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In This Issue


6. Providing Outstanding Care

8.Take the Plunge

10. Dupuytren’s Disease

Training for a Triathlon Swim

What it is. How to treat it.

Physician Assistants and Nurse Practitioners

Determine the best way to train for a triathlon swim. Then read about one teen swimmer who has won medals as a result of her training.

An explanation of this condition of the hand.

Bernadette Shaw explains what Physician Assistants and Nurse Practitioners do, how they are different and what you need to know to experience this excellent level of care.

13. Be Brave Now... and Proud Later

19. Childhood Obesity

Facing Haiti’s Trauma

Childhood obesity is a growing concern for both families and medical personnel. Dr. Lucien Ouellette details some options to forestall this condition in your children.

A medical team from OA Centers and Konbit Sante, a Portland, Maine nonprofit organization spent several days in Haiti helping the injured.


A Growing Problem

5. OA in Motion: What’s New? News and notes on people, places and happenings in the organization.

The OA Update is published by Oser-Bentley Custom Publishers, LLC, a division of Oser Communications Group, Inc., 1877 N. Kolb Road, Tucson, AZ 85715. Phone (520) 721-1300, fax (520) 721-6300, Oser-Bentley Custom Publishers, LLC specializes in creating and publishing custom magazines. Editorial comments: Karrie Welborn, Please call or fax for a new subscription, change of address, or single copy. This publication may not be reproduced in part or in whole without the express written permission of Oser-Bentley Custom Publishers, LLC. To advertise in an upcoming issue of this publication, please contact us at (520) 721-1300 or visit us on the Web at October 2010

The OA Update 3

Opening Remarks This latest issue of the OA Update includes a variety of topics including an article on childhood obesity as well as an article sharing the experiences of a medical team who volunteered their time on a Haiti medical mission trip. This article provides a sobering view of health care in an underdeveloped country in the midst of recovery from a major disaster, and also gives insight into the strength of the people who live there. We hope that you find these articles to be helpful and informative. If there is a particular topic you’d like to learn more about, we’d love to hear from you. Sincerely, The Physicians at OA Centers for Orthopaedics

Satellite Locations: Saco Office 15 Lund Road Saco, ME 04072 (207) 282-4210

OA Centers for Orthopaedics 33 Sewall St. Portland, Maine 04102 (207) 828-2100 • (207) 828-2190 fax John Wipfler Chief Executive Officer OA is the premier orthopaedic practice in Maine. Our 23 highly specialized physicians are experienced in the latest techniques and innovations. OA specialty centers include sports medicine; hand surgery; joint reconstruction of the hip, knee and shoulder; foot and ankle surgery; and complex fracture treatment. OA—Experience in Motion! The information contained in this publication is not intended to replace a physician’s professional assessment. Please consult your physician on matters related to your personal health. 4 The OA Update

Windham Office 4A Commons Ave. Rte. 302 Windham, ME 04062 (207) 893-1738 Specialty Centers Joint Replacement Center Orthopaedic Trauma Center Hand Center Foot and Ankle Center Sports Medicine Center Spine Center MRI Center Orthopaedic Surgery Center Physical Therapy Center Performance Center

OA in Motion Dr. McGrory Published Brian McGrory, MD of the OA Joint Replacement Center, led an impressive group of authors in publishing a total hip arthroplasty article in the Journal of the American Academy of Orthopaedic Surgeons (May, 2010). The article reviewed the indications, effectiveness, and failure rates of metal-on-metal hip resurfacing. Accomplishing this kind of prestigious achievement in a busy private practice is an enormous undertaking. Dr. Heinz Appointed to Advisory Committee William Heinz, MD has been asked to serve on the Sports Medicine Advisory Committee for the National Federation of State High School Associations. Dr. Heinz will be able to leverage his sports medicine expertise for the development of policy and rules, which will affect the safety and playing experience of most high school students around the country involved in sports activities. The NFHS serves its 50-member state high school athletic/activity associations, plus the District of Columbia. Among other things, the NFHS publishes playing rules in 16 sports for boys and girls competition. It provides a variety of program initiatives that reach the 18,500 high schools and more than 11 million students involved in athletic and activity programs. Weekend Sports Injury Clinic OA Sports Medicine Center will again offer Saturday morning walk-in clinics for athletes with acute sports injuries. This will begin at 9:00 a.m. on Saturday, September 4 through October 23rd. Please call us at (207) 8282100 for more information. National Youth Performance Testing Day How fast are you? How high can you jump? How strong are you? Come find out at our next National Youth Performance Testing Day on Thursday, October 28 at 6:00 p.m. in the

OA Performance Center. The event is open to the public ages 7-21 and is FREE! More than 70 kids attended our last event, which was held in June 2010. Those participating test their speed, strength, agility, quickness, and power. To register for the event, call (207) 7105509 or sign up on our Facebook page: OA Parisi School.

Physical Therapy and Occupational Therapy in Windham OA is pleased to announce the opening of physical and occupational therapy services at our Windham facility. The physical therapy clinic features an open concept, which allows the treatment of a variety of musculoskeletal disorders. The clinic is staffed by Ryan Brown, PT, FAAOMPT and Eric Bouchard, PT, who bring to the clinic many years of experience treating both surgical and non-surgical patients. Our hand therapy center features

Photo Credit: John Pineu

Catherine Morrell, OTR/L, CHT who specializes in the treatment of surgical and non-surgical rehabilitation of the hand. OA Moves to Electronic Medical Records (EMR) After 10 years of research and consideration regarding a number of EMR programs, OA’s team is now planning and preparing for the implementation of electronic records and the phasing out of paper charts. This transition will enhance our team’s ability to respond to our patients’ questions and concerns by improving access to the patient record. The anticipated go-live date is in November. OA Welcomes New Providers To better serve the needs of our patients, the following midlevel providers have joined the clinical team at OA: Michelle Stirling, FNP; Kristen Schroeder-Cyr, FNP; and Sarah Lavoie, PA-C (per diem). OA Physical Therapy Center also welcomed Matthew Somma, DPT; Joshua Bailey, DPT; Owen Lennon, DPT; and Eric Bouchard, PT. Yarmouth Clam Festival

OA Cyclemania controls the peloton at the 30th Annual Yarmouth Clam Festival race, which included participants such as the U.S. National Cycle-Cross champion. Photo Credit: Dan Levesque

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Providing Outstanding Care Physician Assistants and Nurse Practitioners By Bernadette Shaw, PA-C OA is proud to employ Physician Assistants (PAs) and Nurse Practitioners (NPs) who work as part of an experienced medical team to provide outstanding care to our patients. PAs and NPs are licensed health care professionals who are trained to diagnose and treat a wide range of health problems. At OA, the PA/NP works with a physician to treat patients in a style developed and directed by the supervising physician. The average physician assistant has a master’s degree and four-and-a-half years of health care experience prior to entering a PA program. Nurse practitioners obtain a master’s 6 The OA Update

degree and clinical training beyond registered nurse training. The typical rigorous training for a PA/NP takes two to three years to complete and is comprised of essential medical sciences such as anatomy, physiology and microbiology. The academic studies are followed by clinical rotations in hospital and private practice settings. All graduates sit for a national certification exam. As part of their role in the orthopaedic practice a PA/NP is qualified to: • Perform comprehensive and problemfocused medical histories and physical exams

• Order and interpret diagnostic assessments such as X-rays, MRIs, CT scans, ultrasounds or laboratory studies • Perform diagnostic and therapeutic procedures including joint and bursal aspirations, closed reduction of fractures or dislocations and injection of joints • Diagnose illness • Develop treatment plans • Assist in surgery • Conduct hospital rounds, write orders and formulate and implement a treatment plan for hospitalized patients

• Order, prescribe, dispense and administer medication • Instruct and counsel patients You may see the physician and PA/NP at the same visit or separately. The physician assistant and nurse practitioner will discuss or review your case with their supervising physician. PAs/NPs are known for their accessibility and focus on health promotion and disease prevention. Our PAs/NPs are excellent health educators who take pride in answering your orthopaedic questions. Whether it is getting you ready for surgery, administering a joint injection or following you through your hospital stay, we are dedicated to providing you with a positive OA experience. OA currently employs more than 17 PAs and NPs. To learn more about our providers, visit the OA team at Bernadette Shaw, PA-C, is a physician assistant and clinical research coordinator who works in the OA Sports Medicine Center.

When would you see a PA/NP at OA? • Initial visit

• Cast room visit

• Follow-up care

• Emergency room visit

• Pre-operative or post-operative visit

• Hospitalization

• Phone discussion regarding care

• At the time of your surgery

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Take the Plunge Training for a Triathlon Swim By Bernadette Shaw, PA-C Whether you are an experienced triathlete or a first-time racer, the swimming portion of a triathlon is often the least favorite and the most intimidating. There are several easy steps you can take to make the swim more enjoyable and improve your overall triathlon experience.

stroke pattern. One arm is always extended forward towards your destination while the other arm performs the stroke. When the arm performing the stroke moves forward and “catches-up” with the stationary arm they change places.

Strength training Prepare in the pool during the preseason Sports-specific cardiovascular training is important, especially when it comes to swimming. Some of the most in-shape land athletes feel hopelessly out of shape when they start training in the pool. It is also important to work on stroke technique in order to become more efficient in the water and conserve energy for the rest of the race. Taking a formal swim clinic or incorporating stroke drills into your regular swim routine is a good way to accomplish this. First, concentrate on getting maximum distance per stroke. This means keeping a long body line, focusing on hip and shoulder rotation, developing a steady rhythm and minimizing resistance. Try counting the number of strokes it takes you to get to the end of the pool. This is a good task to do regularly during a workout, particularly as you tire and your stroke shortens.

Catch-up To improve stroke lengthening and body position you can incorporate the catch-up freestyle drill into your workout. Start with your hands in a streamlined position out in front of you. Pull with one arm at a time following the regular freestyle 8 The OA Update

Upper body strength is essential to swimming success and injury prevention. This can be accomplished by several strength training sessions a week, focusing on shoulder stabilization and muscle balance. An easy exercise to perform is the wall push-up.

Wall push-up Keep shoulder blades down and back, and start with your hands at shoulder level. Slowly lower your shoulders towards the wall and return to start position. Avoid shrugging your shoulders. Progress to table-end push-ups and finally to floor push-ups.

Train in your race environment When the weather allows, it is important to gain some familiarity with your triathlon swimming venue. If your race is in the ocean or a lake, wearing a wetsuit may be recommended or required. Spend time swimming in your wetsuit so you are comfortable and have a proper fit. It is also essential to test out the cap and goggles you plan to use on race day. Practice sighting buoys or objects when you train in the ocean or lake. In order to make sure you stay on track, try lifting

your eyes just high enough off the water every five to six strokes and spot your target.

Race Day On race day, get to the event a little early to check out the water conditions. Spend some time on the beach taking note of tides and currents. Review the course entry and exit, paying special attention to details such as rocks, wave action and beach slope. Get in the water, test out your gear and warm up. Keep in mind that it can be difficult to catch your breath during the first several minutes of the race due to the cold water and chaotic environment of other swimmers and crashing waves. Take comfort in knowing that your swimming heat will spread out. Focus on getting into your own rhythm. Most importantly, have fun! Bernadette Shaw, PA-C, is a physician assistant and clinical research coordinator who works in the OA Sports Medicine Center. She enjoys competing in local triathlons and open water swim races.

It pays to train! Jenni Roberts is a high school senior who has been training at the OA Performance Center since February of 2009. Over the past year Jenni has put a large emphasis on the Total Conditioning and Strength Training classes we offer in our membership program to improve her relative strength and prevent shoulder problems that have plagued her in the past. By dedicating herself to training three days a week year-round she made her 2009-2010 swim season one of the most impressive individual seasons ever by a Maine athlete. This past year she swam in four individual

events at the State Championships and not only did she win all four events, but she broke state records in every event and became All-American in all four events! She then went on to the YMCA Nationals and placed 6th in the 200 backstroke, 4th in the 100-yard backstroke, 3rd in the 200 butterfly, and went on to become the National Champion in the 100 butterfly! Her impressive performance earned her a full scholarship to the University of Maryland, one of the top college swimming programs in the country. Congratulations, Jenni!

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Dupuytren’s Disease What it is. How to treat it. by Sacha Matthews, MD, and Sarah C. Starbird, PA-C

Dupuytren is a disease involving the palmar surfaces of the hand, and very seldom, the feet. The tissue just below the surface of the skin, called the fascia, thickens abnormally, causing firm lumps or cords that can extend from the palm out to one or more fingers in the affected hand. Over a period of time these thickened cords can shorten, pulling the finger(s) down into the palm and making it difficult to perform many functions such as shaking hands, wrapping the hand around a glass, wearing gloves, or putting the hand into a pants pocket. Fortunately, the deeper structures of the hand including arteries, veins and tendons are not directly involved. Nerves can be intertwined with the cord, making it a difficult dissection if surgical excision is elected. The cause of the disease is not known but it does tend to run in families—particularly those of Northern European descent. It is also common in men over the age of 40. Many times the facial thickening starts and then remains a small, painless bump in the palm. If this is the case, then no intervention is 10 The OA Update

necessary. However, if the nodule progresses into a cord that begins to pull the finger(s) down into the palm, resulting in a functional deficit, then referral to a hand specialist should be considered. This process of tethering and contracting usually takes months, if not years, to advance, thus leaving plenty of time to consider if and when anything needs to be done. Treatment options depend on the severity of the disease. As mentioned above, an isolated painless nodule in the palm needs no more treatment than a watchful eye. Even a more advanced cord needs no treatment if it is not interfering with hand function. Concern for treatment arises when daily life activities are affected and improvement in finger extension is desired by the patient. Surgery, along with the newly approved collagenase injections from the Federal Drug Administration (FDA), are two of the options available. Collagenase is injected by a hand specialist into the tissue. This dissolves the cord over a period of 24 hours, allowing it to be manipulated and straightened. Splinting and therapy follow.

Unfortunately, this treatment is not covered by most insurance carriers and needs to be paid for out of pocket, which makes it too expensive for most patients. Surgical excision of the cord(s) removes the diseased tissue and allows the finger(s) to straighten and function normally. This procedure can typically be completed as an outpatient surgery. It takes between one to two hours to perform the surgery, depending on the severity of the disease. A post-operative splint is worn for several weeks post-surgery, to keep the finger(s) in an extended position. Therapy is recommended to assure optimal post-operative success. The disease can reoccur over time despite all attempts. Keeping this as well as the operative and injection risks in mind, overall goals and expectations should be discussed thoroughly with a hand surgeon prior to any invasive procedure. Sacha Matthews, MD, is a hand surgeon in the OA Hand Center. Sarah C. Starbird, PA-C, is a physician assistant who works in the OA Hand Center with Dr. Matthews.

Be Brave Now... and Proud Later Facing Haiti’s Trauma

By Linda Ruterbories, ANP and Joanne Leblanc, BSN, RN

Haiti, the poorest country in the Western Hemisphere, had challenges long before the January 12th earthquake devastated the island. Konbit Sante, a nonprofit organization based in Portland, Maine, has been dedicated to the medical needs of Haiti, specifically northern Haiti, since 2000. The organization’s name comes from two Creole words konbit, which means “working together” and sante, which means “health.” Konbit Sante works with local medical professionals at the Justinian Hospital, a medical training facility in Cap-Haitien. This location was not directly in the earthquake zone, but both the city and Justinian Hospital have welcomed and aided the injured, displaced and lost. The OA Update 13

Members of the team arriving in Haiti for the first time were simply not prepared for the reality of the poverty and the distressing living conditions.

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The team arrives in Cap-Ha

Dr. Pierre Louis and Dr.

Forming the team OA Centers for Orthopaedic’s CEO John Wipfler, learned of Konbit Sante’s plan to send a team to Haiti through Mary Anne Ringle, a program specialist at Konbit Sante. Ringle previously worked for Wipfler on the Maine Health and Finance Commission. Wipfler asked the OA Centers physician board if there was interest in participating in Konbit Sante’s team, and when the response was positive, OA, in conjunction with Maine Medical Center, formed a seven-person volunteer team. Team members included:

Matt Camuso discuss the

instruments OA bought to


the non-profit since its inception. Since 1994, Dr. Broaddus has visited northern Haiti nine times. The team members believed they could offer services that were needed, and that the connections in place through Konbit Sante and the Justinian would expedite the team’s mission—to offer their colleagues at Justinian Hospital specific surgical services in orthopedics and trauma care. The team also agreed that nurses with wound care expertise would be of particular value.

Culture shock OA Centers for Orthopaedics Matt Camuso, MD, Orthopaedic Trauma Surgeon Linda Ruterbories, ANP, Director of OA Surgery Center Joanne Leblanc, RN, Director of Clinical Services Maine Medical Center Brad Cushing, MD, Chief of Surgery Samuel Broaddus, MD, Chief of Urology March Truedsson, RN, wound care nurse Marieta Atienza, RN, wound care nurse OA’s Ruterbories and Maine Medical’s Broaddus spearheaded the surgical and wound care team. Dr. Broaddus, who has been traveling to Haiti since before Konbit Sante was formed, has been affiliated with

Members of the team arriving in Haiti for the first time were simply not prepared for the reality of the poverty and the distressing living conditions. The sheer mass of people surviving not just the earthquake, but an obviously status quo poverty, was a devastating sight. From the moment of arrival through the team’s departure, it was apparent that there was neither space nor resources to accommodate the large numbers of residents. It was clear that no public waste disposal system existed in the country. Garbage is simply left on the side of the roads. Occasionally it’s burned to create more space. Housing consists of one-room metal buildings with openings for windows and doors, but no coverings across the openings. Many of these homes are built into the mountainside. Mud slides are inevitable due to the weather and the tin homes are often swept away. Yet the most surprising contrast the team saw was that no matter how impoverished the people were, The OA Update 15

Dr. Louis and Dr. Camuso

in surgery.

Haitians in Cap-Haitien were consistently dressed in their Sunday best, impeccably white and pressed. The Haitian people are proud of their appearance no matter where they are going or what they are doing. A cultural reality that was more pleasant, visually, was Haitian transportation. The primary source of travel within the city is in the back of pickup trucks or on mopeds, three or four people at a time. For greater distances the solution is both unique and colorful—and somewhat unsettling as well. Haiti has no official transit system. Long distance travel is facilitated by individually-owned, brilliantly-colored and artfully decorated vehicles called Tap Taps. These vehicles, primarily buses, do not have schedules or regular destinations. There are no seat belts and the roads are bumpy. The Tap Taps travel only when a vehicle is full and they transport chickens and goats as well as humans—all at the same time. The name comes from the fact that passengers tap on the metal of the bus or truck to signal that they want to stop.

Establishing relationships

Haitian transportation called Tap Taps.

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Understanding the importance of building relationships in Haiti was the key to the team’s success. Dr. Broaddus, over his 16 years of volunteer experience in Haiti has established successful methods for building relationships. His extensive experience gave the team valuable insights in breaking down language barriers and understanding cultural differences. Nate Nickerson, Executive Director of Konbit Sante, has also spent considerable time immersed in the Haitian culture. He led the team through the process of making initial contact with Dr. Pierre Louis, the sole orthopaedic surgeon in Cap-Haitien.

Dr. Camuso partnered with Dr. Louis. Together, they performed several surgeries, including a difficult lower leg fracture repair on a young woman, a dancer, who refused to have her leg amputated despite the difficult, long road ahead of her during recovery from her devastating injury. Dr. Louis expressed his gratitude to Dr. Camuso for providing their facility with the modern fracture instrumentation and implants that the team brought with them from the United States. The two physicians spent several hours together, discussing cases as Dr. Louis mastered his new tools. Dr. Camuso’s personality and his finesse within the OR facilitated a trusting bond between the two surgeons. The team felt that the goal, which was to provide assistance and surgical expertise within limited resources, had been well met. Dr. Camuso’s expertise as a trauma surgeon was instrumental in preparing Dr. Louis by providing him with the knowledge and training he would need to operate on cases that might otherwise have been seen as hopeless or inoperable.

Reflections When it was time to leave Haiti and return to their regular jobs in the United States, the team experienced frustration and sadness. Although much had occurred, it seemed to the team as though very little had been accomplished. They felt they could have done more, saved more, and been more help. Limiting factors such as sterilization issues, inadequate staffing resources, time constraints and the inability to perform as many surgical procedures as were needed, contributed to the team’s depression. The consensus was that they had not, as hoped, really made a difference in the days they had been in Cap-Haitien. It was painful to leave patients behind. As team members transitioned back into the land of plenty, it was difficult to forget the faces of those patients and troubling to realize they might never know the outcome of the surgeries that did take place. In an effort to offset the frustration and depression these thoughts brought to the team, Nickerson made a point of expressing his gratitude and emphasizing the value of the visit. He made it clear that in spite of the overwhelming and difficult reality of Haiti (before or since the quake), the team’s contributions were in fact, invaluable.

the same limited resources? The number of people critically injured by the quake is overwhelming. Many of the patients at the Justinian were transported from Port-au-Prince to Cap-Haitien. Orthopaedic fractures and wounds were complex. Recovery for the injured will be long and arduous, complicated by a lack of rehabilitation medicine. Living in Haiti is a challenge in and of itself; becoming a paraplegic or an amputee as a result of the quake simply compounds the magnitude of survival. The assessments completed by Konbit volunteers identified the needs to be addressed. However, they also illustrated that the real challenge, given the current reality, is to determine how to introduce and maintain the changes. Are the changes that need to take place even feasible in Haiti? Will those outside of Haiti continue to support the efforts that surely will need to continue for decades? The long-term outcome of this catastrophic event is impossible to predict. Yet for the OA and MMC team sponsored by Konbit Sante, the efforts of collaboration and relationship building will continue. The team plans to return to Haiti in the fall of 2010. Linda M. Ruterbories, ANP, is the Director of Surgical Services and Program Development at OA. Joanne T. LeBlanc, BSN, RN, is the Director of Clinical Services.

Future plans In the short term, Haiti has been supplied with resources that were not available to them prior to the earthquake. However, many improvements made prior to the tragedy are now complicated by an influx of short-term solutions that obscure many more substantial longterm solutions. Even so, there is hope that as tragic as the situation is, it may prove to have a silver lining. By bringing Haitians more options for working together, (konbit) and improving the quality of living for its population through health (sante) and knowledge, long-term changes will become more viable. The goal of Konbit Sante is to participate in the creation of a system that encourages the Haitian people to take care of their own, through increased knowledge and the ongoing ability to improve skill levels. There is a focus on high-impact solutions with minimal resource requirements. That is, how do you learn to do things differently with

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Childhood Obesity A Growing Problem By Adam Tielinen BS, CSCS and Lucien R. Ouellette, MD, FAAP What is one of the largest growing epidemics our country is facing each and every day, month and year? If you look around at different schools, playgrounds, malls or any place a child may be, the answer is clear—childhood obesity. According to the Centers for Disease Control (CDC), over the past 20 years, the number of children who are overweight has doubled for those aged 2-5 and tripled for those 12-19 years old. Children who are obese have an 80 percent chance they will remain obese as adults. Most people are aware of the issue, but what is being done about it? What are we doing to fight this ongoing problem with our youth? At the current pace, our children will be the first generation of Americans in nearly a century to die younger than their parents. Researchers have found many factors associated with childhood obesity: •Transportation (riding rather than walking) •Sedentary activity (video games, computers, television)

•Large portion sizes, high-calorie drinks and food •Genetics. In addition, there are endless consequences involving all facets of life: •Decreased performance in school •Increased behavior issues at school and home •Adult-type illnesses at younger and younger ages • Increased rate of depression and poor self-esteem. No part of life can escape the consequences of childhood obesity. So why are our children “growing?” What are parents, teachers and society doing to combat childhood obesity? What examples are they setting in their personal lives? How do we “thin down” our children? There is no easy answer to any of these

questions. The simple explanation of balancing your energy intake (food) with your energy output (activity) is easy to understand, but much harder to apply to each choice we make throughout the day. For a lasting answer, children need to learn lifelong skills regarding what the healthy choices are in the two major areas of nutrition and activity. Our society has molded itself into a quick service, fast food and a constant entertainment culture. It is very easy to access oversized portions of calorie-dense, nutritionally poor food or drink multiple times a day, without ever leaving your car. The average daily calorie need for an adult woman is 1,200-1,500, and for an adult man 2,000-2,500. Kids need less, but with the average McDonald’s Cheeseburger Happy Meal having 550 calories, it doesn’t take long to surpass this daily amount. Did you know that healthy meals can be convenient as well? Planning and preparing meals ahead of time, The OA Update 19

packing healthy snacks in the car and in lunchboxes, and most importantly, setting a good example by eating healthy meals and snacks can go a long way in educating our children about healthy choices. Show the child that healthy food does taste good and can be refreshing. Keep children involved in meal selection and preparation so they understand the choices they have in food selection. Have them help you prepare a healthy meal or pick out fruits and vegetables at the supermarket. Schools have started implementing the 5-2-1-0 model, which is easily adaptable to the home environment as well. This model promotes five servings of fruits and vegetables each day, no more than two hours of screen time per day (TV, computer, video games), one hour of physical activity each day, and no sugar sweetened beverages. This is an easily adaptable model that incorporates both the nutrition and activity side of the puzzle. One of the biggest ways to prevent childhood obesity is to get the child moving, and

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it doesn’t have to be complicated or expensive. Society again has created an environment where free play has disappeared and organized sports are everywhere. In the case of healthy living and weight control, free play is best! Children need to be outside moving and learning about their bodies through tag, chase, made-up sports, riding bikes, jumping rope, climbing, crawling, etc. Most importantly, do it with them! Show them how much fun exercising can be, so they develop lifelong skills they can use later in life. Exercise doesn’t have to be painful, but the initial transition to an active lifestyle will be met with some resistance. Start easy with family walks after dinner, short trips to the park to play catch, use stairs instead of the elevator, park farther away from stores to get the extra walk, and drink water to stay hydrated instead of sports drinks that are made for endurance athletes. Any challenge is easier as a family! At OA Centers for Orthopaedics, we are aware of childhood obesity and are taking steps to fight this serious problem. With the addition

of the OA Performance Center, home of the Parisi Speed School, we strive to empower America’s youth through sport and exercise. Programs are aimed towards teaching kids how to eat healthy and use proper exercise techniques at an appropriate frequency through mentoring and personal commitment. In addition, kids are taught how to set goals and learn habits they can carry with them into adulthood. With this positive personal environment, they can create healthy lifestyles and strength in character. Now that seems like the right kind of growth for any child! Lucien R. Ouellette, MD is a Board Certified Pediatrician and holds a Certificate of Added Qualification in sports medicine. Dr. Ouellette works within the OA Sports Medicine Center. Adam Tielinen BS, CSCS is a Performance Coach at the OA Performance Center. He is a member and a Certified Strength and Conditioning Specialist (CSCS) with the National Strength and Conditioning Association (NSCA).

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Advertising Directory OA Centers for Orthopaedics thanks the following advertisers for making this publication possible. Acadia Benefits Inc. ...................................................... 18 Berry, Dunn, McNeil & Parker ........................................ 21 Broom Service Inc. .........................................................20 Creative Printed Solutions Inc 71 Pleasant Hill Rd. PO Box 6660 Scarborough, ME 04074 (207) 939-8523 • Fax (207) 883-1580 DJO Incorporated........................................................... 21 Ethos Marketing & Design............................................. 23 Ferring Pharmaceuticals............................................... 11 Hebert Construction LLC ............................................... 17 Holbrook Center .............................................................. 7 Maine Medical Center ................................................... 22 Maine Uniform .............................................................. 18 Mercy Hospital ................................................................ 2 New England Medical Transcription Inc ........................ 18 New England Rehabilitation Hospital of Portland ......... 21 PDT Architects............................................................... 18 RBC Wealth Management ............................................. 20 Spectrum Medical Group................................................. 9 Surgical Systems Inc..................................................... 24

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OA Centers for Orthopaedics 33 Sewall St. Portland, Maine 04102

The OA Update - Version 3 Issue 2  
The OA Update - Version 3 Issue 2  

The OA Update is published by Oser-Bentley Custom Publishers, LLC, a division of Oser Communications Group, Inc., 1877 N. Kolb Road, Tucson,...