Neurologic & Orthopedic Hospital Blog — Drs. Cerullo & Sheinkop, Chicago

Complicated Treament Decisions

May 8, 2008 – 3:39 pm
Speaking of decisions. I saw a young lady today, about 30 years old. She was diagnosed with a pituitary tumor about five years ago during an evaluation for lactating breasts and irregular menstrual periods. Luckily, the tumor was small and of the type which could be treated with oral medications. She began taking the pills, which she tolerated well. Her periods became regular, and she stopped the treatments. She had no desire to become pregnant at the time. Her symptoms (irregular menses and galactorrhea) recurred, so she resumed the medication. Now, four years later, she remains free from symptoms on treatment but desires pregnancy. She has the option of continuing the medication while becoming pregnant or undergoing surgery. She was told there are small risks to the fetus if she becomes pregnant while taking the medicine for her tumor. On the other hand, there are risks of surgery, including the ...

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Procedures Cut Pain After Joint Replacement

April 28, 2008 – 5:21 pm
If it’s the fear of pain, of being immobile and dependent on others and months of rehabilitation that keeps you from undergoing hip or knee replacement, let us at the Neurologic & Orthopedic Hospital of Chicago (NOHC) tell you about our accelerated recovery technique. Since mid 2007, the joint replacement surgeons at NOHC use three practices to reduce pain, reduce blood loss and speed up recovery. First we use minimally invasive (M.I.S.) techniques that reduce blood loss, pain and enhance recovery. I was part of the team of several orthopedic surgeons that created M.I.S. approaches for the hip and knee starting in 2001. The national average for blood replacement is 33 percent. Our rate for hip and knee replacement is under 8 percent. The second part of the technique involves using regional rather than general anesthesia including epidurals with femoral and sciatic nerve blocks. The third component of the accelerated recovery ...

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The Risks of Operating on a Brain Tumor

April 28, 2008 – 5:03 pm
The risks of any brain tumor operation are of two types. First, there are the general risks. These include some problem with the heart, lungs, kidneys or liver which would be considered secondary to the anesthesia. There is excessive bleeding requiring blood transfusions (which carry a small risk of blood borne diseases such as hepatitis and AIDS and the risk of an allergic reaction). There is always a risk of infection, including sepsis (blood poisoning). Then there are the specific risks which are a function of the type and location of the tumor. These include stroke, blindness, paralysis or other neurological deficit and seizure. Although the risks sound daunting, the probability of any single one is usually low. Remember, though, that statistics never apply to the individual. If there is only a ½ percent chance of an untoward effect occurring but you are the victim, your exposure is one hundred percent. Risks ...

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Meningiomas: Defined

April 14, 2008 – 8:57 am
Meningiomas are tumors that are within the head (intracranial space) but not within the brain. They compress, rather than invade, the brain. Generally, meningiomas are benign, but there are subsets that tend to be more aggressive, often recurring and occasionally metastasizing to other organs such as the lungs and liver. Meningiomas are located over the upper surface of the brain (convexity), between the major divisions (falx or tentorial) and under the brain (skull base). The latter will frequently cause dysfunction of one or more of the nerves entering or exiting the brain to supply the face and neck (cranial nerves). Symptoms could include loss of vision, double vision, facial numbness or weakness, loss of hearing or balance and difficulty swallowing. Meningiomas tend to grow slowly, allowing the brain time to accommodate to their presence. Many, therefore, do not become symptomatic until they have become quite large. In addition, some meningiomas are associated ...

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Medicare Reimbursement Declines for Prosthetics

April 14, 2008 – 8:47 am
Everything is going up but our reimbursement from Medicare and the insurance industry. In 1992, MEDICARE reimbursement for hip replacement was $1,697; in 1997, $1,583; in 2002 it was $1,452; and in 2007, it was $1,136. All this time, the expense of practicing orthopedics continues to go up with increasing cost to the point that an orthopedic surgeon must either work at 150% or stop working. Yet at the Neurologic & Orthopedic Hospital of Chicago, we have determined not to pass that financial burden along to our patients. Unlike other area orthopedic surgeons who have stopped accepting Medicare reimbursement and who require an out-of-pocket fee of $10,000 to $15,000—contracting out of Medicare—we at NOHC have determined that your access to orthopedic care should not be means tested but rather treated as an inherent right of citizenship. Yet at NOHC, we offer contemporary designed prosthetic choices to match your individual needs ...

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Hip Resurfacing: Improve Range of Motion, Restore Abduction

April 14, 2008 – 8:46 am
As a Professor of Orthopedic Surgery, I feel the need to continually study the results of my surgery as well as update my data base. So too must you as a potential patient progress in the understanding of knee and hip replacement surgery . As the surgeon, I may serve as the boss/CEO/conductor, you as a patient must have the knowledge which will empower you in the decision making process. There is a revolution taking place in joint replacement surgery at the hospital level, the incision level, the physical therapy level and the prosthetic implant level. Over the next several weeks I week seek to update you on how at the Neurologic & Orthopedic Hospital of Chicago, we are turning our knowledge into the power that will provide the best possible outcome and longevity for all hip and knee replacement in 2008. In the Spring of 2007, the Chicago Tribune featured Hip ...

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NOHC’s Orthopedic Surgeons: Up to Date with Prosthesis Options

April 7, 2008 – 2:15 pm
It is important for the orthopedic surgeon who will inplant your hip or knee to have up-to-date knowledge of the particular prosthesis chosen for your surgery. Total hip resurfacings with metal-metal bearings currently is the fastest growing orthopedic procedure world wide and with good reason. Just ask A.B., a former professional baseball player, or J.M., the one time Chicago Bears quarterback; both who underwent hip resurfacing at the Neurologic & Orthopedic Hospital of Chicago in 2007. Metal-on-metal designs have a long history in orthopedics. But it is important to remember that today’s metal-on-metal technology has little in common with that which it did even 20 years ago. As we compare the science of metal-on-metal articulations, I recognize the great opportunity that this relatively new technology presents for reducing wear. As with any important advancement in implant material and design, we at the Neurologic & Orthopedic Hospital of Chicago believe it inherent ...

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NOHC’s Stand on Direct-to-Consumer Advertising

March 28, 2008 – 2:22 pm
Does direct-to-consumer advertising improve patient education or simply increase profits for those who pay to market? Until recently, a patient would be referred to an orthopedic surgeon by a family physician, a family member or a friend. Then came the era of managed care and choices were based on third party payer pre-certification and approval. More recently, the patient has looked to patient information educational initiatives as found on the Internet or in the media. But now it is direct advertising such as direct-to-consumer marketing to be found every year at this time in the non-professional magazines and National Inquirers for sale when you check out at your local drug and grocery store. While the benefits and downsides of direct-to-consumer advertising is currently being debated within the policymaking arena, we at the Neurologic & Orthopedic Hospital of Chicago (NOHC) believe that every patient should have a consultation if so desired to ...

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Genuine Patient-Physician Relationships at NOHC

March 17, 2008 – 9:07 am
Orthopedic patients who are to undergo hip or knee replacement procedures should be aware of the recent settlement agreements between five orthopedic implant manufacturers and the U.S. Department of Justice. These settlements require that the orthopedic implant manufacturers post information on their financial relationships to orthopedic surgeons without any explanation as to why the payments were made. In addition, under terms of the settlement agreements, all companies are required to now post information on indirect payments to surgeons. The relationship between orthopedic surgeons and industry is seen as important and necessary, but it must be carefully scrutinized to avoid the pitfalls of real or perceived conflicts of interest that could ultimately affect your care. In late September, four orthopedic manufacturing companies entered into Deferred Prosecution Agreements, agreeing to pay civil settlements amounting to a total of $311 million. All companies will be subject to oversight by a federal monitor. Because of the ...

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Brain Tumors in General

March 17, 2008 – 8:53 am
Brain tumors are becoming increasingly common. Perhaps it’s because more people are undergoing MR & CT scans of the head for headaches or after traumatic injuries. Perhaps it’s because people are living longer. Possibly it’s because people with cancer are surviving their disease throughout the body only to be stricken by a metastasis to the brain. And then there are the questions of environmental influences like cell phones and sugar substitutes. At any rate, I thought it would be interesting to talk about brain tumors generally, and in later blogs, more specifically. Contrary to conventional wisdom, most brain tumors are not discovered in people whose only complaint is headache, though headache can be part of the symptom complex. Brain tumors are usually found in people who present with a neurologic deficit such as visual loss, weakness or paralysis, change of personality or thinking, and loss of sensation to name a few. Brain ...

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