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
Medical Tourism: Canadians Travel to Arizona for Visits with Desert Docs New Physical Therapy Clinic in Surprise Serves Wide Range of Needs
Raise Your Hand Reverse Shoulder Replacement Restores Arm Function for Veteran
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WELCOME VOLUME 9, ISSUE 1 – SPRING 2018
FROM THE CHAIRMAN
‘Spring Into Motion’ Poets have spent centuries extolling the virtues of spring, and for good reason: everywhere you look, you see life in motion. Mountain snows recede and waves of wildflowers emerge. Northern trees suddenly blossom, while cactus flowers transform the desert with their brilliant shades of nature’s most exotic colors. Wildlife everywhere stirs and is on the move. Life is filled with a new sense of energy. All that helps inspire our spring issue of “CORE Ink.” Our cover features the inspirational story of John R. Williams, a Vietnam veteran who saw his mobility slipping away after losing the use of his right shoulder. He had trouble driving and couldn’t even lift a cup of coffee. Finally, John’s wife said, “talk to the shoulder surgeon who helped me, Dr. Arash Araghi at The CORE Institute.” Turn to page 8 to see how Dr. Araghi helped put john back in the driver’s seat. On page 18, you’ll read why a growing number of Canadians seeking affordable, state-of-the-art orthopedic care are coming south to The CORE Institute. Plus, a patient’s heartfelt gratitude to Dr. Clifford Jones for helping her recover from a horrific boating accident, and Dr. Ryan Scott explains how the latest in minimally invasive foot surgery could have you back on your feet fast. Top that off with the addition of two outstanding new surgeons and the opening of our brand new physical therapy center in the city of Surprise, Arizona and you can see there’s a lot of energy in this issue. But that’s our story here at The CORE Institute, where a constant and never-ending dedication to best-in-class care and continuous improvement makes every day feel like the first day of spring.
Keep Life in Motion!®
David J. Jacofsky, MD Chairman & CEO
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Raise Your Hand Reverse Shoulder Replacement Restores Arm Function for Veteran. See page 8.
Broken to Pieces Accident leads to complicated fracture with successful recovery. See page 12.
D E PART M E N T S Research
6 M eet Xena, The CORE Institute’s newest “staff member.”
18 F or Canadians Seeking Affordable, State-of-theArt Orthopedic Care, Desert Docs Have What It Takes.
What’s New? 7 T he CORE Institute is pleased to introduce new physicians to the team.
Ask the Expert
connect with us 1.866.974.2673
16 Put Your Best Foot Forward: New Treatment Approach Speeds Recovery
Specialty Spotlight 20 N ew Surprise Physical Therapy Clinic Serves Wide Range of Needs
Bits & Bites 22 S mall Steps in the Workplace Earn Big Wellness Benefits
XENA THE GERMINATOR Meet The CORE Institute’s newest staff member By Candace Hoffmann How do you improve an already world-class, destination orthopedics specialty center? You get Xena the Germinator to enhance infection prevention. At least, that’s what The CORE Institute Specialty Hospital in Phoenix, did. Despite already having one of the lowest surgical site infection rates in Arizona, The CORE Institute’s leadership reviewed the clinical evidence and peer reviewed data and
chose the Xenex LightStrike Germ-Zapping Robot for optimal disinfection. And of course, if you get a robot, you have to name it. “We had an internal naming contest,” said Keith Wigman, COO of the Specialty Hospital. Thus, Xena, the Germinator was born. Along with cleaning the hospital’s five operating and patient rooms, the Germinator will be back zapping germs between every orthopedic and joint replacement procedure.
The hospital keeps Xena busy as Lawless noted that the hospital, including its imaging center, sees 580 patients each month. Of those patient encounters, 400 are surgeries. So why this particular robot? The Xenex LightStrike uses pulsed xenon, an environmentallyfriendly noble gas, to create full-spectrum high-intensity ultraviolet (UV) light that can destroy infectious bacteria and viruses within five minutes. She is effective against even the most dangerous pathogens, including Clostridium difficile
(C.diff), norovirus, carbapenem-resistant Enterobacteriaceae (CRE), Methicillin-resistant Staphylococcus aureus (MRSA), influenza, and even the Ebola virus. While The CORE Institute Specialty Hospital isn’t dealing with such infections, having Xena on board certainly adds an extra layer of protection for both patients and staff. Xena does not roam the room like those little household robot vacuums. Instead she is placed strategically in rooms and programmed for the cleaning, whether a quickLEARN MORE at
WHAT’S NEW NEW PROVIDERS ARIZONA
The CORE Institute is pleased to announce additions to our provider team: BRIAN L. SEETO, MD Dr. Seeto is a fellowship-trained orthopedic surgeon specializing in arthroscopic and reconstructive surgery of the shoulder and elbow and orthopedic traumatology. He cares for patients at our Peoria and West Phoenix locations. J. TRACY WATSON, MD An internationally respected, fellowshiptrained, and board certified orthopedic surgeon, Dr. Watson specializes in orthopedic trauma, and adult fracture care, infections, osteomyelitis, amputations, nonunions, malunions, complex limb deformities, leg length inequality, complex periarticular fractures, and foot and ankle trauma. He cares for patients at the Orthopedic & Spine Institute in downtown Phoenix.
Along with cleaning the hospital’s five ORs and patient rooms, the Germinator will be back zapping germs between every orthopedic and joint replacement procedure. burst 2-3 minute cycle between surgeries, or 2-8-minute cycles at the end of the day. How does the environmental services staff feel about having Xena on their team? “They love it,” Lawless said.
Xena is enhancing their jobs and allowing them to concentrate on their regular daily disinfection and cleaning, which is already resulting in nearly perfect cleanliness scores. Matt Crowe, Regional Business director for Xenex, the company that makes the robot, noted that when patients choose The CORE Institute Specialty Hospital for their orthopedic surgery, they know they will get top-notch care. “By adding the robot, the hospital is investing in a technology to further enhance the safety of their patients and staff and ensuring the safest environment possible. This adds an extra layer of confidence,” he added.
Raise Your Hand
Reverse Shoulder Replacement Restores Arm Function for Veteran Story by Elise Riley | Photos by Rick Dâ€™Elia
FOR MORE INFORMATION If you would like to learn more about reverse shoulder replacement, visit thecoreinstitute.
ohn R. Williams wasn’t in a car accident. He didn’t suffer a catastrophic injury. But something was most definitely wrong with his right shoulder. “It had a nasty habit of catching and releasing,” Williams said. “I’d get a cup of coffee up to my mouth and I’d have a face full of coffee.” Williams had heard horror stories about recovering from shoulder surgery — and like most people, understood that a torn rotator cuff meant his options were limited. But his wife Jackie had a successful shoulder surgery with Dr. Arash Araghi of The CORE Institute, so Williams made an appointment.
LIVING WITHOUT PAIN Today, after a successful reverse shoulder replacement of his right shoulder in 2016, Williams has full use of his arm — and is readying himself for another procedure on his left shoulder later this year. “It has been so good that I don’t even think about it being a replacement,” Williams said. “I don’t have any pain. I don’t have any difficulty with motion. I think what Dr. Araghi replaced it with was better than what was in there in the beginning. I had lots of confidence in him, and even more now.” Williams, 76, experienced gradual reduction in the function of his right shoulder. A Vietnam Veteran who grew up working on a farm, he had always been
comfortable with physical activity, but he suffered no specific injury to his shoulder. It just stopped working. “It was a progressive thing,” Williams, 76, said. “But I lost the use of it. I lost my range of motion. At the end I could not reach over in my truck and pull the sun visor down on the passenger DR. ARASH ARAGHI side. I couldn’t pull my billfold out of my right hip pocket.” Dr. Araghi and his team ordered an MRI and confirmed that Williams had a torn rotator cuff and limited mobility of the shoulder joint. Years ago, that would be a difficult proposition. Torn rotator
cuff surgeries were difficult and painful, with some mixed results. Williams was an ideal candidate for a reverse shoulder replacement. THE PROCEDURE In a reverse shoulder replacement, the ball and socket joint is replaced in reverse. Dr. Araghi replaced the socket with a metal ball, and replaced the ball with a cup-like socket. “In the past we would not do a full shoulder replacement in a patient who has arthritis or a rotator cuff tear,” said Araghi, who also is Chief Medical Officer and Director, Division of Shoulder Surgery for The CORE Institute. “This is something we typically do in patients older than age 70. It’s typically a combination of pain on a constant basis, and pain that worsens when you try to use the arm. There’s limited mobility of the shoulder joint and an inability to perform actions where you
Wonderful, wonderful people started working on me. We increased the motions a tiny bit at a time. It was the only time I felt pain. I went as far as was tolerable. I knew the importance of the physical therapy.” — John R. Williams move your arm over your head. After the surgery, Williams stayed in the hospital overnight. The following morning, he was discharged with orders on exercises (and limitations) from home before he started 15 weeks of physical therapy.
POST SURGERY “Wonderful, wonderful people started working on me,” Williams said. “We increased the motions a tiny bit at a time. It was the only time I felt pain. I went as far as was tolerable. I knew the importance of the physical therapy.” Gradually in a few months, Williams had function back in his arm. Scratching an itch on his back was possible again. Drinking a cup of coffee was safe and predictable again. And when pain in his left shoulder started to keep him up at night, he returned to Dr. Araghi to explore his options. A surgery is slated for the spring. “When you’ve got good people working on you and you have confidence in them, it makes a difference,” Williams said. “I have no reservations about going in to get this next one done. As a matter of fact, I’m eager to get it done.”
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N E K BRO ES C E I P TO
ACCIDENT LEADS TO CO MPLICATED FRACTURE WITH SUCCES SFUL RECOVERY Story by TJ Gibson
n a hot, August day in 2016, my life unexpectedly turned a little sideways. My family and I had set out to paddleboard at Lake Pleasant. After a brief lap around part of the lake, I jumped in to cool off. I wasn’t expecting a large rock to be sitting about two feet under the surface. I heard a loud CRACK above the water; my breath caught, and pain raced up my body. Waves of nausea hit me. SPLIT LIKE FIREWOOD The crack, I would later learn, was the sound of my femur slamming down on the top of my tibia, and splitting it vertically like firewood in about four places. Then from mid-shin down, my bone splintered into small fractures. The bones of my foot also tore through the fatty padding on the ball, leaving it bone-on-skin. I had heard about The CORE Institute through a colleague who had a successful hip replacement. I knew they had a good reputation. Little did I know I had inadvertently picked the best of the best. The first physician I met with at The
CORE Institute was brutally, but wonderfully honest when he told me my break was incredibly complicated, so he was recommending a different surgeon, Dr. Clifford Jones. Now that’s honesty at its finest; I immediately respected him for clearly thinking in the best interest of the patient. RESPECT AND EMPATHY From X-rays to bloodwork, bone scans and even on-time schedules, I was treated with the utmost respect and empathy. Dr. Jones was no nonsense for which I was thankful. As I DR. CLIFFORD JONES drifted into a drug-induced stupor presurgery, I asked Dr. Jones if he was nervous. Dr. Jones smiled sardonically and said, “Yep, this is my first time.” As it turns out, he’s a renowned trauma surgeon. Just what I needed. I had been mentally trying to prepare myself for the recovery road ahead. I woke up with a plate, four screws,
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a repaired meniscus and bone grafts holding my leg together. Dr. Jones told me to immediately begin my own form of physical therapy while healing by slightly bending and straightening my leg as far as I could. “It will feel weird, like you’re pushing your knee too far back, but do it. I don’t want you walking with a limp if we can help it,” he directed. I was vigilant about it and it paid off. THE ROAD BACK I was in a wheel chair and a walker for four weeks then crutches for another two weeks and a cane for another two. When I went to a follow-up appointment with Dr. Jones, still shaking his head that I could have such a complicated, high-impact break just from a paddle boarding trip, he asked me how far I could bend my leg. I popped my foot up on the exam table, bringing my heel close to my hip. Dr. Jones smiled and nodded, “You don’t need physical therapy; you’re clearly working yourself hard enough.” I began to cry a little. My ordeal was over. Yes, I’d need to rebuild my muscles, and work on further flexibility. My foot pad will never be the same where the bone rests on skin, but this summer, on the one-year anniversary of the trauma, I went paddle boarding again. My scar is barely visible. Life is good thanks to Dr. Jones and The CORE Institute.
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Best Foot Forward FOR MORE INFORMATION To learn more about Dr. Scott, and our other foot and ankle providers, visit thecoreinstitute.com.
New Treatment Approach Speeds Recovery By Julie Maurer The idea of foot surgery may seem like a daunting one — with visions of weeks away from your normal activities. That is not the case anymore with new minimally invasive foot surgery done by Dr. Ryan Scott, with The CORE Institute Through a new tool called the Wright Medical MICA System, Dr. Scott is able to conduct surgeries with small incisions that used to require him to do larger, more open surgeries. And smaller incisions can often mean faster recovery times for patients. “With these patients we have them almost full weight bearing immediately in a protective boot,” Dr. Scott said. The surgery also means less operating room time and less anesthesia. Dr. Scott uses this new method with several types of foot surgeries, including bunion correction, hammertoe repair, metatarsalgia, removing lumps or bumps. SPECIAL TRAINING Dr. Scott received special training to use the Wright Medical MICA System, and is one of only about 20 surgeons in the United States who have been certified to use it. While he was one of the first in the nation qualified in the procedure, other CORE doctors are now
soft tissue to make it inflamed training as well. and irritated.” “I’ve been utilizing this The Wright Medical Mica approach since Summer of Screw is currently 2017, and the only for foot system launched operations, but nationwide in Dr. Scott also May 2018,” Dr. conducts ankle Scott said. surgeries with The instrument a less invasive is a much smaller method. drill that can DR. RYAN SCOTT “Arthroscopy cut bone, but it is a similar tool, doesn’t typically requiring a smaller approach require many sutures to to ankle surgery. It reduces close. According to Dr. the sutures to roughly three Scott, an open surgery can stitches rather than 15 to 20,” require 16-20 sutures, while minimally invasive only takes one or two. A lot of skill is required for this technique because when the foot is not open there is less visibility. “You have to do it by feel, and everything is done by x-ray, so you can see where you’re at internally,” Dr. Scott said. MINIMALLY INVASIVE He believes the minimally invasive surgery is the better approach, and may encourage patients who have avoided seeking help for foot issues for fear of complications with open surgeries. “The biggest complication with surgery is chronic swelling and scarring, but with minimally invasive, you are not moving all that soft tissue out of the way,” Dr. Scott said. “There is less disruption of the surrounding
Dr. Scott said. He uses this method on many of his sports medicine patients, along with ligament reconstructions for ankle stability. Whether the foot or the ankle, Dr. Scott and his colleagues at The CORE Institute aim to give their patients the best outcomes with less pain and shorter recovery times. “I’ve had patients with little to no pain. They haven’t taken anything for pain after their surgery,” Dr. Scott said.
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T R EN DS FOR CANADIANS SEEKING AFFORDABLE, STATE-OF-THE-ART ORTHOPEDIC CARE, DESERT DOCS HAVE WHAT IT TAKES
Y H T L HE A L E V A TR By Leigh Farr Every year, Arizona welcomes thousands of Canadians who travel to the desert seeking superior medical care at affordable prices. As insurance premiums continue to rise along with higher deductibles and out of pocket costs, it is no surprise that patients are turning to programs that offer alternative payment solutions for surgical procedures with best-in-class quality orthopedic care. To accommodate patients with spine and joint conditions requiring surgery, The CORE Institute offers comprehensive medical packages featuring superior orthopedic care and an outstanding overall experience. “Our goal is to get people back to enjoying their life. In their native Canada, they are waiting anywhere from two to three years to get care so we want to be able to provide the highest quality, expedited treatment,” says Allison Horn, Senior Vice President, Marketing, Branding and Sales at The CORE Institute, a nationally recognized center providing adult orthopedic reconstruction, sports medicine and surgical spine procedures. Horn says the weather is a major asset for Canadians seeking treatment in sunny Arizona. “With surgical care often delayed in their country, people with chronic conditions like arthritis travel to various locations throughout the U.S. and even abroad. We believe that our climate is optimal for somebody to recuperate in and to be able to enjoy the weather while they recover.” QUALITY, AFFORDABLE CARE Visitors seeking orthopedic procedures such as total knee, hip and shoulder replacements, spine procedures and regenerative medicine, can rest assured they are receiving the highest level of orthopedic care from physicians who are nationally recognized educators, researchers and leaders in orthopedics when they come to The CORE Institute. Packages include a fixed price for all services including surgeon fees, facility and hospital fees, anesthesia fees, and medical supplies used during the procedure and hospital stay.
“We’ve been ranked the number one orthopedic group for six years and running in Arizona. Patients who seek care from our orthopedic experts, expect best-in-class outcomes,” says Horn. “Through our technologies and platforms, our providers use standardized, evidence-based pathways and protocols so the care is consistent no matter what location they are receiving treatment.” SUPERIOR PATIENT EXPERIENCE With patient care the top priority at The CORE Institute, a specially trained Patient Accelerator is available to assist patients every step of the way. ALLISON HORN The Patient Accelerator is there to schedule medical appointments, answer medical questions and offer recommendations for luxury accommodations and entertainment for the family. Patients also have access to a convenient online portal and translator services, if desired. “People travel long distances for the quality and outcomes they receive with our physicians and for the seamless integration of their care,” says Horn. “Our goal is to help them keep life in motion so they can do the things they love and get back to their quality of life.”
To learn more about The CORE Institute’s medical tourism program and pricing, visit thecoreinstitute.com/medical-tourism www.thecoreinstitute.com
The evidence is inâ€Ś Enhanced Outcomes from Enhanced Stability For more information visit www.HipFx.com Supporting healthcare professionals
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The CORE Institute’s New Surprise Physical Therapy Clinic Serves Population with Wide-Ranging Needs By Brian Sodoma For years, residents of Surprise, Ariz., on the Valley’s west side, have traveled five miles to The CORE Institute’s Sun City West facilities for physical therapy services. But now Surprise has a world-class site of its own. Opened in mid-January, The CORE Institute’s Surprise Physical Therapy location has brought the orthopedic specialty group’s extensive clinical expertise to one of Arizona’s fastest-growing cities. “It’s exciting to open a clinic in such an up and coming town. There’s a big need in the city of Surprise, and this allows us to better serve this population,” said Dan Neal, Senior Vice President of Physical Therapy and Physical Therapist at The CORE Institute.
WHAT THE NEW CENTER OFFERS The 4,000 square-foot center brings The CORE Institute’s evidence-based approaches, using the latest research, to develop treatment plans for a full spectrum of orthopedic and sports medicine care for all ages. Whether you need post-operative physical therapy, orthopedic rehabilitation for sports injuries, joint replacements or injury prevention and work conditioning, the clinic can accommodate a wide range of needs.
The layout of the new dedicated clinic is an open format with an integrated plyometric area at its center to allow patients to perform rehabilitation exercises requiring running, jumping, sharp cutting. There’s also specialized training equipment for higherlevel rehabilitation. DAN NEAL, “This allows us to PT, MSPT, MBA serve anyone from youth athletes on up to that 75-year-old who just had a knee replaced,” Neal added. COORDINATED TREATMENT As the use of the clinic grows, it will have the capacity to serve 500 to 600 patient visits per week, Neal said. The new site, located at 13995 W. Statler Blvd, is The CORE Institute’s seventh physical therapy clinic in Arizona. The clinic also improves the coordination of physical therapy services throughout the West Valley, Neal explained. “Not only do our physical therapists work closely with our orthopedic care team, we support outside physical therapy clinics to serve as a resource for evidence-based pathways and protocols that provide optimal outcomes and allow patients to keep life in motion.” Neal said.
LEARN MORE To learn more about The CORE Institute’s dedicated physical therapy center in Surprise, call 623-537-5661 or visit thecoreinstitute.com.
BITS & BITES
Motivating Healthy Actions Small Steps in the Workplace Earn Big Wellness Benefits
By Joan Westlake The warnings are clear. Sitting for long periods of time is harmful to our bodies and overall health. To combat this, businesses are hiring staff, instituting programs and offering incentives to help employees get up from their desks and move toward healthy goals. PROPER POSTURE Megan Raebel, a facilities specialist trained in ergonomics with The CORE Institute, said the first step is proper posture. Sit up straight and back in your chair, not on the edge of the seat, hunched over. Adjust your monitor stand so you are looking at the top third of the screen. If you are having specific issues such as back pain or wrist discomfort, ask for a specialist to access your work space. “Studies show that workers who add two hours standing each day avoid many of the health risks of sedentary lifestyles,” she said. “Start out slowly, adding a few changes each month to increase getting up and in motion. As exercise times increases, so do energy levels and the ability to focus.”
WAYS TO ADD STANDING AND MOVING >> Hold standing team meetings >> Walk for one-on-one meetings >> Stand to read emails >> Move for 10 minutes every hour >> Do stretching exercises at your desk >> Schedule a brief walk during your breaks or at lunch >> Eat your lunch somewhere that’s not at your desk >> Plan time to be outside and enjoy fresh air >> Park a distance away from your office Wearing proper footwear is important. Raebel suggests keeping a pair at your desk to slip into rather than wearing high heels on outdoor strolls. There are supportive, foot friendly and business-appropriate shoes available.
EMPLOYEES IN MOTION GOOD FOR BUSINESS “There are proven benefits for businesses to encourage employees to stand and move,” Raebel pointed out. “Research indicates employees who reduce their sitting time with exercise are more creative, more focused and more productive. Incentive programs work very well and don’t need to be elaborate. Don’t under estimate the motivating impact of earning lunch with the CEO or enjoying the competitive fun of departments verses departments.” Fitness committees, health fairs, competitions and wellness professionals are effective tools to help motivate employees to take healthy steps. Use internal communications, supervisor reinforcement and messages from top management to promote those small behavioral changes that can net big health benefits.
Robots are helping replace your knee
Robotic-assisted technology improves knee replacement surgery
10 YEARS AGO
Patient was required to stay in hospital 1-2 NIGHTS
Patient goes home the SAME-DAY
10 YEARS AGO
Patient was required to stay in hospital 3-4 NIGHTS
Patient may stay 1 NIGHT
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patients encouraged to walk the same day of procedure
Sources: Gerontol A Biol Sci Med Sci. 1995 Nov;50 Spec No:5-8, American College of Sports Medicine, Exercise and the Older Adult, US Department of Health and Human Services, Osteoporosis Research, Education and Health Promotion, Annals of internal medicine (Impact Factor: 16.1). 04/1996; 124(6):568-72, J Am Geriatr Soc. 1995 Jul;43(7):756-60, J Am Geriatr Soc. 2004 May;52(5):657-65, Health Day March 11, 2014, Journal of Strength & Conditioning Research: October 2012, Volume 26, Issue 10, p 2806-2811, Archives of Internal Medicine August 6, 2012, Nutrition & Metabolism May 17, 2012
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