Price: $7,931
CPT Code: 29888
Anterior cruciate ligament reconstruction (ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after anterior cruciate ligament injury. The torn ligament is removed from the knee before the graft is inserted through a hole created by a single hole punch. The surgery is performed arthroscopically.
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- PCOS Weight Loss Medication By Christine Traxler, MD Medically Reviewed by Kim Langdon, MD on 07.16.23 Polycystic ovary syndrome (PCOS) is a complex metabolic disorder seen in up to 12% of women of reproductive age. While the name suggests it results in cysts on your ovaries, you don’t have to actually have cysts to have this disorder. Some of the more common symptoms of PCOS include menstrual irregularities, insulin resistance, weight gain, excess facial and body hair, mood dysfunction, acne, and infertility. When you combine excess weight with high blood sugar, you risk complications like diabetes, heart disease, and certain hormone-sensitive cancers. Among women trying to manage the disorder, the biggest challenge is fighting weight gain with PCOS. Weight gain around the midsection—sometimes referred to as PCOS belly—is often due to the combination of male hormone dominance and insulin resistance. Weight loss is important to managing PCOS because even a small amount of weight loss (around 5% to 10% of your total weight) can have a significant impact on symptoms and outcome. You may be wondering if medications like those we have been hearing so much about lately could help someone with PCOS lose weight. The answer is yes. Medications used for weight loss in other situations may also benefit those with PCOS and obesity. Some options include Orlistat, metformin, and semaglutide (brands Ozempic and Wegovy). They act in different ways to improve weight loss. Many are specifically recommended for those who have type 2 diabetes. This guide goes over the medications you can consider if you want to lose weight with PCOS. Learn how the medications work and the side effects you may experience if your doctor prescribes them for you. Medications that can help with PCOS weight loss Some women with PCOS can lose weight using only diet and exercise. In many cases, weight loss can be achieved by eating food with fewer calories and burning them through increased activity. Others have metabolic issues like low thyroid function and insulin resistance that negatively impact their ability to lose weight. If you’re having difficulty losing weight with PCOS, you may want to talk to your doctor about taking medications to help you lose weight. Your doctor is the best resource for deciding which, if any, of these medications are appropriate for your unique condition. This list will hopefully help you collaborate with your doctor by explaining how they work. It is not intended to provide you with medical advice but, instead, to educate you regarding what’s out there and why they help some individuals with PCOS and obesity. Metformin Metformin is a commonly used drug for diabetes and prediabetes. When it was studied in the prevention of diabetes, researchers noted that those who took the drug steadily prevented diabetes by 31%. In addition, users of metformin lost about 3.5% of their body weight and kept it off. The fat loss was more often located around the midsection. Metformin acts to reduce the risk of diabetes by blocking the production of excess glucose in the liver. When it does this, less insulin is released by the pancreas. In addition, it reduces appetite and changes the gut microbiome to promote enhanced weight loss. The major side effects of metformin are nausea, diarrhea, and bloating, which may also transiently affect appetite. It may cause some foods to taste different, too. Researchers have noted that you would need to remain on the drug long-term to reap the maximum benefits. Weight gain after stopping metformin is entirely possible. Take Control of PCOS by Partnering With a Dietitian 90% of Zaya Care patients pay $0 for one-on-one counseling with a Registered Dietitan >> Find Your Match Acarbose (Precose) Acarbose is an antidiabetic drug that prevents glucose absorption by blocking the enzymes responsible for bringing glucose into the bloodstream from the gut. The drug itself doesn’t get absorbed into your system to a great degree. By blocking sugar uptake, acarbose lowers blood sugar and insulin levels. Acarbose has been found to reduce triglycerides and lower the risk of diabetic complications. Those who take it have reduced weight compared to those taking a placebo. In one study, the BMI was reduced from 30 (obesity) to an average of around 23 (normal). The main side effects of acarbose are flatulence and diarrhea. This occurs because there is excess food that doesn’t get absorbed by the gut, particularly carbohydrates. Like most of these medications, stopping the medicine may mean that you’ll gain the weight back. Orlistat (Alli or Xenical) Orlistat has been used for several years to reduce weight in individuals with or without diabetes. It is not an antidiabetic agent but instead inhibits a pancreatic enzyme called lipase. It prevents the absorption of dietary fat. Other nutrients are easily absorbed without change. Years of use of the drug from the time it was placed on the market in 1999 indicate that it does promote a modest weight loss among those who use it regularly. Only about four to six pounds of excess weight are lost in most individuals but, for some, it can improve the risk of obesity complications. The main side effects are greasy stools and diarrhea, but they tend to pass within a few weeks in most users. Rarely, the drug can cause kidney stones or an inflamed pancreas. Tizepatide (Mounjaro) Tizepatide (Mounjaro) is a drug acting in two ways to combat diabetes. It mimics the GIP hormone (glucose-dependent insulinotropic peptide) and also acts on the GLP-1 (glucagon-like peptide-1) receptors. The result is a reduced amount of glucose sugar entering the body from the GI tract. By lowering blood sugar, insulin levels are reduced. For those with obesity, Tizepatide lowers body weight by up to 20% of your original weight. Lipid metabolism is also improved. Appetite can be suppressed and, for those with diabetes, blood sugar is reduced. Mounjaro must be injected into the soft tissue of your body (often under the skin of the abdomen or thigh) every week. Side effects can include nausea or abdominal pain. Diarrhea or constipation may occur as well. It is also extremely expensive if your insurance won’t cover it. >> Read more: Mounjaro diet plan: Best foods to eat & which to avoid Liraglutide (Victoza or Saxenda) Liraglutide is an injectable drug that acts as a GLP-1 agonist. When you take it, it can promote insulin secretion, slow gastric emptying, and suppress your appetite. It is believed that this is how weight loss is achieved. It also improves diabetic control in those who have diabetes or prediabetes. Liraglutide must be injected regularly to be effective. Most doctors begin prescribing a low dose injected daily to see how well you tolerate it. Side effects are mostly gastrointestinal in nature (nausea, stomach pains, constipation, or diarrhea). Individuals using this drug lose about 10 to 11 pounds on average, mostly because they aren’t hungry. Low blood sugar does not happen as long as other diabetic drugs aren’t taken at the same time; however, those with high blood sugar have improved blood sugar numbers. >> Read more: Saxenda diet plan: Best foods to eat & which to avoid Semaglutide (Ozempic or Wegovy) There are two drugs marketed under the generic name of semaglutide. They are the same drug; however, Ozempic is prescribed for diabetes, while Wegovy has been approved for weight loss. Other than the semantics, these GLP-1 receptor agonists are the same drug. Both are injected; however, some take the drug daily and others take it once per week. Like all of these GLP-1 receptor agonists, the side effects include nausea, abdominal pain, bloating, and diarrhea or constipation. They act to reduce your appetite and slow the emptying of your GI tract. On average, it takes around 6 months to lose 11% of your weight on Ozempic, but it varies from person to person. Note that Ozempic typically isn’t covered by insurance unless it’s prescribed for diabetes. Wegovy, on the other hand, can be prescribed for weight loss and is covered by many insurance plans. You can learn more about what the research says about using Ozempic for PCOS here. >> Read more: Ozempic diet plan: Best foods to eat & which to avoidWhy am I not losing weight on Ozempic?Cost of Wegovy with & without insurance Phentermine-Topiramate Phentermine-topiramate is a combination drug used for short-term weight loss. It is an oral pill that combines phentermine (a stimulant) and topiramate (often used as an anticonvulsant). The drug has the potential for abuse because the phentermine is similar to amphetamine, so few doctors prescribe it. It is an oral pill that suppresses your appetite. This results in weight loss that varies by person. It is only recommended for 12 weeks or less and may increase heart rate or cause nervousness in some individuals. In women of reproductive age, it can cause birth defects if a pregnancy occurs. >> Find a PCOS nutritionist who accepts your insurance How insulin resistance from PCOS causes weight gain Why would drugs used for diabetes help weight loss? Much of this question is answered by understanding the impact of insulin resistance on weight. Insulin resistance is the underlying problem among most with type 2 diabetes. When sugar enters the body, insulin is produced to put it into the cells. If you are resistant to the effects of insulin, the sugar remains in the bloodstream, unable to enter and nourish the cells of your body. This excess, unused energy is put into the fat cells as fatty acids. PCOS and insulin resistance go hand-in-hand. If you have PCOS, you almost certainly have insulin resistance. The drugs most often effective in weight loss are those that also lower blood sugar and improve your sensitivity to insulin. Once you lose some weight, you will naturally improve insulin resistance because less fat means your insulin will work better—even if you stop taking weight loss medication. >> Read more: Supplements that may help with PCOS weight loss How a nutritionist can help with PCOS weight gain Losing weight is never a matter of just taking a pill or injecting yourself with a drug. It often takes increased physical activity and better eating habits to lose weight and keep it off. Unless you need the drugs for type 2 diabetes, you may decide to stop taking them after losing enough weight. A PCOS nutritionist can help in so many ways. PCOS nutritionists are trained in nutrition and the intricacies of managing PCOS through nutrition. Your PCOS nutritionist can evaluate your goals and current situation. They can make food recommendations and help you create a PCOS diet plan that will work at any stage in the weight loss process. While they cannot prescribe medications, a PCOS nutritionist can help you determine how diet and exercise can work with weight loss medication to influence your weight. They can also help you cope with the side effects of medications like nausea and constipation through changes to your meal plan. A nutritionist specializing in women’s health issues like PCOS can follow your progress, helping you succeed through individual attention and personalized recommendations so you can achieve your health-related goals. Take Control of PCOS by Partnering With a Dietitian 90% of Zaya Care patients pay $0 for one-on-one counseling with a Registered Dietitan >> Find Your Match By Christine Traxler, MD Christine Traxler MD is a family physician, lifelong writer, and author with a special interest in mental health, women’s healthcare, and the physical after-effects of psychological trauma. As a contributing writer and editor for numerous organizations, she brings a holistic focus to her work that emphasizes healing and wellness through daily self-care, connecting with others, and setting stepwise goals toward achieving more balanced and authentic lives.
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An ACL reconstruction is sometimes referred to, incorrectly, as an ACL repair. A torn anterior cruciate ligament cannot be “repaired”, and must instead be reconstructed with a tissue graft replacement.
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Two alternative sources of replacement material for ACL reconstruction are commonly utilized:
- Autografts (employing bone or tissue harvested from the patient’s body), and
- Allografts (using bone or tissue from a donor’s body, typically a cadaver’s or a live donor).
Since the tissue is one’s own in an autograft the probability of rejection (sans infection) is minimal.
Sterilization and redundant donor screening process make allografts a generally safe choice for patients; however, risks remain. Irradiation of donor content to remove infectious agents potentially weakens the selected tendon, although for ACL surgery the weakened tendon is generally as strong as the replaced ligament. Infection may also require removal of the graft.
- Synthetic tissue tissue suitable to ACL reconstruction has also been developed. Few data exist on its strength or reliability.
Allograft
The patellar tendon, anterior tibialis tendon, or Achilles tendon may be recovered from a cadaver and used as an allograft in reconstruction. The Achilles tendon, due to its large size, must be shaved to fit within the joint cavity. There is a slight chance of rejection, which would lead to more surgery to remove the graft and replace it.
Autograft
An accessory hamstring or part of the patellar tendon are the most common donor tissues used in autografts.
Hamstring tendon
Unlike the patellar tendon, the hamstring tendon’s fixation to the bone can be affected by motion in the post-operative phase. Therefore, following surgery, a brace is often used to immobilize the knee for one to two weeks while the most critical healing takes place. Evidence suggests that the hamstring tendon graft does just as well, or nearly as well, as the patellar tendon graft in the long-term.
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Many patients struggle with recovery after a hamstring graft procedure. Problems include strengthening of the quadriceps, T-band and calf. Proper healing procedures and medical care (physical therapy) are essential to regain strength.
The main surgical wound is over the upper proximal tibia, avoiding the typical pain sensation when one kneels down. The wound is typically smaller than the patellar tendon graft and hence less pain after the operation. A new technique for minimal-invasive harvesting from the back of the knee has been developed in the last years. This technique is faster, easier and produces a significantly smaller wound. his procedure is typically an outpatient procedure.
There seems to be some controversy as to how well a hamstring tendon regenerates after the harvesting. Most studies suggest that the tendon can be regenerated at least partially, while still being inferior in strength to the original tendon.
Patellar tendon
The patellar tendon connects the patella (kneecap) to the tibia (shin). The graft is taken from the injured knee, but in some circumstances, such as a second operation, the other knee may be used. The middle third of the tendon is used, with bone fragments removed on each end. The graft is then threaded through holes drilled in the tibia and femur, and finally screwed into place.
The graft is slightly larger than a hamstring graft, however graft size is not a determinant of outcome. The most important factor in determining the outcome is correct graft placement.
The disadvantages include: 1. Increased wound pain. 2. Increased scar formation as compared to a hamstring tendon operation. 3. Risk of fracturing the patella during harvesting of the graft. 4. Increased risk of tendinitis. 5. Increased levels of pain with activities that require kneeling years after post op.
Choice of graft
Type
Typically, age and lifestyle choices help decide the type of graft to be used for ACL reconstruction. The overall factors in knee stability are correct graft placement by the surgeon and treatment of other menisco-ligament injuries in the knee, rather than type of graft.
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The advantage of an allograft is the patient does not sustain additional injury through removing a tendon, thus making it faster to recover. Disadvantage are the risk of infection from foreign bodily materials and a typically slightly weaker graft.[5]
Site
No ideal graft site for ACL reconstruction exists. Surgeons have historically regarded patella tendon grafts as the “gold standard” for knee stability, however the procedure suffers a slightly higher complication rate, including knee pain when lunging.[6]
Hamstring grafts historically had problems with fixation slippage and stretching out over time. Modern fixation methods avoid graft slippage produce similarly stable outcomes with easier rehabilitation, less anterior knee pain and less joint stiffness.
Recovery
Initial physical therapy consists of range of motion (ROM) exercises, often with the guidance of a physical therapist. Range of motion exercises are used to regain the flexibility of the ligament, prevent or break down scar tissue from forming and reduce loss of muscle tone. Range of motion exercise examples include: quadriceps contractions and straight leg raises. In some cases, a continuous passive motion (CPM) device is used immediately after surgery to help with flexibility. The preferred method of preventing muscle loss is isometric exercises that put zero strain on the knee. Knee extension within two weeks is important with many rehab guidelines.
Approximately six weeks is required for the bone to attach to the graft. However, the patient can typically walk on their own and perform simple physical tasks prior to this with caution, relying on the surgical fixation of the graft until true healing (graft attachment to bone) has taken place. At this stage the first round of physical therapy can begin. This usually consists of careful exercises to regain flexibility and small amounts of strength. One of the more important benchmarks in recovery is the twelve weeks post-surgery period. After this, the patient can typically begin a more aggressive regimen of exercises involving stress on the knee, and increasing resistance. Jogging may be incorporated as well.
After four months, more intense activities such as running are possible without risk. After five months, light ball work may commence as the ligament is nearly regenerated. After six months, the reconstructed ACL is generally at full strength (ligament tissue has fully regrown), and the patient may return to activities involving cutting and twisting if a brace is worn. Recovery varies highly from case to case, and sometimes resumption of stressful activities may take a year or longer.
The reconstructed ACL has a high success rate. Studies show that cases in which the ACL retears are generally caused by a traumatic impact. Some studies indicate that wearing a brace during athletic activity does not reduce probability of re-injury to the ACL&llt;sup>[citation needed], but a study of active post-ACL replacement skiers shows a 300% reduction in re-injury likelihood by using a knee brace after recovery.[7] A sufficiently traumatic impact to retear the ACL is unlikely to be mitigated by the use of a brace.[citation
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This post was last modified on Tháng mười một 27, 2024 6:20 chiều