Posts

How a 30-minute doctor’s visit inspired this surgeon’s career

Making the RoundsWe caught up with Dr. Chaitu Malempati, an orthopaedic surgeon with UK Orthopaedic Surgery & Sports Medicine who works at The Medical Center at Bowling Green, for our latest Making the Rounds interview.

Dr. Malempati is also the medical director and team physician for Western Kentucky University Athletics, a role that allows him to treat athletes from a variety of different sports.

What types of injuries do you treat?

In my clinic, I see most frequently shoulder and knee injuries. These can be acute injuries that are sports-related or work-related or they can be general chronic injuries caused by arthritis.

At Western Kentucky, I take care of all the sports teams and I travel with the football and men’s basketball teams. I do training room a couple times a week, seeing various athletes in all kinds of sports.

When is surgery recommended for an injury?

Although I’m a surgeon and I love surgery – that’s why I went into the field – I want people to have surgery only when the benefits outweigh the risks. I will do everything in my power to treat people non-surgically first. I really only like to do surgery when I know I can help someone with minimal risks.

What inspires you to go to work each day?

Helping people. Getting people back to the lifestyle or the function they were at before pain or decreased function took over. Getting people back to where they can do the things that make them happy and live the lifestyle that they want to live. That’s really what drives me and encourages me to come to work every day. Whether it be surgical or non-surgical treatment, just helping them get back to where they want to be.

There’s really nothing better than hearing a patient say that they’re doing better or that I helped them get back to playing sports or doing what they love. That’s what inspires me.

When did you decide to pursue medicine as a career?

To be honest, I didn’t know I wanted to do medicine at all when I was an undergrad at the University of Iowa. I played tennis there on scholarship and I hurt my shoulder between my junior and senior years. I went to see an orthopaedic surgeon at the University of Iowa, who I thought was great. He explained to me what the shoulder was, what the labrum was and why my injury was causing pain. And after that 30-minute visit, I realized that’s what I wanted to do.

If you could travel anywhere in the world, where would you go?

I recently traveled to Italy, which was on my bucket list and was great. But if I could travel anywhere else, it would probably be Australia because there’s a lot of interesting stuff there – there’s the Outback, there’s the Great Barrier Reef and the people there seem very happy.

What’s your favorite food?

Pizza and pasta. Anything Italian.

How would your friends and family describe you?

Energetic, goofy. Someone who likes to enjoy life, who likes to have fun with anything I’m doing, whether it be related to work or not. I try to enjoy everything I do.


Watch our video interview with Dr. Malempati below, where he talks more about the integrative approach his practice offers patients to help treat a variety of orthopaedic injuries.


Next steps:

Exercise pain could be compartment syndrome, says UK team doctor

Dr. Kimberly Kaiser

Written by Dr. Kimberly Kaiser, a physician with UK Orthopaedic Surgery & Sports Medicine and a team physician with UK Athletics.

Each of our arms and legs have compartments that contain muscles and nerves which are surrounded by tough walls of tissue called fascia.

When we experience an injury or overuse our muscles, these compartments can fill with fluid and swell. In some people, the fascia surrounding each compartment is not very flexible and swelling can restrict blood flow, which can lead to pain, numbness and weakness in the affected limb. These may be signs of compartment syndrome.

Compartment syndrome occurs when excessive pressure builds up in an enclosed muscle space. The acute condition is often the result of bleeding or swelling into the muscle after an injury like a severe bone fracture or a crush injury, and while rare, it is a surgical emergency.

The chronic condition, called chronic exertional compartment syndrome or CECS, is often the result of prolonged physical activity and is most common in endurance athletes like runners and soccer players.

Symptoms and treatment

For those experiencing CECS, the associated symptoms occur, or worsen, during physical activity and subside immediately after stopping. Symptoms of CECS can mimic symptoms of other overuse injuries such as plantar fasciitis or shin splints, and if you’re middle aged or older, it may be the result of cholesterol build-up in the blood vessels. Your doctor may want to perform several tests to rule out other diagnoses.

Treatment for CECS depends on your activity levels and fitness goals. A physician may suggest modifying or taking a break from the exercise causing the injury or performing low-impact activities such as biking or swimming. Physical therapy, strengthening and stretching are a few approaches that can help relieve symptoms.

For those who don’t respond to conservative measures, or if activity modification is not an option, surgery may be the most effective treatment. The surgical procedure, called a fasciotomy, involves opening or removing the fascia in each affected compartment to relieve pressure. While there is a risk of complications associated with surgery, compartment syndrome left untreated can lead to permanent muscle and nerve damage, or the inability to continue participating in your favorite activity.

If you experience symptoms after an injury, or if symptoms develop during physical activity and worsen over time, it’s important to talk with your primary care provider and see a doctor who specializes in sports medicine.


Next steps:

sports physical therapy residency program

New sports physical therapy residency program begins at UK

When Morgan Lester tore her ACL in high school, she knew she wanted a career working with athletes. In 2016, Lester achieved her dream and completed her doctor of physical therapy, or DPT, at the UK College of Health Sciences.

When Lester completed her studies, she began working full-time as a physical therapist, but kept her eye on the sports physical therapy residency program taking shape at UK. The program was developed and created, and on Sept. 1, Lester became the program’s first resident.

Completing a residency program after earning a DPT is uncommon. There are thousands of physical therapy graduates each year, but there are far fewer accredited programs in the nation that offer a specialized residency. The sports physical therapy program at UK wants to change that, aiming to become the first accredited program of its kind at UK HealthCare.

Earning accreditation

The program is currently in a two-phase process to become accredited. The guidelines and requirements of the program have been set, and soon a team from the American Physical Therapy Association will observe Lester and her mentors in order to complete the accreditation process.

Ryan McGuire and John Jurjans, staff physical therapists and directors of the sports physical therapy residency program, worked with members of UK HealthCare, UK Sports Medicine and the UK College of Health Sciences’ physical therapy program to build a collaborative program.

“A team approach to rehabilitation is what works best for an athlete, and this is the best kind of program to demonstrate that,” Jurjans said.

A resource for her hometown

As part of her residency, Lester works with physicians, athletic trainers and physical therapists. She frequently works with Jenni Williams, an athletic trainer assigned to work with Lafayette High School athletics. This experience gives Lester the best opportunity to see an athlete’s journey from the initial injury, to physician diagnosis, physical therapy rehabilitation and return to play. Seeing multiple perspectives throughout the residency will better prepare Lester to work with injured athletes in a way that simply working in an office might not.

After completing the one-year residency, Lester plans to return to her hometown of Louisa, Ky., with her husband, who is a student in the UK College of Dentistry.

“When I was in high school and had my injury, I had to come all the way to Lexington to have functional testing and see the doctor,” she said. “I’m hoping to be a resource to the area so people don’t have to drive the 2½ hours to Lexington to get the care they need.”


Next steps:

knee replacement

Don’t fear knee replacement, says surgeon Dr. Stephen Duncan

Dr. Stephen Duncan

Dr. Stephen Duncan

Written by Dr. Stephen Duncan, an orthopaedic surgeon at UK Orthopaedic Surgery & Sports Medicine.

From simple wear and tear to an old high school sports injury, there are many reasons why you might develop debilitating knee arthritis that affects your daily life.

Over time, this arthritis causes the cartilage – protective cushion between the bones in your knee – to wear out. Unfortunately, once the knee cartilage has worn out, there are not great regenerative treatment options to help restore it.

At this point, you might be offered a knee replacement.

Fear of replacement

Once the word “replacement” is said, some patients fear the worst. And this fear prevents many individuals from going through with the surgery.

Although it takes about a year to fully recover from knee replacement, the truth is that the surgery can help you get back to enjoying the activities you love.

One common misconception is that knee replacement is only for older patients. That’s not the case. There isn’t a minimum age for knee replacement, and younger and older patients alike can undergo the surgery.

Surgery specifics

Another misconception about knee replacement is that we remove a large portion of the thigh bone (femur) or shin bone (tibia). Actually, we only remove about 5-9 millimeters of bone, which is about the size of a pen or pencil.

It’s almost better to think of knee replacement as a “recapping” or “resurfacing” procedure. We remove the worn-out portion of the cartilage and place caps of metal on the ends of the femur and the tibia.

This provides a strong surface to then place a plastic or polyethylene spacer in between these two surfaces. The replacement is often held to your bone with cement, which helps keep it in place.

Partial replacement

Another fear about replacement surgery is that it won’t last for very long.

Although early iterations of this surgery typically lasted around 10-15 years, the current implants are designed to last twice as long – between 20-30 years.

That means instead of having to wait until a patient is older, we can offer knee replacement to younger patients to help improve their quality of life earlier in life.

For some individuals, a partial knee replacement may be an option. This entails only recapping one part of the knee. If only one part is worn out, it doesn’t make sense to replace the entire knee, and a partial replacement might be a better option. Today, we’re doing more and more partial knee replacements to help improve patients’ pain and function.

Recovery

Regardless of the surgery, it does take about one year to fully recover and get back to trusting your knee to do activities such as hiking, jogging or tennis.

The good news is that you should be able to return to simple activities like shopping within four to six weeks after the procedure.

How we can help

The team at UK Orthopaedic Surgery & Sports Medicine offers a comprehensive knee replacement program, including advanced partial knee replacement techniques.

This year, the U.S. News & World Report’s Best Hospitals Rankings designated our program as High Performing in Knee Replacement. Learn more about our program and what you can expect during the knee replacement process.


Next steps:

Dr. Carolyn Hettrich

Shoulder specialist, researcher joins UK Sports Medicine team

UK Orthopaedic Surgery & Sports Medicine welcomed shoulder specialist Dr. Carolyn Hettrich to the team earlier this summer. Hettrich will see patients, take care of UK athletes and conduct research.

Originally from Portland, Ore., Hettrich has studied and worked across the country. She completed her undergraduate studies in Los Angeles at Pomona College and went to medical school at the University of Washington. After graduating medical school, Hettrich completed a residency at the Hospital for Special Surgery in New York and a fellowship at Vanderbilt University. She has spent the past six years working in Iowa.

As a member of the team at UK Sports Medicine, Hettrich said she is looking forward to providing care for patients with shoulder disorders and conducting leading-edge research studies.

In fact, one of the reasons Hettrich decided to join UK HealthCare is because of UK’s emphasis on research.

“I’ll have the opportunity to do the research I’m interested in,” she said.

Hettrich’s research interests focus on three areas: clinical outcomes after shoulder surgery, computer modeling for shoulder replacement, and tendon and bone healing. Hettrich is the principal investigator on the largest prospective study in the world for shoulder instability surgery. The study has 950 patients currently enrolled and is operating at 12 sites nationwide.

Her research expertise meshes well with work already being done at UK Sports Medicine, particularly the work of Dr. Christian Lattermann. Hettrich and Lattermann are both part of the Multicenter Orthopaedic Outcomes Network (MOON) and share a mentor.

“We are very proud Dr. Hettrich joined UK Sports Medicine,” Lattermann said. “She brings an extraordinary expertise in shoulder-related, patient-centered translational research, which accelerates our efforts at UK to become a national leader in patient-related outcomes research.” Additionally, she is an outstanding shoulder surgeon, Lattermann said.

When she’s not conducting research, treating patients or working as a team physician for the UK football team, Hettrich is looking forward to continuing her advocacy work on behalf of her patients. Her master’s degree in public health focused on health policy gives her insight into how she can advocate for her patients and research funding.

Each year, on Research Capitol Hill Days, Hettrich takes patients to meet with congressional leaders in Washington D.C. to show the direct impact of research funding. Hettrich is especially interested in musculoskeletal research because musculoskeletal conditions affect half of the adult population in the U.S., with expenditures related to these conditions accounting for nearly 6 percent of the gross domestic product.


Next steps:

ultrasound-guided injections

Innovative pain-relief treatment allows woman to enjoy trip to Italy

Geri Maschio spent more than a year planning a girls trip to Italy, but pain in her hip threatened to keep her from getting on a plane and experiencing the cities she’d been dreaming about.

Maschio started experiencing pain in her hip two years earlier. She tried a variety of treatment options to find relief, but none fixed the issue. Unfortunately, physical therapy didn’t help, and Maschio needed a hip replacement.

She was referred by her primary care doctor to Dr. Jeffrey Selby, an orthopaedic surgeon at UK Orthopaedic Surgery & Sports Medicine.

By that time, Maschio’s pain had become too severe for her to continue without treatment. Hip replacements require about four to six weeks of recovery, but Maschio’s trip was quickly approaching, and she refused to forgo her long-planned vacation.

“I wasn’t going to be the person who bailed at the last minute – the trip was a year in the making,” she said.

Another route to pain relief

Luckily, Selby knew of another orthopaedic physician at UK who might be able to help. He referred her to Dr. Kyle Smoot, who suggested using ultrasound-guided injections to treat Maschio’s hip pain. The procedure required little recovery time and would allow Maschio to travel.

Ultrasound-guided injections are used to treat pain stemming from conditions like chronic tendinopathy, muscle tears and carpal tunnel. They’re used in a variety of joints – including the hip and knee – and can also be used diagnostically to identify and differentiate a patient’s pain.

Maschio felt prepared for the procedure, which was performed while she was awake and numbed, but wasn’t sure what the outcome would be.

“I trusted Dr. Smoot because I was totally confident seeing anyone Dr. Selby recommended,” she said. “And Dr. Smoot and the athletic trainer [Amy Waugh] were so kind when they explained everything to me.”

The day before her trip to Italy, Maschio had an appointment with Smoot to receive her injections. Recovery was simple, she said. She let the numbing medication wear off and then felt immediate relief from the pain that had threatened to keep her from going on the trip of a lifetime.

The very next day, Maschio got on the plane for an eight-hour trip. She spent 12 days in Italy walking five to seven miles a day – pain-free.

“I know I wouldn’t have made it on this trip without Dr. Smoot and Dr. Selby – I couldn’t have done it without them,” she said.


Next steps:

  • Learn more about UK Orthopaedic Surgery & Sports Medicine, which provides leading-edge treatment for a variety of injuries and conditions.
  • When Patty Lane was diagnosed with arthritis in her hip, she was told her time as a competitive triathlete was over. Not willing to give up on her dreams, Patty turned to UK Orthopaedic Surgery & Sports Medicine for a second opinion. Read Patty’s story.
muscle soreness

How to reduce muscle soreness after exercise

Written by Laurie Blunk, an athletic trainer at UK Orthopaedic Surgery & Sports Medicine.

When you try a new exercise, lift heavier weights or run steeper hills, your muscles experience strain and micro-tearing at the cellular level, which can cause them to become sore.

Thankfully, there are ways to prevent and treat muscle soreness. Foam rolling, stretching and eating foods with anti-inflammatory properties can help reduce pain, alleviate discomfort and get you back to your favorite exercise.

Make sure to stretch

Stretching is an important recovery step in reducing muscle soreness and preventing injuries. Muscles can’t react to changes in exercise or intensity effectively when they are tight, but stretching before you work out can help muscles move more effectively.

Static stretching, or holding a stretch without movement, can be done before exercise, but is most important after activity.

Kinetic stretching, or warming up muscles with movement, is also beneficial. Your muscles will get the most benefit when you combine kinetic stretching with static stretching.

Roll it out

Foam rolling has become a popular recovery technique. Foam rolling consists of using a cylindrical tool, called a foam roller, and body weight to massage muscles.

Foam rolling can be helpful when combined with stretching because it breaks up adhesions in the soft tissue around the muscle, allowing for a better and deeper stretch.

Consider using a foam roller both before and after exercise for different reasons. Rolling out before can help break up adhesions, and rolling out after acts as a form of self-massage, which has been shown to aid in muscle recovery.

Targeting large muscle groups with the foam roller, like your leg muscles (quads, hamstrings, calves, glutes etc.) offers the most benefit. Foam rollers can also be used on the large muscles of the back. If you have muscle soreness from the previous day’s exercise, you can foam roll on subsequent days to help alleviate muscle soreness.

It is recommended to foam roll soon after activity and every 24 hours thereafter to reduce soreness.

Food for recovery

Diet also plays a role in recovery. Tomatoes, olive oil, green leafy vegetables, nuts, fatty fish like salmon and tuna, and fruits (especially berries) have anti-inflammatory properties that help reduce muscle soreness. Try working these healthy foods into your diet to help alleviate pain after exercise.

Don’t let muscle soreness deter you from trying a new workout. Just be sure recovery through stretching, foam rolling and a healthy diet are also part of your routine.


Next steps:

UK Sports Medicine Research Institute

New UK Sports Medicine Research Institute focuses on injury prevention, athlete performance

UK celebrated on Tuesday the opening of the new UK Sports Medicine Research Institute (SMRI), spearheaded by the UK College of Health Sciences and supported in part by a grant from the U.S. Department of Defense.

The 10,000-square-foot facility, part of the UK Nutter Training Facility on campus, will conduct research into injury prevention and performance optimization for professional and collegiate athletes, the tactical athletes of the U.S. military, and physically active people of all ages in Kentucky and beyond.

“Our research and scholarly endeavors offer the brightest hope for transformation and change for our Commonwealth and the broader world we serve,” UK President Dr. Eli Capilouto said. “This sentiment fuels the work of this university, and it fuels the work of the Sports Medicine Research Institute.”

Capilouto held the institute up as an example of the university’s efforts to collaborate across disciplines in addressing the challenges and disparities that face the Commonwealth, noting that seven UK colleges are involved in the work of the SMRI, in addition to personnel from UK HealthCare.

There is no similar facility within 400 miles of Lexington.

State-of-the-art technology

The SMRI is outfitted with sophisticated equipment to assess biomechanical, physiological, musculoskeletal and neurocognitive health. It’s supported by a team of eight core faculty, staff, and research assistants and 40 affiliate faculty. In addition to its Lexington location, SMRI operates a facility in Camp Lejeune, N.C., where its team works directly with MARSOC – the Marine Corps Forces Special Operations Command.

A biomechanics laboratory conducts motion analysis studies using 14 cameras and a dual-force plate system in the floor, similar to the technology used to make video games and animated movies. Equipment shaped like a horse simulates realistic movement for jockeys and other equestrians.

There is also a neurocognitive lab that uses virtual reality to assess visual acuity, reaction times and balance, which are critical measurements for concussion recovery.

Other equipment is designed to measure oxygen consumption, workload and metabolic costs, physiological stress, and the influence of sleep deprivation/fatigue, all of which are important contributors to musculoskeletal strength, endurance, operational performance and injury risk.

Dr. Scott Lephart, dean of the UK College of Health Sciences and founder of the SMRI, leads the $4.2 million Department of Defense grant that helped launch the institute. He said that the military can adapt from lessons learned in athletics and vice-versa.

“The elite warriors of the U.S. military are expected to be at peak performance in extremely dangerous and unpredictable situations, and there’s no room – either financially or personally – for them to sustain a preventable injury,” said Lephart, who is also UK Endowed Chair of Orthopaedic Research. “Our research with athletes both military and civilian is mutually beneficial, and it will result in strategies for injury prevention and performance for every walk of life.”

Impacts in education, health

University of Kentucky Provost Tim Tracy emphasized that the SMRI serves an educational need, in addition to its missions in research and clinical care, noting that the program provides educational experiences for both undergraduate and graduate students across the university.

“With this emphasis on collaboration, the different branches of UK’s mission – education, research, service and care – converge in the work of the SMRI,” he said.

Dr. Michael Karpf, UK executive vice president for health affairs, predicts that SMRI’s impact will extend far beyond the realms of tactical warriors and professional athletes.

“SMRI is a powerful merger of research, outreach and collaboration, enhancing UK HealthCare’s efforts to address chronic disease and poor health in Kentucky,” Karpf said.

UK Director of Athletics Mitch Barnhart noted that the SMRI was not just a valuable resource for UK athletes, but for professional and youth athletes across Kentucky and nationally.

“This is yet another example of the power of partnership on our campus,” Barnhart said. “By working together, we are creating cutting-edge resources for athletes both here at UK and beyond. The efforts of the SMRI will help minimize injury and maximize athletic performance in sports ranging from football to NASCAR and from basketball to horse racing.”

UK Sports Medicine Research Institute

Leaders from UK, UK HealthCare and UK Athletics came together to celebrate the opening of the SMRI.


Next steps:

In the latest edition of Making the Rounds, Dr. Scott Mair discusses always wanting to be a doctor, his hobbies and why he enjoys living in Lexington.

A passion for sports led Dr. Scott Mair to orthopaedic surgery

Making the RoundsWe sat down with Dr. Scott Mair, an orthopaedic surgeon at UK Orthopaedic Surgery & Sports Medicine, for our latest installment of Making the Rounds, a blog series that introduces you to some of our providers at UK HealthCare. Dr. Mair specializes in shoulder and knee arthroscopy and shoulder reconstruction.

How did you first become interested in medicine?

I grew up in Rochester, Minn., and everybody there is a doctor, basically. My dad was a pediatrician. I didn’t know there was anything else to do. I’m kind of kidding, but there are an unbelievable number of doctors there, per capita, just because the Mayo Clinic’s there and it’s a small town. So obviously I knew a lot of doctors, and they seemed to like what they did.

Why did you decide to specialize in orthopaedics?

It had more to do with my love of sports. I wasn’t a spectacular athlete, but I played a lot of sports, and I enjoyed being around sports. So when I would hear about team doctors, it seemed like a good fit. I get to work with several of the UK teams, which is a lot of fun.

What types of injuries do you treat?

Mostly what I see is shoulder problems. Probably about 80 percent of my practice is shoulder things. A lot of young athletes with stability problems, and then older people who have rotator cuff problems. But I see all kinds of other, different shoulder abnormalities, too.

What should patients know about rehab after surgery?

People think rehab is something where they have to push through the pain and do everything they’re supposed to do – which, in certain surgeries or certain rehabs, is important. But a lot of times, it’s almost the opposite, where once people start feeling well, we’ve got to slow them down because some things take months to heal.

For a lot of my younger patients especially, after a couple of months when we’ve stabilized their shoulder, they feel like they’re good as new, and they start doing things they’re not supposed to do before they’re healed. So half my time I spend trying to slow people down while they’re healing up after surgery instead of pushing them along, like you do in some surgeries.

What do you do in your spare time?

I have four daughters, so most of the time I’m doing things with them. I used to play a lot of golf, but they’re not much into that, so I spend a lot of time chasing them around for their sports and things. They range from age 12 to 20 now.

Describe your ideal weekend. 

I’d be at a UK basketball game and hanging out with my family after that, doing something with our friends. Maybe go fishing.

What do you like most about living in Lexington?

I’ve been here about 18 years and I think it’s a fun place. There’s a lot to do, it’s easy to get to big cities, but it’s not such a big place that you can’t get around where you need to go. And it’s got friendly people.

What’s your favorite movie?

I like some of the old-school movies like Caddyshack and Fletch. Those are probably still my favorites.


Check out our video interview with Dr. Scott Mair below, where he talks about why working with the student-athletes at UK is so rewarding.


Next steps:

  • Learn more about UK Orthopaedic Surgery & Sports Medicine, which provides leading-edge treatment for a variety of injuries and conditions.
  • When Patty Lane was diagnosed with arthritis in her hip, she was told her time as a competitive triathlete was over. That’s when she turned to UK Orthopaedic Surgery & Sports Medicine for a second opinion. Read Patty’s story.
Dr. Lattermann, director for Cartilage Repair and Restoration at UK HealthCare, spoke about what inspired his career in sports medicine.

Watch: 5 questions with sports surgeon Dr. Christian Lattermann

Each day brings something different for Dr. Christian Lattermann; that’s one of the things that keeps him passionate about his job.

As director of the Center for Cartilage Repair and Restoration at UK Orthopaedic Surgery & Sports Medicine, Lattermann treats patients, does community outreach, conducts research and mentors students.

Even though he’s a leader in the field, he says his patients teach him something new every day.

Watch this episode of “Five Questions” to learn how a semi-professional soccer career inspired Lattermann to become an orthopaedic surgeon and why he’s so excited about the sports medicine research happening here at UK.


Next steps:

  • Learn more about the UK Center for Cartilage Repair and Restoration, which offers operative and nonoperative treatments for a wide array of cartilage-related conditions.
  • After a torn meniscus and a failed surgery, marathon runner Lisa Hall was told she would need a knee replacement. Not willing to give up on her goals, Lisa turned to UK Sports Medicine and Dr. Lattermann for help. Read Lisa’s story.