Debunking the “July Effect”

For decades, doctors have all shared one piece of common advice, “Don’t get sick on the first of July.”

This timeline, known as the July Effect, is an infamous phenomenon in the medical world. Recent medical school graduates step foot in teaching hospitals as residents for the first time, as the class above them takes on new duties.

It’s at this time of the year that patients in even the nation’s best teaching hospitals notice budding physicians being replaced with a new class of diffident, albeit eager, students. With their white coats neatly pressed, brand new stethoscopes around their necks and pockets full of smart devices, offering a world’s worth of information at their fingertips, it’s not difficult to distinguish this new crop of aspiring doctors from their much more experienced counterparts.

Throughout the medical world, there’s the understanding that even the smallest of errors, committed by inexperienced interns, can have catastrophic consequences for patient care.

While this concern of overenthusiastic residents, perhaps enjoying more independence than they really should have in teaching hospitals of the past, may have very well have once been warranted, Arnot Health chooses to look more closely at the future of our teaching programs to cultivate the true potential of our incoming residents as aspiring medical professionals and valuable assets to our caregiving team.

In fact, we believe that the introduction of these eager residents and interns is an added dynamic to our hospital’s total patient care opportunities, and most importantly, the patient experience.

Long story short…things have changed. The July Effect is just a myth, now more than ever. Our residents are just as much an integral part of our team as anyone else.

They learn from our doctors and listen to our nurses, and are always closely supervised. As a result, the kind of care that our residents can provide for our patients is better now than ever before.

Arnot Health is in its third year as a teaching hospital. In those three short years, we’ve made it our mission to transform the way our residents gain hands-on experience, in a world class educational setting.

Before being given any kind of independent authority, aspiring doctors go through a kind of “resident bootcamp,” if you will. For months, residents are drilled on the basics: where specific medical materials are located, who to talk to depending on any given situation, the importance of listening to a nurse’s recommendations and so on. There’s so much supervision, it wouldn’t be uncommon for a resident not to take a call on their own for the first six months of their residency.

We watch our residents like hawks. We take the job of teaching these students incredibly seriously.

And, there’s something important to remember: We are absolutely responsible for the patients that these residents are working with. We make very certain that they continue to receive the proper care no matter what, and from whomever may be providing it.

Ultimately, with so much supervision and attention to detail paid to our residents’ roles and responsibilities, Arnot Health is ensuring that they become a truly necessary, effective branch of our caregiving team. As a result, the hospital has more eyes on its patients, and more skilled boots on the ground providing the kind of total care that wasn’t possible before the insertion of medical students into the hospital’s various departments and programs.

What may have once been a legitimate concern to both doctors and their patients is no more, at least when it comes to the kind of care that Arnot Health prides itself on offering.

Rather than succumb to the myth of the July Effect, aspiring physicians and their supervisors hunker in for the long haul. We work off of one-another’s strengths and expertise and provide the best possible and complete care to anyone who steps foot in an Arnot Health facility.

Dr. Beth Dollinger, orthopedic surgeon for Arnot Health, writes a blog series to help answer frequently-asked questions, offer perspective on newsworthy events, and essentially give patients a hand in their own healthcare. If you’d like more information, or to schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.

Flat Feet May Develop Over Time

Over time, the physical stress of our everyday lives can begin to take a toll on our feet. When you begin to notice a change in the shape of your foot, your shoes not fitting properly or striking the ground on the sole, or your arch in getting increasingly closer to the ground when standing, you might be on your way to developing flat feet. This condition, referred to as adult acquired flat feet, is a condition that can cause pain in your feet, pain and swelling of the ankles and/or knees, and generally make normal mobility a painful activity. In addition, standing on your ‘tippy-toes’ can become difficult or nearly impossible and you may develop signs of arthritis.

What’s Happening in There?
When developing flat feet, you can certainly notice the outward signs of a lowered arch, shoe issues, and the physical pain. What is actually happening inside your body is that your tendons are beginning to stretch out, leading to strain and collapse. After this occurs, your ligaments become overworked and can follow in the same downward progression, furthering the condition and weakening the structure of the entire foot.

Possible Causes:
There is no specific set of circumstances that will absolutely lead you to developing flat feet in your adult life, however, there are a few conditions that may increase your risk:

  • Decreased or low activity level
  • Overweight
  • Previous injury
  • Genetic pre-disposition

In my practice, I am noticing a higher ratio of women to men presenting with this condition and typically seeing patients in their 40’s through 60’s.

Diagnosis and Treatment:
When a patient presents with the signs and symptoms of adult acquired flat feet, the first step is diagnosis and identifying how severe the condition is. This can be done with a thorough physical exam, which then may be followed by an x-ray, MRI, and/or CAT scan. If the condition is identified early, treatment may include physical therapy, orthotic inserts or shoes. They may also advise you to wear a brace which can range from soft to ridged or hard depending on the level of support needed.

If the condition has progressed, more aggressive treatment may be necessary, including surgery. Surgery can also vary in severity and may include cleaning up tendons, transferring a tendon, and/or breaking and fusing bones to return your foot to it’s proper structural state.

If the condition is identified early or the damage is not severe, with the proper orthotics and dedication to physical therapy, you may see improvement within a few weeks. Once surgery is involved, the recovery time becomes much more drawn out including up to eight weeks in a cast or a boot followed by months of physical therapy.

Adult acquired flat feet can threaten the ease and comfort of staying active. Mobility and physical activity are key components to a healthy lifestyle, and we want to help you stay active. If you notice any of the symptoms or you aren’t feeling as comfortable on your feet as you once were, don’t hesitate to call us, and together we’ll get that spring back in your step!

Dr. Beth Dollinger, orthopedic surgeon for Arnot Health, writes a blog series to help answer frequently-asked questions, offer perspective on newsworthy events, and essentially give patients a hand in their own healthcare. If you’d like more information, or to schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.

Is Your Clothing Bad For Your Health?

For most of us, picking an outfit for the day is driven by a few factors including where we plan on going (work, the grocery store, hiking, etc.), what is seasonably appropriate, and to a varying degree, what looks good. When we are getting dressed or picking out clothes at the store, we are typically thinking thinks like, “Is this flattering? Is it appropriate for work/school/etc.? Does it match my new shoes? Does it match anything I have in my closet?” One question that isn’t typically top of mind (but might be the most important) is, “Is this bad for my health?” If that question wouldn’t even occur to you to ask, than the rest of this article may just be great information for you …

How Can Your Clothes be Bad for You?

In general, wearing cloths isn’t particularly bad for you. In fact, I would venture that wearing them on a daily basis probably keeps you out of trouble. However, there are a few things we should be cognizant of when we’re picking out our attire. Here are just a few examples:

Bowties, Neckties, and Shirt Collars:
Make sure you are measuring correctly for your shirt collar size and wearing your ties loose enough to feel comfortable. If they are too small or tight, you may be causing a decrease in blood flow to your head, causing tingling and numbness, in addition to, well, less blood flowing to the brain. According to the British Journal of Ophthalmology, wearing your shirt collar too tight can even increase intraocular pressure, possibly leading to glaucoma. How many men could possibly be walking around with their collars and ties to tight? According to some studies, it’s as high as 70%!

Skinny Jeans:
We’ve all seen them, and a vast majority of us may even have a pair or two. However, if you do have them, check for these signs that they are a little too tight: tingling in the thigh, numbness, or the feeling that your foot is no longer under you. If you have any of these symptoms when you’re sporting your trendy trousers, it may be time to take them off and opt for a looser-fitting style.

Tight Belts & Tight-Waisted Pants:
Belts and the waistband of your pants are designed to keep your britches on, not change your shape. Wearing your belt cinched too tight a waistband a few sizes to snug can cause a myriad of problems including acid reflux, indigestion, bowl discomfort, and can even cause temporary nerve damage.

Compression Wear/Shape Wear:
Shape wear (Spanx, etc.) are designed to smooth you out, not shrink you down. Wearing a garment of this nature is not inherently bad, you just have to make sure it’s the right size. Much like a tight belt, shape wear can cause increased acid reflux and indigestion. In addition, wearing restrictive clothing can limit your lung capacity and ability to breathe. If you are uncomfortable, lightheaded, or you’re experiencing trouble breathing, it’s too tight.

Finding clothes that fit could be better for your health

So the next time you open those closet doors and decide on an outfit, make sure you add one additional question to your list … “Is this a healthy choice?” Wearing clothes should be a comfortable experience. If something doesn’t feel right, choose another option. Don’t sacrifice your health for fashion.

If you’d like more information, or to schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.

Why is it important to walk after knee or hip surgery?

If you are undergoing a knee or hip replacement procedure, we want you to be aware of the entire process, including what to expect before, during, and after your surgical procedure. Patients are often shocked to hear their physician ask, just hours post-surgery, for them to get out of bed and take a walk. This, I assure you, is for a very good reason, and that reason is the prevention of blood clots.

Deep Vein Thrombosis (DVT), or the formation of a blood clot, is a serious post-surgery complication. Blood clots can form in the lower extremities due to excess swelling, debris in the veins, and immobilization- basically all things that occur with hip or knee replacement surgery. Blood clots can block the flow of blood to the immediate and surrounding areas causing local damage or, they can dislodge travelling to other parts of the body including the heart or lungs causing very serious complications including heart attack, stroke, or death.

How Does this Effect You and Your Post-Surgery Experience?
Following your hip or knee replacement surgery, ensuring that blood continue to flow properly returning it quickly and effectively back to the heart is essential in the prevention of blood clots. You can expect your physician to take one or more of the following steps to reduce your risk including:

  • Mechanical prophylaxis: a pneumatic pump to compress the foot and/or leg aiding in blood return
  • Chemical prophylaxis: Xarelto, Aspirin, etc. to thin the blood
  • Getting you out of bed, on your feet, and walking

Understanding Your Risk:
While anyone can develop a post-surgery blood clot, there are certain risk factors which may increase the possibility of developing a clot such as:

  • Advanced age
  • Varicose veins
  • Smoking
  • Estrogen therapy
  • Cancer
  • Factor 5 deficiency
  • Genetic predisposition

It may seem counter intuitive, or even downright cruel, to get you on your feet following these particular procedures, however, we assure you it is for your benefit. Blood clots are a very real, and very serious, post-surgical risk. Once you develop a blood clot, you are more likely to develop them again in the future; taking proper measures to prevent them now can have an impact on your present and future health. Your healthcare team is committed to your safety, and that means getting you moving as soon as possible post-surgery.

DVT or Deep Vein Thrombosis is the formation of a post-surgery blood clot

DVT (Deep Vein Thrombosis), or the formation of a blood clot, is a serious post-surgery complication.

The Ultimate Guide to Frostbite from Arnot Health

As you head off to the slopes, send the kids out to play in the snow, or simply make a wintery trek out to the grocery store, keep this in mind- it can only take a few minutes for frostbite to occur. Exposed skin can develop frostbite at 20ºF with winds at 20 mph in less than five minutes. You don’t have to be stuck in the wilderness for hours; it can happen in your own front yard.

When exposed to cold temperatures, the body begins to move blood away from the extremities, pulling it towards the core to protect vital organs and systems. This leaves fingers, toes, ears, the nose and eventually hands and feet more vulnerable to damage, known as frostbite. Frostbite occurs when ice crystals form in the cells, damaging the tissue. Frostbite can range from effecting the top layer of skin all the way to deep tissue damage.

Signs and Symptoms:
Here are signs and symptoms to look for while you’re in the elements:

  • Tingling and numbness
  • White, yellow, or grayish coloration
  • Waxy look to the skin or skin that feels abnormally hard to the touch

When rewarming or returning indoors:

  • Flushing
  • Blistering
  • Burning sensation
  • Black scab which can form several days or weeks following exposure

Next Steps:
If you believe you may have frostbite, seek medical attention as soon as possible. If medical help is not immediately available, here are a few steps you should take to minimize damage:

  • Warm the area by submerging the area in warm, not hot, water
  • Avoid dry heat such as fires and radiators, and avoid direct heat
  • If blisters form, leave them intact- they are sterile, biological dressings that form to help mend damage and avoid infection
  • Do not apply pressure or rub the affected areas; if the toes/feet are effected, avoid walking as this can increase damage

What can increase your risk for developing frostbite?
While everyone can develop frostbite under the right conditions, several circumstances can increase your risk. Some of these include:

  • Cardiovascular disease
  • Diabetes
  • Smoking
  • Consumption of Alcohol or other substances
  • Damp clothing
  • Previous frostbite

Long-term Effects:
If you experience frostbite, some of the lasting effects may include:

  • Increased sensitivity to cold
  • Numbness
  • Stiffness
  • Pain
  • Gangrene
  • If the effected tissue has died, amputation of the affected area/body part may be necessary.
Skier Avoids Frost Bite

Avoiding frost bite is important whenever you’re outside in the winter.

Frostbite can be a fast-acting and serious condition. Make sure when you head out into the elements this winter you know your environment, your limits, and your risk. IF you suspect you may have frostbite, seek medical attention as soon as possible. Stay safe out there!

A few extra tips for our winter sports enthusiasts: Frostbite isn’t the only cold weather injury to be concerned with. To keep yourself safe, use the buddy system, know yourself and your limitations, stay hydrated, and be sure to warm up your muscles and tendons prior to heading out for optimal range of motion. Have fun and stay safe this winter!

The Backpack: Dispelling Myths and Finding the Right Fit

At the start of a new school year, every so often I hear a rumor begin to circulate that a heavy, ill-fitting backpack can cause scoliosis. Scoliosis can be described as a condition in which there is a horizontal curvature of the spine, typically occurring during a child’s growth spurt just before puberty. While the cause of most scoliosis cases is unknown, it is generally agreed upon by physicians that the backpack is not a likely culprit.

Now that we’ve put that rumor to rest, there are still many reasons a well-fitting backpack is important. A poor-fitting, ill-constructed, overloaded backpack can cause unnecessary stress and vertical pressure on the shoulders and back taxing core muscles and bowing out the spine, which, in addition to being uncomfortable, can be harmful. Choosing the right backpack may not seem like a difficult task until you hit the store or on-line retailer of your choice and find yourself faced with every size, shape, style, and color imaginable. So what makes for a good fit?

Safe Backpacks for Children

To start, the size of the backpack should be no larger than your child’s actual back- roughly from the outer edges of the shoulder blades for the width and from shoulder line to a few inches below the waistline for the height. Selecting the right size will assist in making sure the weight of the bag is distributed evenly throughout and ensure the straps hit in just the right spot (about half way between the neck and the shoulder joint).

Second, and speaking of straps, you want to choose a bag with two, well-padded straps. When wearing, make sure the straps are nice and tight. This will protect the shoulders and again help to distribute the weight evenly. One-shoulder, or messenger style, bags may look studious but unless your child is packing lightly I wouldn’t recommend them. To the coffee shop with a light laptop perhaps, but not from the house to the school locker hauling every text book imaginable … for that I’d stick with the standard two straps for sure. Finally, try to find a backpack with a padded back panel to cushion the spine. Furthermore, you may also want to find one with a waist strap to further secure the bag keeping it and it’s contents from bumping and jostling around. You may get a not-so-enthusiastic look from your pre-teen, but I’ll let you handle any ensuing style disagreements.

If you start to notice your child complaining of back pain, numbness, or tingling in their arms, there may be an issue. Try repacking the bag, putting the heaviest objects low and in the center, and encourage them to take only what they need for the day. Leave the bowling ball collection at home.

If the fit is correct but it’s a struggle to pick up or they appear to be to be one soft breeze away from toppling over backward, it still might just be too heavy, even without the bowling balls. In this case, you may want to consider a rolling bag in lieu a traditional backpack. They’ll be prepared for school and their next trip to the airport. It’s a win-win.

If you’d like more information, or to schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.

Dr. Dollinger: The Marvelous Rotator Cuff

The shoulder, in my opinion, is probably the most magnificent joint in the body. Its amazing range of motion, flexibility, and strength are stunning, especially when it comes to gymnastics, golfing, and weightlifting, to name a few. It’s an absolute marvel of biomechanics to have such a large ball in such a shallow socket. What makes it all possible is the rotator cuff.

The rotator cuff is made up of 4 muscles and their tendons that hold the shoulder joint together. These muscles endure a lot of stress, however, because the structure of the shoulder joint is so unstable. From overhead lifting to throwing softballs to using a jackhammer: these activities all put a tremendous amount of stress on the shoulder. This is why certain athletes, like baseball players and weightlifters, and people in certain trades, like carpenters and painters, are prone to rotator cuff injuries.

Injury to the rotator cuff involves either a partial tear or a full tear of any of the tendons. For example, if you fall onto an outstretched arm, this could pull the tendon from the bone and cause a hole to form in the tendon. Or, the tendons could simply wear down over time due to repetitive stress or decreased blood flow, which can cause scarring and tears.

Typically, people with rotator cuff injuries experience pain, stiffness, weakness, and cracking or crunching when lifting or lowering their arm. In this case, they need to consult their doctor, who will perform a careful physical exam to make sure the pain isn’t actually caused by something in the neck or elbow. The diagnosis can also be based on patient history and x-rays, which check for tears, arthritis, or calcium in the tendon. An MRI or ultrasound may be needed for more detailed information.

If it is a small tear, most doctors will want to treat it conservatively for 4 to 6 weeks in order to avoid surgery, recommending rest and decreased activity, ibuprofen or Aleve, and possibly physical therapy and/or a steroid injection for the inflammation.

If it is a tear larger than 3 cm or is a chronic condition, your doctor may recommend surgery. Most cases can be eligible for arthroscopic surgery (as with knee surgery), which requires fewer and smaller incisions, with less risk of infection, fewer muscles impacted, and shorter recovery time. However, if it is a large tear that requires more work on the tendons, it may require open surgery.

The rotator cuff is an anatomical wonder. Just remember that the next time you high-five someone or dance to YMCA or cram your carry-on luggage into that tiny overhead compartment. Your shoulder can perform marvelous deeds because of the magnificent rotator cuff.

If you’d like more information, or to schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.