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A PUBLICATION OF THE CORE INSTITUTE

®

SPRING 2021

Check Your Spine

Balance issues, clumsy hands could be a warning sign

Routine Shape-Up

10 tips for your best home workout

Back on the Go! Bilateral shoulder surgery transforms life for auto industry engineer


NATIONALLY RECOGNIZED SPECIALISTS IN ORTHOPEDIC & SPINE CARE

The CORE Institute Specialty Hospital is a physician-owned and operated orthopedic and spine specialty hospital that is a destination center for patients across Arizona, the U.S and internationally. The state of the art facility is nationally recognized for superior orthopedic and spine surgical outcomes and outstanding patient experience. The entire center is dedicated to orthopedic and spine care and utilizes the latest surgical technologies, including the Mako™ robotic-arm assisted surgery system and the Xenex LightStrike Germ-Zapping Robot. Everything from the personalized approach to nursing care, who are only focused on musculoskeletal care, to the in-house chef and bistro menu has been designed to provide the best surgical experience anywhere in Arizona. Healthgrades Joint Replacement Excellence Award Healthgrades Specialty Excellence Award — America’s 100 Best Hospitals for Spine Surgery Ranked by US News as High Performing Hospital for Knee Replacement Better Than 90% Patient Satisfaction Scores

Find out more at TheCOREInstituteHospital.com 6501 N 19th Ave, Phoenix, AZ 85015 | 602.795.6020


There’s always a story behind the story. Providing the full story to help you navigate unpredictable times.

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My hand was injured so badly that I thought I would never play guitar again.

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WELCOME VOLUME 12, ISSUE 1 – SPRING 2021

FROM THE CHAIRMAN

Perseverance During These Challenging Times

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ach year as Spring blooms, it brings with it a renewed sense of optimism. That hopefulness may be more impactful this year than ever before, as we begin to see the roll-out of vaccinations across the country and cities begin to slowly reopen. This progress gives all of us tangible hope that we are on the path to getting back to life before the pandemic. For this issue, we wanted to highlight the stories of patients whose optimism and unwavering commitment to recovery allowed them to emerge healthier and get back to the life they knew before their injury. We will share positive stories about new starts. This Spring, our cover story features Mark, a 64-year old Michigan-based automotive engineer who after many months of debilitating shoulder pain, sought the expertise of Dr. William Kesto for total shoulder replacement surgery. Amazed by the success of his shoulder replacement and the pain relief he experienced, Mark opted for a shoulder replacement on his other shoulder as well. Not long after, he is back to all the things he enjoyssnowskiing, riding his beloved jet skis, and looking forward to kayaking this summer. Plus, we share the inspiring story of Sue, an Arizona resident, who is getting things back on track after a slip-and-fall accident left her with a serious hamstring injury. Having always been a very active person, Sue was left broken-hearted when her

injury prevented her from her favorite hobby, riding her Peleton indoor bike. This is when Sue met Dr. Michael Rose, who was able to surgically repair her torn hamstring. Sue’s determination and dedication to her recovery helped get her back in the saddle of her Peloton and connecting virtually with her workout friends once again. In this issue we also highlight a spine condition known as “myelopathy” along with an emerging technology in the United States that is proving successful in slowing down the progression of the condition’s symptoms. Dr. Joseph Maslak, one of The CORE Institute’s renowned Spine Surgeons, discusses a surgical procedure called Cervical Laminoplasty and the improvement in symptoms that patients experience from this procedure. Finally, as many people are still spending most of their time at home social distancing, home workouts have become even more desirable and popular for people that are trying to stay healthy. Our own Dr. Timothy Degan covers the top ten tips for working out at home and shares his thoughts on how to make the most of your exercise routine. Please enjoy our first issue of CORE Ink in 2021. We wish you a happy and healthy spring filled with hope and optimism. Even during these challenging times, please try to 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

16 COVER STORY

Back on the Go!

Bilateral shoulder surgery transforms life for auto industry engineer. 8

Back on Track

After a slip-and-fall accident that tore her hamstring, Sue Gaines is back to participating in group exercise classes. 12

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DE PA RT ME NTS What’s New? 6

CONNECT WITH US 866.974.2673 TheCOREInstitute.com

Ask the Expert

18 1  0 tips for your best home workout

Research

Trends

Specialty Spotlight

Nutrition

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21

 he CORE Institute is T pleased to introduce a new provider

 tudy examines patient S modesty concerns and a novel approach to solving them

16 C  heck your spine — Balance issues, clumsy hands could be a warning sign

20 T  he CORE Institute’s Urgent Ortho clinics deliver fast care for orthopedic injuries

21 D  elicious advice for expanding your healthy food choices

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WHAT’S NEW NEW PROVIDERS ARIZONA IAN AL’KHAFAJI, MD is an internationally Fellowship Trained Orthopedic Surgeon specializing in sports medicine and reconstruction surgery of the hip, knee and shoulder. His practice focuses on advanced knee and hip surgeries such as knee ligament reconstructions, cartilage resurfacing procedures, meniscus transplants, lower limb malalignment correcting osteotomies, patellofemoral stabilization procedures, partial knee arthroplasty, hip arthroscopy, labral repair/reconstruction, knee/hip robotic arthroplasty and periacetabular osteotomies. He is also experienced in the use of biologic modalities such as plateletrich plasma and bone marrow aspirate concentrate. Before joining The CORE Institute, Dr. Al’Khafaji received his residency training from Wake Forest University in North Carolina. Afterward, Dr Al’Khafaji completed his Fellowship

Training at the Kerlan-Jobe Institute focusing on clinical and surgical care of injured athletes. He then spent over a year in Australia completing numerous fellowships treating complex knee and hip disorders including multi-ligament knee injuries, failed ACL reconstructions, limb malalignment, hip dysplasia/ impingement, and failed knee/hip arthroplasty. During this time, he has worked with several professional sports teams, leagues, and athletes such as the LA Galaxy, USA Mens and Womens Soccer, World Surf League, International Surf Association, LA Sparks, and Australian Football League. Dr. Al’Khafaji is originally from Tampa Florida and received his doctoral degree from the University of South Florida. Dr. Al’Khafaji is active in the medical community serving as a committee member in AOSSM. He holds memberships with AAOS, AOSSM, AANA, ISHA, ESSKA, and ISAKOS. He has given numerous international lectures on a variety of topics regarding hip and knee care. In addition, Dr Al’Khafaji is a keen researcher with numerous peer-reviewed publications in prestigious orthopaedic journals.

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RESEARCH

Comfort in Care Study examines patient modesty concerns and a novel approach to solving them

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By Brian Sodoma

or as long as most of us can probably remember, it’s been standard practice to remove all street clothes, including underwear, before surgery. Patients are then asked to wear a loose-fitting gown into surgery with an open back that allows a surgeon easy access to all surgical regions. The removal of street clothes is one of the ways hospitals and surgery centers help reduce infection risk during procedures. However, this long-time practice has created anxiety in some patients who would prefer to wear their underwear into surgery for privacy and dignity. Some even forego care. In a British Journal of Anesthesia-published study, gown use induced preoperative anxiety in 45.2% of inpatients and 38.3% of outpatients. In another study at Samara State University, anxiety around potential exposure even had an adverse effect on outcomes.

ARIZONA STUDY SEEKS SOLUTIONS

This spring, the MORE Foundation, in cooperation with The CORE Institute, will conduct a study involving 200 orthopedic surgery patients to gather

the impact of the coverings offered on more perspective on the subject of the entire surgery experience. patient modesty and to test a potential “We may be surprised by the number solution: surgical underpants that are of people who actually want the manufactured to medical equipment garment when it’s offered to them,” Dr. grade hygiene and quality standards. Marc Jacofsky added. “Some may turn it “Some of the reasons for this anxiety down, too.” can be gender bias — a female patient, for example, with a male surgeon. Some of it might be religious in nature, or the PATIENT ADVOCACY belief you should only expose yourself Dr. Jacofsky said that while the issue to your spouse or to parents. We know of patient modesty might not be top this is important for of mind for everyone, a growing number of the growing discussion people, and we want to warrants research. The learn more and explore subject has spurred patient a possible solution,” said advocacy organizations Marc Jacofsky, Ph.D., the into action. study’s lead investigator “Because we have the and Executive Director for partnership with The Research and Education CORE Institute Specialty at the MORE Foundation. Hospital, where it’s a very Marc Jacofsky, Ph.D. Dr. Marc Jacofsky controlled environment, says the research is randomized and it’s easy for us to run a study like this,” single-blinded, so patients won’t know he added. “This used to be a very topahead of time if they will be offered down ‘surgeon says’ issue, but as people the underpants or not. The study will push back from that norm and feel more evaluate responses from pre- and postempowered, we want to explore the surgery patient surveys about the topic best alternatives and not be resistant to of patient modesty in general, as well as change.”

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COVER STORY

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Back on the

Go! Bilateral shoulder surgery transforms life for auto industry engineer By Brian Sodoma Photos by Michelle Massey Barnes

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or many people who require a joint replacement surgery, nagging pains start slowly. For Mark Messer, they arrived quickly and were debilitating. In early 2018, the active 64-year-old Michigan-based automotive engineer who loves riding jet skis, snowskiing and tossing around a baseball with his grandkids began feeling pain in his right shoulder. “It got to the point where it started to ache all the time. I couldn’t sleep lying down. I had to sleep in a Lazy Boy [recliner] with pillows all around me,” he recalled. “I’d be sleeping, then wake up in the middle of the night and it felt like a car ran over my shoulder.”

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Messer relied on pain medication for pain relief at first, but he eventually went to see his primary care physician for guidance.

NEW SHOULDERS ON THE HORIZON

Messer tried cortisone shots for about six months and even spent time in the gym to see if he could regain his shoulder’s strength and William Kesto, MD mobility. Ultimately, his primary care physician referred him to The CORE Institute. There, Dr. William Kesto, a Fellowship Trained Sports

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Medicine Surgeon, quickly saw that osteoarthritis had fully deteriorated Messer’s right shoulder socket. The shoulder would need to be replaced. Messer was stunned by the news initially: “I thought, ‘what do you mean I need a new shoulder? People don’t do that.’” The total shoulder replacement procedure Messer needed involves replacing the humeral head, or the top part of the arm (humerus), as well as the socket (glenoid) that attaches the humerus to the shoulder

blade. Messer was impressed with Dr. Kesto’s ability to explain the procedure and why it works so well. “I always walk patients through their x-rays, so they understand the pathology,” Dr. Kesto said. “I have an anatomic model of the shoulder in my office, so I can show them what the implant looks like and how we perform the surgery. That visual aid helps patients understand why it works and why they’re going to eventually feel a lot better.” Typically, patients with osteoarthritis who need a total shoulder replacement have difficulty reaching their arms above their head and using their hands behind their back. The simple act of

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“After the right shoulder was done, I realized how bad the left one really was. Now, my range of motion for both arms is above 90%. Now I can change lightbulbs up in the ceiling and I’m going to ride my WaveRunners again this summer and do some kayaking.”— Mark Messer

threading a belt through belt loops can be challenging. “Technology has improved tremendously in the last five to ten years, so many more patients can get this procedure now,” Dr. Kesto added. “The sockets last longer, and you don’t have to put a long stem on the humeral side, just the humeral head which may result in less pain and surgical time.”

AFTER CARE, RECOVERY

Depending on your goals, shoulder replacement surgery recovery can take between three and six months to get all the muscles working together again and to fully regain motion. Messer

spent six months in physical therapy, three sessions per week, after his right shoulder replacement. After the success of the first surgery in October of 2018, Messer opted for a left shoulder replacement in May of 2020 and had twice-a-week physical therapy for six months for that procedure. “After the right shoulder was done, I realized how bad the left one really was,” Messer said. “Now, my range of motion for both arms is above 90%. Now I can change lightbulbs up in the ceiling and I’m going to ride my WaveRunners again this summer and do some kayaking.” Like Messer, many of Dr. Kesto’s patients are still surprised to learn a

total shoulder replacement is even possible today. “I think that’s one of the things people don’t know. They can regain a lot of their function and get back to doing the things they like to do with these operations,” Dr. Kesto explained. “I think the message is to inquire about these procedures and not just accept the functional limits you have in life.”

FOR MORE INFORMATION

For more information about shoulder or other joint replacement procedures, visit TheCOREInstitute.com.

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PATIENT FEATURE

After a slip-and-fall accident that tore her hamstring, Sue Gaines is back to participating in group exercise classes

Back on S

By Elise Riley

Track

ue Gaines prided herself on being active. A resident of Sun City West, Gaines, 66, is an avid hiker and walker. She grew up riding horses. Her favorite hobby — riding a Peloton indoor bike — kept her healthy and engaged with friends across the country who enjoyed group cycling classes. But it wasn’t an injury on the bike or a slip on a hiking trail that sidelined Gaines and threatened her mobility. Instead, it was an everyday accident at work. “It was just a slip and fall,” she said. “They had just gotten done mopping the floors, and my legs just went out Michael Rose, MD from under me. I did the splits without meaning to — I’ve never been able to do the splits, but I did on that day. I couldn’t get up. I knew it was pretty serious.”

SERIOUS INJURY

Gaines hit her head in the fall, suffered a black eye, and tore her left hamstring. While the immediate concern was a possible head injury, Gaines said she knew the damage to her left leg was more serious. “I tolerate pain pretty well,” she said. “And I kept saying that my leg just wasn’t moving correctly.” Gaines called The CORE Institute, where she’d previously had a successful shoulder surgery. This time, she saw Dr. Michael Rose, a Fellowship Trained Orthopedic Surgeon specializing in Sports Medicine. “I was very adamant with him: I ride my bike five, six times a week and wanted to continue to do that,” she said. “He reassured me that with my surgery, I’d be able to get back on the bike.”

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TORN HAMSTRING

Ten days after the fall, Dr. Rose surgically repaired Gaines’ torn hamstring. “She tore the tendon of the hamstring off the lower part of the pelvis,” he said. “It was completely torn off. What we do for people who do a lot of activity like (Gaines) is repair the hamstring tendons.” Hamstring injuries like Gaines’ aren’t especially common as everyday injuries. Still, athletes such as hurdlers or running backs often suffer hamstring injuries because their skills involve explosive pushing from the legs. Gaines’ hamstring tear was likely the result of years of activity and wear and tear. Dr. Rose likened it to the degradation of fabrics that are washed and worn over and over.

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“You get small tears in the tendon, and then the tendon doesn’t have a great blood supply, so it doesn’t have a great way to repair itself,” Dr. Rose said. “It’s the same process as with the rotator cuff in the shoulder. It’s like when you have a pair of jeans that you wear a lot, and at the knee it kind of wears out, and then it gets small tears, and the tears become bigger over time.”

RECOVERY TIME

Immediately after the surgery, Gaines had to immobilize her leg so it wasn’t bearing any weight and couldn’t be extended. “Once Dr. Rose fixed my leg and the surgery happened, I felt so much better,” she said. “Once he went in there and reattached it, as soon as he did that, my pain level was very low. I didn’t even take pain pills.

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GET BACK IN ACTION To learn more about how The CORE Institute can help with your injuries, visit TheCOREInstitute.com.

It was amazing.” Three weeks after the surgery, Dr. Rose permitted Gaines to return to her bike without any weight/resistance on the pedals. She also went to physical therapy for six weeks. “Every time I’d go into physical therapy, they’d allow me to have more mobility in the leg,” she said. “It was 8-12 weeks before the brace came off completely, and I was able to do what I was supposed to do. I was still weak, but I could do normal activity.” At her 12-week checkup, Dr. Rose cleared her to resume normal activity. She was back on her Peloton and connecting with her virtual friends who’d missed her. Now after her successful procedure she found she was riding with the same vigor as before the accident. “My left leg is actually stronger than my right,” Gaines said. “There’s nothing I can’t do now.”

  

 

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Failure is Not an Option We’ll help you get back in the swing of things with the right physical therapy plan designed specifically for you. Because with Team Rehab in your corner it isn’t over ‘til you say so.

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SPECIALTY SPOTLIGHT

Balance issues, clumsy hands could be a bad sign — Cervical Laminoplasty stops myelopathy in its tracks By Julie Maurer

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CHECK YOUR SPINE

hile one may think tingling hands or balance issues may be a sign of age, they could indicate something

more. According to Joseph Maslak, MD, a Fellowship Trained Orthopedic Spine Surgeon with The CORE Institute, these symptoms could be an indication of myelopathy. This is a condition which most commonly results from spinal cord compression or cervical stenosis and can look very different from other spine

and nerve problems. “Most conditions of the spine involve pain, but with myelopathy, the symptoms are often vague and painless,” Dr. Maslak said. “Patients come into clinic with balance difficulties, and sometimes even reports of falls. They have tingling in their hands and difficulty with fine motor control, and often find themselves dropping things and having a hard time with things such as buttons and eating utensils.”

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TREATING MYELOPATHY

Joseph Maslak, MD

One of the surgical procedures to help treat myelopathy is called a Cervical Laminoplasty, which involves moving the arc of bone that protects the spinal cord and hinging it open to relieve compression. Screws and plates are often used to keep the hinge open while the bone heals. “This procedure is nice because it makes room for the spinal cord, but we are not fusing any joints, so there isn’t a limitation of the patient’s motion,” Dr. Maslak said. Recovery from the surgery takes a couple of months. While the goal is to prevent myelopathy from getting worse, Dr. Maslak notes that some studies have shown that patients may demonstrate slow improvements in their existing symptoms over time after surgery.

ENDING THE PAIN

DIAGNOSIS THE PROBLEM

The symptoms worsen over time, which is why it is difficult to get an early diagnosis. Dr. Maslak notes that patients are typically referred to him once the patient has an MRI that shows compression, or they’ve been to multiple doctors that can’t quite figure out what’s going on. “Myelopathy is characterized by a progressive, step-wise decline in function,” he said. But according to Dr. Maslak, catching

the condition early can go a long way toward slowing down its progression. “Ninety-five percent of people get worse with time, so this is one of the conditions where we discuss surgical options earlier,” he said. “The compression doesn’t resolve without surgery, so as soon as we recognize myelopathy in the patient, we have a conversation about preventing its progression as the symptoms almost universally get worse over time.”

While cervical laminoplasty often doesn’t cure patients of symptoms completely, it may prevent them from getting worse. “If myelopathy goes untreated — these people won’t be able to function, won’t be able to take care of themselves,” Dr. Maslak said. “The ultimate outcome of remaining untreated is lack of independent function — patients can become wheelchair-bound.” Dr. Maslak has been performing the procedure for about three years and new surgeons now learn how to do it during their training. “It’s an emerging technology in the United States,” he said, “and has shown increasing utility for patients with such spine issues.”

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ASK THE EXPERT

Home workouts have always had advantages, even before social distancing health imperatives, says Dr. Tim Degan, a Fellowship Trained Sports Medicine Surgeon at The CORE Institute. Convenience tops the list. Forget commuting; just go into your designated exercise area. Plus, you can travel with most home routines. Here are some suggestions to reap the most benefits from working out at home.

Tips for Your Best Home Workout By Joan Kay Westlake

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CREATE YOUR WORKOUT

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Make a plan with set appointments as to when you are going to work out. Remember establishing a habit takes at least 21 days, so stay the course.

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Choose fun. Don’t pursue a routine you hate just because it worked for someone else. Swim, climb stairs, put up a basketball net, or play outdoors with your kids.

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Prepare your workout area so you have ample room to exercise without knocking into walls and things.

Target your cardio at a vigorous pace. The goal is 30 minutes a day, but you can break the total 30 minutes into shorter segments if you must. Get your heart rate up but stay in tune with your body and how hard you are working, don’t just compare to numbers.

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Consult an expert such as a physician or fitness professional if you haven’t been active in awhile or have health issues such as diabetes, arthritis, or previous injuries.

Perform exercises correctly. Injuries result when you aren’t executing a movement properly. If you have not worked out recently, consider a one-on-one consulting session.

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Find a workout buddy. Dr. Degan shares that his wife in Arizona and her sister in Florida take virtual classes together. Someone holding you accountable makes a big difference in your adherence.

Dress comfortably but with common sense. For example, weight lifting in flip flops, while it may be comfortable it is also very unsafe.

Warm-up slowly. Don’t launch into big stretches, squats, and other stressors on ligaments, joints and muscles. A five-minute stroll or easy bicycle pedal works fine.

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Include strength training at least twice a week, engaging all your muscle groups. You want to build muscles, which burn calories even after you stop exercising. Heavyweights aren’t required; you can use your body weight.

Tim Degan, DO, is a Fellowship Trained Orthopedic Surgeon specializing in Sports Medicine. His interest in the field grew from his own experience as a football player at the University of Montana and as a physician for a number of athletic teams, including Texas A&M University.

“The right routine builds cardio fitness, strength and endurance, and is the one you enjoy enough to stick with,” he concludes. “Just keep moving. It is important to be active for your best health.”

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TRENDS

FASTER SERVICE ... NO APPOINTMENT NECESSARY

orthopedist first and avoid multiple appointments.” The CORE Institute’s Urgent Ortho clinics welcome patients with all kinds of orthopedic injuries including sports injuries, sprains and strains, fractures, back and neck injuries, hand and wrist injuries, shoulder, knee and hip injuries and much more. Patients can walk in and see an orthopedic specialist with little to no wait, receive imaging and have their injuries addressed and treated. If necessary, they’ll schedule follow-up visits with orthopedists who have subspecialties related to the injury.

HELPING WHERE IT COUNTS

The CORE Institute Urgent Ortho Clinics opened in 2020 and so far have helped over 1,800 patients. “Since the start of the pandemic, we By Elise Riley know hospital ER’s have been focusing their efforts on treating those with COVID-19 symptoms and we wanted “If you’ve hurt your ankle, and you’re to do our part to help ease the burden. wondering if there’s a problem, you’ve By allowing patients to previously had two avoid the hospital, it choices,” said Dr. Mark allows the providers in Campbell, a Fellowship the ER to focus on those Trained Orthopedic with COVID-19 related Surgeon at The CORE symptoms and those with Institute. “You could go to orthopedic conditions the emergency room, but to stay out of the ER that may be the highestaltogether. From that risk COVID-19 option perspective alone, it’s right now. You could also Mark Campbell, MD been a great program,” go to your primary care Dr. Campbell said. “We heard stories of physician, but that office may be focused people who had injuries or problems, on caring for sick patients and harder and they were having trouble being seen to get into as a result. While seeing a in an ER. We saw a need.” primary care physician is a good option, afterward it might be necessary to order imaging or refer you to an orthopedic To view locations and hours of specialist. With Urgent Ortho, we operation for any of the Urgent Ortho offer patients direct access to see an clinics, visit TheCOREInstitute.com

The CORE Institute’s Urgent Ortho clinics deliver fast care for orthopedic injuries

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e’ve all been there at one time or another: ending an afternoon bike ride abruptly because of a throbbing ankle, wrestling with the family dog and losing after a knee gives way, or simply getting out of bed and feeling seizing back pain. Orthopedic injuries can happen in a split second, but help for them is not always so instant. That’s where The CORE Institute’s Urgent Ortho clinics come in, bringing much-needed, fast relief to patients.

WALK-IN CARE

The CORE Institute offers Urgent Ortho in Arizona and Michigan, where patients can walk in and receive care from orthopedic experts with no appointment needed.

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NUTRITION

Turn to page 22 for delicious recipes!

Changing Your Spring Diet Lineup Delicious advice for expanding your healthy food choices By Michelle Jacoby

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he season’s changing from winter to spring marks a renewed sense of doing away with the old and welcoming in the new. Whether it’s giving your home a good scrub down from top to bottom, breathing new life into your wardrobe, or simply getting out from the indoors and enjoying the sunshine. But nothing says “spring awakening” better than revamping your diet and trying something new. With the season comes a new crop of fresh foods and ingredients that promise to expand your mealtime repertoire and, most importantly, be good for you, too.

LET’S TALK ABOUT SNACKS

It’s mid-morning. The breakfast you enjoyed hours before is fast becoming a distant memory, but it’s way too soon to even think about lunch. Hunger pangs are beginning to set in, and all you can think of is, “Where’s the closest snack?” While the urge to make a beeline for a bag of chips, a package of cookies, or a handful of candy may be allconsuming, opt instead for a fresh change of pace with a snack of fruits and vegetables. The variety, taste and, of course, health benefits may surprise you. “Fresh fruits and vegetables make for the perfect snack,” says Laurie McDonald, a registered dietician in Mesa. “They’re low in calories, high in fiber and rich in vitamins and minerals. Plus, they’re a great way to meet your daily nutrition requirements.” EATING continued page 22 >>

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NUTRITION

>> EATING continued From 21

GO MEATLESS

While the thought of forgoing your favorite protein may strike dread in your heart, don’t worry. The goal of going meatless isn’t to avoid meat altogether. Rather, it’s more about adding more vegetables to your plate and upping your plant-based protein intake. In an article on NBCNews.com, Cynthia Sass, a registered dietician who specializes in plant-based nutrition, says the only switch you need to make is to trade meat for a plant alternative. “For many people, when they think about what to make for dinner, they focus on meat first,” she said.” Change that pattern by adding pulses (the umbrella term for beans, lentils, peas and chickpeas) and pea protein-based meat substitutes to your protein list.”

NATURALLY SWEET

The average person takes in 400 calories a day from added sugar, mostly from refined sugar and syrup sweeteners. With this in mind, more of us are decreasing our sugar intake by substituting it with artificial sweeteners that may satisfy the sweet tooth but may also have harmful side effects. Fortunately, natural sweeteners are healthy, and delicious alternatives to refined sugar, high fructose corn syrup and artificial sweeteners. They taste like sugar, act like sugar, and can be used like sugar. Better yet, according to a study in the Journal of the American Dietetic Association, substituting natural sweeteners can increase your antioxidant intake. If you’re looking to keep things sweet the all-natural way, try such things as raw honey, maple syrup, blackstrap molasses, dates and coconut sugar.

GO WITH YOUR GUT

How is your microbiome doing these days? Thousands of studies have discovered the links between a healthy gut and improved mental health, digestion, immunity and metabolism. Foods rich in probiotics—such as yogurt, kimchi, sauerkraut, kombucha, and some cheeses— help keep your gut healthy by promoting the growth of beneficial bacteria that contribute to overall health. In addition, staying hydrated has been shown to have a beneficial effect on the mucosal lining of the intestines, as well as on the balance of good bacteria in the gut. We’ll raise our glasses to that!

Spinach Pesto Pasta with Shrimp Pesto 2 cups packed fresh baby spinach 1 cup packed fresh basil leaves 1/2 cup loosely packed fresh flat-leaf parsley 1/2 cup seeded chopped plum tomato 6 tbsp. chopped toasted walnuts 2 tsp. fresh lemon juice 1/2 tsp. kosher salt 1/2 tsp. black pepper 1-1/2 oz. Parmesan cheese, grated (about 1/3 cup) 1 garlic clove, chopped 2 tbsp. extra-virgin olive oil Pasta 8 oz. uncooked whole-wheat penne pasta 1 lb. fresh asparagus, cut into 2-inch pieces 1 tbsp. olive oil 1 tbsp. unsalted butter 1 lb. large fresh shrimp, peeled and deveined 1/4 tsp. ground red pepper 1/4 tsp. black pepper 1/2 cup halved multicolored grape tomatoes 1/4 tsp. kosher salt To prepare pesto, bring a large saucepan filled with water to a boil. Add spinach and basil, cook 20 seconds. Remove spinach mixture to a bowl filled with ice water (reserve water in pan), let stand 30 seconds. Drain and pat dry with paper towels. Source: cookinglight.com/food/recipe-finder/best-spring-recipes?slide=269246#269246

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Broccoli, Cheddar and Brown Rice Cakes Cooking spray 1 tbsp. butter, unsalted 3/4 cup yellow onion, chopped 4 garlic cloves, chopped 3/4 cup unsalted vegetable stock 12 oz. fresh broccoli florets, cut into 1/2-inch pieces 1 package (8 oz.) precooked brown rice 1/4 cup whole-wheat panko

1 tbsp. grainy mustard 1/2 tsp. black pepper 3/8 tsp kosher salt 3 oz. pre-shredded, reduced-fat sharp cheddar cheese 2 large eggs, beaten Sliced green onions (optional)

Preheat oven to 450 degrees. Coat a baking sheet with cooking spray. Melt butter in a large skillet over medium-high heat. Add onion and garlic, sauté 4 minutes. Add stock and broccoli. Bring to a boil, cook 3 minutes. Heat rice according to package directions. Combine broccoli mixture, rice, panko, mustard, pepper, salt and 1/2 cup cheese in a large bowl. Stir in eggs. Divide and shape broccoli mixture into 8 (2-1/2 inch) patties. Arrange patties on a prepared pan, coat them with cooking spray. Bake for 15 minutes. Top with remaining 1/4 cup cheese and bake for 4 more minutes or until cheese melts. Garnish with green onions, if desired. Source: cookinglight.com/recipes/broccoli-cheddar-brown-rice-cakes

Grilled Pineapple Lemonade 6 oz. fresh pineapple, sliced 4 cups hot water 3 tbsp. granulated sugar 3/4 cup fresh lemon juice (4 large lemons) Heat a grill pan over medium-high heat. Add pineapple slices in a single layer and cook 5 to 6 minutes on each side, until dark char marks appear. Set grilled pineapple slices aside to cool. Combine 4 cups hot water and sugar in a large pitcher, and stir with a whisk until sugar is dissolved. Process pineapple and lemon juice in a blender until relatively smooth. Pour pineapple mixture through a fine-mesh strainer into pitcher with sugar mixture; discard solids. Stir well until fully blended. Serve over ice. Source: cookinglight.com/ recipes/grilled-pineapple-lemonade

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Here at Agua Fria dental we take pride in our customer service and enjoy serving our patients in all aspects of dentistry. We are confident you will love our team and your experience, that we will give you $50 towards treatment or a $25 gift card for trying us out. We look forward to seeing you!

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(623) 933-3684 | AguaFriaDental.com 11126 W. Wisconsin Ave, Youngtown AZ 85363 AR-GCI0599840-01


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