Wednesday, 14 of November of 2018

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What Are Non-Steroidal Anti-Inflammatory Drugs?



shutterstock_163544123Happy Thanksgiving from Dr. John Kagan and staff to all of our patients and their families. We are grateful for the support we have received from the Southwest Florida community for more than three decades. In this week’s blog we address Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), which are the most frequently prescribed medication on the market today for people with osteoarthritis, bursitis and tendonitis. NSAIDs relieve pain, reduce swelling and inflammation, and help lower fevers.

Most people know NSAIDs by their brand name, such as Advil, Motrin, ibuprofen, Aleve, Ecotrin and aspirin, all of which are available over the counter without a prescription. A higher-dose strength NSAID is available by prescription only. These medications include Celebrex, Naprosyn, Voltaren, among others. NSAIDs are very effective and considered reasonably safe, but there are potential side effects to consider.

According to the American Academy of Orthopedic Surgeons, NASIDs work by preventing an enzyme in the body called COX from doing its job. One form of the enzyme, COX-2 (cyclooxygenase), is created when a joint is inflamed or injured. But another form of the enzyme, COX1, protects the lining of the stomach from digestive acids. Blocking this protection can increase the risk of stomach pain and bleeding, heartburn and ulcers.

In addition, NSAIDs reduce the blood-clotting ability of the blood, which may be positive for some people, but could be harmful to others. Be sure to talk with your doctor before taking an NSAID if you already take a blood-thinning medication such as Coumadin for heart disease. A warning label appears on every NSAID bottle or package that cautions about the increased risk for heart attack, high blood pressure, stroke or stomach bleeding in certain people who take the drugs. NSAIDs may also cause a severe allergic reaction in some people, as well as interfere with liver or kidney function.

To reduce any potential complication, talk with your doctor about whether NSAIDs are right for you and the dose that is best. In general:

1) Take the lowest dose of NSAID that brings pain relief.

2) Don’t take NSAIDs longer than is necessary and take only the dosage prescribed for you.

3) Be sure to let the doctor know about any pre-existing medical conditions you may have, such as high blood pressure, asthma, or a history of ulcers, kidney or liver disease, heart attack or stroke – as well as other medications that you may be taking that could interfere with NSAIDs.

If you have any questions or concerns, do not hesitate to call of our office at 239-936-6778. For more information about orthopedic-related conditions and treatment, go to

Can Diet Make A Difference With Osteoarthritis?



We’ve all heard about a heart-healthy diet to reduce your risk of cardiovascular disease. But what about osteoarthritis? Is there an “arthritis diet” that will make a difference in alleviating the pain, stiffness and swelling associated with chronic joint disease?

Healthy Diet

An article in the November issue of Arthritis Today, reports that yes, a balanced, nutritious diet does make a difference when it comes to managing osteoarthritis and may even reduce your risk of developing it. What type of diet is best? One that emphasizes plant-based foods, says Ruth Frenchman, a spokesperson for the American Dietetic Association, who is quoted in the Arthritis Today article. Here are some of her suggestions for a joint-friendly diet:

*Small portions are the key. As you get older you need to eat less to stay the same weight. Maintaining a healthy weight reduces stress on the joints. You can also cut down on extra calories by avoiding sugary foods and limiting carbohydrates.

*Two-thirds of your daily diet should come from fruits, vegetables and whole grains. How much is enough? The recommended daily serving of fresh, frozen or dried fruit for the average adult is one-and-a-half to two cups. But be careful of fruit juice, which is high in sugar. For vegetables, here is the rule of thumb: eat two to three cups of vegetables daily, preferably dark green and orange vegetables, such as spinach, broccoli, greens, sweet potatoes, carrots and squash.

*Choose whole grains and lean, low-fat meat, poultry and fish, or dried beans, peas, nuts and seeds.

*Add low-fat or no-fat calcium-rich dairy products to help maintain strong bones. A total of three cups of cheese, milk or yogurt daily is recommended. Keep in mind that one-and-a-half ounces of cheese equal one cup of milk.

But it’s not only eating healthy that is important; maintaining an appropriate weight for your body type is also essential. Did you know that each pound you gain adds nearly four pounds of extra stress to your knees and increases pressure on the hips six-fold? The extra weight can eventually damage the cartilage that cushions and protects the joints, especially in the hips and knees. 

The Arthritis Foundation also reports that new research is showing a potential link between diabetes, blood sugar and joint damage – yet another reason to eat healthy and manage your weight. High blood sugar levels may trigger inflammation and “cause the formation of certain molecules that make cartilage stiffer and more sensitive to mechanical stress.”

Dr. Kagan and his staff certainly recommend eating a nutritious diet, keeping your weight down and making sure that you exercise regularly. But despite your best intentions, osteoarthritis may affect your quality of life. If chronic joint pain begins to limit your day-to-day activity level, we are here to help. Call us at 239-936-6778 or go to for more information.

AAOS Co-Sponsors Distracted Driving Campaign



Photo Credit: IntelFreePress/Flickr

Photo Credit: IntelFreePress/Flickr

This week, as Florida bans texting and emailing while driving, Dr. Kagan joins the American Academy of Orthopedic Surgeons in raising awareness about the dangers of driving while distracted.

For the past few years, the AAOS has co-sponsored a major national campaign titled, “Decide to Drive,” that emphasizes how easy it is to be distracted and how quickly accidents can occur.

“If you’re doing something else while you’re driving, you’re not focused on the road, and orthopedic surgeons would much rather keep bones strong them put them back together after a traumatic accident,” says an AAOS spokesperson about why the national medical organization has put so much effort into education about this important safety issue.

According to the Florida Department of Transportation, nearly 5,500 people have been killed since 2009 and an additional 448,000 injured from motor vehicle crashes related to distracted driving The National Safety Council (NCS) estimates that nearly 28 percent of crashes — about 1.6 million a year — can be attributed to cell phone talking and texting while driving.

While texting, emailing and talking on the phone are a major cause of distracted driving, they are not the only concerns.  Reaching over to adjust radios ,portable music players or navigation systems, eating and drinking, applying makeup, brushing your hair, reading a map or newspaper, and children and pets in the backseat are all potential distractions that can cause drivers to take their eyes off the road, hands off the wheel and mind off the task at hand, says the AAOS.

Here are some recommendations from the AAOS to make sure you arrive safely at your destination.

Before Starting Your Car:

  • Put on sunglasses and other accessories such as Bluetooth ear pieces
  • Adjust seats, headrests and mirrors
  • Fasten your seat belt
  • Adjust the music volume
  • Enter address in your GPS navigation system
  • While You’re Driving
  • Don’t talk on the phone, text or email
  • Don’t eat or drink, change your clothes or groom yourself
  • Pull over any time there is a major distraction such as disciplining a child, retrieving an item, or looking at printed directions

Dr. Kagan strongly supports the AAOS slogan, “Behind the wheel, there is no such thing as a small distraction.” For more than 30 years, the doctor has been serving the orthopedic needs of Southwest Florida.  For information on the practice, go to or call 239-936-6778.

Don’t Let Your Golf Swing Limit Your Game: Tips For Avoiding Common Golf-Related Injuries



shutterstock_3009221It’s not a surprise that golfing is one of the most popular sports in Southwest Florida. Top quality courses designed by all the pros, ranging from Arnold Palmer to Tom Fazio, are easy to find and enjoyable to play.

Most people think of golf as a relatively low-impact sport. But a variety of factors can contribute to shoulder and rotator cuff pain, low back pain, and injuries to the hand, wrist and elbow.

According to the American Orthopaedic Society of Sports Medicine, one of the best steps you can take to reduce your risk of injury is to warm up slowly before stepping up to the tee. It’s also critical to follow proper body mechanics and learn good technique.  In addition, participating in regular exercise off the course can help you build core strength and keep muscles and joints more flexible.

The most injury prone aspect of golf is related to the swing and how you grip the club.  Avoid swing-related injuries with these suggestions from the Mayo Clinic.

Stand with feet shoulder-width apart, don’t strain your neck or back by hunching over the ball and distribute your weight equally on both feet.

Make sure your swing is smooth, easy and relaxed; don’t over-swing by trying to hit the ball too hard or too fast. Duffs, or hitting the ground during the swing, along with over-swinging and twisting the spine during the swing are very common – and a major reason for muscle and joint pain in the shoulders and back.

Shoulder and back injuries can also be related to lifting clubs out of the car, or carrying your bag improperly. Remember to use good body mechanics when lifting and carrying anything, including golf clubs.

Prevent grip injuries to the hand, wrist and elbow by selecting the correct club length and using a neutral rather than tight grip. Elbow pain is often related to overuse – don’t overdo it and strain the ligaments and joints. Like any sport, don’t play through pain or play too many days in a row without rest.

Minor aches and pains can be treated with cold or heat and topical creams, as well as over-the-counter anti-inflammatory medications.  If you have ongoing problems, consider taking lessons from a golf pro. But if you have serious muscle or joint pain, get an evaluation by an orthopedic specialist. For more information, go to or call 239-936-6778.

Don’t Let Hip Pain Slow You Down



Hip pain is a common orthopedic complaint

What do former Olympic gymnast Mary Lou Retton, singer Billy Joel, former president George Bush and golfer Jack Nicklaus have in common?  Each suffered from years of chronic hip pain until they decided to undergo successful hip replacements surgery.

At age 37, Retton was younger than most hip replacement patients when she had surgery.  But years of rigorous training, plus a congenital hip deformity, made it almost impossible for her to be active without surgery. Nicklaus was in his late 50s by the time he decided to have the procedure done. The pain from osteoarthritis had become severe enough to prevent him from enjoying golf and playing with his grandchildren.

While hip pain can be debilitating and disabling, there are many surgical and nonsurgical treatment options to take away the pain and return patients to an active lifestyle.

Hip Anatomy

The first step is to understand how the hip joint works.  One of the body’s largest and strongest joints, the hip joint is designed as a ball and socket, with the rounded end of the thighbone fitting into a socket formed in the pelvis bone.

Cartilage covers the surface of the bones and acts as a cushion to reduce friction during movement.  Muscles, tendons and ligaments connect the bones and keep the hip joint stable, allowing us to run, walk, jump, climb, turn and sit.

While the hip joint is built to handle a significant amount of pressure, accidents, degenerative conditions like osteoarthritis, and activities that repeatedly overstress the joint can lead to problems.

The most common complaint is sharp or lingering pain that may begin in the hip area and radiate to the lower back, thigh, buttocks or groin.  Many people find the hip joint feels stiff.  Others experience swelling, redness or tenderness to the touch.  All of these symptoms are signs of an underlying problem that will need to be evaluated by a specialist so appropriate treatment can be prescribed.

Nonsurgical Treatment for Hip Pain

Not all hip pain requires surgery.  It all depends on the reason for the discomfort. Runners, cyclists, tennis players and soccer players are often prone to “overuse” injuries, leading to inflammation and irritation of the hip tendons, or tendonitis. Pain occurs when the swollen tendon rubs against the pelvic bone. Rest, ice, anti-inflammatory medication, injections and physical therapy can be helpful in treating tendonitis.

Tight muscles or muscle imbalance can also cause hip pain.  Both athletes and people who sit for long periods of time, especially at a computer, are prone to tight hip flexors, hamstrings and abductors.   Stretching exercises that promote flexibility in this area can help reduce discomfort and correct imbalances.

Bursitis is another common cause of hip pain.  The bursa are fluid-filled sacs located near the joints in the body.  Like cartilage, the bursa serve as a lubricating cushion, but rather than covering ends of the bone, the bursa are located between the bone and muscles or tendons.

Bursitis occurs when the bursa becomes inflamed and irritated, making walking, climbing stairs and even crossing the legs painful.  Treatment usually includes rest, ice, anti-inflammatory medication and injections.

When Surgical Intervention is Required

Surgery is indicated for more serious causes of hip pain, including fractures, dislocation and osteoarthritis.

According to the American Academy of Orthopedic Surgeons, about 10 million men and women in the U.S. have osteoarthritis, a common degenerative condition of the joints that causes stiffness, pain and disability.

Osteoarthritis is often called the “wear and tear” arthritis.  In its advanced stage, there is chronic inflammation of the joint, the development of bone spurs around the edges of the joint and the wearing away of the cartilage that cushions the bones. Osteoarthritis of the hip makes it difficult to rotate or flex your hip. Walking, sitting, climbing or any activity can be a challenge.

There isn’t a “cure” for osteoarthritis, but the discomfort and disability can be alleviated with treatment.  When nonsurgical interventions fail to provide relief, arthroscopic surgery, which can include hip resurfacing, total hip replacement or minimally invasive hip replacement, is the answer.  An estimated 230,000 hip replacement surgeries are performed in the U.S. every year.

For more information hip pain and treatment options, go to or call the office for a consultation at 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


Sprains & Strains

Whether you’re a teen playing high school sports, an adult who is an avid runner or a senior who plays weekly doubles tennis, chances are that at some point, you’ll experience the discomfort of an occasional sprain and strain – the most common injury sustained in sports today, reports the American Academy of Orthopedic Surgeons.

Many people think of sprains and strains as the same injury. They’re similar, but distinct. Here’s the difference.

A sprain occurs when you overstretch or tear a ligament. For example, step awkwardly off the curb and land on the side of your feet and chances are you’ll sprain your ankle. Jump down from break wall at the beach onto a sidewalk and you can twist and sprain your knee. Or try to break your fall by stretching out your arm and chances are you’ll sprain your wrist or shoulder.

When you sprain something, it means that you’ve injured one or more ligaments, the fibrous band of connective tissue that connects the bones and stabilizes the joint. Overstretching or tearing a ligament puts pressure on the joint and can force it out of alignment.

A strain is an injury to a muscle or tendon. Just like ligaments connect the bones, the tendons connect the muscles to the bones. Overstretching or the opposite, contracting a muscle or tendon, can cause injury. Chronic overuse and repetitive movement, perhaps caused by intensive training, can set up a repetitive injury cycle.

Who’s at risk for sprains and strains?

Just about everyone, but especially athletes. RICE or rest, ice, compression and elevation are typically the first line of defense prescribed by the physician. Anti-inflammatory over-the-counter medication can also help reduce swelling and decrease discomfort.

But a severe sprain or strain may require medical treatment. If the pain and swelling continue after initial treatment with RICE, call your doctor. You may need X-rays, more intensive treatment or even physical therapy to help strengthen and rebuild the injured tissues.

Prevention Tips

It’s not always possible to prevent a sprain or strain if you’ve an avid athlete. But NIAMS (The National Institute of Arthritis and Musculoskeletal and Skin Disease) offers these prevention tips: 1. Wear appropriate shoes for the sport and make sure they fit well. 2. Warm up and stretch before intensive exercise. 3. Run on flat surfaces. 4. Stop exercising when you’re tired or in pain.

Want to know more about orthopedic-related injuries? Go to

Back Safety For The Holidays: Travel, Tree Trimming and More

Tis the holiday season and time to reflect on the many blessings in our lives and to enjoy the company of friends and family. But it’s also the time of year when we’re busier than ever and often feeling stressed, which can show up as tense shoulders, neck and back pain. Add to that all the lifting, pulling, pushing and twisting we do to clean and decorate the house, set up the tree and put up the outdoor lights. It’s easy to hurt yourself or aggravate old injuries.

For many people, the holidays also mean traveling by airplane to visit to family and friends. And improperly lifting or carrying heavy suitcases and carry-on bags can literally be a real pain in the neck. Even if you’re not traveling, heavy shopping bags full of presents can put a strain on your back, shoulders and neck, too.

Here are some holiday safety tips from the American Orthopedic Association:

Choose the right luggage. Two smaller bags are easier on your back than one heavy one – and make sure you are using a lightweight suitcase with a handle, one you can pull behind you, not carry.

Lift properly. Bend your knees and lift using your leg muscles, being careful not to twist your spine. Never stretch and reach for anything heavy – that’s a sure way to hurt your back. Carry heavy suitcases or shopping bags close to your body for better balance and carry the bags in both hands, rather than on just one side. The same applies to backpacks. Carry a backpack over both shoulders rather than slinging it onto one shoulder only.

Be careful of overhead compartments. Lifting your luggage into an airplane’s overhead compartment can be a challenge, especially if you don’t have a lot of upper body strength. Don’t lift your bag straight up into the compartment. Instead, lift luggage onto the top of the seat. Then place both hands on either side of the suitcase and lift up. If your luggage has wheels, put the side with wheels in first; then push the bag to the back of the compartment.

Ask for help and avoid rushing. If your suitcase is heavy or awkward, ask a flight attendant for assistance. It’s not worth attempting it yourself and making your holiday miserable because of neck or back strain.

Dr. John Kagan and his staff wish all of their patients and their families a safe and happy holiday. For more information about orthopedic-related medical conditions, go to

NSAIDs for Joint Pain

NSAIDs or non-steroidal inflammatory drugs are the number one choice for everything from headaches, colds, muscle aches and stiffness to minor orthopedic injuries like a sprained ankle or pulled muscle.

According to the American Academy of Orthopedic Surgeons, NSAIDs are also the most commonly prescribed medication for joint pain related to osteoarthritis in the hip, knee, elbow and shoulder.

Chances are that at some point in your life, you’ve benefited from taking an NSAID, which includes the familiar list found in most people’s medicine cabinets: aspirin, ibuprofen, Motrin, Advil and Aleve, all of which are available over the counter without a doctor’s prescription. Relafen, Celebrex and Naproxen are also NSAIDs, but require a doctor’s prescription.

How NSAIDs Work For Joint Pain

NSAIDs relieve pain and discomfort, lower fevers and reduce inflammation, which is why they are so effective for joint pain caused by osteoarthritis, a degenerative inflammatory disease that breaks down the cartilage cushioning the bones.

More specifically, NSAIDs block an enzyme called clocooxygenase or COX from being released by the body. There are two forms of COX: COX-1 helps maintain kidney function and protects the lining of the stomach from stomach acid, while COX-2 is produced when joints are injured or inflamed.

A Few Precautions

As with all medications, NSAIDs have potential side effects. For NSAID’s that means possible gastrointestinal stomach upsets, including ulcers and GI bleeding. To reduce this risk, it is generally recommended that you take NSAID medications with food and to not exceed the recommended dosage.

NSAIDs can also prevent blood clotting, which makes them helpful for people at risk for heart attack and heart disease. But the drugs’ anti-blood clotting properties can also make them a problem for people with heart disease who already take blood-thinning drugs. Because of these possible medical concerns, your doctor may prescribe an NSAID like Celebrex, which only blocks the action of COX-2 – it does not affect the lining of the stomach or interfere with blood clotting.

If you are unsure about whether it is safe to NSAID medications – or which ones, ask your doctor. While ultimately, patients with severe joint pain may need surgery to gain adequate pain control and restore mobility, most of the time non-surgical treatment that includes NSAID medication can be very effective, at least in the initial stages of osteoarthritis.

For more information about joint pain, go to

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