Make Pain a Thing of the Past – knee surgery – Physician Partners of America

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The MIDASVu endoscopic camera is used for joint surgery and regenerative medicine

 An age-old problem with some types of joint surgery isn’t one that patients hear much about: for the surgeon, finding the target area isn’t always precise.

“Forty percent of knee injections are not in the knee. Even with people who know what they’re doing, it’s easy to miss the capsule,” says Dr. Abraham Rivera, Chief Medical Officer of Physician Partners of America.

Knowledge and experience are critical to a specialist’s success, but PPOA has taken patient safety a step further. It has becoming a pilot center for a device called MIDASVu. This next-generation endoscopic video camera can see what a live x-ray, or fluoroscope, can’t.

MIDASVu is an 18-gauge needle with an endoscopic camera attached to the tip. The creator, IntraVu Medical, Inc. of California, developed the device for a number of applications. These include arthroscopic surgery and regenerative medicine procedures.

“It’s an amazing piece of equipment. The endoscopic camera allows us to make certain that the needle is exactly inside the joint to deliver the medication or stem cells exactly in the right place inside the joint. It’s one order better than the fluoroscope,” Rivera says.

“Additionally, a physician can now quickly and easily check on healing and progress following a procedure with a simple, in-office needle stick using the MIDASVu,” Rivera says. “That’s something which previously required another visit to the MRI.”

MIDASVu is available in all PPOA locations.

Watch a demonstration here:


Interviewer: There are so many different types of pills out there. Pain pills, vitamins, blood pressure medicine, depression medication, the list goes on and on. There’s a good chance that you probably take a few of those. But have you thought about what they could possibly be doing to your organs? Dr. Rudy Gari from Florida Pain Relief Group is back to shed some light on this. Dr. Gari, great to have you here, and this is a really important topic.

Dr. Gari: Yeah, absolutely it is. And so one of the problems with pain pills is that, if you think about it, when you take a pill through your mouth, it has to travel first to your stomach. It gets absorbed. From there it goes to your liver…90% plus gets broken down, and then it gets spread from head to toe.

Interviewer: Okay, so what if you are taking multiple medications and they’re all going into your liver? What’s that doing to your organs?

Dr. Gari: Well, that can have a significant effect in your organs, especially those… So let’s talk about some of the pain pills. A lot of the pain pills have acetaminophen. Acetaminophen is a very good analgesic, but it wasn’t meant to be taken in very high dosages. So it’s metabolized by the liver, and we know that taking too much acetaminophen can affect your liver. So that’s a big problem with taking pills. We see a lot of that when patients come in. One of the things that we do is we want to give them their medications, but we want the medications to be absorbed right directly to where the problem is.

Interviewer: Yeah.

Dr. Gari: So we like to use some different ointments and creams. For example, if you have low back pain, we might apply some of that right exactly into the back or to the joints to get absorbed through the skin. You don’t have to take this pill that gets to your stomach, liver, and then goes head to toe and only a small fraction gets to the problem area.

Interviewer: Yeah, if you can bypass those organs and keep them as clean as possible, then…

Dr. Gari: Absolutely. So like a perfect example, let’s just take morphine, which is a medication. I can inject a tiny fraction of morphine, let’s say, into your back…maybe one-tenth of a milligram. A half a milligram. That’s actually a lot more powerful than if you take a hundred milligrams of morphine by mouth.

Interviewer: Wow. I don’t know why everyone wouldn’t say, “That’s the better method.”

Dr. Gari: Well, and what happens is when you take a very small portion and you put it to the area that’s painful, that’s the only place that it goes. When you have to take, for a hundred milligrams to get to equal one, you have to take a lot of it and it goes from head to toe. Liver, all your organs get affected that don’t really need to be affected by that medication.

Interviewer: When we see ads on TV, we see pills being advertised, and they are a cure-all for everything. It’s not, right?

Dr. Gari: Well, unfortunately, no it’s not. You know, you all want to take a pill and have it go away. But a lot of times, and what’s exciting now is that we target exactly where that problem area is and go right to it and use the smallest amount of medication necessary to get that taken care of.

Interviewer: How can medication affect you mentally as well as physically?

Dr. Gari: Well, what happens, if you think about it, our bodies and our selves can become dependent. So if you have to take a pill, it almost becomes a reflex.

Interviewer: Right.

Dr. Gari: We don’t want you getting into that habit of having to take pills all the time. So let’s say, like a patch. We can place a patch on you that’s good for seven days. We can do some ointments and creams that you don’t have to worry about taking a pill four times a day. So people get very dependent on that.

Interviewer: And we’ve all heard of people dying because of it too, because of overdosing.

Dr. Gari: And the problem is when you take it, sometimes you become…and we don’t know exactly how it’s going to work. We do a lot of different things like pharmacogenomics to determine your metabolism of that, but still, even with that, there’s side effects.

Interviewer: Okay, Dr. Gari, important stuff here. Thank you very much. Visit their website, to schedule your same-day appointment or you can give them a call.  We’ll be right back with more Daytime, so don’t go away.