the lateral approach has an increased incidence of abductor insufficiency when compared to posterior approach. Abductor muscles of the hip help us pull the leg away from the midline of the body. We use this action every day when we step to the side, get out of bed or get out of the car.

Direct Anterior Approach

This approach is not new. In fact, it has been in use US since the 80-ies.  However, new instrumentation allowing it to be performed using smaller incisions has made it increasingly sought after. The cut is made on the front to access the hip. The posterior capsule and muscles are not cut, but are moved aside along their natural tissue planes, without detaching any tendons. The size of the incision is about 4-5 inches long. This approach allows the surgeon to work between the muscles without detaching them from the femur.

The direct anterior approach is generally considered a minimally invasive approach because of its muscle sparing nature. You would be on your back and a specialized or standard radiolucent table can be utilized. Some surgeons prefer to use specialized X-rays during this procedure. These X-rays allow them to see images on the monitor in real-time, very much like a movie. That aids in new joint placement.

Surgeons face a steep learning curve for this procedure. The anterior incision provides a restricted view of the hip joint, making it a technically demanding procedure. Depending on the surgeon’s experience, this surgery may not be appropriate for obese or very muscular patients, because the additional soft tissue can make it difficult for the surgeon to access the hip joint.

What is right for you?

It is much discussed in the medical literature which approach is better. The researchers at Mayo Clinic found that Mayo Clinic patients who underwent direct anterior approach hip replacement procedure had objectively faster recovery than patients who had a mini-posterior approach. According to the Mayo clinic study, the recovery time with the anterior approach is approximately 5 days ahead.

The study also documented quicker recovery by direct approach patients compared with mini-posterior approach patients in:

  • Discontinuing use of a walker (10 days after surgery versus 14.5 days)
  • Discontinuing use of all gait aids (17.3 versus 23.6 days)
  • Discontinuing use of narcotics (9.1 versus 14 days)
  • Ascending stairs with gait aid (5.4 versus 10.3 days)
  • Walking six blocks (20.5 versus 26 days)

 

When discussing the type of approach your surgeon will be using keep in mind that the first two have been used by many doctors for many years. They are therefore considered traditional and safe. Anterior approach will require that your surgeon has specific training and experience to handle the operation successfully. Your surgeon should be able to tell you why he or she recommends one approach over the other. Go to the doctor you can trust and have a conversation with about your total hip replacement needs and expectations.

In our next blog, we will be talking about the use of robotics in total hip replacement. Stay tuned and as always if you have any questions please reach out to us by toll-free or email: 1 877 344 3544 or info@healthvantis.com

September 2018 Newsletter

Hello everyone and welcome to fall! Time to get back to our routines and get settled in work and school mode. Summer is short and sweet in most parts of Canada, but I personally am getting to love the fall – with its vibrant colors, cooler mornings and crisp air. The month of September has a few important health awareness dates. In this issue we will talk about Ovarian Cancer, Alzheimer’s disease and Prostate PSA test screening significance.

Ovarian Cancer Awareness Month – September 2018

Ovarian cancer has been called the Silent Killer because its presenting symptoms can be mistaken for other benign conditions such as the ones that affect the gastrointestinal system, or simply changes in a woman’s body as she ages. However, it is the fifth most common cancer affecting women. It is estimated that this year 2,800 Canadian women will be newly diagnosed with this disease.

Early detection

It is very unfortunate but there is no reliable screening test for ovarian cancer. That is why early detection is very difficult and the diagnosis is often delayed because the symptoms are considered nonspecific. Often times the symptoms are either ignored or attributed to other age-related problems like constipation, irritable bowel or indigestion.  The majority of ovarian cancer diagnoses are made in stage 3 and 4, when it has spread to other parts of the body. According to the American Cancer Society, only 20% of ovarian cancers are found at an early stage.  If it is found early, about 94% of patients live longer than 5 years after diagnosis.

Symptoms

According to Ovarian Cancer Canada, the common symptoms include:

  1. Bloating – increased abdominal size/persistent bloating
  2. Eating – difficulty eating or feeling full quickly
  3. Pain – in pelvic or abdominal areas
  4. Urinary symptoms – urgency or frequency

Other symptoms may be present such as changes in bowel habits, extreme fatigue or unexplained weight loss. Just because you have those symptoms doesn’t necessarily mean you have ovarian cancer. You should seek the advice of your doctor, however, if these symptoms are new, persistent and frequent. Women should pay attention to their symptoms and seek professional advice.

Testing

Although neither of the below tests on its own can tell whether or not one has ovarian cancer, the three work together to identify a possibility. The only definite way to confirm the diagnosis is through a biopsy.

  • Complete pelvic exam
  • Transvaginal or pelvic ultrasound
  • CA-125 blood test

If any of these tests suggest the presence of ovarian cancer your doctor may advise surgery to examine the cells and check for malignancy. Ensure that you are referred to a gynecologic oncologist for the surgery. Research has shown that when surgery is performed by a gynecologic oncologist instead of another physician, the patient outcomes are improved.

Risk factors and groups

The causes of ovarian cancer are unknown. The likelihood of developing the disease may be higher if a woman has one or more risk factors. One of the key risk factors is age. Most women who develop ovarian cancer are diagnosed after menopause, at age 55 or older, although patients in their 40s and 50s have also been diagnosed with the disease.

If you have a strong family history of breast or ovarian cancer, you may also be at an increased risk. Talk to your doctor about genetic testing and other steps you may be able to take to monitor or reduce your ovarian cancer risk, such as preventive surgery.

Other risk factors include:

  • Lynch syndrome
  • Never being pregnant or giving birth
  • Hormone replacement therapy
  • Ashkenazi Jewish ancestry
  • Obesity

If you are suspecting something is not right with your body, please talk to your medical doctor. If you are being diagnosed with ovarian cancer, seeking a second opinion in diagnosis and treatment plan is always a good idea. Remember it is your right to seek a second opinion. Health Vantis works with one of the best Cancer treatment facilities in the US and we are always here to help.

 

September 21 Is World Alzheimer Awareness Day.

 

 

 

 

 

 

 

 

 

 

Do you know that it is possible to have Alzheimer’s in your 40-ies and 50-ies? It is estimated that in Canada approximately 16,000 people experience an early onset of dementia. Some of those people may still have children living at home, have full-time jobs and maybe caregivers to their own parents.

Dementia can happen for a number of reasons.  Alzheimer’s disease is one of them. If you are wondering what is the difference between dementia and Alzheimer’s, we have this fantastic video for you kindly provided by Trinity Brain Health. The disease is irreversible and it destroys brain cells causing deterioration with memory and thinking ability. For more videos about dementia click here.

Diagnosing young onset Alzheimer’s disease can be difficult. Doctors usually don’t consider the disease in younger people. Symptoms can be incorrectly attributed to stress or there may be conflicting diagnoses from different healthcare professionals. People who have early-onset Alzheimer’s may be in any stage of dementia – early stagemiddle stage or late stage. The disease affects each person differently and symptoms will vary.

The 10 warning signs of the disease are listed below and are taken from the Alzheimer Society Canada website:

  1. Memory loss affecting day-to-day abilities – forgetting things often or struggling to retain new information.
  2. Difficulty performing familiar tasks – forgetting how to do something you’ve been doing your whole life, such as preparing a meal or getting dressed.
  3. Problems with language – forgetting words or substituting words that don’t fit the context.
  4. Disorientation in time and space – not knowing what day of the week it is or getting lost in a familiar place.
  5. Impaired judgment – not recognizing a medical problem that needs attention or wearing light clothing on a cold day.
  6. Problems with abstract thinking – not understanding what numbers signify on a calculator, for example, or how they’re used.
  7. Misplacing things – putting things in strange places, like an iron in the freezer or a wristwatch in the sugar bowl.
  8. Changes in mood and behavior – exhibiting severe mood swings from being easy-going to quick-tempered.
  9. Changes in personality – behaving out of character such as feeling paranoid or threatened.
  10. Loss of initiative – losing interest in friends, family and favorite activities.

If you are experiencing memory problems:

  • Have a comprehensive medical evaluation with a doctor who specializes in Alzheimer’s disease. Getting a diagnosis involves a medical exam and possibly cognitive tests, a neurological exam and/or brain imaging.  Reach out to your provincial Alzheimer’s Society.
  • Write down symptoms of memory loss or other cognitive difficulties to share with your healthcare professional.
  • Keep in mind that there is no one test that confirms Alzheimer’s disease. A diagnosis is only made after a comprehensive medical evaluation

September Is Also Prostate Cancer Awareness Month.

Prostate cancer is the most common cancer in Canadian men. Many older men have this disease without knowing it. It usually grows slowly and can often be completely removed or successfully managed when it is diagnosed. While a cancer diagnosis can be scary, prostate cancer has high survivor rates, especially when it is caught and treated early.

Routine screening has improved the diagnosis of prostate cancer in recent years. Men over the age of 50 should talk with their doctor about whether they should have testing for early detection of prostate cancer.  Men with one or more risk factors should consult a doctor about whether to begin screenings earlier, before age 40. Known risk factors for prostate cancer are family history, race and a diet high in saturated fat and red meat.

The following tests may be used to help detect prostate cancer early:

  • Direct Rectal Examination
  • Prostate Specific Antigen (PSA).

Although PSA test may not be perfect, Prostate Cancer Canada insists that it is the best indicator in clinical practice and an important red flag to show that something may be wrong. It recommends that men in their 40ies get a PSA test to establish their baseline.

So what is PSA and why is it used? Prostate Specific Antigen (PSA) is a protein produced within the prostate gland and is secreted into seminal fluid. The PSA test is a simple blood test. It measures the level of PSA in the blood. An elevated level of PSA may be a sign of prostate cancer. However, a high reading of PSA may also indicate non-cancerous conditions such as inflammation and enlargement of the prostate.

No single normal level has been established. Historically, a level of 4.0 ng/mL or higher was used to justify a biopsy of the prostate (a sample of prostate tissue) to try and determine if a man has prostate cancer. However, this practice has been changing and other factors are being considered in the decision to perform a prostate biopsy.

Prostate cancer has been detected in men with levels less than 4.0 ng/mL. And many men with PSA levels higher than 4.0 ng/mL do not have prostate cancer. There is no PSA level below which the risk of cancer is zero. Two men with the same PSA level may have very different risks of prostate cancer depending on other risk factors.

Common signs and symptoms of prostate cancer are:

  • Burning or pain during urination
  • Difficulty urinating, or trouble starting and stopping while urinating
  • More frequent urges to urinate at night
  • Loss of bladder control
  • Decreased flow or velocity of urine stream
  • Blood in urine (hematuria)

If you or your loved one are experiencing any of these symptoms ensure you raise the question of prostate cancer possibility with your doctor.

 

 

Sodium Intake: the Good, the Bad and the Ugly.

The recent report of sodium intake by the Canadian government brought alarming news to our households. We still consume too much salt. According to the report, Canadians exceed the recommended maximum daily intake of sodium: the recommended intake is 2300mg and on average we consume 2760 mg a day. Males take in more sodium than females, and males of age category 14 to 50 consume by far the most sodium, nearly doubling the recommended daily intake. So, what does that mean to our health?

The Good: Role of Sodium in Human Body

Our bodies need sodium. It’s an electrolyte. It takes on a positive charge when dissolved into our body and is necessary to maintain blood pressure. Sodium dissolves in our blood and attracts and holds water thus helping maintain the liquid portion of the blood.

It’s also an integral part of our nerve and muscle function. Both muscles and nerves require electrical currents to work properly.  Muscles and nerve cells generate electrical currents by controlling the flow of electrically charged molecules, including sodium. For muscle cells, these electrical currents stimulate contraction of the muscle.

Nerves, on the other hand, need electrical activity to communicate with other nerves. Cells use molecular pumps to keep sodium levels outside the cell high. When an electrical current is needed, cells can allow the positively charged sodium ions into the cell, generating a positive electrical current.

Our kidneys are the regulators of sodium. They release it in the urine when the levels are too high and hold on to the water when the levels are too low.

The Bad: Too Much or Too Little Sodium

Studies have confirmed that high sodium intake increases blood pressure.  Sodium attracts water. Excess amounts of sodium increase the amounts of water, and therefore increases the volume of blood. The blood pressure will rise because the blood vessels cannot accommodate the increased blood volume. This creates more work for the heart. Over time this can lead to stiff blood vessels, heart attack and stroke as well as heart failure.

When there is not enough sodium in your body, things go wrong as well. Hyponatremia is a condition where there is too little sodium in the blood. The symptoms vary from person to person and can include weakness, fatigue, nausea, headache, and vomiting. Losing sodium quickly is a medical emergency. It can cause loss of consciousness, brain seizures and coma.

The Ugly: Where does sodium come from in diets of Canadians?

Many foods contribute to sodium intake. Bakery products, which include: breads, muffins, cookies, desserts, crackers, and granola bars are the top food sources (20%) of sodium. Mixed dishes such as pizza, lasagna, refrigerated or frozen entrées and appetizers, frozen potatoes and prepared salads are the second most important contributors to dietary sodium (19%), followed by processed meat products such as sausages, deli meats, canned meats, chicken wings, burgers and meatballs (11%). Together, these 3 broad categories account for half of all the sodium Canadians consume. Other important contributors include cheeses (7%), soups (6%), sauces and condiments (5%), fat, oils, spreads, and dressings (3%), snacks, such as chips and pretzels (3%), and fish and seafood products (2%).

What should you do about your sodium intake?

We can say that it is safer to stay on the lower side of sodium intake. However, this can be very individual.  You need to consider your overall health, fitness and nutrition. The studies about salt intake so far have only been successful in establishing the link between high salt intake and high blood pressure. It has also been proven that people with high blood pressure benefit from lower sodium intake. So if you have high blood pressure make sure you are eating a low sodium diet. The current recommended low dose is about 1100 mgs, which is a little less than half of teaspoon of table salt.

We should also consider the sources of sodium in our diets. Processed foods have been linked to many health issues and continue to be high in sodium. Cutting out processed foods, eating fruits and vegetables, exercising regularly and sleeping well are still the pillars of good health. Read the labels of the food you are purchasing in the supermarket. The Canadian government is doing the right thing by proposing to the food manufacturers to use front package labels for foods that are high in sodium, sugar and saturated fat.  All those can bring harm if consumed excessively.

If you have any questions about this blog, please don’t hesitate to give us a shout – tool-free 877 344 3544.