Travelgirl: COVID is the new normal. Initially we were wearing gloves everywhere. What’s the current protocol for covering your hands for safety reasons?
Dr. Jeffrey Klugman: Currently the recommendation is for frequent hand washing and/or sanitation. Gloves continue to be helpful as a protective barrier and as a reminder to avoid contact with mucosal surfaces such as your eyes, nose and mouth.

TG: Dr. Klugman, I know many parents will want to know — do you think children should be returning to sports during the pandemic?
JK: This is a difficult and controversial question. While there is clearly some increased risk of COVID infection with participation in organized sports, there are also physical and emotional benefits for children during this time of increased isolation. I believe this is a choice that individual families must make, recognizing that children generally have a mild course if infected but potentially could serve as vectors to infect others in the community. I would recommend to the extent possible mask wearing while engaging in group sports activities and appropriate COVID precautions.

TG: What are the standards in visiting a doctor’s office these days and should all visits be virtual? What are your thoughts on tele-med?
JK: Physician offices should be strictly practicing COVID precautions, which include temperature screening at check-in as well as asking appropriate screening questions concerning exposure risks and baseline health. The entire office staff and patients should be wearing appropriate facial coverings. Waiting rooms and exam spaces should enforce strict social distancing protocols. All contact surfaces should be thoroughly disinfected after each patient’s examination. It would be prudent to contact your physician’s office prior to a visit to ensure they are following these safety guidelines. Many physician offices are adding an additional supplemental fee to offset the significant new costs associated with taking proper COVID precautions.
   Tele-med remains a viable option to avoiding an in-person visit. However, there are significant limitations with tele-medicine. Physicians cannot physically examine a patient and are significantly limited with diagnostic options such as X-rays, office ultra-sound, EKGs, etc. It is particularly limiting for many of the sub-specialties such as hand surgery. There is very little that can be done diagnostically or therapeutically for hand surgery without an in-person evaluation.

TG: How has COVID affected you as a physician, husband and father?
JK: COVID has presented a unique challenge to me as a physician, husband and father. I feel a strong responsibility to provide consistent, high-quality care to my patients through this pandemic. I also feel a responsibility to protect the health of my wife and children. Practicing medicine in the office and surgical setting potentially exposes me to an increased risk of contracting the Coronavirus. To minimize risks, I consistently wear an N-95 mask the entire time I am at work. I wear gloves for any and all patient interactions and practice frequent hand washing. In addition, my office strictly follows the recommended COVID guidelines.   

TG: You treat both adults and children. How do you help children with congenital deformities? 
JK: My partners and I have a special interest in pediatric hand surgery and we are often asked to see children with congenital differences. These patients require specialized care and attention as these often are very unique problems. Time must be spent in discussion with the families so they can understand the medical issues, treatment options to improve function and cosmesis, timing of treatments, and long-term prognosis. Congenital issues affect the child but also have an impact on families. Treatment can include therapy, splints, comprehensive medical work-ups and surgical intervention. Our practice supports a Pediatric Hand Fellowship through the Children’s Healthcare of Atlanta system to hopefully educate future clinicians in how to manage these difficult problems. 

TG: Carpal tunnel is also a problem now that so many people are on computers all day. What is it exactly, and how is it treated? Would you also explain what a trigger finger is?
JK: Carpal Tunnel Syndrome is among the most common problems I treat. Carpal Tunnel is compression of the median nerve as it traverses from the forearm into the hand. Carpal Tunnel is compression of the median nerve as it traverses from the forearm into the hand. The carpal tunnel is a defined space with bone on three sides and a dense ligament forming the roof of the tunnel. When pressure increases in the space, it causes the nerve to become compromised and results in numbness to the thumb, index, middle and part of the ring finger. It can also cause weakness to the muscles at the base of the thumb, which significantly affects fine motor function. Patients who present with Carpal Tunnel Syndrome often require an EMG/Nerve conduction study to objectively evaluate their complaints. Treatment can include a variety of non-operative measures as well as carpal tunnel release surgery, which has a very high success rate in improving symptoms and preventing them from worsening or recurring over time.
   Trigger finger is another common problem. Trigger finger results from inflammation and catching as the flexor tendon glides through the sheath and the first pulley that keeps the tendons adjacent to the bone. In a trigger finger, the tendon becomes inflamed and catches at the first pulley creating a mechanical block, like a truck that’s too big to fit through a tunnel. The solution is to make the “truck” smaller with a steroid injection or, if that does not solve the problem, I can permanently make the “tunnel” bigger with a small outpatient procedure to release just the first pulley. Trigger finger release surgery is very effective with high patient satisfaction and minimal down time. 

TG: Baseball, basketball, soccer, football and other sports spark numerous injuries in professional players and, of course, in children and adults — whether joining in group activities or practicing alone. What are some of the more common injuries you see?
JK: Fractures and sprains about the wrist and hand are clearly the most common sports related injuries. Overuse injuries are also a significant issue. Baseball pitchers, for instance, are exposed to repetitive use injuries. Early presentation with repetitive use injuries can significantly improve long term outcomes. Precautionary measures include proper training and coaching. When dealing with sports-related injuries, appropriate sub-specialty care and early evaluation result in a higher potential for correct initial diagnosis and treatment and optimizes the ability to return to play early and safely. 

TG: On another topic, as women age, they seem to be at a higher risk for hip and wrist fractures. What proactive steps can be taken to avoid injury?
JK: Women are at an increased risk of distal radius wrist fractures primarily due to diminishing bone density. Osteopenia and osteoporosis are the clinical terms to describe this condition that is typically associated with aging. The typical osteoporotic fractures include spine, hip and wrist. Your primary care physician should diligently screen for osteoporosis to optimize early treatment in an effort to diminish risks. In addition, taking reasonable precautions to minimize fall risks would be advisable. (installing railings, safety bars, etc.) Routine precautionary splint wearing is not recommended.

TG: Will you please discuss arthritis? I can remember my mother suffering with arthritis, in pain and coping with the twisted shape of her fingers. Are there any new solutions?
JK: There are multiple types of arthritis such as osteo, rheumatoid, post traumatic, septic, etc. It sounds like your mother had osteo-arthritis. This is a very common problem affecting the hands seen more often in women than men. It is typically a genetically preprogramed process, meaning it affected your grandmother, mother and will probably affect you. Arthritis of the hand can result in deformity, stiffness and pain. Unfortunately, there is no way to prevent this process from occurring or progressing in patients with a pre-disposition. There are options to help with function and cosmesis, which is the preservation, restoration, or enhancement of the physical appearance. Arthritis of the thumb base is a particularly common problem I frequently see that can be painful and functionally limiting. Fortunately, there are good options available to treat this and dramatically improve both pain and function including splinting, steroid injections and surgery.

For more on Dr. Klugman’s practice, go to: https://www.handcenterga.com

The post The Doctor is in: Dr. Jeffrey Klugman appeared first on Travelgirl.