Dr. Dollinger: The Marvelous Rotator Cuff

The shoulder, in my opinion, is probably the most magnificent joint in the body. Its amazing range of motion, flexibility, and strength are stunning, especially when it comes to gymnastics, golfing, and weightlifting, to name a few. It’s an absolute marvel of biomechanics to have such a large ball in such a shallow socket. What makes it all possible is the rotator cuff.

The rotator cuff is made up of 4 muscles and their tendons that hold the shoulder joint together. These muscles endure a lot of stress, however, because the structure of the shoulder joint is so unstable. From overhead lifting to throwing softballs to using a jackhammer: these activities all put a tremendous amount of stress on the shoulder. This is why certain athletes, like baseball players and weightlifters, and people in certain trades, like carpenters and painters, are prone to rotator cuff injuries.

Injury to the rotator cuff involves either a partial tear or a full tear of any of the tendons. For example, if you fall onto an outstretched arm, this could pull the tendon from the bone and cause a hole to form in the tendon. Or, the tendons could simply wear down over time due to repetitive stress or decreased blood flow, which can cause scarring and tears.

Typically, people with rotator cuff injuries experience pain, stiffness, weakness, and cracking or crunching when lifting or lowering their arm. In this case, they need to consult their doctor, who will perform a careful physical exam to make sure the pain isn’t actually caused by something in the neck or elbow. The diagnosis can also be based on patient history and x-rays, which check for tears, arthritis, or calcium in the tendon. An MRI or ultrasound may be needed for more detailed information.

If it is a small tear, most doctors will want to treat it conservatively for 4 to 6 weeks in order to avoid surgery, recommending rest and decreased activity, ibuprofen or Aleve, and possibly physical therapy and/or a steroid injection for the inflammation.

If it is a tear larger than 3 cm or is a chronic condition, your doctor may recommend surgery. Most cases can be eligible for arthroscopic surgery (as with knee surgery), which requires fewer and smaller incisions, with less risk of infection, fewer muscles impacted, and shorter recovery time. However, if it is a large tear that requires more work on the tendons, it may require open surgery.

The rotator cuff is an anatomical wonder. Just remember that the next time you high-five someone or dance to YMCA or cram your carry-on luggage into that tiny overhead compartment. Your shoulder can perform marvelous deeds because of the magnificent rotator cuff.

If you’d like more information, or to schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.

6 Rules for ATV Safety from Dr. Dollinger

For many of us, summertime in upstate New York means enjoying the great outdoors. When the weather is beautiful, it almost seems like a crime to stay inside. Many people choose to go camping, boating, hiking, fishing, and riding around on ATVs. Well, as fun as ATVs may be, it’s important to remember that they are not toys. Just because they may not be subject to strict regulations and you don’t need a driver’s license to drive one in New York State, it doesn’t mean you don’t need to exercise caution.
Every year, there are over 350,000 ATV accidents across the country; 100,000 of them involve children under the age of 18. These accidents include everything from head injuries to spinal injuries to all types of broken bones. Sadly, there are hundreds of ATV-related deaths each year as well. These accidents occur because ATVs are fast vehicles with a high center of gravity that can drive over uneven ground: they are notorious for flipping and ejecting passengers.
“The American Academy of Orthopedic Surgeons would love to see national regulations for ATVs, since they are indeed motor vehicles like cars, motorcycles, and boats. They also call for the need for licenses and ATV safety courses. They also recommend that children under the age of 12 should not be allowed to drive ATVs, and children between the ages of 12 and 16 should be under adult supervision. ATVs aren’t just adult-sized Power Wheels; they’re motor vehicles made to be driven by adults! Here are 6 rules that will increase your safety while riding:
  • Anyone driving an ATV should wear appropriate protective gear, like helmets, gloves, and boots.
  • Driving should occur during daylight hours.
  • ATVs should not be driven on paved or public roads.
  • Be sure to read the owner’s manual.
  • Always make sure the ATV is in proper working condition.
  • Never let a second person ride on the back of a single-person ATV, because they could be thrown off of the vehicle at higher speeds or over uneven ground.”
Just use common sense and exercise appropriate caution when driving ATVs. They can be exhilarating fun, as long as no harm is done.
 ATV Safety Tips from Arnot Health
Click here for more information through the NYS DMV and resources through the ATV Safety Institute.

Dr. Dollinger: Ticks and Lyme Disease

In recent years, the increase in number and spread of deer ticks has been all too noticeable, and this summer is no different. In fact, deer ticks have been appearing in places we generally think to be tick-free, like public parks, residential backyards, and at higher altitudes. As a result, we need to increase our awareness of how to protect ourselves from deer ticks and Lyme disease.

Lyme disease was named after the town of Lyme, CT, when a number of cases were discovered in the late 1970’s. Since then, some progress has been made in terms of identifying the direct causes and ways to prevent Lyme disease.

In general, ticks tend to live in grassy areas. Since ticks usually always climb upward, the best way to protect yourself is to wear long pants that are tucked into your socks and a long sleeved shirt that is tucked into your pants. Special insect repellent may also be helpful, especially if you know you will be in a high-risk area. When you come back indoors, be careful to check yourself for bites, and if you find a tick embedded in your skin, carefully remove it using these steps.

In terms of diagnosing Lyme disease, often a tell-tale bullseye rash will appear around the tick bite. However, not everyone reacts the same, and it is possible to have Lyme disease without any rash at all. In these cases, fever, joint pain, or flu-like symptoms develop. If detected early enough, doctors can use x-rays to look for specific swelling and can look at your blood work to see if you have a high white blood cell count. There is a definitive test, but, unfortunately, it takes up to 4 weeks to get the results.

If, however, you have the target rash and immediately seek treatment, since Lyme disease is caused by bacteria, you will be given antibiotics. Doxycycline is typically first choice, but alternatives exist in the case of young children and pregnant women. The treatment may last up to a month, and usually reduces your risk of Lyme disease.

The danger is when you don’t treat Lyme disease soon enough. If left untreated (for example, the person doesn’t know they were bitten and didn’t develop a rash), the disease then spreads throughout the body and becomes a great imitator of other diseases. It can appear as arthritis, heart problems, nervous system problems, or simply chronic fatigue. This is why it is so hard to diagnose it when it reaches the chronic stage, with critical and often debilitating effects.

So, be careful when you have a picnic or go on a camping trip or take a hike in the woods. If you are vigilant and catch things early, you may save yourself a lot of grief. The last thing you want is for something to spoil your Fourth of July vacation! Click here for more information.

To schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.

Dr. Dollinger: How Pregnancy Affects Joints & Bones

Pregnancy brings about many changes, and some of them are more obvious than others. Room is made in the home for the baby to arrive, and gifts pile up leaving the parents wondering how many rubber duckies does one kid need? Of course, the mother’s body goes through many obvious changes as well, with that prominent belly and amazing glow. However, since pregnancy has a major impact on hormone levels and the immune system, the mother also can experience other surprising, and not so surprising changes as well.

Lower back pain and joint pain (like carpal tunnel) is not so surprising. 70 – 75% of pregnant women complain of back pain, which gets worse the older you get and the more children you have. The weight of the baby in the front increases the curvature of the back, adding stress and strain to lower back muscles. Sometimes this pain can even radiate down into the hips and legs. Of course, since a pregnancy is involved, the treatment options are limited to Tylenol, bed rest, slight heat, gentle stretching, and perhaps a corset that supports the belly.

Carpal tunnel is the second most common joint pain to occur during pregnancy, affecting the wrists and causing numbness or tingling in the hands. And again, it is more common in pregnant women who are older. Conservative treatment includes a brace and ice, and under specific circumstances, maybe a shot of cortisone. Usually, however, you just have to wait it out, as much as it is very annoying.

More rare problems involve damage to the bones of the hips and legs, possibly caused by too much of one of the hormones produced by the body. If you suddenly experience bone pain, it could be temporary osteoporosis, which would require an MRI for proper diagnosis. If you have persistent hip pain that goes down the front of the thigh and you can’t put weight on your leg, there may have been an interruption in blood supply to your hip bones causing serious bone damage, which again would need a MRI for proper diagnosis.

One surprising occurrence is that many women who have rheumatoid arthritis actually feel better during pregnancy. When you are pregnant, in addition to extra hormones and a boosted immune system, the body also produces more cortisol, and the combination of these factors brings relief to pregnant women with RA. Of course, once the baby is delivered, there is a rapid rebound in RA symptoms, which can actually be more painful than before, until treatment can get it back under control again.

Of course, always talk to your OB/GYN doctor about any symptoms you experience during your pregnancy. Arnot Health also offers childbirth & maternity classes, and you can learn more by following this link.

To schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.

Dr. Dollinger: Pregnancy & Exercise

We’ve come a long way in understanding the best way for a woman to take care of herself during pregnancy. This doesn’t mean, however, that we are free from lots of conflicting advice. One of these controversial topics is exercising during pregnancy. There are old myths like: don’t raise your hands above your head (for fear of causing the umbilical cord to wrap around the baby’s neck) and don’t watch sporting events (because it may cause you to become too excited). But these are easily dismissed as unscientific extremes. But still, what about regular old exercise?

Doctors have a much better understanding of women’s health during pregnancy, and one of the things they have found is that women who have a higher level of fitness, good core strength, and a strong back have an easier time during pregnancy, in terms of back pain, and an easier time during labor and delivery. These women can also safely continue a level of physical activity and exercise during pregnancy that is close to their previous usual level. Of course, use common sense: no contact sports, no exercise that brings the heart rate up too high (it may redirect too much blood away from the fetus), no excessive exercise, and no scuba diving, rollerblading, or skiing. That said, there’s no reason not to continue your usual level of exercise almost to your delivery date, as long as it is the proper type (perhaps modified), the proper amount, and still feels good to you.

On the other hand, if you are not used to exercising regularly or only usually have a low level of physical activity, it is not a good idea to start up a new fitness regimen or take up a new sport when you are pregnant. The best advice for you is to continue at that level or simply take it easy.

Of course, always talk to your OB/GYN doctor about what he or she thinks is best and safest for you and your pregnancy. Arnot Health also offers childbirth & maternity classes, and you can learn more by following this link.

To schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.

Dr. Dollinger: Star Trek & Sports Nutrition

There is an old Star Trek episode where Kirk and his team visit a planet and inevitably encounter a couple of power-hungry humanoids who capture them. In a display of dominance, the leader pushes a button, which “distills” one of Kirk’s (more expendable) team members into a 6-inch cube, by removing all of the water in their body. He then crushes that cube in his hand as Kirk looks on in dismay. Moral of the story: water is crucial for our body’s survival.

60% of our body weight comes from water. So, in terms of sports nutrition, which is really what we’re going to talk about today, hydration is this most important part. It is absolutely crucial, during high intensity activities or exercise lasting more than 1 hour, that you drink water before, during, and after. Feeling thirsty is not an accurate way to gauge dehydration: if you wait until you are thirsty, you have already lost 2% of your body weight in water.

Instead, drink smaller amounts of water more frequently, for example, every 10 – 20 minutes during intense activity. Drinking cool water can also help bring down your core temperature. If possible, weigh yourself after a workout, and drink 2 – 3 glasses of water for every pound lost. Another good indication of adequate hydration is the color of your urine: if it’s clear, almost like water, then you are well-hydrated.

In terms of food, sports nutrition requires the right combination of carbohydrates, protein, and fat. 60% of your calories should come from carbohydrates from high quality foods like fruits, vegetables, whole grains, etc. Your body breaks down carbohydrates into glucose, which is used for immediate energy. The rest is turned into glycogen, which is stored in muscle and used for endurance. If your body does not have enough glucose or glycogen, it will then break down protein for energy.

This is why runners carbo-load a few days ahead of a marathon: this provides them with lots of glycogen. During exercise for more 1 hour, you should replenish with carbohydrates (as opposed to proteins), and there are some sports drinks that contain carbs in addition to electrolytes, which are a great solution. Try to avoid, however, eating solid food within 3 – 4 hours before exercise.

20% of your daily calories should come from protein, which is found in meat, dairy, nuts, and beans. Protein is the nutritional powerhouse, helping to build new tissue. If you are physically active, you need more protein, especially if you do high endurance exercise, which will end up burning that much needed protein.

The last 20% of your calories should come from fat. Your body needs fat in order to absorb certain vitamins and minerals, so it’s actually unhealthy to have a completely fat-free diet. However, if your exercise is targeted to burn fat, keep in mind that this can trigger a release of substances called ketones, which can be toxic to the body in high amounts. So, once again, make sure you drink plenty of water in order to flush them out of your system.

So there you have it, sports nutrition in a nutshell. Or, shall I say, distilled down into the equivalent of a 6-inch cube.

To schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.

Dr. Dollinger: Muscle Cramps

Muscle cramps: they can be one of the more uncomfortable things a person can experience. The areas that are more commonly affected are the hamstrings, quads, calves, rib cage, and feet. They may wake you up at night or suddenly occur during physical activity. Some people are predisposed to getting muscle cramps; some only get them in very particular circumstances or hardly at all. One thing is for sure: muscles cramps can really get you down.

Of course, athletes and people engaging in physical activity have a higher chance of getting muscle cramps, especially when they are not getting enough hydration (especially 4 – 6 hours after exercising) and/or in case of an electrolyte imbalance. Heat or sharp changes in temperature may be the culprit, as well. An inadequate amount of warm-up and stretching the muscles also increases the risk of getting muscle cramps.

However, there are other things that can cause muscle cramps that are not related to physical activity. Advanced age increases frequency of cramps, as do certain medications, like diuretics. Various disorders and illnesses, like circulation problems, hormonal imbalances, dietary imbalances, thyroid disorders, cirrhosis, and neurological disorders may put you at a greater risk of muscle cramps.

For some, treating cramps may be as easy as eating a banana, which is rich in potassium. However, if your muscle cramps are a continuous problem, you should see your doctor. They will want to talk about the entire history surrounding those muscle cramps, in order to get a clear picture of all of the possible causes, because the majority of diagnoses come from in-depth analysis of a patient’s history.

For the rest of us, the best thing to do is to simply warm up before exercising, keep hydrated, replenish electrolytes during and after exercise, and stop and stretch when muscle cramps attack. It’s the body’s natural way of telling us to slow down and take care of ourselves.

To schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.