PATIENT SAFETY

HOW TO CARE FOR YOUR CAST

Wearing a cast can be awkward for kids, says Pediatric Orthopaedic surgeons at Carolina Regional Orthopaedics, P.A, in Rocky Mount, NC (CRO), but sometimes, the best way to help a broken bone heal correctly.
Some fractures can be treated with splints or slings. Others - in which bone segments are out of place - require realignment and a cast to hold them secure. Limiting movement also can help decrease pain.

DON'T get non-waterproof casts wet. If conventional padding inside a cast gets wet, it will not dry. Neither will the skin next to it. That can cause significant problems, including skin infections, skin death and permanent scarring, CRO says.

So, avoid the swimming pool. And try sponge baths instead of showers. Use a plastic bag or special cast cover (available in stores) for splash protection.

Bathtub dunks and other accidents do happen, however. If your child gets his or her cast wet, call the doctors as soon as possible. The cast should be replaced within 24 hours.

Waterproof casts - which can be completely submerged in fresh water - are an option for some.

"Waterproof padding does not conform as tightly as cotton, so it is not appropriate for fractures that require the most immobility," CRO says.

DON'T stick anything in the cast. You have heard about sticking a coat hanger or pen inside the cast to scratch an itch. Don't do it. Broken or irritated skin - which you cannot always detect under a cast - can lead to infection. "I have seen permanent skin injuries from something as simple as losing a pen cap inside a cast," CRO says. "If something presses on skin for too long, it can cause scarring."
Also steer clear of sand, dirt and other granules that can infiltrate a cast and irritate skin.

DO soothe itches. Use a hair dryer to blow cool air into the cast. Or try antihistamines to control itching. Never put powder, lotion - or anything else - inside the cast.

DO call the doctor if your child has pain, tingling or swelling. The fingers, toes or other body parts extending from your child's cast should be their normal size and color. If they are changing color, swelling or numb, the cast may be too tight. See a doctor for help.

Other reasons to get a doctor include:
• Foul odor from the cast
• Increased pain
• A crack or break in the cast
• Fever above 101 degrees Fahrenheit

DO treat the cast as part of your body. That means do not pick at it (or the padding), stick things inside it or otherwise try to damage it.

"Treat your cast with care," CRO says. "If your child lets the cast do its job, he or she should be cast-free in a few short weeks."

KETO DIET

In order to undergo safe joint replacement surgery for the hip and knee, there is an ideal body weight range. When a patient is unfortunately overweight, the risks from having less often very needed surgery are two great and weight loss is required before the surgery.

Here is a very effective diet that Carolina Regional Orthopaedics approves for safe weight loss. However, because some patients may have unique dietary requirements, we advise that you review this dietary suggestion with your primary care physician prior to implementing it.

KEMKER'S KETO DIET
High protein diets are not new. Every couple of years a new high protein diet comes around from the Zone Diet to the now Keto diet. While you do not need to go full concern when recommending any medical treatment is always; is it SAFE. Many of my patients ask if this is safe for them. Yes, many studies have validated that it is not only a safe weight loss strategy for diabetics, but it quickly lessens their HBa1c. So much so that many diabetics no longer require their diabetic medications.

The next question diabetics ask me is how is this different from a low carbohydrate diet. First, a high protein diet is designed so you do not go hungry and makes it easier to follow. And for the "nerds" out there, a recent randomized controlled trial (the best kind of science) found that a high protein diet is vastly superior to the low carbohydrate diet for diabetics in weight loss. Additionally, as a surgeon, wound healing is of critical importance to me. Wound healing requires protein, and a malnourished (low protein) patient will never heal a surgery, wound, or ulcer. This is why I give surgical patients my Keto diet. Finally, as a bone and joint doctor, are high protein diets good for bone health? Once again, the high protein diet shines through, and is not only safe, but good for bone health. While the Kemker Keto diet is not a full restrictive "keto" diet, we have had multiple patients lose just shy of 20 pounds in 6 weeks. Come into Carolina Regional Orthopaedics and ask if the Kemker Keto diet is safe for you!

VERY IMPORTANT SAFETY INSTRUCTIONS

Before you take any medications our Doctors prescribe you must obtain permission from your Family Doctor and seek safety advice from your pharmacist. It is your responsibility to fully understand not only the possible benefits of the prescribed medicine, but also all the potential risks before you buy or take any medication we prescribe to you. If any one of the potential or possible risks, hazards, or complications of the prescribed medication is not completely acceptable to you, or if you cannot afford the medicine, contact your Doctor immediately as alternatives exist. You must get all of your prescription medications, non-prescription drugs, supplements from only one pharmacy so that they may help identify any potential problems.

SIDE EFFECTS

All medications have side effects! Side effects can be chemical interactions that may cause medications to be either completely ineffective or dangerously overactive. Many patients ignore the early warning signs of a drug complication and fail to communicate them effectively with their Doctor. It is the patient’s complete responsibility to recognize that even very minor or unexpected change in their condition may indicate a significant complication and that the immediate reporting of such changes to their Family Doctor, all medical specialists involved in their care. In this case, if we cannot be reached immediately, you are to go instantly to the Emergency Room or call 911.

ANTIBIOTICS

Prescribed antibiotics should be purchased from the same pharmacy that you get all of your medications. Antibiotics can cause serious problems that can be avoided if you take supplement called PROBIOTICS to protect you. Probiotics are living microorganisms similar to the good bacteria found in your digestive tract. There are dozens of brands, so keep it simple and get Philips Colon Health probiotic capsules or chewable gummies. Please also eat yogurt containing live cultures and unpasteurized raw milk cheeses if you can tolerate them.

IMPORTANT: Take the probiotic 2 hours after you take the antibiotic to prevent the antibiotic from killing the good bacteria contained within the probiotic pills.

ANTI-INFLAMMATORY PAIN MEDICATIONS

Prescription and over-the-counter anti-inflammatory pills (NSAIDs), such as Advil, Aleve, CeleBREX, aspirin, meloxicam, Naprosyn, and diclofenac can cause significant problems. They can totally prevent the normal healing of both broken bones, sprained ligaments and wounds. Also dangerous bleeding, which you may not be aware of, resulting in your hospitalization and requiring emergency blood product transfusion. This, in addition to an increased risk of heart attacks and strokes, may even result in your death! Patients on blood thinner medications or steroids or those with asthma or an aspirin allergy should not take these medicines. If any of these medications were prescribed, or it was done so in error, you must NOT consume them unless specifically directed to do so by another specialist! The best way to lower the risk of serious side effects from NSAIDs is to use the lowest amount for the shortest time period, or simply do not take them.

AGE & SICKNESS

Compared with younger or healthy people, elderly or sick patients show twice as many bad drug reactions caused by greater drug usage, poor compliance, and physiologic changes. An elderly patient’s factors related to aging, such as diminished visual acuity, hearing loss, forgetfulness, the need for many medications, socio-economic factors, etc., combine to make compliance a special problem. Over one-third of elderly patients fail to take their medications as directed. They may fail to take the correct dose, take them at wrong time, consume drugs prescribed for other disorders, or stop them too soon. Elderly or very sick patients may also have multiple prescriptions for the same or very similar medicine from other Doctors and inadvertently take an overdose.

Some of the signs and symptoms of bad drug reactions include headache, confusion, weakness, lethargy, diarrhea, nausea, vomiting, psychotic reactions, water retention, unusually dark or possibly tar-like stools, bloody mouth, nose, or pee, easy bruising, etc. IF any bad reaction is not reported to the Doctor immediately, the patient may continue to take the drug, and even b given unnecessary additional drugs to treat that complication. Every year, many thousands of hospitalizations and deaths result from patients both not taking medications as prescribed and their failure to report any potential or real complication to their Doctor.

LIFE SAVING MEDICATION INFORMATION

The medicines we prescribe are, in general, very reasonable treatments for your medical problem. Although medications have a potentially positive benefit, all drugs carry potential risks, hazards, and complications, some of which may be very serious and life threatening. Some examples of conditions which affect the medicines we take include advanced age, cancer, obesity, alcohol or tobacco consumption, aspirin-like medicines (NSAIDs), steroids (Prednisone, etc.), or blood thinners (Coumadin, aspirin, Plavix, Arixtra, Lovenox, Aggrenox, Pradaxa, etc.), history of allergic reaction, diabetes, asthma, heart, liver, kidney, neurological, or gastrointestinal disease (bleeding ulcers), etc. These conditions cause physiologic changes that may alter the desired (therapeutic) and bad (toxic) effects of the drug prescribed.

Elderly or sick patients may have decreased stomach acid secretion and decreased stomach or intestinal mobility, slowing can be significantly greater risk of medication toxicity or bad overdose reaction. Many side effects are minor and can be managed with over the counter medications. For example, constipation caused by narcotic and Calcium pills can be treated MiraLAX and Senakot.