Happy & Healthy: New Year’s Resolutions

We know diet and exercise are completely cliché when it comes to New Year’s resolutions. However, they are a great way to commit to maintaining your bone, and of course, overall health. So now that the ball has dropped and the confetti has been swept away, make good on your resolution for a healthier you. paper-3042645_1280

Here’s some suggestions for resolutions that will make a positive impact on the year ahead:

Nosh nutritiously – You are what you eat. Processed food and sugar can sabotage your health and actually weaken your bones. Foods high in vitamin D are essential for providing your body the ability to absorb calcium. Fatty fish, egg yolks, cheese and vitamin D-fortified foods like cereal, dairy products and orange juice are all great sources.   Boost your calcium intake by adding leafy greens, fish, such as sardines and rainbow trout, and foods fortified with calcium. Salmon is a great option for both vitamin D and calcium. Start eating foods that will bolster your bones and keep osteoporosis at bay.

Get physical – Physical activity helps build strong bones when we are younger. As we age, we run the risk of osteoporisis, a disease that weakens the bones and makes them more susceptible to breaking. That’s why it’s important to continue exercising to maintain healthy bones. Strengthen your bones with weight-bearing exercises like walking, jumping rope, tennis and dancing. Increasing the weight placed on bones while exercising makes them work harder and increases bone density. Jazzercise, Prancercize or just plain aerobicize your way to better health and stronger bones.

Lose the extra lbs – Extra weight places more stress on your joints. In fact, obesity is a key contributor to osteoarthritis, a joint disease that results in painful wear and tear typically affecting the hips and knees. Maintaining a healthy body weight is important because each pound puts about five pounds of pressure on your knee joints.

Don’t worry be happy – Stress can wreak havoc on your health . . . and bones. According to a study by the Journal of Clinical Endocrinology and Metabolism, higher levels of the hormone cortisol, commonly known as the stress hormone, decreases bone mineral density. To combat stress, get plenty of rest, take time for yourself, learn to say “no,” identify unrealistic expectations and laugh more. So put down that never ending to-do list and turn on “I Love Lucy” reruns because sometimes laughter really is the best medicine.

Resolutions can be hard to stick with so take it slow and start with small changes. Practicing healthy habits daily can ultimately lead to a long-term healthy lifestyle. Have questions? We’d be happy to schedule a consultation! Call us at 618-288-9460. You can also visit for more information.

Fracture Care

The human skeleton, by adulthood, has 206 bones. That’s a lot of potential for something to break. Fortunately, our bones are surprisingly strong. However, as we age we begin to lose bone density, making the bones more susceptible to a break or fracture. A healthy diet and regular physical activity are essential for maintaining strong bones. After all, sticks and stones may break your bones if you’re not getting enough Vitamin D, calcium and exercise.

Types of Fractures

Simply put: a fracture is a break in the bone. However, there are several different types of fractures:

  • Stable fracture. There is a break, but the bones are still properly aligned.
  • Stress fracture. Tiny crack(s) in the bone.
  • Closed or simple fracture. The bone is broken, but does not puncture the skin.
  • Open or compound fracture. The skin in punctured by the break.
  • Transverse fracture. The bone breaks perpendicular to the length of the bone.
  • Oblique fracture. The break is diagonal across the bone.
  • Comminuted fracture. The bone is shattered or has splintered into several fragments.Fracture, Broken Bone, CAO

Causes of Fractures

Fractures can occur for various reasons. Those diagnosed with osteoporosis are more susceptible to breaking a bone. Osteoporosis is a disease that reduces the bone density leaving them weak and more liable to break. Something as small as bending over to sneeze or stepping wrong can cause a fracture.

Broken bones can also be trauma-induced. Car accidents, falling, even from a short distance, or a high-impact sport can all result in a trip to the ER. Overuse or repetitive motion injuries can also be the culprit of a crack. Overusing certain muscles can weaken them over time, leaving the bone more vulnerable to injury, such as stress fractures. This type of fracture is more common in athletes participating in sports that involve running or jumping repeatedly.

How the Body Heals Fractures

When a bone breaks, the body works quickly to heal the damage. A blood clot and protective callus form to protect the newly exposed area. New bones cells grow from either side of the break, branching out towards eachother until the gap is closed. The callus is absorbed into the new bone growth and the bone is completely healed.

Diagnosis of Fractures

Our orthopedic physicians will examine your injury. They will also disuss with you how the injury occurred, examine your overall health and review your medical history to ensure there are no underlying issues. The doctors also perform x-rays to confirm the bone is, in fact, broken, the type and exact location of the break.

Treatment of Fractures

Rest and immobilization are required to heal a broken bone. This can be achieved with a cast once the bone is positioned correctly. A brace can be used to allow some controlled movement.

X-ray of ankle with external fixator. Fracture, broken bone. CAO
X-ray of ankle with external fixator.

More serious breaks may require surgery. An external fixator uses metal pins, screwed around the fracture, that are afixed to an external bar to stabilize the bones so they heal correctly. An open reduction and internal fixation involves realigning the bones and holding them in place with metal rods, plates and/or screws.

The healing process can take anywhere from several weeks up to a year, depending on the severity of the break, your bones’ state of health and how well you follow your doctor’s advice. Rehabilitation may be required for weakened muscles due to prolonged immobility.

Fractures should not be left untreated. To avoid complications in the healing process, please schedule an appointment by calling 618-288-9460. You can also visit for more information.

CAO’s Toys for Tots Toy Drive

#GivingTuesday Toys for Tots

Help make a less fortunate child’s Christmas a little brighter this holiday season. Please consider purchasing and donating an extra toy or two to the Marine’s annual Toys for Tots toy drive.

CAO has partnered with them this year to serve as a drop off location. Drop off your new, unwrapped toys in the designated Toys for Tots box at any of our three metro east locations to help spread Christmas cheer to a child in need. Our locations include:


Maryville: Physician’s Building (connected to Anderson Hospital) 6812 State Route 162 Ste. 123, Maryville, IL 62062

Staunton: 400 N. Caldwell St., Staunton, Il 62088

Highland: 1212 Broadway, Highland, Il 62249

Repairing Your Rotator Cuff

The shoulder, a ball and socket joint, is one of the most mobile joints in the human body. It’s a hardworking joint that helps you to keep the golf ball in the fairways (hopefully) when swinging your club. The rotator cuff is made up of four muscles that attach to and form a “cuff” over the top of the humerus (the upper arm bone). The cuff actually works to keep the arm inside the socket.


The rotator cuff can tear as a result of impact, like a fall, which is known as an acute tear. Wear and tear on the joint, known as a degenerative tear, is another cause. There are two different types of tears: a partial tear, in which some of the tendons remain attached, and a full-thickness tear (a complete tear).

Symptoms of a torn rotator cuff include pain in the front of your shoulder that sometimes extends down your arm. You may notice pain when performing different activities or movements in the affected shoulder. If you experience shoulder pain, it’s always best to make an appointment with your orthopedic surgeon to have it examined and diagnosed.

Typically, these tears are unable to heal on their own and will require surgery. However, you can first try a more conservative treatment with rest, anti-inflammatories, steroid injections and physical therapy. If pain persists, a surgical procedure may be required to correct the tear.

There are three different commonly-used techniques to correct a torn rotator cuff: open repair, mini-open repair and arthroscopic repair.

  • Open Repair – This option involves creating an incision, typically several centimeters long, to reattach the tendons. This type of surgery is usually required for larger tears.


  • Mini-Open Repair – A mini-open repair requires a smaller incision than the open repair method and uses arthroscopy to examine and correct some of the damage. The tendons are then reattached via traditional surgery.


  • Arthroscopic Repair – This type of surgery is the least invasive and is often an outpatient procedure. During surgery, an arthroscope (a tiny camera) is inserted into the patient’s shoulder. This enables the surgeon to view and assess the damage. Then, using much smaller surgical instruments, the surgeon can repair the damage through tiny incisions.

Physical therapy will be required after any surgery option. You can expect to recover within several months, with full recovery at one year.  Goals of surgery outcomes include better range of motion and regain strength with less or no pain.

If you’ve been experiencing shoulder pain or recently suffered a shoulder injury, please schedule an appointment by calling 618-288-9460. You can also visit for more information.

Need a Foot and Ankle Doctor? Look for the “O”!

Recently Dr. Grebing visited Seattle. He was there to do more than catch fish at Pike Place Market and enjoy views of the Puget Sound. He was visiting the coffee capital of the world to attend the American Orthopaedic Foot & Ankle Society’s Annual Meeting. The conference features numerous informative presentations, as well as Guest Speaker Jim Whittaker, the first American to summit Mount Everest, former CEO of REI, and award-winning author.

This year’s conference also highlighted the campaign, “Look for the ‘O.’” This campaign stresses the importance of seeking medical attention from a foot and ankle orthopedic

American Orthopaedic Foot & Ankle Society (AOFAS) Guest Speaker Jim Whittaker, the first American to summit Mount Everest, former CEO of REI and award-winning author.
AOFAS Guest Speaker Jim Whittaker, the first American to summit Mount Everest, former CEO of REI and award-winning author.

surgeon. We wanted to share with everyone why it’s in your best interest to “look for the o” when it comes to your foot and ankle health, as stated by AOFAS:

  • They are fully trained medical doctors. Grebing is a fully trained medical doctor. He takes a patient’s overall health into consideration when diagnosing a foot or ankle problem, as it could be a sign of a more complex problem.


  • They are highly specialized. Grebing completed more than 14 years of training. This was a combination of undergraduate, medical school, an orthopedic surgery residency and a fellowship in foot and ankle orthopedic surgery.


  • They don’t just operate. Just because he’s a surgeon doesn’t mean Dr. Grebing always recommends or only sees patients needing surgery. In fact, the most conservative approach is always taken to avoid surgery when possible.


  • They know how to treat complicated cases. With one-quarter of the entire body’s bones located in the feet, plus 33 joints and more than 100 tendons, ligaments and muscles, MD’s are bound to come across complicated cases from time to time. Foot and ankle orthopedic surgeons, like Dr. Grebing, can rely on their vast, specialized training to correctly diagnose and treat your pain.


  • They’re great for second opinions. Don’t gamble when it comes to your health. It’s always advisable to get a second opinion from a foot and ankle orthopedic surgeon, especially when surgery is a possibility.


Dr. Brett Grebing attended the American Orthopaedic Foot & Ankle Society Conference
Dr. Brett Grebing attended the American Orthopaedic Foot & Ankle Society’s Annual Meeting in Seattle.

Make sure your ankles and feet and in good hands by seeking a foot and ankle orthopedic surgeon. Dr. Grebing strives to provide the best care to all his patients. Schedule an appointment by calling 618-288-9460 or visit for more information. For more information about AOFAS and the Look for the “O” campaign, visit:

How to Pick the Perfect Orthopedic Surgeon

Choosing an orthopedic surgeon is like finding a hair stylist; you want someone that does excellent work and is easy to talk to. Okay, maybe there’s a few more stipulations when it comes to orthopedic surgeons, but you get the idea.

Your health is your most valuable asset. Picking an orthopedic surgeon is a major decision and it’s important to find one you feel comfortable with and can trust. Below we’ve listed some of the key items to consider before selecting your surgeon:

  1. Insurance – It is always best to contact your insurance provider to confirm which doctors are in-network with your insurance plan before scheduling an appointment. Many practices also provide a list of accepted insurance plans on their website (link to CAO’s insurance page).


  1. Experience – An orthopedic surgeon’s experience isn’t just commensurate with how many years they have been practicing. Also take into consideration the number of specific surgeries they have performed and their success rate. You may also want to consider if they are knowledgeable about the most up-to-date technology, latest practices in their field and if they conduct continuous research in their area of expertise.


  1. Credentials/Qualifications – Board certification and fellowship training are great indicators that an orthopedic surgeon is highly qualified. Dr. Bicalho is board certified in orthopedic surgery through The American Board of Physician Specialties in Orthopedic Surgery. Dr. Grebing received his board certification through the American Board of Orthopedic Surgery.

Orthopedic Surgery and Surgeons, Orthopedists

As the American Board of Medical Specialties states, “Board Certification demonstrates a physician’s exceptional expertise in a particular specialty and/or subspecialty of medical practice . . . It challenges physicians to focus on the continuous development of their skill set . . . Board Certification and ABMS MOC are peer-developed, externally validated programs which serve as important markers for a higher standard of care. They reflect the critical core physician values of compassion, patient-centeredness, and a passion for education.”


Orthopedic surgeons can apply to subspecialty fellowship programs for an additional year of training towards a specialized orthopedic surgery. By completing a fellowship they are considered experts in that specialty field.


For instance, both Dr. Grebing and Dr. Bicalho are fellowship trained. Dr. Grebing completed fellowship training in foot and ankle surgery at the Idaho Foot and Ankle Fellowship Program. Dr. Bicalho performed his fellowship in joint replacement surgery at the Missouri Bone and Joint Center / Barnes Jewish West County Hospital.


  1. Communication/Bedside Manner – According to a recent study by The Associated Press-NORC Center for Public Affairs Research, 59% of Americans felt the physician-patient relationship and the physician’s personality were most important when discerning high-quality physicians.


While experience and qualifications are important when choosing an orthopedic surgeon, the surgeon’s bedside manner can also improve the entire doctor-patient experience. The physician should be attentive, compassionate, a good listener and take the time with each patient to fully explain procedures and answer any questions.


  1. Reviews – Online reviews via com,, Google or even on social media sites like Facebook are extremely helpful when researching physicians. These reviews can also provide information about the practice’s staff, ease of scheduling appointments and wait times.


  1. Referrals/Ask a Friend – While online reviews provide insight about a physician, it’s always good to get a referral from someone you personally know and trust. Patients typically place higher value on a family member, friend, or referring physician’s opinion moreso than an anonymous online review.

We understand that the selection process can be overwhelming. We are happy to answer any questions you might have. Dr. Bicalho and Dr. Grebing, are both fellowship trained, board certified, have excellent reviews and published research.

If you’re in need of compassionate, caring and qualified orthopedic surgeon, please call to schedule an appointment at 618-288-9460 or visit for more information.

Arthritis: Osteoarthritis vs. Rheumatoid Arthritis

In general, arthritis can be a real pain in the . . . joints! Although both osteoarthritis and rheumatoid arthritis are a result of the same overarching disease and are both painful, the two different types of arthritis are just that—different.

There are currently more than 30 million adults in the US suffering from osteoarthritis, according to the Center for Disease Control and Prevention. Osteoarthritis, which only affects joints, can be brought on by injury, getting older, being overweight or genetics. It’s a degenerative disease that causes the cartilage to thin and weaken. Over time the lack of cartilage results in the bones rubbing against each other creating a great deal of pain.


Rheumatoid arthritis currently affects 1.3 million U.S. adults, with women three times more at risk than men. It’s an autoimmune disease that can affect any part of the body. An autoimmune disease occurs when the immune system attacks the healthy cells in your body. Rheumatoid arthritis is when the immune system attacks the synovial membrane, which lines the joints, causing excess fluids on the joints. Also causing a great deal of pain.

Both forms of arthritis cause the following symptoms:

  • Swelling
  • Stiffness
  • Joint pain
  • Reduced range of motion

However, the two diseases do differ as to when the symptoms are worst. Osteoarthritis symptoms typically worsen as the day goes on. Rheumatoid arthritis symptoms are usually worse in the morning or after sitting and/or standing still for long periods of time.

Treatment for both ailments typically starts with exercises to decrease inflammation, medication and cortizone/steroid injections may also be administered. If the joints have deterioated too much, joint replacement surgery may be required to help reduce the patient’s pain and regain movement.

If you’re experiencing joint pain, please call us at 618-288-9460 to get assessed by one of our board-certified orthopedic surgeons.