by Cory Franklin

Chicago Tribune Opinions of the People

November 12, 2011

“The people who receive the worst care in America,” I said, “are the very poor and the very rich that the very poor received substandard medical care notion that the very rich received poor medical care.

The rich are used to telling everyone what they want and how they want it, and they think nothing of bending a doctor’s will to their own. The doctor abandons his medical judgment.

Last week, the point was driven home following the trial of Dr. Conrad Murray, found guilty of manslaughter by giving the intravenous anesthetic drug Propofol to pop star Michael Jackson to help him sleep Safe to say, no middle-class American has ever suffered Michael Jackson’s fate as the result of a doctor’s house call.

Lest there be any lingering doubt about medical care for the very rich, the new biography by Walter Isaacson of Apple co-founder Steven Jobs provides another graphic example. Isaacson discusses Jobs’ medical care in detail. He outlines the force of Jobs’ personality in dealing with his medical team and how the patient delayed an operation for nearly a year for a malignancy that might have been cured with immediate surgery.

Though Jobs received much of his medical care at Stanford University Medical Center, one of the world’s top medical institutions, Isaacson states that no one there fully took charge of all aspects of Jobs’ condition. Physician, heal thyself. The cases of Michael Jackson, Elvis Presley and Steve Jobs provide cautionary tales and proof that in today’s America, the rich and powerful sometimes receive no better medical care than the poor and disadvantaged. Space constraint requires excerpting; yet this we aren’t at the end of the saga.

From The American Academy of Orthopedic Surgery’s Headline news

11/21.2011

Today’s Top Story

“Super-Committee fails to reach deal”

Politico reports that the Joint Select Committee on Deficit Reduction has announced its failure to come to an agreement for reducing the federal deficit by $1.2 trillion over the next ten years. Under terms of legislation that created the committee; the committee’s failure means the automatic spending cuts including reductions to Medicare and Medicaid; are now scheduled to take effect in 2013. In addition though, a 27% decrease in Medicare reimbursement to physicians is scheduled to take effect on January 1, 2012. It seems that Congress is aiming to include everyone in the Bad Medicine scenario.

Mitchell B. Sheinkop, M.D.

1565 N. LaSalle Street

Chicago, Illinois 60610

847-390-7666

There is increasing evidence confirming that many things seen on MRI and blamed as the cause of the patient’s pain leading to invasive surgery are really normal findings. This has shown to be the case with knee MRIs. For years orthopedic surgeons have operated on almost all meniscus tears while modern studies have shown that an awful lot of patients without symptoms have meniscus tears on their MRI. A recent NY Times piece highlighted a study by an orthopedic surgeon that showed the same thing for shoulder MRI. The study involved scanning the shoulders of 31 perfectly healthy baseball players without pain. Despite imaging normal players, the shoulder MRIs found abnormal cartilage in 90 percent and abnormal rotator cuff tendons in a whopping 87% .A patient went skiing and developed knee pain. An MRI seemed to show a tear in his ACL so two surgeons wanted to perform surgery. The third consultant told him his ACL was normal on exam and found an occult fracture that was the real cause of his pain when a bone scan was completed. The story highlights a huge problem. Many physicians have abrogated their exam to the MRI scanner. Too many patients come to us transfixed on their MRI.

 Starting in middle age, asymptomatic meniscus tears are common; meniscus tears are part of normal aging. There are two distinctly different meniscus tear types: the normal degenerative tear and traumatic tear that’s really causing pain. A physical examination helps determine the difference, so beware of relying solely on an MRI to make a diagnosis without a thorough exam to confirm that finding.

As of late, there has been an explosion in the diagnosis and treatment of hip labral tears and femoral-acetebular impingement. There are many causes of hip pain other than FAI or hip arthritis. When the radiologist diagnoses FAI on an MRI, how certain is it that the actual cause of pain has been identified? One recent study of 21 professional and 18 college hockey players without any symptoms of hip pain indicated 77% had abnormalities on hip MRI.  Another  study looked at 200 mostly younger patients without hip pain and showed that FAI was present in 14% of patients. 1 in 4 of the men (24.7%) without any hip problems in this study were qualified as having FAI.  I encourage all patients to get an accurate diagnosis before considering FAI or hip labrum repair surgeries. The most common cause of “hip” pain with a “negative” hip x-ray, positive MRI and an equivocal physical examination is referred pain from lumbar disc disease.

Mitchell B. Sheinkop, M.D.

1565 North LaSalle Street

Chicago, Illinois 60610

847-390-7666

The promise of regenerative and cell based medicine is staggering and research to date points to astounding potential. The problem clinically is that the field has been defined by anecdotal evidence. My particular interest is restoration of function for those who are impaired by arthritis, the loss of cartilage; and the painful limitations associated therein. What makes the situation more difficult is that until there is a clinical research database, Medicare and private indemnification will not cover expenses associated with Platelet Rich Plasma and Autologous, Mesenchymal, Bone Marrow derived Stem Cell management of arthritic joint clinical therapy or research. 

I personally will not offer Regenerative Care unless there is scientific research to support such treatment. With the publication last year of a pilot study showing positive results by injecting Platelet-Rich-Plasma into the knees of patients afflicted with primary and secondary arthritis, I began a similar clinical program in my practice. By the end of this month, I will have met with four different orthobiologic companies requesting research funding for IRB co-coordinated studies of bone marrow concentrate-stem cell-management of osteoarthritis of the knee.  Keep reading my blog to learn of who, what, why, when, and how I will expand my Regenerative Medicine initiative?

 How though will you be able to cover your health care costs if there is an “out of pocket” requirement whether it is for PRP, BMC or any health care treatment? CareCredit, a GE Capital subsidiary, provides a flexible, convenient way to pay for healthcare needs. My practice is enrolled with this patient financing alternative because of low monthly payments, ease of establishing a line of credit, and an opportunity to allow patients acceptance of my recommended procedures when Medicare and private indemnification won’t cover the cost. My interest was piqued when a patient wouldn’t allow herself the potential benefit of PRP explaining she would have to delay treatment because it was an Uncovered Health Care Cost. To learn more, about patient financing, go to  www.carecredit.com. To continue the Regenerative Medicine discussion, earlier today I submitted my first grant request concerning a clinical trial with Bone Marrow concentrate.

The Impact of Alternative and Complementary Treatment for Arthritis

Musculoskeletal Care of the Mature Patient

Complementary and alternative medicines (CAM) are widely marketed and used by orthopedic patients. Herbal supplements can have a negative impact on the perioperative period and may interact with conventional medicines used to manage chronic conditions. One third of the US population uses CAM. The greatest usages is in the over 65 population or those with chronic pain. An estimated $33.9 billion was spent on CAM in 2007. Many forms of CAM exist including herbal, nutritional, and megavitamin supplements; physical manipulation (e.g., massage, chiropractic); and other modalities, e.g., aromatherapy, self help organizations, folk and ayurvedic remedies, hypnosis, energy healing). Unlike conventional medicines, the FDA does not regulate herbal remedies. The Dietary and Supplement Health and Education Act of 1994 classified herbal remedies as dietary supplements, which rendered them exempt from the safety and efficacy regulations required of prescription and over-the-counter medications. Compounding the matter, herbal remedies are marketed to consumers as “natural” and “homeopathic”. These labels do not assure safety. At the same time, the Tuesday, October 11, 2011 AMA Member Communication Headline: “Vitamins associated with increased risk of death in older women.”

What about those medications approved by the FDA for the management of osteoarthritis? The news here is of concern as conventional medicines prescribed for OA are prone to produce their own set of undesirable side effects. While Non Steroidal Anti-Inflammatories reduce inflammation, pain and stiffness in arthritic joints, the side effects may include GI ulcers and bleeding, renal failure, and worsening of congestive heart failure.

I believe that the lesson here is that all medicines must be monitored by a patient’s primary care physician including those falling under the Complimentary and Alternative Treatment Modalities in addition to standard over the counter and prescription medications. While I do not view myself as an expert in pharmacology, I have spent a lifetime avoiding drugs when possible. The alternative for well-being and the care and treatment of arthritis? Try weight reduction, stretching, strengthening, hydrating and aerobic exercising with some exposure to sunshine. When progression of arthritis limits your functional capacities, start with physical rehabilitation and investigate platelet rich plasma. Continue to monitor advances in stem cell treatment of arthritis

 Mitchell B. Sheinkop, M.D.

847-390-7666

1565 N. LaSalle Street, Chicago, Illinois 60610

While watching the July 12^th edition of The Steven Colbert Report, I was reminded during his interview with Michael Shermer, of how we Americans are so readily and willingly influenced by marketing campaigns including those involving health care, Orthopedic Surgeons not excluded. Mr. Shermer has written a book, The Believing Brain, From Ghosts and Gods To Politics and Conspiracies-How We Construct Beliefs and Reinforce Them as Truths (Macmillan). In his book, Shermer supports the idea that the natural inclination is to believe and that skepticism and the scientific approach is unnatural. Is his thesis born out in fact?

Today Wednesday, 13 Jul 2011, a headline was published on CNBC.com: “Stryker withdraws from hip resurfacing business”. Above that announcement appears the following ad from a law firm: “The Depuy Hip Recall: Is Your Implant Defective?” Last year, an article appeared in The new York Times (March 3, 2010) “Concerns Over Metal-on-Metal Hip Implants. On February 14, 2011, I wrote my blog calling attention to the growing problem. All artificial hip replacement systems have risks related to implant or material wear but metal-on-metal hip replacement systems have proven to have unique risks in addition to the general risks of all hip implant systems. On the one hand, at the current time, there is no evidence to support the need for checking metal ion levels in the blood if a patient is asymptomatic or has anticipated findings on an X-ray. My experience is such that if you have a metal-on metal hip either of the resurfacing or total hip variety, a yearly follow-up with an orthopedic surgeon is good practice. If you are having any new symptoms, then metal ion level testing is indicated, as is an x-ray so as to exclude granuloma formation or osteolysis, the latter two resulting from metal debris.

So newly converted surgical skeptic, how might you best approach care of your arthritic hip? Seek a surgeon who will discuss a procedure with no greater neurovascular injury rate than 0.4%; a dislocation rate of no greater than 0.2%; an infection rate of no greater than 0.4% and an operating room average of 45 minutes. Inquire about a prosthetic survivorship of 20 years and not a 23-hour hospital stay. Discuss a 97% chance for a satisfactory outcome and not a 3 inch skim incision.  Recently, the FDA approved a new Ceramic-on-Metal Total Hip Replacement. Is this the latest and greatest?  Better yet, keep reading my blog and hope that I soon can announce the availability of stem cell management for hip arthritis.

In continuing to assure my reader fairness and balance in the field of reconstructive surgery, I want to call your attention to the publication of a Letter To the Editors, I co-authored, appearing in the June edition of the scientific journal Knee Surg Sports Traumatol Arthrosc: “Comparison of two minimally invasive implantation instruments-sets for total knee arthroplasty”

We interrupt this weekly Blog posting for a special announcement:

Mitchell B Sheinkop, MD will move his practice to the new Orthopedic Institute offices at 1565 No. LaSalle in Chicago scheduled to open on Monday, March 14, 2011. The time has come to return to the future.

The Weil Foot-Ankle & Orthopedic Institute is very pleased to announce the opening of our new Lincoln Park office located at the corner of North Avenue & LaSalle Street (1565 N. LaSalle Street, Chicago, IL 60610) on Monday March 14, 2011. 

We are very pleased to have Mitchell B. Sheinkop, MD join us in this new venture.

Mitchell B. Sheinkop, MD

Board Certified Orthopedic Surgeon, Fellow of the American College of Surgeons

Dr. Sheinkop is a Board-Certified Orthopedic Surgeon and is past director of the joint replacement program at the Neurologic & Orthopedic Hospital of Chicago.  Prior to that, he was director of the Joint Replacement Program at Rush University Medical Center where he practiced until his retirement from Academics for over 35 years. He is a leading authority on the treatment of patients with complex hip and knee disorders, and is well known for his pioneering use of computer-assisted navigation, minimally-invasive technologies and hip resurfacing techniques. He did fellowships in Pediatric Orthopedics and Hand surgery. He is a professor emeritus in the Department of Orthopedics at Rush University and an active lecturer and educator. He has done extensive research in the fields of non-operative orthopedics and his current interests involve exploration of the use of stem cells and other biologics in the treatment of orthopedic disorders. Dr. Sheinkop will be practicing Non-Operative Orthopedics and Rejuvenative Cellular Medicine.

Our new site offers state of the art:

• Comprehensive Podiatric and Orthopedic clinic
• Rejuvenative Cellular Medicine Consultation
• Sports medicine urgent care clinic
• Chiropractic Clinic, Radiology and Magnetic Resonance Imaging (MRI)
• Physical Therapy by Accelerated Rehabilitation featuring a “Running Gait Analysis” device

 In addition to Dr. Sheinkop, Podiatric physicians, Dr. Greg Amarantos, Dr. Jeff Baker, Dr. Donna DeFronzo, Dr. Anthony Borrelli, Dr. James Lawton, Dr. Lowell Scott Weil, Sr., Dr. Frank Bongiovanni, Dr. Stephen Weinberg, and Chiropractor, Dr. Joy Sung will be seeing patient at this facility.

For appointments and more information, please call 847-390-7666 or visit our websites at www.weil4feet.com.    www.drsheinkop.com/

You may read his weekly Blog at  www.sheinkopmd.com