Integrating healthcare to deliver the highest quality patient care

Texas Medical Concierge is dedicated to helping patients achieve better health through the use of state-of-the-art resources available around the world. Earlier this month, Mr. Robert Stall, Executive Director of Cleveland Clinic International Operations & Ms. Aura Lopez, Manager, Center for International Medical Education, visited us at the Texas Medical Concierge Lounge in New Delhi.

Cleaveland Clinic Visit to TMC lounge

Cleveland Clinic is a top-ranked nonprofit academic medical centre founded in 1921.  The motto at Cleveland Clinic is “Every life deserves world class care”. Cleveland Clinic is dedicated to providing expert inpatient and hospital care through innovation, quality, teamwork and service. It is ranked as one of the top hospitals in America by U.S.News & World Report (2014). Contact Texas Medical Concierge for priority access to America’s No. 1 heart hospital for 20 straight years, Cleveland Clinic!

At Texas Medical Concierge we help you navigate the complex world of health-care by simplifying your search for a specialist doctor and the hospital best suited for your needs. Our tagline “integrating healthcare beyond borders” is possible through our cutting edge telemedicine services and relationship with centers of excellence. We facilitate super – specialized second opinion, medical travel services, tele – pathology and remote diagnostic services designed to deliver highest quality patient care.

The meeting that was held earlier this month looked at closer collaboration between Cleveland Clinic and Texas Medical Concierge.  Health Hub is a useful patient portal from Cleveland Clinic which offers a diverse range of information for the patients. Through Texas Medical Concierge, our patients can now have access to the content shared on Health Hub.

It is only through e-health and telemedicine that people living in the far flung rural areas can be adequately provided with healthcare cover. Texas Medical Concierge has a state of the art telemedicine lounge and we will arrange videoconferences with our telemedicine facilities for second opinion on the status of your health from the health professionals at Cleveland Clinic.

If you are seeking excellence in healthcare and access to the expertise and opinions of the world’s most revered experts hassle-free, then get in touch with us at Texas Medical Concierge. Here you will gain access to our esteemed panel of medical specialists with a wide range of expertise from anywhere in the world, including Cleveland Clinic!

In conversation with Dr. Jonathan Glashow, Co-Chief of Sports Medicine Orthopaedics at New York’s Mount Sinai Medical Centre

jonathan-l-glashow-md

We present to you excerpts from our conversation with Dr. Jonathan Glashow, a leading orthopaedic surgeon for over 23 years, who is widely respected for his precision and application of groundbreaking surgical techniques. For his superior patient care, Dr. Glashow has been awarded numerous distinctions. Castle Connolly a major healthcare research company has ranked him one of America’s Best DoctorsNew York Magazine has featured him in numerous annual Best Doctors issues, and he has been listed as one of New York Metro Area’s Best Doctors every year since 2000. Texas Medical Concierge asked him a few important questions on the latest in joint replacement surgeries, exciting developments in stem cell therapy and prevention strategies to avoid joint trouble.
Q1. In the field of orthopaedic medicine, new technologies, instruments and related advances in navigation, robotics and bone substitutes are expected to lead to less-invasive and more physiologic surgical interventions. Please explain to our readers the advantages of the latest innovations and current state-of-the-art techniques in the field of orthopaedics.

Dr. Glashow: “There are many advantages that come along with the latest innovations we currently use in Orthopaedic medicine. One of the most innovative amongst the current cutting-edge technologies is the use of robotics to perform partial knee replacements. Patients who previously would have needed a complete knee replacement, which includes the removal of all ligaments and cartilage, even though some may not be damaged, may now undergo partial knee replacements. A “mini” approach replaces a segment of what’s worn out in the knee with a small piece of metal and plastic. However, the undamaged ligaments and cartilage throughout the rest of the knee is left untouched.

An even more exciting technology is that of growing cartilage in a laboratory to perform arthroscopic cartilage repair surgery and arthroscopic ligament reconstruction. We are seeing the use of Biologics and stem cells in many areas.  Increasing the odds of success and increasing the rate of recovery after arthroscopic repairs of both the shoulder and knee, are just one of their many benefits. These innovations have brought about a significant change by returning patients to their daily routine, faster than ever before. These cutting-edge technologies and early treatment of patients at the onset of their issues can have patients back in their daily routine faster than ever. Not only that, but also return the patient to activity/sport at a higher functioning level than prior to injury.”

Q2). What are some of the biggest changes you have seen in orthopaedic surgery over the last five years?

Dr. Glashow: “One of the biggest changes Orthopaedics has seen in the past five years is the drive for a much more minimally invasive surgery. Using technologies such as Robotics and Biologics, we can now approach many issues on a drastically smaller scale, performing surgeries on an ambulatory basis with the smallest incisions and shortest downtime seen yet to date. Our philosophy in Sports Medicine Orthopaedics has shifted from waiting for smaller issues to become larger before addressing, to just the opposite! Today it is about addressing the smaller issues with precise technology.  Tackling these issues before the problems of today becomes much worse, leaving fewer options for treatment tomorrow.” 

Q3). What, according to you, are the primary causes of joint trouble?

Dr. Glashow: “Joint troubles are multifaceted and have different levels of complexity. For some people, the cartilage simply wears out sooner than others in the natural degradation of joints. We cannot control the natural deterioration of cartilage or joints but there are some factors that we can control. Early injuries during our teen or early adult years that involve cartilage or ligament damage often develop into problems that require joint reconstruction midlife. If we identify and repair these cartilages, ligament or tendon injuries early on, we can often prevent the progression of arthritis, which is far more difficult to address should one wait for treatment.”

Q4). Could you tell our readers about shoulder instability and when to use bone grafting around the shoulder?

Dr. Glashow:”The shoulder is comprised of what we call a ball and socket joint and is the most movable joint in the body. Because of this constant use, the shoulder is subject to overuse injuries, such as shoulder instability. The shoulder is also the most frequently dislocated joint in the body, this is in part due to the fact that the “ball” the Humerus, is very round and the “socket” the Glenoid is very flat. Numerous dislocations and postponing medical treatment for a dislocation can often lead to damage of the Glenoid and Humerus and can make for a very challenging soft tissue reconstruction. I often recommend medical treatment for shoulder instability issues after the first or second injury to prevent bone damage. It is only after severe bone damage has occurred, where at least 20% of the Anterior Glenoid Rim is affected or that of a Hills-Sachs Lesion, that I suggest bone substituting procedures such as bone grafting and bone transfers such as that of a Latarjet. Performing these procedures through the use of Arthroscopy or by a very limited open approach, I find bone grafting and transfers to be treatments of choice. This is especially true for the high-level, high risk, collision athlete such as those of the National Football League (NFL).”

Q5). Could you please share some exciting developments in using stem cell therapy to treat orthopaedic health issues?

Dr. Glashow: “We are learning more everyday about what therapeutic effects stem cells are capable of, in the field of orthopaedics. There are several recent peer-reviewed articles that suggest the value of stem cells in the treatment of early to moderate arthritis in the knee and now shoulder as well. We now know through limited liposuction like techniques, we can generate enough stem cells to centrifuge and then install what’s been gathered into the joint. These innovative technologies may prevent the need for joint replacement surgery in early stages of arthritis. In the near future, I am personally attending a stem cell conference where I will be joining an IRB (Institutional Review Board) to study and observe the continuing advancements. Aside from it being a minimally invasive and a forward procedure, I have learned through my use of stem cell therapy in my patients, that there is great promise for this treatment with little to no down time.”

Q6). And finally, could you tell our readers some of the steps that they can take to avoid or delay joint replacement surgery?

Dr. Glashow: “As briefly touched upon earlier, the most effective way to prevent the need for a full joint replacement later in life is by the treatment of cartilage injuries or ligament problems before they become much larger and complicated. “If you feel something, say something” Addressing small issues today, prevents issues from being worse tomorrow. Keeping one’s weight and fitness on track are also very helpful keys in keeping both those ligaments and muscles strong and joints healthier. When genetics play their role in bone and muscle health, which we cannot control, it is best to seek medical advice early as there are alternatives to traditional invasive joint replacement, in forms of partial replacements and surface replacements. These procedures offer patients a far less invasive experience, often slow the progression of arthritis and prevent the need for full joint replacement.”

Texas Medical Concierge is delighted to provide priority medical access and advisory services with the Co-Chief of Sports Medicine Orthopaedics at New York’s Mount Sinai Medical Center, Dr. Jonathan Glashow through our Concierge Services in various international cities.

Painful Knees? We are here to help!

 

In modern times, doctors are encountering a greater frequency of young individuals with advanced knee arthritis. Osteoarthritis was once thought of as a disease prevalent in elderly people.  However, it is becoming more and more common in women and in patients 20-50 years old.  People with knee pain know how miserable & debilitating it can truly be!  A history of prior injuries, for example, after a sports injury of the meniscus and anterior cruciate ligament (ACL) also sets the stage for developing conditions that cause pain in the knees.

Women are three times more at risk for arthritis than men are, especially menopausal women. You will definitely need a confirmed diagnosis of arthritic pain, for sure. However, the constant pain and ruthless clicking sound of the knee bones yelling at the other parts of the leg is a sure and unmistakable sign as well. According the Journal of Bone and Joint Surgery (JBJS), there will be a 670 percent increase in total knee replacements (artificial joints) by 2030, which may include you unless you take steps to avoid it.

Treating Knee Pain- Prevention & Relief

  • See your primary doctor first-

First of all, you need to discover the cause of the pain. The start of any good diagnosis is a careful history and physical exam. It is best to not ignore the ache and pain in your knees and get yourself thoroughly checked up. This includes getting X-rays and especially a high-field, high-quality magnetic resonance imaging (MRI) done. These techniques add significantly to the accuracy of the diagnosis.  If the diagnosis is a minor injury to the ligaments or soft tissues, you won’t need surgery. Non-operative care of knee joint injuries has vastly improved over the past 10 years and if you’re looking for help, Texas medical Concierge offers a vast array of integrative healthcare solutions suited for your wellbeing.

  • Consult a specialist-

Persistent pain, inflammation and swelling, ligament tear, and dislocation of the knee cap require prompt action. Timely treatment can help preserve joint function and prevent permanent joint damage & other serious health problems. Discuss options like treatment with sudamenafin or anti-inflammatory medications with your doctor to reduce knee pain. Consult your doctor; it is important to be well informed about the safe use of these pain relievers.

  • Other Treatment-

1. Hyaluronic Acid (HA) Injection:

Hyaluronan is a naturally occurring substance present in the synovial fluid that surrounds the joints. It functions as a shock absorber and helps to lubricate joints by providing a cushion between cartilages of the knee. During osteoarthritis, the synovial fluid has lower levels of hyaluronic acid thereby making the joints less “greased” and less able to protect the bones and cartilage from damage and destruction. Hyaluronic acid (also called hyaluron and hyaluronate) joint injections replace some of the natural supply in the affected knee in order to return some mobility to the affected joint. Anti inflammatory gel to relieve pain or HA injections are a FDA approved viscous lubricant derived from mostly from a rooster comb. Therefore, if you are diagnosed egg, bird, poultry, or feather allergies then you must talk to your doctor and avoid using this medicine. However, there are a few exceptions which may be a safer option for people with allergies. These include the non-avian derived hyaluronic acid which derived from bacteria instead, Orthovisc & Euflexxa.

2. Platelet-rich plasma (PRP) injection:

Many famous athletes — Kobe Bryant, Tiger Woods, Rafael Nadal, to name a few— have received PRP injections for various problems, such as sprained knees and chronic tendon injuries. Our blood can be separated into two parts- a pale yellow liquid called as plasma, and cells such as red cells, white cells, and platelets. Platelets are best known for their role in clotting blood; however, they also contain hundreds of proteins called growth factors. This is an autologous blood therapy that uses the patient’s own blood components to stimulate a healing process. A typical PRP preparation can have 5-10 times greater concentration of platelets and growth factors (proteins) to speed the healing of the injury site naturally.

3. Bone Marrow Concentration (BMC) injection:

This is a promising regenerative therapy to help accelerate healing of inflamed joints. In essences, it is similar to therapies that use Platelet Rich Plasma (PRP) fractions. BMC utilizes the regenerative cells found in a patient’s own bone marrow to produce an injectable product.  This injectable product contains all of the growth and healing factors that were present in PRP, along with concentrated “pluripotent” or stem-like cells which further contribute to the regenerative process.