A New Option for Knee and Hip Replacements: Robotic-Assisted Joint Replacement

Modern joint replacement surgeries are some of the most successful and common surgeries that can improve a patient’s quality of life. Medications, exercise and injections may limit joint pain for a period of time. However, for many patients, a knee or hip joint replacement is needed for long-term pain relief.

Knee or hip joint replacement surgery may be considered when the joint pain limits everyday activities such as walking, standing for long periods, or stiffness that limits your ability to lift or move your leg.  The MAKOTM robotic-assisted joint replacement surgery is an evolution in the technology of how knee and hip replacements are done.

This technique provides a personalized surgical plan based on each person’s unique anatomy. With the robotic-assisted procedure, a 3D model of a patient’s knee or hip is made to specifically match the individuality of each patient. This allows for the surgeon to prepare a very specific and precise plan for each patient, using implants to help ensure a long track record of success.

What to expect with robotic assisted surgery:

  • A 3-D model of your joint is made and used to personalize your surgery.
  • The surgical plan is made well before your surgery based on a CT scan of your joint. It is important to understand that the surgery is performed by the surgeon, who guides the robotic arm during surgery to precisely align and position the new joint.
  • A customized treatment plan helps to get you back to your active lifestyle as quickly and safely as possible.

Robotic-assisted surgery aligns well with the principles of minimally invasive techniques which can make for smaller incisions, less injury to surrounding tissues, and often a more rapid recovery.

Each person’s body is unique, and the joint replacement surgery should be, too. Robotic-assisted hip and knee replacement surgeries offer the most innovative and personalized technology for our community.

Dr. Brian Silvia MD, PhD is a board certified, fellowship trained orthopedic surgeon specializing in joint replacement surgery with Medical Associates Clinic. Currently, Dr. Silvia is the only surgeon in the Tri-State area with experience and expertise in robotic-assisted joint replacement options.

silvia Brian A. Silvia, MD, PhD
Department of Orthopedics
Medical Associates Clinic




Is a vasectomy right for you? Top things to consider

Portrait shot of an attractive, successful and happy middle aged man male arms folded outside wearing a blue sweater

A vasectomy is a safe, outpatient (same day) procedure that makes a man sterile (unable to father a child). It’s the most effective birth control method for men while also being a simple and relatively inexpensive procedure. However it is a major step, and you and your partner should know all the facts and share in the decision. Our Board Certified Surgeons at Medical Associates have put together some key facts and questions to consider when contemplating this form of birth control.

Think it through:
Having a vasectomy should be thought of as a permanent decision. Before you make this choice, be sure it’s what you want. Many men choose it because their families are complete. Others choose it because it is more reliable than other birth control methods. If you choose a vasectomy, you and your partner should be in agreement and you should have no doubts about your decision. A vasectomy will not fix problems you and your partner may be having. And it is not a choice that you should make during times of stress.

Know your facts:
A vasectomy is safe and effective. There are no serious complications associated with vasectomies. Most men feel perfectly normal after surgery, with only minor discomfort. The procedure is far safer than the equivalent operation for women, a tubal ligation. A vasectomy also will not affect your sex drive. Your male hormone levels remain the same. It has no effect on libido or the ability to perform sexually.

The procedure:
Prior to surgery, you will have a consultation with your doctor. A vasectomy is an outpatient procedure and it is done in an exam room in the Surgery Department at the East Campus of Medical Associates. You will be awake for the procedure (which takes around 30-45 minutes) and a local anesthetic is used to numb the area. As with any surgery, there are possible risks and complications. Your doctor will discuss these potential risks with you prior to your surgery during your consultation appointment.

After surgery:
After the procedure, you will need to rest (with minimal movement) for the next several days to recover and may be given a prescription painkiller to take as needed. Again, most men feel perfectly normal after surgery, with only minor discomfort. Although you may feel well, it is strongly advised that you take the time to rest and recover. After three days you should be able to resume normal activities, but with caution. After a vasectomy, some active sperm remain in the semen. You and your partner need to use another form of birth control until lab tests prove you are sterile. This is done at a follow up appointment a couple months after the procedure. You will be asked to provide a sample that will be tested to verify that you are sterile.

To schedule an appointment at Medical Associates, please contact 563-584-3450 to set up a consultation. In most cases, this procedure is covered by your insurance and only requires an office visit co-pay. Please check with your health insurance provider if you are unsure.


1000 Langworthy  |  Dubuque, Iowa 52001  |  563.584.3450


Urinary Incontinence: Common but not Normal

There are some body issues that no one really likes to discuss, even with their doctor. Incontinence (leakage), urinary or fecal, is one of those issues. Incontinence affects both men and women, but did you know that it is two times more likely in females than males? The National Association for Continence (NAFC) says 1 in every 4 women over the age of 35 experiences incontinence. Incontinence is common, but that does not mean it is an inevitable part of aging and it does not mean you can’t find relief.

First, let’s review how the bladder functions: your kidneys filter your blood and remove waste/toxins which creates urine. Little tubes, called ureters, take the urine from the kidneys to your bladder where it is stored. As the bladder fills, it stretches. When it reaches a certain level, a message is sent to the brain telling you it’s time to find a bathroom. When you reach the restroom the brain tells the muscles of the bladder to contract (you can’t control this part, it just happens) and your pelvic floor muscles to relax (you can control this part).. If something interrupts the communication process between the brain and bladder or if the muscles of the pelvic floor are weak (or sometimes even tense), leakage can occur. While you cannot control the contraction of your bladder, you can control your pelvic floor muscles. Strengthening these muscles with a specific type of physical therapy can help.

Incontinence is not only a physical problem, but it can affect your personal life. Every patient is unique, but incontinence is usually a bigger issue than needing to wear a pad or change your clothing. Many sufferers experience impacts on their emotional and psychological well-being. A decrease in social activity is also common. Incontinence has also been associated with a 26% increased risk of falls in the elderly population, as reported by the NAFC. Some can lose their balance when experiencing a sudden need to reach the bathroom quickly.

There are many different types of incontinence and they all mean something slightly different. Knowing the various types can help when trying to communicate the problem to your doctor or physical therapist.

  • Stress Incontinence: loss of urine with physical activity/exertion. Often individuals note this leakage is associated with cough, sneeze, laugh, jump, or exercise.
  • Urge Incontinence: loss of urine that is preceded by a strong and sudden need to empty the bladder. With this type of incontinence, you may notice every time you hear running water or pull into your garage after work you feel the need to urinate and can’t make it to the toilet.
  • Overactive Bladder: with overactive bladder symptoms of urgency, urinating frequently, and not feeling like you empty your bladder all the way tend to coincide and one may or may not have leakage along with these symptoms.
  • Mixed Incontinence: this simple means a combination of any of the above listed types of incontinence; most often a combination of stress and urge incontinence.

No matter the factors contributing to your incontinence, you can find relief. It may be embarrassing to discuss with your doctor, but it is important to speak up. Your physician can rule out larger medical conditions, assess if any of your medications are contributing to the problem, and recommend a form of treatment. Ask your doctor about a referral for pelvic floor physical therapy. Return to your beloved social activities and experience less anxiety over incontinence. Have confidence and take back control!

Gosse_B_2017_ultiproBrittany Gosse, DPT
Department of Physical Therapy
Medical Associates Clinic



Your Health is Important When Trying to Conceive

Every aspect of your health – from the drinks you consume to the exercise you do (or don’t do) – can have an impact on your fertility and on the health of your pregnancy. By looking at your healthy (and unhealthy) habits now (before the bun is in the oven) you can start off on the right foot. Our expert OB/GYN team has shared some important steps to take to ensure your health is at its best for conception, which will hopefully make conception easier and your pregnancy safer.

Habits to Break

Smoking is never good for you, so just don’t do it. But if you need a little motivation not to light up, repeat this fact to yourself: smoking (cigarettes, e-cigarettes, hookahs, vape pens, and so on) causes my 30-year-old eggs to act more like 40-year-old eggs. This results in a more difficult path to conception and a greater risk of miscarriage. Heavy smoking damages the ovaries as well as the uterus, and secondhand smoke can harm your health and fertility, too, so just choose to stay away!

Along with smoking cigarettes, smoking marijuana isn’t good for conception either. Whether you smoke, vape, or consume edibles, you can inadvertently affect the ability of your partner’s sperm to fertilize an egg – even if he doesn’t smoke marijuana! The active ingredient in marijuana, THC, gets in your vaginal fluids and reproductive organs. So to be most fertile (not to mention safe), say goodbye to marijuana. (And you should obviously also not use any illicit drugs, including cocaine, crack, or heroin, etc.).

Some studies have linked too much caffeine consumption with lowered fertility and an increased risk of miscarriage. If a baby is in your immediate plans, it’s time to put a little less coffee in your cup. You don’t have to give it up completely but moderation is the key here. Limit your caffeine intake to no more than 200 mg per day. That’s equivalent to 12 ounces of brewed coffee per day.

Another beverage to limit (or eliminate completely) is alcohol. Drinking alcoholic beverages in excess can mess with your menstrual cycle, possibly interfering with ovulation. And because you won’t necessarily know the moment you conceive, there’s a chance you might be drinking in the first few weeks of your baby’s growth. Drinking alcohol while pregnant could harm your little one in the future. Choose to reduce your drinking to less than 7 drinks a week and never more than one on any occasion when trying to get pregnant. Only you and your bartender need to know you’re drinking a mocktail.

As far as medications go, most over-the-counter and many prescription meds are considered safe while you’re trying to conceive. But because some medications may compromise fertility, you should run any medications you take by your provider before you consume them. This includes the medications you take for your chronic condition and any vitamins or herbals you may take on a regular basis. The good news is there are almost always safer alternatives. Just ask your healthcare provider before making any changes to your medication routine.

Habits to Keep

There is a strong connection between weight and fertility. Reaching a healthy weight for your body type is an important step for conception. It’s not just the scale that determines this, though. The relationship between your weight and height are factored to determine your body mass index, or BMI. Being overweight can cause diminished egg quality, decreased ovarian function, or polycystic ovarian syndrome (PCOS), a fairly common cause of fertility issues. Alternatively, women with a low BMI can also experience conception woes. Being underweight can lower estrogen levels, which can lead to irregular ovulation or periods (or even no ovulation or periods). Women who are obese or underweight when they become pregnant also have a higher risk of miscarriage.

Though it may be different for everyone, a moderate exercise program is the key. Moderate exercise can boost fertility, and you only need 30 minutes of aerobic exercise to do this. It can be walking, stretching, strength training, or anything that increases your heart rate. Remember to keep an eye on your body fat though. Prolonged, strenuous exercise can disrupt the delicate balance of hormones needed for ovulation and conception, especially if your BMI is very low. An ideal BMI for conceiving is between 18.5 and 24.9.

Before you put yourself on a diet or start packing on the carbs, it’s important to talk to your healthcare provider. Come up with a simple plan that features a well-balanced diet. Fill your meals with lean protein, veggies and fruits, and low-fat dairy. Cut down on junk foods and sugary drinks. Try water instead. Add in that moderate workout routine discussed above and you’ll be ready to kick-off your healthy path to pregnancy!

A good night’s rest is also very important. Six to nine hours of sleep per night is best. Beating the stress of the day and letting your body recuperate will only encourage fertility.

Finally, take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day if you are planning a pregnancy or are currently pregnant. You can take a vitamin or eat a breakfast cereal containing your daily quota of folic acid. This will lower your risk of some birth defects of the brain and spine, including Spina bifida. Talk with your doctor about your folic acid needs. Some doctors prescribe prenatal vitamins that contain higher amounts of folic acid.


Whether it’s your first, second, or fifth baby, your body needs to be nurtured and cared for so that it can do the same for your future child. Both the female AND the male partner’s fertility can benefit from the advice listed above. And remember that no two bodies are exactly the same, so talk to your doctor before getting pregnant. They will discuss your medical history, any medical conditions you have, any medications you are currently taking, and any vaccinations you might need. This will help make a preconception health plan that is best for you.

For more information on preconception health, check out this conception plan template from the CDC.


The Obstetrics/Gynecology & Infertility Team at Medical Associates Clinic:
Joseph Berger, MD  |  Tara L. Holste, DO  |  Lisa A. Kramer, MD
Trupti S. Mehta, MD  |  Laura Neal, MD  |  Erika O’Donnell, MD

Call 563-584-4435 to schedule an appointment.