Orthopaedics: Live Question and Answer Session
April 20, 2004

From strains and sprains to muscle tears, fractures and pain. Our orthopaedic experts answer your questions.

A live question and answer session about orthopaedic issues was held on Tuesday, April 20, 2004. This is the transcript from the chat session. If your question was not answered during the chat, please check back throughout the week. Our experts will do their best to answer your questions by April 30th.

Thank you to our sponsors and the healthcare professionals at Columbia St. Mary's and Advanced Healthcare.

To find a physician to answer your questions or to schedule an appointment, please use the physician search found at the top of this page.

Q: Peggy from Waukesha - I have spondylolisthesis of L5-S1. I am in daily pain with radiating leg pain and numbness in my toes in both feet. I have been through therapy and injections none of which seemed to help. My ortho has recommended an anterior and posterior lumbar fusion with laminectomy and instrumentation at that level. He has told me that my spine is unstable. I know I need the procedure, but I am scared to death to do it. I am 40 years old and pretty active. Is there anything else that can be done for this condition?
A: Moderators - Peggy, I appreciate you situation and am sorry for the delay in responding. The constant pain can be debilitating. Given your situation, our best advice would be to consider your options and seek advice from another surgeon - specifically a spinal surgeon. The other route you could take would be to call the Columbia St. Mary's Spine Center for an intake assessment. Our protocol is to arrange an appointment with a physiatrist for evaluation who will develop a treatment plan. Feel free to call Lou Ann at 414-961-5559 at the CSM Spine Center for more information.

Q: Lee from Jefferson - I was medically discharged from the military in 1995 with a Herniated Nucleus Puplosus with spinal stenosis at the L4/L5 level - 5 Doctors in the military said they would not put a "knife" to me, therefore I was discharged and sent home. I am the 1 to 2% that does not respond to conservative treatment since 1995 I have lived with pronounced chronic pain with little intermittent relief, presently I get the most relief from a TMS device and drugs...my question is "what are the long term consequences of living with this condition. I've heard nothing but negative comments about having surgery that one is better off to live with it than to have surgery, unless the disc ruptures". THANKS! I am now 58.
A: Moderators - Lee, living with chronic pain is exhausting - glad you have some relief with the TMS device. Given your history our best advice would be to consider your options. You might want to call the Columbia St. Mary's Spine Center, go through the telephone intake process with Lou Ann who can refer you to one of our physician specialists. The phone number for the CSM Spine Center is 414-961-5559. Feel free to contact her for more information. My apologies for the delay in responding to you.

Q: Joe from West Bend - What can you tell me about the surgical treatment for Scheuermann's Kyphosis (75degrees)? Do most orthopedic surgeons believe this is the best option?
A: Moderators - Joe, I'm unable to answer your question. I'd suggest that you contact Lou Ann at the Columbia St. Mary's Spine Center, 414-961-5559. She'd be happy to send a list of our orthopaedic and spinal surgeons to you.

Q: Kathy from Milwaukee - I have a ruptured C5 and C6 which I tolerated with accommodations for many years. I got jarred last May and my nerve got pushed into a bone spur which developed. I have had PT which helped but pain and weakness in my left arm has come back. There is a difference in my right and left reflexes per the neurosurgeon I saw last week. I am afraid of surgery (fusion with a cadaver bone,) afraid of anesthesia because I smoke. What are my options at this point? What's recuperation like? I live alone.
A: Moderators - Kathy, I'm sorry for the delay in responding to you. I understand your concerns, but also appreciate that living with limitations and pain can be difficult. Given your history, I suggest that you might want to get a second opinion. Be certain to share your concerns about surgery. Perhaps he/she could recommend a conservative approach to you situation. You can visit the Columbia St. Mary's website for physician information. Another option would be to contact Lou Ann at the Columbia St. Mary's Spine Center. She can be reached at 414-961-5559 and can describe the intake and treatment options.

Q: Jan from South Milwaukee - Dear Doctor: Just last week, I was diagnosed with Degenerative Disk Disorder in my lower back as seen from x-rays. I've had considerable pain which has been on the increase over the last two years. I was told that taking an anti-inflammatory such as Advil every day for two months combined with some physical therapy (exercises) may help me. First of all, I'm concerned about taking that much medicine (is that a common treatment?) Secondly, I'm ONLY(!) 41 years old and wonder what can I expect as I age. Lastly, what if these options don't work, what other options might be helpful. (I'm not necessarily looking toward surgery, but wonder if that may have any positive responses.)
A: Moderators - Jan, I'd suggest that you contact the Columbia St. Mary's Spine Center, 414-961-5559. Lou Ann in the Patient Care Coordinator, who can describe the specialists and various treatment options. She can arrange an appointment with one of our physiatrists. You'll want to bring any x-rays or other information with you. I'm sorry for the delay in responding to your question.

Q: Cheryl from Germantown - I am a 39yr old female that is very active. Working out 5 x per week cardio and weight training. Last year I started having chronic neck pain and also pain in my left shoulder. I have been able to manage the pain by seeing a chiropractor. In the past 3 months I have developed chronic back and hip pain. My hip pain is mostly while I am trying to sleep at night on either side my right side is worse then my left The pain is so bad I can't sleep at night. I am also having problems with my right knee. In the past 3 months it seems to be getting worse. I am wondering if this may be a disc problem or maybe related to my sciatic nerve or possibly Fibromyalgia?
A: Moderators - Cheryl, I'm sorry for the delay in responding to your concern. Chiropractors can be very helpful, but my best advice is to contact the Columbia St. Mary's Spine Center at 414-961-5559. You'll talk with Lou Ann who will do an intake interview with you. She then can arrange an appointment with one of our physiatrists for a thorough assessment and a treatment - which might include sessions with a chiropractor or other therapies.

Q: Maureen from West Allis - For several years I have had pain in the knees (I have a parent that has arthritis and had a 2x knee replacement) Last year I saw an orthopedic surgeon and he told me that I did not have arthritis but I had bone spurs on the knee. He recommended anti-inflamatories, replacing my shoes every couple of months and some physical therapy. 2 years ago I saw a podiatrist for foot pain. I was diagnosed with plantar fasciatis. I was fitted for orthotics and had some relief but the pain is back. I was also given anti-inflammatory medication which did not help the foot pain and the knee pain that I was experiencing both at the same time. Is there anything I can do conservatively to treat this?
A: Moderators - Plantar Fasciitis is treated with orthotics, calf and toe extension stretching, anti-inflammatory medicines and a night splint. If not improved, a cortisone injection can be helpful and/or casting the foot. Finally, if still with pain beyond 6 months of conservative care, surgery or some newer non-invasive procedures can be used. 90 % of patients with plantar fasciitis should improve with conservative care. If you are not improving, feel free to call my office for an evaluation.
- Eric Malicky, M.D.
Orthopaedics - Surgery of the Foot and Ankle
Advanced Healthcare
262-387-8300



Q: Jill from Milwaukee - For the past two days I've been having what feels like a bad cramp on the upper right (top) of my foot. I'm unable to walk normally (i.e. can't support full weight) and stairs are especially bad. Can you tell me what this might be and what causes it? Is there anything I can do for it?
A: Moderators - Possible causes include: contusion, tendon strain, stress fracture, a pinched nerve, or midfoot arthritis. You can try and modify your shoewear toward an athletic walking shoe or even try a simple over the counter shoe insert. It is not "normal" for your foot to hurt in that location so if no improvement, you should either contact your primary MD or call my office to schedule an appointment for a formal evaluation.
- Eric Malicky, M.D.
Orthopaedics - Surgery of the Foot and Ankle
Advanced Healthcare
262-387-8300



Q: Linda from Milwaukee - The toenail on my big toe keeps falling off completely. It fell off a year ago due to an injury and had regrown, although it was thicker than before and now is almost all torn off again. Will it grow back OK?
A: Moderators - Your toenail may be cracking from an underlying injury to the nail bed (from your toe injury a year ago). Other possibilities are due to an underling bone problem of the toe or more simply bad toenail fungus. If you continue to experience problems with the growth of your toenail, you should contact your primary MD or call my office for a formal evaluation.
- Eric Malicky, M.D.
Orthopaedics - Surgery of the Foot and Ankle
Advanced Healthcare
262-387-8300



Q: Ellen from Port Washington - I have intermittent pain on the outside of my right foot. Occasionally when I step down the foot will "give away" and then I'll have pain for awhile. Recently it's been more prevalent and I sometimes have a burning sensation along with the pain.
A: Moderators - Outer border foot pain may either from a problem along that area of your foot, or, may be compensatory pain from a problem along the inner border of the foot. The burning sensation could be pressure related or even due to problems with the nerves. The "give away" sensation could be from several reasons. You can try and simply treat these problems using a good over the counter shoe insert or an athletic walking shoe. If you don't improve, you should either contact your primary MD or call my office for a formal evaluation.
- Eric Malicky, M.D.
Orthopaedics - Surgery of the Foot and Ankle
Advanced Healthcare
262-387-8300



Q: Mary from Waukesha - My teenager has an unstable shoulder with chronic pain. She has been through multiple series of physical therapy and continues with the exercises at home. She has quit all competitive sports. The pain continues and cortisone only provided temporary relief with the return of pain after only a couple of weeks. Treatment with anti-inflammatories has also been unsuccessful. Her orthopaedic surgeon has recommended surgery to smooth off the damage to her rotator cuff and tighten up the ligaments. We would like to get a second opinion, but with summer approaching and a lengthy recovery predicted, time is short. How does one go about arranging for a second opinion without offending their current physician, and how difficult is it to get into see another surgeon without a long wait?
A: Moderators - Several points need to be made regarding your e-mail question. First off, teenage female athletes often have somewhat loose or 'unstable' shoulders. This is due to their genetic makeup and therapy can help, but in severe cases the shoulder continues to be troublesome. This condition occurs virtually in exclusion of rotator cuff injuries. Teenage individuals do not, as a general guide, sustain rotator cuff tears. The rotator cuff tendon is very strong at this age, and actually the bone is the weak link. If a severe injury occurs, usually the bone will break before they would tear a rotator cuff tendon. I would be concerned over a diagnosis of instability AND partial rotator cuff tear in a teenager.

Your next comment on a second opinion is excellent. Do not worry regarding asking for a second opinion, it is your right. Something like this needs another look. Also, your surgeon does not even need to know that you are obtaining a second opinion. Just tell the new physician not to forward a copy of their note to your original surgeon.

As for timing, everyone is different. Many orthopaedists reserve slots for acute or urgent cases. If you are having trouble obtaining a time, try and impress upon the receptionist the urgency that you feel. Occasionally by telling them it is a second opinion for surgery you can get in a bit quicker.
R. Sean Churchill, M.D.
Orthopaedics - Surgery of the Shoulder and Elbow
Advanced Healthcare
262-387-8300




Q: Tamara from Greenfield - I HAVE A PAIN THAT EXTENDS FROM THE INSIDE OF MY RIGHT KNEE DOWN MY LEG TO THE TOP OF MY FOOT AND WRAPS AROUND THE INSIDE OF THE FOOT TO THE BOTTOM ARCH AREA. THE PAIN IS GREATEST IN THE MORNING AND LESSENS SOMEWHAT WITH WALKING, HOWEVER THROUGHOUT THE DAY IT FEELS LIKE IT IS PULSATING AND STAYING OFF MY FEET DOES NOT HELP WITH THE PAIN. THE ENTIRE AREAS IS SORE TO THE TOUCH, SIMILAR TO THAT OF PRESSING ON A BRUISE, HOWEVER THERE IS NO DISCOLORATION, BRUISING OR SWELLING. I HAD THIS EXACT SAME PAIN TWO YEARS AGO AND IT LASTED FOR A MONTH. I CANNOT RECALL ANY PHYSICAL ACTIVITY THAT WOULD HAVE CAUSED ANY TYPE OF INJURY TO MY LEG MUSCLES AND I HAVE NOT RECENTLY DONE ANYTHING OUT OF THE ORDINARY TO AGGRAVATE THESE MUSCLES. WHAT IS THIS PAIN, WHAT IS CAUSING IT AND WHAT CAN I DO TO ELEVATE THE PAIN?
A: Moderators - One of the important things that an orthopaedic physician does is to obtain a thorough history of symptoms, similar to what you have described. The location, what is the pain like, what makes it better, worse, and so on. They may request x-rays and/or other tests, and perform a physical exam. All to make a good diagnosis about what is causing the pain.

There are a few more questions that I might ask you, but I can not give you a diagnosis over the Internet. I would recommend that you see your physician, an orthopaedic specialist or talk with the staff in our Spine Center. From the description of your symptoms, I would suggest you might ask whether this pain coming from a problem in your back. Good luck and I hope it gets better. Barb Jones RN




Q: Ruth from Elkhorn - I had both of my knees replaced almost 18 mos ago. They were replaced with the same knees that were recalled. My orthopedic physician says that he cemented the knees in so I couldn't be having a reaction to them like the one that has been reported with the improperly cleaned ones. My knees have been hurting badly ever since the surgery. The surgeon feels they have healed properly and that the pain must have to do with the arthritis in the bones attached to the knees. I have a brother-in-law who has had both knees replaced also and has no pain and a friend with one replaced and nothing is hurting either. Do you know much about the batch of knees that were recalled and how the patient feels afterwards? I wouldn't welcome the idea of replacing them again, but living with this pain is terrible, too. What do you suggest?
A: Moderators - What a worry it must be to know that your "brand" of knee prosthesis was recalled, and to wonder all the time if that could happen to you. One of the difficult things about pain is that everyone experiences it differently. I don't know that anyone can tell you what the pain other patients with recalled prostheses experienced, because again it could be very different for each of them. After 18 months your surgical pain should be gone, but maybe it is a related muscle or tendon issue.

You need a plan, and first I would recommend your orthopaedic specialist, because he knows you best. But you may also consider a second opinion. Perhaps some further physical therapy or other nonsurgical interventions would help. I think you can be reassured that the orthopaedic physicians would be aware of your situation and would monitor you and your prostheses in the future.

If you need information about orthopaedic specialists, I refer you to our Medical Moments and Columbia St. Mary's websites. Good luck! Barb Jones RN




Q: Beth from Milwaukee - Can having flat feet contribute to knee pain? I am 47 yrs. old, over weight, and continue to have problems with one of my knees. I get loud clicking noise while walking down stairs and pain. I recently noticed after wearing dress heels/shoes (approx. 2-2-1/2" heels) that my knee felt "wacked out" ie: pain w/loud clicking noise. I want to walk for exercise, this condition is a deterent. Any suggestions for treatment and/or exercise?
A: Moderators - Yours is a good question, can flat feet contribute to knee pain. There are two kinds of cartilage in our knees, the type that protects the ends of the bones and the "shock absorber" type, or meniscus cartilage. We need both to be healthy and to work together for strong healthy knees. It would make sense that flat feet may cause the cartilage in the knee to wear unevenly in some people.

Beth, you give a good beginning description of your knee symptoms. More questions and an exam would help an orthopaedic physician to give you a good diagnosis of what is going on in your knee. That diagnosis is important because it determines the treatment plan. Therapy and exercise can be part of a treatment plan, as can different shoes and orthotic supports. At Columbia St. Mary's we have many orthopaedic physicians who work with people with knee problems, so I encourage you to start with getting a good diagnosis. Good luck. Barb Jones RN




Q: Terri Ann from Milwaukee - My daughter knees crack and creek when she bends, her pediatrician said she has no lubrication on her knees and that the joints are rubbing together making that cracking sound, I asked if she knew how I could get lubrication around her knee area and she could not tell me but suggested I call a bone doctor, could you shed some light on this problem or point me in a direction of someone who could.
A: Moderators - I think that your pediatrician gave you good advice by recommending that you have your daughter see an orthopaedic physician. Check back with your pediatrician to see if there is someone they have worked with and would recommend. Another option that I would recommend is that you check out our Columbia St. Mary's and Medical Moments websites. We have information on our many great orthopaedic physicians, and that list would give you a place to start. Thanks for your question. Good luck. Barb Jones RN




Q: Rosemary of Cedarburg - What type of knee brace would you recommend for a patient who dislocates their knee cap repeatedly?
A: Moderators - There are several well-designed knee braces to directly address patellar dislocators. I personally prescribe a brace manufactured by DonJoy called the "TruPull" brace which provides a good lateral buttress to limit the kneecaps lateral motion. I would recommend you see an orthopaedic specialist for further evaluation to see if a brace is even an appropriate treatment for you. Michael Gordon, M.D. Columbia St.Mary's




Q: jill again of milwaukee - can you tell me the risks in having the unicompartmental knee surgery? thank you!
A: Moderators - There are many risks associated with any type of joint replacement beyond the usual risks of surgery. These include fracture, knee stiffness, need for future surgery, failure of fixation of the implant (i.e. loosening), infection and need for removal of the implants, blood clot/pulmonary embolism/death, and need for conversion to a total knee replacement. Any arthroplasty surgery requires lifestyle changes (i.e a need to take antibiotics prior to dental procedures) and a vigilant patient. That being said, these procedures can be life-altering and help return patients back to a healthy and active lifestyle. Michael Gordon, M.D. Columbia St.Mary's




Q: Melissa of Ashippun - I'm 19 years old and my knees crack. They do this every time I sit, squat, or get up off the floor. Is there anything I can do to stop the cracking or help? There is no pain, it just bothers me and I'm starting to worry that they are getting bad on me.
A: Moderators - Generally, painless "cracking" and "clicking" is not a problem. If you are having pain at all, then I would suggest that you see an orthopaedic surgeon for further evaluation. There is no association that I know of between painless cracking and future arthritis. Michael Gordon, M.D. Columbia St.Mary's




Q: Susan of Shorewood - I have been diagnosed with C 5-6 radiculopathy, with herniation in the disk and bony formations. I have been through a pain clinic, physical therapy, traction, and two injections of a cortizone-like medication. There has been some pain relief but some days are still very painful. I have been told that surgery may be the only option left. I've heard that vertebrae that have been fused put more pressure on vertabrae above and below. Could you tell me a little about this kind of surgery, recovery time, and benefits and risks?
A: Moderators - Any type of fusion will ultimately place more stress on the "joints" above and below. You have attempted pretty much the entire gamut of conservative treatment and are left with either "living with it" or considering surgery. The procedure is generally performed from the front with the offending disk being removed and a bone plug placed in its place. The benefits are the improvement of the radicular symptoms. The risks are several and I'd refer you to your spine surgeon for a complete discussion of them. The recovery time is generally 2-3 months. If you are looking for a spine specialist, feel free to contact the Spine Center at Columbia St. Mary's (414-961-5005) Michael Gordon, M.D. Columbia St. Mary's




Q: Chrissie of Mequon - On February 22 of this year I hurt my knee coming back from a 3 mile run..it was feeling tight and got progressively worse. I saw the Dr. March 17th for the initial consult and had the MRI which showed the tear. My Dr. indicates for my age 54 and the location of the injury from the MRI that I should not run for 2/3 weeks and then try cortisone shot if it has not gotten better rather than surgery. I have been a life long runner and have attempted to remain somewhat fit through the injury by doing other things..infrequent and varied..swimming, walking, workouts to strengthen with CYBEX equip, prescribed excercises etc. On April 17th I tried a light intermittent jog long walk to test it and developed some fluid in the knee as evidenced by tightness and more limited range of motion at the bend. The symptoms and pain (less) have changed...and I am scheduled to see him in another 9 days. How would you rate the progress of this injury and though I did not jump the gun in terms of suggested time back to running, would just like some additional/outside observationns on the progress of this knee.....
A: Moderators - The fluid in your knee strongly suggests a problem with either the joint surface or the meniscus. The fact that the swelling has persisted despite limiting your activities is concerning that simple activity modification alone isn't going to solve your problem. A cortisone shot would be my next suggestion as well as a focused physical therapy program. Ultimately, if these interventions don't work, then surgery is a very realistic option. Good luck! Michael Gordon, M.D. Columbia St.Mary's




Q: Thomas of Oak Creek - I have been having hip pain-an x-ray was done-they said I had a non-malignant anomaly on my femor.That was about a month ago.They finally are talking about doing a bone scan. In the meantime I have made an appointment to see an orthopedic surgeon because I'm also having severe shoulder pain.Am I being too impatient concerning my hip? Thank you for your time
A: Moderators - No, I don't think that you are being impatient about your hip. The good news for you is that the vast majority of "abnormalities" of bone are normal variants or benign, but appropriately working it up is always prudent. The bone scan is a very reasonable next step. Michael Gordon, M.D. Columbia St. Mary's




Q: jill of milwaukee - my doctor suggests a partial knee replacement for my knee. arthritis. do you believe 45 yrs old is pretty young to have this done. i do look forward to relief of pain and active family life i am forfeiting now. i had 15 treatments that have not worked.
A: Moderators - A unicompartmental knee replacement ("partial" knee) is a great procedure to help relieve pain related to advanced arthritis. Many years ago, 45 would be considered very young for this surgery and certainly you are still on the "early" side for any type of arthroplasty; however, if you are being seriously limited in your lifestyle because of it and are willing to accept the risks of this type of procedure then it is an excellent option. Michael Gordon, M.D. Columbia St.Mary's




Q: Nancy of West Bend - What is the best treatment for stress fractures seen in high school atheletes. I see a lot of basketball players with their legs taped.
A: Moderators - First and foremost, I would like to evaluate the patient's body type and their nutritional status (are they getting enough calcium and vitamin D? do they have an eating disorder?). There is a well-known issue of stress fractures in young female athletes relating to an eating disorder and a secondary lack of menstrual periods. Assuming that these issues are not present, I would want to closely evaluate the athlete's leg, knee, and foot/ankle alignment. Many times, simple interventions such as a shoe insert can reduce the risk of a stress fracture. Michael Gordon, M.D. Columbia St.Mary's




Q: Donna of Muskego - I started playing racket ball a few weeks ago and now my elbow is painful even when I'm not playing. It is painful when I do weight training also. What might the problem be?
A: Moderators - There are several possible sources of your pain. You likely have an "overuse" injury such as a tendonitis of the muscles crossing the elbow and wrist joints (i.e. "tennis" or "golfer's" elbow). These generally respond to activity modification and a gentle stretching and strengthening program. Michael Gordon, M.D. Columbia St.Mary's




Q: carrie of Ottawa - Is there anything that can be done besides surgery for compressed and bulging disks? I thought I had heard about a new procedure using laser surgery for bulging disks? Also, are there exercises that can be done to help build up the muscle around the spine to help strengthen it?
A: Moderators - There are multiple interventions available for a herniated or bulging disk. They range from physical therapy to improve strength and posture to oral and injected medications. There are also newer procedures that can potentially "shrink" the bulging disk, but these techniques are less established. I would recommend that you contact the Spine Center at Columbia-St. Mary's for further information (414-961-5005) Michael Gordon, M.D. Columbia St. Mary's




Q: bryan of waukesha - i have had two knee operations within the past year. the first one was for a miniscus tear and when that didnt work 7 months later he performed a lateral release. to no avail neither has worked and was told that i am a candidate for a knee replacement but at the age of 37 the orthopedic wouldnt advise it. the otherpedic now would like to do a fulkerson surgery to see if that will help the pain in my knee. could you tell me what the percentage of sucess is with this kind of surgery.
A: Moderators - The surgeries appear to be addressing two different problems. The meniscus is inside the knee and the lateral release would address the "anterior" or patellar problems. The Fulkerson procedure is a very successful surgery in experienced hands and when the patient is appropriately selected. I would definitely try to avoid a total knee replacement at your young age. Michael Gordon, MD. Columbia St. Mary's




Q: John of Wauwatosa - My daughter, a sophomore in high school, was just diagnosed with four stress fractures. Two in her right tibia, and one at the top of each ankle. She plays soccer and has done so since 1st grade, she also did a considerable amount of road biking this summer and fall preparing for a century bike ride at the end of last October. Any suggestions as to why just now she develops these stress fractures?
A: Moderators - The clear reason for stress fractures is more activity than the bone can manage. Therefore, less is necessary to allow them to heal. Then the hard part is to figure where the over use is occuring and manage it. I would think the running activity is more likely the culprit than the bicycling. Therefore, measured activity, better footwear, would be the beginning. Hope this is helpful. David Becker, M.D. Columbia St. Mary's




Q: Martha Eigner of Milwaukee - I had two herniated disk in my back. I have had three epiderals in the past. The right leg in the back upper thigh is numb always. Does this mean the nerve is damaged?
A: Moderators - If you have already had the epiderals and they have been ineffective, I would suggest that you call our Spine Center, 414-961-5005. Speak with them to direct you to one of the non-operative spine specialists. Best of luck. David Becker, M.D. Columbia St. Mary's




Q: Victoria of Franklin - I have severe osteoarthritis. I went to an orthopedic surgeon, got x-rays, and when he examined my knee, he told me to have gastric by-pass surgery, lose 50 pounds of weight, and then come back. That was in September. I lost 35, hit a plateau, and haven't been able to lose any more. I do not want to have gastric by-pass, because I know someone who had it, and everything that could go wrong did. Is there an orthopedic surgeon with Columbia/St Mary's who will operate on my knee if I don't lose any more weight. I fully understand the advantages of having the weight off as far as recovery, but I'm in a catch-22 situation. I cannot exercise, because I have limited mobility, and I can't lose the weight unless I exercise. I used to walk five miles a day, and since I stopped, I've gained back all I lost. Help!!!!!
A: Moderators - Your orthopaedic surgeon is of course correct in reminding you of the risks involved with a major operation such as a total knee. The risks of blood clots and anesthesia as well as wound healing are always more risky. There are other surgeons who will do the surgery, but the risks will be the same. It is a catch 22, but the risks are real. I usually recommend one of our hospital nutritionists if a patient is not already knowledgeable about calorie management. All three hospitals in our system have nutritionists available for you. Call 414-961-3300 and ask for Peg Mayer. David Becker, M.D. Columbia St. Mary's




Q: Ellen of Menomonee Falls - For the past three years, I've experienced shin splints and a stiff knee from wearing orthotics for plantar fasciaitis. The inflamation still seems to be present in my foot. The shin splint bothers me most when I'm trying to fall asleep. The stiff knee makes changing position from sitting to standing/walking difficult. Any help?
A: Moderators - I would suggest that the orthotics/shoes are not effective enough. There are two fellowship trained foot specialists who might help you. Dr. Eric Malicky (414-352-3100)and Dr. Anthony Ferguson (414-961-0304). Happy trails. David Becker, M.D. Columbia St. Mary's




Q: susan of waukesha - i have been diagnosed with frozen shoulder.... have been given 1 cortizone shot and am in the process of going through physical therapy....in general, does the patient usually recover fully with this method of treatment or is surgery usually in the future?? if surgery is necessary, can the be done orthscopically ( don't know if this is the correct spelling) and if so, what is the usual time of recovery......
A: Moderators - This is usually a difficult rehabilitation problem, but can be dealt with surgically by a shoulder specialist. There are two such specialists in the Columbia St. Mary's system, Dr. Churchill (414-352-3100)and Dr. Ziegler (414-223-2727). Good luck! David Becker, M.D. Columbia St. Mary's




Q: aija of wauwatosa - I have developed a pain in the back of my right leg,from top to bottom, it especially hurts when I drive or sit in one position too long. Sometimes when I drive I have hold the side of my knee to keep from crying out. I take aspirin, etc. but it's still there. It does not hurt when I walk or sleep, only in the afternoon after a long day at work of sitting. I will be traveling overseas in 2 weeks and am a little worried about what all this means. thanks.
A: Moderators - Call your primary physician and ask for an examination. It may only need some stretching and physicial therapy treatments, but you need more answers before you go overseas. Bon voyage David Becker, M.D. Columbia St. Mary's




Q: Ellen of Menomonee Falls - Is anyone at Columbia doing kyphoplasty? When is it indicated? I have osteoporosis and am losing height in spite of taking Fosamax and two calcium tablets daily. My chiropracter said that my discs are losing volume. Thanks.
A: Moderators - Yes, Dr. Steven Robbins. His office is in the Columbia Hospital Medical Building, 414-961-2225. I hope this helps. David Becker, M.D. Columbia St. Mary :)




Q: kay of new berlin - i submitted a question regarding syringomyelia, and am wondering about activity restrictions,specifically tennis, and if she should be followed by a neurologist. Thank you.
A: Moderators - I think that the neurologist should be following the diagnosis as they are better at helping you with restrictions, particularly for vigorous activity. Thank you for your question. David Becker, M.D. Columbia St. Mary's




Q: J.T. of Milwaukee - I woke up two days ago with a marked pain in my upper left hand shoulder (right below the neck). I imagine this was caused by sleeping in an akward position. Unfortunately, the pain doesn't seem to be going away --what can I do?
A: Moderators - Heat applied with a wet towel, warmed in a microwave, anti-inflamation medicines (asprin, ibuprofin, Alleve) are usually helpful within two-four days. Fold a thin pillow into a C shape to support your neck while you sleep and sit so that the neck muscles can rest better. If it persists, you may need to see your personal medical physician. David Becker, M.D. Columbia St. Mary's




Q: Rosemary of Cedarburg - What type of knee brace would you recommend for a patient who dislocates their knee cap repeatedly?
A: Moderators - A snug knee sleeve with a curved or banana shaped firm pad on the outside of your knee cap can encourage the knee cap not to dislocate. Muscle tone, particularly endurance, is however more helpful. If these methods are already well done you may need an operation to stablize the patella. David Becker, M.D. Columbia St. Mary's




Q: Sally of Cedarburg - My ten year old son hurt his neck today at recess when he was wrestling with another ten year old. The other boy apparently really twisted his neck, and he heard a noise. I picked him up at school and they called it a stinger. I gave him Tylenol, and an ice pack, and am watching him closely. Should I take him to the doctor?! This is a child that seems to have a high tolerance for pain...and usually goes to school no matter what!!! Thank you for your consideration. Sally
A: Moderators - The ice and rest are important. Use asprin or ibuprofin. He can take one or two asprin or ibuprofin four times a day safely. They are anti-inflamation medicines and will help better than Tylenol. If he is not better in 48 hours, I would have him see his pediatrician. If you are uncomfortable, see a physician sooner. David Becker, M.D. Columbia St. Mary's




Q: Kimberly of Dallas - I am experiencing great difficulty/pain in my right shoulder. I met with an orthopedist and he diagnosed me with bursitis. I have tried laying off. I tried using Aleve (though - the dose scared me so I stopped). What type of physician should I be seeing? Is there physical therapy that could help me? Is surgery or dealing with the pain my only options? Thank you for your assistance.
A: Moderators - I would return to the orthopaedic surgeon for more advice. Injections, shoulder rehabilitation, and home program are often helpful. The shoulder is our most complicated joint; therefore, more effort, education and help are necessary. David Becker, M.D. Columbia St. Mary's




Q: Jon of Kewaskum - When I throw a ball I have a really bad pain in my shoulder, I was just wondering whatthis could be? It doesn't hurt when I do anything else just a throwing motion.
A: Moderators - The throwing motion is the most difficult job for the shoulder. If you want to throw, you need to go to your orthopaedic surgeon to be certain of the reason for the pain. Most of the time, a careful rehabilitation program can allow you to throw. Bluffing will probably not accomplish anything. David Becker, M.D. Columbia St. Mary's




Q: Della Rose of Brookfield, WI - I am soon to be 66 years old. I have been running and walking for 20 years. Recently I've noticed my hip joints starting to ache. I also have an 18 pound grandson that I carry around frequently. New shoes are purchased about once a year. I have been on Tamoxifen for almost five years and have been breast cancer-free for almost six. Is there anything I can do to rectify this or is there something I should be more aware of. I have had bone density tests and they were fine. Thanks for your efforts on my behalf. Della
A: Moderators - Before making any decision about activity levels, it would be helpful for your primary physician to x-ray your hip to know if there is any significant wear-type arthritis. If there is, you will need to be more careful with your choice of activities. Otherwise, a well-rounded rehabilitation home program would be ideal. But begin slowly and advance slowly. Yours fondly, David Becker, M.D. Columbia St. Mary's




Q: Michele of Milwaukee - Are there any surgical or other options for adults that have Genu Valgum / (Knock Knees)?
A: Moderators - Yes, depending on age, activity, arthritis, etc. Surgery is the last option. Examination and x-rays are needed to guide the options. Muscle tone in the front and back of the knee are the primary options for managing your knees. This is the first and most important option and needs to be done well before the next choice. David Becker, M.D. Columbia St. Mary's




Q: Colleen of Oak Creek - I have pain (at times, severe) in the heel of my right foot. The pain radiates up my leg and into the top and side of my foot. It began about one week after beginning an exercise routine using a tread mill. What could be causing this pain and what can I do to aleviate it?
A: Moderators - The cause of your pain is too much activity too quickly and the heel is inflamed because of that. I recommend stopping, buying new or stronger shoes, cross train with a bicycle, stretching exercises and limited walking until the pain goes away. Then, begin again slowly. David Becker, M.D. Columbia St. Mary's




Q: Jill C. of Milwaukee - I had a very successful microdiscectomy/ laminectomy about 3 years ago and am happy to say that I am free of the electric pain that accompanied the L5/S1 herniation. However, now if I stand in one place for 5 or 10 minutes, or do a lot of bending over, gardening or other fairly easy tasks, the muscles in my lower back stiffen to the point that I can barely walk comfortably. It goes away with time (and cold packs) but will happen at least 2 or 3 times a day. Could this be arthritis or the side effects of a 4-inch incision through layers of muscle? Thank you.
A: Moderators - This could be both. Better or more rehabilitation would be helpful. The Spine Center at Columbia St. Mary's 414-961-5005 has a group of physicians who specialize in answering these questions and problems. David Becker, M.D. Columbia St. Mary's