Physicians & Staff: Jonathan E. Fenton, D.O. Sam Russo, N.D., LAc. Mary Benoit, R.Tech. Pam Godin, office manager/billing Karen Brown, front desk/scheduling
Pre & Post Injection Instructions
Procedure Description: Non-steroid injections
What To Expect: Soreness,
a bruised feeling, increased pain, local numbness at the injection
sites, swelling (sometimes a lot) are typical post injection.
The worst of it is usually over in 24 hours, but it can last 4-7 days.
Pain
medicines such as Tylenol (acetominophen), Ultracet, Vicodin/Lortabs
(hydrocodone), or Percocet (oxycodone) can be used for post injection
pain, but use for as short a period as possible.
Try to use ice very sparingly, if at all.Avoid heat for the first 24-48 hours.
Preprocedure: !!
NO anti-inflammatory medicines before or after injections (minimum of 5
days prior and 3 weeks after)!!!!!. This includes Advil (ibuprofen),
Aleve (naproxen), Orudis (ketoprofen), aspirin (if on mini-dose for
your heart stop it for 3 days prior and 3 days after injection), even
Arnica cream! Also no prescription anti-inflammatories, such as,
Celebrex, Motrin, diclofenac, Relafen, etc.
Stop taking fish oil for 3 days before and 3 days after injections.
If
I suspect hormonal or vitamin deficiency, initial blood testing may be
done before any injections, and any optimization of hormonal/vitamin
levels to maximize healing potential will then be based on laboratory
data.
Postprocedure: Be as active as you can once the anesthetic agent wears off. MOVE IT!
If
injections were to the spine (thoracic, ribs, lumbar, sacral) or lower
extremity, avoid prolonged sitting, walk soon after the procedure,
avoid twisting, heavy lifting, pushing/pulling, and don?t ?push it? for
at least 4 days post injection.
After neck, upper back / ribs,
and upper extremity injections go through easy range of motion and
gentle stretching often in the 4 days post injection, and avoid any
vigorous activities with the arms (again, don?t ?push it!?), preferably
for 3 weeks.
Typically, results start to really happen in ~12
weeks, even though you may feel better sooner. It is a process, and
your body has to generate a healing respond. It is not an instant fix;
it takes time.
Typically 2-8 sessions are necessary (less with
platelet rich plasma injections, ore without), spaced 3-6 weeks apart.
Even for those who feel early/rapid improvement, don?t fool yourself
into thinking you?re all better and overdo.
Nutritional Advice during treatment
Eat
a high protein diet, preferably small portions 5 times a day. The body
can?t store protein, and muscle and ligaments are made of protein!!!
Beef/beefalo, bison, turkey, eggs, chicken, or fish. Dairy and soy are
OK. Vegetarians must make a special effort, and several types of
protein powders are available. There are egg, whey (Physician?s
Protein), non-soy and soy protein powders. -For vegetarians, those
with poor eating habits, or those who can?t manage to eat protein
frequently (or enough), use amino acids capsules, 2-3times/ day.
Strongly consider eating high protein bars as snacks.
-Avoid all
trans fats!! These are toxic/poisonous to the cells of your body, and
impede healing. They are in virtually all commercial baked goods, even
those from local supermarkets.
-Take a high potency
multivitamin/mineral preparation. It?s important to get adequate
amounts of B vitamins, C, D, E, calcium, magnesium, zinc, chromium,
selenium, and manganese. Best to take them with each meal (or at least
with 2 meals/day), so a multi that requires 2-6 capsules per day makes
that easier (eg. PolyPhenol Nutrients,Twice Daily Vitamin).
-To
help the healing process, using MSM (Methyl Sulfonyl Methane, elemental
sulphur) in doses of at least3000mg/day, but preferably 6-10grams/day.
Also take trace minerals and Vitamin C daily for rehabilitation.
-If
joints are involved, take Glucosamine Sulfate (without chondroitin)
daily. The dose is 1500mg/day if your weight is under 150 lbs, and
2000mg/day if over 150 lbs. It can be taken as once or twice a day
dosing, with or without food.
-It also helps joints greatly to
take ultra purified fish oil capsules, 4000-9000mg/day, in order to get
at least 2000mg/day of EPA (but not 1 week before or after injections).
-For
those on cholesterol lowering drugs (statins), it is essential to take
CoEnzyme Q10 30-100mg twice daily. Statins deplete this naturally
occurring substance, which results in depleted cellular energy. Healing
is often quite difficult without adequate CoQ10.
All of the supplements listed above are available at this office at discounted prices.
Lectures Given
Use
of Platelet Rich Plasma (PRP) Injections in Sports Medicine,? Athletic
Trainer Department, University of Vermont, Burlington, VT; June 12, 2009
Update
on the Use of Platelet Rich Plasma (PRP) in Office Orthopedics,
lecturer and table trainer for interventional spine workshop,
Naturopathic Academy of Therapeutic Injections, Module IV, National
College of Naturopathic Medicine, Portland, Oregon: May 8-10, 2009
Workshop
on Musculoskeletal Ultrasound: Diagnostic and Interventional, American
Association of Orthopedic Medicine, Annual Convention, Morengo Resort,
Palm Springs, California: April 22, 2009
Workshop on
Musculoskeletal Ultrasound: Diagnostic and Interventional, 25th annual
PM&R Update, The Canyons Resort, Park City, Utah, February 1, 2009
Office
evaluation and treatment of Tendinopathy, 102nd fall conference of the
Vermont State Association of Osteopathic Physicians & Surgeons,
Stowe, Vermont; September 12, 2008
Experience Using Ultrasound
Guidance for Regenerative Injection Treatment, American Association of
Orthopedic Medicine, Annual Conference, Clearwater, Florida; April 12,
2008
Workshop in Lumbar Spine Injections, Naturopathic
Academy of Therapeutic Injections, Vancouver, B.C., Canada; February 28
- March 2, 2008
Workshop in Diagnostic and Interventional
Musculoskeletal Ultrasound, Naturopathic Academy of Therapeutic
Injections, Docere Medical Clinic, Salt Lake City, Utah; January 25-27,
2008
Use of Musculoskeletal Ultrasound in Clinical Practice,
101st fall conference of the Vermont State Association of Osteopathic
Physicians & Surgeons, Stowe, Vermont; September 14, 2007
Ligament
Generated Spinal Pain Syndromes, pain fellowship program, FAHC Dept of
Anesthesiology, South Burlington, VT; June 6th, 2006
Osteopathic
Medicine: Principles and Practices, alternative medicine bridge
program, University of Vermont Medical School, Burlington, VT; October
24, 2005
Diagnostic Musculoskeletal Ultrasound & Ultrasound
Guided Injections, 99th fall conference of the Vermont State
Association of Osteopathic Physicians & Surgeons, Stowe, Vermont;
October 14, 2005
Post Traumatic Arthritis: Strategies in
Treatment, Arthritis Assessment & Management, Vermont Arthritis
Coalition, Burlington, Vermont; November 19, 2004
Pearls in
Acute and Chronic Pain Management, 98th fall conference of the Vermont
State Association of Osteopathic Physicians & Surgeons, Stowe,
Vermont; September 19, 2004
Osteopathic Medicine: Principles and
Practices, alternative medicine bridge program, University of Vermont
Medical School, Burlington, VT; June 18, 2004
Evaluation and
Treatment of Neuropathic Pain, 97th fall conference of the Vermont
State Association of Osteopathic Physicians & Surgeons, Stowe,
Vermont; September 19, 2003
Osteopathic Medicine: Principles and
Practices, alternative medicine bridge program, University of Vermont
Medical School, Burlington, VT; February 21, 2003
Workers Comp.
Update,? 2nd annual Addison county business conference, Addison County
Chamber of Commerce, Middlebury, VT; August 22, 2002
Prolotherapy,
mid year meeting on musculoskeletal and sports medicine, American
Osteopathic College of Physical Medicine & Rehabilitation,
Baltimore, Maryland; March 2, 2002
Electrodiagnosis and
Neuropathic Pain, 95th fall conference of the Vermont State Association
of Osteopathic Physicians & Surgeons, Stowe, Vermont; October 14,
2001
The AMA Guides - What Every Lawyer Should Know, Vermont
Bar Association seminar on workers compensation, Montpelier, Vermont;
January 10, 2001
Understanding Soft Tissue Pain Syndromes, and
Their Appropriate Treatment, continuing education seminar, Liberty
Mutual & Royal SunAlliance Insurance Companies, Bedford, New
Hampshire; December 4, 2000
Modern Treatment of Neuromuscular
Pain, 94th fall conference of the Vermont State Association of
Osteopathic Physicians & Surgeons, Stowe, Vermont; October 20, 2000
Services Offered
-Orthopedic
Medicine: including diagnostic and therapeutic injections into joints,
ligaments, muscles, and nerves (spine and extremities). -Regenerative Injection Treatment. -Prolotherapy. -Mesotherapy and Neural therapy. -Fluoroscopic and Ultrasound guided injections. -Conscious sedation for injections. -Glucosamine, steroid, and platelet rich plasma injections of joints, tendons, and ligaments. -Sarapin and steroid nerve blocks. -Pain Management: traditional and complimentary/alternative approaches. -Diagnostic Musculoskeletal Ultrasound -Osteopathic
Diagnosis and Manipulative Treatment: including fascial release,
facilitated positional release, muscle energy, HVLA, cranial, indirect
and direct techniques. -Medical Acupuncture -ElectroDiagnostic (EMG/NCV) testing. -Nutriceutical and pharmaceutical treatment, including laboratory testing based natural hormone replacement. -On site Physical Therapy.
What's New
We've begun using the Harvest Technologies system for concentrating a patient's own platelets for injections.
Platelet
rich plasma has been used in surgery for years to speed healing, and
it's very effective for injection into torn muscles, tendons,
ligaments, and damaged joints. -It has become very common in
professional sports medicine, with football, baseball, basketball,
soccer, ski racers and other celebrated athletes receiving treatment.
We
are the only center in Vermont to offer diagnostic and interventional
musculoskeletal ultrasound for more than podiatric evaluation.
Ultrasound offers a rapid, inexpensive, and painless way to very
accurately (sometimes more accurately than MRI!) diagnosis such
conditions as rotator cuff tears, carpal tunnel syndrome, ligament
sprains, and muscle tears. It is the standard of care in orthopedic
diagnosis in Europe, Canada, and several large US urban medical
centers.
We're very excited not only at its diagnostic
capabilities, but also for its use to accurate inject ligaments,
muscles, and joint under direct ultrasound guidance.
The "miss
rate" for blind joint injections is incredibly high (55-74% in the
shoulder!), and with ultrasound guidance the miss rate goes down to 0%!!
Regenerative Injection Treatment
By Dr. Fenton +
Treating musculoskeletal pain with 'RIT' can benefit many.
Regenerative Injection Therapy (RIT)is a treatment for spinal,
ligament, and joint pain that has been studied and practiced by
physicians since the 1950s. RIT is performed by D.O.s, N.D.s and M.D.s
practicing Orthopedics, Physical Medicine & Rehabilitation, and
Interventional Pain Management who receive extensive training in these
types of injections.
Studies have been done on RIT with more
than 500,000 patients. With time, knowledge of RIT has increased and it
is currently being practiced at Yale University Hospital, The Mayo
Clinic in Rochester, Minn., and Scripps Institute in California. The
American Academy of Pain Management and the American Academy of
Orthopedic Medicine endorses RIT for chronic unresolved musculoskeletal
pain.
Chronic musculoskeletal pain is the No. 1 cause of
chronic disability in the United States and the leading reason for
patient visits to physicians. Treating musculoskeletal pain can be
difficult. Conventional treatment options are, at times, insufficient
to restore function and reduce pain. Physical therapy, manipulation,
drug treatment, corticosteroid injections and surgery can be beneficial
in certain circumstances. When they are not successful, however,
patients are often left without options.
RIT gives ligaments,
tendons, and joints a second chance at healing and is often described
as "anti-aging medicine" for the joints. When a joint is injured,
ligaments and tendon insertions are strained. This causes an
inflammatory response, a critical phase of healing.
Inflammation
at a site of injury clears dead cells, promotes capillary growth and
restores damaged tissue. However, there is the misconception that with
time sprains and strains will heal completely.
In fact,
post-injury healing of ligaments and tendons is only 50 to 70 percent
of pre-injury strength. When ligaments are lax, joints become unstable,
and degenerative changes can occur, which can lead to osteoarthritis.
For
example, if one of the ligaments in the knee were strained, the knee
joint is predisposed to early onset of arthritis. Because RIT gives the
ligament a second chance at healing, the ligament is strengthened, the
joint is stabilized and the predisposition to arthritis is reversed.
To
determine if a person is a candidate for RIT, a complete history and
physical exam are done, sometimes along with lab tests, ultrasound
evaluation, X-rays, CT scans, and MRI's. The joint is evaluated and the
site of ligament laxity / degeneration is determined. A detailed
orthopedic physical exam is the most important part of any evaluation.
If
there are no contraindications, a solution local anesthetic and some
combination of natural substances (eg. dextrose, vitamin B12, Sarapin,
glucosamine sulfate, platelet-rich-plasma, homeopathic remedies, etc.)
are introduced into the damaged ligament, tendon and/or joint.
This
launches the healing cascade leading to deposition of new,
better-organized collagen/cartilage and restoration of
ligament/tendon/joint health and function.
An average patient requires 4-6 treatments spaced a 3-6 weeks apart.
People with certain conditions may have contraindications for RIT.
Additionally,
diabetics, smokers, those over 85, and patients with fibromyalgia or
disease associated with poor tissue healing may have less than optimal
responses. They may benefit from a course of nutritional
supplementation prior to treatment with RIT.
Clinical success
rates for RIT can be as high as 91 percent, depending on the location
(but not duration!) of the problem. This makes RIT is a treatment with
great potential benefit for many.
