CORE Ink Magazine - April 2019

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

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SPRING 2019

The CORE Institute’s experts take on injuries unique to baseball players Spinal cord stimulators offer hope for those who suffer chronic back pain The CORE Institute expands robotic surgery program in Arizona and Michigan

On top of the world!

Valley man is back on his feet, loving life

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

NOW

Patient goes home the SAME-DAY

10 YEARS AGO

Patient was required to stay in hospital 3-4 NIGHTS

NOW

Patient may stay 1 NIGHT

BROUGHT TO YOU BY

FIND AN ORTHOPEDIC DOCTOR NEAR YOU

602.346.9827 OR VISIT BANNERCORECENTER.COM CALL

10 YEARS AGO

SEVERAL MONTHS

NOW

6-8 WEEKS,

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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WELCOME VOLUME 10, ISSUE 1 – SPRING 2019

FROM THE CHAIRMAN

Time for Spring Renewal. Rebirth, Reinvigoration. Those are just some of the words used to describe the joyous season of Spring, which has now arrived. In this edition of CORE Ink, I think you’ll find those words also apply to the work being done at The CORE Institute.

Take our cover story, for example. You’ll see how former U.S. Marine Corey Mardick, who served our country with honor and distinction, turned to The CORE Institute to overcome an ankle injury that was limiting his ability to live a full, active life at home with his family and on the job. After lateral ligament reconstruction surgery, he’s back at work and finally able to keep up with his young children.

Spring also means the return of baseball. From the sandlot to the Major Leagues, America’s pastime can put a lot of pressure on the players, and injuries often result. On page 12, you’ll get advice from two of The CORE Institute’s most experienced sports medicine specialists, Dr. John Kearney and Dr. William Kesto, on

how to avoid injuries, and what to do if problems arise.

This issue offers important information on wound care, featuring the expert insights of Dr. Victor Nwosu and Dr. Tharesh Udupa. And you’ll learn how research at The CORE Institute is helping to combat the enormous damage being done by the opioid abuse epidemic.

Plus, the inside story on our new clinics in Mesa and West Phoenix, along with a look at the new, high-tech scheduling system we have developed.

It’s an exciting issue for an exciting time of the year, a time that reminds us that our possibilities are endless if we drive to be our best. And that’s precisely what we do at The CORE Institute, where our commitment to excellence is equaled only by our devotion to our treasured patients. Happy Spring and Keep Life in Motion!

Keep Life in Motion!®

David J. Jacofsky, MD Chairman & CEO

CREATED BY REPUBLIC MEDIA CUSTOM PUBLISHING FOR THE CORE INSTITUTE Editor: Jim Williams, JLWilliams@republicmedia.com Design: Rachel Tullio

Contents

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COVER STORY

On Top of the World!

Valley man is back on his feet, loving life. See page 8.

PATIENT CARE

8 20

Sports Medicine CORE experts share how to prevent, treat and overcome injuries unique to baseball players See page 12.

D E PART M E N T S What’s New? 6 The CORE Institute pleased to introduce its new providers

Specialty Spotlight 7 The CORE Institute opens 2 more orthopedic clinics in Greater Phoenix

connect with us 1.866.974.2673

Trends 14 The CORE Institute expands robotic surgery program in Arizona and Michigan

Research 16 Spinal cord stimulators offer hope for those who suffer chronic back

Ask the Expert 18 Wound care: Amniotic tissue, silver dressings speed up healing

Nutrition 20 Spring has sprung‌yum!

www.thecoreinstitute.com

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WHAT’S NEW

NEW PROVIDERS The CORE Institute is pleased to announce a new member to our Michigan provider team

EPHRAIM ZINBERG, DO

Ephraim M. Zinberg, MD is a board certified and fellowship-trained specialist in hand and upper extremity surgery.

Prior to joining The CORE Institute, Dr. Zinberg served as Division Chief of Hand Surgery at Detroit Medical Center and Clinical Professor of Orthopaedic Surgery at Wayne State University – School of Medicine. Dr. Zinberg is dual fellowship – trained, receiving his fellowship training in hand surgery at University of Louisville and his microvascular surgery fellowship

training from the world-renowned Mayo Clinic. Dr. Zinberg completed his residency at Maimonides Medical Center and his medical degree from State University of New York – Downstate Medical School.

Dr. Zinberg is well known in the orthopedic medical and educational community, providing numerous didactic lectures on topics related to his specialty.

He has participated in several case studies, research projects, and educational seminars that allow him to stay in the forefront of innovative patient care.

Scheduling an appointment

JUST GOT EASIER! Your patients can now schedule appointments online at thecoreinstitute.com.

Look for the ‘Schedule Online Now’ button and follow the prompts to schedule today!

Schedule Online Now

SPECIALTY SPOTLIGHT

Enhanced Convenience The CORE Institute opens 2 more orthopedic clinics in Greater Phoenix

By Debra Gelbart Now, in the heart of Mesa and in the West Valley in Greater Phoenix, patients who have orthopedic needs will find easy, convenient access to The CORE Institute services.

In December 2018, The CORE Institute Mesa Clinic opened a new orthopedic clinic on the campus of Banner Desert Medical Center, where all kinds of bone and joint needs can be addressed. These include hand and shoulder injuries, foot and ankle conditions, knee injuries, total joint replacement evaluation, spine and neurological management and evaluation, pain management, podiatry, casting of broken bones, and trauma evaluation. Two radiology suites Jennifer Bravo are also located there. If surgery is recommended, patients can be easily transferred and admitted to an adjacent outpatient surgery facility.

“This is a larger, more comfortable clinic that’s easier to find than our previous clinic,” says Jennifer Bravo, Associate Vice President of Integration and Facilities for The CORE Institute.

WEST VALLEY GETS NEW CORE INSTITUTE LOCATION The CORE Institute’s West Valley Clinic, a 15,000-square-foot facility, opened in January 2019 just across the street from Banner Estrella Medical Center. It also includes a full-service orthopedic clinic, three radiology suites, and a separate 4,100-square-foot physical therapy gym.

Both locations are conveniently located steps from an ambulatory surgery center and a hospital. Orthopedic specialists evaluate patients at both locations. So, whether

a patient needs a neurologist, a foot and ankle expert, or a surgeon who primarily operates on knees, the appropriate physician will be available to evaluate the situation.

A PERFECT PARTNERSHIP Both of these newly relocated clinics are situated on or near Banner hospitals in which a co- management program, Banner CORE Center for Orthopedics, is located.

“Our patients can expect enhanced quality of care, streamlined protocols and better outcomes through this collaboration,” Bravo said.

The two new clinics are the 18th and 19th CORE Institute facilities, respectively, in Greater Phoenix, Bravo said.

Appointments are recommended and online scheduling is available through The CORE Institute website, www.thecoreinstitute.com. Same-day appointments often can be accommodated, Bravo said.

REACH THE NEW CLINICS The CORE Institute West Phoenix Clinic 9321 W. Thomas Rd., Suite 205 Phoenix, Arizona 85037 Phone: 866-974-2673

The CORE Institute Mesa Clinic 1500 S. Dobson Rd., Suite 202 Mesa, Arizona 85202 Phone: 866-974-2673

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8

www.thecoreinstitute.com

COVER STORY

One Step Time

Moving Forward ...

at a

Valley man overcomes an ankle injury and reclaims his life

By Meghann Finn Sepulveda Photos by Jay Worsley

T

continued to bother him and affected wo years ago, Corey Mardick his ability to work and care for his two was playing basketball young children. He sought further with his colleagues when treatment and was referred to Ryan T. another player jumped and Scott, DPM, who is part of a large team accidentally landed on his leg. The of fellowship-trained foot and 25-year-old former ankle surgeons at The CORE Marine, who at the time Institute. was stationed in North Carolina, immediately A CLEAR DIAGNOSIS knew something was When Corey first met with wrong. His ankle began Dr. Scott in August 2018, his to swell, and the pain mind was immediately put was unbearable. After he at ease. was treated for a sprain, Ryan T. Scott, DPM “He was very thorough Corey continued to have and knew right away difficulty bearing weight that something was wrong after he on his ankle and maintaining stability. performed a physical evaluation and Last year, Corey retired from the Marine reviewed my X-ray images,� said Corey.

Corps and moved to Phoenix. His ankle

9

Corey Mardick, with son Liam, 4 (left), wife Chanice and son Elijah, 2.

Below left, Corey with Liam in a Humvee at Camp Lejeune, North Carolina. Right, on the beach at Camp Pendleton, California.

“The ankle sprain had damaged the ligaments and needed to be reconstructed.”

According to Dr. Scott, only about 20 percent of patients with an ankle sprain require surgery.

“The ligaments often heal on their own,” Dr. Scott said. “But sometimes, other factors like chip fractures in the cartilage and damage such as a tendon injury, can require surgery.”

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TREATMENT PLAN Since Corey could bear weight on his ankle, Dr. Scott first recommended conservative, non-operative treatment.

As a chef at a local Valley restaurant, Corey continued to work but after the end of each shift, he would need to take a pain reliever and ice his ankle at home.

“We put Corey in a walking boot for three weeks and then transitioned him into a sport brace,” Dr. Scott explained.

“Four months after the injury, he continued to have pain in his ankle. An

MRI was performed to determine if his ankle was healing appropriately or if surgery was the next step in treatment.

There was not much improvement and because of the severity of the injury, I recommended surgery.”

On Dec. 10, 2018, Corey had lateral ligament reconstruction surgery at The CORE Institute. The minimally invasive outpatient procedure lasted approximately 45 minutes.

“First, I used an ankle scope to clean out the fractured piece of cartilage and loose debris within the ankle joint,” Dr. Scott said.

“Next, a small incision was made to rebuild the torn ligament with newer

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COVER STORY

technology that can help augment ligament repair.�

ROAD TO RECOVERY After surgery, Corey used crutches for three weeks and then transitioned to a walking boot, followed by a sport brace.

He also completed physical therapy to regain strength in his ankle.

In early February, Corey returned to work. “My ankle healed so well, I no longer have to worry about it,� he said. “I am confident and free to do whatever I want like running, jumping and holding my kids.�

AT-HOME TREATMENT FOR A MILD ANKLE SPRAIN Accidents happen. If you ever roll your ankle, one of the best home treatments, according to the American Academy of Orthopaedic Surgeons, is the RICE method: >> Rest your ankle by not walking on it. >> Ice should be immediately applied to keep the swelling down. It can be used for 20 to 30 minutes, three or four times daily. Do not apply ice directly to your skin. >> Compression dressings, bandages or acewraps will immobilize and support your injured ankle. >> Elevate your ankle above the level of your heart as often as possible during the first 48 hours.

However, if you have severe pain or notice swelling or bruising, it’s important to see a health care provider immediately for further evaluation and treatment.

Learn more about lateral ligament reconstruction at thecoreinstitute.com.

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Let’s Play Ball CORE experts share how to prevent, treat and overcome injuries unique to baseball players

By Brian Sodoma

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T

he sounds and smells of our age-old national pastime fill the air as the ‘boys of summer’ take the field.

But outside major league ballparks, weekend warriors, Little Leaguers and other competitors are also working hard to fine tune their game. In baseball, arm injuries are increasingly common, and certain leg injuries can plague players, too.

Here, two medical experts at The CORE Institute talk about how to prevent

and treat some of the most common baseball injuries.

ARM INJURIES TO WATCH FOR The shoulders and elbows are the two most vulnerable areas of the arm for baseball players, thanks to the game involving repetitive throwing or swinging motions.

In warm-weather states like Arizona, the mild climate can also be a problem, as the weather allows for more opportunities to play throughout the year and less

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ent sports to work a variety of muscle arm rest, explains John Kearney, MD, a groups. sports medicine specialist at The CORE >> Rest proactively and plan breaks Institute, in Arizona. throughout the year.

Without rest, stabilizing muscles in the >> When you come back from a break, back weaken, creating poor throwing take three weeks to one month to tranmechanics, putting stress on the labrum, sition into full-speed throwing. Many rotator cuff and elbows, Dr. Kearney said: injuries occur right after a rest period, Dr. “Once you have those poor mechanics Kearney noted. then you start getting the serious injuries.”

Here are the three most common arm ARM INJURY injuries for baseball player: TREATMENT >> Rotator cuff stress: World-class care starts The vital rotator cuff tenwith a proper diagnosis. It’s dons help the top of the important to work with a humerus (the long arm highly-experienced orthobone) rest securely inside pedic professional trained the shoulder socket. With in these injuries. “There are repeated throwing, these some pains that are absotendons become strained William Kesto, MD lutely fine to work through and can eventually tear. and play through, others Symptoms: Players often that aren’t; a specialist complain of a dull, persisknows that,” Dr. Kearney tent ache. added. >> Labrum tears: If injured, a period of Cartilage known as the rest is most often the first labrum wraps around prescription, followed by the shoulder socket, physical therapy and work improving stability and with a throwing specialist. allowing for a wide range John Kearney, MD If an MRI reveals a signifiof motion. With repetitive cant tear, surgery may be required, which throwing, the labrum can eventually tear. would be followed by rest and physical Symptoms: Players will feel a deep, achy therapy as well. pain within the shoulder. >> Ulnar Collateral Ligament injury: LEG INJURIES TO WATCH FOR This ligament is a tissue band that Less common than arm injuries are ankle holds the bones of the elbow together. sprains or fractures and Anterior Cruciate Unfortunately, with repetitive overhead Ligament (ACL) and Medial Collateral throwing motions, it can eventually tear, Ligament (MCL) strains and tears in the too. The reconstructive Tommy John knee, explains William Kesto, MD, a surgery may be required, which could be sports specialist with The CORE Institute career altering. Symptoms: Players feel a pop after they throw, along with arm pain. in Michigan. “These injuries are less frequent (than arm injuries), but anything can happen when you’re fielding or runPREVENTING ARM INJURIES ning the bases,” he said.

Dr. Kearney offers the following prevenHere’s what happens when these injution tips: ries occur: >> Don’t throw more than six to eight >> Ankle sprains: Here, the ankle months out of the year. Play differ-

To learn more about prevention and treatment of sports injuries and the world-class care you’ll find at the CORE Institute, visit thecoreinstitute.com.

joint’s ligaments stretch and tear, often as a result of an awkward twist or rolling motion. It could happen while sliding into a base or running. >> Knee injuries: The ACL and MCL are stabilizing ligaments that allow a person to pivot and rotate. Injuries usually occur when an athlete sharply twists or switches directions. Many players hear a popping noise and experience pain that does not subside after 24 to 48 hours.

PREVENTING LEG INJURIES Dr. Kesto offers the following prevention tips: >> For ankles, train your lower leg muscles, including the calf and the muscles around the foot that control ankle stability such as the tibialis posterior and tibialis anterior. This can be done with ankle raises, calf extensions and using balance boards. >> For knees, make sure hamstrings are properly stretched and train both the quadriceps and hamstrings equally in the upper leg to prevent overuse injuries, such as muscle strains.

TREATING LEG INJURIES Ankle sprains can frequently be resolved with two to six weeks of rest, depending on their severity. Easing your way back into play is always advised, too. If there are repetitive ankle sprains, some athletes may require surgery.

ACL and MCL tears are rated on a one to three scale, the higher the number the worse the tear is. “A small sprain can be treated nonoperatively with rest and rehabilitation, but severe sprains can lead to an unstable knee and may require surgical treatment,” Dr. Kesto added.

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TRENDS

The CORE Institute expands robotic surgery program in Arizona and Michigan

By Leigh Farr

Precision Technology C

December. The minimally invasive technology is now available onsistent with its innovative approach to at both locations for partial knee, total knee and musculoskeletal medicine, total hip replacements.

The CORE Institute now offers “The CORE Institute prides itself for being on the Mako™ robotic-arm assisted cutting edge of technology and utilizing the latest joint replacement surgery in both its techniques for our joint replacement surgeries,” Arizona and Michigan locations. The CORE says Steven Myerthall, MD, an orthopedic surgeon Institute Specialty Hospital was the first at The CORE Institute. “We’re known for being on facility in the Southwest to provide total the forefront of technological changes in orthopedic knee replacement using Mako roboticsurgery and it is exciting to be able to provide that arm assisted surgery, and a Mako system technology to our patients.” was added to the Michigan location last Steven Myerthall, MD

14

www.thecoreinstitute.com

are able to be more precise,” Dr. Myerthall says.

PERSONALIZED SURGERY During Mako robotic-arm assisted surgery, the surgeon Mako robotic-arm assisted surgery enables orthopedic guides the robotic arm to resurface the joint and secure an specialists to provide their patients with a state-of-the-art implant so the hip or knee can move smoothly again. The surgical experience tailored to their particular diagnosis surgeon is in control of the robotic arm at all times and can and unique anatomy. The system’s precision allows the make adjustments to the plan as needed. surgeon to resurface bone damaged by osteoarthritis “By using CT guidance and computer-aided navigation while preserving surrounding healthy tissue. Compared we are able to specifically guide how we’re putting in the to traditional surgery, Mako technology also allows more implants,” Dr. Markel says. “Our ability to be accurate placement and alignment of a precise ensures greater soft tissue protection patient’s implant. than traditional surgery.”

“One of the advantages of the Mako system is the ability to plan out the surgery in a ALL GAIN, NO PAIN three-dimensional environment,” says David Mako robotic-arm assisted surgery offers Markel, MD, Michigan Market President and numerous advantages over traditional an orthopedic surgeon at The CORE Institute surgery. Patients typically are up and walking in Michigan. “Having a precise surgical plan around within hours of their surgery. Most allows you to put implants in exactly how you David Markel, MD patients recovering from robotic-assisted want them.” joint replacement surgery are able to return Prior to the procedure, a patient undergoes home after one day in the hospital and with the benefit of a CT scan of their hip or knee. The scan is uploaded to the physical therapy they are able to resume their daily activities Mako system, providing a 3D digital map of the surgical without pain. site. The medical team uses the digital model to create a “With the Mako system, our patients enjoy a quicker blueprint for surgery. return to activities, decreased levels of post-operative “Because we use 3D imaging as opposed to 2D X-rays pain and decreased requirements of post-operative pain and because we can fine tune the pre- operative plan at the medication,” Dr. Myerthall says. time of surgery based on how we identify the anatomy, we

THE ROBOTIC ADVANTAGE To find out how you can get back to your active lifestyle and live pain-free, visit www.thecoreinstitute.com.

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RESEARCH

Shutting off the Spinal cord stimulators offer hope for those who suffer chronic back

I

By Elise Riley t’s described as sharp, dull, pulsing, even paralyzing. It affects men and women equally. The World Health Organization puts its price tag in the United States well over $200 billion annually for cost of care and lost wages. Chronic back pain touches every segment of the population.

According to the National Institute of Neurological Disorders and Stroke, an estimated 80 percent of adults experience back pain at some point in their life. Previously, those who suffer

16

from chronic back pain had few options for relieving the debilitating symptoms: surgery and/or prescription painkillers to numb the pain.

But thanks to advances in technology, two clinical trials with The CORE Institute have a promising outlook for patients who want to relieve their chronic back pain while also reducing Eric Feldman, MD their need for opioids.

MONITORING THE PAIN Spinal cord stimulators are small devices — like pacemakers for your spine — that can modulate pain signals. The newer versions of devices

that use this technology send highfrequency energy that can “shut off” the sensation of pain, as well as the tingling/numbing sensation that previously accompanied these devices.

“It’s been pretty monumental,” says Eric Feldman, MD, a physiatrist with The CORE Institute.

“The majority of these patients have sciatica, peripheral neuropathy, chronic back pain. Most of these patients have failed with traditional treatments.”

Implanting the device requires a small surgery — not an extensive spinal surgery — to place the lead in the epidural spine. It’s later attached to a bat-

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Pain tery. If successful, patients can generally feel relief quickly, if not immediately.

Dr. Feldman estimates that it takes two to three weeks to recover from the procedure.

“Stimulators are a major tool in my armament,” Dr. Feldman said.

“Some studies have shown that they work well, especially for patients who failed Marc Jacofsky, PhD with back surgery. It’s something that can be life altering.”

“Not every patient will be a candidate for the potential benefits of spinal cord stimulators. Please discuss with your doctor or one of the expert physicians at The CORE Institute who

can thoroughly discuss if a spinal cord stimulator may be an option for for you.

NEW HOPE Spinal stimulators can be promising for patients who have had unsuccessful back surgeries and live life in chronic pain. For these people, loss of mobility accompanies the pain, which starts a cascading effect of health problems. While opioids can help to numb some of the pain, they cannot restore function or their wellbeing. Patients over time find opioids less effective, and dependency remains a concern.

“There’s a big issue in the country with opioids and opioid addiction and

there are certainly legitimate uses of opioids in the treatment of orthopedic patients,” says Marc Jacofsky, PhD, Chief Scientific Officer of The CORE Institute and Executive Director, Research & Education for the MORE Foundation.

“But for chronic pain patients who have to be prescribed opioids over a long period of time, obviously that can be detrimental to their health on a variety of levels.”

The CORE Institute currently has two spinal cord stimulator studies. To find out if you might be a good candidate, visit the MORE Foundation’s website, www. more-foundation.org, and click on Research under the Programs tab.

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ASK THE EXPERT

Tending to Health WOUND CARE:

Amniotic tissue, silver dressings speed up healing

By Julie Maurer For patients who have chronic or traumatic wounds that need extra attention, the latest treatments in wound care help speed up healing and reduce infections.

“In the past five years, it’s been remarkable,” says The CORE Institute wound-care specialist Victor Nwosu, DPM. He noted there has been a lot of focus in recent years on stem cell treatment and the use of bone marrow tissue and amniotic tissue for severe wounds.

“We are basically trying to provide

18

a way to build or create new tissue for patients who have difficulty with their wounds healing,” Dr. Nwosu said.

“We’re seeing healing in four weeks, sometimes faster than that, and these are chronic wounds that they have had for three months to a year or even longer.”

Udupa, DPM, who said that in the last 10 years they have started to use dressings that contain silver in them.

“Silver has antimicrobial properties, so it’s like putting an antibiotic right on the wound,” he said.

According to Dr. Udupa, they have to change the mindset in patients that open air and scabbing are good for wounds.

HEALING TOUCH Amniotic tissue comes DEBUNKING MYTHS from donated placentas Victor Nwosu, DPM “A lot has changed in our that have been thinking about wound healing in the processed. The nutrients in the tissue last 10 years. Covering wounds instead help speed up the healing process. of leaving them open to the air can help And even the materials they use shield the environment and promote to wrap a wound are different these faster healing,” Dr. Udupa said. days, according to The CORE He noted that the dressings absorb Institute wound specialist Tharesh

www.thecoreinstitute.com

some moisture from the wounds but leave enough so that the wound can heal.

“Too moist and it will stall too, but because it’s being covered it never completely dries so it heals from the inside out,” Dr. Udupa said.

Physicians have also reconsidered Tharesh Udupa, DPM the mindset of changing wound dressings multiple times a day.

“A lot of these dressings can be changed three to four times a week. If there is not a lot of drainage you don’t

need to be changing that dressing,” Dr. Udupa said. “Keeping it covered creates a homeostatic environment which promotes healing.”

MANY FACTORS TO HEALING The CORE Institute Wound Care Centers treat many types of patients, including patients with diabetes, older patients and those with traumatic wounds or venous ulcers.

Dr. Nwosu noted there are many factors that bring patients to a wound care clinic. If a patient has a wound that is deep and has a lot of bleeding,

they should first go to the emergency room. But for chronic, non-healing wounds, The CORE Institute specialists see patients who are referred to them by their primary care physicians or those who contact them directly.

“If you have had the wound for more than a month and there hasn’t been at least 50 percent decrease in size of the wound, then you should see someone,” Dr. Nwosu said.

“If it starts to develop an odor, if it’s painful, if it starts to saturate your clothes or sheets, if you start to develop a fever, redness around the wound, you should see someone right away to get it under control.”

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NUTRITION

Spring has Sprung

…Yum!

Putting a healthy spin on your springtime festivities

By Michelle Jacoby Leftover chocolate bunnies, cream-filled eggs, marshmallow treats, jelly beans galore — this time of year can feel like a carb and sugar free-for-all. Add to that, big breakfasts, weekend brunches and family gatherings, and you may as well kiss your healthy eating goals goodbye.

What if you find yourself staring down a monster buffet table? What should you get? When is it OK to indulge?

What should you avoid at all costs?

Questions, questions, questions!

As we enjoy the beautiful springtime temperatures, we tend to give ourselves a ‘pass’ when it comes to eating, there are ways to make nutritious choices. Here are a few tips to help keep your spring a healthy success.

IS IT BRUNCH OR IS IT BREAKFAST? According to experts at the Academy of Nutrition and Dietetics, one of the most surprising mistakes people make when it comes to brunch is not eating beforehand.

Essentially, you need calories to burn calories, meaning you need

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to eat food to get your metabolism going. If you wait until late morning or early afternoon to eat something, your metabolism won’t operate at maximum capacity. Plus, going to brunch hungry can lead to overeating.

Also, people may think that because they’re combining two meals — breakfast and lunch — they can eat more. If you’re not careful on choices and portion-size, brunch can quickly exceed calories consumed in two separate meals.

Before heading out to brunch, try to have a healthful snack in the morning. Things that combine fiber and protein make for good choices, like low-fat cheese with an apple, or yogurt with berries and almonds.

CHOOSE SAVORY OVER SWEET Pancakes or eggs? French toast or bacon? Waffles or sausage? These are the central questions of any brunch.

And while the natural inclination may be to treat yourself to a fluffy stack of pancakes or waffles with whipped cream, the choice should inevitably be savory.

Dieticians agree that because carb-heavy foods like pancakes and waffles are digested so quickly, they can make your blood sugar spike and drop like a rollercoaster.

You may feel fine for a while, but you’ll inevitably start to feel tired and sluggish a couple of hours later.

While perusing your brunch options, choose things that have a healthy balance of protein, complex carbs (preferably from whole grains), and some healthy fat like avocados.

BEWARE THE DRINK MENU Finally, while brunch and adult beverages go hand in hand, it’s easy to go overboard on the calories without even realizing it. In fact, having multiple drinks, especially those high in calories, such as Bloody Marys and sweetened coffee drinks, can end up being a high calorie-meal on its own.

You could opt for a refreshing water or unsweetened iced tea, but if you must have an alcoholic beverage with brunch, consider lighter options such as a mimosa or wine spritzer.

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Green Eggs and Ham Frittata 2 tbsp. vegetable oil 1 bunch kale, stems removed, leaves cut into thin ribbons 6 scallions, white and light green parts, chopped 6 oz. boiled ham, diced 8 large eggs, lightly beaten 1/2 cup grated Parmesan Salt and pepper Set an oven rack about 6 inches from heat source; preheat broiler to high. Warm oil in a large, oven proof nonstick skillet over medium-high heat. Add kale and cook, stirring until wilted, about 3 minutes.

Add scallions; sautĂŠ for 1 minute. Stir in ham; sautĂŠ 1 minute longer.

Whisk eggs and cheese; season with salt and pepper. Arrange kale mixture evenly in skillet and pour egg mixture over. Reduce heat to medium-low and cook without stirring until frittata is almost set in center, 10 to 12 minutes.

Transfer skillet to broiler and cook, watching carefully to avoid burning, until top is set and golden brown, 1 to 2 minutes. Run a spatula around edges of

skillet and cut into wedges.

(To safeguard your pan, you can slide frittata onto serving plate before slicing.) Serve hot or allow to cool and serve at room temperature.

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NUTRITION Salmon Croquettes with Succotash 1 package (15 oz.) frozen baby lima beans 2 cups frozen yellow corn kernels 1 can (14.5 oz.) diced tomatoes, drained and rinsed 1/2 cup red onion, chopped 2-1/2 tbsp. Champagne vinegar 1 tbsp. dried parsley 6 tbsp. olive oil, divided 2-1/4 tsp. kosher salt, divided 3/4 tsp. black pepper, divided 1 package (10 oz.) frozen seasoning blend (chopped bell pepper, onion, celery) 3 cans (5 oz.) skinless, boneless pink salmon, drained 1 cup panko (Japanese-style breadcrumbs) 1/4 cup mayonnaise 1 tbsp. Creole mustard 1 large egg, beaten

Pistachio-Crusted French Toast with Strawberry and Neufchatel Filling 6 oz. Neufchatel cheese, softened 3 tbsp. crème fraiche 3 tbsp. honey 2 tsp. lemon zest 2 cups strawberries, hulled and quartered, divided 8 slices stale*, day-old challah (cut from 1-lb. unsliced loaf), about 1-inch thick and 5 inches wide 2 large eggs

2/3 cup whole milk 1/4 tsp. vanilla extract 1/8 tsp. kosher salt 1-1/4 cups shelled unsalted pistachios 4 tsp. sugar 1/4 cup vegetable oil 1 tbsp. unsalted butter 1/4 cup berry syrup

In a bowl, stir Neufchatel cheese until smooth, using a whisk or the back of a spoon to help get rid of lumps. Mix crème fraiche, honey and lemon zest into Neufchatel. Fold in 1-1/2 cups strawberries. Spread berry mixture onto 4 slices of bread, leaving about 1/4-inch border. Top with remaining plain slices of bread, pressing down lightly.

Thoroughly whisk eggs, milk, vanilla and salt in an 8- or 9-inch baking dish. Whirl pistachios in a processor to finely chop, then spread on a plate.

Quickly dip one French toast stack into custard, making sure all sides and edges are covered, then set it in pistachios, turning to coat both flat sides. Set on a plate. Repeat to coat remaining French toast stacks.

Sprinkle about 1/2 tsp. sugar on top side of each stack.

Heat oil and butter in a nonstick 12-inch frying pan over medium heat (flick a drop of water into the pan; if it sizzles, it’s ready for cooking). Add French toast stacks to pan, sugar side down. Sprinkle top of each stack with 1/2 tsp. sugar. Cook, turning once, until dark golden brown on each side, 3 to 5 minutes per side.

Cut French toast stacks diagonally. Set on plates and top with remaining 1/2 cup strawberries and the syrup. *If you have only fresh bread, put slices on a rimmed baking sheet and bake in a 200-degree oven until dry to touch, about 20 minutes, turning halfway through baking.

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Bring a medium pot of water to a boil over high heat. Add lima beans; cook until just tender, 12 to 14 minutes. Add corn; cook until tender, about 2 minutes. Drain, then gently toss beans, corn, tomatoes, onion, vinegar, parsley, 2 tablespoons of the oil, 1-3/4 teaspoons of the salt; and 1/2 teaspoon of the pepper in a large bowl. Set aside.

Heat 1 tablespoon oil in a large, nonstick skillet over medium-high heat. Add seasoning blend and cook, stirring occasionally, until liquid has evaporated, about 5 minutes. Transfer mixture to a large bowl; cool 10 minutes. Wipe skillet clean.

Stir salmon, panko, mayonnaise, mustard, egg, and remaining 1/2 teaspoon salt and 1/4 teaspoon pepper into seasoning blend in bowl. Shape salmon mixture into 8 (about 1/3 cup each) 3/4-inch-thick patties, and place on a parchment paper-lined baking sheet. Cover and chill at least 30 minutes.

Heat remaining 3 tablespoons oil in skillet over medium heat. Cook patties in batches until golden brown, 3 to 4 minutes per side, adding additional oil, if needed. Serve croquettes with succotash.

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The information presented is intended to demonstrate the breadth of Stryker’s product offerings. A surgeon must always refer to the package insert, product label and/or instructions for use before using any of Stryker’s products. The products depicted are CE marked according to the Medical Device Directive 93/42/ EEC. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets.

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