General Guideline Principles for Occupational Interstitial Lung

Disease Diagnostic Testing 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 Hip and Groin Disorders.

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.

Diagnostic Approach of Occupational Interstitial Lung Disease

The diagnosis of occupational ILD is typically made clinically, taking into account the occupational history of sufficient exposure with the appropriate latency, objective radiographic evidence (chest radiograph and/or HRCT), assessment of pulmonary function (including consistent changes in ventilatory capacity, static lung volumes, or gas exchange), and consideration of other differential diagnoses.

Lung biopsy is infrequently required to make the diagnosis of occupational ILD in a worker with a typical clinical picture (containing exposure history, latency, and radiographic presentation).

It may occasionally be necessary to perform a pathologic investigation of lung tissue when the clinical or radiographic characteristics are ambiguous or unusual.

Recommended: Follow-Up Diagnostic Tests

In the medical assessment of pulmonary occupational disease, periodic medical follow-up is necessary. This includes imaging scans and lung function testing.

Spirometry of Diagnostic Testing

A good initial test for lung function is spirometry. Spirometry distinguishes between obstructive and restrictive lung patterns of lung function and provides physiologic evidence for occupational ILD. All patients should undergo spirometry as a critical step in the diagnosis and follow-up of occupational interstitial lung disease.

Spirometry, however, does not identify ILD. According to recognised ATS recommendations, abnormal spirometry results should prompt additional testing, including confirmation by lung volume assessment, or a referral to a specialist.

Measuring lung volumes and diffusing capacity should ideally be a part of the contemporary diagnostic evaluation of pulmonary occupational illness. In addition to the diagnostic and therapeutic evaluations of occupational lung illness, further research on gas exchange physiology, cardiopulmonary exercise testing, and/or the six-minute walk test should be employed when clinically necessary.

Diagnostic spirometry testing technique:

  • Should be carried out by a technician who has the necessary training, using the recommended tools and techniques.

  • Should be carried out in line with the American Thoracic Society’s most recent recommendations or specifications, as well as those of OSHA, NIOSH, and the Mine Safety and Health Administration (MSHA).

  • When diagnostic spirometry results are abnormal, testing should be performed again as soon as practical to make sure the worker was inhaling as deeply as possible, blowing out forcefully, and exhaling completely throughout the test.

  • The most common way to determine whether short-term reversibility of the spirometry results can be reversed is to repeat the test after the subject has gone through a prescribed short-acting bronchodilator inhalation protocol if the results are still abnormal.

  • The diagnostic interpretation may compare the worker’s highest results with normal ranges derived from suitable similar groups once an acceptable test has been recorded for the individual.

Interpretation – The examination of workers at risk of occupational ILD includes a number of procedures, including the interpretation of spirometry tests. First, the interpreter must assess test quality, offer feedback, and decide whether acceptability standards have been fulfilled.

Adjust for age, height, gender, and race/ethnicity using the proper reference tables for normal or projected values if the test is deemed acceptable for interpretation.

Patients who have previously undergone spirometry have their test results monitored over time for changes.

Spirometry for the Diagnosis and Monitoring of Occupational Interstitial Lung Disease

Spirometry of Diagnostic Testing

  1. Spirometry of Diagnostic Testing is recommended when diagnosing and keeping track of people with interstitial lung illnesses brought on by their jobs.

    Indications – Diagnostic criteria include patients having a history of ILD and/or chest radiography that supports the diagnosis, as well as workplace exposure that supports plausible etiologies (e.g., a worker complaining of a persistent or sporadic cough, shortness of breath, or diminished physical capabilities). In general, spirometry should be postponed in cases of recent surgery, respiratory illnesses, or heart issues.

    Indications – Monitoring/Surveillance: For workers in occupations with exposures that are either known or suspected to be related with the development of occupational lung disease, periodic spirometry (yearly) with longitudinal examination of loss of pulmonary function is advised.

    Monitoring FEV1 decline over time allows for longitudinal study. since the most reproducible lung function parameter, the FEV1, is time. Calculating such an evaluation should be done when The technical quality of spirometry testing is adequate.

    In general, a decline in FEV1 greater than 50 ml/year is regarded as a pulmonary function loss that exceeds the ageing impact. The National Institute of Occupational Safety and Health (NISOH), American Thoracic Society (ATS), and American College of Occupational Medicine (ACOEM) have all proposed various methodologies to calculate the loss of pulmonary function and determine whether such loss is greater than the expected age-related loss of pulmonary function.

    Trends over time can be calculated using computer software, such as Spirola from NIOSH.

Static (Full) Lung Volumes of Diagnostic Testing

When additional diagnosis clarification is required, measurement of static lung volumes, such as Total Lung Capacity (TLC), Functional Residual Capacity (FRC), and Residual Volume (RV), is recommended to supplement the results of a spirometry test.

Spirometry results showing a decreased FVC could result from a number of different illness processes. Measurement of static lung volumes is necessary to validate the diagnosis of a truly restrictive disease, i.e., a lowered TLC below lower limits of normal, in order to properly explain a reduced FVC on spirometry.

For example, in emphysema or asthma, static lung volumes can be utilised to determine whether air trapping is present in obstructive disorders. The RV/TLC ratio and the TLC are both higher under these circumstances.

The static lung volumes can be measured using body plethysmography or inert gas dilution.

  1. Static (Full) Lung Volumes of Diagnostic Testing

    Static (Full) Lung Volumes of Diagnostic Testing is recommended To explain a lower FVC on spirometry, particularly when the FEV1/FVC ratio is normal, in the assessment of occupational ILD.

    Indications – In particular, when the FEV1/FVC ratio is normal, static lung volumes are advised in the assessment of occupational ILD to shed light on a lower FVC on spirometry.

Measurement of Oxygenation of Diagnostic Testing

An arterial blood gas sample or non-invasive oximetry can be used to measure oxygenation.

Oxyhemoglobin, or the oxygen saturation of the hemoglobin, is measured by non-invasive oximetry. It is an easy technique that is frequently used in an outpatient setting.

Alveolar-arterial oxygen gradient can be calculated using arterial blood gas and is useful for precisely determining the partial pressure and saturation of oxygen.

Measurement of Oxygenation of Diagnostic Testing

  1. Measurement of Oxygenation of Diagnostic Testing is recommended Pulse oximetry is a non-invasive method of measuring oxygenation used in the diagnosis and treatment of occupational ILD.
  2. Measurements of Oxygenation of Diagnostic Testing are recommended Indications Measurements of oxygenation are recommended in the assessment of Occupational ILD.

Indications – Oxygenation measurements are advised in the evaluation of occupational ILD.

Chest Radiographs of Diagnostic Testing

Imaging tests should be part of the evaluation of pulmonary occupational illness. A chest radiograph PA and Lateral should be the absolute minimum of the diagnostic process. It is preferred to interpret chest radiographs for pneumoconiosis in accordance with the International Labor Organization Classification.

In addition to providing information on the level of involvement and disease progression, radiographs provide structural anatomic information about the lung parenchyma and pleura that aids in the differential diagnosis of occupational ILD.

Radiographs, while useful in the identification of occupational lung disorders, lack the sensitivity and specificity of CT/HRCT.

In order to diagnose ILD and occupational lung disease, radiographs should be evaluated by a doctor with the necessary education, experience, and expertise. It is preferable for readers who have “B” reader certification for this classification system or people with the necessary education and experience to interpret radiographs in accordance with the International Labour Organization (ILO) classification(80) in order to document the patterns and severity of radiographic appearances of pneumoconiosis.

The Board is aware that other standard-setting bodies occasionally demand “B” reader qualifications for radiological interpretation.

  1. Posterior-Anterior (PA) and Lateral Chest Radiographs

    Posterior-Anterior (PA) and Lateral Chest Radiographs are recommended for determining the cause of work-related interstitial lung disease.

    Performed – It is recommended that medical professionals who interpret chest x-rays for the diagnosis of occupational lung illness possess the necessary education, training, and expertise. They should also be certified as “B” readers under the ILO categorization system.

High Resolution Computed Tomography (HRCT) Scans /Computed Tomography (CT)

When additional diagnostics are necessary for the diagnosis of occupational ILD based on clinical findings, HRCT/CT should be taken into consideration (including spirometry and chest X-Ray). Readers of HRCT/CT images for occupational lung illness should possess the necessary knowledge and skills. A thoracic radiologist with specialist training should examine the chest CT image.

HRCT/CT

  1. HRCT/CT is recommended in order to confirm or rule out an ILD diagnosis during the assessment of occupational ILD

    Indications/Technique: In order to confirm or rule out a diagnosis of occupational ILD, HRCT/CT may be useful.

  • Lung, mediastinal, and high-resolution windows should be included in HRCT/CT of the chest where warranted.
  • HRCT/CT is often conducted while the patient is supine, although in some cases, such as when confirming that mild peripheral and/or basilar results are indicative of interstitial abnormalities, prone imaging may be helpful.
  • When examining air trapping linked to HP, inhalatory/expiratory imaging is especially helpful.

HRCT/CT is recommended As this imaging study not only has diagnostic value but can also be used as a screening test for early detection of lung cancer, it can be used in the diagnostic workup of pneumoconiosis and other pulmonary occupational diseases, particularly in those lung diseases that result in increased risk for lung cancer.

Magnetic Resonance Imaging (MRI) of the Chest

  1. Magnetic Resonance Imaging (MRI) of the Chest

    Magnetic Resonance Imaging (MRI) of the Chest is not recommended as a major instrument for detecting occupational ILD

PET/CT Scans of the Chest

  1. PET/CT Scans of the Chest

    PET/CT Scans of the Chest is recommended in select cases in the evaluation of cancer associated with ILD (lung cancer and mesothelioma) and certain other comorbid conditions.

Carbon Monoxide Diffusing Capacity (DLco)

The DLco test (Diffusing capacity of the lungs) gauges the flow of gas from the lungs’ alveoli and air gaps to the blood coursing via the pulmonary capillaries. The single breath diffusing capacity test, which gauges this diffusion, is referred to as DLco.

A specified amount of CO is breathed by the patient during this test, and the difference between what is inhaled and the CO detected in the exhaled gas is calculated as the lung’s capacity to diffuse a gas into blood.

Through the use of a calibrated test gas, CO, the test evaluates the lungs’ capacity to deliver oxygen to blood in an indirect manner.

The test can be used to evaluate lung function and the existence of numerous lung disorders, including ILD, by using the right test procedures and result adjustments.

The test should be conducted in accordance with the 2017 ATS/ERS statement. This claim outlines the procedures and modifications that must be carried out in order to provide a reliable test.

Further:

  • The average of at least two DLco tests should be reported.

  • The two DLco measurements must agree within 10%.

  • It’s crucial to find out if a person smokes, as doing so may result in quantifiable baseline CO levels that increase back pressure and carboxyhemoglobin.

  • The patient’s haemoglobin must be on hand because anaemia will reduce the measured diffusion. There are equations available for correcting anaemia.

Carbon Monoxide Diffusing Capacity (DLco)

  1. Carbon Monoxide Diffusing Capacity (DLco)

    Carbon Monoxide Diffusing Capacity (DLco) is recommended to be used in the analysis of occupational lung illness.

    Indications – In patients with lung disease, DLCO may be utilised to aid in the diagnosis of anomalies in gas exchange.

    Advantages and Limitations – DLC may be impacted by a variety of ailments and exposures (Table 3). When interpreting the test findings, these need to be taken into account.

Table 3. Diseases /Conditions Associated with Alterations in DLCO

 

 

 

 

 

 

 

 

 

 

 

 

Biological Sampling of Diagnostic Testing

Invasive Procedures

Although bronchoscopy, bronchoalveolar lavage analysis, and lung biopsy are not always necessary to diagnose occupational lung illness, they should be part of the diagnostic toolbox when they are clinically indicated and/or required to confirm or rule out a particular diagnosis. In several illnesses, specific CT findings are frequently regarded as diagnostic.

Sputum Samples and Bronchoalveolar Lavage (BAL)

Additional testing, such as biological sampling, may be necessary to confirm the diagnosis of occupational ILD if the objective clinical evidence from the physical examination, chest radiography, and spirometry is insufficient.

  1. Sputum Sample (both induced and spontaneous)

    Sputum Sample (both induced and spontaneous) is recommended as a tool for the diagnosis of occupational lung illness in a subset of individuals.

    Indication/Technique – Additional testing, such as sputum sampling, may be necessary to confirm the diagnosis of occupational ILD if insufficient clinical objective evidence is discovered through physical examination, chest radiography, and spirometry.

    Given the availability of contemporary testing, such as HRCT, sputum sampling may support the diagnosis of occupational lung disease but is not strictly necessary.

    In order to collect a sample, the patient is made to cough in an effort to release sputum from the patient’s deep lungs. Each sample should be at least 15 mL in volume in order to improve the sample’s sensitivity.

  2. Bronchoalveolar Lavage

    Bronchoalveolar Lavage is recommended as a tool for the diagnosis of occupational lung illness in a subset of individuals.

    Indications/Technique – to aid in the detection of interstitial lung disease associated with employment. Given the availability of contemporary testing, BAL may help with the diagnosis but is not necessary (i.e. HRCT).

    The ATS guidelines for performing BAL for ILD should be followed when performing BAL.

Bronchoscopy and/or Lung Biopsy

Bronchoscopy and/or Lung Biopsy is recommended in a small number of individuals to confirm or rule out a diagnosis in particular situations

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.

We are orthopedic surgeons and do not treat chest diseases. We will refer you to someone in your area who does treat respiratory symptoms.

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
js_loader
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
js_loader

Disclaimer

Complete Orthopedics is a medical office and we are physicians . We are not attorneys. The information on this website is for general informational purposes only.

Nothing on this site should be taken as legal advice for any individual case or situation. The information posted is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship or a doctor-patient relationship nor shall the information be used to form an legal or medical opinions.

You should not rely on any of the information contained on this website. You should seek the advice of a lawyer or physician immediately for more accurate information surrounding any legal or medical issues.

This information has been posted for informational and/or advertisement purposes only. You consent to these terms and conditions by using our website

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.