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Dr. Keith V. Anderson Announces Retirement

Keith V. Anderson, MD has announced his upcoming retirement effective March 31st, 2018. Forthe last 27 years, Dr. Anderson has practiced orthopedic medicine at Washington Orthopaedic Center in Centralia and Olympia. Over the years, he has helped thousands of people from the Pacific Northwest recover from their sports injuries, and has performed thousands of orthopedic surgeries.

Dr. Anderson has had an impressive career that started well before he joined Washington Orthopaedic Center. He was the past chief of staff at Providence Centralia Hospital and has done significant work overseas. He worked at Tenwek, a Kenya Mission Hospital under MAP- Reader’s Digest International Fellowship Scholarship, and has done volunteer work at mission hospitals in Papua New Guinea, the Dominican Republic, Nicaragua, and Bhutan. Washington Orthopaedic Center will have been his longest place of employment.

Over Dr. Anderson’s long tenure, he was highly regarded by his peers and community for his expertise in arthritis surgery, total knee and total hip replacement, sports medicine, and arthroscopic surgery. “Dr. Anderson has demonstrated capable leadership at Washington Orthopaedic Center and for Providence Centralia Hospital for many years. The WOC staff and our patients appreciate his dedication to this practice and our community and his dedication to our core values and mission.” says Dr. Birchard.

“My tenure (at Washington Orthopaedic Center) has been most gratifying. It is a pleasure to work in an office that shows genuine care for each other and genuine concern for our patients”, says Anderson. “I leave the practice in excellent hands. Dr. Scott Slattery…bringing with him a wealth of knowledge and expertise in Sports Medicine… Dr. Keith Birchard (son of Dr. Carl Birchard, one of the founding surgeons) with energy and humor focusing on hand surgery but with a broad range of skills and expertise… Dr. Michael Dujela with a specialty focus on the foot and ankle with a broad international perspective in which he remains active on the lecture circuit… Dr. Mark Morshige with experience in sports medicine and hip arthroscopy and soon to join is Dr. Melissa Kounine with a background in total joint replacement and minimally invasive procedures.”

We welcome the public to celebrate Dr. Anderson’s career with us at 6 PM on March 29th at Washington Orthopaedic Center – 1900 Cooks Hill Road, Centralia, Washington.

What You Need To Know About Runner’s Knee

Runner showing knee

Runner’s Knee or Patellofemoral pain syndrome is a common knee problem found in many athletes, especially new runners. Patellofemoral pain is seen most commonly in athletes and runners; this constitutes 25% of all identified knee injuries [1]. PFP affects women more than mend in a 2:1 ratio and is seen most commonly in adolescents [2].

What Causes Patellofemoral pain syndrome?

Patellofemoral pain syndrome is due to the kneecap (patella) not tracking properly in the femoral trochlea, causing rubbing of the cartilage in abnormal ways. The cartilage on the underside of the kneecap is there to let your knee cap glide back in forth between the groove on the femur. The abnormal tracking of the kneecap is usually due to a muscle imbalance of the Quadricep muscles pulling the knee cap usually to the outside of the knee. Can also be caused by tight hamstrings, poor foot mechanics, hip problems or various other causes.

There is also various ligaments that attach to the inside and outside of the patella, which can be injured, stretched, or torn in trauma which can lead to kneecap instability. These are best assessed with an MRI.

Symptoms

Most common symptoms of patellofemoral pain syndrome include a dull or achy type pain to the anterior or front of the knee. The pain is usually worse with squatting movements, stairs, and walking up or down hills. You may experience knee swelling.

What a practitioner may observe during your appointment

A clinician may observe the way you walk, looking for any abnormalities in foot, knee, or hip mechanics. You will also assessed for evidence of weakness to the quad muscles and reduction in the range of motion of your knee. A practitioner will assess the knee ligament for instability. Address any possible meniscus issues causing referred pain to the knee cap. Also assess for any kneecap instability or patella pain.

Imaging:

Possible imaging that may be obtained to assess patellofemoral pain include an x-ray to look at knee cap alignment, arthritis, or possible fractures that may be seen on x-ray. Occasionally an MRI or bone scan will be obtained to look at the cartilage or soft tissues and ligaments. These are usually only obtained if patient is not progressing with treatment.

Treatment:

There are many treatment options for this problem. First and foremost is rest. If you knee is acutely in pain, you should rest and ice it. Your practitioner may prescribe some anti-inflammatory type medications to help reduce some of the inflammation that is occurring in your knee. One of the best treatments for this issue is working with a physical therapist to help and strengthen the quad muscles to realign the patella into the femoral groove. Other treatments include bracing, additional treatments to the hips or feet. If you are not getting better after some of these modalities, an MRI may be obtained to assess the ligaments. Occasionally surgery may be indicated.

Lukas Steffan PA-C

Lukas Steffan PA-C

If you or a friend may think you are having issues with patellofemoral pain, you can schedule with one of our providers for evaluation or treatment at Washington Orthopedic Center! Contact us now to set up an appointment at 360-736-2889

Article by Lukas Steffan (PA-C)

References

[1] Baguie, & Brukner. (1997). Injuries presenting to an Australian sports medicine centre: a 12-month study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed?term=9117522

[2] DeHaven KE, & Lintner DM. (1986). Athletic injuries: comparison by age, sport, and gender. [Abstract]. Retrieved February 21, 2018.


By |February 23rd, 2018|

Exploring Lewis and Thurston County With Jessica Hannigan PA-C

Jessica Hannigan has done plenty of exploring since establishing herself in Lewis and Thurston counties last year. Originally from South Carolina, and having done her physician assistant schooling in Tennessee, exploring the new and unique environments of the PNW was only natural for her. The new opportunities allow her to express her interest in finding new challenges outdoors, and in the clinic, and speak to her active disposition.

If you know Jessica, you know she likes to keep moving. Her coworkers may know that best. What you do not see as a patient while waiting to be seen in our orthopedic clinic is the hustle and bustle through the hallways. No matter the reason to be hurrying through the halls, it is up to each individual provider team to stay on time and have all the necessary documents for each of the day’s patients. Jessica is among the quickest in the clinic; she always seems to be everywhere at once. Jessica says it seems this way because she enjoys the challenge. Joining a new practice means encountering many new challenges, and for many, the best way to combat the challenges is by allowing more time to spend on them by getting from place to place more quickly. Jessica’s life outside the clinic may play a part in her ability to be so quick.

Outside of the clinic, Jessica is an avid hiker and outdoor adventurist. A few hikes she has tried this year are the hikes to Annette Lake, Mount Eleanor, and High Rock Lookout. She recommends them to anyone in decent shape that is searching for a good vista. She has also ventured up to White Pass to ski, which she says is much different and more difficult than skiing on the east coast as there is more powder than she is used to. Other attractions that Jessica has especially enjoyed in the PNW have been the state fair in Puyallup where she traversed a variety of fried foods and the George Amphitheater where she saw the Zac Brown Band.

More than anything, Jessica said she’s discovered the kindness that accompanies people in the PNW.

Jessica noted, “people often talk about southern hospitality as being something that is hard to find outside of the south, however, I feel that people here in Washington are just as welcoming and friendly.” Working as a healthcare provider is oftentimes a very difficult and frustrating job, but Jessica says that the positive outcomes and kindness people demonstrate remind her how great and rewarding the field of medicine is.

That is our update on a year completed by Jessica Hannigan PA-C. If you have any questions about the kind of orthopedic injuries Jessica sees, or if you think Jessica may be a good fit for you, give Washington Orthopaedic Center at 360-736-2889 to arrange an appointment today.

By |February 20th, 2018|

Expanding our Community: Lukas Steffan PA-C

Lukas completed his physician assistant program at Bethel University in St Paul, Minnesota. While finishing his undergraduate degree at the University of Minnesota Lukas gained experienced by working with individuals with disabilities and participated in research in the field of cancer genetics. After his undergraduate degree, he took a year off to gain even more experience by working at an internal medicine clinic and a mental health clinic.

For this article, we aimed to get to know Lukas Steffan PA-C by asking him a few questions about himself:

Why did you choose to move to the PNW and what’s your favorite aspect of the PNW so far?

I chose to move to the PNW for the outdoors and the mountains, also to get away from the cold winters in Minnesota. I would say my favorite aspect of the PNW would be hiking in the forests and exploring all of the new places each weekend.

What moved you to pursue a career in healthcare?

I wanted to pursue a career in healthcare because I’ve always been a people person. I enjoy meeting new people and finding out about their stories while trying to help with whatever ails them and ultimately make a difference in their lives.

Do you have a bucket list? If so, what’s at the top of your list?

man in antarctica

I do have a bucket list, and the top item is to visit every continent (including Antarctica).

If you could choose an orthopedic superpower, what superpower would you choose?

If I could choose an orthopedic superpower, I’d choose to be able to heal bones instantly!

What “guilty pleasure” song do you sing when no one is around?

Mr. Brightside by the Killers

Hopefully, you have a better idea of who Lukas is and what he represents. Join us in welcoming him into our practice and communities! If you have any more questions about Lukas or any of our providers please visit our website by clicking HERE, or give us a call at 360-736-2889 to schedule an initial consultation for your orthopedic injury.

By |January 29th, 2018|

What You Need To Know About Dupuytren’s Contracture

A Dupuytren’s contracture is the result of thickening fascia beneath the skin of the palm most often near the pinky and ring fingers. Over time the skin at the base of an affected finger will become thicker before finally creating a knot and dimple appearance. A knot formation is indicative of the fascia thickening aspect of Dupuytren’s. Fascia is a layer of tissue between the skin and muscle layers that help anchor down your skin. Otherwise, the skin on your palm could be manipulated much like the skin on the back of your hand. As the fascia tightens into a knot like structure, the tightened skin and fascia cause the fingers to become progressively flexed, making extending the fingers difficult. Unlike a similarly presenting problem, trigger finger, Dupuytren’s does not involve any tendons.

Although there is no known cause of Dupuytren’s, there are several risk factors:

    Gender: The prevalence is greater in men than women

    Ancestral Descent: People from Northern European or Scandinavian descent are most likely to develop the condition

    Age: Likelihood increase with age

    Alcohol & Tobacco Use: People who smoke and drink more regularly are more likely to present with the condition

    Medical Conditions: People with diabetes or a seizure disorder are more likely

Treatments depend on the severity of the contracture.

Factors such as the functionality of the finger(s), pain level, and your current activity status should be taken into account when considering treatment options. During the early stages of the disease small finger stretches can be used to prolong finger use, however, the nature of the disease is progressive and normally results in losing the finger’s functionality. During mild to moderate stages, a doctor may try using a needle to mobilize the knot to decrease symptoms.

Severe Dupuytren’s typically calls for surgical intervention.

In this case, the knotted fascia and possibly some of the surrounding tissue is excised during a short 15-30 minute procedure that can be done at our Ambulatory Surgery Center.  Afterwards, the finger(s) is slowly rehabilitated through physical therapy until full or near full extension and functionality is restored.

Dr. Birchard at Washington Orthopaedic Center has a special interest in hand procedures and performs Dupuytren’s release surgeries on a regular basis. Feel free to give us a call at 360-736-2889 to schedule your initial consultation to discuss treatment options for your Dupuytren’s contracture.

By |January 19th, 2018|

Myths of Orthopedic Surgery

“I can eat breakfast since my surgery isn’t until this afternoon.”  Do I really have to skip breakfast before surgery?

Our policy is that you are unable to eat after midnight the night before your surgery with us. We have this policy to protect you, as the patient, from aspiration during surgery.  In addition, if we needed to move you up in the schedule, due to a cancelation or simply running ahead of time, it is important that you have not ate or drank anything since midnight.

Patient safety is of utmost importance to us; therefore, we don’t ask you to skip breakfast just for fun, it is vital to follow these instructions to help ensure you have the best possible outcome.

“I always drink coffee in the morning, one cup won’t hurt me.” Can I drink coffee before surgery?

cof

No!  You cannot drink coffee before surgery.  Due to the increased risks associated with eating or drinking anything after midnight the night before surgery, we ask that you refrain from your morning cup of joe too. No eating or drinking includes no water, no coffee, no gum, no candy, no breath mints, nothing at all.  Kind of like a Gremlin, don’t feed after midnight. 😊

“I had my wisdom teeth out and drove myself home, I’ll be fine to drive after this surgery.” Can I drive after surgery?

driving car after orthopedic surgery

You will not be able to drive home after surgery, any will need to have someone to transport you home.  Due to the anesthesia, you won’t be able to drive for at least 24 hours. If you are taking any narcotic pain medication and depending on what type of surgery you have it may be even longer before you are able to drive.  It is always best to check with your orthopedic surgeon or one of our RN’s on when you are able to drive again.

When can I fill my pain medication?

pain pill after orthopedic surgery

You will be able to fill your post-op pain medication prescription after surgery. We will send you home with a hard copy of the prescription that you can then take to a pharmacy of your choice. If you use a local pharmacy, your family member can be given the prescriptions and while you are in surgery they can take them to your pharmacy and get the prescriptions filled.  If you have any concerns regarding your pain medication, be sure to discuss this with you surgeon or one of our RN’s. 

“My surgery is 2 weeks away, what time do I need to check in?”

Due to any schedule changes and emergent add on cases, we don’t set our surgery schedule until the day prior to surgery.  Our surgery scheduler will call you the afternoon prior to surgery. If your surgery falls on a Monday then we will call you on the Friday prior to surgery. When we call you, we will let you know what time to check in on the day of surgery. This is not your actual surgery time, rather it is just an arrival time.  This will give you time to get checked in and fill out any paperwork you may have.

Learn more about our orthopedic ambulatory surgery center (ASC) available for our Centralia and Olympia patients

By |January 10th, 2018|

Orthopedic Myths – Knuckle Cracking, Surgery Misconceptions, and More

#1: “Total joint replacements are only for the elderly.”

kayaking injury elbow pain

There is no age prerequisite to total joint replacements. While the rate of receiving a total joint replacement is great for ages 64-85, younger adults are more frequently receiving total joint replacements every year. In fact, one study analyzed the trend of knee replacements done in adults aged 45-64 over a ten year period ending in 2014 and saw a 188% increase in total knee replacements in that population over ten years. However, it’s best to keep in mind that the younger one is and the longer that person lives, the more likely they are to need a revision or replacement of their prosthetic. Studies show that 85% of total knee replacements last 20 years and that around 10% of patients will need a revision at some point.

#2: “Cracking knuckles causes arthritis.”

knuckle cracking cause arthritis?

No one can definitively say that cracking knuckles causes arthritis. In fact, studies have shown no difference in the prevalence of arthritis between those who crack and do not crack their knuckles. On the contrary, some anecdotal accounts have stated that cracking their knuckles has resulted in some cartilage damage and one study looking at the side effects of knuckle cracking noticed an increased rate in hand swelling and a weakened grip in those who crack their knuckles more often. Although cracking your knuckles may not cause arthritis, there may be a reason to avoid the habit anyway.

#3: “Do orthopedists really just perform surgery?”

orthopedic doctors in the surgery room

Contrary to popular perception, orthopedic clinics treat patients with a variety of musculoskeletal issues. Yes, many of the patients that enter an orthopedic office do require surgery. However, the number of patients requiring surgery is probably less than you’d expect. On average, only 2 out of 10 patients on any given day require some form of surgical intervention. What happens to the other 8 patients? Common non-surgical treatments often include physical therapy, anti-inflammatories, steroidal injections, muscle relaxants, casting and bracing, and referrals to other specialty clinics.

Ultimately, a trip to an orthopedic clinic doesn’t always result in surgery, nor should one expect to have surgery when entering an orthopedic clinic. Surgery should be seen as a last result of injury or chronic problem. The providers at Washington Orthopaedic Center(WOC) have a host of methods to treat your pain without the use of surgery. Call our office at 360-736-9777 to get scheduled with one of our orthopedic experts and discuss customized treatment options for you.

By |December 21st, 2017|

MRI’s Explained – Open vs. Closed Operating Systems

Magnetic resonance imaging (MRI) didn’t start as the technology we now commonly know. Researchers Felix Bloch and Edward Purcell first discovered the magnetic resonance phenomena in 1946 and later harnessed the abilities of magnetic resonance to analyze chemicals, leading to their Nobel Prize in 1952. Later on, scientists discovered the same technique could be used to visualize different human tissues. By 1973, aided by the rapid technological progression of computers, researchers developed the MRI that we now use today. Then, in 2003, the MRI led to another Nobel Prize, this time awarded to researchers Paul Lauterbur and Peter Mansfield for developing MRI as a diagnostic tool.

What is an MRI?mri-2813912_1920

An MRI uses a strong magnetic field and directs the field at a specific area of the object or person of interest. As the magnetic field enters different tissues and fluids within the body, hydrogen atoms become excited similarly to how a smaller magnet becomes excited as a larger magnet inches closer. Depending on the tissue or fluid that the hydrogen atoms are in, the atoms return to a resting state at different rates as the magnetic field is turned on and off several times. This allows a computer to analyze the different rates and create an image that shows a contrast in the different tissues and fluids.

The process of turning a magnetic field on and off is repeated numerous times over each body part being imaged and is then completed in multiple planes of motion. Collecting images through each plane of motion allows a doctor the ability to see an injury, or lack thereof, from each viewpoint. Resultantly, a doctor would then be able to develop the most accurate diagnosis to create the most effective treatment protocol.

MRI’s differ from x-rays in that they are more effective at demonstrating abnormalities in tissue samples rather than bone samples. For example, a torn or degenerative meniscus may present a decreased joint space in the knee as apparent on x-ray, but an MRI would show the actual torn or missing tissue of the meniscus that causes the decreased joint space. Without the MRI the diagnosis would not be confirmed and an effective treatment protocol could not begin.

How does an MRI show an injury?Washington Orthopaedic Center open MRI

Trained health professionals can locate a severed or partially torn muscle, tendon (connects muscle to bone), or ligament (connects bone to bone) by comparing the shape of the tissue of interest to that of a normal, healthy tissue. For example, a torn anterior cruciate ligament (ACL) in the knee may appear frayed at one end if torn. The frayed image appears as fluid from the knee flows around the torn ACL to encompass the tissue and project different rates of hydrogen atoms returning to a resting state as explained above, leaving only the tissue to present a darker contrasting appearance.

Open vs. Closed MRI’s

There are two kinds of MRI systems, open and closed, which differ by just a few key points.

  • Comfort: As one might expect from the name, an open MRI offers a much more comfort. For someone who is injured, sick, or claustrophobic, an open MRI presents a greater amount of restfulness when compared to the cramped spacing of a closed MRI system. As a result, a patient who is able to remain calmer during MRI imaging often gets a better picture of the area of interest due to there being less movement during the process.  In addition, the open space allows imaging technicians to place patients into positions that improve the quality of images, something that can’t always be done in a closed MRI.
  • Imaging Power: On the other side, closed MRI’s have greater imaging power (1.5 Tesla in closed MRI compared to 0.3 Tesla in open). Larger imaging power can result in a clearer MRI image if scanning a deep tissue sample. However, in the case of orthopedics, an open MRI’s power of around 0.3 Tesla is sufficient to obtain clear images of bones, muscles, and ligaments.
  • Cost: A sometimes significant cost difference is found between open and closed MRI’s due to the larger magnets closed MRI’s. Less upkeep is needed to maintain an open MRI system and can result in a price decrease of 40-50% when compared to the cost of a closed system.

Washington Orthopaedic Center offers an on-site open MRI machine in Centralia to improve convenience and comfort. Our imaging technologists are even kind enough to play your music of choice during your MRI to improve your experience, as the process typically takes between 30 – 60 minutes. Washington Orthopaedic Center also contains an x-ray imaging center to accompany the MRI machine. For the greatest convenience, without the hassle of wandering through a hospital, turn to Washington Orthopaedic Center for your care.

By |November 20th, 2017|

Dr. Dujela Chapter on Evidence Based Bunion Surgery

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By |November 3rd, 2017|

Frozen shoulder: from freezing to thawing, a guide to repossessing your shoulder

If you’ve experienced shoulder pain, you know it can be one of the most debilitating forms of pain. A painful shoulder can make everyday tasks like picking up a cup to sleeping seem impossible. The dull toothache feeling of chronic inflammation in a shoulder is enough to make just about anyone go mad. Sometimes, as ongoing shoulder pain prevents someone from using his or her shoulder, the condition can turn into a disease called frozen shoulder.

  • WomenWoman with pain in her shoulder on light background. Frozen shoulder
  • Adults of 40-60 years of age
  • Those with diabetes
Frozen shoulder most often occurs in a 3-step process.*
  • Freezing (6 weeks– 9 months): This phase begins with progressing tightness in the shoulder capsule as the tendons that comprise the shoulder movers become more stiff, scar tissue forms, and the amount of synovial fluid(lubricant for your shoulder joint) decreases. The freezing stage is typically the most painful stage.
  • Frozen (4-6 months): The shoulder capsule is extremely tight making daily activities very difficult. However, the pain experienced in the “freezing” stage is less severe.
  • Thawing (6 months – 2 years): The stiffness and pain in the shoulder slowly recede as daily activities become easier to complete.

As you can tell, recovery from a frozen shoulder is no quick fix.

Treatment, as always, begins conservative and progresses from there if treatments prove ineffective. The first stage of treatment involves the use of anti-inflammatory medications and gentle range of motion exercises. If this doesn’t do the trick, your doctor may recommend formal physical therapy for an extended period of time, a cortisone injection, or possibly an injection of sterile water into the shoulder capsule to help stretch the area, a process called joint distension. Normally, these treatments, along with time, do the trick. In special situations, surgery may be the last and only option left. If this is the case, consider the amount of treatments and time you’ve spent rehabbing your shoulder. Obtaining a second opinion may be beneficial as well.

Washington Orthopaedic Center’s physicians have over 40 years of experience treating frozen shoulders with great success. If you’ve been facing debilitating shoulder pain and immobility for an extended period of time, an orthopedic consultation with one of our four providers who treat frozen shoulder may provide an answer to your mysterious shoulder condition. Allow us to provide the tools you need to thaw your shoulder by giving us a call at (360) 736-2889 to set up your first consultation.

*Timeline according to the American Academy of Orthopaedic Surgeons

By |October 31st, 2017|