WINTER 2017
A P U B L I C A T I O N O F T H E C O R E I N S T I T U T E
CrossFit Athlete Returns to the Gym Following Bi-Lateral Meniscus Tears Breaking ‘Bone’ Myths
Committed to
the Valley The CORE Institute and Banner Health Expand Partnership
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WELCOME VOLUME 8, ISSUE 3 – WINTER 2017
FROM THE CHAIRMAN
Lots to Celebrate It’s the most wonderful time of the year. That’s how songwriters have described the holiday season, those magical days when we give thanks for what we have, gather together with those we love, and celebrate life. And this issue of CORE Ink highlights that we have a lot to celebrate! First, our cover story detailing the extraordinary things happening at the Orthopedic & Spine Institute in downtown Phoenix. You’ll read how world class surgeons are working with academic experts in bioscience, genomics, and robotics to produce better outcomes and improved patient experience. The Orthopedic & Spine Institute is a key part of our expanding relationship with Banner Health. Then we have the inspiring story of Tony Atwater, a fitness professional who once weighed more than 300 pounds, but saw his health and business imperiled by knee injuries. Tony explains how The CORE Institute got him back on his feet and back to living the life he loves. That’s on page 10. There’s exciting news about non-surgical treatments for osteoporosis, a potentially devastating condition which impacts an estimated 57 million Americans, plus the inside story on Kyphoplasty, a minimally invasive surgical technique now being used to treat spinal compression fractures. Looking for ways to avoid ‘over-indulging’ during the holidays? We have some tips for you. You’ll also read how chiropractic treatment can dramatically improve the quality of life for many patients. And finally, a heartwarming example of the spirit of giving. We take you behind the scenes at Ride N’ Raise, the MORE Foundation’s annual fundraiser that’s helping homebound military veterans get much needed transportation to enable them to see their doctors. That’s a lot of ground to cover in one issue, but it reflects the wide-ranging mission of The CORE Institute, and our ongoing commitment to deliver best-in-class patient care. It is wonderful being able to celebrate superior outcomes, and all of us at The CORE Institute are thankful for our opportunity to serve our treasured patients.
Keep Life in Motion!®
David J. Jacofsky, MD Chairman & CEO
A P U B L I C A T I O N O F T H E C O R E I N S T I T U T E
CREATED BY REPUBLIC MEDIA CUSTOM PUBLISHING FOR THE CORE INSTITUTE
General Manager: Cami Kaiser/ cami.kaiser@republicmedia.com Creative Development Director: Isaac Moya/ imoya@republicmedia.com
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®
Contents
14 COVER STORY
Committed to the Valley Banner Health and The CORE Institute Expand Partnership for Integrated Orthopedic Care. See page 14.
PATIENT CARE
10
Pushing Limits CrossFit Athlete Returns to the Gym Following Bi-Lateral Meniscus Tears. See page 10.
D E PART M E N T S Ask the Expert
Specialty Spotlight
6 Getting the Kinks Out.
18 Understanding the Treatment and Prevention of Osteoporosis.
What’s New? 9 The CORE Institute is pleased to introduce a new physician to the CORE team.
20
Trends
connect with us 1.866.974.2673
17 Minimally-Invasive Producdures Bring Immediate Pain Relief for Spinal Compression Fractures.
Nutrition 20 Making Nutritional Choices During Holiday Gatherings.
Research 22 The MORE Foundation’s Veterans Fundraising Event Huge Success.
www.thecoreinstitute.com
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ASK THE EXPERT
been satisfied or they would rather utilize a conservative route. One of the better conservative options would be chiropractic manipulation or chiropractic care in totality. Q: What conditions does chiropractic therapy benefit? Primarily what I treat in the spine is subluxation, a disarticulation of the vertebral joint. When vertebrae are moved out of place or not aligned, they can cause soft tissue to become swollen, strained or sprained and it can also cause nerve compression so the patient can feel numbness, tingling or soreness. We essentially are articulating and bringing back into order that subluxation. Additional to that are headaches, any type of extremity pain and there are a lot of secondary things that come from spinal ailments that measure out in pain.
Q&A
GETTING THE KINKS OUT Chiropractic Treatments Send Pain on its Way
Yes, they definitely do. Chiropractic treatments reduce pain and increase functionality and those are two qualityof-life measures that patients can hang on to. These are tangible measures so patients can see that their range of motion has increased and they are able to do activities with less pain.
By Leigh Farr For many people, chronic pain prevents them from living life to the fullest. Here, Dr. Gagandeep Arora, of The CORE Institute, draws on his career as a chiropractic physician to talk about the Q: Do you see patients DR. GS ARORA benefits of chiropractic who have exhausted therapy. In addition to other treatments and working with the general public, Dr. are looking for a solution that works? Arora treats professional athletes I do. So often I get patients who have including the Texas Rangers baseball taken the route of surgical consult, team. sometimes even surgery that hasn’t been successful. They’ve done interventional Q: Do chiropractic treatments measures whether it’s medicine or make a difference in the quality of injection therapy or another type of life of many patients? procedure and either they haven’t
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Q: What is the best way to find a chiropractic physician? You can ask your primary physician for a referral or you can go onto websites that cater to the marketing of chiropractic specialties. Q: Do chiropractic physicians go through a lot of training and certification? Yes, most chiropractic physicians like other healthcare provider physicians have an undergraduate degree and then they do a post-graduate four-year program. The first part of the program is analogous to medical training and dental training which is basic sciences and the second half is your clinical training. Then you take the Medical Board Exam. FOR MORE INFORMATION To connect with a chiropractic physician, visit thecoreinstitute.com or call 866.974.2673.
www.thecoreinstitute.com
Over 100,000 patients have been treated with FDA-approved XIAFLEX® since 2010.* If bent fingers from Dupuytren’s contracture are affecting you, explore XIAFLEX.com and find a hand specialist near you.
*Based on estimates through May 2017. Actor portrayal.
WHAT IS XIAFLEX®? XIAFLEX® is a prescription medicine used to treat adults with Dupuytren’s contracture when a “cord” can be felt. It is not known if XIAFLEX® is safe and effective in children under the age of 18. IMPORTANT SAFETY INFORMATION FOR XIAFLEX® Do not receive XIAFLEX® if you have had an allergic reaction to collagenase clostridium histolyticum or any of the ingredients in XIAFLEX®, or to any other collagenase product. See the end of the Medication Guide for a complete list of ingredients in XIAFLEX®. XIAFLEX® can cause serious side effects, including: • Tendon rupture or ligament damage. Receiving an injection of XIAFLEX® may cause damage to a tendon or ligament in your hand and cause it to break or weaken. This could require surgery to fix the damaged tendon or ligament. Call your healthcare provider right away if you have trouble bending your injected finger (towards the wrist) after the swelling goes down or you have problems using your treated hand after your follow-up visit • Nerve injury or other serious injury of the hand. Call your healthcare provider right away if you get numbness, tingling, increased pain, or tears in the skin (laceration) in your treated finger or hand after your injection or after your follow-up visit
• Hypersensitivity reactions, including anaphylaxis. Severe allergic reactions can happen in people who receive XIAFLEX® because it contains foreign proteins. Call your healthcare provider right away if you have any of these symptoms of an allergic reaction after an injection of XIAFLEX®: — hives — swollen face — breathing trouble — chest pain — low blood pressure — dizziness or fainting • Increased chance of bleeding. Bleeding or bruising at the injection site can happen in people who receive XIAFLEX®. Talk to your healthcare provider if you have a problem with your blood clotting. XIAFLEX® may not be right for you. Before receiving XIAFLEX®, tell your healthcare provider if you have had an allergic reaction to a previous XIAFLEX® injection, or have a bleeding problem or any other medical conditions. Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Using XIAFLEX® with certain other medicines can cause serious side effects. Especially tell your healthcare provider if you take medicines to thin your blood (anticoagulants). If you are told to stop taking a blood thinner before your XIAFLEX® injection, your healthcare provider should tell
you when to restart the blood thinner. Ask your healthcare provider or pharmacist for a list of these medicines if you are unsure. The most common side effects with XIAFLEX® for the treatment of Dupuytren’s contracture include: • swelling of the injection site or the hand • bruising or bleeding at the injection site • pain or tenderness of the injection site or the hand • swelling of the lymph nodes (glands) in the elbow or armpit • itching • breaks in the skin • redness or warmth of the skin • pain in the armpit Tell your healthcare provider if you have any side effect that bothers you or does not go away. These are not all of the possible side effects with XIAFLEX®. For more information, ask your healthcare provider or pharmacist. Please see the Medication Guide on the adjacent page. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/ medwatch, or call 1-800-FDA-1088.
Rx Only XIAFLEX® is a registered trademark of Endo International plc or one of its affiliates. © 2017 Endo Pharmaceuticals Inc. All rights reserved. Malvern, PA 19355 XD-05413/August 2017 www.xiaflex.com 1-800-462-ENDO (3636)
Explore XIAFLEX.com
and find a specialist near you.
Medication Guide XIAFLEX® (Zī a flex) (collagenase clostridium histolyticum) For injection, for intralesional use Read this Medication Guide before you receive XIAFLEX for the treatment of Dupuytren’s contracture and each time you get an injection. There may be new information. This Medication Guide does not take the place of talking with your healthcare provider about your medical condition or treatment. What is the most important information I should know about XIAFLEX for the treatment of Dupuytren’s contracture? XIAFLEX can cause serious side effects, including: 1. Tendon rupture or ligament damage. Receiving an injection of XIAFLEX may cause damage to a tendon or ligament in your hand and cause it to break or weaken. This could require surgery to fix the damaged tendon or ligament. Call your healthcare provider right away if you have trouble bending your injected finger (towards the wrist) after the swelling goes down or you have problems using your treated hand after your follow-up visit. 2. Nerve injury or other serious injury of the hand. Call your healthcare provider right away if you get numbness, tingling, increased pain, or tears in the skin (laceration) in your treated finger or hand after your injection or after your follow-up visit. 3. Hypersensitivity reactions, including anaphylaxis. Severe allergic reactions can happen in people who receive XIAFLEX, because it contains foreign proteins. Call your healthcare provider right away if you have any of these symptoms of an allergic reaction after an injection of XIAFLEX: • hives • chest pain • swollen face • low blood pressure • breathing trouble • dizziness or fainting What is XIAFLEX? XIAFLEX is a prescription medicine used to treat adults with Dupuytren’s contracture when a “cord” can be felt. It is not known if XIAFLEX is safe and effective in children under the age of 18. Who should not receive XIAFLEX? Do not receive XIAFLEX if you: • are allergic to collagenase clostridium histolyticum, or any of the ingredients in XIAFLEX, or to any other collagenase product. See the end of this Medication Guide for a complete list of ingredients in XIAFLEX. Talk to your healthcare provider before receiving this medicine if you have any of these conditions. What should I tell my healthcare provider before receiving XIAFLEX? Before receiving XIAFLEX, tell your healthcare provider if you: • have had an allergic reaction to a XIAFLEX injection in the past • have a bleeding problem • have received XIAFLEX to treat another condition • have any other medical conditions • are pregnant or plan to become pregnant. It is not known if XIAFLEX will harm your unborn baby. • are breastfeeding or plan to breastfeed. It is not known if XIAFLEX passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby if you receive XIAFLEX. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Using XIAFLEX with certain other medicines can cause serious side effects. Especially tell your healthcare provider if you take: • medicines to thin your blood (anticoagulants). If you are told to stop taking a blood thinner before your XIAFLEX injection, your healthcare provider should tell you when to restart the blood thinner. Ask your healthcare provider or pharmacist for a list of these medicines, if you are not sure. Know the medicines you take. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine. How will I receive XIAFLEX? • XIAFLEX should be injected into a cord by a healthcare provider who is experienced in injection procedures of the hand and treating people with Dupuytren’s contracture. If you have more than 1 contracture, your healthcare provider may give you 2 injections in 1 of your hands during your visit. • Your healthcare provider will inject XIAFLEX into the cord that is causing your finger to bend.
• After an injection of XIAFLEX, your affected hand will be wrapped with a bandage. You should limit moving and using the treated finger after the injection. • Do not bend or straighten the fingers of the injected hand until your healthcare provider says it is okay. This will help to keep the medicine from leaking out of the cord. • Do not try to straighten the treated finger yourself. • Keep the injected hand elevated until bedtime. • Call your healthcare provider right away if you have: • signs of infection after your injection, such as fever, chills, increased redness, or swelling • numbness or tingling in the treated finger • trouble bending the injected finger after the swelling goes down • Return to your healthcare provider’s office as directed 1 to 3 days after your injection. During this first follow-up visit, if you still have the cord, your healthcare provider may try to extend the treated finger to “break” the cord and try to straighten your finger. • Your healthcare provider will provide you with a splint to wear on the treated finger. Wear the splint as instructed by your healthcare provider at bedtime to keep your finger straight. • Do finger exercises each day, as instructed by your healthcare provider. • Follow your healthcare provider’s instructions about when you can start doing your normal activities with the injected hand. What are the possible side effects of XIAFLEX? XIAFLEX may cause serious side effects, including: • See “What is the most important information I should know about XIAFLEX?” • increased chance of bleeding. Bleeding or bruising at the injection site can happen in people who receive XIAFLEX. Talk to your healthcare provider if you have a problem with your blood clotting. XIAFLEX may not be right for you. The most common side effects with XIAFLEX for the treatment of Dupuytren’s contracture include: • swelling of the injection site or the hand • bruising or bleeding at the injection site • pain or tenderness of the injection site or the hand • swelling of the lymph nodes (glands) in the elbow or armpit (axilla) • itching • breaks in the skin • redness or warmth of the skin • pain in the armpit Tell your healthcare provider if you have any side effect that bothers you or does not go away. These are not all of the possible side effects with XIAFLEX. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. General information about the safe and effective use of XIAFLEX. Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. This Medication Guide summarizes the most important information about XIAFLEX. If you would like more information, talk to your healthcare provider. You can ask your healthcare provider or pharmacist for information about XIAFLEX that is written for health professionals. For more information, go to www.XIAFLEX.com or call 1-800-462-3636. What are the ingredients in XIAFLEX? Active ingredient: collagenase clostridium histolyticum Inactive ingredients: hydrochloric acid, sucrose, and tromethamine. The diluent contains: calcium chloride dihydrate in 0.9% sodium chloride This Medication Guide has been approved by the U.S. Food and Drug Administration. Distributed by: Endo Pharmaceuticals Inc. Malvern, PA 19355 US License No. 1816 US Patent Nos. 7,811,560 and RE39,941 118324 Approved: 07/2017
XD-05404
WHAT’S NEW NEW PROVIDER The CORE Institute expands Bone Health Program with Medical Director, Kelly Krohn, MD. ARIZONA
KELLY KROHN, MD is a board certified and fellowship-trained rheumatologist. His primary interests are metabolic bone diseases, non-surgical management of knee osteoarthritis, fracture healing, spine fusion and rehabilitation in the elderly. Dr. Krohn served as the Senior Medical Advisor for Eli Lilly for 10 years from 20062016 with primary responsibility for the Forteo osteoporosis medical team as well as working with the global team with multiple Forteo® projects. Prior to his role with Eli Lilly, Dr. Krohn served as Director of Clinical Research at Mercy Hospital in Pittsburgh. He previously served as the
Rheumatology Fellowship Program Director at the Oregon Health and Sciences University, where he had a joint appointment in the departments of Medicine and Orthopedics. Dr. Krohn served as the team physician for the Portland Rockies as part of the Colorado Rockies Kelly Krohn, MD medical team Dr. Krohn completed his rheumatology fellowship at Indiana University and internal medicine residency at Creighton University. He obtained his
medical degree from Creighton University and his bachelor’s degree from Jamestown College. Dr. Krohn is a member of several professional organizations, including the Orthopaedic Trauma Association, Orthopaedic Research Society, American College of Rheumatology and the American Society of Bone and Mineral Research. He remains active in academic research and is a contributor to numerous journal articles, abstracts, and book chapters.
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www.thecoreinstitute.com
PUSHING LIMITS CrossFit Athlete Returns to the Gym Following Bi-Lateral Meniscus Tears BY ELISE RILEY
At age 50, Tony Atwater was in the best shape of his life. He was strong and fast, and getting inspiration daily from clients in his CrossFit gym in Farmington, Michigan. And then the pain started. Squatting was unbearable. Lateral movement was difficult. His speed was gone. “It was a no-brainer,” Atwater said. “I (went) to The CORE Institute. The doctors there are amazing.” Following separate surgeries to repair meniscus tears in both knees, as well as to remove bone spurs from his right knee, Atwater is back in the gym.
ting healthier and finding greater confidence. Nothing was more inspiring. But when the DR. JAMES BOLZ LIFE CHANGING knee pain returned and Physical fitness was more than began preventing him a hobby or a business for Atwater. It was from exercising, he knew he needed to a rebirth. After being overweight and suftalk to a doctor. But he wanted a doctor fering from joint pain for most of his adult who understood the effect that the pain life, Atwater found a solution in CrossFit. It had on his quality of life. changed his life. “I was a pretty heavy guy for most of RESTORING FUNCTION, my life, and I’ve always had knee pain,” PERFORMANCE he said. “I started working out doing Atwater met with Dr. James Bolz of The CrossFit and that knee pain went away.” CORE Institute. “The first thing he said to In the gym, Atwater would see friends me — which is exactly what I wanted to and neighbors pushing themselves, gethear — was, “Let’s find out what’s going
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LEARN MORE To hear more from Tony, visit thecoreinstitute.com/ tony-atwater
on,’” Atwater said. After ordering an MRI of Atwater’s knees, Dr. Bolz identified meniscus tears. He recommended surgery to restore function and performance. Dr. Bolz first repaired Atwater’s left knee. Atwater returned a couple months later to have the right knee treated as well. During that second surgery, Dr. Bolz removed bone spurs from the joint. The CORE Institute’s physical therapy team had Atwater moving and rehabilitating quickly. He worked out both in the physical therapy center and his own gym. “I attribute a lot of the success to the folks at physical therapy,” Atwater said. “I was following up in the gym, doing some of the exercises they prescribed for me, just trying to expedite the recovery and get back on my feet.”
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BACK TO HIS NORMAL Atwater wanted to coach again. Within weeks of his left knee surgery, he began to feel a sense of normalcy. The right knee
— which had more damage in addition to the bone spurs — took a couple months of rehab before Atwater felt his strength return. Today, eight months post-surgery, Atwater is back to jumping, shuttle runs and squatting. “I’m starting to feel complete again,” Atwater said. “I’m starting to feel like an athlete again. One of the thing injuries can do to you when you’re an older athlete, it can mess with you mentally.” Today, Atwater’s clients are supporting and motivating him as he continues to improve his strength and performance. “I’m coaching people that are trying to get fit, I’m trying to lead by example,” he said. “One of the beautiful things about CrossFit is the sense of community that that we have here. This community rallied behind me. “Life is good.”
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COVER STORY
The CORE Institute and Banner Health Expand Partnership
Committed to
the Valley BY KRISTINE BURNETT
The CORE Institute and Banner Health have, for years, been collaborating to deliver superior orthopedic care through the Banner CORE Center for Orthopedics. Located at various Banner Health hospitals throughout Arizona, these centers of highly specialized orthopedic services are distinguished for superior patient outcomes.
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Today, the two healthcare powerhouses are advancing their shared commitment to orthopedic excellence with the Orthopedic and Spine Institute at Banner – University Medical Center Phoenix. TRAINING THE DOCTORS OF TOMORROW Under the Banner CORE Center for Orthopedics umbrella, the Orthopedic and Spine Institute is an academic medicine and research-focused
Dr. Adam Lundberg of The CORE Institute and Juliann Arnold, RN, navigator, perform an interventional spine and pain management epidural at the Orthopedic and Spine Institute.
outpatient clinic. It’s also an integral part of the academic medicine model in place at Banner – University Medical Center Phoenix. Here, board certified and fellowship-trained surgeons deliver unparalleled musculoskeletal care while training the doctors of tomorrow. Banner – University Medical Center
www.thecoreinstitute.com
Within the Orthopedic and Spine Institute are six specialty centers: »» Spine Health Center »» Musculoskeletal Trauma Center »» Hand and Upper Extremity Center »» Sports Medicine Center »» Adult Reconstruction Center »» Concussion Center
medicine and musculoskeletal health. These include the Spine Health Center, Musculoskeletal Trauma Center, Hand and Upper Extremity Center, Sports Medicine Center, Adult Reconstruction Center, and Concussion Center. “Banner – University Medical Center Phoenix has a welldeserved reputation for being a world-class teaching hospital because of its willingness to implement and invest in programs like the Orthopedic and Spine Institute,” said Jason Scalise, MD, Vice Chairman of The CORE Institute. “Our co-management model for the Orthopedic and Spine Institute leverages the collective expertise of our physicians, researchers and patient care advocates.” POWER OF PARTNERSHIP Steve Narang, MD, CEO of Banner – University Medical Center Phoenix, says the hospital’s role as a state and regional leader in orthopedics wouldn’t be possible without The CORE Institute.
ATI Physical Therapy
Phoenix is one of Arizona’s oldest and most highly regarded academic teaching hospitals. Banner Health’s collaboration with The CORE Institute has elevated the hospital’s orthopedic teaching credentials, augmented the experience of its orthopedic residency program, and introduced a sophisticated hand, upper extremity and microsurgery fellowship program. ADVANCING CARE THROUGH RESEARCH While caring for patients, physicians working within the Institute are actively conducting academic research and participating in clinical trials that have the potential to shape the future of orthopedic medicine. For patients, this means having access to the latest treatment techniques and medical technologies. Add subspecialty programs spanning everything from spine, hand and joint replacement surgery, to orthopedic trauma services, and the Orthopedic and Spine Institute stands as a destination facility for all things in orthopedic medicine. PATIENT-CENTERED CARE Within the Orthopedic and Spine Institute are six specialty centers, each dedicated to a specific aspect of orthopedic
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Help is Waiting The Orthopedic and Spine Institute is a robust outpatient clinic that treats virtually all injuries and disorders affecting the bones, joints, muscles, ligaments, tendons and cartilage, including: »» Sports Medicine »» Ligament and tendon injuries »» Muscle strain »» Overuse injuries (i.e. tendonitis) »» Spine Health »» Osteoarthritis »» Degenerative disc disease »» Herniation »» Spine fractures »» Scoliosis »» Myelopathy »» Hand & Upper Extremity »» Carpal tunnel syndrome »» Cubital tunnel syndrome »» Ganglion cysts »» Wrist fractures/dislocations »» Nerve compression injuries »» Lateral epicondylitis (tennis elbow) »» Bone Health »» Osteoporosis »» Osteopenia »» Calcium/vitamin D deficiency »» Orthopedic Trauma »» All fractures (hip, femur, pelvis, humerus and wrist) »» Acute compartment syndrome »» Crush injuries/polytrauma
X-ray technician Chris Rogers, left and Dr. Simon Görtz, an orthopedic surgeon at the Orthopedic and Spine Institute.
“The Orthopedic and Spine Institute is differentiated by the programs, protocols and people within it,” he said. “The quality of care they provide, their commitment to teaching and their laser-sharp focus on research is unmatched. The Institute truly is a testament to the power of partnership.”
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The Orthopedic and Spine Institute at Banner – University Medical Center Phoenix takes a multidisciplinary approach to care. Patients’ care teams may include primary care sports medicine physicians, sports medicine surgeons, orthopedic spine surgeons, orthopedic
trauma surgeons, total joint surgeons, and hand and upper extremity surgeons, to name a few. For more information about the Orthopedic and Spine Institute, visit bannerhealth.com/universityinstitutes.
www.thecoreinstitute.com
T R EN DS
A Better Way to Heal Minimally-Invasive Procedures Bring Immediate Pain Relief for Those With Spinal Compression Fractures By Brian Sodoma Unfortunately, with age, spinal compression fracture risk increases. These fractures are most common in the elderly, post-menopausal women over 55 and those who suffer from osteoporosis, or diminishing bone surgical procedures that could bring density. almost immediate pain relief. Spinal compression fractures involve actual cracks in the vertebra OPTIONS THAT WORK of the upper (thoracic) or lower One option for pain relief is a (lumbar) spine. Feeling back pain vertebroplasty surgery, which involves while lifting something that is not injecting cement into the fractured very heavy is a common first sign of vertebra area to stabilize the bone. The a spinal compression procedure requires only two fracture, says Dr. Ali tiny injection sites, each only Araghi, DO, director of a few millimeters in length. The CORE Institute’s The procedure is done on Spine Division. A an outpatient basis with patient will often feel intravenous sedation and better while laying local anesthesia is used. down, worse with “Typically, pain relief from ALI ARAGHI, DO movement; however, the fracture is immediate,” it’s not uncommon for Dr. Araghi adds. the body to heal the fracture within six For some, however, the fractures weeks. can be more severe and the height There are also patients whose of a vertebra could be considerably bodies cannot heal the fracture in that compromised. To potentially regain time frame. If the pain persists, it’s some of the lost vertebra height, a critical to see a physician immediately, surgeon may look to kyphoplasty. The Dr. Araghi asserts. Newer fractures procedure uses a balloon to create a may benefit from minimally-invasive cavity at the fracture site. The balloon
is removed and the cavity immediately filled with cement, potentially reducing the chances of cement extravasation. “It can potentially restore some of the height of the vertebral body which is lost due to compression,” Dr. Araghi added. “That cavity creation is really what differentiates kyphoplasty versus a vertebroplasty.” Kyphoplasty is available at The CORE Institute, but Dr. Araghi emphasizes that tending to the fracture early is critical to success. Identifying the fracture at the three week point and not waiting until it is six to eight weeks old can make a difference. “With well-selected patients, the results are outstanding and it’s one of the more successful spinal procedures we do,” he added. LEARN MORE To learn if spinal compression fracture surgery is right for you, call 866.974.2673.
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SPECIALTY SPOTLIGHT
“When people think of it, they think of an 80-year-old lady. If a man has a fracture we really need to put our antennas up,” Dr. Krohn said. And while many women are encouraged to get a bone density test at 65 or older, Dr. Krohn recommends men age 70 and older also get the test. He also encourages patients to get an X-Ray of their back with the bone density scan to look for spine fractures. “Many people don’t realize that they’ve ever had a fracture in their spine, but we see them on x-ray if we look. Those fractures are very important because it is an early warning sign that someone is a high risk for other fractures related to osteoporosis.”
Breaking Bone Myths Understanding the Treatment and Prevention of Osteoporosis By Julie Maurer “Don’t break a hip” might be a joke thrown around when someone is advancing in age, but for the nearly 54 million Americans with osteoporosis, it is no laughing matter. Osteoporosis is a condition where the body loses too much bone, causing breaks. While the misconception is that the disease primarily impacts senior women, people of all ages and genders can experience bone disease. The CORE Institute’s Bone Health Medical Director Kelly D. Krohn, MD helps dispel myths about the disease. MYTH 1: AGE “There are bone diseases that affect kids, and there are medications that people of any age take that can make their bones fragile,” Dr. Krohn said. He said the most common reason for
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bone fragility is old age, so it is easier to diagnose in senior patients. “With someone in their forties you must put your thinking cap on to figure out how they got here (with broken bones),” Dr. Krohn said. “It’s kind of like being a detective.” Dr. Krohn started his medical career as a rheumatologist, and took an interest in osteoporosis when he learned one of the common drugs to treat inflammation, prednisone, was causing patients to have weak bones and fracture. “There are still some diseases that prednisone is necessary to treat, but we try to think about the patient’s bones and protect them with medications that will protect their bones,” Dr. Krohn said. MYTH 2: GENDER Beyond age, gender is a stereotype when it comes to osteoporosis.
MYTH 3: TREATMENT AND PREVENTION While some may think they are destined for broken bones as they age and there is no way to prevent it — new medications are making it easier to preserve bones and strengthen bones, Dr. Krohn said. “That’s exciting because you can improve and restore some of the skeleton you have lost,” he added. As for prevention, Dr. Krohn believes good nutrition is important, and physical activity. “For young women now, many are active in sports, where they weren’t in the past,” Dr. Krohn said. “That mechanically fortifies their bones.” And while menopause does cause women to lose bone, being active is still important to prevent bones from breaking. “The more active older people are, the less they are going to fall,” Dr. Krohn said. LEARN MORE For more information about The CORE Institute’s Bone Health Program, visit the thecoreinstitute.com/bonehealth.
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NUTRITION
Making Nutritional Choices During Holiday Gatherings
Eat, Drink & Be Healthy By Michelle Jacoby Tis the season for family, friends, neighbors and co-workers coming together to celebrate and, let’s face it, overindulge in holiday fare. Another glass of eggnog? Don’t mind if we do. A heaping helping of creamy green bean casserole? Why, yes, please! That extra slice of pecan pie? If you insist. While we tend to give ourselves a “pass” when it comes to eating, drinking and being merry during the holidays, there are ways to stay healthy and make nutritious choices. PREPARATION IS KEY “You’ll be going to a lot of parties with a lot of food,” says Nicole Hahn, registered dietician and nutritionist at Banner Boswell Medical Center in Sun City. “It’s OK
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to enjoy what’s being served, just keep mindful tabs on what you’re eating.” When attending holiday gatherings, Hahn suggests bypassing the bowls of chips and dip, and making a beeline for the fruit, vegetable and crudité plate. You can also fill up on leafy green salad and sip on water with lemon. “If you know you’re going to a party, preparation is key,” Hahn says. “If the party is at night, cut back on sugar and carbohydrates during the day, and maintain a balanced intake of proteins and
vegetables” she says, adding the most important thing to do to prepare for a holiday party is to not starve yourself and go to the party hungry. “That’s when portion control and overeating go out the window,” Hahn says. SWAP AND SUBSTITUTE If you’re entertaining friends and family, there are simple things you can do to make your dishes healthier. Swap out whole grains for refined ones, choose low-fat dairy products, and opt for minimally processed sugars like honey or dehydrated cane juice sugar over
granulated sugars. Another good tip is to reduce ingredient amounts and substitute ingredients, says Hahn. “When making desserts, use half the sugar the recipe calls for. Or replace it with Stevia,” she says. “You can also use mashed bananas or applesauce as sweeteners. Chia, which is packed with omega 3 fatty acids, is also a good substitute for eggs.” To lighten up beverages, make your wine go a long way by spritzing it with mineral water or seltzer. And instead of serving sugary sodas and juices, consider offering
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NUTRITION Smoked Trout with Apple-Horseradish Cream on Potato Pancakes 1/2 cup all-purpose flower 4-3/4 cups shredded, peeled baking potato (about 2 lbs.) 1/2 cup grated fresh onion 1 tsp. salt 1/2 tsp. freshly ground black pepper 2 large egg whites
3 tbsp. olive oil, divided Cooking spray 1/4 cup reduced-fat mayonnaise 3 tbsp. finely chopped Granny Smith apple 2 tbsp. plain fat-free yogurt 4 tsp. prepared horseradish 4 oz. smoked rainbow trout, bones removed, broken into 48 pieces 3 tbsp. chopped fresh chives Preheat oven to 400 degrees. Lightly spoon flour into a dry measuring cup; level with a knife. Combine flour and next five ingredients (through egg whites) in a large bowl, stirring until blended. Divide mixture into 48 level tablespoon-sized pancakes, squeezing each to remove excess moisture. Heat 1 tablespoon oil in a nonstick skillet over medium-high heat. Add 16 pancakes; cook 3 minutes on each side or until browned. Arrange on two baking sheets coated with cooking spray. Repeat procedure twice with remaining oil and pancakes. Bake at 400 degrees for 5 minutes until cooked through. Combine mayonnaise, apple, yogurt and horseradish in a small bowl; place 1/2 teaspoon mayonnaise mixture on each pancake. Top each with a trout piece; sprinkle with chives.
unsweetened teas with honey or sugar cane juice. THE PERFECT PLAN If you’re looking to stay more health-conscious this holiday season, avoid holiday party pitfalls with these simple tips: • Party at home beforehand – Enjoy a small snack of nuts, string cheese and whole grain crackers. This ensures you’ll arrive at the party feeling satisfied, not starving. • Don’t build food towers – Use a salad plate rather than a full dinner
plate, and make it a rule not to stack foods on top of each other. This helps in controlling portions. • One and done – When going through a buffet or food line, go once and forget about the second trip. One trip, one plate, and you’re good to go.
Roasted Chestnut Soup with Thyme Cream 3 cups whole roasted bottled chestnuts 2 cups chopped yellow onion 3/4 cup thinly sliced carrot 1 tbsp. olive oil 6 cups fat-free, lower-sodium chicken broth 5/8 tsp. kosher salt, divided 1/3 cup heavy whipping cream 1-1/2 tsp. chopped fresh thyme leaves Preheat oven to 400 degrees. Place chestnuts on a jelly-roll pan. Bake for 15 minutes. Place chestnuts in a large bowl; cool to room temperature. Combine onion, carrot and oil on pan; toss to coat vegetables. Bake for 1 hour or until tender, stirring occasionally. Add to chestnuts; stir in broth. Pour half of broth mixture into a blender; blend until smooth. Pour pureed mixture into a Dutch oven. Repeat procedure with remaining broth mixture. Stir in 1/2 teaspoon salt and pepper. Place pan over medium-high heat; bring to a simmer. Reduce heat, and simmer 20 minutes. Place cream in a medium bowl; beat with a mixer at high speed until soft peaks form. Add remaining 1/8 teaspoon salt; beat at high speed until stiff peaks form (do not overbeat). Ladle about 3/4 cup soup into each of 10 bowls; top each serving with about 1 tablespoon cream. Sprinkle with thyme. Serve immediately.
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RESEARCH
MORE Fund-Riding for Vets The MORE Foundation’s Veterans Fundraising Ride Raises More Than $21,000 in 2017 By Joan Westlake Veterans will again receive transportation to their medical appointments thanks to funds raised at the MORE Foundation’s 2nd Annual Ride N’ Raise, Nov. 12, 2017, at Harley-Davidson of
Scottsdale. Sponsored by The CORE Institute, more than 110 participants attended the event, contributing $21,271. All proceeds benefit the MORE Foundation’s V-Tap Program. “We are pleased to again support this event that provides vital services for our veterans,” said Jason J. Scalise, MD, a MORE Foundation Board Member and specialist in reconstructive and arthroscopic surgery of the shoulder with The CORE Institute. “It is an honor to participate in this endeavor
that assists those who have served our nation.” The MORE Foundation was founded in 2009 by a group of senior leaders at The CORE Institute as a means to give back to the communities they serve. As the MORE Foundation’s reputation has grown in the orthopedic community, the Foundation has garnered corporate sponsors and expanded support from private individuals. With this increased support base, the nonprofit MORE Foundation has pioneered innovative orthopedic research programs, conducted educational programs in the field of musculoskeletal healthcare and launched charitable assistance programs that enhance access to healthcare for vulnerable populations. It’s innovative, communityfocused programs seek to create a world of active people. In July 2015, the Veterans Transportation Assistance Program (V-TAP) was launched by the MORE
Foundation and Quality Transport Services of Arizona. Since then, over 1,000 transports have been provided to veterans with a goal of 800 for 2018. The program is designed to provide veterans transportation to and from their medical appointments. Since launching the program, the MORE Foundation’s V-Tap program has made a positive impact for many veterans across Arizona. This program is helping veterans overcome a significant challenge when medical recovery depends on reliable, low-cost, medical transportation. The CORE Institute was joined by Harley-Davidson of Scottsdale, the Arizona Diamondbacks and JC Printing in sponsoring the Ride N’ Raise event. DONATE TO VETERANS MEDICAL RIDES You can still donate to the V-Tap program, providing medical transportation to veterans at morefoundation.org/donate.
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