Reducing the Risk of Implant Failure: Hormone Replacement Therapy and Orthopedic Services

Just one year ago, doctors and researchers alike were puzzled by the fact that women who underwent hip-replacement surgery were almost 30 percent more likely than men to need repeat surgery within the first three years.

Because of ongoing negligence litigation against the manufacturer of one hip-replacement model, the focus tended to be on the replacement itself, rather than on the patients. That was until a study of more than 35,000 patients found that, no matter what model was used, women who received this type of orthopedic service experienced replacement failure more often.

The statistic was all the more troubling because the majority of the more than 400,000 Americans who undergo full or partial hip replacement surgeries each year are women.

Co-author of the 2013 study, Dr. Art Sedrakyan, associate professor of public health at Weill Cornell Medical College in New York City, said that, although the overall risk of the surgery remains low, "What we've observed is, regardless of size, women had higher rate of revision occurrence."

One year later, researchers may have found a treatment that can lower the risk of joint-replacement failure for women overall. In other words, while the 2013 research focused on hip replacement, new research indicates there could be a way to help women avoid a second surgery after any joint replacement. According to a new British study published online in Annals of the Rheumatic Diseases, hormone replacement therapy offers significant promise.

Implants fail for several reasons, but the most common is osteolysis, which results from bone loss caused by inflammation that occurs when small particles from the implant irritate the supporting bone.

In order to prevent this bone loss, researchers tried administering bisphosphonates, the class of drugs typically used to treat osteoporosis; drugs like Actonel, Fosamax and Boniva. However, bisphosphonates are associated with rare but serious side effects, so they decided to look at hormone replacement therapy (HRT) instead due to its ability to relieve symptoms of menopause, including thinning bones.

They looked at the records of women undergoing a first hip or knee replacement between 1986 and 2006. Of the 24,733 women who had joint surgery, they selected 2,700 who had used HRT for at least six months before or after the surgery and matched them with 8,100 nonusers. Then they followed the two groups for at least three years.

At the end of the study, 168 women from the original group had undergone revision surgery. After accounting for control factors such as age, weight, the type of joint replacement, and other drugs the patients were taking, results indicated that women who used HRT for at least six months after the original joint replacement were 38 percent less likely to need a repeat procedure than those who had not used HRT.

Results improved over time too. For those who continued taking HRT for a year, odds of needing a second surgery decreased an additional 10%.

As lead researcher, Dr. Nigel Arden, director of musculoskeletal epidemiology at the University of Oxford in England, pointed out, "There is evidence that drugs like hormone replacement therapy, used usually to prevent osteoporosis and fractures, might have a beneficial effect on implant survival in patients undergoing knee or hip replacement.”

"These findings must be confirmed in further studies, but they are consistent with previous reports by our group showing an association between use of other drugs that have similar effects on bone and the risk of implant revision [surgery],” he concluded.

Using HRT for any length of time before surgery had no effect on bone loss or implant failure. In fact, Dr. Arden suggests that pre-surgical HRT could cause harm by preventing implants from anchoring properly to the bone. Additionally, he notes that hormone therapy should be stopped six weeks before surgery to reduce blood clot risk.

Even post-operatively, there are still side effects and risks associated with HRT such as blood clots and increased risk of certain cancers. Many women are reluctant to try it for that reason. Study results notwithstanding, the question remains as to whether the benefits related to joint replacement revision surgery outweigh those risks.

Elena Losina, PhD, codirector of the Orthopedics and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital in Boston, calls the Oxford study “very well designed and executed using appropriate, modern analytic methods.”

However, she adds, “As [the study authors] highlighted, in order to consider these results more definitively in clinical practice, they need to be confirmed and reproduced in a multicenter, randomized controlled trial.”

Dr. Arden agrees. He points out that his study adds “a relevant piece of information for women who have received a total knee or hip replacement and are considering hormone replacement therapy for menopause. [But] it is only proof of principle and shouldn’t actually influence prescribing until [a randomized control trial] is performed.”

After all, while the risk to women of a second surgery is higher than for men, it is still small overall. Doctor Arden agrees that this is a consideration, but suggests women look at HRT as part of their healthcare in general, not just orthopedic services alone:

"Indeed, this is only a small added benefit of hormone replacement therapy. However, it is a relevant piece of information for women who have received a total knee or hip replacement and are considering hormone replacement therapy for menopausal symptoms.”

If you are a woman who has just begun seeking orthopedic services for joint pain, or are already considering or have decided to undergo joint replacement surgery, these study results are important.

If you are already considering HRT for other symptoms - especially osteoporosis - discuss with your doctor whether or not post-operative HRT would be right for you, or whether the HRT drugs you are already taking should be discontinued prior to surgery, then restarted as part of your recovery.

As with any surgery, it is important to talk with your doctor about any medications you are taking. Where orthopedic services like joint replacement surgery are concerned, there is promising new evidence that HRT may reduce your risk of needing a revision surgery by 40-50 percent.

As a 229-bed acute care hospital located in the heart of Slidell, LA, Slidell Memorial Hospital provides access to orthopedic services, as well as the latest treatments, technology and expert physicians.

BYOD: How Emergency Services Can Benefit from a Business Technology Trend

Bring Your Own Device (BYOD) to work has become so commonplace in most workplace environments it’s hard to call it a “trend” anymore; it’s more of a given. Employees want to bring their own devices to the job because they know how to use them. Since most people carry their own devices on their person throughout the day - primarily in case of family or personal emergency - they don’t want to carry two devices or use their work-issued device for personal matters.

One environment where BYOD might be considered more trendy than common is the emergency services sector. Public safety agencies are typically risk-averse, and choose a one-size-fits-all approach to devices to meet their requirements for resilient, task-specific communications. Hospital IT departments also tend to have limited staff and funds to devote to managing or supporting multiple operating systems or apps.

That said, technology is advancing rapidly with a refresh occurring roughly ever 10 years, so we are likely to see significant advances in how our emergency responders communicate in the coming years. New categories of technology such as wearables, drivables or even flyables will change the way we communicate. Public safety agencies in Australia and New Zealand are already test-driving some of these technologies.

There are wearable cameras that relay real-time video from a users' perspective back to command base, and sensors that monitor pulse and other biometric indicators. All of this technology can be connected seamlessly to command centers, emergency rooms, or even nearby safety vehicles which are equipped to serve as computers on wheels.

The popularity and utility of these categories for emergency response lies in their ability to be designed as task-specific, and the implications for hospital emergency use are exciting. Imagine an EMT wearing a camera on her head as she stabilizes a patient at an accident scene, speaking into a microphone so she and ER personnel can communicate while seeing the same thing. One can take note of the patient’s pallor, injuries or wounds while the other collects and transmits vital signs, perhaps using other mobile devices.

Another possibility would be that the ambulance itself might communicate with an app on EMT smart phones, reporting back to a command post who is inside the vehicle, who is driving, if they are moving or stopped, etc. Knowing who is where without necessarily interrupting their care of patients could improve response times, and minimize distractions that make it harder for the EMT to communicate with doctors.

Emergency services agencies will need to figure out how to connect consumer devices to dedicated private data networks, protecting patient confidentiality, as well as integrating devices with vehicles like ambulances and police cars, while maintaining necessary levels of encryption.

The good news is that it is getting increasingly easy to secure data, even between a diverse array of consumer devices. Technology companies are responding to the healthcare and emergency services industry with apps and services to make it easier for emergency service workers to use the devices they know and trust to do the jobs we rely on them to do, safely and securely.

 As a 229-bed acute care hospital located in the heart of Slidell, LA, Slidell Memorial Hospital provides access to emergency services, as well as the latest treatments, technology and expert physicians.

When a Loved One Needs Cancer Services: Preparing to be a Caregiver

A cancer diagnosis is a life-altering thing, and not just for the patient seeking cancer services. Family and friends often find themselves suddenly playing the role of caregiver, not an easy one to perform.

Patients getting cancer services are likely to need help with the following things:

• Shopping and preparing food                    
• Taking medication
• Personal care and hygiene (bathing, grooming, dressing, using the bathroom)
• Housecleaning and laundry
• Bill paying
• Finding the right doctors and treatment facilities
• Coordinating scheduling for treatments with multiple providers
• Finding a support group
• Managing symptoms and treatment side effects at home
• Advocating for the patient with cancer services providers

         

The tendency is for caregivers to suffer in silence, feeling guilty about their inability to provide more help, or even about being healthy. The fact is, caring for someone with cancer costs both time and money, and if the caregiver is not careful it can take a toll on his or her health, as well.

If you are serving as a caregiver to a loved one receiving cancer services, it is normal to feel good about what you are doing, even when it costs you dearly emotionally, financially and physically. However, it is important to get the information, outside help and support you need. The better you take care of your own needs, the better prepared you will be to care for your loved one.

Here are the top 10 challenges you may have to deal with while helping a loved one with cancer.

·         Communication – It can be hard to learn to talk to someone with cancer, or to talk with those who provide their cancer services and treatments. You may not understand the terminology they are using and have a lot of questions, or you may be nervous about asking your loved one questions for fear of worrying them or hurting their feelings.

·         Understanding the health care system – Today’s health care system can be difficult to navigate, even for professional healthcare workers. Finding your way around treatment protocols, follow-up care, seeking second opinions, finding cancer service providers in the first place, and making sense of bills can be hard.

·         Making health decisions – Whether it’s choosing a doctor or hospital, helping your loved one decide on treatment options, or how to take care of the healthy parts of their bodies while undergoing treatment, decisions about their health (and yours) will become more pressing and more difficult.

·         Long-distance caregiving – If you need to care for someone who lives far away, or you simply have to travel with them so they can receive cancer services at a facility a long way from home, distance will become a factor in your caregiving.

·         Treatment timeline – This goes hand in hand with understanding the system and communicating with your loved one. Understanding the timeline - what steps are involved, in what order, and how long it will take - will be essential for you. You may need to explain it to your loved one and to other caregivers. You will also need to understand it to plan for travel and expenses.

·         Staying organized – Keeping track of all the details of your loved one’s care: names and contact numbers of those providing cancer services, prescriptions and proper directions for how to take them, leads for possible back-up caregivers, and everything in between - will be a crucial part of your job. You also have your own life to keep on track, so the more organized you are, the better.

·         Taking care of yourself – Getting enough rest, eating right, and exercising will ensure you have the stamina and emotional strength to deal with this very trying time. When someone you love is suffering, it’s natural to feel guilty about taking care of your own health. However, you won’t be much good to them when you are exhausted or sick.

·         Asking for help – Asking for help isn’t selfish or lazy, and it doesn’t mean you love them any less; it’s just plain smart! There’s a lot to do. At times, other people will be able to fulfill parts of the caregiving duties better than you can, or fill-in when you need to do something else. Never be afraid to seek help, and ask for it. Often, you will be doing the other potential caregiver a favor as many will want to help but be unsure of how. Asking for help can be a gift, as well as ease your burden.

·         Job, insurance, and money concerns – If cancer treatment is making it hard for your loved one to work, you may have to deal with their job, insurance or money concerns. If you need to take time off, you may have your own concerns to contend with, as well. Staying organized and asking for help can lessen these concerns.

·         Legal issues – If you run into problems you can’t solve, either dealing with the healthcare system, a job, or perhaps even a paid caregiver, you may encounter a legal issue. Think about how you might address that in advance, and familiarize yourself with resources that can help if you need them.

Being a caregiver is a tough job, but it’s an important and rewarding one, too. Today, more than 12 million Americans have had cancer. Each one probably needed a caregiver to help them through their cancer experience.

In many cases, a caregiver makes the difference, not just to the patient’s prognosis, but also in their everyday experience dealing with the disease. What may be an emotional no-brainer at first - deciding to “be there” for your loved one in any way you can - can quickly turn into a full-time job you aren’t prepared to do without major sacrifices to your own well-being.

This list of tasks and challenges can help you better prepare so your role as caregiver can be a rewarding one. Also, consult our list of cancer resources to help you and your loved one while they are receiving cancer services.

As a 229-bed acute care hospital located in the heart of Slidell, LA, Slidell Memorial Hospital provides access to cancer services, as well as the latest treatments, technology and expert physicians.

Emergency Services: When You Need Them, and When You Don’t

Let’s face it: no one ever wants to visit the Emergency Room. Emergency Services are those things we don’t even want to think about until we need them. In fact, most of us hope we never need them!

How many of us stop and think about what a “need” for emergency services really looks like? How can we tell the difference between an “emergency” and a need for “urgent care?”

Why are there waiting rooms?

 It’s no secret that ERs around the country are often overrun, with waiting rooms filled to capacity, and sometimes beyond. But how can people wait for “emergency” services? The simple answer is, usually they can’t. The fact that ER waiting rooms are full is a clear indicator that too many people are seeking emergency services when what they really need are “urgent care” services.

The difference is not just semantics either. An ER visit will cost much more than a visit to a Primary Care physician or Urgent Care facility. In addition, when people who don’t really need ER doctors, nurses, and facilities use them, those people and places are less well prepared to deal with those who do.

When is it really an “Emergency?”

 The following situations or conditions require emergency services, delivered at the ER closest to you, or a phone call to 9-1-1:

•  Symptoms of a heart attack or stroke
•  Severe shortness of breath
•  Bleeding that doesn’t stop after 10 minutes
•  Sudden, severe, especially unexplained pain
•  Poisoning (You should first contact your local poison control hotline for home remedies. Since most poisons need to be vomited as soon as possible, steps you take at home could save your life.)
• Severe or persistent vomiting
•  Major injury, or head trauma
•  Coughing up blood
•  Suicidal or homicidal feelings

Of course, when in doubt, it’s always better to be safe than sorry. For example, many conditions mirror a heart attack? With young children, it can be hard to know how severe a situation is because they are less able to communicate about their symptoms.

When is it NOT an “Emergency?”

 The following situations or conditions do not require emergency services, or are better served by a primary care physician or urgent care facility:

•  Earache
•  Fever
•  Colds, cough or flu
•  Broken bone (You can call your doctor. Unless the bone is showing, he or she may be able to treat you in the office the same day.)
•  Minor cuts, where bleeding is controlled.
•  Sprain
•  Insect bite
•  Sunburn
•  Animal bites
•  Swallowed or stuck foreign objects, if breathing and swallowing are possible.
•  Nebulizer breathing treatment

Why are you considering emergency services?

Now that you see what types of situations do and don’t require emergency services, you’ll be better able to decide what to do the next time you’re facing a healthcare situation late at night, on the weekend, or when you can’t get an appointment right away with your doctor.
Ask yourself why you are considering heading to the ER? Is it out of necessity, or for convenience? If you feel sick or uncomfortable, it’s understandable that you would want to get care right away, but will you really feel better sitting in the waiting room of a hospital, full of other sick people?

Also, wouldn’t you feel better seeing your own primary care doctor, who knows you, even if you have to wait overnight, or a day or two?

The bottom line is this: Before deciding to use emergency services, think carefully about whether you really need them. Taking the few moments to ask yourself these questions can save you time, money, and considering the comfort level of most hospital waiting rooms, added discomfort, as well!

As a 229-bed acute care hospital located in the heart of Slidell, LA, Slidell Memorial Hospital provides access to emergency services, as well as the latest treatments, technology and expert physicians.