Better Living: Summer 2015 by Coordinated Health

better living Summer 2015

COORDINATED HEALTH MAGAZINE

REGAIN YOUR FREEDOM

Joint Friendly Recipes

Same Same Day Day Rapid Rapid Recovery Recovery Knee Knee Replacement Replacement MODIFIED MODIFIED YOGA YOGA coordinatedhealth.com

Coordinated Health coordinatedhealth.com 1-877-247-8080 1

our team Colin Coleman Nicole Kutos Alex Newbegin Hannah Ropp Florence Trapp Martin Wambold

Photographer Designer Writer Managing Editor Editor Photographer

contributing authors Christopher Ferrante, MD Mark Gittleman, MD Lindsey Goffredo-Hughes, DO Gregg Guilfoyle, DO Susan Lee, MD Thomas Meade, MD James Reid, MD Gerald-John Rossini, MD Leo Scarpino, MD Nicholas Slenker, MD Dan Terpestra, DO Steven Clemson, PT, DPT

Orthopedic Surgeon Breast Surgeon Primary Care Physician Plastic and Reconstructive Surgeon Rheumatologist Orthopedic Surgeon Orthopedic Surgeon Orthopedic Surgeon Orthopedic Surgeon Orthopedic Surgeon Orthopedic Surgeon Physical Therapist

EASY RIDER

better living

CONTENTS 6.

Shouldering the Pain

9. 10. 11. 12.

13. 14. 16. 18. 20.

STRIKING OUT

Overuse Injuries in Youth Baseball

YOGA

for joint replacement patients

A Family Affair

22. 23. 25. 26. 27. 28. 30.

Same Day Rapid Recovery Knee Replacement Returning Home After Joint Replacement Surgery Shouldering the Pain Once and Done New Imaging Tool Offers Hope for Breast Cancer Patients Home Away From Home 5 Signs You Need a Joint Replacement Simply the Best Food for Thought Easy Rider Yoga for Joint Replacements Striking Out: Overuse Injuries in Baseball Pitch Perfect Rheumatoid Arthritis From Pain to Pinehurst Summer Ready Surgery Quench Your Thirst Beating the Heat Athlete of the Year Family Affair

Visit us at coordinatedhealth.com or call at 1(877)247-8080 to schedule an appointment today.

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Letter From the Editor Hannah Ropp

By the year 2030, itâ&#x20AC;&#x2122;s expected that over 3.5 million people will need to have a knee replacement. That makes knee replacements one of the fastest growing surgical procedures in the United States with hip and shoulder replacements following close behind. As the regional leader in joint replacements, Coordinated Health performs over 2,100 joint replacements each year and has 18 physicians who perform shoulder, hip, knee and ankle replacements. Throughout this issue, we feature several people who have been able to reclaim their lives with the help of joint replacements and it was an eye opening experience for me. I learned that joint replacements are a new beginning for people who want to remain active. In fact, I surprised at just how active our joint replacement patients are! Much of this magazine is dedicated to joint replacements. You can read some wonderful patient stories, find out if you need a joint replacement, what food you need to maintain joint friendly yoga poses. In addition to joint replacements, we have some other great topics in this magazine. Orthopedic surgeon Nick Slenker,

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MD, shares how young baseball players can avoid overuse injuries. We also have some tips on staying healthy this summer including how to spot signs of heat conditions like heat stroke and heat exhaustion and what to do to avoid dehydration. Also, Coordinated Health Orthopedic Surgeon Dan Terpstra, DO, opens up about how he grew close to a local family after treating three of the sons who were all high school athletes. Better Living Magazine is also available online with engaging videos that include interviews with both patients and physicians. You can tell which articles are linked to these videos because they are now marked with an orange television at the end ( ). As always, we look forward to sharing our patients' experiences with you and hope you enjoy their stories as much as I do. If you have a story you would like to share, we'd love to hear from you too! Feel free to email us through the Coordinated Health website. As always, thank you for your continued support. Have a happy and safe summer season!

Same Day Rapid Recovery Knee Replacement Imagine having a knee replacement without a lengthy hospital stay, now it’s a reality. Coordinated Health orthopedic surgeon, Tom Meade, M.D.performs outpatient knee replacements at both of Coordinated Health’s hospitals. To look at Hazleton resident Debbie Antolick, you would never know that she had a knee replacement just a few short months ago. The active mother of three suffered from knee problems for over 30 years and knew that she was going to eventually need a knee replacement, but didn’t really consider herself a candidate until recently. “I tore my ACL when I was 17 and since then I’ve had ten surgeries, but still had to deal with quite a bit of pain,” says Antolick. After her most recent MRI, Dr. Meade told Debbie it was time to begin thinking about a knee replacement. However, she had some concerns about undergoing a traditional total knee replacement. “I was worried about the amount of time I would be in the hospital and unable to care for my family after a knee replacement. My husband is out of town a lot and I need to be able to take care of the kids,” she says. Fortunately, Dr. Meade had a solution. He believed she was the perfect candidate to have an outpatient knee replacement, which would allow Debbie the opportunity to have a knee replacement and be home the same day. Dr. Meade has outpatient knee 6

been performing replacements at

Debbie Antolick Hazleton, PA Coordinated Health hospitals for over eight months and has found them to be extremely popular and successful. He says they were created specifically with patients like Debbie in mind. “If you look at the sheer demographics of knee replacements, it is absolutely exploding. One of the largest groups requiring knee replacements will be in the younger more active groups with people between the ages of 40 and 55 and with them there is no reason we can’t perform outpatient knee replacements,” says Dr. Meade. He cautions that outpatient knee replacements aren’t for everyone. In order to be considered for an outpatient

knee replacement, you need to be a motivated and healthy individual with a good support system at home. Those who suffer from a chronic illness have heart or lung issues or diabetes should not have the procedure. For those that qualify, outpatient knee replacements can be extremely beneficial. According to Dr. Meade, eliminating your hospital stay can decrease your risk of infection or complications and shorten your recovery time. As a former registered nurse, Debbie claims she didn’t have any qualms going into her surgery. She had the procedure done at Coordinated 1-877-247-8080

Health's Allentown Hospital on the morning of March 2 and was able to attend her son's basketball game that night. “I couldn’t believe how well I did. If I had a traditional knee replacement I would have been in the hospital for several days,” claims Debbie.

Dr. Meade is the only orthopedic surgeon in the region to perform outpatient knee replacements.

Debbie Antolick

FAQs What is the Same-Day Knee Replacement? The Same-Day Knee Replacement is an outpatient total knee replacement surgery method that allows patients to return home the same day that surgery is performed. What are the benefits of SameDay Knee Replacement? Some benefits of Same-Day Total Knee replacement include shorter recovery period, decreased hospital stay, lower cost and increased patient comfort as you are able to recover in your own home. There have also been less complication rates reported since patients are able to start moving faster, reducing the risk of blood clots.

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Is this surgery right for me? Eligible patients are healthy, determined and have a good care partner or support waiting for them at home. Chronic medical conditions such as advanced heart disease, pulmonary disease, advanced sleep apnea, or diabetes may be causes for ineligibility. The average age for a Same-Day Total Knee candidate is between 45-55.

• They have to be comfortable with their pain relief • Ability to walk a certain amount of steps • Ability to go to the bathroom • Demonstrated use of a walker If a patient does not pass those criteria, they will not be discharged home.

What if I change my mind and want to stay at the hospital? You will still have the opportunity to stay in the Coordinated Health hospital after your surgery. Every patient in the program must pass discharge criteria before they go home: • They must confirm that they wish to return home

Thoams Meade, MD Department Chair Orthopedic Knee Surgery 7

Returning Home After Joint Replacement Surgery If you're planning to return home following a joint replacement surgery, you will want to make sure that both you and your home are prepared. According to physical therapist Steven Clemson, you will know whether you will be able to recover at home if you have assistance available, are able to negotiate stairs prior to your release from the hospital and don’t have any pre-existing medical conditions. Steven has some tips to ensure your transition from the hospital to your home is seamless and safe: Try to avoid devices with cords if possible. If not, keep devices close to their outlets. Keep personal devices within reach.

Make sure all rooms and hallways are well lit.

Remove all throw rugs from walkways. • Be aware of small pets • Wear shoes or socks with grips • Take extra care when bathing. If possible, sit in the shower to prevent slips and falls. Ask for assistance if you don't feel comfortable. • When standing from a seated position, don't grab onto anything fragile or that moves, such as your walker. 8

• Try to limit the amount of trips up and down stairs • It’s generally more comfortable for people to sleep in a recliner immediately following joint replacement surgery. Steven Clemson, PT, DPT

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Shouldering the Pain Pam Miller didn't let debilitating shoulder pain hold her back, instead she took action. East Stroudsburg resident Pam Miller is no stranger to Coordinated Health. After falling down her basement stairs several years ago, she underwent extensive foot surgery with Coordinated Health Podiatrist Steve Brigido, MD. After 13 screws in her foot and months of physical therapy, Pam was finally feeling better; however, she unfortunately began experiencing other problems.

The CT scan showed that Pam hadn’t torn her rotator cuff, but had degenerative osteoarthritis that wore down her shoulder bones.

“I remember the first time it happened,” says Pam. “I reached down for the child I was babysitting and I had trouble lifting him because of the pain. From there it got worse.”

“Shoulder replacements are the best course of action for people who have undergone other less invasive procedures without any success,” says Dr. Terpstra.

Thinking she may have torn her rotator cuff, Pam made an appointment with Coordinated Health Orthopedic Surgeon Dan Terpstra, DO, who ordered a CT scan.

Pam tried corticosteroid injections and physical therapy, and though both helped in the short term, the pain soon came back. Dr. Terpstra finally suggested shoulder replacement surgery.

her head. She credits Dr. Terpstra and her physical therapists Tara Zambri and Jeremy Regina. “Tara and Jeremy were great. They really listened to me and worked with me to get me where I needed to be,” says Pam. Thanks to her shoulder replacement, Pam is now able to babysit once again and can even joke about her surgery. “It’s great. My husband says he is getting a new 20-year-old wife, one body part at a time,” she laughs.

Though Pam was initially nervous about the idea of undergoing shoulder replacement surgery, she knew she didn’t want to live within the limitation of her shoulder pain, so she chose to go through with the surgery. During the procedure, Dr. Terpstra replaced the ends of her upper arm bone and the shoulder bone with a metal and plastic component. The shoulder joint components were then held in place with cement. Pam did well with her recovery and was determined to exceed Dr. Terpstra’s expectations. “He told me that his goal was for me to be able to raise my arm to shoulder level and I said no, that’s not good enough. I wanted to be able to raise my arms above my head,” she says. Thanks to intensive physical therapy twice a week centered on building mobility and strength in her shoulders, Pam met her goal of being able to raise her arms over

Pam Miller coordinatedhealth.com

Pam Miller East Stroudsburg, PA

Dan Terpestra, DO Department Chair Orthopedic Shoulder Surgery 9

Once and Done Walter Emery’s family and friends were skeptical when he told them he was going to have both of his knees replaced at once. But, with the help of Coordinated Health orthopedic surgeon Dr. Christopher Ferrante, Walter was able to once again enjoy his daily activities without pain. Walter Emery Asbury, NJ Walter Emery takes a lot of pride in the home he built himself in Asbury, New Jersey. However, the house, which is situated on eight acres of property including a wooded area, takes a certain amount of upkeep. “I have a tractor that I use to get around and a shed where I keep a lot of tools and that kind of thing,” Walter says. “But when my knees were hurting it was hard to get around even on the tractor.” Walter began seeing Coordinated Health orthopedic surgeon Christopher Ferrante, MD, who diagnosed him with osteoarthritis. He took over-the-counter medication to control the pain, and when that no longer worked he turned to corticosteroid injections. “The injections worked well for a while, but then even they didn’t work anymore,” says Walter. Walter knew that he needed both of his knees replaced, and to many people's surprise chose to have them both done at once. “I knew it was going to be a challenge, but having them both done at once meant only having to have surgery once and only going to rehab once,” says Walter. “I was afraid that if I only did one, I wouldn’t get the second one done.” During the procedure, an 8- to 10-inch incision is made in the front of the knee and the damaged part of the knee is removed from the surface of the bone. The surface is then reshaped to hold the artificial joint in place. Cement or special material is used to keep the artificial joint attached to the thighbone, shin, and kneecap. 10

Once it's fitted, the artificial joint relies on surrounding muscles and ligaments to function properly. Even though Walter had both of his knees done at once, Dr. Ferrante still had him up and moving around soon after surgery. "The sooner we get the patient moving, the quicker we will be able go get full motion. Years ago, we used to immobilize the knees for days or even weeks, but we can now get people moving and feeling better in much less time" Since Walter had both of his knees done at once, he spent a week after his surgery at a rehabilitation center similar to Coordinated Health’s Transitional Care Center. Staying at a rehab center decreases the likelihood of a fall or accident following a joint replacement and can speed up recovery time. Following his week at the rehabilitation center, Walter returned home and continued physical therapy on an outpatient basis. Now, several years after the surgery, Walter says his knee replacement is holding up well and he's still able to do daily activities without pain. “I’m very grateful to Dr. Ferrante for his help. I couldn’t have asked for a better outcome," says Walter.

Christopher Ferrante, MD Orthopedic Surgeon 1-877-247-8080

New Imaging Tool Offers Hope For Breast Cancer Patients Coordinated Health is the first health care facility in the region to use a new breast-imaging tool that’s helping increase the odds of finding breast cancer in women with dense breast tissue. It’s no secret that the key to fighting and beating breast cancer is early detection and treatment. However, nearly 50% of women have dense breast tissue, which makes getting an accurate image and diagnosis difficult.

One of the main benefits of the system is the fact that it gives consistent, operator-independent results. With traditional ultrasounds, a technician uses a probe to scan over the breast and pauses to take pictures of areas of concern. The two problems with operator-dependent ultrasounds are that the images are still and that they’re difficult to reproduce, since a different technician may do it each time and may not be able to find the same area or use the same amount of pressure.

“It’s kind of like looking for a golf ball in a snow drift,” says Coordinated Health Breast Surgeon Mark Gittleman, M.D. “Very dense breast tissue looks white on a mammogram, and cancer is very often white as well. For years, we’ve just noted that it’s dense and difficult to interpret the mammogram and kept bringing patients in year after year, but the Automated Breast Volume Scanner is changing that.”

The ABVS eliminates the issues found in traditional ultrasounds by using an automated transducer to scan the breasts. The transducer is in a special frame that is placed over the breasts and automatically moves back and forth, covering the entire area with uniform pressure and speed. The ABVS also creates video clips as opposed to stills.

The Automated Breast Volume Scanner (ABVS) is the latest tool in the fight against breast cancer. This 3D ultrasound helps with the diagnosis of lesions or other areas of concern in dense tissue.

Dr. Gittleman has nothing but high praise for the ABVS. “This is the perfect solution for our patients. We will be able to find more cancers and save more lives.”

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5 Signs You Need a Joint Replacement Living with chronic joint pain can certainly affect your quality of life, but before deciding whether or not you should have a joint replacement, you should weigh the risks and benefits and speak to your doctor.

Shirley Edwards

Home Away From Home While many people choose to return home following a joint replacement or other type of surgery, others may require some additional care. That’s why Coordinated Health recently opened their skilled nursing facility or Transitional Care Center. One of the top reasons people choose not to have a joint replacement surgery is because they’re concerned about their recovery. The recovery process can take up to 12 weeks, and during that time most people will need help around their home, rides to and from physical therapy and other doctor appointments, and assistance with daily activities. “I didn’t want to be a burden to my family, because they have jobs and families and their schedules are tight,” says Transitional Care Center patient Shirley Edwards, who had a total knee replacement. “And I wanted to be in a place where I would be trained how to handle getting around my own home.” If you have joint replacement surgery at Coordinated Health, you’ll meet with a case manager prior to your surgery to go over your recovery plans. At that time, you can decide whether you have the means to recover at home or if you’d like some additional help.

If you’re still not sure whether you’re a good candidate for joint replacement surgery, take a look at the list below. If you answer yes to one or more of these questions, it may be time to consider a joint replacement.

ou can’t complete daily Y tasks without the help of others.

Y ou’ve talked to your doctor and and they’ve said that lesscomplicated surgical procedures are unlikely to help.

2 ou’ve been diagnosed Y with osteoarthritis and feel the disease is wearing you down physically, emotionally, and mentally.

3 Tests show advanced arthritis or significant joint damage.

5 You have pain that keeps you awake at night despite the use of medications, keeps you from being able to walk or bend over, that isn’t relieved by rest, or helped by non-surgical approaches.

If you choose to stay at the Transitional Care Center, you’ll receive a tour prior to your stay. The Transitional Care Center is designed to provide a homelike atmosphere with private rooms and bathrooms, flat-screen televisions, couches that pull out into beds, and a full menu. The Transitional Care Center is also equipped with a fully staged kitchen, laundry room, and bathroom so that skilled professionals can help prepare patients for the most common tasks in their own home. “I can’t complain about any aspect of my care,” says Shirley. “Every question has been answered, every person I have spoken to has given me support, and I feel great about going home.” 12

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Simply the Best Coordinated Health is the only hospital network in the area to achieve the coveted five-star rating in the inaugural CMS review program Area patients have a new reason to choose Coordinated Health after the hospital network achieved the highest patient recognition and government rating from the Centers of Medicare and Medicaid Services (CMS). This marks the first time a rating of this caliber has been awarded. The ratings, known as Hospital Compare Star Ratings or HCAHPS Star Ratings, were given to help consumers choose hospitals and understand the quality of care that they deliver. The Centers of Medicare and Medicaid Services also want to promote a health care system that delivers better care and spends money more efficiently in order to build a healthier population. The ratings measure 11 components of the patient experience, including communication between physicians and nurses, responsiveness of hospital staff to patient needs, pain treatment, hospital cleanliness and quietness, preparation of parents for post-hospital settings, and patients’ recommendations of the hospital to others. The survey also takes into account all patient feedback, not only those with Medicare. Only six other hospitals in Pennsylvania received a five-star rating, and all of them are outside of the Coordinated Health coordinatedhealth.com

hospital network service area. In fact, only about 7% of hospitals nationwide received five stars. Pennsylvania’s statewide average hospital rating is 3.2. “We’re proud that both patients and CMS have recognized Coordinated Health for unparalleled quality and care,” said Dr. Emil DiIorio, CEO of Coordinated Health. “Only through true integration and our cross-functional teams can you achieve this level of quality and outcomes. We are committed to providing a standard of excellence in care that exceeds the expectations of our patients.” Coordinated Health also recognizes that this accomplishment would not be possible without the hard work and dedication of their employees. “Most of the factors that contributed to the ratings have a direct relationship to our employees – like their communication and responsiveness to our patients. If the staff didn’t care so much about our patients and their positive outcomes, we wouldn’t receive good ratings,” says Chief Compliance Officer Laurie Gombert. 13

Food for Thought Millions of people suffer from joint pain and inflammation, but a simple change in diet could help.

Easton resident Javan Small is a chef with a vested interested in healthy cooking. He was diagnosed with Type 1 diabetes at the age of seven and has always had to be conscious of his diet. In addition to watching his sugar intake, Javan also tries to eat a joint friendly diet since diabetes can predispose him to joint problems like arthritis. “I try to include a lot of joint friendly foods in my diet to fight off inflammation,” he says. According to Coordinated Health orthopedic surgeon Gerald-John Rossini, M.D., there are a variety of foods you can include in your diet to promote joint health.

“Foods rich in Omega-3 fatty acids like salmon, mackerel, trout and walnuts can help prevent inflammation and reduce symptoms associated with arthritis. Other foods containing vitamin A,C, E and 14

selenium like papaya, broccoli and avocado can help counteract damage caused to joints,” says Dr. Rossini.

to add joint friendly foods like nuts, berries and apples to salads.

Dr. Rossini also recommends foods high in calcium and Vitamin D like spinach and kale in order to help maintain strong bones.

While some people have expressed that they are intimidated to cook seafood dishes, specifically fish, Javan claims that it’s not difficult.

As the Executive Chef at Third and Ferry in Easton, Javan specializes in seafood fare and says there are several dishes on the menu that he would recommend to people who suffer from joint pain.

“Fish is extremely easy to make and it can be prepared in a number of ways. I know a lot of people are scared of it, but they should try it. It’s definitely easier than people think,” he says.

“We incorporate a lot of joint friendly foods into our dishes. One thing we really serve a lot of is fish like salmon and halibut, which are high in fatty acids and Omega 3’s. Along with that we use a lot of leafy greens and nuts in our dishes,” says Javan. Javan also recommends cooking with extra virgin olive oil in lieu of butter or vegetable oil. He claims that it’s fairly easy

Gerald-John Rossini, MD Orthopedic Surgeon 1-877-247-8080

Javan Small Easton, PA

Lemon Thyme Vinaigrette Yield: 8oz Ingredients: 2 oz. lemon juice 2 oz. white balsamic vinaigrette 1 tsp salt ½ tsp ground black pepper 1 tsp dry thyme or 2 tsp fresh thyme 1 tsp Dijon mustard 4 oz. extra virgin olive oil Directions: 1. In a jar with a lid, combine all ingredients and close the lid on it 2. Shake the jar vigorously for 1 minute until all ingredients are fully incorporated 3. Dress any salad or use as a condiment for any application

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Summer Root Vegetable & Orange Salad with Blackened Salmon Ingredients: Extra virgin olive oil for sautéing or grilling 1-8oz. piece Wild Caught Salmon blackening or Cajun seasoning of your choice 2 oz. baby kale ¼ cup shaved fennel ¼ cup shaved red beets 1 oz. salad roasted pistachios 2 oz. lemon thyme dressing (recipe on left) 1 orange segmented, seeds removed salt and pepper to taste

Directions: 1. Preheat grill or pan to medium high heat, if using grill brush with oil, if using sauté pan add oil about 2 Tbsp 2. Season the salmon with the spices and more salt and pepper if desired, and place on grill or in sauté pan, cooking about 3 minutes on each side to desired temperature from rare to well done 3. Meanwhile, prepare the salad in a mixing bowl and blend all vegetable, oranges, pistachios and dressing, taste for seasoning and adjust if needed 4. Present your salad on your favorite platter and top with the salmon to enjoy.

EASY RIDER When hip pain began to interfere with Allentown resident Peter Goldman’s busy life, he knew what he had to do. A double hip replacement has helped him regain control over his life. Former physician and Air Force veteran Peter Goldman, M.D. is not your typical 72-year-old. The motorcycle-riding father of four still works, enjoys time with family and friends, and maintains a busy lifestyle. In fact, he’s so busy he initially dismissed increasing hip pain. “I had hip pain for quite some time, and as a physician I knew what it was, but I just kept putting off the surgery because I thought I didn’t have time,” says Dr. Goldman. Ultimately, Dr. Goldman’s hip pain became too intense to ignore. The motorcycle enthusiast could no longer safely ride his bike and he had trouble performing his daily activities. “I’ve been riding bikes since I was 16, so when I could no longer do that or go on walks with my family, I knew I had to do something. Plus, I wasn’t getting sympathy from my family anymore,” he claims. Dr. Goldman went to see friend and Coordinated Health orthopedic surgeon Dr. Leo Scarpino, who confirmed that he needed a double hip replacement through imaging and a thorough history and physical. 16

“Peter had osteoarthritis and his bones were literally rubbing together, which caused the pain,” says Dr. Scarpino. Dr. Scarpino was the first doctor in the area to use anterior hip approach, and suggested Peter undergo the tissuesparing alternative. Patients who have anterior hip replacements as opposed to traditional hip replacements also experience less pain, faster recovery, and better mobility. During an anterior hip replacement, a small incision is made through the front of the leg, making it possible to reach the joint by separating muscle rather than cutting and reattaching it. Dr. Goldman chose to have each hip done separately and says he was never nervous about the procedure. “I’ve know Dr. Scarpino for years and used to refer my own patients to him on a regular basis. I trust him implicitly.” Like all hip replacement patients, Dr. Goldman was up and moving within a day of his surgery. Because of his background as a physician, he needed little physical therapy and did most of his rehabilitation on his own.

While many people who have joint replacements worry about getting around their homes following surgery, Dr. Goldman says he had little trouble making his way around his house. “I just used the walker and slowly got up the stairs and managed to walk that way for a while. I was able to manage just fine getting around my house,” he says. His experience with hip replacement was so positive, he had his right hip done just a few months later. He credits Dr. Scarpino for his swift recovery. “Dr. Scarpino is truly an artist,” Dr. Goldman says. “He did an amazing job. I feel like I have the hips of a 20-year-old. I can do the things I wasn’t able to do before, like ride my bike, go for walks, and just move around without pain.”

Leo Scarpino, MD Chief of Staff, Chief of Surgery, Chair of Orthopedics

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Dr. Scarpino was the first surgeon in the Valley to perform an anterior hip coordinatedhealth.com replacement.

Peter Goldman Allentown, PA 17

Yoga FOR JOINT

REPLACEMENT PATIENTS

See how to do these poses and more at CoordinatedHealth.com/Yoga

Asanas for Hip Replacements Modified Bridge Pose (Setu Bandha Sarvangasana) • Push palms and heels down, lift hips to comfortable level • Engages surrounding muscles: glutes, hamstrings, core Tree Pose (Vrksasana) • Sole of the foot can be on ankle, calf or thigh • Creates stability for both hips

The Basics Yoga poses are called asanas. They can be practiced as part of a dynamic flow of movements called ashtanga yoga. The asanas shown here should be practiced with a certified yoga instructor like Laurel Attanasio, who teaches classes daily at The Yoga Loft in Bethlehem. Joint replacement patients can discuss yoga with their doctor starting around 6-8 weeks after surgery.

Tree Pose

Coordinated Health orthopedic surgeon Dr. James Reid worked with Laurel Attanasio to select these asanas. The goals of these poses are to build strength in the joints and to give balance to the areas surrounding the joints.

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Asanas for Knee Replacements

Asanas for Shoulder Replacements

Modified Child’s Pose (Bālāsana) • L engthens muscles that support the knee • U se a bolster to relieve pressure on the knee Warrior 1 Pose (Virabhadrasana I) • G ood for shoulders, hips and knees • L engthen into the pose instead of sinking down

Cobra Pose (Bhujangasana) • Supports back and buttock muscles • Keeps ball and socket in neutral, safe position Cat/Cow Pose (Marjaryasana/Bitilasana) • Helps increase flexibility into shoulder through stretching • Shoulder should stay stable and centered throughout

Child's Pose

Warrior 1 Pose

Cobra Pose

Cow Pose

Bridge Pose

James Reid, MD Department Chair Orthopedic Hip Surgery

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Stephanie Faerber, Managing Editor, Fig.Bethlehem

STRIKING OUT Overuse Injuries in Youth Baseball As the assistant team physician for the Los Angles Dodgers, Coordinated Health orthopedic surgeon Nick Slenker has seen and treated numerous shoulder overuse injuries. Now, he is using that experience to help young baseball players in our area prevent serious overuse injuries. Shoulder overuse injuries among youth athletes have always occurred, but according to Dr. Nick Slenker, they have become even more common over the last 10 years.

“Baseball can actually be a very violent sport. The human body wasn’t really meant to throw 90 mile per hour fastballs, especially on a regular basis,” says Dr. Slenker.

He adds that cross-training is also very important for young baseball players in order to develop their skills and become all around better athletes. Physical therapist Mike Price agrees.

“It’s really becoming an epidemic because so many kids are specializing in a sport at such a young age. It’s very unusual to see a three sport athlete anymore,” claims Dr. Slenker.

He claims that he always treats shoulder overuse injuries conservatively, which means physical therapy and rest. Unfortunately, many young athletes are hesitant to rest their shoulder and not pitch because they think it will affect how well they play.

“A lot of kids feel that they aren’t going to get better if they aren’t playing year-round, but that’s not true. Kids have inconsistent motor patterns so it’s more important for them to become a better athlete by crosstraining than to throw year-round.”

Shoulder overuse injuries are classified as a type of muscle or joint injury resulting from repetitive motion or trauma, like throwing. Symptoms of an overuse injury include pain during and after activity, swelling and stiffness and weakness. Overuse injuries differ from acute injuries because they are chronic and worsen over time. On an MRI, you’ll notice several micro tears on the laberal or rotator cuff instead of one large tear. Shoulder overuse injuries are most often found in throwing athletes, like pitchers, football players and even javelin throwers. But, Dr. Slenker says that baseball pitchers are far more likely to suffer from an overuse injury than other athletes, a fact that surprises many parents. 20

“When I was taking care of professional baseball players, they would rest their shoulder at the end of the season. Often times, they wouldn’t even pick up a ball for three months after they ended for the year,” he says. In addition, Dr. Slenker recommends that young athletes follow the pitch counts that were set up at the recommendation of orthopedic physicians. The pitch count outlines how many times a young athlete can throw per week according to their age. Since many young baseball players play for multiple leagues, Dr. Slenker suggests parents keep track of the pitches instead of coaches.

Dr. Slenker says the advice he has for young baseball players is to take care of their shoulders while they are young and to branch out and try more than one sport. “A lot of people think that specializing in one sport will make them a better player, but cross training can actually help develop other skills like eye hand coordination,” says Dr. Slenker.

Dr. Slenker trains under the surgeon who performed the first Tommy John surgery, a procedure that has saved the careers of many professional baseball players. 1-877-247-8080

Nick Slenker, M.D. Orthopedic Surgeon Coordinated Health coordinatedhealth.com

Pitch Perfect Proper pitching techniques can go a long way in preventing baseball injuries in student athletes. Lehigh Valley Baseball Academy Instructor Sean Heimpel has some advice for aspiring young baseball players. For 26-year-old baseball player Sean Heimpel, baseball is not just a past time; it’s a way of life. Sean has been playing baseball since he was four-years-old and even got picked up by the San Diego Padres before he suffered a career ending injury. Now, as a baseball instructor, Sean coaches some of the most promising young players in the Lehigh Valley. He claims that many baseball injuries are preventable just by learning proper pitching mechanics. “A lot of kids don’t realize how important it is to pitch correctly, technique is very important,” says Sean.

League Age

Pitches Allowed Per Day

17-18 13-16 11-12 9-10 7-8

105 95 85 75 50

Sean Heimpel Lehigh Valley Baseball Academy 22

One thing that Sean stresses to his students is control. He claims that many pitchers have a tendency to overthrow, which can lead to shoulder and elbow injuries. He encourages pitchers to throw at 80% and focus on control over sheer power. He also likes his pitchers to find one pitch that works best for them and stick with it. He says that many times pitchers try to mix up their pitchers and they become inconsistent. Above all, Sean tells his players and their parents to follow pitch count rules in order to avoid injury. “We really stress to our players the importance of adhering to proper pitch counts. A lot of them don’t want to stop pitching, but those rules were put in place to protect pitchers from injuries that can end any dreams they have of playing professionally,” he says.

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Rheumatoid Arthritis Rheumatoid arthritis affects nearly 1.5 million people in the United States. However, despite many differences, people still confuse rheumatoid arthritis with the degenerative joint disease osteoarthritis. Like most people, Sonia Vasquez occasionally suffered from aches and pains, which she attributed to her busy lifestyle. But when she began to notice increasing pain and swelling in her hands and fingers, she called her primary care physician, who ordered blood work. Sonia’s blood work revealed that she had rheumatoid arthritis, an autoimmune disease in which your immune system mistakenly attacks your joints, causing damage to both joints and organs. The diagnosis caught Sonia off guard. “I had heard of arthritis, but I didn’t really know much about rheumatoid arthritis, so I was definitely surprised,” says Sonia. Sonia isn’t alone. According to Coordinated Health Rheumatologist Susan Lee, MD, many people think of arthritis as only a degenerative disease. “Rheumatoid arthritis is very different than osteoarthritis, but many people don’t know that,” Dr. Lee says. “People who have rheumatoid arthritis will have different symptoms and require a different course of treatment.” Symptoms of rheumatoid arthritis can range from mild to severe and are similar to osteoarthritis. Symptoms include pain, inflammation, and red, warm joints. If you have rheumatoid arthritis, you may notice increased joint stiffness in the mornings. The most common joints affected by rheumatoid arthritis are the hands, wrists and feet.

treatment options available to slow the progression of the disease. “Disease modifying drugs or DMARDS like methotrexate act on the immune system to slow down the disease. We also use biologics like Enbrel to help reduce inflammation,” says Dr. Lee. Sonia takes both methotrexate and Enbrel, which require her to give herself weekly injections. She says it took some time to get used to the idea of giving herself injections. In addition to taking the medication, Sonia also goes for blood work every six weeks to make sure that the medication isn’t affecting her liver. She also visits Dr. Lee every three months. Dr. Lee says that while medication is important, there are other things you can do to control symptoms associated with rheumatoid arthritis. “If you have rheumatoid arthritis, it’s important to stay active and eat a healthy diet,” says Dr. Lee. “There are even some foods like ginger that have been shown to reduce inflammation.” Sonia believes that her medication and regular visits to her rheumatologist have helped her to maintain a good quality of life. “I’m doing really good,” she says. “I don’t have any pain and I’m able to work full time and do everything I need to now.”

Sonia Vasquez Allentown, PA

Myths and Facts About Rheumatoid Arthritis Myth: Rheumatoid arthritis only affects people over a certain age. Fact: While rheumatoid arthritis most commonly affects women between the ages of 40 and 60, anyone can be diagnosed with the disease. In fact, there is a specific form of rheumatoid arthritis found specifically in people under the age of 17. Myth: You can’t live an active life if you have rheumatoid arthritis. Fact: If you have rheumatoid arthritis, it’s actually important to maintain an active lifestyle. Myth: Rheumatoid arthritis only affects the joints. Fact: Because rheumatoid arthritis is a systemic disease, it can affect various parts of your body, including your heart and lungs. Modern medicine has helped reduce instances of rheumatoid outside of the joints.

While no cure currently exists for rheumatoid arthritis, there are several coordinatedhealth.com

George Petrole Woodstone Golf Pro 24

Steve Brigido Foot and Ankle Surgeon Coordinated Health 1-877-247-8080

Dr. Brigido performs 93% of total ankle replacements in the area.

From Pain to Pinehurst As a golf pro, George Petrole spends most of his days on the golf course. So when his ankle pain began to interfere with his game, he knew he needed to take action. For George Petrole, golf is more than just a game; it’s his livelihood. There are some days that he spends over 12 hours on his feet, either teaching students or caring for the course. But, his ankle pain was keeping him from his daily routine.

“I had seen other versions of ankle replacement and they all seemed outdated, but Dr. Brigido showed me a computer simulated version of the surgery and assured me it was the best option,” says George.

“I had problems with flexibility and mobility. I had pain at work and when I left for the day. I even had trouble sleeping. That’s when I decided to put my confidence in Dr. Brigido and it was well founded,” says George Petrole.

According to Dr. Brigido, not everyone is an ideal candidate for an ankle replacement.

Since Coordinated Health foot and ankle surgeon Stephen Brigido is an avid golfer himself, he understood George’s love of the game. Based on an extensive history and physical and imaging studies, he diagnosed George with degenerative ankle arthritis, which was most likely the result of a previous injury. Initially Dr. Brigido tried conservative treatment including cortisone shots and physical therapy, however, when that didn’t work he suggested an ankle replacement. George admits the idea of undergoing an ankle replacement was unnerving, especially in his line of work. coordinatedhealth.com

“Some people just can’t get a replacement because the bone quality isn’t good enough, because the joints around it are too arthritic, or because of the bowing in their legs. But, George was the ideal patient,” says Dr. Brigido

three times a week and his motivation even impressed Dr. Brigido. “George should be our spokesperson for physical therapy. People like George come in and treat it like an exercise regimen. They are motivated,” says Dr. Brigido. All of George’s hard work paid off. Much to Dr. Brigido’s surprise, George played golf at North Carolina’s Pinehurst course just six weeks after surgery. “I was able to facilitate a golf swing, whereas before I wasn’t. This is a true solution. My game is better now than it was 20 years ago,” claims George.

During the procedure, Dr. Brigido removed a portion of the tibia and the portion of the talus and replaced them with a metal tibia and talus component. A plastic piece was placed between them to act as a shock absorbing bearing so that the ankle could move up and down and also absorbs the shock and pressure of walking in order to preserve the life of the implant. Following the surgery, George was surprised by how quickly he was out of bed and moving around and says he had minimal pain. He began physical therapy

Stephen Brigido, DPM Department Chair Foot and Ankle Reconstruction 25

Summer Ready Without Surgery If you can’t wait to get out and enjoy the summer weather but cringe at the idea of summer clothing, then VASER may be the right choice for you.

Unlike many other plastic surgery procedures, VASER is so easy it can be done over your lunch break. In fact, it generally only takes 40 minutes to one hour.

VASER is a non-surgical procedure that reduces cellulite and melts fat using a combination of heat therapy and ultrasound. According to Coordinated Health Plastic and Reconstruction Surgeon Gregg Guilfoyle, DO, VASER is perfect for people who may not be candidates for traditional plastic surgery.

During VASER, fat cells are heated to 42 degrees Celsius using a small amount of gel and a probe. The area that can be treated at one time is generally the size of an 8 x 11 sheet of paper. Once heated, the area is hit with varying wavelengths of ultrasound, causing the fat cells to rupture and break apart.

“VASER is great for reducing cellulite all around, for reducing fat that occurs up to two centimeters beneath the skin, and for small amounts of skin laxity, like after child birth or mild weight loss,” he says.

Over the seven to ten days following the procedure, your lymphatic system will remove the dead fat and your skin will tighten as collagen and elastin regrow. Because fat cells don’t regenerate, the procedure is permanent for as long as you keep weight off.

Dr. Guilfoyle believes that VASER is a great alternative to traditional surgery for some patients. He says it is noninvasive, pain free, and relatively inexpensive compared to other options. However, he claims that while VASER is a great option for many people, it isn’t ideal for everyone. “It is not recommended for extreme weight loss,” says Dr. Guilfoyle. “Also, typically once stretch marks are in place, you will need surgical intervention. It’s also not for use around the clavicle.”

Gregg Guilfoyle, DO Plastic and Reconstructive Surgeon

Quench Your Thirst

Staying hydrated is always important, but especially during the summer months when the heat and humidity can deplete your body’s fluids more quickly. If not treated, dehydration can be serious and require hospitalization. Some signs and symptoms of dehydration include dry mouth, sleepiness, thirst, decreased urination, muscle weakness and headache. As dehydration worsens, you may notice extreme thirst, confusion, irritability, lack of sweating, and lack of tears, rapid heartbeat and fever. The best way to stay hydrated is to drink the recommended 8-10 glasses of water a day. But, if you’re the type of person that just can’t get used to the bland taste of water try some of our hydrating tips.

Drink Seltzer Water. Dilute 100% Juice with Water. Add a little flavor to your water with fruit or mint. Eat hydrating foods like watermelon, cucumber and spinach. Avoid consuming too much caffeine or alcohol, which promote dehydration.

Beating the Heat The summer sun makes heat illnesses more prevalent and serious during this season. Being able to identify between different heat exhaustion and heat stroke can be critical. Identifying the severity of an instance of heat illness can help you and your family. Heat Exhaustion Heat exhaustion, while less severe than heat stroke, is still a serious condition that must be addressed and treated. According to Coordinated Health Primary Care Physician Dr. Lindsay GoffredoHughes, heat exhaustion is characterized by symptoms such as excessive thirst, nausea and headaches. If you have these symptoms you should get out of direct heat, lie down and elevate your legs. You can also use damp cloths to cool down.

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Heat Stroke Unlike heat exhaustion, heat stroke is a serious medical emergency that occurs if heat exhaustion is not treated in a timely manner. Heat stroke is characterized by many of the same symptoms as heat exhaustion, but also unconsciousness, erratic behavior and seizures. According to Dr. Goffredo-Hughes, when someone stops sweating in hot conditions, this can often be indicative of the onset of heat stroke. Emergency services should be contacted

immediately, and ice should be applied to the core of the body. If possible, anyone suffering from heat stroke should be submerged in cold water in order to rapidly bring down body temperature.

Coordinated Health’s Athlete of the Year scholarship program awarded almost $50,000 to 36 student athletes from 17 schools throughout the region, including a $10,000 scholarship to Athlete of the Year Amber Thomas.

Amber Thomas Slatington, PA

Northern Lehigh graduate and softball standout Amber Thomas isn’t one to let obstacles stand in her way. At 13 she suffered an ischemic stroke, which was followed by months of migraines and then at 15 she had surgery to remove a cyst from her tibia. “She’s had her own struggles in life and a lot of students may not have been able to handle it as well, but Amber never used it as an excuse. She always gave it her all,” says Northern Lehigh High School Principal Robert Vlasaty. Coordinated Health and The Morning Call chose Amber as The Athlete of the Year based on her athletic performance, academics and community involvement. In addition to being a stand out softball player, Amber also played basketball, was a member of student council and in the top five of her graduating class. 28

As a pitcher she led Northern Lehigh’s softball team to ten wins. She also played with the competitive tournament team the Phantoms. Amber will be attending Drexel University in the fall and plans to study biomedical engineering. She is also mulling over whether to try out for the softball team as a walk-on. “Like many athletes, I’ve experienced a lot of ups and downs, but am just thrilled to accept this scholarship as a testament to the hard work and dedication I put in to my athletics, academics, and my leadership roles in the community,” Thomas said. “I’m excited for my next chapter, college.”

“Amber is a tremendous student-athlete who serves as a role model on and off the field. She reflects the values of Coordinated Health values of leadership, excellence and community participation,” says Dr. DiIorio. Amber received the title of Athlete of the Year at the end of the year banquet, which honored all 36 Athlete of the Week recipients. The event was held at ArtsQuest in June and was hosted by Troy Hein, anchor of WFMZ Big Ticket; New York Giant’s Running back Henry Hynoski was the featured speaker. Last year’s Athlete of Year, F & M quarterback and Catasauqua graduate, Zach Bradley, presented the award to Amber.

Coordinated Health CEO Emil DiIorio, M.D. believes that Amber embodies the spirit of the Athlete of the Year program. 1-877-247-8080

CONGRATULATIONS TO ALL OF OUR ATHLETE OF THE WEEK WINNERS! Wyl Miller Emmaus High School Football Mackenzie O'Brien Emmaus High School Volleyball Carter Paules Emmaus High School Swimming Cam Richardson Northwestern High School Football Joe Schuyler Saucon Valley High School Soccer Jason Lynch Saucon Valley High School Wrestling Brian Wildrick Saucon Valley High School Baseball Jude Luckenbill Whitehall High School Soccer Brooke Robertson Parkland High School Volleyball Madi Marshall Parkland High School Softball Kara Chyung Moravian Academy Tennis Jeff Brown Moravian Academy Lacrosse Travis Edmond Southern Lehigh High School Football Jenna Forrester Southern Lehigh High School Swimming Ludwin Gonzalez Liberty High School Basketball Jake Young Freedom High School Football Sam Magnan Freedom High School Swimming Andrew Sinai Freedom High School Tennis Kalista Walters Bethlehem Catholic High School Basketball Andrew Dunn Bethlehem Catholic High School Wrestling Shane Simpson Easton High School Football Colin Abert Easton High School Cross Country Hassan Greenfield Easton High School Basketball Kaitlyn Toman Salisbury High School Track and Field Phil Pierfy Wilson Area High School Basketball Alyssa Mack Central Catholic High School Basketball Nicole Sagl Central Catholic High School Swimming Brett Kline Nazareth High School Basketball Kassie Behler Nazareth High School Basketball Noah Durnin Northampton High School Baseball Mike Comunale Piux X High School Wrestling Amber Thomas Northern Lehigh High School Softball

Josh, Jake, and Joe Young

A Family Affair Bethlehem resident and mother of three Carla Young is familiar with Coordinated Health. All three of her sons are stand out athletes who also happen to be accident-prone. Her youngest son Joe had an especially difficult year. The old adage of boys will be boys rings true for Carla Young. The mother of three active boys, Josh 21, Jake 18 and Joe 16, certainly has her hands full. All three of her boys have been seen over the years at Coordinated Health and have been treated by orthopedic surgeon Dan Terpstra, DO. “You can’t take the athlete out of these boys. Everything is a game with them. I’m constantly telling them to be careful,” laughs Carla. Joe’s had the most difficult year. After recovering from a fractured hip in the fall, the Freedom High School quarterback injured his elbow while playing basketball in gym class. “I went up to dunk a basketball and hung on the rim and came down and my elbow just kind of popped. I knew that it was bad and I couldn’t believe I hurt myself again,” says Joe. Joe went to see Dr. Terpstra and after a thorough history and physical told him that he had sprained a ligament on the inside of his elbow. “It’s not a big deal for most athletes, but it can be a big deal for throwing athletes,” claims Dr. Terpstra. Dr. Terpstra immobilized Joe’s injury in a sling and told him that he would need six weeks of physical therapy. Since Joe had just finished his rehabilitation with physical therapist Mike Price, he knew what to expect. 30

They began the physical therapy by increasing Joe’s range of motion as well as strengthening his arm. After that, they went into proprioceptive activities, which Mike describes as restoring a sense of balance in the arm. Though Joe was injured this year, both of his brothers have dealt with their share of sports related injuries as well and both have recovered and gone on to play college sports. Josh is going to be a junior at Franklin and Marshall and plays football while Jake will be attending Columbia in the fall and wrestling. “I definitely look up to both of my brothers. I saw what they did in physical therapy and I knew that I could do it as well,” says Joe. Today, Joe has been released from physical therapy and is training hard in order to be ready for football in the fall. Dr. Terpstra believes that Joe will be ready and recovered from his injury well. “When you’re an athlete injuries are going to happen. The big thing that you need to worry about is that when you do have the injury you take care of it in the right way and get back on the field,” says Dr. Terpstra.

Dan Terpestra, DO Department Chair Orthopedic Shoulder Surgery 1-877-247-8080

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Joe Young Bethlehem, PA 31

DISCOVER

Only 5-Star hospitals Only 5-Star in the hospitals Only region 5-Star in the hospitals Only region 5-Star in the hospitals Only region 5-Star in the hospitals regionin the region rated by patients ratedinby Medicare patients rated survey inby Medicare patients rated survey inbyMedicare patients ratedsurvey in byMedicare patients survey in Medicare surve

THE 5-STAR DIFFERENCE At Coordinated Health, we efficiently deliver the most advanced treatment and pain management methods, with significantly fewer complications or infections than the national average. Experience the 5-star difference and discover how healthcare should be.

Discover the difference for yourself at coordinatedhealth.com/5-star-care *Patient survey conducted by HCAHPS and The Centers for Medicare and Medicaid Services Physician-owned hospital systemÂŠ2015 Coordinated Health