“New Recommendations”
Antibiotic Prophylaxis for Dental Work
In the past we have always recommended that patients with hip and knee
replacements who require dental procedures that involve bleeding from
the gum line, receive prophylactic antibiotics. This has been a hotly
debated issue with the dentists. They have data reviewing all published
literature that indicates infection of a total joint from a dental procedure
is so rare that you have more chance of a serious reaction to the antibiotic
than getting an infection.
Even if it is rare, some orthopedists still feel the consequences of a
joint infection are so great that antibiotics should be given.
Recently the Committee on Infection of the American Academy of Orthopedic
Surgeons met with representatives of the American Dental Association and
have agreed to make “no recommendation” for antibiotics for
dental procedures. This is their way of saying that there is not enough
information to make a recommendation either way. That leaves it up to
individual patients and individual doctors to decide.
In a recent article reviewing the subject, other authors also conclude
that, for most patients, prophylactic antibiotics for dental procedures
or endoscopy are not necessary and could even be harmful if the patient
had a reaction to the antibiotic. This article did recommend prophylaxis
for certain high-risk patients such as those with rheumatoid arthritis,
diabetes, lupus, AIDS, or hemophilia. It was also suggested that all patients
may be at risk in the early postoperative period (first one to two years),
and prophylactic antibiotics should be considered.
Therefore, we no longer will recommend antibiotics prophylaxis for routine
dental procedures (unless the patient is considered “at risk”),
but if the patient feels they would like to use prophylaxis, and are able
to tolerate the antibiotics, we will prescribe them at their request.
Please note that we consider patients on long term steroids or methotrexate
to be “at risk” as well as, any patient with a chronic illness
that is known to be associated with immune system depression (i.e., rheumatoid
arthritis, diabetes, AIDS, etc.). Also, it is suggested that all patients
consider taking prophylactic antibiotics for dental work in the first
one or two post operative years.
This is their way of saying that there is not enough information to make
a recommendation either way. That leaves it up to individual patients
and individual doctors to decide.
Cartilage Regeneration: Fact and Fancy
There have been many reports in the popular press about a new process
that allows the regeneration of damaged articular cartilage using the
patient’s own cartilage cells grown in tissue culture. While this
new technology may offer a promise to patients with acute (i.e. traumatic)
damage to the cartilage of their knee joint, long-term studies are still
required before we will be able to evaluate the effectiveness of this
treatment. Unfortunately, this new technology only is applicable to those
with fresh damage to the knee cartilage and for the near future does not
appear to have any practical application in the case of advanced arthritis
of the knee joint.
Office Reminders & Suggestions
Please remember prescription refills need to be called into our office
at least 24 hours prior to your need for them. This allows time for the
physician to approve the renewal. These requests need to be made from
you to your pharmacy, and they will call our prescription line (916) 733-8299
and leave the appropriate information for us to process the renewal.
Our office experiences extremely heavy phone calls on Mondays and Fridays.
We are asking that you refrain from calling on these days whenever possible,
if it is something that can wait a day or so. The second half of this
request is that if you do need to call and the nurse for your physician
is not available, leave a message on their voice mail. They do set aside
time to address these calls and it avoids your having to call back.
Dr. Taylor sees patients on Mondays and Wednesdays, and it is difficult
for Kim, his assistant to take calls on these days. Please leave a voice
mail message or whenever possible, save your call for a Tuesday or Thursday.
Dr. Bargar sees patients on Tuesdays and Thursdays, therefore Elizabeth
is busy with patients. It is recommended you reach her on Monday and Wednesday
afternoons and Friday mornings.
The days that the doctors are not in clinic, they are in surgery.
Phone Hours are:
9 a.m.-11.30 a.m. and
2:00 p.m.-5:00 p.m.
We are closed all major holidays.
Dow-Corning Wright
Many of you have seen or heard information regarding the bankruptcy of
Dow Corning or its former subsidiary, Dow-Corning Wright. According to
Dow-Corning bankruptcy material, the implants about which patients might
make a claim include “silicone orthopedic joint implants used in
fingers, toes and wrists” and metal orthopedic joint implants used
in knees, hips and wrist.”
We (Dr. Jeffery K. Taylor & Dr. William L. Bargar) have never used
implants from Dow-Corning Wright.
Patient Profile
Mr. Stephen Sebillian is a retired veteran of the USAF with time spent
in Korea and Japan. He also retired from the US postal service where he
worked as a vehicle maintenance technician and later as a letter carrier.
Mr. Sebillian first came to see Dr. Bargar in June of 1984 with a complaint
of persistent left knee pain. X-rays revealed a suspicious lesion at the
top of the tibia (long lower leg bone). A biopsy of this lesion provided
to be a chondrosarcoma (malignant bone tumor).
With such a diagnosis surgery was scheduled immediately. A limb salvage
procedure (removal of bone tumor and replacement of lost space with an
artificial joint or donor bone) was performed. In this instance Mr. Sebillian’s
lost bone was replaced by an artificial knee joint.
He remained symptom free for several years with rapid advancement from
crutches to cane and then to full weight bearing without assistive devices.
During this time he was very active in being an adult volunteer with the
Boy Scouts of America holding the position of troop leader to being a
member of the executive board of BSA Buttes Area, Golden Empire Council
Yuba City and Sacramento.
In 1990 he experienced some swelling of his knee with discomfort on ambulation,
it was determined that the artificial joint needed to be revised. This
revision surgery was performed in 1991 and he continually improved. He
did wear a leg brace to protect his knee during increased activity. In
1995, four years after the revision surgery he continued to do well. The
leg brace was still being worn when he was exceeding his activity limitations.
He was last seen in our office in August of 1996, thirteen years from
the initial surgery. Dr. Bargar felt he was doing well clinically with
no recurrence of the chondrosarcoma.
Mr. Sebillian is active in several organizations including Masons, order
of the Eastern Star, Scottish Rite Bodies, Ben Ali Temple, Shriner and
the Drum and Bugle Corps. During the years of his involvement with these
organizations he has been given the following awards: Boy Scouts of America
Silver Beaver in 1980, Hiram Award, Mason of California 1992, OES Service
Award 1982 and Shriner of the Year 1995.
Thanks to early diagnosis and treatment, Mr. Sebillian has indeed led
a long and rewarding life and presently lives in Yba City with his wife
and family.
Staff Profile
She’s Back. Karen Reilly that is! Many of you may remember Karen
when she worked in our office from 1990 to 1993. She left after becoming
a mom. She and her husband transferred to the Bay Area. Her three-year-old
son, Tim, is attending preschool and Karen is back to work for us full-time.
Additionally, her husband will be transferring back to Sacramento soon.
We are all very happy she is back on our team!
New
Recommendations 