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Cortisone: A Quick Relief Guide to Orthopedic’s Most Common Injection

Levi Bale Intern

Article by Levi Bale

I injured my hip entering my sophomore year of high school. I was a top ranked discus thrower and although I managed to get off one great throw during an early in the season meet, my distances quickly diminished after reinjuring my hip in practice. Running became difficult, and soon enough, I was hardly able to train due to the discomfort in my hip. My primary care physician referred me to Dr. Slattery at Washington Orthopedic Center, and after exploring different options Dr. Slattery and I decided to move ahead with a cortisone injection. Now I won’t say the injection was a miracle worker; I didn’t make state that year in discus nor did my pain vanish. However, the cortisone did give my body the advantage it needed to overcome the chronic inflammation in my hip and make a return to full sport participation in the following years. That’s what cortisone does; it provides a kick-start of sorts to prevent an overactive recovery system.

To understand what a cortisone injection does, you first need to understand inflammation.

Perhaps the most popular term in health sciences right now, inflammation in the product of damage done to your body’s tissues. Every injury results in inflammation. Exercise causes inflammation. Even eating food triggers inflammation. Typically inflammation is a good thing. It results in increased blood flow to an area to stimulate recovery by providing essential nutrients and by bringing white blood cells, cells that fight off foreign invaders and clean up waste products, to the injured site. Over time, the waste products are disposed of naturally by your body and the blood flow returns to normal. Yet, as in the case of my hip, sometimes the body’s inflammations response is too efficient, which may result in chronic inflammation that produces the discomfort felt a day after an event like an ankle sprain, but over the long term.

This is where a cortisone shot jumps into action. A cortisone shot typically contains a corticosteroid, a strong anti-inflammatory, and a local anesthetic to be administered directly to the area of interest. The injured area may feel immediately improved thanks to the effects of the local anesthetic, but may be more painful after the anesthetic effects wear off since the body reacts to a needle entering the tissue. Yet, after 3-4 days, you may begin feeling the beneficial effects of the corticosteroid, which leads to less inflammation and pain. Cortisone shots are administered at most four times per year, however, many orthopedists prefer to use the shot less frequently. Here are the advantages and disadvantages of cortisone shots:

Advantages:cortisone injection syringe
• Fast and strong reaction to inflammation
• Easy to administer
• Cheaper than alternatives like synthetic joint injections or surgical procedures
• High success rate
• Minimal side effects

• Possible shrinkage and/or lightening of skin at the injection site
• Post injection soreness at the injection site
• Elevated blood sugar for those with diabetes
• Possible, but very unlikely, avascular necrosis (dying blood vessels), acne, or osteoporosis

Cortisone shots may benefit people of nearly any age or activity level given the right circumstances. The shot is one of the most rapid and dependable ways to overcome long acting pain and inflammation, and can be as easy as a quick visit to your doctor. Specifically, an orthopedist, with their specialized knowledge of anatomy and prior experience using these shots on a regular basis, can provide the best opportunity for success.

Do you think you need a cortisone shot in Centralia or Olympia? Luckily, Washington Orthopedic Center has you covered. With five doctors and four physician assistants on staff, we have the experience and availability to meet your specific health needs. Call us today at 360-736-2889 to schedule an appointment with one of our providers and learn more about how a cortisone shot may improve your long-term discomfort.

By |September 26th, 2017|

What You Need to Know About ACL Tear & Repair

basket ball player jumping about to landFor athletes and “wanna-be” athletes alike, an anterior cruciate ligament (ACL) tear is one of the most feared injuries one can sustain. More common in females than males, and commonly seen in sports requiring quick changes of direction, the ACL is typically torn as an athlete plants their foot on the ground with an extended leg and rotates internally. Accidents involving falling from some height with an extended knee can also results in an ACL tear. The initial injury may be accompanied by a “snap” or “pop,” but often doesn’t keep an athlete from walking off the field under their own weight. In fact, some people may go an extended period of time, months to years, with lingering knee pain only to find out they actually tore their ACL long ago. Unlike other areas of the body that have self-repairing tissue, an ACL tear will not repair itself. Thus, the only corrective treatment for a torn ACL is found through surgery.

While the only real fix for an ACL tear lies within surgery, chances are you will get three different answers from three different orthopedic surgeons if you ask each of them how they repair an ACL. From the angles that surgeons drill, to the tissue that is used to replace the ACL, this is a heavily debated topic for those in the field. Here is some information on the different types of ACL repairs that are done.

The Tissue:

As you learned earlier, an ACL tear does not fix itself. Instead, the tissue is replaced with new tissue in the form of an allograft or an autograft, which calls for slightly different operative procedures.

  • Allografts are tissue samples taken from cadavers that are fitted specifically for the size of the injured knee. Since the graft is harvested for specific size, it is more expensive than an autograft. In addition, the graft may take a greater amount of time to adapt to one’s knee and may have an immune response. However, an allograft allows for a faster surgery since the graft is ready prior to the procedure and doesn’t require taking tissue from other areas of one’s body as an autograft does.
  • Autografts are tissue samples taken from other areas of an individual’s body. Since this procedure requires additional work to harvest tissue, the procedure does take longer than using an allograft, but the tissue often adapts more easily to one’s knee. There is more healing that needs to be done from this procedure, but in an athletic population, the results of a healed product are typically better than when an allograft is used. These are the most common areas used to create the autograft.
    • Hamstring (semitendinosus or gracilis) – Using the hamstring to create an autograft often leads to the least painful and quickest recovery to activities of daily living. Also, the incision used to harvest the tissue is the same incision used during the actual ACL repair. On the downside, taking tissue from the hamstring, a major muscle in any sport competition, requires more time immobilized at the hamstring to allow it to heal completely, which also increases the time it takes to reach sport participation with full power capabilities.
    • Patellar Tendon – This tendon is often referred to as the strongest option for ACL replacement. Additionally, harvesting from the patellar tendon increases the recovery speed and return to sport with full power capabilities. On the other hand, the initial rehabilitation from this graft is more painful than other options, may results in patellar tendonitis, and requires an extra incision site when compared to the hamstring graft.

Did you tear your ACL, or has someone you know torn his or her ACL? Know that there are several options available for treatment. Consider your lifestyle and the goals you have for yourself moving forward before committing to any method of operative treatment. Washington Orthopaedic Center has several surgeons that routinely complete ACL repair procedures near Olympia. Give us a call at 360-736-2889 to set up a consultation with one of our providers today.

Article by Levi Bale

By |September 22nd, 2017|

Life Can Be A Pain In The… Foot?

A guide to fixing the base of your big toe: 1st MTP arthrodesis

Life can be a pain in the foot, and trust me, you’ll quickly realize how much a painful foot can control your life once it really starts hurting. For some, myself included, it’s flat feet that lead to a host of complications, while for others the pain started when a weight was dropped on their foot. A common issue is found at the base of your big toe, officially called the first metatarsal-phalangeal joint.

Whether the pain at the 1st MTP joint is caused by a foot deformity, chronically wearing bad footwear, or from an acute injury, the pain can be significantly detrimental to one’s quality of life due to the natural push off from the big toe during activities like walking and running

What causes the pain?

Runner holding foot from MTP toe pain

No matter the origin of the pain, acute or gradual, the eventual chronic pain is caused by the wearing down of cartilage between the two bones that form the MTP joint. The lack of cartilage leads to inflammation in the joint, osteophytes (small bones fragments) that grind inside the joint, and the development of arthritis in and around the joint, which limits the 1st MTP’s range of motion and increases pain. The nature of the issue is typically progressive, meaning the longer the problem lingers the greater the formation of arthritis will be and the greater the pain will become.

Progression of treatment:

Conservative (non-operative) – Conservative treatments include employing stiff-soled shoes, sometimes accompanied by a Morton’s extension custom orthotic, to decrease the amount of movement required by the 1st MTP joint during activity without affecting normal gait, corticosteroids, and NSAID’s. Although these methods may limit the discomfort for a period of time, the injury will often progress to the point of needing to take more invasive action.

Operative Treatment – Luckily, operative treatment is very successful in managing 1st MTP pain and stiffness. The first line of defense comes in the form of a cheilectomy, which is the removal of bony spurs from bone that decrease a joint’s function and causes discomfort. Recovery from a cheilectomy is typically quick; often progressing to normal shoe after sutures are removed 10-14 days postoperative. The next treatment, in select cases, would be an emerging technology called Cartiva, a synthetic cartilage implant that replaces the worn out cartilage in the MTP joint. Cartiva may be a great option for more active individuals, as it allows weight bearing as tolerated immediately after surgery. The final line of defense, a 1st MTP arthrodesis, removes the joint surfaces and screws the two bones together to create a joint fusion, sometimes aided by an additional plate placed on top of the joint. Furthermore, bone graft can be placed on the joint surfaces to aid in the creation of new bone to fuse the joint even more.

Dr. Dujela performing surgeryDr. Dujela, our foot and ankle expert at Washington Orthopaedic Center, who also serves as national chairman for the Education and Scientific Affairs Committee for the American College of Foot and Ankle Surgeons, is a frequent international lecturer of the techniques above and teaches the procedures to surgeons around the globe. In addition, Dr. Dujela is currently writing a textbook chapter on the very topic of MTP treatment. Choosing to walk and move comfortably is a lifestyle choice for someone with pain at the base of his or her big toe. Get your foot checked out by Dr. Dujela, the doctor you want whether or not your toe pain requires surgical foot treatment.

Call Washington Orthopaedic Center at 360-736-2889
to schedule an orthopedic appointment at your convenience.

By Levi Bale

By |September 12th, 2017|

Have a Chronically Dislocating Kneecap? We Can Fix That!

Anyone can dislocate his or her kneecap, or patella, given enough torque. Young, old, muscle bound, or lean, it doesn’t matter much. The real difference maker is your anatomy. If you, or someone you know, have a chronically shifting patella, know that there is a safe and secure way to fix your knee and that Washington Orthopaedic Center has providers with years of experience doing just that.

knee joint image with tendons The knee joint primarily consists of three bones, the femur, tibia, and the patella. The fibula is more or less along for the ride here. The femur has two large condyles on either side of the knee, which is what you feel when you palpate the sides of your knees, and in between the condyles lies a groove called a trochlea. Naturally, the patella glides in the trochlea as the knee flexes and extends, fixed in the middle by the two opposing condyles. This is where things get interesting. With enough internal rotation under pressure with a knee flexed between 20 and 40 degrees, the patella can slip out of the trochlea.

For the most part, anyone with average knee anatomy won’t ever experience his or her patella shifting outside normal position. However, people exhibiting abnormal anatomy are at a greater chance of either dislocation, a complete shift of the patella often due to a tear in the medial patella-femoral ligament (MPFL), or a subluxation, partial dislocation of the patella due to a loose or partially torn MPFL.

If you find yourself with a dislocated knee, you’ll have it reduced by an emergency response team. Afterward, it’s not a bad idea to have it checked it checked out by an orthopedist in case there was more damage to your knee during the dislocation. Normally, however, nonoperative treatment like a light brace or physical therapy is recommended after only one dislocation. It’s a different story for a chronically dislocating knee. Multiple dislocations is typically a clear sign that there is abnormal anatomy or a torn MPFL, the ligament that holds your patella to the medial side of the femur, that is causing the patella to shift unnaturally. When this occurs, an orthopedist will take a look at your x-rays to assess for abnormal alignment and anatomy, physically test your knee for instability, and then recommend surgical intervention if the signs and symptoms are positive for chronic patellofemoral instability.

MPFL Surgery and Recovery:arthroscopic knee surgery by orthopedic doctors

Washington Orthopaedic Center has several providers who are well practiced in the reconstruction of the MPFL. MPFL surgery is arthroscopic, meaning the repair is done inside the knee without opening the leg up and lasts around one hour. After surgery, you are sent home, and you are walking, with a brace to stabilize your lateral motions, that same day without any restriction on your knee’s range of motion. After roughly four weeks, the brace is off, and light weight-bearing activities can be resumed with caution. For athletes, running is continued at around 10 weeks, and full return to sport takes place around four months.

Washington Orthopaedic Center has the world-class providers and assistants you need to succeed after a reoccurring injury such as a chronically dislocating patella. Dr. Slattery, a board certified sports medicine specialist, and Dr. Morishige, a fellowship trained sports medicine specialist, have specific training in this procedure and deliver a quality of medical expertise that we are blessed to have in our small community. Schedule an appointment to have your knee evaluated by one of our providers today by calling us at 1-360-736-2889.

-Article by Levi Bale

By |September 5th, 2017|

The Surgical Scheduling Process Demystified

Prior to working in a surgical setting, I always thought that once it is decided to have orthopedic surgery, you would be put on the next available surgery spot with your Surgeon, and that was that. Now I know it is not that simple. Nothing is ever that simple; there is a rather extensive process to even be on the surgery schedule. 

When I first started learning about this process, it seemed overwhelming to me. However, after a few deep breaths and getting to know the awesome staff at Washington Orthopaedic Center, I now know that the process is very manageable.  And just like me, you will have the wonderful staff at WOC to help guide you on your journey to wellness.

Senior woman with her hands on a painful knee while sitting on examination tableThe first step on this wellness journey is obviously coming to WOC with an orthopedic issue.

You will first be scheduled with a provider to assess any injuries and issues that can be treated by one of our orthopedic specialists.  In the clinic, the provider will look into non-surgical options first and work with you, the patient, to see what works best for your lifestyle. We always strive to do the least invasive option whenever possible for our patients. Once it is decided that the best possible option is surgery the process begins.

Every patient has a different journey, but they all follow the same general surgical path.  We always start with a review of insurance and the urgency of the procedure. If the procedure is deemed urgent by the surgeon or if you are double covered or have Medicaid or Worker’s Comp insurance, you will proceed directly to our ASC surgery scheduling department.

If you do not fall into either one of the categories listed above, you will proceed to our financial services representative, Traci.  She then contacts your insurance to review your benefits.  This process provides her with the amount of your co-insurance and any outstanding deductible amount.  Once you have reviewed your insurance benefits and amount responsible with Traci, our Surgery Scheduler will begin the insurance authorization process for your surgical procedure at our ASC.

Either Janet or Michele, our surgery schedulers, will also contact you and review a quick series of health history questions. Some questions you would be asked are, do you have a history of diabetes, or high blood pressure, or use diuretics. Based on your medical history and the procedure that you are having, then determines if you are one of the lucky individuals who will be meeting with one of our RN’s in the house for a preoperative teaching or if we are able to complete the teaching via telephone. 

The teaching takes place in the comfort of our education room at the surgery center. You will meet with one of our highly qualified RN’s and be asked additional health history questions, what medications you take, if you have any allergies, and past surgical history to name a few. Some patients may need to have certain lab draws or an EKG at this teaching as well.  An EKG is a simple noninvasive test that looks at the electrical activity in the heart. If there is an abnormal result, the test results are reviewed by our anesthesiologist.  After the questions are all finished, and tests were done, we review with the patient what to except for the upcoming surgery. You are encouraged to ask whatever questions you may have or review anything that may need to be clarified.  We want you to be as ready and prepared for the procedure as possible, therefore if you have any questions, no matter how irrelevant you might think it is, please be sure to ask.

Dr. Dujela performing surgery

We will discuss this with you during your teaching, but please note that for the safety of our patients, you must have someone to drive you home after surgery because of the anesthetic used during surgery.  To help our patients on their journey to recovery, we ask that they also have someone stay with them for at least the first twenty-four hours, and sometimes longer after the procedure.

I know this may seem a bit overwhelming at first, it definitely was for me, but the dedicated staff at WOC is here the entire way to make this journey as easy as possible for you to navigate through the 8 step program.   

Step 1: Make an appointment with a WOC provider.

Step 2: If surgery is the best treatment option, you may be directed to Traci.

Step 3: Traci contacts your insurance and reviews everything with you.

Step 4: Janet or Michele will start the authorization process.

Step 5: Janet or Michele will contact you to review your medical history and get you on the schedule.

Step 6: You will have your pre-operative teaching, either in person or on the phone.

Step 7: You will be contacted the business day prior to notifying you of what time to arrive at the ASC.

Step 8: Day of surgery!! Remember, no eating or drinking anything after midnight.

Now it’s time to start the process, be sure to give us a call and make an appointment with an orthopedic surgeon today at 360-736-2889 to get started on your journey to wellness!

-By Josie Dekoker

Washington Orthopaedic Center – Patient Reviews

General Comments

– The team is solid from front office to X-ray to surgery center and everything in between.
– The receptionist Stacy is so very kind and explained about the scheduling that Dr. said. She is so compassionate to the patients.
– You are the answer to my prayers for help with my arthritic legs and the stiff walking. You give me hope!
– This facility and their staff are awesome.
– I enjoyed my 2 visits everyone was amazing! Clean comfortable building. Great to know where to go if I need you again Christy thank you!
– The Staff at the clinic are very professional courteous and expeditious in their services. I would definitely highly recommend their practice to anyone seeking any Orthopedic services.
– I’m so happy you now have an office in Olympia.
– Glad to have such a high quality facility in our area.
– I really like having the Tumwater location as an option

Keith V Anderson M.D. Comments

– Excellent care throughout from everyone. Was very impressed!
– Excellent diagnosis and treatment. I never felt rushed.
– Looking forward to having Dr Anderson fixing Both knees in the near future.
– Very professional help with my shoulder/arm area. Thank yo Dr. Anderson you are the best! Dr. made me feel a lot better about my problem.
– I feel very confident in his care. I am so lucky to have him as the doctor on my leg.

Keith R Birchard M.D. Comments

– Dr Birchard is very personable man. I very happy he is my Dr
– Easy to talk to very understanding listen to my priblem and explained to me what the problem was in laymens terms.
– Outstanding service!
– Dr. Birchard was excellent!
– Keith R Birchard listened to me and answered all questions I had. He did not make me feel rushed or like he had to leave for the next patient.
– Dr. Birchard replaced my left knee in 2014 and it has functioned with no problems. His answering my questions about the steroid injection this time was very clear answers
– A caring professional.
– Everything went well. I guess I always would like more time to understand better. Dr Birchard did well though and I learned about my condition and generally what to expect. Thank you.
– Keith Birchard did a great job.
– I appreciated that he agreed to try a few alternative treatments to help my knee pain before we made the decision to go to knee replacement. He explained things well and when I came in with concerns during the healing he was patient and considerate.
– Dr. B. took a lot of time with me and explained many things for me. He also recommended getting a second opinion on another matter from another Dr. I was pleased with this visit.
– Has been very helpful in my recovery and getting me back to work

Mark Morishige M.D. Comments

– nice, kind, patient. Listened to any questions and gave reccomendations. Told me about what I need to do to continue healing.
– Excellent patient rapport.
– He was decisive clear and competent. I feel 100% better.
– Dr. Morishige was very knowledgeable about the injury to my shoulder and the options available to me. I appreciated his thorough explanation and patience in answering any questions I had.

Michael D Dujela D.P.M. Comments

– We are blessed to have a doctor of this caliber in Lewis County. I feel so fortunate to have found him a and I have great trust in his skill and judgement.
– Competent qualified personable reassuring.
– He’s an awesome Dr….
– If I had a son who was a doctor I would want him to be just like Dr. D!
– Knowledgeable caring and efficient.
– I told him from the start. That I do not want to have Surgery because of my age and don’t want to be off my feet for that long. So he told me about other things that might help. I tried them and the have helped a great deal am getting along pretty good now. Frank
– Thank you so very much Dr. Dujela for your expertise! I sure wish I had contacted you first when my “little” problem started! It would have saved me some critical months…now I need to await yet another month before surgery to fix my achilles. I have already recommended you to many more people! And my primary doctor who I saw yesterday Dr. Judith Son also has great things to say about you!
– Staff provided good information on footwear I should be using and exercises for my feet.
– He is the best
– He always remembers me even if I haven’t seen him for many months or years. Outstanding personal interaction. Thank you Dr. Dujela!
– Excellent service
– The best foot and ankle doctor I have seen. He knows a lot more than the others I have visited.

Scott S Slattery M.D. Comments

– Dr Slattery honestly gave me information about treatment of my right knee.
– Dr. Slattery is an excellent listener and cares a lot of his patients pain and issue and addresses them in a very professional and promptly manner.
– My 4th surgeon visit (over a year and a half time) for my shoulder. I am pleased and will do surgery with Dr. Slattery.
– He has been my ortho for many years I will always return to him as long as he is in practice he’s informative respectful and exstremly passionate about well being of other there is no one better.
– He is very thoughtful and kind answered all my questions does not give advice just suggestions
– Very good care
– He is very professional. He had everything ready for my appointment and the shot was quick and almost painless. He did a good job.
– Dr. Slattery was extremely professional in his approach to my concerns and really listened for a long time before he offered his advice referrals and follow-up suggestions. I so appreciated his approach and how correct he was in his possible diagnosis.
– I felt like the care was personalized and not just a surgical procedure. Please don’t loose that – it takes more time but makes for far better care & outcomes.

Christy Caple PA-C Comments

– She made me feel like s person..not just a number….thank you…
– I appreciated the professional manner of everyone I cam in contact with. I also very much appreciated the cleanliness of the main lobby area. In previous visits that area needed attention.
– Christy is awesome I was comfortable right away!
– Excellent she’s very thorough and very personable.
– She was extremely skilled in injecting the OrthoVisc into my knees and I really appreciated that! She really listens to your needs is very timely and plans for the future. She gives me hope even tho I am still very stiff but I don’t hurt.
– I made two visits to Wa. Ortho and was very impressed with the swiftness and professionalism of the staff.

Jessica Hannigan PA-C Comments

– She was very courteous and seemed genuinely concerned.
– She was excellent.
– She is awesome
– Thought she was great really liked her.

What is an ASC? By Josie Dekoker RN

RenderedIMy name is Josie Dekoker, and I’m new here! WOC’s newest ASC RN to be exact I graduated from Centralia College in June and obtained my nursing license in July. This is my first nursing job, and I couldn’t be happier to call WOC home. The staff (AKA: Family) here have been so welcoming and helpful in my transition into practice. That coupled with my desire to learn, and the diversity of daily duties makes this job opportunity perfect for me! Besides taking care of patients, I love being able to learn new things every single day. Each day I have a brand new experience.  Whether it be a new question from a patient, to a new surgery or a new opportunity, all of these new things help foster the RN that I am becoming.

You’re probably wondering where I am going with all of this. I am writing, WOC’s ASC blog to be exact.

Do I like to write? Nope. Not even a little bit. However, that’s not what this is about.  This blog is a learning experience, and as I previously mentioned, I love to learn!  As a fresh RN, straight out of school, you can imagine that I have a limited scope of experience in a surgery setting.  And what is the best way to learn? To teach someone else what you know. And I am going to do just that. I am going to teach you the ins and outs of our ASC. You get to join me on this learning journey, and we can learn together. So buckle up! We have a long journey ahead, and I can’t wait to get started.

What better day to start than the beginning of National ASC week! Yes, an entire week to recognize the ASC’s around the country. ASC’s give patients a choice. A choice of where they want to have a surgical procedure. This year marks the 11th anniversary of National ASC week. However, the first ASC has been around for much longer than that.  Our ASC was actually one of the first ASC’s in Washington State! How neat is that?!

Okay, so let’s get started.

What is an ASC?

ASC stands for Ambulatory Surgery Center and is also sometimes referred to as Outpatient Surgery Centers.  Patients who visit an ASC are lucky enough to go home the same day, often within hours, of having a surgical procedure.

Why would someone choose to have surgery in an ASC?

There are many reasons for patients to choose to have surgery in an ASC. Some include, but are not limited to:

  • Lower cost
  • Lower risk of infection
  • More personalized care
  • Shorter “stays.”
  • More relaxed setting for both the patient and family

What procedures does WOC offer to be done in the ASC?

We can do a number of orthopedic cases in our ASC. From the removal of a Ganglion cyst (that bump often on the back of your wrist) to even replacing a total joint! Our surgeons are trained to complete a wide array of procedures.

How do I decide if I should have a procedure at the ASC?

The most important thing you can do is schedule an appointment with one of our providers. The provider will evaluate any ailments, review any surgical and non-surgical options, then discuss the best course of treatment with you. If surgery is the next step, then our surgeons will work side by side with you to decide where your surgery should be completed to provide an optimal recovery and have the best possible outcome for you.

Whatever your orthopedic ailment may be, be sure to give us a call today at 360-736-2889! We look forward to hearing from you soon!

Until next time,

Josie Dekoker

Dr. Birchard Lends a Helping Hand

Dr. Keith Birchard Orthopedic SurgeonAs an orthopedic surgeon, Dr. Birchard prides himself in his hands. For a guy who uses numerous tools most of us have never heard of or could even imagine, his hands are surely his most important tool. And what better way to use his hands than fix others’ hands? Whether Dr. Birchard is in the clinic, the operating room, or out in the local community, Dr. Birchard is always willing to lend a helping hand.

Dr. Birchard grew up in Chehalis as his dad, also an orthopedic surgeon, helped get Washington Orthopaedic Center off the ground. His family was very involved in local community service events and international missions, and these are two aspects of service he still continues today. Simply look for Dr. Birchard’s United Way campaign poster on your right between exits 81 and 79 as you head south on I-5 to see the impact he has on our local community. His medical mission trips in countries like Papua New Guinea, the Dominican Republic, and India have had similar positive effects. Dr. Birchard also continues his participation in Boy Scouts of America by volunteering with his son’s Cub Scout Pack 301 in Chehalis.

Dr. Birchard has a special interest in hands when it comes to surgery. The hand, much like the foot, demands a slightly different surgical approach than other areas of the body like the hip or knee. For example, while there are only three bones in contact within the knee joint, there are twenty-seven bones in each human hand along with countless joints. While the knee performs gross, large, movements, the hand completes fine, small, movements requiring greater precision and accuracy. Due to the more finely tuned nature of the hand, the surgeries sometimes require a greater attention to detail, something Dr. Birchard is an expert at.

Dr. Birchard cheering up patient

Dr. Birchard has been involved in medical mission projects in the Dominican Republic, Papua New Guinea, and India

Among Dr. Birchard’s most commonly performed procedures are trigger finger releases, de Quervain’s releases, and carpal tunnel releases. As you can see below, the following table details the conditions, treatment options, surgery, and rehabilitation periods. These three conditions are often inevitable fixes in order to maintain an active quality of life. Luckily for us, Dr. Birchard has decades of experience working with these conditions and sees a very high rate of success following his corrective procedures.

These three conditions are not uncommon. If you work with your hands on a daily basis, you have a higher risk of developing a condition like carpal tunnel syndrome. A 2010 study completed by the Center for Disease Control and Prevention indicated that 3.1% of employed adults between the ages 18-64 developed carpal tunnel syndrome. In addition, the risk of developing carpal tunnel syndrome was greater with increased age and higher in women.

Hand condition and treatment, trigger finger, de quervain's tenosynovitis, carpal tunnel

If you find yourself with chronic pain similar to one of the descriptions above, place your trust in Dr. Birchard’s hands. He has the experience and knowledge to improve your quality of life in a dramatic way. Give us a call at 360-736-2889 to set up a consultation today.

– Article by Levi Bale

There’s No Replacement for Excellence, But There’s An Excellent Place For Joint Replacements

In a 2013 Consumer Reports article titled Your Safer-Surgery Survival Guide, Centralia’s Providence Hospital was listed as one of Washington’s top rated hospitals for surgery. Other hospitals rated as highly as Providence Centralia hospital were Seattle’s Swedish Medical Center – First Hill and Renton’s UW Medicine/Valley Medical Center. The ratings were produced with the help of MPA, a health care consulting firm, and were categorized by analyzing the percentage of a hospital’s Medicare surgery patients who either died while in the hospital or spent a greater length of time in the hospital than was expected. 27 separate surgeries were examined, although five procedures were main points of emphasis: back surgery, hip and knee replacements, angioplasties, and carotid artery surgery. You can find more information on the safety ratings of Providence Centralia Hospital and other hospitals at Consumer Reports Hospital Ratings.

Providence Hospital - Centralia, Washington

Providence Hospital – Centralia, Washington

In addition to the article by Consumer Reports, Centralia Providence Hospital had zero reports of infection for patients having undergone a total joint replacement in 2016. While we in the US like to think our infection safety guidelines rule out the possibility of infection, this is not always true. In fact, in a 2016 report on hip and knee joint replacement by the American Joint Replacement Registry, 8.4% and 9.3% of total hip and total knee revision surgeries, respectively, indicated an infection and inflammatory response. With more people than ever opting to receive a total joint replacement, it’s extremely important to ensure you will be receiving your replacement surgery from a facility with a proven track record of success.

So what does this say about us?

Washington Orthopaedic Center’s surgeons all have privileges at Centralia Providence Hospital to complete total joint surgeries within their hospital. That means our surgeons complete these procedures, our surgeons and physician assistants track the health status of patients until they leave the hospital, and our surgeons oversee the rehabilitation period of the patients until they have recovered. Thanks to the thoroughness of our surgeons and staff, in conjunction with the staff at Providence Centralia Hospital, our patients having undergone a total joint replacement surgery at Providence Centralia Hospital had the lowest rate of infection in the state for 2016, 0%. This low rate of infection also surely contributed to the outstanding safety rating in the 2013 Consumer Report article on safe surgery.

our patients having undergone a total joint replacement surgery at Providence Centralia Hospital had the lowest rate of infection in the state for 2016, 0%

Joint replacement surgery at Providence Centralia Hospital is continuing to improve every year. This year has seen the addition of two HANA tables, specialized tables that allow our Dr. Slattery to perform his direct anterior approach total hip surgeries. These are the only tables available in the area to perform these procedures, a procedure that often cuts a patient’s recovery time in half when compared to the traditional posterolateral approach that requires more navigation through dense muscle tissue.


If you are having any pain in your major joints, don’t hesitate to give us a call at 360-736-2889 to set up a consultation with one of our providers. Washington Orthopaedic Center now has clinics in both Centralia and Olympia, Washington to better serve the public. Remember, there is no replacement for excellence when it comes to major joint surgery, but there is an excellent place for replacement, Providence Centralia Hospital with Washington Orthopaedic Center’s surgeons.

A Review of WOC’s Sports Medicine Seminar

IMG_3998Washington Orthopaedic Center held a comprehensive sports medicine seminar June 3rd in Olympia. In attendance were primary care providers, physical therapists, chiropractors, and athletics trainers from around the region.  All five of our surgeons spoke on 18 different topics over the course of 10 hours, including the effects of platelet-rich plasma injections, direct anterior hip replacement and persistent ankle pain.  They were joined as faculty by Dr. David Brown, a board certified sports medicine family physician who works with Providence Medical Group in Olympia. Dr. Michael Dujela, the national chairman of the Education and Scientific Affairs Committee for the American College of Foot and Ankle Surgeons, led the seminar. We were also able to hold a break out session, which allowed the faculty an opportunity to work in smaller groups and demonstrate physical examinations of the shoulder, knee and foot.

IMG_4002Chances are you have probably experienced the disconnect that is often found in being referred from clinic to clinic…

The disconnect is sometimes unavoidable because each provider prefers every step of treatment to be completed a specific way, and these preferences are not always easily communicated over phone or dictations. A main goal of hosting this seminar for local healthcare providers was to educate them on our treatment protocols, so that our patients are more effectively cared for as they are referred to separate clinics for their rehabilitative processes. For example, Dr. Slattery and Dr. Morishige are both top notch surgeons who have years of experience performing Anterior Cruciate Ligament (ACL) Reconstructions, yet they each prefer a similar, but different technique. The two techniques utilize different angles to reposition a replacement ligament, which could potentially alter the treatment plan of a physical therapist or at least serve as a reference for why a patient may be exhibiting a specific rehabilitative complication. Without knowing the details of which procedure a certain provider prefers, other healthcare professionals may not be able to provide their best quality rehabilitation.

IMG_4012The same goes for us. We took this opportunity to ask questions of our local colleagues as well. We want to know what we can provide to give them the best opportunity to succeed with the patients we send their way. We take pride in personally getting to know our colleagues and we believe it is in our patients’ best interests too, because, although we are a series of separate clinics, we still work toward the same goals for our patients’ benefit. As a rural specialty clinic in this community, we strive to deliver more personalized care than you may receive in a large city hospital. The ability to educate our patients, colleagues, and ourselves, is an integral aspect of maintaining our personalized care.  Thank you to all who were able to attend the seminar, we appreciate you taking time out of your busy schedule to do so.

If you have questions about the chronic joint, muscle, or bone pain you have been experiencing, give us a call at 360-736-2889; we would love to help.