General Guideline Principles for Opioids: Initiating Transitioning

and Managing Long-Term Oral Opioids for workers

compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Opioids: Initiating Transitioning and Managing Long-Term Oral Opioids.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Opioids: Initiating Transitioning and Managing Long-Term Oral Opioids

Long haul Utilisation of Narcotics in the Narcotic Guileless Patient: Narcotic Helpful Preliminary
Overview of Opioids: Initiating Transitioning and Managing Long-Term Oral Opioids

A narcotic preliminary is a timeframe during which the viability of utilizing narcotics is tried to check whether the objectives of expanded capability and diminished pain are met. While considering long haul narcotic use, doctors ought to ensure that:

  • Other agony the executive’s systems, including physical, conduct and non-narcotic measures have fizzled, and

  • An effective narcotic preliminary somewhere in the range of 30 and 60 days, during which the patient exhibited maintained improvement in capability and torment levels, has been finished.

  • Patients ought to be observed week by week.

Objectives and Targets of Narcotic Preliminary of Opioids: Initiating Transitioning and Managing Long-Term Oral Opioids

An effective preliminary ought to meet the accompanying objectives:

  • Further developed capability, including return to work as well as expansion in exercises of day-to-day living, and basically a 30% decrease in pain,1 upheld by approved objective proportions of further developed capability and torment which ought to be plainly recorded. (See General Standards A.1, Clinical Consideration; A.3, Positive Patient Reaction; and A.4, Rethink Treatment.).

  • No critical antagonistic incidental effects; and

  • No unusual medication related ways of behaving.

    If preliminary objectives are not met inside 30 to 60 days, the preliminary ought to be suspended, narcotics tightened/ceased, and another option approach taken to treating the aggravation.

    In a specific level of patients, it will become obvious right on time in the time for testing that they are not answering this method of treatment.

    For these patients, to limit the gamble of unfriendly clinical results like clinical reliance, the narcotic preliminary ought to be stopped when clinically doable. This direction ought to not be understood as requiring an entire 60-day time for testing.

Hazard Appraisal/Delineation of Opioids: Initiating Transitioning and Managing Long-Term Oral Opioids

Before considering a restorative narcotic preliminary, physical, and mental evaluation, including a full assessment for liquor or illicit drug use, reliance or misuse, ought to be directed.

  • Evaluating for likely comorbidities and hazard factors is critical so that expected gamble can be checked likewise. Individual or family background of substance misuse is the most grounded prescient component for abuse.

  • Evaluation of substance misuse, abuse, or compulsion risk, utilizing the Narcotic Gamble Device an approved clinical instrument (See Table 2: Narcotic Gamble Apparatus

  • The patient ought to be defined as to low, medium, or high risk for misuse.

    • High-risk patients are those with dynamic substance maltreatment of any sort or a background marked by solution narcotic misuse. As a rule, these patients shouldn’t be put on constant narcotics.

    • High-risk patients who are considered proper for constant narcotic treatment ought to be dealt with by a doctor spend significant time in compulsion medication.

    • Patients with a background marked by substance misuse or then again other psychosocial risk factors ought to be co-dealt with a doctor gaining practical experience in fixation medication.

Restorative Preliminary Rules (Narcotic Guileless Patient)/ Therapeutic Trial Criteria (Opioid-Naïve Patient)

While considering narcotic treatment in a narcotic gullible patient, the following preliminary measures should be met:

  • The disappointment of torment the board choices counting dynamic treatments, mental social treatment, torment self-administration methods, and other proper clinical methods.

  • Cautious assessment and documentation of the patient’s torment condition, general ailment, psychosocial history, mental status, and substance use history.

  • No untreated psychosocial issues driving or entangling the clinical show.

  • Narcotics ought to be viewed as just when the potential advantages are probably going to offset potential hurt and the clinician will resolve to proceed checking the impacts of treatment, counting an arrangement to end narcotic treatment if vital.

  • The preliminary ought to begin with a standard evaluation of capability and agony.

  • The treatment plan ought to incorporate continuation of fitting adjuvant treatments reliable with proposals in the New York Non-Intense Agony Clinical Treatment Rules to ease agony and help the patient adapt to the condition.

  • The treatment plan ought to incorporate fitting coordination of care.

  • The patient ought to have a careful comprehension of all the assumptions for narcotic use including the requirement for a restorative preliminary.

  • The doctor and patient should concur upon characterized useful as well as agony objectives.

  • The full range of aftereffects ought to be checked on, furthermore, a Patient Informed Assent for Narcotic Treatment Structure making sense of the dangers and advantages of narcotics must be endorsed by the patient and the doctor. (See Index F)

  • A composed Patient Comprehension for Narcotic Treatment Structure illustrating the supplier’s and patient’s obligations in narcotic treatment (counting affirmation that remedies will be acquired from a solitary expert) should be endorsed by the patient also, doctor. (See Addendum G)

  • Doctors recommending narcotic treatment should follow I-STOP and other pertinent regulation.

  • Doctors’ ought to finish the schooling suggested by the FDA, specifically the Gamble Assessment and Relief Methodologies (REMS).

Table 2: Opioid Risk Tool (ORT)

Therapeutic Trial

  • There is no proof that any one narcotic is better than some other for introductory treatment.

  • The preliminary ought to record supported improvement in torment control (essentially a 30% decrease on approved torment gauges) and worked on practical status, including get back to work as well as expansion in capacity to perform exercises of day-to-day living.

  • While directing a preliminary of narcotic treatment, begin with a low dose, increment slowly and screen narcotic viability until ideal portion is achieved. (See Reference section D: Dosing Limits for Chosen Narcotics)

  • Follow-up each seven to ten days is encouraged to titrate measurement and survey clinical viability.

  • During measurement titration, encourage the patient to keep away from taking part in wellbeing delicate word related and nonoccupational exercises, including yet not restricted to: working engine vehicles or other fueled gear; working at levels or in bound spaces; working gear or hardware with high probability of cut, cut or smash wounds; utilization of burnable or acidic synthetic substances; or participating in any movement where decreased readiness or smartness could represent a danger to work environment or public security, until a steady measurement is laid out and it is sure that the narcotic doesn’t cause sedation.

  • Pee Medication Testing (UDT) – See Area F.3.d, Pee Drug Testing (UDT) for Checking Narcotic Treatment.

  • Arbitrary pill counts. Unannounced pill counts are prescribed as demonstrated by risk classes or hazard factors.

  • If objectives are not being met the narcotic preliminary ought to be rethought.

Long haul Utilization of Narcotics: Changing/Overseeing Patients on
Overview of Existing Narcotic Treatment

The doctor treating a patient on long haul narcotics ought to start a re-appraisal/re-assessment of the patient’s clinical status, progressing to the executives and treatment as indicated by the standards for safe long haul narcotic administration and rules for streamlining narcotic consideration. (See Segments F.2.c and F.3)

Patients WHO ARE ON long haul narcotics shouldn’t have their drugs ceased basically because they have not met the preliminary models or the rules for safe long haul narcotic administration nitty gritty in this rule.

It ought to be noticed that the New York Non-Intense Agony Clinical Therapy Rules doesn’t need the end of narcotics for this subset of patients who have been on long haul narcotic treatment.

The objective is to change to the guidelines of care recognized beneath and stay away from sudden suspension of narcotics in patients who have been getting long haul treatment preceding the inception of the New York Non-Acute Agony Clinical Treatment Rules.

Approach

  • Cautious re-assessment and documentation of the patient’s torment condition, general ailment, psychosocial history, mental status, and substance use history to decide the adequacy and security of existing narcotic treatment.

  • Physical and mental as well as mental evaluation including a full assessment for liquor or chronic drug use, reliance, or misuse.

    • Chance Evaluation: Evaluating for potential comorbidities and hazard factors is significant so that expected chance can be checked appropriately.

    • Note: Individual or family background of substance misuse is the most grounded prescient element for abuse.

    • Chance Delineation: The patient ought to be separated as to low, medium, or high gamble for misuse in view of ways of behaving, approved clinical instruments and earlier history of misuse.

    • The gamble of substance misuse, abuse or enslavement ought to be evaluated by suggested and approved clinical instruments (See Table 2: Narcotic Gamble Apparatus

  • At the point when assessment distinguishes untreated psychosocial issues driving or convoluting the clinical show, suitable reference ought to be advertised.

  • Distinguishing proof and additionally continuation of fitting adjuvant non-narcotic treatments steady with proposals in the New York Non-Intense Agony Clinical Therapy Rules to alleviate torment, further develop capability and help the patient adapt to the condition.

  • Lay out an underlying continuous timetable for normal observing and re-assessment to decide the viability and security of the current narcotic treatment, need for adjustment/suspension of narcotics, creating plan for observing including UDT, pill count, need for specialty meeting/co-the board, commencement of non-narcotic adjuvant treatments, survey and fulfillment of Patient Comprehension for Narcotic Treatment Structure and Patient Informed Assent for Narcotic Treatment Structure.

  • Doctors’ ought to be proficient about and keep up with consistence with significant Government and state-controlled substance regulation and guidelines.

  • The objective is to change to the principles of care recognized underneath and stay away from unexpected discontinuation of narcotics in patients who have been getting long haul treatment before the inception of the New York Non-Intense Torment Clinical Treatment Rules.

  • Thought of other co-grim circumstances that need to be tended to (for instance, sorrow, uneasiness, grim stoutness), with fitting references as shown.

Ongoing, Long-Term Opioid Management
Overview of Ongoing, Long-Term Opioid Management

When a choice is made to establish as well as proceed (for those specialists who didn’t begin these meds) constant narcotic treatment, the doctor is answerable for regularly observing the wellbeing and adequacy (worked on tolerant capability and agony control/help) of continuous treatment.

Principles for Safe Management include:

  • Long haul narcotic treatment ought to just be started based on an unequivocal choice and understanding between the patient and doctor (Patient Informed Assent for Narcotic Treatment Structure [Appendix F] and Patient Understanding for Narcotic Treatment Structure [Appendix G]).

  • When narcotic portion, type, or patient condition changes, the Patient Informed Assent for Narcotic Treatment also, Patient Comprehension for Narcotic Treatment structures should be refreshed and appropriately endorsed by the patient and the doctor.

  • Remedies from a solitary expert and a solitary drug store.

  • Doctors’ ought to recommend opiates in consistence with state and Government regulation.

  • Most minimal conceivable viable portion. The peculiarity of resilience should be offset with relief from discomfort. Procedures to accomplish the most minimal conceivable successful portion might incorporate narcotic pivots, periodic narcotic portion decreases, or conceivable reinstitution of already fruitful treatment plans.

  • Proceeding with audit of in general treatment plan in regard to nonopioid method for torment control and upkeep of practical status to incorporate ID or potentially continuation of suitable adjuvant non-narcotic treatments steady with proposals in the New York Non-Intense Agony Clinical Therapy Rules to assuage torment and help the patient adapt to the condition.

  • All endeavors to empower and support dynamic activity (as gone against to aloof) to empower and uphold patient self-management.

  • A few pieces of these rules suggest thought of reference to experts in Agony Medication or potentially Fixation Medication. These suggestions ought not be viewed as inseparable from a proposal to tighten, deprescribe or end a particular medicine. Rather, they are a suggestion to enroll extra ability.

  • Observing/Screening

    • Progressing survey/reassessment and documentation of relief from discomfort, practical status, suitable prescription use, and antagonistic secondary effects, occasionally and as justified by evolving conditions (torment force, level of capability, progress toward objectives). This should be reported at every patient experience.

    • Chance appraisal/separation for directing way to deal with recurrence of observing:

      • In patients at generally safe for antagonistic results and on stable portions of narcotics, checking at any rate when each three to a half year might be adequate.

      • Patients with earlier history of a habit-forming jumble, utilized in an occupation requesting smartness, more established patients, patients with shaky or useless social climate and those with comorbid mental or clinical conditions require more incessant observing.

      • For patients at an exceptionally high gamble for unfavorable results, week after week observing and ecomanagement with a doctor spend significant time in compulsion medication might be a sensible procedure.

      • Checking of conduct for indications of conceivable substance misuse demonstrating an expanded gamble for habit and conceivable requirement for discussion with a doctor spend significant time in fixation medication.

      • Pee drug testing ought to be performed arbitrarily at least one time each year and even more oftentimes as considered proper by the recommending doctor concurring to gamble with class (See Table 4: UDT Dangers and Recurrence of Testing).

      • It is suggested that unannounced pill counts be proceeded as demonstrated by risk class or risk factors. For atypical way of behaving, unannounced pill counts are unequivocally suggested.

      • On the off chance that no obvious explanations for portion decrease or cessation of narcotics are distinguished, and the patient illustrates benefit from the narcotic treatment (upheld by approved proportions of moved along capability and torment), continuation of narcotics can be fitting. Progressing treatment, be that as it may, requires progressing appraisal/observing.

      • Utilize restricted to limit of two narcotics:

    • A long-acting narcotic for upkeep of relief from discomfort what’s more, a short-acting narcotic for restricted salvage use when torment surpasses the standard level.

    • If more than two narcotics are being considered for long haul use, or then again on the off chance that patients are requiring > 50 Prescription/24hrs, a second assessment from an expert who is Board Affirmed in Compulsion Medication or Agony Medication is unequivocally suggested.

    • All narcotic meds ought to be utilized with alert in patients with a potential for misuse.

    • Buccal-conveyed drugs ought not be utilized in this populace.

    • Acetaminophen cautioning with mix items: hepatotoxicity can result from delayed utilization of portions in abundance of suggested greatest day to day portions of acetaminophen, including over the counter meds. (See Segment F.1.e.i, “Acetaminophen”)

What our office can do if you have workers compensation injuries

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

Call Us Now!

5.0
Based on 96 reviews
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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5.0
Based on 96 reviews
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

You can see my full CV at my profile page.