South Platte Sentinel Wednesday, July 29, 2009 Page 24

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AbusingDiscretion

Abuse of discretion occurswhen a trial judge is deemedto have made a significantmistake that is “clearly againstreason and evidence” oragainst established law andthat results in a person beingdenied a fair trial. An appeals

court may usesuch a findingof abuse as a ba-sis for reversingthe previouscourt’s result.Examples ofabuse of discre-tion include not

allowing an important wit-ness to testify, showing bias,or making rulings on evi-dence that deny a person thechance to tell his or her ver-sion of events. This does notmean that judges must be per-fect. It does mean, however,they must act well within thebounds of fairness. At our office, we are here to helpyou through your legal matterand protect your legal rights.With many years of experience,ARNOLD, WRIGHT & WILL-IAM-SON, LLC is familiar withthe challenges our clients face andpride ourselves on providing ef-fective, personal service. Whenyou need legal representation, callus at 970-522-2341 to schedulean initial consultation. We arelocated at 214 Poplar St., Ster-ling. Proudly serving the com-munity for more than 50 years.

Heel Pain?

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H e a l t hH e a l t h

Physically Speaking

Better Health Today

ByDr.PhilipPollock

ByDr. MarkMcDonald

Avascular necrosis is an unseen adversary

I read a recent article in one of mychiropractic publications where theauthor cited a study on back pain.This study was published in the “Jour-nal of the American Board of FamilyMedicine, January 2009.”

The Title of the article was, “OverTreating Back Pain.” Dr. Dan Murphypointed out some very significantpoints made in the study. Did youknow that pain complaints are theleading cause of medical visits? Theprimary source of those pain com-plaints, are musculo-skeletal in na-ture, of which, the neck and backpain are the biggest reason for the

consult.Because of the prevalence of back

pain, a host of new tests and treat-ments have become the norm. Thetreatments include, injections, sur-gical procedures, implantable de-vices, and medications.

While each form of treatment isvaluable for some patients, much ofthe care is driven by professionalconcern, patient advocacy, market-ing, and the media, rather than sci-entifically valid indications.

It is important to note that 25% ofthe U.S. adult population will reporthaving back pain within the past 3

months. This fact has not changedfor the past several decades. Thisgoes to prove that expanded testingand treatment have not improved

patient outcomes, but have in-creased complications, includingdeath.

From a Medicare standpoint: therehas been a 629% increase in epidu-ral steroid injections; A 423% in-crease in expenditures for opioidsfor back pain, which, by the way, youshould know actually increases theperson’s pain sensitivity; A 307%increase in the number of MRI’s per-formed; A 231% increase in facetjoint injections, and a 220% increasein spinal fusion surgery rates. Asmentioned before, the patient out-comes or disability rates have not

improved.Did you know that anywhere from

33%-66% of CT and MRI studiesmay be inappropriate? At $3,000 to$4,000 each, this is a significantcost, considering that positive find-ings such as herniated discs arecommon in asymptomatic people.

There are no magic bullets forchronic back pain. In fact chronicback pain, like diabetes or asthma isa condition we can treat but rarelycure. I have made this statementbefore, “Once you injure a joint it willalways be damaged and thus weak-ened. Over the years it will tend todegenerate faster or slower depend-ing on the number of times you injureit.”

The number of times you injurethe joint will usually vary directly withthe amount of proper diet and exer-cise you give it.

Yours for better health today.(Dr. Philip Pollock is a north-

eastern Colorado chiropractorwith his office in Sterling.)

In a world of injuries - sprains,strains, fractures, etc. - one particu-lar complication of these injuries isthe condition known as avascularnecrosis (AVN).

In AVN, as it is often called, theblood supply to the bone is affectedby the injury itself, and as such,impairs the bones ability to repair aswell as impairing it’s ability to thriveand live.

Avascular necrosis takes severalforms, one of the most common be-ing the avascular necrosis of thescaphoid. The scaphoid is a smallpeanut shaped bone in the wrist andfollowing wrist sprains or fractures,the scaphoid can be broken at theneck of the bone leaving the proxi-mal pole of the scaphoid without ablood supply.

When this vital nutrient source isremoved, the remaining bone is un-able to repair and subsequently de-generates and dies. This necrosis isnot limited to the bone, however,and also necrotizes the cartilagewhich is also nourished by the bone’sblood supply.

One of the most insidious thingsabout AVN is that it is often notimmediately apparent upon x-ray. Infact, it is rarely apparent other thanthe fact that the particular areas whichare affected are frequently the sourceof AVN related concerns.

The scaphoid in particular is wellknown for its propensity to developthis necrosis. Therefore, any timethat an injury affects the scaphoidwhether it be a sprain or fracture,physicians are careful to re-evaluatethe bone as time goes along to de-

termine if there are avascular de-generative changes occurring to thebone and cartilage.

Dislocations of the hip can alsocause vascular necrosis to the headof the femur as Bo Jackson foundout in his awful hip dislocation injurywhich was televised for the wholeworld to see. Once the hip is dislo-cated, the ligament teres which at-taches to the femoral head and whichalso carries with it the blood supplyto a large part of the head of thefemur is torn during the dislocation.

With this vital nutrient “umbilicalcord” broken, the blood supply to thefemoral head is compromised aswell as the blood supply to the carti-lage on this weight bearing joint,leaving the joint susceptible to bonedeath and cartilage degeneration.

As Bo Jackson found and as manyhip dislocation patient discover,avascular necrosis is a common sideeffect for this reason. Although theblood supply is not entirely from thetorn vessel, often the damage issevere enough in AVN to necessi-tate hip replacement surgery or femo-ral head prosthetic hemi arthroplasty.

Avascular necrosis also occurs in

the foot in both the navicular andtalus bone and is a less common butpotential source of AVN followingfoot and ankle trauma and fracture.

This is very difficult to treat as bothbones are further traumatized beingweight bearing structures.

In short, avascular necrosis is aside effect of certain sprain, strainsand fractures which should not beoverlooked and when injuries do notseem to be healing properly, it iswise to consult with a skilled ortho-pedist regarding these reasons theseinjuries are not healing.

Avscular necrosis is insidious and

manifests itself weeks, even months,to the process of a healing injurywhere no evidence was present earlyon.

For more information on avascu-lar necrosis, consult your local or-thopedist.

(Dr. Mark McDonald, PT, DPT,OCS is a lifelong Sterling nativeand board certified orthopedicphysical therapist with 21 yearspractice in Sterling. He is a clini-cal partner with Body Quest Fit-ness, Devonshire Acres, andNortheast Plains Home HealthCare in Sterling.)

Are treatments necessary or driven by marketing?