CORE Ink - Fall 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

®

FALL 2019

Gone Fishin’

Ablation procedure for pain rejuvenates 80-yearold angler

Cutting-Edge Research Study brings new energy to rotator cuff repair surgery

Strength of Will A Valley woman’s courageous journey to overcome a debilitating injury

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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 3 – FALL 2019

FROM THE CHAIRMAN

Change is in the Air

I

t’s that time of the year again. Vacation memories have been packed away, the kids are back in school, and the searing heat of summer is yielding to the invigorating days of autumn. The season has changed.

Change, as in changing things for the better, is a hallmark of The CORE Institute, and our Fall Issue of “CORE Ink” offers ample evidence of that.

Our inspiring cover story features Ashley Owens, a young woman who lost the ability to walk after a seemingly minor injury. She spent a year in agonizing pain and was losing hope that any doctor could help her. But then she turned to The CORE Institute’s Dr. Ali Araghi and you’ll read how he established her diagnosis and developed the treatment plan that gave Ashley a second chance at life.

You’ll also read how Dr. Kelly Krohn, leader of The CORE Institute’s nationally-renowned Bone Health Program, has developed innovative treatments that offer new optimism to the millions of people suffering from osteoporosis.

Plus, we’ll take you inside a major study being conducted by The CORE Institute and MORE Foundation to improve the outcomes of rotator cuff surgery, show you how our cutting-edge pain management techniques helped an 80-year old fisherman set sail once again, and explain how The CORE Institute is educating the next generation of medical experts through one of America’s most prestigious fellowship programs.

I hope you enjoy these stories of change, because we are excited to share them with you. And we are, as always, very grateful for the trust you put in The CORE Institute. It is our privilege to serve you.

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

12 COVER STORY

Strength of Will A Valley woman’s courageous journey to overcome a debilitating injury. 8

PATIENT CARE

8 20

Ablation procedure for pain rejuvenates 80-year-old fisherman. 12

D E PART M E N T S

connect with us 1.866.974.2673

Gone Fishin’

What’s New?

Research

6 T he CORE Institute is pleased to introduce its new providers

16 S tudy brings new energy to rotator cuff repair surgery

Specialty Spotlight

Ask the Expert

7 The CORE Institute’s advanced training program helps physicians become experts

18 K elly Krohn, MD, answers questions about osteoporosis

Nutrition 20 S low and easy wins the day for healthy cooking

www.thecoreinstitute.com

5

WHAT’S NEW NEW PROVIDERS BRIGITTE FLANAGAN, DO specializes in

interventional spine and pain management.

Before joining The CORE Institute, Dr. Flanagan worked as an anesthesiologist caring for patients with Valley Anesthesia Consultants. Prior to this, she served in the United States Air Force, giving medical support to our troops. Dr. Flanagan completed her residency at Tufts University.

She received her Doctor of Osteopathic Medicine at Midwestern University in Glendale, Arizona. She also completed a transitional internship at Wilford Hall Medical Center in San Antonio. Dr. Flanagan gained her masters and bachelor’s degrees from Rivier College in Nashua, New Hampshire graduating cum laude.

ROBERT RAVINSKY, MDCM, MPH, FRCSC is board certified and fellowship-trained orthopedic spine surgeon. Dr. Ravinsky joins The CORE Institute following his fellowship training at Cedars-Sinai Medical Center in Los Angeles, California. Prior to California, Dr. Ravinsky fulfilled a spine fellowship in Canada at Toronto Western Hospital. Dr. Ravinsky completed his residency in orthopedic surgery at University of Toronto, in Canada. Before completing his Master of Public Health at Harvard University in Massachusetts, Dr. Ravinsky received his medical degree in Canada at McGill University where he also obtained his bachelor’s degree.

SHAD SIDDIQI, DO is a fellowship-trained physician special-

izing in interventional spine and pain management, chronic pain, and anesthesiology. Dr. Siddiqi received his fellowshiptraining from Henry Ford Hospital in Detroit, Michigan. He completed his residency in anesthesiology at the University of Michigan and earned his Doctor of Osteopathic Medicine at Michigan State University College of Osteopathic Medicine. While obtaining his degree, Dr. Siddiqi assisted in a research project on the ability of ultrasound to detect bicipitoradial bursitis of the elbow compared to CT scans. Dr. Siddiqi obtained his bachelor’s degree at Michigan State University, graduating magna cum laude.

Scheduling an appointment

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

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

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SPECIALTY SPOTLIGHT

FELLOWSHIP IN EXPERTISE The CORE Institute’s advanced training program helps physicians become experts

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By Debra Gelbart ou may not realize that The CORE Institute physicians, as experts in their specialty, are also teaching the next generation of physicians in the latest advances, research and techniques in orthopedics and musculoskeletal medicine through The CORE Institute’s nationally recognized Fellowship training programs.

Fellows are fully licensed physicians who have completed residency training in orthopedics or musculoskeletal medicine and are choosing to participate in an additional year-long rigorous course of advanced and fully supervised training in a specific area.

EXCLUSIVE TRAINING Options for these doctors include an emphasis on either joint reconstruction and replacement surgery, shoulder surgery, trauma surgery, foot and ankle surgery or interventional spine/ pain management, said Jason Scalise, MD, an orthopedic surgeon with The CORE Institute who specializes in shoulder reconstruction. In addition, the Hand Surgery Fellowship that The CORE Institute began in conjunction with the University of Arizona is the only Hand Surgery Fellowship training program in Arizona.

This year, 11 Fellows are enrolled in

The physicians at The CORE Institute The CORE Institute’s Fellowship proare themselves fellowship-trained, he grams. “Residency programs are known added. “The level of difficulty and comfor training physicians to be well-versed plexity in modern orthopedics is so high in all aspects of orthopedics and musnow that without dedicated fellowship culoskeletal care,” Dr. Scalise said. “But training, it’s challenging to remain at the the year spent in Fellowship training is a focused time in that area and it provides a forefront of and have the skill set without it. Many would say that there is simply much higher degree of competency and not enough time to learn everything in expertise in that discipline.” The CORE five years of orthopedic training if you Institute has had dedicated Fellowship want to be the best at what you do.” programs since its inception in 2005, and

it has always been “integral to what we DEDICATED TRAINING do — providing education and training Not only do the Fellows become more for highly qualified physicians, always educated, he said, the faculty — innovating and improving overall patient fellowship-trained surgeons care,” Dr. Scalise said. and mentors on staff at The

CORE Institute — learn ADVANCED more as well.

OPPORTUNITY IN “The mentors have to HIGH DEMAND maintain the highest level The Fellowship program of expertise in order to is highly competitive, properly train those in the said Dr. Scalise.The fellowship program.”

CORE Institute receives So “the next time you see hundreds of applications Jason Scalise, MD a CORE Institute physician from candidates each teaching and educating another year from all over the U.S. and the well- trained physician in the clinic or world for just a handful of positions. the operating room,” Dr. Scalise said, “These are highly sought-after positions “you’ll know that The CORE Institute is given the track record of training, rigor continuing its mission of education and and expertise that The CORE Institute innovation for the next generation of provides,” Dr. Scalise said. “The experts and by doing so, holding itself to candidates know that a year spent the highest possible standards.” with us will be intense but rewarding.”

7

COVER STORY

8

www.thecoreinstitute.com

A Valley woman’s courageous journey to overcome a debilitating injury

PERSEVERING through the pain

By Meghann Finn Sepulveda | Photos by Mark Lipczynski

F

our years ago, Ashley Owens was coaching basketball in Kingman, Arizona, when she was knocked down and suffered a painful landing. The active and healthy 31-year-old felt sharp pain when she was sitting and walking, but she pushed through and continued doing normal activities. Ashley was working as a traveling physical therapist and, days later, while lifting a Ali Araghi, DO patient’s legs into bed, she aggravated the injury. The pain became so severe, she could no longer walk.

For nearly a year, Ashley saw doctors and specialists and tried almost everything including medication, physical and

psychological therapies, injections and nerve ablation to stop the pain. It wasn’t until she met Ali Araghi, DO, a board certified and fellowship-trained orthopedic spine surgeon and the director of the spine division at The CORE Institute, underwent minimally invasive sacroiliac (SI) joint fusion surgery, that the pain was finally alleviated.

HITTING ROCK BOTTOM As an experienced physical therapist, Ashley is very knowledgeable about how muscles and joints work together and move within the body.

When she was injured, she was immediately aware that something was wrong.

“I thought I had injured my sacroiliac joint and the pain was excruciating,” she

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recalled. “I couldn’t function and lost the ability to take care of myself.”

The sacroiliac joint is the strong connection that is formed where the bottom of ones spine meets the pelvis. When the sacroiliac joint is disrupted, it can cause inflammation and severe, debilitating pain in the lower back, as well as the pelvis, groin and hip. Many physicians have a hard time identifying a SI joint injury because it does not always easily appear on diagnostic imaging studies such as MRI or X-ray.

Ashley spent the next eight months enduring physical therapy and seeing several specialists to obtain an effective

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treatment plan. She tried everything but her condition continued to worsen.

“Eventually, I was completely bedridden and had to move into an assisted-living facility where I spent the next two years,” she said. “The doctors I saw couldn’t help me and I thought I would never walk again.”

HOPE ON THE HORIZON In September of 2017, Ashley met with Dr. Ali Araghi at The CORE Institute.

“Ashley was transported by gurney to the appointment because she had no mobility,” Dr. Araghi said. “I knew she was in extremely poor condition and had

FOR MORE INFORMATION exhausted all other treatment options.”

After reviewing Ashley’s medical history and performing a physical exam, Dr. Araghi consulted with the pain management team and ordered a numbing medication to be injected into Ashley’s sacroiliac joint in order to identify the pain source.

“It was evident that the injection significantly reduced her pain,” Dr. Araghi said.

Following the appointment, Dr. Araghi determined that Ashley was a good candidate for SI joint fusion surgery, where spine surgeons fuse the sacroiliac joint during a minimally invasive procedure.

RELIEF FROM PAIN In October of 2017, Ashley underwent SI joint fusion surgery at The CORE Institute on the left side of her sacrum. Two months later, Dr. Araghi performed the surgery on her right side.

“After surgery I was immediately able to stand and walk a few feet with a walker,” she said. “The surgeries completely resolved my pelvic pain.”

Today, Ashley goes to physical therapy and is still working on regaining strength and range of motion that was lost during the time she was bedridden. Although she admits the healing process has been slow, she is making excellent progress.

Learn more about SI joint fusion surgery at The CORE Institute by visiting thecoreinstitute.com.

After years of enduring pain, Ashley is excited for her future.

“I’ve returned to swimming, lifting light weights and shooting hoops and hope to go skiing this winter,” she said. “I am thankful for those who helped me survive this ordeal and am filled with gratitude for my incredible family, friends and team of healthcare professionals, including Dr. Araghi, who gave me a second chance at life.”

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GONE FISHIN’ Ablation Procedure for Pain Rejuvenates 80-Year-Old Fisherman

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PATIENT FEATURE

V

By Brian Sodoma incent Depaulis has led a full and active life.

He grew up around his father’s restaurant business in Michigan and developed a passion for cooking and gardening, as well as fishing.

Years later, after enjoying an engineering career in the auto industry, Depaulis fully committed himself to doing those three activities he enjoys as much as possible in his retirement years. Unfortunately, nagging, and even debilitating back pain cut into Vincent’s plans.

NEEDING TO FIND ANSWERS The pain stemmed from an injury when he was younger and was exacerbated by activity through the years.

By his mid-70s, the rarely idle senior was running out of answers. He turned to cortisone shots for years, but the time windows without pain grew shorter and shorter, and Vincent’s will and determination could only take him so far.

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“It zaps all your strength. I couldn’t go fishing. I couldn’t do my gardening … even cooking became difficult because you’re standing so much,” he said.

At 76, he met with specialists at The CORE Institute, a move that has Depaulis now feeling younger than he’s felt in years. “I go to the gym. I don’t eat processed foods or sweets. My weight is right where it should be. I want a good quality of life. I want to keep fishing until I’m 90,” he added.

MANAGING THE PAIN With his new lease on life, Depaulis also turned to the ablation technology for neck and knee pain. In the past four years, he has also made The CORE Institute his ‘go-to’ for all his pain management needs; he has utilized stem cell therapies and other pain treatments as well.

“I like to check in with them. I’m a frequent visitor,” he added. “I don’t mind sharing my story with other individuals, ABLATION TECHNOLOGY too. I don’t mind talking about all that CHANGES EVERYTHING Michael Slesinski, DO they’ve done for me.”

Depaulis worked with The CORE Depaulis’ experience also motivates Institute’s Dr. Michael Slesinski, an others, including his own doctor. interventional spine and pain management specialist “It’s the whole reason I went into physical mediwho suggested a radio frequency ablation procedure cine and rehabilitation,” Dr. Slesinski said. “You’re for his back pain. The treatment involves using a really not just focusing on pain, you’re focusing on hollow needle with a probe inside it. Radio waves transforming these people’s lives and being able to heat the probe’s tip and allow it to burn sensitive improve their function to get them back doing the nerves in painful joint areas, decreasing pain signals things they really want to do.” to the body, explained Dr. Slesinski.

For an active adult like Depaulis, getting back to A couple of days after the short outpatient procethe things he loves, without pain, is his prescription dure, Depaulis felt like a new man. for a joyful life.

“Your pain is never completely gone, but it’s about 85 percent gone. It has left me with a great quality of Learn more at thecoreinstitute.com or call (844) life,” he said.

304-3522.

14

www.thecoreinstitute.com

RESEARCH

HEALING SCIENCE Study brings new energy to rotator cuff repair surgery

By Elise Riley

T

he CORE Institute and MORE Foundation are conducting a study of a procedure that appears to improve outcomes of rotator cuff surgeries. In the study, participants wear a device that stimulates the shoulder with pulsed electromagnetic fields, which may aid in healing.

“It’s technology that has been previously used to heal bones, known as a bone stimulator,” said Dr. Michael Amini,

16

a shoulder and elbow surgeon with The CORE Institute. “It’s shown good promise for rotator cuff healing in basic science studies, and we’re trying to prove that in a clinical setting.”

FASTER HEALING On average, Dr. Amini said, repaired rotator cuffs re-tear 20 to 30 percent of the time. If the device helps the tendon heal, it could reduce the rate of reinjury and provide both better function and strength.

“A lot of the focus of current rotator cuff research is on improving the biology of healing,” Dr. Amini said. “The device may provide a stimulation effect to the repair. If you have a cut on your skin that gets stitched up, the skin has to heal. The rotator cuff is the same but at a much slower speed. This is trying to stimulate (the tendon) to make it heal faster and speed up the recovery.”

In the study, participants wear the device for 90 minutes a day the first six months after rotator cuff surgery. The

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FOR MORE INFORMATION To learn more about the study and to find out about participating, visit MORE Foundation at more-foundation.org/research.

team will follow their progress for two years.

COMMON PROBLEM It’s estimated that one in four people will have a torn rotator cuff tendon by the time they reach age 65. While not all people who have torn rotator cuffs experience pain or loss of function, it is a frequent problem as people age.

“It’s very common because of the wear and tear our shoulder sees over the course of a lifetime,” Dr. Amini said.

“But a lot of people don’t have any symptoms. They’re not in pain.”

For those who do need an operation because of pain or lack of function that has not responded to nonsurgical treatments, it generally takes 6-12 months to fully recover following rotator cuff surgery. The majority of healing takes place during the first three to six months.

HIGH EXPECTATIONS The CORE Institute and MORE Foundation have great hopes for the

study. “This is an exciting opportunity for rotator cuff tear patients because the only way to obtain this cuttingedge treatment is to participate in this clinical trial,” said Marc Jacofsky, PhD, Executive Director of MORE Foundation and Chief Scientific Officer for The CORE Institute.

“This further demonstrates how the relationship between MORE Foundation and The CORE Institute benefits the patients in the communities we serve and helps to Keep Life in Motion.”

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ASK THE EXPERT

OSTEOPOROSIS? Kelly Krohn, MD, Medical Director of The CORE Institute’s Bone Health Program, answers questions

T

By Julie Maurer he numbers are staggering: Osteoporosis affects 44 million people in the United States and is responsible for an estimated 2 million fractures every year.

For patients with osteoporosis, which is a weakening of the bones due to age and hormonal changes, any bump or fall can put them at risk for fractures. In fact, it’s the most common reason for broken bones among the elderly. But The CORE Institute offers best-in-class care to help those

18

suffering from osteoporosis.

Kelly Krohn, MD, is Medical Director of The CORE Institute’s Bone Health program. He is a board-certified and fellowship-trained rheumatologist with a unique background in medicine and pharmaceuticals related to bone metabolism.

He’s made it his mission to develop a treatment plan for patients to avoid future breaks.

“Osteoporosis is a condition of bone fragility,” says Dr. Krohn.

“We are worried that Kelly Krohn, MD if you fall, or in many cases when you fall, the chances of you breaking a bone are very high.” So, there’s also an emphasis on preventing falls.

While osteoporosis is commonly detected by a bone density test, Dr. Krohn notes that it is not always perfect.

“Think of it like a cholesterol test.

There are people out there who still have heart attacks with normal cholesterol,” he said. “But it’s a test that a smart clinician can interpret with additional questions into the patient’s history and determine if that patient is at high or low risk of breaking more bones.”

The age factor can also be misleading. While osteoporosis is indeed linked to getting older, Dr. Krohn says he has also seen younger patients with the disease.

www.thecoreinstitute.com

“Another myth is that osteoporosis is a women’s disease. I saw five male patients with it today,” he said. “Men are living longer these days, so we are seeing it more often.” Even so, Dr. Krohn reports seeing two female osteoporosis patients for every male.

“The average woman doesn’t achieve as high a bone mass (the measure of minerals contained in bone) as the average man and then, when a woman goes through menopause, they rapidly lose bone density and then continue to lose it as they age,” he said. “The lack of estrogen leads to significant bone loss.”

Dr. Krohn says that’s why it is never too early to think about bone health.

“If you have little girls in your lives,

“If you have little girls in your lives, make sure they have good nutrition as they are growing. Your bone health is a consideration of the entire lifespan.” — Kelly Krohn, MD

make sure they have good nutrition as they are growing. Your bone health is a consideration of the entire lifespan,” he said.

Treatment options for osteoporosis include some medications that help maintain bone density and others that stimulate bone growth.

“We have very good treatments to reduce the likelihood of a fracture, by at

least 50 percent, and some by even 85 percent.” Krohn said.

“There are seven or eight approved medications available to us now. So, we figure out the right one for the right patient, and one they can afford.”

And he says exercise can offer dual benefits, improving bone health and keeping patients on their feet.

“I’ve sent patients to Tai Chi — it’s a wonderful way to improve balance and prevent potentially catastrophic falls.”

So, as you think about staying healthy in everything you do, don’t forget about your bone health. Your bones have brought you this far; let the Bone Health experts at The CORE Institute help you keep them strong to keep going further.

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NUTRITION

Slow and easy wins the day Slow cooking is perfectly healthy for these fast times

W

By Michelle Jacoby ith back-to-school often meaning back-to-back activities, this time of year can be hectic and challenging — especially when it comes to mealtime. After a grueling day at work, the kids’ homework and extracurriculars, the last thing you want to do is hover over a hot stove.

That’s why slow cookers set the perfect pace for fast times. A few minutes in the morning (or even the night before) free you up for the rest of the day, and dinner will be ready when you are.

20

THE GO-TO GADGET Old or new, there’s a reason the slow cooker remains a gadget go-to for busy families. Offering maximum taste for minimal effort, simply drop the ingredients into the pot, turn it on and walk away. Allowing foods to braise the day away means broths and sauces are richer, meaty morsels more tender, and flavors fully permeate every piece.

While there are whole cookbooks dedicated to slow cooking, as well as endless recipes online, slow cookers are almost so foolproof you can create meals without any instructions at all.

Many delicious dinners have come from combining a little of this, a little of that and in an instant, you’ve got a hearty and healthy meal just waiting to be devoured.

SOMETHING FOR EVERYONE While the idea of slow cooking conjures up images of hearty stews, heavy roasts and cream-based meals, slow cooking can actually help keep your meals healthier. For instance, you typically don’t need to add extra fats when cooking meals in a slow cooker. You can also use lean cuts of meat that could otherwise be tough if cooked over a stove.

In addition, people with dietary restrictions need not fear since this handy appliance can adapt to recipes of all kinds in fix-it-and-forget-it fashion. Soups, stews, casseroles, pastas and even meatloaf come out flavorful and moist, without drying out like they can in the oven. In fact, the sealed-in moisture ensures even tougher cuts of meat and the densest root veggies come out perfectly cooked.

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BE A MEAL PREP MASTER To further help make mealtime simpler during an over-scheduled week, consider meal prepping. Practiced “preppers� know it’s a proven way to help busy, health conscious people and their families stay on track with their eating plans by keeping nutritious meals and snacks at the ready.

But for many, the thought of spending hours in the kitchen on Sunday just to save a few minutes during the week — or eating the same thing for days in a row — seems overly complicated, a tad monotonous and frankly, not worth the effort.

According to registered dietician and nutritionist Kristina Hallberg, meal prep doesn’t have to be complicated or boring, and it really can help you eat better while spending less time and money on food. “We all know we’re going to get hungry and need to eat, and most of us know what we should be eating to manage our weight and health,� she says. “It’s lack of planning that causes us to make poor choices.�

Slow-Cooker Blueberry Oatmeal Unsalted butter, for greasing 3 cups whole milk 2 cups water 2 cups old-fashioned oats 1/4 cup brown sugar 2 tbsp. maple syrup, plus more for serving 2 tsp. vanilla extract 2 tsp. cinnamon 1/4 tsp. kosher salt 1 cup frozen blueberries 1/4 cup shredded coconut Butter the inside of your slow cooker. Add in all ingredients except blueberries and coconut. Cook, stirring occasionally, on high for 4 hours, or on low for 8 hours. In the last 10 minutes of cooking, turn dial to warm and gently stir in the blueberries and coconut. Serve topped with maple syrup.

Source: www.delish.com/cooking/recipe-ideas/a50916/slow-cookerblueberry-oatmeal-recipe

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NUTRITION

Slow Cooker Zucchini Lasagna

Slow Cooker Honey Garlic Chicken and Veggies 8 bone-in, skin-on chicken thighs 16 oz. baby red potatoes, halved 16 oz. baby carrots 16 oz. green beans, trimmed 2 tbsp. chopped fresh parsley leaves Sauce 1/2 cup reduced sodium soy sauce 1/2 cup honey 1/4 cup ketchup 2 cloves garlic, minced 1 tsp. dried basil 1/2 tsp. dried oregano 1/4 tsp. crushed red pepper flakes 1/4 tsp. ground black pepper In a large bowl, combine soy sauce, honey, ketchup, garlic, basil, oregano, red pepper flakes and pepper. Place chicken thighs, potatoes, carrots and soy sauce mixture into a 6-quart slow cooker. Cover and cook on low heat for 7 to 8 hours, or on high for 3 to 4 hours, basting every hour. Add green beans during the last 30 minutes of cooking time.

Optional: Preheat oven to broil. Place chicken thighs onto a baking sheet, skin side up, and broil until crisp, about 3 to 4 minutes. Serve chicken immediately with potatoes, carrots and green beans, garnished with parsley, if desired.

15 oz. part-skim ricotta 1 large egg 1/4 cup freshly grated Parmesan cheese 1 cup spinach, chopped Salt and pepper 4 cups homemade tomato sauce or your favorite sauce 4 medium zucchini, sliced 1/8-inch thick 16 oz. part-skim mozzarella cheese, shredded 2 tbsp. parsley, chopped In a medium bowl mix ricotta cheese, egg, Parmesan cheese, spinach. Stir well and set it aside. Lightly coat the inside of the slow cooker with cooking spray. Ladle about 1 cup tomato sauce on the bottom of the slow cooker and spread it well. Layer 5 or 6 zucchini slices to cover. Place some of the ricotta cheese mixture and top with the mozzarella cheese. Repeat the layers until all your ingredients are all used up. Top the lasagna with mozzarella and Parmesan cheese. Cover and cook on high for 3 to 4 hours.

Turn off the slow cooker and let stand for about 3 hours. Before serving, top with fresh parsley.

Note: Grill zucchini slices before placing in the slow cooker. This will help draw out some of the moisture and prevent the lasagna from being soupy.

Source: www.primaverakitchen.com/slow-cookerzucchini-lasagna/#wprm-recipe-container-27359

Source: damndelicious.net/2015/06/05/slow-cooker-honey-garlic-chicken-and-veggies/

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