Beyond Your Bones - Spring 2017

Spring 2017 CURRENT RESEARCH OPPORTUNITIES INCLUDING CLINICAL TRIAL FOR KNEE OSTEOARTHRITIS

DR. KAYES DISCUSSES CHILDREN AND ORTHOPEDIC INJURIES

OrthoIndy Partners with Pippa Mann Photo by IndyCar

Letter from the President

At OrthoIndy, our patients are what makes going to work everyday worth it. Beyond Your Bones highlights our wonderful patients and the amazing things they are doing after surgery. We hope you find the information in this publication interesting, informative and inspirational.

In this issue, learn about our newest research studies and how one physician is using DNA testing to help his patients. We also feature a variety of patient stories. We love to hear from our patients, especially when a patient shares how OrthoIndy has impacted their life for the better and allowed them to get back to doing the things they love.

Please email us any suggestions, comments or story ideas you might have at support@orthoindy.com.

Best wishes and good health,

Dr. Tim Dicke

No referral needed.

President and CEO Timothy Dicke, MD Editor Megan Golden, Public Relations Specialist Graphic Designer Jackie Bilskie Contributing Writers Melissa Foor Megan Golden Kosmas Kayes, MD Shelby Maue

Contributing Photographers Ali Markus Photo Christian Kemp IndyCar Jackie Bilskie Max Bailey Photography Megan Golden Rach Loves Troy Photography

OrthoIndy is your one stop shop for bone, joint, spine and muscle care.

Request an appointment online at OrthoIndy.com/ Request.

Ready to Run

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A New Option

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Children and Orthopedic Injuries

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After two total hip replacements, patient completes a marathon

OrthoIndy patient receives bilateral knee surgery

Featuring Dr. Kosmas Kayes, OrthoIndy pediatric orthopedic specialist

Injured Overseas

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Overcoming Disasters

12

Press Ganey Guardian of Excellence Award for Outstanding Performance

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Current Research

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Orthopaedic Research Foundation

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Car accident causes New Zealander to visit OrthoIndy Trauma

OrthoIndy patient overcomes four surgeries in two years

OrthoIndy knee specialist Dr. Jack Farr is recruiting patients for a randomized clinical trial for knee osteoarthritis

Dedicated to the advancement of musculoskeletal science

One Last Chance

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Pippa Mann Shares How She Stays in Shape for Racing

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Be Kind to Your Gut

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Complex spine surgery gives patient a new life

OrthoIndy nutritionist explains fiber

DNA Testing Helps Bilateral Hip 30 Replacement Patient Get Back to Life Faster One After Another

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Bouncing Back

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Patient sees multiple OrthoIndy physicians for different issues

Cheerleader returns to competition after complex knee injury

OrthoIndy partners with Verizon IndyCar Driver, Pippa Mann. Learn more on page 24.

ON THE COVER

Max Bailey Photography

PAGE 22 Elbow injury threatens to take Hannah Toschlog’s passion of horseback riding away.

We want to hear from you.

Write a review, read the latest OrthoIndy news or post pictures on our sites.

Are you an OrthoIndy patient?

Email us your story at MyStory@OrthoIndy.com.

Ready to Run

AFTER TWO TOTAL HIP REPLACEMENTS PATIENT COMPLETES A MARATHON By: Megan Golden Leading an active lifestyle helps you stay happier and healthier. Working out 30 minutes a day, three times a week is said to reduce stress and anxiety, improve your mood, increase energy levels, improve sleep and boost your self-image.

Toney Groves believes in maintaining an active lifestyle. He has always been an avid runner and has completed many marathons during his lifetime. However, debilitating hip pain started to get in the way of his exercise routine. As it gradually got worse with daily activities, it also prevented him from enjoying one of his favorite pastimes, playing outside with his grandchildren. Toney knew he needed a solution.

After a recommendation from a friend, Toney decided to make an appointment with Dr. David Fisher, an OrthoIndy total joint replacement specialist. Dr. Fisher determined that the only way Toney would feel pain-free again would be to have a total hip replacement.

The hip is one of the body’s largest joints and is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone.

The ball is the femoral head, which is the upper end of the femur also called the thighbone.

The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily. A thin tissue called synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.

In a total hip replacement the damaged bone and cartilage is removed and replaced with prosthetic components.

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Toney had his right hip replaced in April 2014 at 68 years old. After that total hip replacement, Toney ran the Disney Wine and Dine Half Marathon.

“I had zero pain from the right hip that was replaced,” said Toney. “But my left hip was crying and whining so I knew I needed to go back to Dr. Fisher to take care of it.”

Two years later Toney had his left hip replaced.

A brief eight months later he completed the Chicago Marathon, running a total of 26.2 miles.

“If a patient wasn’t an avid runner before having a hip or knee replacement, I don’t recommend they suddenly start running marathons after,” said Dr. Fisher. “But I have had soccer players, professional tennis players, snow skiers and runners return to those activities after a hip or knee replacement procedure. If they were competent in those activities before and really want to get back to them most times they can, like Toney did.”

“Except for the four inch scar on each hip I would not know I had two total hip replacements,” said Toney. “My experience with OrthoIndy was professional, yet friendly; just as if I had been an old friend for many years.”

Toney is grateful to be back to his active lifestyle, including playing with his grandchildren. In 2017, at 70 years old with two total hip replacements, he plans to enter a triathlon.

“I have recommended Dr. Fisher to several people who I have talked to who are experiencing pain in their hip. I truly can say I had no problems and hardly any pain,” said Toney. “Plus afterwards I was able to run again and finish a half and full marathon. I had difficulty walking, let alone running, before the hip replacements. Thank you OrthoIndy and especially Dr. Fisher for allowing me to play with my grandchildren and continue my passion of running.”

To schedule an appointment with Dr. Fisher please call 317.802.2828 or request an appointment online at OrthoIndy.com/Request.

David Fisher, MD Dr. Fisher, an Indiana native, received his undergraduate degree from DePauw University in Greencastle, Indiana in 1977. He attended Indiana University-Purdue University in Indianapolis for his post-graduate studies and received his medical degree from Indiana University in 1982.

Dr. Fisher interned at Methodist Hospital in Indianapolis before completing his residency in the Department of Orthopedic Surgery at Indiana University in 1987. He then went to St. Anthony Hospital in Columbus, Ohio to perform a one-year fellowship in joint implant surgery.

Dr. Fisher is affiliated with two Indianapolisarea hospitals: OrthoIndy Hospital and St.Vincent. He is a member of the American Academy of Orthopaedic Surgeons as well as a past president of OrthoIndy. Dr. Fisher is the current director of the Total Joint Center of Excellence at OrthoIndy Hospital and president of the Orthopaedic Research Foundation.

Dr. Fisher has had numerous articles published in professional journals, presented at national and international medical associations and participated in many research projects and FDA trials.

Practice Focus Arthroscopic Surgery • Hip • Knee Total Joint Replacement (Hip and Knee) Revision Total Hip and Knee Replacement Located At OrthoIndy Northwest 8450 Northwest Blvd.

Indianapolis, IN 46278

Beyond Your Bones | 5

A New Option ORTHOINDY PATIENT RECEIVES BILATERAL KNEE SURGERY By: Shelby Maue After many years of unbearable knee pain, OrthoIndy patient, Brian Dowers finally had enough. In 1986 Brian had an ACL repair on his right knee; while his repair was successful, he never felt pain free again. The searing pain in his right knee caused him to rely heavily on his left knee and in time, this wore out the cartilage in both knees and left him to develop osteoarthritis.

Osteoarthritis is the most common chronic condition of the joints. This occurs when the cartilage between the joints break down and cause bone on bone contact.

Over the past 30 years, Brian had various surgeries to try and alleviate the pain in both knees with no success. His condition was completely taking over his life. He was unable to enjoy participating in sports, outdoor activities or excursions on his family vacations without severe pain.

“My knees would hurt to the point that I would have to stop and sit or I would choose to stay behind,” he said.

After five prior knee surgeries, Brian decided to consult another physician for a new option.

A friend referred Brian to OrthoIndy where he met Dr. Joseph Randolph, a sports medicine physician.

In 2011, Dr. Randolph performed a total knee replacement on his left knee and then five years later a total knee replacement on his right knee.

“I have had an excellent experience with OrthoIndy from my very first appointment,” said Brian. “I’ve never been more impressed with a medical facility than I have been with OrthoIndy. In fact, OrthoIndy is the standard 6 | Spring 2017

I now use when evaluating other medical needs.”

Brian’s left knee has completely recovered since surgery and is very impressed with how much it feels like his real knee, without the pain. As for the right knee, he is still waiting on a full recovery from that. He is now able to do his daily activities; however, he still stays cautious about his physical limits as he still feels slight pain. He says he has full confidence that his right knee will recover just like the left and has already started making plans for when he fully recovers.

“I am now two months post-surgery and I am riding my motorcycle to and from therapy. This fall I look forward to climbing hunting stands for deer season.” Brian is thrilled at the opportunity to do the activities he loves, free of pain for the first time in 30 years.

“The surgical experience is the best I have ever experienced. The nurses and staff treated me as if I am the only patient they are assisting, though I realize that is not the case,” explained Brain.

“My experience at OrthoIndy Hospital was so positive with my first knee replacement that I had no concerns at all when making the decision to have my second knee replaced.”

Joseph Randolph, MD

Practice Focus Arthroscopic Surgery Knee Sports Medicine Shoulder Joint Replacement (Knee) Located At OrthoIndy Fishers 10995 N. Allisonville Rd. Suite 102 Indianapolis, IN 46038 To schedule an appointment with Dr. Randolph, please call 317.802.2822 or request an appointment online at OrthoIndy.com/Request.

OrthoIndy Northwest 8450 Northwest Blvd.

Indianapolis, IN 46278 Beyond Your Bones | 7

Children and Orthopedic Injuries FEATURING DR. KOSMAS KAYES, ORTHOINDY PEDIATRIC ORTHOPEDIC SPECIALIST

Q. As an orthopedic pediatrics specialist what are the most common conditions you evaluate in the office?

A. Fractures, sports injuries, overuse injuries, bone dysplasias, cerebral palsy and other neuromuscular disorders and congenital or developmental deformities.

Q. How are these conditions treated?

A. Most injuries can be treated non-operatively; some require surgery or simple closed reductions (or ‘setting’) of the fracture in younger patients. Neuromuscular conditions and deformities often require surgery. Some patients with neuromuscular or genetic conditions are followed throughout their childhood.

Q. How do these conditions play a part in how the child develops as an adult?

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Such as, if a child fractures his/her arm, how will the bone develop?

A. Most fractures heal completely back to normal without any problems. If it is in a joint it can lead to early arthritis. If it involves the growth plate it can cause growth abnormalities such as a shortened extremity or a deformity if it is a partial growth arrest.

If a child has a genetic or neuromuscular disorder then it can affect the growth and development of the child in many different ways.

Q. As a parent, what is the best course of action to take when a child complains of an injury?

A. If it is serious injury with a lot of pain, swelling and deformity, the best course is to get to either an emergency room if there is significant pain or deformity; or an urgent care

center if it seems less serious. More serious injuries should go directly to the emergency room as urgent care centers are more for minor injuries and non-displaced fractures.

If the injury appears to be very minor and not really interfering with the child’s daily activities or causing much pain, then one could wait a day or two and see if it improves.

Q. Do children heal sooner than adults?

How long does it take for a child to get back to play after an injury?

A. Children usually heal more quickly than adults but still can have fractures that are slow to heal. It usually takes any where from a few weeks to a few months to get back after most injuries depending on the injury and the severity.

Q. How can parents better protect their children from orthopedic injuries?

A. By making sure they are playing on safe equipment and safe surfaces, both for at home play and for sports participation.

Unfortunately, some activities kids enjoy the most such as trampolines and monkey bars, are also some of the most dangerous activities. Also, parents should make sure kids are ready physiologically for what they are doing; including being coordinated and strong enough for the activity. We see a lot of sports overuse problems because children are doing too much at too early of an age, or doing things that should be postponed until they are older, such as throwing curve balls. There is good evidence to suggest children should not play a single sport year round and should engage in more free play rather than organized sports when they are young.

To schedule an appointment with Dr. Kayes, please call 317.802.2491 or request an appointment online at OrthoIndy.com/ Request.

Kosmas John Kayes, MD

Practice Focus Cartilage Restoration Knee Pediatric Orthopedics Sports Medicine Located At OrthoIndy at St.Vincent Carmel OrthoIndy at St.Vincent Indianapolis OrthoIndy South Beyond Your Bones | 9

By: Megan Golden

Injured j Overseas CAR ACCIDENT CAUSES NEW ZEALANDER TO VISIT ORTHOINDY TRAUMA

Every May, Indianapolis receives an influx of visitors to witness the greatest spectacle in racing, the Indianapolis 500. In 2016, New Zealand native Craig Wallen decided to travel to the United States for the 100th running of the race.

Craig and his friend were invited by Chip Ganassi racecar driver and fellow New Zealander, Scott Dixon and were looking forward to a weekend full of IndyCar racing. After arriving in Indianapolis, they attended a few practice sessions at the track and took part in cheering on the drivers as they practiced for race day.

On the Friday before the race, they left the Indianapolis Motor Speedway excited to return on Sunday to watch the Indy 500; the reason for their trip. However, when they were driving on the interstate, the GPS started to dysfunction and Craig and his friend became lost.

Frustrated and trying to figure out the correct route, they exited the interstate and tried to correct their path. In a quick flash, they were suddenly struck on the side by another car, trapping Craig in his vehicle.

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Craig was rushed to St.Vincent Trauma Center where Dr. Timothy Weber, OrthoIndy trauma surgeon was on-call. Dr. Weber determined that Craig had a pilon fracture, which is typically very difficult to treat.

“When I first met Craig, he was very easygoing while enduring a great deal of pain,” said Dr. Weber. “After discussing the details of the procedure that would be required to ultimately fix his leg, including that it would require two separate operations, Craig was confident to proceed.”

A pilon fracture is a type of break that occurs at the bottom of the tibia (shinbone) and involves the weight-bearing surface of the ankle joint.

With this type of injury, the other bone in the lower leg, the fibula, is frequently broken as well.

“Dr. Weber and his team were the silver lining of being in another country while suffering an accident,” said Craig. “They are true professionals and are very caring in everything they did from caring for myself on the operating table to helping my wife deal with what was basically unknown at the time.”

“Dr. Weber and his team were the silver lining of being in another country while suffering an accident.”

Craig considers himself lucky that he was taken to St.Vincent Trauma Center to see Dr. Weber that day.

“I did not choose OrthoIndy, I was taken to the hospital by EMS and am very lucky to have had such a dedicated team of professionals fix my leg, and help me back to being able to walk again,” said Craig. “If I had a choice, I now know it would be OrthoIndy as I feel they are a dependable bunch of surgeons who are well respected across the world for the surgical repairs they performed on my pylon fractured left leg.”

Soon Craig returned to New Zealand. He was unable to put any weight on his left leg for three months. He couldn’t walk, which meant no work or exercise. However, he was not alone in the recovery process. Brent Ambler, Dr. Weber’s physician assistant continued keeping in touch with Craig by email to make sure Craig was on the road to recovery.

“I would like to give a special mention to Brent Ambler for his continued support to check on my progress even as I am on the other side of the world,” said Craig, “Also, I want to thank the staff and the nurses for the level of care shown to me, my wife and my entire family.”

The bond Craig felt to the people at OrthoIndy was mutual.

“Craig and I bonded quickly by sharing a love for racing and the sport of rugby,” said Dr. Weber. “When I told him that my favorite rugby team was the All Blacks, the national team of New Zealand, I had his full trust. I think he only half believed me until the next day when I showed up wearing my All Blacks rugby jersey; from that point on, a very strong friendship was forged. After he returned to his home in New Zealand, he sent Brent and I each a new All Blacks jersey because he thought mine was too old.”

As Craig continues his recovery, he looks forward to returning to work and a normal life of playing sports with his son and taking walks with his wife.

Craig also hopes to make another trip to Indianapolis to see the Indianapolis 500.

To make an appointment with Dr. Weber please call 317.917.4369 or request an appointment online at OrthoIndy.com/Request.

Timothy Weber, MD Practice Focus Located At Orthopedic Trauma OrthoIndy at St.Vincent Indianapolis Adult and Pediatric Fractures OrthoIndy at St.Vincent Carmel Foot and Ankle Trauma OrthoIndy South Nonunions and Malunions Bone Defects and Infections Osteotomies and Joint Preservation Surgery as an Alternative to Joint Replacement for Young Adults with Early Arthritis Ankle Replacements and Foot and Ankle Fusions Beyond Your Bones | 11

Overcoming Disasters ORTHOINDY PATIENT OVERCOMES FOUR SURGERIES IN TWO YEARS By: Shelby Maue

Spring break: the time of year that most families look forward to as they get ready to head south for warm weather, rest and relaxation. The Stumpf family headed to the peaceful beaches of Florida in March 2010 to get away from the hustle and bustle of their busy lives. OrthoIndy patient, Terry Stumpf, was thrilled to be lying on the beach with her kids, soaking up sun and watching her husband practice his hobby of flying stunt kites.

Terry, noticing her husband struggling to get his kite in the air, rushed to help him. As she took a running head start, she saw a few beach chairs in her path. She tried to avoid them but found herself in midair attempting to jump over them. She landed solely on her left leg which sent a shearing pain through her body. Terry had twisted her knee, shattering her tibial plateau and pulling the peroneal nerve.

Terry was rushed to an unfamiliar Florida hospital where she was immediately sent to the operating room. She had surgery performed that day and had a total of 20 screws put into her affected knee and leg. After a five day hospital stay, the Stumpf family could finally go home and focus on the recovery process.

surgery. Due to some complications, Terry had to endure two years of physical therapy and follow-up appointments. She, slowly but surely, was able to move out of the restraints of her wheelchair to walking independently.

Terry decided to visit OrthoIndy to get her X-rays examined and receive a course of action. She was referred to Dr. David Brokaw, who specializes in foot, ankle and general orthopedics; he concluded that the injury would need to completely heal before he could perform correctional

In February 2012 Dr. Brokaw determined that a total knee replacement would ensure Terry a lifetime of mobility and a quick recovery. In preparation for the total knee replacement, Dr. Brokaw removed the hardware that had been holding Terry’s knee together for the past two years.

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Rach Loves Troy Photography

Just one month later Dr. Brokaw referred Terry to Dr. Frank Kolisek, who specializes in total joint replacement of the knee and hip at OrthoIndy.

Terry was excited to have surgery so she could get back to walking normally and continue her daily activities free of pain.

Then, February 2014 Indiana’s winter got the best of Terry. She slipped on an icy patch and as she fell she remembered thinking, ‘my knee doesn’t bend this far.’ It was in that exact moment that she felt an earthshattering yet familiar pain shoot through her left leg. This

“One of my biggest and proudest moments was when my son married my lovely daughter-in-law in Savannah, Georgia. I was able to put my cane aside and dance the mother/son dance.”

She had the surgery in March 2012 without complication and headed down, what looked like, a quick and painless recovery. “I had excellent care at OrthoIndy Hospital,” Terry explained; she was quickly on the road to recovery.

After regaining some strength in her knee Terry finally got back to doing the things she loved such as, gardening, hiking and going to the gym. She was thankful for all of the physicians at OrthoIndy but particularly, Dr. Brokaw.

“He took the time to get to know me, my cares and concerns,” said Terry. “Dr. Brokaw was able to explain my operations and procedures in terms that were easily understandable. It is always a joy to have an appointment with the doctors at OrthoIndy even if it is not under the best of circumstances!”

After all was said and done, Terry was thankful to be done dealing with her injury from almost two years ago.

was the same leg, she had just gotten done going through two years worth of surgery and physical therapy.

She was once again, rushed to the hospital and hurried to the operating room immediately following the diagnosis of a broken femur in her left leg.

Several months after her fall and surgery, she was still experiencing excruciating pain. She was now unable to garden and hike, which are two things that are very important to her. That was when she decided to revisit Dr. Brokaw. He took one look at her X-rays and read about the procedure she had; immediately he knew he would need to do another surgery. After a lot of thought and study of the injury, Terry had another test ordered to look at the possibility of the actual femur bone being infected.

Her test for infection unfortunately, came back positive. So on November 7, 2014, Dr. Brokaw

Multiple X-rays of Terry’s knees.

Beyond Your Bones | 13

David Brokaw, MD Located At OrthoIndy Fishers OrthoIndy Northwest OrthoIndy South went in and inserted antibiotic beads, a rod and a few screws to repair the broken femur. The procedure went very well and Terry once again, started physical therapy. Terry is very thankful to be walking again, even if it is with a cane sometimes. “The fact that I am walking at all is a testament to Dr. Brokaw and Dr. Kolisek,” explained Terry.

Terry doesn’t let any of her pervious injuries or procedures hold her back from living her life to the fullest. Apart from going to just about any sports game, she and her husband were able to watch all of their children graduate from several different universities and schools.

Terry said, “One of my biggest and proudest moments was when my son married my lovely daughter-in-law in Savannah, Georgia. I was able to put my cane aside and dance the mother/son dance.”

She is ready to take on whatever life gives her, with a happy attitude and a supportive family by her side.

“From the receptionists, hospital employees, physician assistants and the physicians, I have always been treated with respect and care. The PA’s, Dr. Brokaw and Dr. Kolisek felt like good friends by the time I was dismissed from their care,” said Terry.

To schedule an appointment with Dr. Brokaw, please call 317.917.4388. To schedule an appointment with Dr. Kolisek, please call 317.884.5160. You can also request an appointment online at OrthoIndy.com/ Request.

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Practice Focus Acute and Subacute Orthopedic Trauma Clinical Interests in Reconstructive Surgery Nonunions and malunions of long bone and periarticular fractures, management of complex foot and ankle fractures, specifically: • Calcaneus • Talus • Tibial Pilon • Osteomyelitis • Care of the Traumatic Amputee Worker’s Compensation • Management of acute and chronic orthopedic injuries sustained in the work place • Second opinions • IME’s • Take-over-care

Frank Kolisek, MD Located At OrthoIndy South

Practice Focus • Hip and Knee Arthritis Surgery • Partial Joint Resurfacing • Total Joint Replacement • Computer Assisted Surgery • Soft Tissue Sparing Minimally Invasive Surgery

OrthoIndy Receives 2016 Press Ganey Guardian of Excellence Award for Outstanding Performance in Patient Experience By: Megan Golden OrthoIndy is pleased to announce it has been named a 2016 Guardian of Excellence Award® winner

by Press Ganey.

This is the fourth year in a row OrthoIndy has received this award. The Guardian of Excellence Award recognizes top-performing health care organizations that have consistently achieved the 95th percentile or above for performance in Patient Experience.

The Press Ganey Guardian of Excellence Award is a nationally-recognized symbol of achievement in health care. Presented annually, the award honors clients who consistently sustained performance in the top 5 percent of all Press Ganey clients for each reporting period during the course of one year.

“We are proud to partner with OrthoIndy,” said Patrick T. Ryan, CEO of Press Ganey.

“This award is a testament to the organization’s leadership in delivering patient-centered care. By achieving and sustaining this level of excellence, OrthoIndy continues to demonstrate their commitment to reducing patient suffering and advancing the overall quality of health care.”

recognition from the industry’s leader in measuring, understanding and improving the patient experience.

“We are pleased to receive this award,” said Dr. Dicke. “Our physicians and staff are committed to providing the best patient experience and the highest level of satisfaction that this award demonstrates. They work hard every day to provide the best outcomes, safety and high quality customer service to each patient and their family member.”

About Press Ganey Press Ganey is a leading provider of patient experience measurement, performance analytics and strategic advisory solutions for health care organizations across the continuum of care. With over 30 years of experience, Press Ganey is recognized as a pioneer and thought leader in patient experience measurement and performance improvement solutions. Our mission is to help health care organizations reduce patient suffering and improve clinical quality, safety and the patient experience. As of January 1, 2016, Press Ganey served more than 26,000 health care facilities. For more information, visit www.pressganey.com.

According to Dr. Timothy Dicke, President of OrthoIndy, the award represents an important Beyond Your Bones | 15

Current Research ORTHOINDY KNEE SPECIALIST DR. JACK FARR NOW RECRUITING PATIENTS FOR A RANDOMIZED CLINICAL TRIAL FOR KNEE OSTEOARTHRITIS

Dr. Jack Farr is currently recruiting patients for the PROGRESS IV clinical trial that evaluates the safety and clinical effectiveness of autologous protein solution (APS) on pain and function associated with knee osteoarthritis (OA). APS is prepared from a small sample of the patient’s own blood with an investigational device called the nSTRIDE® APS Kit. In this study, nSTRIDE APS will be compared to a saline injection. Since this is a randomized study, half of the study participants will receive an APS injection and half will receive a saline injection. The patient will not know which injection was received until the end of the study.

“Our team joined the study as we seek to help the many patients who find themselves in between a osteoarthritic knee with minimal symptoms and a knee that is ready for knee replacement,” said Dr. Farr. “While there are several options, many patients have limitations on the available injections and some are not paid by insurance companies. nSTRIDE APS is based on the science of using the body’s own proteins to decrease osteoarthritis effects. The proteins concentrated by the nSTRIDE APS Kit appear to have the potential to interfere with the osteoarthritis symptoms and moderate the ill-effects.”

Possible Benefits of Taking Part in the Trial The patient may or may not benefit from taking part in this trial.

The possible benefits may or may not include the relief of osteoarthritis symptoms in the knee, including pain relief, knee function restoration and anatomical improvement within the joint. Information learned in this trial may help patients with osteoarthritis in the future.

Potential Risks Potential risks involved with participating in the PROGRESS IV clinical trial may include side effects such as bruising, local pain or swelling associated with the blood draw, joint fluid aspiration or knee injection. Other possible risks 16 | Spring 2017

include infection at the injection site, fainting, scar tissue formation or nerve/nervous system damage. There are risks associated with MRI and X-ray procedures, such as exposure to radiation and anxiety. The patient’s osteoarthritis may not improve or may get worse. Dr. Farr will discuss all the possible risks with each patient before they choose to participate in the trial.

Costs The patient will not incur any extra costs for the medical care and examinations that are not considered standard of care. However, the patient may incur costs associated with travel to Dr. Farr’s office. Extra visits to Dr. Farr’s office are required for follow-up care throughout the trial.

Select Trial Requirements Some of the criteria the patient must meet to be in the trial are listed below. If the criteria are not met, the patient will not be eligible. However, if all are met Dr. Farr will ultimately determine if the patient meets the remaining criteria and can be enrolled in the trial.

Minimum Requirements • Have symptomatic osteoarthritis in only one knee • Be between 21 and 80 years old • Be willing and able to comply with the trial procedures and visit schedules • Have a body mass index less than or equal to 40 kg/m2 • Have undergone at least one conservative osteoarthritis treatment without satisfactory pain relief • Not have had recent intra-articular steroid injections (3 months) or hyaluronic acid (HA) or other joint injections (6 months) in the arthritic knee Trial Duration Participation in the trial will last approximately 16 months, with at least six visits with Dr. Farr.

Schedule of Visits The schedule of visits is as follows: • Screening visit (includes an X-Ray and MRI) • Injection visit (within 28 days of screening) • Follow-up visit one month after injection • Follow-up visit three months after injection • Follow-up visit six months after injection • Follow-up visit 12 months after injection (includes an X-Ray and MRI to assess anatomical changes) After the 12 month visit, the patient may choose to receive an injection of APS. If the patient does choose to receive another injection, he or she will have two additional visits: • Second injection visit • Second injection follow-up visit one month after second injection To learn more visit zimmerbiomet.com/ nSTRIDEtrial. To schedule an appointment with Dr. Farr please call 317.884.5163 or request an appointment online at OrthoIndy.com/Request.

Jack Farr II, MD Practice Focus Knee Restoration • Meniscal Repair/ Transplantation/ Scaffolds and Implants • Carticel (Autologous Chondrocyte Implantation) • Allograft (Fresh Osteochondral Grafts) • Ligament Reconstruction • Patellar Transplantation/Realignment • Knee Arthroplasty Partial Knee Replacement Sports Medicine • ACL Reconstruction (option of all Arthroscopic) • Patellar Instability and Cartilage Surgery • Meniscal Repair and Transplantation • Injury Prevention Located At OrthoIndy South

Orthopaedic Research Foundation

DEDICATED TO THE ADVANCEMENT OF MUSCULOSKELETAL SCIENCE Founded in 1986, the Orthopaedic Research Foundation (ORF) is an independent, notfor-profit dedicated to the advancement of science associated with musculoskeletal disorders. The physicians of OrthoIndy partner with the Orthopaedic Research Foundation to support their research and educational interests. The research staff facilitates and supervises both clinical trials and outcome studies.

The ORF is instrumental in the preparation of abstracts, manuscripts, grant proposals, scientific posters and presentations, literature searches, local, regional and international conferences, outreach programs and multiple other research activities. In 2012, a learning lab was created at OrthoIndy Hospital where orthopedic surgical techniques can be advanced and equipment can be evaluated.

“I believe that the Orthopaedic Research Foundation and its commitment to research is fundamental to keeping OrthoIndy and OrthoIndy Hospital at the forefront of

orthopedic care,”said David A. Fisher, MD, Chair of the Orthopaedic Research Foundation Board of Directors and an OrthoIndy total joint surgeon. “To maintain the excellent level of patient care provided by OrthoIndy and OrthoIndy Hospital, a continued commitment to research and education is essential.”

How to Support the ORF Our goal at the ORF is to improve care to you, our patients. Research improves patient outcomes by answering questions as to how we can provide better orthopedic care. Visit orthopaedicresearchfoundation.org to support orthopedic research by donating to the ORF. Currently Enrolling Studies OrthoIndy physicians are currently enrolling patients for studies about knee, shoulder, hip, spine and trauma care. If you are interested in learning about these studies and how you can become a patient please visit orthopaedicresearchfoundation.org.

2017 ORF GOLF OUTING SAVE THE DATE

Thursday, September 21st Thursday, September 21st is the Orthopaedic Research Foundation’s 16th annual golf outing. As always, it’s going to be a great event!

This year’s outing is a luau theme.

For more information about the event and to reserve your spot, please contact 18 | Spring Brenda 2017 Gould 317.802.2881 or Jenna Sallee 317.802.2880.

One Last Chance COMPLEX SPINE SURGERY GIVES PATIENT A NEW LIFE By: Megan Golden

Imagine living your life in so much pain that you dread going to lay in your bed at night.

You walk around hunched over all day and you are barely able to breathe. For nearly 22 years, this was Marlene Shafer’s reality.

Her back was causing her so much pain that she was unable to stand up straight, which caused a hump to form in her back. The development of the hump hunched Marlene over and made it very difficult for her to breathe.

Going to bed at night provided no relief either. Aside from tossing and turning every night while she tried to sleep, she also had to physically get up and move around her house to try and relieve the pain that was radiating throughout her entire body.

Furthermore, Marlene was unable to do the things in life that brought her joy.

“I absolutely love mowing the lawn and getting out in the garden,” said Marlene.

“But the pain was too much, that I actually started to dread those activities.”

Marlene was no stranger to surgery. In the past she underwent a few back surgeries at another orthopedic practice but it brought her no relief. She thought there were no other options for her and that the pain was just something she needed to live with as she refused to take any pain pills.

After having a total knee replacement, her physician urged her to make an appointment with a spine surgeon at OrthoIndy.

Desperate for one last hope to get rid of the pain Marlene met Dr. Kevin O’Neill, an OrthoIndy spine surgeon.

“Marlene had a very complicated problem.

From her previous surgeries and some additional degeneration of her spine, she was simply not able to stand up straight.

This is an incredibly painful way to live,” said Dr. O’Neill. “She had tried nearly everything to decrease her pain, but she was just not seeing any improvement.

I explained that surgery was an option, but that it would be a complex surgery that would involve cutting the spine in half and re-aligning it to allow her to stand up straight again.”

Although scared of having another surgery and still finding no relief, Marlene was confident in Dr. O’Neill and decided to give surgery one last chance.

Beyond Your Bones | 19

“Dr. O’Neill was personable, knowledgeable and always put a smile on my face,” said Marlene. “No matter what question I asked and no matter how stupid I sounded, he always answered me and never made me feel bad for asking.”

In September 2016, Marlene was ready for surgery.

“Marlene underwent a procedure called a pedicle subtraction osteotomy, which is when a wedge of bone is removed from the spinal column to allow a change in alignment.

The spine is then fused in the improved position, which in her case involved most of her thoracic and lumbar spine,” said Dr. O’Neill.

The type of surgery that Marlene underwent can be anywhere from 6 to 12 hours, depending on each patient’s unique situation; such as whether they have had a previous surgery, if they have pressure on the nerves or spinal cord, or the extent of the fusion required.

“Despite having a major surgery, Marlene always kept a positive outlook and attitude,” said Dr. O’Neill. “She is incredibly motivated to keep getting better, which is making a huge difference for her.”

There are relatively high risks associated with these complex spine corrections like Marlene’s.

20 | Spring 2017

Top: Dr. O’Neill and Marlene celebrate a successful post-operative check up. Left: Marlene’s spine prior to surgery. Right: Marlene’s spine after her corrective spine surgery.

“Fortunately, a majority of these complications can be corrected and treated without long-term consequences. The high risk nature of these

“Whenever I hear about someone experiencing back pain I immediately recommend Dr. O’Neill.

He gave me my life back.”

“Whenever I hear about someone experiencing back pain I immediately recommend Dr. O’Neill.

He gave me my life back.” operations makes it more important than ever to have a good relationship with patients and their family prior to surgery,” said Dr. O’Neill. “As much as we discuss things, I think at the end of the day there is a huge amount of trust required that I’m going to do everything possible to give them the best outcome possible.”

Although there are risks, the benefit of performing this type of surgery is that it corrects the alignment of the spine. When patients are stuck in a position that does not allow them to stand upright, surgery is the only effective long-term solution for patients. The transformation that people can make following surgery is nothing short of remarkable.

Although Marlene is still recuperating and taking it easy, she is ecstatic at how much better she already feels.

“My pain level is now at a three, compared to a 10 or more before surgery,” said Marlene.

“I can finally take deep breaths again, I am taller because I can stand up straight again and I am so much happier.”

Marlene’s family is also thrilled now that she has had surgery. Marlene plans to get back to the yard work this summer, mow the lawn without pain and visit her family in Florida for a vacation.

“I can’t say enough good things about Dr. O’Neill and OrthoIndy. Everyone there is helpful, nice and simply great people,” said Marlene.

To schedule an appointment with Dr. O’Neill please call 317.802.2429 or request an appointment online at OrthoIndy.com/Request. To learn more about Dr. O’Neill, visit his website at ONeillSpineSurgery.com.

Kevin O’Neill, MD

Dr. O’Neill is board certified by the American Academy of Orthopaedic Surgeons and belongs to the American Academy of Orthopaedic Surgeons, American Orthopaedic Association Emerging Leaders, Cervical Spine Research Society and the North American Spine Society.

Practice Focus Spine Surgery • Adult Scoliosis Complex Spine Deformity Located At OrthoIndy Northwest OrthoIndy South OrthoIndy at St.Vincent Carmel

Beyond Your Bones | 21

Back in the Saddle

ELBOW INJURY THREATENS TO TAKE PATIENT’S PASSION AWAY By: Megan Golden

Riding horses is 17-year-old, Hannah Toschlog’s favorite pastime. She normally rides one to three times a week and she constantly looks forward to the time she can spend with the horses. But when Hannah got thrown off a horse and landed on her elbow, her passion for riding horses was instantly threatened.

“I immediately couldn’t move my elbow and I had a feeling it was broken,” said Hannah.

“My biggest fears were that I wouldn’t be able to show at the 4-H Fair this summer or worse, not be able to ride ever again.”

As a parent you never want to see your child in pain. However, with the amount of activities children participate in while growing up, injuries seem to be inevitable.

Hannah’s parents wanted to make sure she received the best care possible. After driving to Indianapolis from Richmond, Indiana to see Dr. Kosmas Kayes, who was not practicing with OrthoIndy at the time but is now an OrthoIndy pediatric and sports medicine specialist, they found themselves meeting with Dr. Greg Reveal, an OrthoIndy trauma surgeon.

“We were so grateful that we were able to get an appointment with OrthoIndy the same day since we were already in Indianapolis,” said Steve Toschlog, Hannah’s father. “We were an hour and a half from home and didn’t want to go back without answers.”

Dr. Reveal determined that Hannah would need surgery if she wanted to ride horses again.

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“At our first visit with Dr. Reveal he answered our many questions about the injury and gave us the reality of the situation,” said Steve.

“He did so in a very down-to-earth and encouraging way.

He made us feel like our daughter was in good hands and that he was confident he could successfully perform the surgery.”

Three days after her injury, she headed in for surgery.

Since it was Hannah’s right elbow and she is right-handed she was having trouble doing most daily activities. She was also struggling to sleep; but worst of all, she was not able to ride horses or do much besides visit them. However, Hannah is now on the road to recovery.

“I currently have a 10 pound weight limit, but I feel like I can do almost anything I could before the accident,” said Hannah a few weeks after surgery. “My flexibility and range of motion is already better than what Dr. Reveal predicted it would be. My occupational therapist said that my recovery time is much faster than other people typically have for the same injury. We credit both Dr. Reveal and God for this.”

In Hannah’s most recent follow-up appointment she was told her arm was healed. She went straight from Dr. Reveal’s office to riding.

Hannah is ready for summer where she plans to continue working with horses and get ready for the 4-H Fair.

“I don’t think we have met a single OrthoIndy employee that hasn’t been nice,” said Steve.

“We’re pleased all around and think Hannah is getting great care.”

To make an appointment with Dr. Reveal please call 317.917.4389 or request an appointment online at OrthoIndy.com/Request.

Greg Reveal, MD Dr. Greg Reveal received his undergraduate degree from Miami University, Oxford, Ohio in 1990. In 1994, he received his medical degree from Wright State University in Dayton, Ohio.

Dr. Reveal completed a one year general surgery internship and his orthopedic surgical residency at Wright State University. In 2001, he completed the Leonard Gordon Hand Fellowship in San Francisco, California. He then went on to complete the OrthoIndy Trauma Fellowship in 2006.

Dr. Reveal is board certified by the American Board of Orthopaedic Surgery.

Practice Focus Trauma Shoulder Hand and Upper Extremity

Max Bailey Photography

Located At OrthoIndy at St.Vincent Indianapolis OrthoIndy Northwest Beyond Your Bones | 23

Ali Markus Photo

Ali Markus Photo

Racing Dreams

IndyCar

VERIZON INDYCAR DRIVER, PIPPA MANN COUNTS ON ORTHOINDY By: Megan Golden

Pippa Mann grew up in Europe as a racing fan; however, there were never any females racing in the top levels so Pippa was uncertain where her love for racing would take her. Then one day she saw a story about Sarah Fisher, a female driver who had finished second in an IndyCar race.

At the end of the 2008 racing season in Europe, Pippa was contemplating what her next step would be. That’s when the United States Panther Racing’s Indy Lights team called Pippa and the next thing she knew she was headed to the United States.

“Suddenly there was a female driver out there,” said Pippa. “And from that moment forward I started following IndyCar as a fan.”

“I had a tough first year competing with Indy Lights,” said Pippa. “But I learned a lot. Then in my second year with Sam Schimdt Motorsports my results really started to come alive and I had the year that launched me into the opportunity to qualify for my first Indy 500 in 2011.”

As a driver, Pippa ended up in IndyCar by chance. She competed in open wheel racing in Europe where she became the first female driver to score points in World Series by Renault and was the first female driver to start a race from pole position in that series.

24 | Spring 2017

That life-changing year was 2010. However, it did not come without a struggle. During testing

for the Toronto Indy Lights race, Pippa made a mistake that resulted in contact with the armco wall, and a broken left hand.

Finally ready for surgery, Pippa met with Dr. Kevin Scheid of OrthoIndy.

“At the time I knew I had hurt it; however, I remember insisting that despite the fact it looked like I had somehow inserted half a tennis ball under the skin on the back of my left hand, I definitely hadn’t broken it. And more importantly, I was good to race,” said Pippa.

“Even as a dare devil racing driver, I am a complete wimp when it comes to doctors, nurses and needles,” said Pippa. “Thankfully the staff at OrthoIndy have dealt with many nervous racing drivers before me, and they were able to reassure me that my hand would be just as good as new once I had the procedure.”

Despite her injury, Pippa raced the next day and finished in the top 10. She was finally persuaded to go for an X-ray on Monday and the physician confirmed her hand was in fact broken and she would need surgery.

Two days after surgery, Pippa was doing physical therapy exercises for her hand. Two weeks later, Pippa finished top five in her first race back.

One month after surgery, she won her first Indy Lights race.

Nevertheless, Pippa was determined to race a second time without treatment. By waiting to have surgery it would allow her to miss one race instead of two, which kept her goals within reach. The weekend after Toronto she raced again with her broken hand in Edmonton, Canada.

“As a racing driver our hands are such important tools for us to be able to drive and compete.

After my surgery, the running joke on our team was that the plate in the back of my hand must have been ‘bionic’ since I had great results the remainder of the racing season, which led me to

“OrthoIndy staff are not only the best in the business in terms of clinical care, but after treating and working with so many pro athletes, they understand the psychology of not only wanting to get better, but wanting to be able to return to competition as quickly as possible too.”

“With the points structure in Indy Lights, missing one race would make it very difficult to achieve my goal of finishing the championship in the top five, and missing two races entirely would make it almost impossible,” said Pippa. “Even though I wasn’t able to drive as well with my broken hand during the races in Toronto and Edmonton, the fact I was able to grit through it and bring home some points made a big difference at the end of the year.

finish in the top five in the championship despite missing one race after all,” said Pippa.

Pippa drove an IndyCar for the first time in March of 2011, and then qualified for her first Indianapolis 500 in May of that year. She was the eighth woman in history, and the first British female to start the 500 mile race. In 2016 Pippa competed in her fifth start at the Indianapolis 500, running as high as 8th place during the race before finishing in 18th place.

Beyond Your Bones | 25

Pippa also works as a performance driving instructor and coach for various racing schools.

She helped found an all-female karting team called Team Empower that is scheduled to take to the track for the first time in 2017. She is passionate about giving back to non-profits and inspiring young girls to follow their dreams.

Outside of her career as a racecar driver, Pippa tries to live a more slow-paced life. She enjoys going to the movies, reading a good book, cooking, hosting get-togethers and spending time with her husband and friends. She and her husband also love spending date nights trying new independent Indianapolis area restaurants whenever they get a chance.

“OrthoIndy is the place the pro-athletes trust. Whatever sport we play, when we have broken

bones, or orthopedic issues, getting them resolved not only so we can live our lives comfortably, but so that we can perform again at the highest levels of our abilities after surgery or treatment is exceptionally important to us,” said Pippa. “OrthoIndy staff are not only the best in the business in terms of clinical care, but after treating and working with so many pro athletes, they understand the psychology of not only wanting to get better, but wanting to be able to return to competition as quickly as possible too.”

OrthoIndy and Pippa partnered together in 2017. OrthoIndy has provided orthopedic care for the racing community for years. Statistics show that women are the primary healthcare decision makers in a household; therefore, it was important to OrthoIndy to align with a female athlete in the Indianapolis community.

Pippa Mann is a strong female athlete in a maledominated profession, who has proved you can do anything you set your mind to.

Pippa Mann Shares How She Stays in Shape for Racing Training to stay in shape for racing requires much more time and effort than I think anyone in the normal population realizes. The running joke about race car drivers of course is that we’re just sitting down, and how hard can it be?

The first thing to understand is that you have a continuously elevated heart rate throughout the entire race. Think of the heart rate of someone running or cycling a two to three hour race and how fit his or her cardiovascular system needs to be to cope with that continued exertion.

Then you have to add in high heart rate spikes to the equation. In racing these are usually caused by stress factors such as the car sliding and you

Visit our Facebook page to watch Pippa’s workouts.

just barely catching it, racing in close quarters with another car, entering a pit lane, getting to your pit stop, exiting a pit lane on cold tires and of course the starts and restarts of the race.

Under these trying conditions it is vital that you are able to cope, react and make good decisions in fractions of a second to try and give yourself a good outcome. We do a lot of endurance style cardio training and sprint interval cardio training. Adding in reaction or balance work right after these big sprint cardio intervals is one of the ways we help teach our brains and bodies to react while our heart rates are spiking.

Additionally, racing cars are actually quite heavy to drive in terms of steering weight. An IndyCar does not have any type of power steering.

This means that when the car is under pressure from all of the force pushing it down on the high-speed corners, it makes the steering wheel heavy to turn.

So to cope with these forces you have to have a strong stable core, strong arms, a strong chest, a strong back and strong shoulders. At the same time, while you have to build this level of strength, you also have to be able to do these movements

repeatedly for that two to three hour period that most races fall into. This means you’re not just strength training, you also need to build endurance into your muscles as well.

I train at PitFit Training Indianapolis where we have weighted steering wheels, cross core trainers, a surge 360 machine, tractor tires and battle ropes to pound up and down until our shoulders feel like they are going to explode and our arms feel like they are going to fall off. We also work on grip strength and neck strength fairly regularly as these are both very important muscle groups for drivers.

Finally, the last big thing to remember is that instead of wearing thin sweat-wicking fabrics, or light weight breathable running shoes, we are wearing layers upon layers of fireproof fabric literally from head to toe, plus wearing a full face, enclosed crash helmet on our heads.

You’re asking your body to be able to cope with a lot, and if you’re not properly prepared, your performance will suffer on race day.

Beyond Your Bones | 27

Be Kind to Your Gut ORTHOINDY NUTRITIONIST EXPLAINS FIBER By: Melissa Foor

Lately, everywhere you go you hear that you should be eating more fiber, but do you know what fiber actually is? It is plant material found in fruits, vegetables and whole grains that your body cannot digest. You may also hear it referred to as roughage.

One of the most well known benefits of fiber is that it helps regulate your bowel movements. Fiber is especially great for those suffering with constipation, a frequent side effect of many different medications.

There are also some initial studies that suggest highfiber diets may help with reducing the risk for cardiovascular disease, weight loss efforts, diabetes control or prevention, and cancer.

How much fiber should you consume?

Many people believe that the usual 25 grams per day recommendation is for everyone. However, this recommendation is only true for women age 50 and under.

Men age 50 and under are recommended to take in 38 grams of fiber per day. For those over 50, women should aim for 21 grams and men should aim for 30 grams. Children over the age of one should consume 19 grams of fiber, working their way up to the 25 and 38 grams recommended for their gender as they age.

The average American does not come close to the recommended amount of fiber, consuming only 14 grams per day. Good news is that we have improved in recent years, but still not enough to meet these recommendations. To find out if a food is a good source of fiber, check the nutrition facts label. If the number for one serving is 3 grams of dietary fiber it is considered a good source. If the number is 5 grams of dietary fiber, even better.

Insoluble vs. Soluble Fiber There are two different types of fiber: soluble and insoluble. Soluble fiber has been shown in some studies to lower blood sugar and cholesterol. It is found in oat bran, beans, peas and most fruits you come across.

28 | Spring 2017

Soluble fiber works best with fluid, when it comes into contact it forms a gel. Soluble fiber also likes to grab onto excess cholesterol. This mixture then passes through the digestive system and is excreted. Less cholesterol in your body equals lowered cholesterol.

Insoluble fiber has been shown to treat and prevent constipation and diverticular disease.

This is found in wheat bran and some vegetables. Insoluble fiber does not form a gel and passes relatively unchanged through the digestive system.

Where should your fiber come from?

Fiber is also being studied for its role in helping to keep the colon healthy. While some people will just reach for the Metamucil, it is recommended that your fiber comes from natural sources. These include whole grains, fruits and vegetables. Unlike Metamucil, these food sources are packed with vitamins and minerals to help you stay healthy.

A lot of people tend to choose low-fiber foods such as white bread or rice which are lower in fiber than whole grain bread or brown rice. Swapping at least one of your normal enriched, refined grains for a whole grain can help you boost your fiber intake each day.

Fiber and Weight Management While there are many diets for weight loss, many of them are missing out on important nutrients, like fiber. The main goal of a diet is to provide people with the feeling of being full while lowering calorie intake. Fiber provides bulk, which helps you feel fuller longer.

One thing to keep in mind is the composition of your food intake when aiming for weight management. While some of these lowcarbohydrate diets utilize a variety approach that includes vegetables and some grains such as quinoa and oats, others rely heavily on protein to make up the rest.

Studies have shown that intake of red and processed meats can raise risk of cancer, especially colorectal and the risk of diverticular diseases. If you choose to follow a low carbohydrate/high protein diet still aim to take in some good sources of fiber including quinoa, oats, legumes and other vegetables.

Fiber Quick Tips Are you convinced you should have more fiber? Here are some helpful hints: 1. Gradually increase your fiber intake. This helps your body get used to the change rather than immediately adding an extra 10 grams a day. Gradually increase your fiber - you are less likely to experience abdominal discomfort.

2. Increase your fluid intake. If your goal is to prevent constipation you have to have enough fluids or fiber cannot do its job.

It’s like trying to go down a water slide that has no water, you are barely inching along.

3. Keep visible reminders. Place fruit in a bowl on your counter so you see it frequently. Keep refrigerated fruits and vegetables at eye level so you don’t forget them in the crisper. Place oatmeal and air-popped popcorn at eye level in your snack cupboard.

4. Keep skins on for fruits and vegetables; some of the best sources of fiber come from the skin of fruits and veggies.

5. Choose one place each day where you can add in a good source of fiber. Stir in extra vegetables with your pasta dish, add fruits and seeds into your yogurt or swap out your normal chips for carrots and hummus at lunch. There are many opportunities to increase your fiber throughout the day.

6. Choose plant protein foods more often.

Beans, peas, lentils, tofu, nuts and seeds are all great sources of fiber. They are also lower in saturated fat compared with animal products.

Beyond Your Bones | 29

DNA Testing Helps Bilateral Hip Replacement Patient Get Back to Life Faster TOTAL JOINT SPECIALIST USES DNA TESTING TO DETERMINE BEST MEDICATION ROUTE FOR PATIENTS

For 10 years Sarah Smith desperately sought answers to the pain she was experiencing in her body. She met with a variety of physicians and tried physical therapy, but nothing was taking the pain away and no one had given her a diagnosis.

“I had difficulty putting on shoes and socks, going upstairs, walking and standing without lower back pain,” said Sarah. “The pain would continually increase throughout the day.”

On the recommendation of her physical therapist she decided to visit OrthoIndy. Sarah’s brother had a hip replacement from Dr. Eric Monesmith, OrthoIndy total joint specialist and he was feeling much better so she decided to start there. A physician had never suggested an X-ray of Sarah’s hips because most of her pain was in her back; however, Dr. Monesmith did and took one look at her X-ray and determined Sarah needed both hips replaced.

“After reviewing my X-rays Dr. Monesmith asked, ‘which hip do you want to do first?’ It was a relief to know I finally had a diagnosis,” said Sarah.

Sarah’s back pain was due to gradual arthritis of the hip joint and bone collapse. The pain had slowly worsened over a ten-year period.

“Sarah had a congenital condition, femoroacetabular impingement to be specific, that caused both her hips to wear out and develop arthritis.

This is a slow degenerative process, and had been causing her pain for many years before she came to see me,” said Dr. Monesmith.

Sarah had her left hip replaced in June 2015 and her right hip replaced four months later.

“I found the entire staff, including Dr. Eric Monesmith, to be caring and very professional from the diagnosis, operation and the recovery process,” said Sarah. “All of my questions were answered immediately and explained to my satisfaction.”

Sarah partially credits her quick recovery to DNA testing, which Dr. Monesmith uses to determine the best medication route for patients after surgery. This test concludes how a patient’s genetic makeup can affect how they metabolize all different types of medications.

“Thanks to Dr. Monesmith I have my life back.

I am also very grateful to all of the wonderful people who represent OrthoIndy.”

30 | Spring 2017

By: Megan Golden

“I attribute my awareness and non-drowsy feeling five hours after surgery to the medication I was given as a result of the DNA testing,” said Sarah.

“It made all the difference of not feeling nauseous and sleepy the day of surgery and during the recuperation period. I have had multiple surgeries and I’ve never felt so good after an operation.”

The DNA test is a simple cheek swab, which is done in Dr. Monesmith’s office the day a patient decides to have surgery. The swab is then sent to a lab and results come back in a few days.

It’s a one time test where the results are good for life and a patient can share it with future physicians when surgery may be necessary.

“I use the DNA testing primarily to help us determine which pain medicine will work best in a given patient,” said Dr. Monesmith. “I have used this test in over 500 patients at this point, and we know that nearly 45 percent of patients demonstrate genetic abnormalities regarding the metabolism of typical pain meds. Additionally, another part of the test helps determine the risk “Thanks to Dr. Monesmith I have my life back,” said Sarah. “I am also very grateful to all of the of blood clots after surgery.” wonderful people who represent OrthoIndy.

Right now the DNA testing is not typically They are sincerely dedicated to helping individucovered by insurance and is an out of pocket als regain their mobility and quality of life. Thank expense for most patients. However, most you for restoring mine.” patients have shared Sarah’s appreciation To schedule an appointment with Dr. Monesmith for the test. please call 317.884.5166 or request an appointment online at OrthoIndy.com/Request.

“I always told doctors my body could not tolerate much pain medication. Now I have proof if I ever need a future surgery. I was given a copy Eric Monesmith, MD of the DNA results so I could share the information with my other doctors,” said Sarah. “What a blessing it is to know what types of medications my body can tolerate. I hope more physicians will listen to their patients instead of the pharmaceutical industry.”

Sarah is now active again and living life to its fullest. She is able to ride her bike, garden and even touch her toes again. Sarah’s friends noticed how she had stopped limping and could walk up stairs with ease again. Additionally, Sarah and her husband plan to spend time traveling and continue their active lifestyle for many years.

Practice Focus Hip and Knee Replacement Knee Care • Arthroscopic Surgery Located At OrthoIndy South 1260 Innovation Pkwy., Suite 100 Greenwood, IN 46143

One After Another PATIENT SEES MULTIPLE ORTHOINDY PHYSICIANS FOR DIFFERENT INJURIES By: Shelby Maue

After months of excruciating back pain, OrthoIndy patient, Sue Arnold, decided to make an appointment with a physician.

In 2007, Sue visited OrthoIndy and had a consultation with Dr. Michael Coscia, an orthopedic spine surgeon. Dr. Coscia informed Sue that she had degenerative scoliosis as well as spinal stenosis.

Degenerative scoliosis is a condition that refers to an abnormal curvature of the spine and develops as joints in the spine degenerate, which causes the spine to bend. Sue’s other condition, spinal stenosis, is a narrowing of the open spaces within your spine, which puts pressure on your spinal cord and the nerves that travel through the spine to your arms and legs.

Sue had an array of uneasy feelings overcome her when Dr. Coscia told her that she would need a hemilaminectomy and a foramenotomy on her L4 and L5 disk in her spine.

Sue was very hesitant about surgery because of her passion for gardening. While she had been in extreme pain in the past, she always seemed to push through and tend to her gardens.

32 | Spring 2017

A hemilaminectomy is a highly invasive spine surgery that removes part of the vertebra called a lamina. Each vertebra in your spine holds two laminae, which are bony segments that form the rear of the vertebral arch and serve as a base for the vertebra.

All nerves aside, Sue went in for her surgery with Dr. Coscia and things couldn’t have gone better. Dr. Coscia was extremely proud of Sue for how well she did.

As if spinal surgery wasn’t enough for one person, in 2012 Sue was involved in a very bad car accident. Her car was t-boned and flipped upside down. Somehow, Sue only walked away with a spiral fracture in her right hand. Sue returned to OrthoIndy to get her hand checked out and thankfully was able to let her hand recover using just a splint.

Fast forward to May 2015, when Sue was able to fully get back to caring for her gardens and doing work around her house, she found herself at OrthoIndy once again. She was working outside and catapulted herself off of a ladder. She was extremely confident that she simply fractured her tibia. She came into OrthoIndy to visit Dr. Bruce Rougraff, who specializes in bone tumor and soft tissue oncology. Dr. Rougraff diagnosed and treated Sue with an immobilizer for six weeks.

Three short days later, Sue was able to go out and continue her social life. Sue coordinates volunteers in her herb garden at the White River Gardens, gardens on her own at home, travels to many different countries and exercises. After her last injury from falling off a ladder, Sue lost a lot of strength and mobility in her leg, from the six weeks she was immobilized.

Seven weeks later, Sue started to move around just slightly when she started to experience lower back pain again. Now exhausted of the pain that she thought she had gotten rid of, Sue came back to OrthoIndy but this time she visited Dr. Meredith Langhorst, who specializes in spinal diagnostics and therapeutics. She gave Sue her very first spinal injection into her L4 disk on July 20, 2015. “It was a painless experience,” explained Sue. “I received excellent attention from all staff involved.”

After several tries of the spinal injections and not much pain relief, Dr. Langhorst ordered an electromyography. An electromyography, often referred to as an EMG, is a diagnostic procedure to assess the health of muscles and the nerve cells that control them.

proud to be

OFFICIAL ORTHOPEDIC PROVIDERS OF THE INDIANA FEVER AND THE INDIANA PACERS

Sue was then sent to physical therapy with OrthoIndy. “Therapy was very helpful with pain relief. Physical therapy taught me the proper way to walk, sit, etc.” Sue is thrilled at the results she has seen in physical therapy. She has follow-up appointments with Dr. Langhorst, regularly.

Sue is now back at work, but with some limitations. She’s back tending to her gardens and has started taking Pilates classes. Sue was even able to travel to Lithuania and Russia this past summer. She is thankful for every single physician she has encountered at OrthoIndy.

To schedule an appointment with an OrthoIndy physician, please call 317.802.2000 or request an appointment online at OrthoIndy.com/ Request.

Beyond Your Bones | 33

© 2014 Christian Kemp

Bouncing Back CHEERLEADER RETURNS TO COMPETITION AFTER COMPLEX KNEE INJURY By: Megan Golden For Natalie Antoni tumbling was life. At the early age of 3, she participated in competitive gymnastics. When she started high school she decided to transition from gymnastics to cheerleading. After a year on the high school cheer team she decided to dedicate her time to tumbling with Noblesville cheer program, Indiana Elite.

The summer before her senior year of high school Natalie severely injured her right knee.

Natalie’s mom immediately made an appointment with Dr. Michael Thieken, sports medicine specialist at OrthoIndy. Natalie’s brother had previously seen Dr. Thieken for a torn ACL and they were hopeful Dr. Thieken would be able to fix Natalie’s knee as well.

34 | Spring 2017

Natalie’s knee injury was complex. Dr. Thieken determined that Natalie had torn her anterior cruciate ligament (ACL), strained her posterior cruciate ligament (PCL), severely tore her medial collateral ligament (MCL) off the bone, had severe bucket handle tear of the medial meniscus, torn her lateral meniscus and dislocated her patella.

Because of her injury Natalie had trouble doing the simplest things in life like getting dressed, riding in the car with her brace and moving around her house. Her high school was two stories and most of her senior classes were on the second floor. Because of this, Natalie had to leave class early and get a special elevator pass to get around.

“The biggest change for me was not being able to do competitive cheerleading. It killed me that I had to miss out on competitions with my Indiana Elite team, especially because it was my senior year of high school,” said Natalie. “Tumbling has always been one of my favorite things and not being able to do it was devastating.”

Natalie was dealing with a serious injury.

“Natalie’s injury was challenging in many ways.

She had significant ligamentous and meniscal injuries,” said Dr. Thieken. “Some of the injured structures required more urgent treatment but I worried about stiffness after surgery if we addressed all of her pathology at one time.

I felt it was best to stage her treatment. First, we repaired her meniscus tears and her MCL. Three months later we reconstructed her ACL, once she had regained her range of motion.”

Surgery is not always necessary for a meniscus and MCL tear; however, since Natalie had also torn her ACL, two surgeries were necessary to get her back to cheerleading.

“Everyone at OrthoIndy was fantastic. From the nurses to the receptionists to Dr. Thieken, everyone was kind, compassionate and really made you feel safe,” said Natalie. “Everyone really makes a point to show that they care, not just about your injury, but also about your overall well being and happiness. Dr. Thieken and his PA, Sean, even sent a congratulatory card in the mail when I graduated high school, which was so thoughtful and meant a great deal to me.”

Because of the complexity of Natalie’s injury, her recovery process was a difficult journey. She spent a lot of time on crutches and switched from one knee immobilizer or brace to another.

“At first, physical therapy was very difficult and hurt quite a bit, but in the long run it helped significantly,” said Natalie. “After a year of rehabilitation, I was able to slowly but surely return to competitive cheerleading for an extra year where my team and I won various competitions around the state.”

Besides returning to competitive cheerleading, Natalie has returned to full health and is able to do almost everything she was able to do before her injury. Furthermore, Natalie claims that her experience with OrthoIndy helped her determine what she wanted to do with her future.

“I personally think the biggest and possibly most important thing that has come out of my experience with OrthoIndy and Dr. Thieken is my career goal. I always knew that I wanted to do something in the medical field as a future career but I was never sure what,” said Natalie. “After learning about the knee, spending time with Dr. Thieken and seeing what he does on a daily basis, I realized that I would like to be an orthopedic surgeon in the future.”

To schedule an appointment with Dr. Thieken please call 317.802.2863 or request an appointment online at OrthoIndy.com/Request.

Michael Thieken, MD Practice Focus Arthroscopic Surgery of the Shoulder and Knee Knee and Shoulder Reconstruction Cartilage Repair and Restoration Sports Related Injuries Fracture Management Work-Related Injuries

Located At OrthoIndy Fishers OrthoIndy Greencastle OrthoIndy at St.Vincent Fishers OrthoIndy at St.Vincent Carmel

Beyond Your Bones | 35

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