Frequently Asked Questions:

 
 
 
Do I need vitamin C and the minerals Manganese and Boron to keep my joints healthy?


How long do I need to continue to take Osteo-Bi-Flex?


Why do you only recommend Osteo-Bi-Flex as a joint supplement?


Do I have to take care of my Total Joint Replacements?


What is the most frequent condition for which orthopaedic surgeons are sued?


What is a uni-compartmental knee?


What is synovial fluid?


What is a dry socket?


How do I know if I have arthritis?


If I lose weight will it help my knee arthritis?


What is MSM and what is it used for?


Does childhood activity help or hurt the development of the knee joint?


Why is osteoporosis called the silent thief?


Does massage help back pain?


Am I too old to exercise?


What are SERMS?


I have heard the term Bone Bruise. I never knew bones could be bruised.
Can they?
Patty S.















Question:
Do I need vitamin C and the minerals Manganese and Boron to keep my joints healthy?
 
Answer:
Vitamin C is needed in the production of collagen and the repair of connective tissues, which support joints.

It is felt that Boron, the element, is needed to maintain the health of muscles and joints. It seems to play a role in regulating calcium metabolism and helps the body retain calcium perhaps preventing osteoporosis.

Manganese is thought to be required for cartilage maintenance and repair as well as in the formation of bone in the body.

Osteo-Bi-Flex has included these three ingredients in its double and triple strength formulas.

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Question:
How long do I need to continue to take Osteo-Bi-Flex?
 
Answer:
In my clinical practice most of the patients for whom I recommend Osteo-Bi-Flex have had knee arthroscopy and I know what the inside of their joint looks like.

If I feel that the patient's degree of damage or change in the joint warrants taking Osteo-Bi-Flex, I recommend that they continue to take it indefinitely as long as the joint continues to be improved.

The approach usually is three pronged in that I have done something arthroscopically to the joint, recommended appropriate exercise therapy and recommended that the joint supplement Osteo-Bi-Flex be taken.

As long as the exercises and the Osteo-Bi-Flex are keeping the joint comfortable, I strongly encourage the patient to continue with the program.

To stop what is helping only invites return of symptoms and that is exactly what the patient and I are trying to avoid.

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Question:
Why do you only recommend Osteo-Bi-Flex as a joint supplement?
 
Answer::
There are countless joint supplements that are available on the shelves at pharmacy and discount retailers. The consumer's eyes literally glaze over when confronted with all of these choices.

If the person is shopping at a pharmacy and asks the pharmacists for his opinion, invariably the pharmacist will recommend the store's version of Glucosamine and Chondroitin. Is this one the best? What is the confused patient to do?

Osteo-Bi-Flex tablets are tested for conformity to rigid final product specifications including potency, microbiological purity, and physical aspects such as hardness, weight and disintegration properties. The manufacturer of Osteo-Bi-Flex, Rexall Sundown has consistently received the highest quality rating of its manufacturing by a leading independent auditing firm used by many pharmaceutical and supplement companies. The name of this auditing firm is Shuster Laboratories, Inc.

Osteo-Bi-Flex is the #1 recommended joint supplement by physicians. It is recommended more than any other brand of Glucosamine and Chondroitin to promote healthy joints, increase mobility and reduce NSAID consumption.

Furthermore, Osteo-Bi-Flex is available in several strength formulas and has attempted to make the caplets as small as possible. Regular and double strength soft gels are available as well as the triple strength formula, which reduces the dose to two per day, which can be taken once a day.

Osteo-Bi-Flex is extremely well tolerated as a dietary supplement having no greater percent of side effects than placebo groups.

We see no reason to recommend any other supplement for joint health.

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Question:
Do I have to take care of my Total Joint Replacements?
 
Answer:
One of the most frequent questions that I am asked by my patients is what they have to do to take care of their total joint prosthesis in the months and years after surgery. They want to know what kind of activities they can perform and what they need to avoid.

While the patient is recovering from surgery a graduated walking program with partial weight bearing is in effect for approximately 6 weeks and is complimented by specific exercises that I and the physical therapist have prescribed for the particular joint replacement that the patient has.

After the person is fully recovered I have no problem with the patient participating in walking as far as he or she wishes, bicycling, swimming, golf, and ballroom dancing. These activities maintain the strength and mobility that supports the new joint prosthesis.

Mostly I would discourage activities such as jogging, downhill skiing and tennis. Cross country skiing would be permitted usually. I don't like jogging because of the pounding activity and stress on the prosthesis. I think jogging and running are wonderful and will never effect or cause arthritis in an otherwise normal joint. But if arthritis problems are beginning to show up in a particular joint or in this case if the person has had a joint replacement I think the potential for running or jogging causing additional problems is very great. Of course we have to deal with this on an individual basis, but I do not make too many exceptions to what I have previously stated.

I don't like tennis for a joint replacement because of the sudden stops and starts and changes of direction that are placed on the lower extremity. Most people who play tennis would not be willing to reduce their activities on the court to protect the prosthesis to make it worthwhile for them to continue to play. They simply would not feel that they are being very effective or competitive. For this reason I discourage tennis.

Normal levels of activity particularly walking will never damage the prosthetic joint replacement. We place no restrictions on the distance a person can walk and encourage them to do this to their limit. In fact, if you are not active your muscles will weaken, which may increase the risk of falling. People who do fall with a joint replacement often cause severe damage to the bone adjacent to the prosthesis and this results in very major surgical reconstruction.

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Question:
What is the most frequent condition for which orthopaedic surgeons are sued?
 
Answer:
Physicians Insurers Association of America identified in a large study of 879 claims that fracture of the femur ranks first on the list of problems for which orthopaedic surgeons are sued. Following fracture of the femur is failure to diagnose a condition. The third leading cause is infection.

I am not surprised at this study as fractures of the femur can be notoriously difficult to manage and complications can often result from treatment with metal fixation devices.

We as orthopaedic surgeons must do a better job to engage in a through discussion with the patient and family concerning the nature of the injury and its severity, proposed treatment, the alternatives available, possible complications and their consequences and realistic expectations.

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Question:
What is a uni-compartmental knee?
 
Answer:
Some patients have very significant arthritis changes in only one part of their knee, frequently on their inner or medial side.

If there are no other major arthritis changes on the other side of the knee or under the knee cap that patient might benefit by a partial knee replacement, which officially goes by the name uni-compartmental knee replacement. It is a less invasive partial knee replacement procedure

Potential benefits for the patient are that it maintains more of the healthy elements of the knee resulting in a more natural feeling during activities. There is a significant potential for reduced hospital stay and less pain medication after surgery. Lastly there is improved stability during movement after surgery.

We feel that the Preservation Uni-compartmental Knee made by DePuy Inc. is the best implant for this purpose.

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Question:
What is synovial fluid?
 
Answer:
Synovial fluid is a thick very slippery substance that is produced by the membrane lining the joint, which is called the synovium.

In the knee for example the membrane is very large and forms the entire surface of the interior of the knee joint. Almost every joint that we have contains synovial fluid.

The synovial fluid acts as a lubricant, carries nutrition to the joint and as a cushion for the joint.

Synovial fluid is known to become thicker and more viscous when a person is very active as in running, jumping, or vigorous exercise of any type.

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Question:
What is a dry socket?
 
Answer:
I have often heard patients use this term and it probably comes from the fact that in the condition of osteoarthritis the slipperiness or viscosity of the joint fluid (synovial fluid) is greatly reduced. The fluid becomes thin and watery and is not elastic when force is applied during weight bearing.

Diseased synovial fluid does not act as a lubricant and shock absorber as it normally would and this can contribute to pain stiffness and decreased mobility of the particular joint.

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Question:
How do I know if I have arthritis?
 
Answer:
Lets use the knee as an example. There are certain signs and symptoms of knee arthritis, which are very characteristic.

  • Pain in and around the knee joint that worsens with weight bearing either standing or walking.
  • Pain in the joint that awakens you at night.
  • Stiffness after rest when you get up to walk.
  • Tenderness around the joint to touch.
  • Limitation of range of motion of the joint.
  • Grating or catching sensation in the joint during movement.
  • Swelling or puffiness in the joint as a result of fluid collection.
  • Joint deformity or angulation of the joint, which occurs later in the arthritis process.

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Question:
If I lose weight will it help my knee arthritis?
 
Answer:
Excess weight over and above one's ideal weight causes stress and trauma to the supporting structures of the joint and to the cushioning tissue inside the joint as well.

It has been known for a very long time that whenever we take a step to walk the pressure on the knee is 3 to 4 times your body weight. That sounds unbelievable, but it is true and has been demonstrated in biomechanic laboratories for many years.

Therefore even a small weight loss can decrease knee pain and stress on the joint to some extent.

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Question:
What is MSM and what is it used for?
 
Answer:
MSM is an abbreviation for methylsulfonylmethane.

It is also known as crystaline dmso.

It has been used orally and topically for chronic pain, arthritis, joint inflammation, bursitis, tendinitis, and musculoskeletal pain.

It is generally considered safe when used orally or topically. Its degree of safety in pregnancy and lactation is not known and therefore it should be avoided at those times.

Whether it is effective is unknown because there is insufficient reliable information available about its beneficial effect on humans.

MSM can cause nausea, diarrhea and headache. There is insufficient reliable information about its interaction with herbs and dietary supplements in general.

There are no interactions known to occur with drugs.

The typical oral dosage is 1,000 mg taken with each meal, in other words three times per day.

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Question:
Does childhood activity help or hurt the development of the knee joint?
 
Answer:
There are many people doing studies in this field who believe that physical activity in children definitely affects the cartilage and joint development of the knee.

They conclude "the current evidence supports a prescription of vigorous physical activity for optimum knee joint development in children."

The early years are important windows of opportunity to increase bone mass and researchers also believe this could be true of joint development.

MRI studies have shown children with no vigorous activity had 25% less hyaline articular cartilage than even mildly active children.

Of course, children gain articular cartilage during growth. However, children undertaking more vigorous sports had significantly higher rates of articular cartilage accrual than their inactive counterparts.

The unknown factor, of course, is the long term significance of the results with regard to arthritis of the knee in later life.

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Question:
Why is osteoporosis called the silent thief?
 
Answer:
It is considered an insidious condition that drains away bone - the hardest and most durable substance in the body. It happens slowly, over years, so that neither doctor nor patient is aware of weakening bones until one snaps unexpectedly.

Unfortunately, this isn't science fiction. It is why osteoporosis is called the silent thief.

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Question:
Does massage help back pain?
 
Answer:
Lower back pain is one of the most common problems in the United States. Research has compared massage therapy with several other forms of treatment and massage was often found to be the most effective, reducing the need for painkiller medication by 36%.

There are many different massage techniques such as Swedish, deep tissue, pressure point and neuromuscular.

Massage therapists believe that when muscle fibers are stiff and tight, it blocks the exchange of fluids and nutrients in the lower back. Massage is sometimes considered to loosen and moisturize muscles.

You can locate a certified massage therapist through the American Massage Therapy Association by calling toll free (888) 843-2682.

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Question:
Am I too old to exercise?
 
Answer:
Without even knowing the age, the answer to that question is am emphatic "NO".

It is known that being active helps. Most doctors tend to be overly cautious with older patients. The probable reason for this is the fear of litigation.

Doctors should be advocating exercise rather than discouraging it.

Fear of having a heart attack or other injury should not preclude a person from starting an exercise program as long as the person starts slowly and builds endurance gradually. But even if you do have risk factors, that doesn't mean that you will have an adverse event and the benefits of exercise far outweigh the risks.

Even in persons whom have had heart attacks and cardiac surgery, exercise rehab programs are extremely important to maintaining their health and improving it for the future.

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Question:
What are SERMS?
 
Answer:
Evista (Raloxifene) is a drug in the class known as Selective Estrogen Receptor Modulators or SERMs. This drug has been shown to reduce the risk for fracture in the spine.

This drug approved by the FDA acts by slowing the turn over of bone rather than stimulating new bone formation.

Bone mass increases because even though osteoclasts can't start new remodeling sites, osteoblasts continue filling in existing cavities. Increases in bone mass are most pronounced in the first year or two after treatment begins and then tapers off. Any gain is helpful even if it doesn't continue because increases in bone mass help reduce fracture risk.

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Question:
I have heard the term Bone Bruise. I never knew bones could be bruised.
Can they?
Patty S.
 
Answer:
Good question, Patty. Before MRI was done we suspected but could not prove bones could be injured short of a fracture. But MRI frequently shows that the knee especially can be bruised even without ligament injury. A study from the University of Texas recently showed this in a large number of adolescents.

Bone bruises can mimic other knee injuries that may require arthroscopic surgery.

If you can be sure that it is only a bone bruise, most patients can be treated without arthroscopic surgery which is a great benefit to those patients.

Bone bruises however should not be considered a trivial injury since they can cause a prolonged period of symptoms and disability.

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