Thursday, 17 of January of 2019

Category » Orthopedic procedures

Celebrating July 4th



Happy 4th of July to you and your family from Dr. John Kagan and staff!  For most people, the 4th of July celebration means cookouts with family and friends, perhaps a day at the beach and certainly fireworks in the evening.

As we celebrate the anniversary of our country’s independence, it’s also a good time to celebrate just how far we’ve come in creating a better quality of life, free of pain and disability, for people with musculoskeletal injuries.

Did you know that the term orthopaedic comes from two Greek words, orthos for correct or straight and paidion for child?  It was a French surgeon named Nicholas Andry who first used the term in the mid 1700s when he published a medical journal on treating children’s skeletal deformities.

But references to treatment of musculoskeletal injuries go back thousands of years. In fact, Hippocrates, often called the “father of  medicine,” describes treating dislocated shoulders, knees and hips. The Egyptians used splints made from bamboo, reeds and bark; many of which been found with mummies discovered in Egyptian tombs.

If you enjoy history, the American Academy of Orthopedic Surgeons, which celebrated its 75th anniversary in 2008, published an interesting timeline of historical achievements, which can be viewed online at

Some of the highlights of the timeline include: the first use of antiseptic in 1865 on a patient with an open fracture, the discovery of the X-ray for diagnosing skeletal injuries in 1895 and the introduction of stainless steel for orthopaedic implant devices in 1926. Jump to more present day with the first total hip replacement in 1960, the first artificial tendon in 1965 and the first use of bone cement in 1970.

Every age has brought new discoveries that have advanced science and medicine and created the specialty of orthopedic surgery that we practice today. But it’s still fascinating to think about how far we’ve come and what is yet to be discovered.

Dr. Kagan has more than 30 years experience as a board-certified orthopedic surgeon. For more information on his services, go to or call 239-936-6778.

Choosing The Right Orthopedic Surgeon – 4 Things To Know

Choosing the right doctor is an important part of your treatment process, especially if you’re looking for a orthopedic specialist. But how do you make the decision about which physician is best? Here are a few guidelines to keep in mind.

1. Check The Doctor’s Educational Background

The first step in learning more about the doctor’s qualifications is to ask about education and training, which includes medical school, internship and residency training. The surgeon should also be board-certified, which means he or she has achieved a certain level of expertise by passing a rigorous national examination and demonstrating in-depth knowledge in a particular specialty. In addition, ask about ongoing training and certification, which ensures that the doctor values staying at the forefront of advances, such as minimally invasive and computer-assisted techniques.

2. Ask About Expertise

How do you determine the doctor’s level of expertise? Years of experience in practice is one indication. Just as important is how often the doctor performs the particular type of procedure that you are considering. Practice makes perfect. The more frequently the doctor undertakes the procedure, the better he or she will be at it and the better the outcome will be for you.

3. Find Out The Doctor’s Reputation in the Community

Chances are someone you know – friends, family member or co-workers may have first-hand experience with the physician you are considering. Another good source of advice is your primary care physician. Although it’s not essential, you might also find out if the physician participates in the community outside his or her private practice. For example Dr. Kagan and his partners are involved with Florida Everblades minor-league hockey team and the Minnesota Twins Baseball Team during spring training in Fort Myers.

4. Evaluate Your Comfort Level

Once the physician’s credentials have been established, you’ll want to make sure that you have a certain level of comfort, confidence and trust in the physician – that the doctor-patient relationship works for you and the doctor has your best interests in mind. For example, does the doctor take time to listen, answer your questions, address your concerns and explain exactly what will take place during the procedure? Patients today are more educated about their healthcare and most want to feel they have an important voice in their treatment options.

In addition to feeling confident about your doctor, you’ll also want to make sure that the office staff is friendly, professional and caring. When you call the office, is the receptionist pleasant? Are you placed on hold for very long? Are your messages returned? Is there a process for reaching the doctor after hours during an emergency? And finally, is your time respected? While you may occasionally wait longer than expected to see the doctor because of an unexpected emergency or other situation, an hour-long wait in the lobby gets tiresome very quickly.

Want to learn more about orthopedic surgery or find out Dr. Kagan’s scope of practice and expertise? Go to


List-Making Can Improve Communication With Your Doctor

Patients today are much more educated about health care thanks to the Internet. But good communication between patients and doctors can still be a problem for many people. Sometimes, patients may feel uncomfortable asking too many questions or they may be intimidated or confused by medical terms.There may be a lot of information to absorb at one visit. Or patients may have more questions once they get home and have time to think about it.

The American Academy of Orthopedic Surgeons suggests the best way to avoid any issues with communication is to be prepared by making a list in advance of your visit. You might want to keep your list on the refrigerator, at your desk, by the TV or even in your purse. That way when ideas come to mind, you can jot them down.

What should be included on your list? Here are some ideas:Make a list for your doctor

  • Jot down your symptoms with as much detail as possible; for example, when did they start, when does it hurt the most, is the discomfort constant or is it only at certain times of the day or during certain activities?
  • List all medications, starting with prescription meds, but also including any daily over-the-counter drugs, vitamins, herbal supplements, alternative medications or treatments and of course, any allergies to medications.
  • Summarize your medical history, which should include any surgery or major medical conditions you have had in the past or currently.
  • Write down questions you want to be sure to ask the doctor. Not sure what to ask? It is your right as a patient to ask about: 1) the benefits and risks of surgery, 2) possible complications, 3) treatment alternatives, 4) what you can expect after surgery in terms of recovery time, treatment outcome and level of discomfort after the procedure, and 5) what limitations you may have during recovery and long-term.

How else will help make your visit with the doctor more successful?

  • Bring recent X-rays, CT scans, or MRIs,with you. If you don’t have them, be sure to bring the name of the physician who ordered the tests and his or her contact information.
  • Be honest with the doctor. Don’t withhold information that might be important. Voice any concerns you may have and speak up when you don’t understand. Sometimes it’s a good idea to bring a family member or close friend to help you remember the information after you get home.

Do you have a visit scheduled with Dr. Kagan to discuss an orthopedic-related concern? The doctor offers easy-to-understand information about the latest treatments for orthopedic-related conditions at


Steps To Prepare Your Home Following Hip Replacement Surgery

A few weeks before you’re admitted to the hospital for hip replacement, you’ll want to begin making preparations for what to expect post-surgery during the recovery period. While some people may opt to spend a few weeks in a short-term inpatient rehab center, others prefer to go directly home.

If you do go home, remember that your spouse, a family member, friend or home health aide will need to assist you with daily activities for the first week or two since your mobility will be limited. You’ll need help with bathing, using the toilet, cooking, grocery shopping, and driving to doctor appointments.

To make your return home safer and more comfortable, here are some suggestions from the American Academy of Orthopedic Surgeons. Consider it your pre-surgery to do list.

1. Sleep on the first floor. You won’t want to climb stairs, so if your bedroom is not on the first floor, designate any area for sleeping. Consider renting a hospital bed rather than sleeping on a couch. You’ll also want the bathroom on the first floor. If necessary, get a portable commode chair.

2. Avoid anything that you could strain your new hip joint. Many of today’s beds are oversize and high off the ground. Be sure that you can sit on the edge of the bed and have your feet easily touch the floor.

3. You won’t want to stand for too long, so place a firm-backed chair in the kitchen, bedroom, bathroom or other room you use frequently. That way you can sit to rest and to do daily tasks.

4. You’ll most likely be using a walker at first. Attach a bag or basket to the walker and place frequently used items in it such as a notepad, pen, tissue, cell phone and the remote control. It will make your life much easier.

5. Make meals in advance and freeze them so you won’t have to worry about cooking. If family or friends ask how they can help, have them prepare a meal for you. Get all items, especially toiletries that you may need now. You want to avoid have to shop for last minute items after you get home.

6. To avoid slipping and falling in the bathtub or shower, consider getting a special rubber-tipped shower chair. At the very least, place non-slip suction mats on the floor of the bathtub or shower floor. Installing grab bars in the bathroom is also a good idea.

7. Temporarily remove all loose throw rugs and make sure that the lighting is good throughout the house. You don’t want to risk tripping and falling.

8. Small pets can get underfoot easily. Consider asking a family member to take them for a short time, have them boarded at the kennel or if appropriate, have them stay outside in the yard during the first couple days or week.

Hip replacement is a very common orthopedic procedure. As the number of baby boomers age, the number of people undergoing the surgery is expected to increase considerably. For information about how the surgery is performed, go to

Hip Dislocation

What does remodeling the house, falling off a ladder, a car accident or hurting yourself in a very physical sport like football, snow skiing, wrestling or basketball have in common? You have a greater risk of dislocating your hip joint.

It takes a lot of force to dislocate the hip, which is structured as a ball and socket joint to give you maximum range of motion and flexibility for walking, turning, jumping and sitting. The bottom of the thighbone has a ball-like shape, which fits into a cup-shaped socket in the pelvic bone. Dislocation occurs when a severe blow to the hip forces the thighbone out of the socket. A car accident is the most common cause of hip dislocation.

The American Academy of Orthopedic Surgeons calls a hip dislocation an orthopedic emergency that requires immediate assessment and treatment. The injury is very painful and temporarily immobilizes the joint. The joint may swell and look visibly deformed or out of place.

X-rays will allow the doctor to determine the extent of damage to the hip joint and to see whether there are other related injuries to the ligaments, bone or cartilage. Depending on the diagnosis, treatment can include reduction and immobilization, or for more severe injuries, surgery. Rehabilitation is required for best recovery.

What is a reduction? During this procedure the physician gently manipulates the thighbone back into place in the socket. It’s usually done under anesthetic in the operating room. After the reduction, then joint may be immobilized for a while until it is safe to begin rehabilitation. It can take several months for a dislocated hip joint to heal completely.

For more information about hip injuries, go to

Nonsurgical Treatment for Joint Pain

Surgery is not always the immediate solution to stiffness, pain and limited range of motion due to joint pain in your knee or hip. Before suggesting the most appropriate treatment plan for your condition, the doctor will take into consideration many factors, including the extent of damage to the joint and whether it was caused by a degenerative condition like osteoarthritis or injury due to an accident, sports or other factors. In many cases, the first step is a series of nonsurgical therapies. These may include one or more of the following.


Exercise can help manage joint pain and increase flexibility by strengthening the muscles that support the joint. Aerobic exercise that increases your heart rate, such as tennis, brisk walking, dancing, climbing stairs and swimming can improve circulation and help keep your weight at a good level, which decreases the stress on the joints of the knee and hips. Some patients may benefit from physical therapy sessions.


RICE, which stands for rest, ice, compression and elevation is always helpful for temporary management of joint pain. Heat therapy increases blood circulation and aids in stretching. Cold therapy with cold packs, ointments and sprays can reduce pain.


Over-the-counter analgesics, anti-inflammatory medications, non-steroidal anti-inflammatory drugs (NSAID) and pain relievers give temporary relief and can reduce swelling and tenderness. Prescription NSAID medications, such as Celebrex, may also be helpful. In addition, oral supplements like glucosamine and chondroitin sulfate can reduce swelling and discomfort.
Cortisone Injections

Cortisone injections are powerful anti-inflammatory agents that provide quick and effective temporary pain relief. However, cortisone can be given only a few times a year because of its effect on muscles and bone.

Joint Fluid Supplements

Hyaluronic acid is one type of joint fluid supplement that can act as a lubricant or “joint grease.” The supplements don’t cure the problem but will provide temporary relief from discomfort.

Supportive Devices

For patients with chronic knee pain, the American Academy of Orthopedic Surgeons recommends using a knee brace, cane, or wearing energy-absorbing shoes or inserts can provide some relief from pain by providing support to the joint.

For more information about treating joint pain, go to

Going Home From The Hospital After Knee Surgery

If you or a family member will be having knee surgery, you might be wondering what to expect when you return home from the hospital. How much discomfort will you be in? Will you be able to get by without help or will you need someone to assist you? How soon will you get back to your regular activities?

Here is an overview of what you can expect for the first few days and weeks after your knee surgery.

1. You will definitely need someone to assist you at home – preferably a spouse or another family member who can stay with you around the clock for a while until you feel strong enough to manage on your own. Because you will not be able to drive a car for about six weeks, you will also need to rely on someone to take you back and forth to doctor appointments, to the grocery store or other errands.

2. Exercise is vital to recovery. Short walks are good and will strengthen the muscles in the upper and lower leg, while helping stabilize the knee joint. You will also be prescribed specific exercises to improve the range of motion and flexibility in your knee. A physical therapy may come to the house or you may go for therapy at the doctor’s office or outpatient center. Expect to use crutches or a walker at first to help you get around. And be sure to rest frequently and not overdo it at first.

3. Medication will be prescribed for pain control. It’s much easier to prevent the pain that to “chase it.” Take pain medication about 30 minutes before physical therapy. Ice packs and elevating the leg will help reduce swelling and discomfort. A footstool can be handy for elevating your leg.

4. For a few weeks, If you can avoid, sitting in chairs that are low to the ground, chairs without arms or overstuffed furniture. It will be difficult to pull yourself up and out of this type of furniture.

5. Expect to use crutches or a walker to help you get around at first. The doctor will let you know how soon you can put weight on the leg and knee that underwent the procedure. Always lead with your non-operated leg and knee first.

6. Don’t leave preparations to the last minute – get your home ready a week or so before surgery. Have the laundry done, the house cleaned, food shopping done and meals frozen and ready for when you need them.

7. Remove throw rugs and eliminate clutter, including moving furniture if necessary, to avoid tripping or falling when you get home.

8. Some final tips for when you do get home:

• Don’t attempt to carry anything. Attach a bag or basket to your walker to make it easier to carry small items. Slide items along the counter rather than picking them up and carrying them.
• To make showering easier, use a hand-held shower hose and be sure to place a non-skid rubber mat on the bottom of the shower stall or bathtub.
• Use liquid soap so you won’t have to worry about bending over to pick up a bar of soap if you drop it.
• Avoid climbing stairs. If you do have to use stairs, make sure there is a handrail to help you.
• Expect full recovery to take approximately six to eight weeks.

For more information, visit

Physical Therapy After Orthopedic Surgery

After orthopedic surgery for injuries like rotator cuff tears of the shoulder, ACL injuries in the knee or joint replacement, physical therapy is a key part of rehabilitation.

Muscles, tendons, cartilage and bone may be weakened from injury and surgery and will need a structured program of progressive exercise. The goal of physical therapy is to help patients rebuild their strength, improve their range of motion and get back to their daily routine and independence faster. It also lessens the chance of re-injury at a later date.

Depending on the injury or surgery, complete rehabilitation may take several months. It also requires motivation. Exercises and putting weight on your injured limb may be uncomfortable at first, but following the instructions of your doctor and the physical therapist will allow you to gradually see a noticeable improvement in your mobility and level of pain. A walker, crutches, splints, ice packs and pain medication will be prescribed to help you cope during the rehabilitation period.

According to the American Academy of Orthopedic Surgery, early mobilization also helps improve circulation after surgery to reduce the potential risk for blood clots. If your surgery requires hospitalization, you can expect to begin physical therapy the day after your procedure. The therapist will assist you in correctly transferring from the bed to a standing position as you begin to put weight on your injured limb. You will receive a structured exercises to do both at the hospital and at home.

Patients recovering from a variety of orthopedic conditions can receive onsite physical therapy at the offices of Dr. John Kagan. For complete listing of orthopedic services provided by Dr. Kagan go to

What You Need To Know About Metal on Metal Hip Implants

There have been many media reports lately about metal-on-metal hip implants and the potential risk they pose. It can be confusing for patients and families to sort through the information and to know what action, if any, should be taken.

First, it’s important to understand how safe and successful hip implants have been for many years. Second, not every patient who has undergone hip replacement received a metal-on-metal implant. Implants may be made of plastic, ceramic or metal.

When metal-on-metal implants were first introduced, it was originally thought they were a superior technology due to their durability and other factors. Now we know they can cause serious complications. When the two metal implants rub against each other, tiny metal particles can flake off and lodge in the tissue or even enter the bloodstream and travel to the organs.

Metal on metal implants also have a higher than normal failure rate, possibly due to a build-up of metal particles in the tissue or an allergic reaction to the metal in the implants.

What’s being done? The FDA called a meeting this summer to discuss these concerns with experts from around the country. Final recommendations have not yet been made, but use of metal on metal implants has declined significantly.

What can patients expect? Only a very small percentage of patients are experiencing symptoms, but physicians are monitoring everyone who received a metal on metal implant to check for signs of adverse reactions. If you are experiencing new or significantly worse symptoms – swelling, pain, numbness or change in ability to walk, call your doctor. Blood tests can check levels of metal ions in the blood and X-ray or MRI may be useful.

To discuss your concerns with an experienced orthopedic surgeon who has performed thousands of joint replacement surgery procedures, please call 239-936-6778 or for more information go to

When Is Knee Replacement Surgery The Right Decision?

If you have chronic knee pain caused by osteoarthritis, eventually, the progressive, degenerative nature of the disease may mean that surgery is the best solution to relieve pain and improve your quality of life. Surgery reshapes the damaged portion of bone caused by the wearing away of cartilage and replaces the joint with an artificial implant.

Even though knee replacement is a very common and successful surgery, making the decision to undergo this procedure is a very big step. How do you know when the time is right to make this important decision?

Many people think of knee replacement surgery as the last resort –that their knee pain must be bad enough to severely compromise their lifestyle before they agree to an operation. But today, most medical experts agree that there is no reason to live with chronic pain. When conservative treatment fails to help, it’s time to consider more permanent measures.

According to the American Academy of Orthopedic Surgery, there are several important signs that you may be a good candidate for knee replacement surgery:

You have tried a variety of conservative, nonsurgical treatments, such as exercise, anti-inflammation and pain-relief medication, hot and cold therapy, and injections. However, these methods have failed to control the pain and improve your condition.

Knee pain wakes you up at night or prevents you from falling asleep.

You find that knee pain makes it nearly impossible to participate in recreational activities that you enjoy – golf, tennis, dancing, walking, shopping.

Knee pain makes performing every day activities, from getting out of bed or a chair to climbing the stairs or standing for very long, even to cook meals, painful and challenging.

Learning more about knee replacement surgery can help you make a better decision about whether it’s for you. Find out how it’s performed and what to expect at

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