CORE Ink - Summer 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

SUMMER 2019

A disastrous motorcycle accident is overcome

Victory Song Good As (Almost) New Total knee replacements give man his mobility back

ÂŽ

Robots are helping replace your knee Robotic-assisted technology improves knee replacement surgery

Robots are helping replace your knee B R O U G H T TO YO U B Y

Better outcomes, less time

�Partial Knee Replacement NOW

10 YEARS AGO

Patient was required to stay in hospital 1-2 NIGHTS

Better outcomes, less time

Patient goes home the SAME-DAY

�Partial Knee Replacement

�Full Knee Replacement NOW

10 YEARS AGO

Robotic-assisted may Patient stay 1 NIGHT technology improves knee replacement surgery Patient was required to stay in hospital 3-4 NIGHTS

10 YEARS AGO

Patient was required to stay in hospital 1-2 NIGHTS

�Rehabilitation Time

10 YEARS AGO

NOW

MONTHS

patients encouraged to walk the same day of procedure

10 YEARS AGO BROUGHT TO YOU BY

NOW

Patient may stay 1 NIGHT

NOW

CALL 602.346.9827 OR VISIT FIND AN ORTHOPEDIC DOCTOR NEAR YOU

BANNERCORECENTER.COM 602.346.9827 OR VISIT �Full Knee Replacement BANNERCORECENTER.COM 10

10 YEARS AGO

Patient was required to stay in hospital 3-4 NIGHTS

Patient was Patient goes required to stay home the in hospital FIND AN ORTHODEDIC DOCTOR NEAR YOU SAME-DAY 1-2 NIGHTS

CALL

Patient goes home the SAME-DAY

�Full Knee Replacement

SEVERAL 6-8 WEEKS, Better outcomes, less time

�Partial Knee Replacement

NOW

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 26, Issue 10, p 2806-2811, Archives of Internal YEARS AGO& Conditioning Research: October 2012, VolumeNOW Medicine August 6, 2012, Nutrition & Metabolism May 17, 2012

�Rehabilitation Time 10 YEARS AGO

SEVERAL MONTHS

NOW

6-8 WEEKS,

patients encouraged to walk the same day of procedure

Patient was Patient 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 required to stay may stay 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 in hospital of Strength & Conditioning Research: October 2012, Volume 26, Issue 10,1 p 2806-2811, NIGHTArchives of Internal Medicine August 6, 2012, Nutrition & Metabolism May 17, 2012 3-4 NIGHTS

TAYLOR SPATIAL FRAME™ External Fixator A solution for bone deformity and limb restoration

From children to adults with bone deformity or in need of limb restoration, you know the physical and emotional pain that one goes through on a daily basis.

You have the power to change you or your child’s life with the TAYLOR SPATIAL FRAME Fixator, a proven orthopaedic technology that can lengthen, straighten, and correct bones. This life changing technology can give you or your child hope in achieving the freedom of normal mobility.

Find out more about Smith & Nephew’s life-changing TAYLOR SPATIAL FRAME product at www.TAYLORSPATIALFRAME.com

™Trademark of Smith & Nephew.

WELCOME VOLUME 10, ISSUE 2 – SUMMER 2019

FROM THE CHAIRMAN

Making a Difference Suddenly, it’s summer. The calendar makes it official, but Mother Nature does a great job of letting us know on her own. Desert temperatures soar past 100-degrees, mountain forests become green and lush, and northern lakes, covered with ice just a few months ago, now beckon to swimmers to take the plunge. Everything is different in the summer.

This issue of CORE Ink focuses on how The CORE Institute is constantly striving to make a difference by making things better for our treasured patients.

Our cover story exemplifies that goal. It features Vincent Robert, who was critically injured in a disastrous motorcycle accident. Doctors worried they would have to amputate his right hand. The CORE Institute’s Dr. Ammar Karim was called into the case, performing complex surgery that not only saved Vincent’s hand, but allowed him to resume playing his beloved guitar. In fact, Vincent recovered so well, he is now performing professionally in Las Vegas.

You’ll also be inspired by Ed Coles, a hiker, biker and camper, who felt the walls closing in on him when both of his knees gave out from arthritis. That’s when he turned to our Dr. Jefferey Michaelson, who came up with the plan for two robotic-assisted total knee replacements and performed them so well that Ed is already back

on the trails, celebrating summer with gusto.

Making a difference also means looking for new answers and MORE Foundation has won a grant to find better ways to treat shoulder injuries. MORE Foundation’s John McCamley, Ph.D. tells us how this extraordinary research project could help patients around the world.

Do you know anybody suffering from pain in the Plantar Fascia, the connective tissue that runs from the base of your toes to your heel? Our Dr. Victor Nwosu shares details on the latest treatments and offers important evidence on prevention techniques.

Plus, we’ll take you behind the scenes at HOPCo, The CORE Institute’s management company, which is growing nationwide, making a difference by helping other orthopedic practices around the country achieve better patient outcomes while lowering costs for patients and providers alike.

I’m glad you’ve made CORE Ink part of your summertime reading, and grateful to each and every one of our treasured patients.

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

8

COVER STORY

Victory Song A disastrous motorcycle accident is overcome at The CORE Institute. 8

PATIENT CARE

Good As (Almost) New

12

Total knee replacements, 8 weeks apart, give man a new set of knees and his mobility back. 12

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

Ask the Expert 7 Diagnosis and treatment of plantar fasciitis

20 connect with us

Research 16 MORE Foundation receives grant to study shoulders

Specialty Spotlight 18 The CORE Institute is now managed by HOPCo

Nutrition 20 Tips for grilling and eating healthy this summer 1.866.974.2673

www.thecoreinstitute.com

5

WHAT’S NEW NEW PROVIDERS BRIAN BUCK, DO

Brian Buck, DO is a board certified and fellowship-trained orthopedic surgeon specializing in orthopedic traumatology.

Dr. Buck completed his fellowship training at the University of Minnesota, Hennepin County Medical Center. He received his orthopedic surgery residency training at the Philadelphia College of Osteopathic Medicine and his medical degree from Chicago College of Osteopathic Medicine; graduating at the top five percent of his class. He obtained his bachelor’s degree from Bucknell University, in Lewisburg Pennsylvania.

Dr. Buck earned the Howard Rosen Table Instructor Award from NA North America on his Basic Principles and Techniques of Operative Fracture Management Course for surgical residents. Dr. Buck has produced several publications and participated in numerous research projects and presentations across the United States.

Dr. Buck holds a strong affiliation with multiple professional societies including American Osteopathic Association, American Osteopathic Academy Orthopedics, American Academy of Orthopedic Surgery, AO Trauma and the Orthopedic Trauma Association.

JOHN WALLACE, MD

John Wallace, MD is a fellowship-trained physician specializing in pain medicine and board certified in anesthesiology. He specializes in the diagnosis and treatment of painful conditions of the entire spine, muscles, joints, and nerves. Dr. Wallace aims to reduce or alleviate a patient’s pain through comprehensive evaluation and treatment plans, minimally invasive procedures, use of cutting-edge technology, and patient participation.

Prior to completing his fellowship training at The CORE Institute, Dr. Wallace cared for patients as an anesthesiologist at Valley Anesthesia, Kalamazoo Anesthesiology, and Central Anesthesia Services. Dr. Wallace completed his residency at the University of Iowa Hospitals and Clinics in Iowa City, Iowa. He earned his medical degree from Michigan State University and his bachelor’s degree from University of Michigan. Dr. Wallace is a member of the American Board of Anesthesiology.

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

ASK THE EXPERT

Q&A

with

Victor E. Nwosu, DPM

The Plantar Fascia

Q: What is the plantar fascia?

A: An elastic thick band of connective tissue located on the bottom of the foot that spans from the heel bone to the base of the toes. It acts as a bow string to stabilize the arch of the foot.

Q: What is a partial plantar tear?

A: A relatively uncommon condition that occurs from an abrupt or sudden high impact exercise. A tear is typically preceded by chronic plantar fasciitisinflammation of the plantar fascia.

Overuse or excessive stress of the fascia can also lead to microtears. Physical exam along with MRI or ultrasound are used for accurate diagnoses.

Q: What are the symptoms?

A: Symptoms include: >> Intense pain in the heel or arch while walking or at rest >> A painful lump in the arch of the foot

Q: How is it prevented?

A: Preventative efforts should focus on understanding and addressing the underlying cause — tight calf muscles and faulty mechanics. Also known as equinus contracture, calf tightness is a major contributing factor in most Q: What is the treatment? foot and ankle problems.

A: Treatment is Once physical therapy is typically nonoperative. completed, it is important Pain is managed with to continue the home a combination of the exercise program to RICE method — rest, maintain laxity of the calf ice, compression and Victor Nwosu, DPM muscles. It is also important elevation — an antito use accommodative foot inflammatory, activity orthotics/inserts which function to not modification, arch support and a walkonly support the plantar fascia, but can ing boot. The role of physical therapy is also be used to reduce abnormal foot important in stretching and strengthenmotion or to improve posture. ing pertinent muscles. Full recovery usually takes up to 3 months or more.

Victor E. Nwosu, DPM is a fellowship trained foot Patients with partial tears have favorand ankle surgeon at The CORE Institute. able outcomes with return to activity. or heel with swelling or bruising >> H earing or feeling a pop or tearing in the foot >> The collapsing of the arch >> Pain when toes are bent upward >> Difficulty walking

7

COVER STORY

A disastrous motorcycle accident is overcome ...

VICTORY SONG a journey to recovery at The CORE Institute

By Meghann Finn Sepulveda | Photos by Mark Lipczynski

V

incent Robert didn’t know his life would change on Sept. 21, 2018.

The 50-year-old Las Vegas motorcycle enthusiast went on a ride with friends that day down the scenic route to Phoenix. But, a few hours into the ride, Vincent’s motorcycle malfunctioned and he was thrown from the bike, hitting his right hand on a pole before landing face down on a 45-foot embankment. He suffered life-threatening injuries and underwent multiple surgeries. Vincent also faced the possibility of hand amputation because the damage was so severe.

But then, Vincent’s family met Ammar Karim, DO, a fellowshiptrained orthopedic trauma surgeon at The CORE Institute, who gave them hope.

WAKING TO A NIGHTMARE Vincent doesn’t remember much about the accident, but his friends say he wasn’t breathing when they reached him before

8

www.thecoreinstitute.com

9

paramedics arrived. He was airlifted to a Valley hospital and spent eight days in the intensive care unit. He suffered bruised lungs, a shattered spleen, a lacerated kidney, and broken ribs, along with deep abrasions and serious wounds.

Surgeons told Vincent’s wife that because his hand was so badly injured, he may need to undergo amputation.

“My wife refused,” Vincent recalled.

“She would not sign the paperwork to allow them to amputate.”

Hospital staff consulted with Dr. Karim from The CORE Institute to see what could be done to save Vincent’s hand.

“Vincent suffered a distal radius frac-

10

ture dislocation and the bone was broken in many pieces” said Dr. Karim. “This is a traumatic and painful injury that can lead to nerve damage, swelling, pain, stiffness, arthritis, and in very severe cases, amputation.”

Dr. Karim earned the trust of Vincent’s wife and successfully realigned the bone and the joint and reconstructed the joint surface with a combination of plates and screws to restore function.

“He did unbelievable work,” Vincent said. “He saved my hand.”

ROAD TO RECOVERY After Vincent was discharged, he was

Ammar Karim, DO

transported to a rehabilitation facility where he spent several weeks restoring strength in his hand and learning how to perform normal, daily activities.

“Recovery for this type of injury is between eight and 10 weeks, and depending on the complexity and severity of the fracture, you may need six to 12 weeks of hand therapy to restore functionality,” Dr. Karim explained.

“It takes time before a patient can begin doing simple tasks such as holding a cup of coffee.”

The grueling rehabilitation paid off.

On Jan. 3, 2019, about three months

after the accident, Vincent returned to work. He was also able to get back to his greatest passion: playing guitar. Being able to strum the strings brought him tears of joy because he wasn’t sure it would ever happen again.

At his follow-up appointment, Vincent brought his guitar to the clinic to demonstrate his remarkable progress and played “Stairway to Heaven” for Dr. Karim.

“He worked so hard to rehabilitate his hand,” Dr. Karim said.

“I am so proud of Vincent and excited that he is able to get back to doing something that means so much to him.”

FOR MORE INFORMATION Learn more about the specialized services available at The CORE Institute at thecoreinstitute.com.

FINDING HOPE Today, Vincent says he is doing well. As part of the healing process, Vincent wanted to get back on his motorcycle. Although he was a little hesitant at first, riding is a hobby he wasn’t willing to give up.

Vincent feels fortunate for the outpouring of love and support he received from family members, friends and colleagues.

“I am so blessed,” he said.

11

Total knee replacements, 8 weeks apart, give man a new set of knees and his mobility back

By Elise Riley

{ ALMOST }

12

www.thecoreinstitute.com

PATIENT FEATURE

E

d Coles knew he had ground out every last step of movement from his knees.

Hiking, camping, biking, backpacking, chasing around his kids, keeping up with his grandkids — he’d done it all. But the shots weren’t working anymore. He could move less and less. It was time for a new set of knees.

It was a big decision, but together with Jefferey Michaelson, MD, of The CORE Institute, they came up with a plan to restore Ed’s mobility: total knee replacements, one at a time, at a pace and recovery that Ed’s body could handle.

The most astounding thing about this, was that the entire process took just eight weeks to complete.

FINDING AN ANSWER second surgery came on April 11.

“Ed’s a very active guy, very high “The more I researched it and read energy,” said Dr. Michaelson, MD, a about it, I knew that there’d be a great board certified and fellowship-trained success rate with the robot,” Ed said. orthopedic surgeon.

“I’d recommend it to “We talked about how anybody. I’ve got two his surgery would be straight legs now.” complex, and so we decided to utilize the PRECISION SURGERY TM Mako Robotic ArmWhile Ed’s situation is special, it does help to Assisted Technology for show what is possible his knee replacements. through total knee He was all in.” replacement. The Ed, 66, had his left Jefferey Michaelson, MD Mako Robotic-Arm knee replaced on Assisted Total Knee replacement Feb. 11. After spending one week was a wise choice for Ed’s complex with a walker and another with a case because it made the entire cane, he walked unassisted into Dr. procedure more precise with less Michaelson’s office to find out when downtime and a quicker recovery. they could finish their plan. That

13

“There are lots of non-surgical treatments that are available. You don’t entertain surgical replacements until you have exhausted all other options. The idea that you’re going to be back to doing what you want — I tell folks you’re going to be happy 90 percent of the time. It’s really good and you will feel better than you did, but it’s not the knee you were born with,” Dr. Michaelson said.

Ed, who was bow-legged and in constant pain, knew it was time to have the surgery.

“It got to the point that I couldn’t keep up with my grandkids,” he said.

“I couldn’t walk. When I took my vacation, I couldn’t make it 100 yards to the ocean.

That was enough.”

Jayesh Patel, PTA

GETTING IN SHAPE Prior to the surgery, Ed made sure he was in the best physical shape possible.

“I knew that I wouldn’t be in better shape the week after the surgery than I was before,” he said. “I was in as good of shape as I could be before going

14

into surgery. You’ve got to do as much physically as you can — whether it’s watching your diet and losing weight or exercising and strengthening those legs. Find something you can do because when you come out of surgery you’re going to be weaker initially.”

Ed spent a total of 12 weeks in physical therapy with The CORE Institute’s Jay Patel, focusing on increasing his range of motion, stretching, strengthening and healing.

“My job is great because I get to help people return to doing the things they truly enjoy,” Patel said.

“You’ve got to do the exercises,”

Ed said. “The range of motion is a big thing. You’ve got to stretch it out.

Your body’s healing. It’s developing scar tissue. You’ve got to stretch it. Listen to your therapist.”

LET THE FUN BEGIN! Ed and his wife Pam just bought new bikes and are ready for a summer full of adventure. His new set of knees are just that — new, different — and he’s adjusting to a new normal.

“My body’s got a new norm,” he said. “It is learning and adapting to something that’s completely new. I tell people to remember the things that you used to do. Do you miss those things? If you want to get back there, maybe it’s time.”

www.thecoreinstitute.com

RESEARCH

MORE Foundation receives grant to study shoulders

R

By Julie Maurer esearchers at MORE Foundation are working on a way to help patients with shoulder injuries get back in action faster than ever. They believe that by gaining a better understanding of how each muscle in the shoulder works, they can identify rehabilitation alternatives for daily activities.

The motion lab at MORE received a grant from DePuy, a branch of

16

Johnson & Johnson, to study, in depth, the way shoulders move and to identify which individual muscles make each movement.

CREATING RESEARCH DATA According to John McCamley, PhD, director of the MORE Foundation’s Human Motion Laboratory, the researchers will create a data set of how specific muscles move the shoulder joint.

“Studies have looked at parts

of what we want to find out, but none in total,” McCamley said.

He noted that movement is usually tracked by putting markers on the surface of the skin, and they can represent the picture of what is going on underneath.

“However, when we have the shoulder blade (the scapula) with muscles underneath, that’s hard to do,” McCamley explained. “Some of the muscles are quite deep.”

www.thecoreinstitute.com

THE SCIENCE OF MOVEMENT THE SCIENCE THEOF SCIENCE MOVEMENT OF MOVEMENT

TRACKING MOVEMENT With this study, they will use a device to track the scapula’s movement by placing a frame over it to identify where it was, and they will move the frame as the shoulder moves.

They will start their study on five subjects to develop their algorithms, some with healthy shoulders and some with rotator cuff tears.

Then, the scientists will use EMG electrodes to measure muscle activity for the main muscles that control upper arm movement. McCamley noted that most movement studies

“If they can’t move their arm a certain way, is there a way for them to do it using a different pattern of movement and different muscles?”

He’s hoping they can find ROBOTIC TESTING better ways to rehabilitate Once they have the shoulder so it will be all the human John McCamley, PhD easier for patients to do data, researchers daily tasks, such as tucking will be able in their shirts and combing their hair. to test rehabilitation methods “This data will be extremely helpful in MORE’s motion lab. for therapists when implementing “Can we use other combinations of plans for patients to return to their muscles to do the same motion as the normal activities,” McCamley said. one that was injured?” McCamley said. only target a couple of specific muscles, but the MORE team is targeting 10.

17

SPECIALTY SPOTLIGHT

Enhanced Management The CORE Institute now managed by Healthcare Outcomes Performance Company

P

atients of The CORE Institute probably haven’t noticed many changes over the past year in the way the orthopedic specialty practice is administered. But they may be glad to know that the physician management company overseeing activities has further streamlined tasks, minimized expenses for patients and most importantly, helped facilitate even better patient outcomes, directly as a result of enhanced efficiencies put in place.

Healthcare Outcomes Performance Company, or HOPCo, has been the new name since last year for the management company that has watched over The CORE Institute since 2005. HOPCo is a physician managed company focused on transforming the patient care experience and improving the delivery of medicine.

18

programs, human resources, billing, COMPREHENSIVE INTEGRATION marketing, growth opportunities, IT, HOPCo provides services for contracting, practice management, musculoskeletal-focused physician outcomes management and hospital practices, such as those offering service line management, for example orthopedic, spine, pain-management, — are services that are provided in neurological and rehabilitation very comprehensive and expertise. integrated manner.” Dr. “HOPCo offers a Scalise said. complete turnkey Dr. Scalise said solution,” explained HOPCo’s extensive Jason Scalise, M.D., an integration “unlocks a orthopedic surgeon with level of insight into an The CORE Institute who organization that allows specializes in shoulder the physicians and clinical reconstruction and Jason Scalise, MD staff to perform at levels is also HOPCo’s Vice not seen before. We have a proven Chairman and Director of HOPCo’s track record of success in all sorts National Physician Integration. of models, including freestanding “Anything and everything that has to orthopedic practices and universitydo with management of the physician based academic programs.” practice — including value-based care

www.thecoreinstitute.com

ANOTHER ARIZONA STANDOUT MANAGED BY HOPCO HOPCo’s alignment with organizations has recently included Flagstaff-based Northern Arizona Orthopaedics (NAO). “HOPCo has been very helpful,” said David Bereson, Director of Business Intelligence Joianne Meyers and Analytics for HOPCo at Northern Arizona Orthopaedics. The Flagstaff practice now benefits “from economies of scale, a qualitybased infrastructure, and a level of efficiency we did not have access to David Bereson previously. This directly benefits our patients,” Bereson said.

Joianne Meyers, the Practice

Manager for HOPCo at NAO, said the transition to HOPCo’s platforms organization took just a few short months last year.

“There was a lot of foundational work that needed to go into effect to fully ‘plug into’ HOPCo’s infrastructure she said. “We are continuing to enhance additional alignment and efficiencies.”

“As a small orthopedic practice, we would be hard-pressed to be able to access the expertise that we have now without the help of HOPCo, a much larger organization, that gives us the ability to maximize use of evidence-based platforms and programs to benefit patient outcomes,” Bereson added.

More than 150 providers continue to be part of various practices that HOPCo manages in Arizona and Michigan, Dr. Scalise said.

HOPCO LEADS THE WAY Dr. Scalise said practices such as The CORE Institute have been benefiting from turnkey practice management for years. “Physician practices are always looking to improve and to provide the best possible care in the most timely way to their patients,” he said.

“HOPCo is a vehicle that has proven it can do that very reliably and is considered a benchmark in many areas.

We also can find the best opportunities, best value and the best outcomes and deliver them to the community and to our patients. That’s why physician practices are increasingly gravitating to our model, as our ability to deliver results continues to resonate.”

NOT READY FOR MAJOR, INVASIVE SURGERY?

EXPERIENCE THE DIFFERENCE OF YOUR OWN POWERFUL FAT AWARD WINNING TECHNOLOGY FOR ORTHOPAEDICS VISIT WWW.UNDERSTANDLIPOGEMS.COM #LIPOLOVEBYLIPOGEMS AR-GCI0194180-01

NUTRITION

It’s Summer...Who’s Hungry?

Tips for grilling and eating healthy

J

By Michelle Jacoby ust as the summer temperatures rise, so do our cravings for all things grilled. From juicy turkey burgers and lean steaks, to tangy barbecue chicken and sweet, succulent shrimp, there’s nothing that captures the essence of summer better than the smoky, slightly charred flavor only grilling can produce.

While grilling is often perceived as a healthy way to cook, there can be some drawbacks — namely the chemical reactions that can turn healthy food into a health hazard. Fortunately, there are ways to make cooking food over an open

20

flame healthier, guaranteeing not only a fun summer, but a tasty one, too.

scallops, oysters, crawfish and lobsters, which don’t seem to form compounds.

BE CAREFUL OF COMPOUNDS According to the National Cancer Institute, cooking most meat at temperatures above 300 degrees can produce potentially carcinogenic compounds. Polycyclic aromatic hydrocarbons (PAHs) form when fat from the meat drips onto hot coals or grill.

They’re then deposited on the food from flame-ups and rising smoke. Heterocyclic amines (HCAs) are produced when most meats are cooked at high heat.

Fortunately, fruits and vegetables — like corn, peaches, pineapple, squash and watermelon — don’t form HCAs when they’re cooked. The same goes for most types of seafood, such as shrimp,

AVOID OVERCOOKING If you do choose to grill meat, keep in mind that some toxins produced by grilling may increase your risk of developing Type 2 diabetes. According to studies by researchers at the Harvard T.H. Chan School of Public Health, cooking on high heat can interfere with the processes that regulate inflammation and insulin sensitivity.

To limit your exposure, experts say to avoid cooking meats until charred or well done, and eat grilled meat in moderation. Also, choose a meat that’s minimally processed, like steak. Unprocessed red meat has plenty of iron, protein and vitamin B, so it’s fine to eat occasionally.

www.thecoreinstitute.com

IT’S ALL ABOUT THE MARINADE Soaking meat in a mixture of oil, water, vinegar and antioxidant rich spices like rosemary, oregano and thyme at least a half hour before grilling can at least partially prevent the formation of HCAs. In fact, some studies have shown that marinating can reduce HCAs by as much as 92 to 99 percent.

Other tips include grilling smaller portions and to flip food frequently, both of which cut down on cooking time. Another helpful tip is to give meats a quick sear or char on the grill, and then finish cooking in the oven.

Grilled Fruit Kebabs with Balsamic Drizzle 8 skewers* 2 cups pineapple chunks 2 cups watermelon chunks 2 bananas, peeled and cut into large chunks 1 package strawberries, stems discarded 2 tbsp. balsamic vinegar 2 tsp. honey 1 tbsp. canola oil Warm grill to medium-high heat. Prepare the fruit by chopping pineapple and watermelon. Peel and thickly slice bananas and remove stems from strawberries. Thread fruit onto the 8 skewers, aiming for 2 pieces of each fruit per skewer: strawberry, pineapple, watermelon, banana, strawberry, pineapple, watermelon, and banana. Place onto a platter or a baking sheet.

In a small bowl, add vinegar, honey and oil. Whisk together with a fork. Use a basting brush to glaze fruit with about half the balsamic mixture.

Add fruit kabobs to the grill. Turn while cooking and baste with remaining balsamic mixture until fruit is caramelized about 8 to 10 minutes. Remove from grill and serve. * If using wooden skewers, make sure to soak them in water for at least 30 minutes.

MAKE SKEWERS YOUR FRIEND A creative, and delicious, way to cut down on grilling time is to grill kebabs threaded with small pieces of meat, chicken or seafood, along with vegetables like bell peppers, zucchini, tomatoes and mushrooms.

For dessert, throw a couple of fruit kebabs on the grill, loaded with fresh summer fruit like pineapple, watermelon and mango.

Source: recipes.heart.org/en/recipes/grilled-fruit-kebabs-with-balsamic-drizzle

PERCUTANEOUS TENOTOMY AND FASCIOTOMY Tenex Health TX® technology is used to precisely cut and remove diseased tissue.

TX2 MicroTip

Calcific debris in the shoulder

Calcific Deposit Tendon Tissue

Common applications • • • • • •

Failure is Not an Option TX2 MicroTip

Patient benefits

Shoulder Tendinosis • Rapid pain relief and return to normal activities within 6-8 Lateral or Medial Epicondylosis weeks Gluteal Tendinosis of the Hip Patellar Tendinosis • Minimally invasive - typically performed with local anesthetic Achilles Tendinosis Plantar Fasciosis • Well-tolerated and quick procedure time

Contact us at Info@TenexHealth.com | 949.454.7500 TenexHealth.com | 26902 Vista Terrace, Lake Forest, CA AR-0008870369-01

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.

Find a location near you at

team-rehab.com

NUTRITION

Minted Tomato, Onion & Glazed Tofu Kebabs 1 package (14 oz.) extra-firm, water-packed tofu, drained 1 tbsp. lime juice 1 tbsp. reduced-sodium soy sauce 1 tsp. minced fresh ginger 16 fresh mint leaves 4 plum tomatoes, quartered and seeded 1 onion; peeled, quartered and separated into layers 2 jalapeĂąo peppers, seeded and cut into 1/2-inch pieces 1/4 cup kecap manis (palm sugarsweetened soy sauce)

Marinated Grilled Vegetable Kebabs 1/4 cup extra-virgin olive oil 1/4 cup balsamic vinegar 2 cloves garlic, minced 1 tbsp. Italian seasoning 1 tsp. salt 1/2 tsp. ground pepper 16 cherry tomatoes 12 mushrooms (medium) 1 zucchini, cut into 1/4-inch slices 4 slices (1/4-inch) red onion Whisk oil, vinegar, garlic, Italian seasoning, salt and pepper in a large bowl. Add tomatoes, mushrooms, zucchini and onion slices and toss well to coat. Marinate in the refrigerator for at least 1 hour and up to 4 hours.

Preheat grill to medium. Remove the onions from the marinade and cut into quarters. Thread the vegetables onto eight 8-inch skewers. Grill, turning once, until tender, 12 to 15 minutes total. Drizzle with the remaining marinade, if desired.

Cut tofu in half horizontally, making two large slices about 1-inch thick. Fold a clean kitchen towel and place it on a cutting board or large plate. Set the tofu on the towel. Put another folded clean towel over the tofu and place a flat, heavy weight (such as a skillet) on top; drain for 15 minutes. Remove the weight and cut the tofu into 1-1/2-inch pieces.

Preheat grill to medium-high. Combine lime juice, soy sauce and ginger in a medium bowl. Add tofu and toss to coat.

Cover and marinate in the refrigerator for 15 minutes. Tuck a mint leaf into each tomato quarter and thread onto 4 or 8 skewers alternately with tofu, onion and jalapenos. Discard any remaining marinade.

Oil the grill rack and grill the kebabs, turning occasionally, for 7 minutes.

Brush with kecap manis and grill until the vegetables are softened and the tofu is well glazed, about 3 minutes more.

Source: eatingwell.com/recipe/248307/ minted-tomato-onion-glazed-tofu-kebabs

Source: eatingwell.com/recipe/270118/marinated-grilled-vegetable-kebabs

22

www.thecoreinstitute.com

Short Bore 49.2 in

The Best Option for Claustrophobic Patients Without Compromising Image Quality

•

Accommodates patients of all sizes, with a table limit of up to 550 lbs

•

1 foot of spacious headroom: eliminates the feeling of being nose-to-nose with the top of the magnet

•

Most exams performed with your head outside the scanner

•

Unlike the Open MRI, the 1.5 Tesla Short Bore provides the best image quality for a more accurate diagnosis

Siemens MAGNETOM Espree the New Definition of Open MRI available at:

Union Hills Office 18444 North 25th Ave. Suite 140 Phoenix, AZ 85023 Schedule your appointment online at valleyradiologists.com or call 623.847.2000 AR-0008870381-01

27.6 in 11.8 in

Together we can transform orthopaedics.

Every day, hospitals across the world are transforming orthopaedics with Mako Robotic-Arm Assisted Surgery.

Isn’t it time you meet Mako?

A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any particular product before using it in surgery.

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.

Please contact your sales representative if you have questions about the availability of products in your area. Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Mako, Stryker. All other trademarks are trademarks of their respective owners or holders.

MKORIO-AD-8 MKORIO-AD-9 07/16