Wednesday, 14 of November of 2018

Tag » Dr. John Kagan

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

Six Halloween Tips To Keep Children Safe



HalloweenAs the little princesses, ghosts and goblins come out in full force this Thursday, Oct. 31, for Halloween, here are a few suggestions from the American Academy of Orthopedic Surgeons to make sure your little trick-or-treater stays safe — and free from any orthopedic-related injuries.

Six Safety Tips

1.  Caution your child to walk on sidewalks whenever possible, to look for cars before crossing the street and to obey all traffic signals.

2.  Make sure that masks, hats and face paint do not block your child’s vision.

3.  Avoid the risk of tripping and falling by making sure that your child’s shoes fit well and are slip-resistant, and that costumes aren’t so long they drag on the ground.

4.  Carry a cell phone in case of an emergency.

5.  Pumpkin carving is fun, but be cautious. Use a pumpkin carving kit or knives specially made for carving. These are designed so they are less likely to get stuck in the thick pumpkin skin.

6.  If someone does get cut, apply pressure with a clean cloth and elevate the area above the heart. Then, clean the wound and apply a bandage. If the cut is deep or the bleeding doesn’t stop within 10-15 minutes, seek medical evaluation.

Halloween is the holiday with the fourth highest number of ER visits according to a study published in Pediatrics. Not surprisingly, children ages 10-14 had the most number of injuries – typically the age when parents are no longer directly supervising their activities. Finger and hand injuries from pumpkin carving and falls from long costumes or costumes that obstruct vision are the most common reason for a trip to the emergency department or a follow-up call with a doctor.

Accidents happen, but following common sense rules and paying attention may help avoid serious injury.  If you have a concern about an orthopedic-related injury this Halloween, or any other time of year, Dr. John Kagan is here to help.  Call 239-936-6778 or go to

October is Physical Therapy Month



In recognition of October as Physical Therapy Month, Dr. Kagan and staff want to acknowledge the importance of physical therapy in helping patients recover from orthopedic-related injuries and thank these professionals for the excellent work  they do every day.

Physical therapists are vital members of the healthcare team. They have completed a master’s degree or doctorate degree in their field and work hand-in-hand with doctors to help patients recover after everything from sports or workplace injuries, to traumatic car or workplace accidents, joint replacement surgery and other orthopedic issues.

“No matter what area of the body ails you – neck, shoulder, back or knee, physical therapists have an established history of helping people improve their quality of life,” reports the American Physical Therapy Association.

What exactly do physical therapists do? Physical therapists have specialized training in anatomy, the musculoskeletal system and kinesiology (the study of how the body moves), which allows them to prescribe various strategies that help reduce pain; improve mobility and range of motion; and prevent injury or re-injury. Often, physical therapy is the first step in the treatment plan when a patient comes for an orthopedic consultation. Physical therapy is also recommended following orthopedic surgery to help patients recover faster.

Just how effective is physical therapy? A study published in the May 2013 New England Journal of Medicine found physical therapy was a good first choice before surgery for moderate knee osteoarthritis and mild meniscus tears in the knee.

Congratulations to the many physical therapists who have helped our patients over the years.

For more information about Dr. Kagan or treatment for orthopedic-related conditions, go to

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.

How Exercise Can Help Joint Pain



shutterstock_127325003While joint pain from osteoarthritis may eventually require surgery, before then, it’s a good idea to explore all the non-surgical ways you can decrease discomfort and increase your range of motion. One of the most overlooked options is free, easy to accomplish and effective – exercise.

You might be thinking that exercise is the last thing on your mind if your joints are achy, tender and stiff. In fact, you might be inclined to move as little as possible. But medical experts will tell you that keeping up an appropriate fitness routine is exactly what you should be doing. In fact, Harvard Medical School calls exercise the secret to joint pain relief. It can definitely help improve the quality of your life.

Here’s why. Exercise strengths muscles, tendons and ligaments that hold the joint in place. It allows your body to stretch and be more flexible, helps maintain stronger bones and gives you more energy. It can also help control your weight, or loose weight, which can take pressure of the joints.

You may not be able to doing anything strenuous like run, play tennis or volleyball, but you could walk outside or on a treadmill, swim laps or do water aerobics, ride a bike or just perform stretching exercises at home or the gym. The key is to pace yourself and not overdo it. If you or a loved one is coping with arthritis and unsure which type of exercise is safe for you to perform, ask your doctor for a recommendation. Perhaps you might even consider a few sessions with a physical therapist if you haven’t been active in a while.

For more information about joint pain and treatment options, contact the office of Dr. Kagan at 239-936-6778 or go to


Shoulder Injuries – What to Expect



Football injuriesAs football season moves into full swing across the country, shoulder injuries are inevitable, whether players are NFL pros, college or high school athletes. Most of the time, injuries come from contact with another player as a result of a tackle, block or collision or fall to the ground. Even though players wear protective gear, rotator cuff injuries, sprains, strains, contusions and fractures are common shoulder injuries that can be sustained during the game or practice.

The American Academy of Orthopedic Surgeons describes the shoulder as several joints that combine with tendons and muscles to allow you to move your arm in a wide range of motion. Of course, this also makes the shoulder prone to injury.

But it’s not only football athletes who can suffer from a shoulder-related problem. The discomfort of bursitis, tendinitis or tendon tears, shoulder instability, impingement and osteoarthritis can affect anyone of any age or athletic ability.

If your shoulder is giving you chronic trouble, making it difficult to lift your arm or the pain wakes you up at night, don’t put off scheduling an evaluation to determine the cause and best treatment plan.

What can you expect during a consultation?

In addition to a physical exam, the doctor may order an X-ray or arthrogram, which involves injecting dye into the shoulder to help better visualize the joint and surrounding tissue. Sometimes, diagnostic imaging tests such as, CT Scan, ultrasound or MRI, may be required if the doctor wants to gain a more detailed picture of the anatomy, especially of the muscles, ligaments and tendons. Arthroscopy, which uses a tiny video-camera to allow the doctor to see inside the joint, can be used for both diagnostic evaluation and surgical repair of the problem.

For more information about shoulder pain or other orthopedic injuries, go to or call the office at 239-936-6778 to schedule a consultation.

Keep Seniors Safe By Preventing Falls



As an orthopedic specialist, I am concerned about the prevalence of falls among seniors. Falls are a leading cause of injury and disability for people age 65 and older. Seniors are especially at risk for fracturing their hip, as well as pelvis, shoulder, arm or spine. If the injury is serious enough, surgery may be required, which could require a lengthy recovery time and sometimes, loss of independence.

What causes such a high rate of falls among seniors? Medical factors such as arthritis, osteoporosis, irregular heartbeat and fluctuating blood pressure, as well as dementia, stroke, Parkinson’s disease, vision and hearing loss and urinary dysfunction are often to blame.

But lack of exercise from a sedentary lifestyle is also a factor. Weak muscles, loss of balance and poor condition all contribute to the risk for falling. The key is to stay physically active with regular exercise you enjoy.

Other concerns include side effects from medications, such as dizziness and lethargy. Ask your doctor to periodically review all medications you may be taking, including over-the-counter drugs and herbal remedies.

It’s also a good to look around your home and see if there are potential hazards that can be easily corrected. Here are several tips from the Lee County Injury Prevention Coalition’s Step Wise Lee program to make your home safer.

  • Get rid of small throw rugs or use double-sided tape to keep rugs stationary and eliminate the chance of slipping on them.
  • Clear all papers, books, clothes and shoes from hallways and stairs.
  • Fix all loose or uneven floors, particularly tile so you don’t trip.
  • Rearrange furniture so you have a clear pathway through halls and rooms.
  • Improve the lighting with brighter wattage light bulbs. Put night-lights in every room.
  • Install grab bars next to the toilet and in the tub or shower. Use non-slip bath mats in the tub or shower
  • Rearrange cabinets so items you use frequently are easy to reach, eliminating the need to use a step stool or chair.
  • Organize lamp, telephone and computer cords and other electrical wires so you don’t have to step over or around them.
  • Wear shoes in the house and outside – avoid going barefoot or wearing slippers.
  • If your home is more than one level, be sure to have handrails or banisters on all staircases.
  • Consider an alarm device that will call for help if you fall and can’t get up.

Dr. John Kagan has been treating orthopedic-related injuries for more than 30 years. For more information or to schedule a consultation, go to or call 239-936-6778.

Could Bursitis Be The Cause of Your Hip, Knee or Elbow Pain?



shutterstock_111719057Just like cartilage acts as a cushion between two bones, small jelly-like sacs called bursa act as a cushion between bones and muscles. Irritation and inflammation of the bursa in the shoulder, elbow, hip, knee and heel is fairly common, but that doesn’t make bursitis any easier to tolerate.  

What causes bursitis? Typically, it result from repetitive movements that stress the joint. Think of carpenters sawing lumber, painters kneeling for a long time to pain a baseboard, gardeners weeding or trimming bushes, musicians strumming a guitar and athletes pitching or throwing a ball. All of these activities increase the risk for bursitis.

How do you know if you have bursitis? The American Academy of Orthopedic Surgery repots that for hip bursitis, the pain usually begins at the point of the hip and spreads to the outside of the thigh area. It may be worse at night if you sleep on the affected hip and can also be painful after long periods of walking, squatting or climbing stairs. 

Medications to control inflammation and discomfort can be helpful, as can cortisone injections. Although it’s not a commonly performed procedure, some doctors remove a chronically inflamed bursa through arthroscopic surgery.

The Mayo Clinic offers the following prevention tips:

  • When possible, avoid repetitive activities that worsen the discomfort.
  • Take frequent breaks when performing repetitive tasks.
  • Use a cushion to protect joints, such as knee pads and elbow pads.
  • Increase the gripping surface on tools by using gloves, grip tape, or other padding.
  • Use an oversized grip on golf clubs and a two-handed backhand in tennis.
  • Use two hands to hold heavy tools.
  • Don’t sit still for long periods.

To schedule a consultation with Dr. Kagan,  call 239-936-6778 or go to for more information on orthopedic-related concerns.

Running Injuries – How To Treat & Prevent Them



shutterstock_110884610Running is a popular exercise these days that offers many benefits, from physical fitness to cardiovascular health. But it also puts runners at risk for orthopedic injuries that can range from bothersome to debilitating. What are some of the most common concerns?

  • Shin splints (pain that runs down the front or inside of the lower leg)
  • Stress fractures (tiny cracks in the leg bone)
  • Achilles tendinitis (inflammation in the tendon that attaches the calf to the heel)
  • Muscle strains or tears (hamstrings, quadriceps, calf and groin muscles)
  • Illotibial band syndrome (inflammation of the ligament that runs from the knee to the hip)
  • Plantar fasciitis (inflammation of the tissue on the bottom of the foot, from heel to toes)
  • Ankle sprains (stretching or tearing of the ligaments around the ankle)

Ankle sprains are one of the most common injuries for all sports, including running, says the National Athletic Trainers’ Association (NATA). A recent article in the New York Times reported on a NATA study that suggests “ankle injuries are often mistreated or not treated at all and should not be taken more seriously to prevent re-injury, prolonged discomfort, chronic ankle instability and greater risk of early arthritis in the ankle.”

How are ankle sprains best treated? The study recommends never walking on a sprained ankle or ignoring the pain. Instead, ice it right away.  Wrap the ankle in a compression bandage, prop it up and apply cold pack for 10 to 20 minutes at a time.  Go ahead and take an over-the-counter pain medicine, such as acetaminophen, but wait a day or two to begin taking anti-inflammatory medications such as ibuprofens.  Initial swelling is part of the body’s healing process, but after 48 hours, you’ll want to prevent the swelling from getting any worse.

Although X-rays are typically taken at the ER or a doctor’s office, the study suggests that a medical professional can usually diagnose an ankle sprain based on guidelines such as deformity, swelling, tenderness and inability to bear weight. Once the initial acute phase is over, “functional rehab” is recommended to help prevent re-injury. That means doing exercises that help strengthen the ankle and improve balance and flexibility.

Here are some suggestions for runners to help prevent injuries of all kinds, including ankle sprains. Warm-up and stretch before going for a run. Vary your fitness routine so you’re not running every day. Select a course that has a flat, smooth surface (be careful of running on the beach and sidewalk, which are uneven) and wear appropriate athletic shoes that fit well and are made for running.

For more information about ankle sprains or other orthopedic-related injuries, go to or call Dr. John Kagan at 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.

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