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A P U B L I C A T I O N O F T H E C O R E I N S T I T U T E

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WINTER 2019

Brace Yourself Researchers finding better, safer fits for braces

Fall Prevention

Check your 3 types of risk factors

The Golden Years

Tom and Brenda returned to an active, pain-free retirement


Robots are helping replace your knee   

Robotic-assisted technology improves knee replacement surgery

   

10 YEARS AGO

Patient was required to stay in hospital 1-2 NIGHTS

NOW

Patient goes home the SAME-DAY

   10 YEARS AGO

Patient was required to stay in hospital 3-4 NIGHTS

NOW

Patient may stay 1 NIGHT

BROUGHT TO YOU BY

  FIND AN ORTHOPEDIC DOCTOR NEAR YOU

602.346.9827 OR VISIT BANNERCORECENTER.COM CALL

10 YEARS AGO

SEVERAL MONTHS

NOW

6-8 WEEKS,

patients encouraged to walk the same day of procedure

Sources: Gerontol A Biol Sci Med Sci. 1995 Nov;50 Spec No:5-8, American College of Sports Medicine, Exercise and the Older Adult, US Department of Health and Human Services, Osteoporosis Research, Education and Health Promotion, Annals of internal medicine (Impact Factor: 16.1). 04/1996; 124(6):568-72, J Am Geriatr Soc. 1995 Jul;43(7):756-60, J Am Geriatr Soc. 2004 May;52(5):657-65, Health Day March 11, 2014, Journal of Strength & Conditioning Research: October 2012, Volume 26, Issue 10, p 2806-2811, Archives of Internal Medicine August 6, 2012, Nutrition & Metabolism May 17, 2012


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WELCOME VOLUME 10, ISSUE 4 – WINTER 2019

FROM THE CHAIRMAN

Gratitude and Giving

T

he holiday season is deeply imbued with these concepts, and so is this issue of CORE Ink, which I am delighted to share with you. Gratitude and giving. Our cover story focusses on how crippling pain imperiled the active retirement plans of Brenda and Tom Bill. It took a team of health care professionals to accurately access their conditions and come up with the right procedures to get them back on their feet. Mr. and Mrs. Bill found that special team right here at The CORE Institute. You’ll also read about the health struggles of a young father named Elliot Munro, who twice overcame cancer, but was destined to have his foot amputated until his wife found The CORE Institute’s Dr. Jeffrey Holmes. The skills and dedication of Dr. Holmes, coupled with Elliot’s courage and dedication, resulted in an outcome that has the whole Munro family extra thankful this year. Just in time for Christmas, we will tell you how The CORE Institute’s Dr. David Markel helped a Santa performer, Ron Kozdron, get the new knees he needed to repeat his beloved performance at one of America’s most historic villages. Plus, this issue brings some vital information about avoiding potentially devastating falls, takes you behind the scenes as the MORE Foundation studies medical braces for safety and comfort, and offers up some nutrition tips for healthy holiday meals. All of this is shared in a spirit of true thankfulness…for the trust our patients place in The CORE Institute to deliver best-in-class care, and for giving us the opportunity to serve you, our treasured patients. Whether a patient or a caregiver this season, may your holidays be filled with love and good health!

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

The Golden Years Tom and Brenda returned to an active, pain-free retirement. 8

PATIENT CARE

18

Stand and Deliver! History buff, educator loving life after bilateral robotic knee replacement. 12

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

20 connect with us 1.866.974.2673

Specialty Spotlight

Ask the Expert

18 C  ORE surgeon tackles rare ankle replacement case involving 3D-printed bone

7 C  heck your 3 types of risk factors for falls

Nutrition

Research

20 H  ost a healthy, holiday dinner party.

16 MORE Foundation research is finding better, safer fits for braces

www.thecoreinstitute.com

5


WHAT’S NEW NEW PROVIDERS DR. THOMAS ACOTT is a fellowship-trained orthopedic physician specializing in hand & upper extremity surgery. Prior to joining The CORE Institute, Dr. Acott obtained his fellowship training in hand and upper extremity surgery at the Indiana Hand to Shoulder Center. Prior to his fellowship, Dr. Acott completed his orthopedic residency at Campbell Clinic in Memphis, Tennessee where he also served as the Administrative Chief Resident. Dr. Acott also spent time in the community serving as a Team Physician for Tennessee high school football teams. Dr. Acott received his Doctor of Medicine degree from Saint Louis University - School of Medicine, graduating Magna Cum Laude. He is a current member of American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, American Association for Hand Surgery, and the American Medical Association.

DR. CHRISTOPHER DESUTTER

is a fellowship-trained orthopedic surgeon specializing in foot and ankle surgery. Prior to joining The CORE Institute, Dr. DeSutter completed his fellowship in foot and ankle reconstruction at the Queen Elizabeth II Health Sciences Center in Halifax, NS, Canada. Before entering his orthopedic fellowship program, he obtained his board certification in orthopedic surgery through the Royal College of Physicians and Surgeons of Canada. Dr. DeSutter received his medical doctor degree with special training in research designation and completed his post-graduate orthopedic surgery residency training at the University of Alberta. Dr. DeSutter has affiliations with the American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, American Orthopedic Foot and Ankle Society, Canadian Orthopedic Association, and the American Medical Association.

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ASK THE EXPERT

Fall Prevention Check your 3 types of risk factors

M

By Julie Maurer ore than 3 million people are treated in emergency rooms every year as the result of a fall, according to the Centers for Disease Control. It also reports that one in five falls results in serious injuries, which makes fall prevention more important than ever. The CORE Institute’s Dr. Victor Nwosu, says he educates his patients about three areas when it comes to fall prevention — biological, behavioral and environmental. BIOLOGICAL RISKS Biological risks for falls include chronic health conditions, muscle weakness, side effects to medications or vision problems. Prevention tips include: >> Regular visits to a primary care physician to review medications >> Annual vision checks >> Having feet checked for neuropathy >> Exercise

Dr. Nwosu recommends patients participate in yoga or Tai Chi. “It strengthens the patient and provides balance. It’s good for building both upper and lower body strength,” he said. BEHAVIORAL RISKS Behavioral risks for falls include inactivity and risky behaviors. Walking outside in inclement weather without appropriate shoes and drinking too much alcohol are also behavioral risk factors. “Trying to get something out of their closet while standing on something unstable or not asking for help could be a risk ... It’s better to ask for help than to end up in the Victor Nwosu, DPM emergency room with a fracture,” Dr. Nwosu said. Dr. Nwosu once again recommends appropriate exercise when possible, plus investing in sturdy, supportive shoes and not being afraid to ask for help when needed.

ENVIRONMENTAL RISKS Environmental risks for falls include: >> Clutter in the home >> Poor lighting >> Lack of grip bars in bathrooms >> Area rugs >> No stair railings Installing safety bars and better lighting in the home are good ways to reduce these environmental risks and Dr. Nwosu strongly recommends a weekly cleanup of clutter. “If you’re having a hard time navigating through your living room, it’s time to clean it up,” he said. While some people may have a hard time accepting the need to make changes in the home or letting others help them, Dr. Nwosu says they often change their minds when they realize just how dangerous falling can be. “I explain to my patients all the statistics surrounding falls and why they want to avoid them,” Dr. Nwosu said. “You could easily end up in a longterm care facility for a year, or worse. Plus, those who fall once are 2 to 3 times more likely to fall again.” Conducting routine reviews of biological, behavioral and environmental risk factors for falls can go a long way in preventing them.

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COVER STORY

8

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THE GOLDEN YEARS Tom and Brenda Bill returned to active, pain-free retirement By Elise Riley

| Photos by Benjamin Braman

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SEEKING HELP hen Tom and Brenda Bill Brenda feared her right knee would need dreamt about retirement, they replacement. She had routine cortisone envisioned playing on jet skis, injections, then gel injections, to provide pain feeling the Arizona sun on their relief. But her “bone on bone” pain wasn’t faces and taking long walks with their dog in ceasing, and she turned to Dr. Steven the winter. Myerthall of The CORE Institute But the reality was for the next step. something different. The Bills, “Knee replacement surgery is who retired from careers with essentially the last resort that a Chicago-area school people should consider when district, found their health other options no longer help,” problems followed them said Dr. Myerthall, an orthopedic south. Tom, 70, experienced surgeon who specializes in hip crippling back pain, and and knee replacement surgery. Brenda, 68, knew her right Steven Myerthall, MD Dr. Myerthall recommends knee was beginning to falter. preparations before a knee They felt old. surgery. Have meals ready in the freezer. “We felt like we could have a more active, Know who is going to drive you to physical outdoor lifestyle,” Brenda said. “Back in therapy. Have someone available for those Chicago, we didn’t see the sun very often. crucial first weeks. We figured we’d be healthier [in Arizona].”

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But, for Brenda, her person was Tom, and his back pain had gotten so crippling, he was literally brought to his knees. They weren’t sure how they would get through the surgery and recovery together. “I was crawling around the house,” Tom said. “It had progressed to a point that I knew I had something going on that was really severe.” FINDING ANSWERS Tom’s primary care physician ordered an MRI. He received an initial reading that wasn’t comforting. “The exact quote was, ‘Your back is a mess,’” Tom remembers. “Nothing short of spinal surgery would correct my problem,” he was told.

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“It was almost miraculous. I went in for an epidural and that afternoon Brenda and I were walking around Sam’s Club.” – Tom Bill colleague at The CORE Institute, Dr. Anuj Daftari, a pain management specialist, for an epidural steroid injection. “Back pain can originate from multiple different causes,” Dr. Daftari said. “It varies from patient to patient. Some patients require one shot and they might be good for many years while others may need to have it repeated in a few months. It depends on when the pain returns.” For Tom, it was very successful. “It was almost miraculous,” he said. “I went in for an epidural and that afternoon Brenda and I were walking around Sam’s Club.”

NON-SURGICAL OPTIONS The couple was calculating how to While Tom clearly was in pain, Dr. Hirsch combine surgeries on their calendars. thought it could be alleviated without Who would go first? Who would be surgery. healthy to drive, when? “I tend to operate on That’s when Tom took his patients for nerve own trip to The CORE compression of the spine, Institute for a consultation whether it’s in the cervical with Dr. Brandon Hirsch, spine or the lumbar spine,” an orthopedic spine he said. “When patients surgeon. The outlook have nerve compression in changed after that the spine, it generally has meeting. radiating pain or “(Dr. Hirsch) took a look Brandon Hirsch, MD numbness in the at my MRI and he shook his extremities. The catch is that, a lot of head. ‘Don’t freak out. You’re going to be times, these problems will resolve on their OK,’” Tom remembers. “He suggested own over the course of 6-8 weeks.” that I have an epidural, followed by 6-8 So, Dr. Hirsch referred Tom to a weeks of physical therapy.”

GETTING THEIR LIFE BACK By late February 2019, Brenda had a new right knee, Tom could walk again, and they were attending physical therapy as a team. Alicia Pagnoni, physical therapist, at The CORE Institute’s Physical Therapy Clinic in Gilbert, Arizona oversaw their progress. “Pain is limiting them from getting Alicia L. Pagnoni, PT, DPT out and enjoying their daily routines,” Pagnoni said. “Our goal is to get them back to their normal level of function, if not better. That means getting back to golfing, getting back to a social life, being able to go out and visit a restaurant.” Today, Brenda and Tom are pain-free and living the retirement they envisioned. “Your body has a remarkable capacity to heal itself,” Tom said. “You have to do the right things to get it to achieve that.” And, for Brenda and Tom Bill, the ‘right thing’ was being treated at The CORE Institute.

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Stand an 12

www.thecoreinstitute.com


nd Deliver!

PATIENT FEATURE

History buff, educator loving life after bilateral robotic knee replacement By Brian Sodoma

A

s part of the Henry Ford Collection in Michigan, Greenfield Village immerses visitors in America’s long history of innovation and progress. At the 80-acre campus, you’ll see working Model T’s, steam-powered locomotives, the Wright Brothers’ home and bicycle shop, along with collections of houses from the 1600s on up to the early 20th century. Plus, on any given day, you’ll likely meet one of the site’s master presenters, Ron Kozdron. Kozdron, 66, is a history buff who has worked at Greenfield Village for over a decade, educating thousands of guests as a craftsman/ lecturer in the old tin shop. He also plays Santa

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at Christmas time and a Halloween ringmaster who dances and sings in the streets in October. “I love history because you get to see how things started,” Kozdron said. “Some people love to go to sporting events, although in my free time, I always took the kids to visit museums.” That made Ron a natural to lead countless tours of the Village, but then two bad knees halted him in his tracks. LIVING WITH KNEE PAIN Kozdron’s job involves standDavid Markel, MD ing on his feet for long stretches throughout the day. About a year-and-a-half ago, he developed tremendous pain in both knees. Ron took daily pain medication just to endure the walk from the

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parking lot to the tin shop. He could barely make it, and could no longer ride a bike or work in his garden. Even lifting his legs to get into his car was a challenge. “When you hurt that bad, it affects your life, your personality. You can even be gruff, sometimes,” he said. Kozdron’s knees had simply deteriorated through the years and after his primary care physician referred him to Dr. David Markel, a hip and knee surgeon at The CORE Institute, Kozdron learned he was a candidate for knee replacement. He would need both knees replaced, and surgeries were scheduled for early 2019: one operation in January, then another for the second knee in March. “People start to notice that there are things they can’t do and they’re unhappy, and there’s no reason to have to be unhappy,” Dr. Markel said after meeting his new patient. A NEW LEASE ON LIFE TM MAKE PAIN HISTORY Dr. Markel utilized the Mako To learn more Robotic-Arm Assisted Total Knee about robotic knee Replacement for Ron, and after replacement surgery each surgery, Kozdron spent about or alternative three to four weeks rehabilitating treatment options, call the new knee replacement. (866) 974-2673 or visit Doctors encourage patients to thecoreinstitute.com. move as much as possible after a knee replacement. “Pain was almost immediately minimized,” Kozdron said, and that was enough motivation to keep moving every day. Today, with both knees replaced, the master presenter enjoys a new lease on life. “My job involves a lot of walking around, and now I can do it all day,” he said. “My biggest worry was not being able to kneel to work in my garden. Dr. Markel said I could keep working on that during rehab, little by little — now I put down a pad, and I can do it. I’m riding my bike again, too.” “To see someone after that, walking independently, not taking pain medicine, being really happy, to give somebody that is really gratifying, I really love it,” Dr. Markel added. Kozdron and his wife also recently opened their home to an energetic puppy. “I can’t run too far, but I can get down there and play, no problem,” Kozdron added.

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RESEARCH

Brace Yourself!

MORE Foundation research is finding better, safer fits for braces

F

By Tressa Jumps eeling sore? Take a moment before you grab a random brace off the store shelf. How do you know it’s safe and effective? That’s the question specialists from the MORE Foundation, a non-profit partner of The CORE Institute, tackled in a new study. Despite the prolific selection of braces consumers can find at stores, there’s been little research of their effectiveness and safety. Dr. Marc Jacofsky, Executive Director

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not voluntarily test their designs. MORE of MORE Foundation notes, “Because Foundation is working with most brace designs the industry’s most reputable have been on the medical brace manufacturers market for decades, to validate their designs and the Food and Drug provide feedback during their Administration (FDA) design and development.” does not require performance testing. CRITICAL TESTING Investigating the perDr. John McCamley, formance and safety of Director of the Human these braces requires John McCamley, Ph.D. Motion Laboratory at MORE significant time and Foundation explained the study, “In the expense, so most manufacturers will

www.thecoreinstitute.com


FOR MORE INFORMATION lab we were tasked with examining the characteristics of specific braces for companies that supply braces to medical practices and hospitals. The braces we tested are intended to be fitted to the person by a trained technician. Most better-quality braces are designed in a manner to fit a range of sizes and have adjustments where necessary. It is important that these braces are properly adjusted by a trained person so that a good fit is achieved.” MORE Foundation is one of the few labs in the nation that has the expertise and equipment to perform these studies. The lab work included measuring a patient’s range of motion for their head while they are wearing a cervical collar brace as well as measuring the pressure between the brace and the skin surface.

One of the keys to wearing a brace effectively is that it needs to restrict motion while also remaining comfortable over a prolonged period. Since these braces are worn for long periods of time, excessive contact pressures between the brace and skin can result in skin breakdown and sores that are difficult to heal, creating real complications for patients. The braces the MORE Foundation team tested were all medical-grade devices that passed both criteria of limiting movement and ensuring comfort and safety. PT PARTNERSHIP During the study, MORE Foundation researchers worked closely with physical

If you would like to learn more about how your contributions can help the MORE Foundation’s mission, please visit more-foundation.org.

therapy students from MidWestern University. The partnership allows students to see direct results of research, but also receive training on proper fitting and function — impacting the next generation of care providers through the Foundation’s research. “There are many different brace designs available and it is important that the correct brace is used for proper treatment,” said Dr. McCamley. MORE Foundation plans to test additional brace designs in the future, deepening medical understanding of these tools for healing.

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SPECIALTY SPOTLIGHT

Joint Solution CORE surgeon tackles rare ankle replacement case involving 3D-printed bone

T

By Brian Sodoma o Dr. Jeffrey Holmes of The CORE Institute, something just didn’t look right. The intake paperwork for 35-year-old Elliot Munro indicated an amputation consult. What could have possibly gone wrong, the foot and ankle surgeon wondered, for someone at such a young age to be asking about amputation? Munro, he would eventually learn, brought with him a complex medical history. After battling leukemia twice, for which he endured chemotherapy, radiation, two bone marrow transplants and extensive steroid medications, Munro was diagnosed with avascular necrowife, who is the biggest advocate you sis in his lower body. By interrupting could ask for, and I’m thinking, ‘that’s blood flow to the bones, the condition the only option anyone has deteriorates bones and given him?’” joints, and after a recent bout of pain in his right THINKING OUTSIDE ankle, hospital physicians THE BOX informed the Mesa, Ariz. With the bone and joint father of four that ampucondition, Munro wasn’t tation would be his only particularly surprised when option. he felt pain in his ankle “That’s what intrigued Jeffrey Holmes, MD late last year. The talus, me the most about this a bone that joins the lower leg and case,” Dr. Holmes said. “This guy shows foot, required replacement, but with up … and I’m looking at him, with his

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his bones eroding, the traditional ankle fusion surgery was not an option. “Because I have avascular necrosis in more than one joint, you can’t fuse dead bone to dead bone. That’s why the prior doctor said the only thing to do is amputate,” Munro said. Through a Facebook group, Munro’s wife, Stephanie, learned about custom 3D printing capabilities developed for replacement bones and joints. The technology could create a custom talus, allowing for a more traditional ankle replacement to occur. In the procedure,

www.thecoreinstitute.com


you’d never know I had the surgery,” Munro said. “I’m so thankful for the support from my wife and Dr. Holmes rallying to get it done.” Feeling better than ever, the Mesa dad is eager to tell others his story. “There are people who may think amputation is their only option. They need to know this is out there,” he added. Munro’s story inspired Dr. Holmes as well. “This definitely opened my eyes to how medicine is changing, and how you have to be open to other treatment modalities and opportunities,” the surgeon noted. “This really could help a lot of people.”

Dr. Holmes would remove dead bone in areas of the foot and lower leg, and then fuse the custom titanium 3D-printed talus to healthy bone. “We discussed the procedure with another surgeon who’d done it and the engineers at the company that printed the talus. It is a stressful operation, but I thought it could be done,” Dr. Holmes recalled. IMPRESSIVE RECOVERY The surgery was completed successfully on March 19th. After that, Munro spent time in in physical therapy and utilized a special walking boot, crutches and a scooter at times in order to regain his mobility. Today, he has returned to normal function and is able to play football and catch in the yard with his kids. “If you didn’t know anything about me

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NUTRITION

Host a healthy dinner party

I

By Michelle Jacoby f you long for the days of intimate dinner parties where close friends gather to share fine food and drink over lively conversation, you’re in luck: the dinner party is back. Rather than throwing large, over-the-top blowouts, today’s at-home entertainers are opting for small gatherings featuring a lovely dinner among friends. While hosting a dinner party may sound like a brilliant idea, it can also feel like an overwhelming task — especially when you’re planning a meal to satisfy all your guests, from your meat-loving best friend, to your plant-based, health-conscious next-door neighbor. Thankfully, creating a versatile and, more importantly, healthy menu isn’t as daunting as you may think. There are a number of things you can do to provide nutritious food that will have your guests coming back for more. DO YOUR HOMEWORK If you’re not sure if someone has allergies or dietary restrictions, simply ask. Your guest will be honored to be invited to your gathering and appreciate you taking the time to learn about their dining preferences. If you’re not familiar with their dietary restrictions, ask them what they can eat, rather than what they can’t. This will help ease the stress of learning about their restrictions and running the risk of getting it wrong. If you have a dinner guest with restrictions you’re not sure

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how to cook for, ask them to contribute a dish to the meal or give you a recipe they think everyone would enjoy. KEEP THINGS SIMPLE While your first instinct may be to make multiple entrées to please all your guests, keep things simple — and less stressful — by choosing a main dish that’s customizable, such as make-your-own tacos or build-your-own burrito bowls. Put out a spread of taco shells, tortillas, rice, beans, cheeses, proteins and vegetables, then invite your guests to come up with their own culinary creations. You can also make a large pot of vegetable stew and serve cheese, shredded chicken, and noodles or quinoa on the side to allow for everyone to ladle to their liking. Or prepare a veganand/or gluten-free dish as your entrée — such as braised lentils and vegetables, or zucchini noodles with pesto and tomatoes — and serve meat, cheese and bread on the side. RELY ON SIDES If you’re famous for your tender roasted chicken or a hearty pot roast made from your grandmother’s recipe, don’t hesitate to serve it — even if you have vegetarians on your guest list. These dishes can be made first and left to roast or cook while you whip up a variety of side dishes — such as a quinoa salad, roasted veggies, and a bean or lentil dish — that will cater to all of your guests dietary restrictions.

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Meatball-Stuffed Football Bread

6 cloves garlic, finely chopped 1/2 cup whole milk 1/2 cup fresh flat-leaf parsley, roughly chopped 1/2 cup grated Parmesan 1/2 tsp crushed red pepper flakes 3 large eggs Kosher salt Freshly ground black pepper 3 lbs. ground beef 6 cups marinara sauce Nonstick cooking spray Prepared pizza dough (two 22-oz. packages), room temperature 2 cups shredded mozzarella 4 tbsp. unsalted butter, melted 1 tsp. garlic salt 1 tbsp. sesame seeds Position the oven racks in the upper and lower thirds of the oven and preheat to 350ºF. Line two baking sheets with parchment. In a large bowl, whisk together garlic, milk, parsley, Parmesan, crushed red pepper, two eggs, 1-1/2 teaspoons salt

and a few grinds of black pepper. Add the beef and use your hands to mix everything together until well combined. Drop heaping tablespoons of the meat mixture onto the prepared baking sheets (about 40 mounds). Use slightly damp hands to roll the mounds into balls. Bake until just browned and almost through, about 20 minutes. Bring the marinara to a simmer in a large saucepan over medium-high heat. Add meatballs, bring back to a simmer and cook, stirring occasionally, until the meatballs are just cooked through, 7 to 8 minutes.   Discard the parchment from the baking sheets and wipe one sheet clean. Coat the baking sheet with nonstick cooking spray. Using your hands, spread one package of dough into a 15-by-12-inch rectangle on the baking sheet. Draw the outline of a football shape in the dough, about 1-inch wide and 15 inches long. Spoon half of the meatballs, tapping off any excess sauce, inside of the football outline on top of the dough. Sprinkle with 1 cup of mozzarella. Repeat with the remaining meatballs and remaining 1 cup mozzarella.  On a lightly greased surface, spread the remaining package of dough into a rectangle big

enough to cover the meatballs. Place the dough on top of the meatballs and press the dough together around the meatballs. Cut out the football shape, leaving a 1-inch border around the edges; reserve the scraps. Tuck and tightly secure the edges underneath the dough to prevent leaking. Beat the remaining egg with 1 tablespoon water in a small bowl. Brush the top of the football with the egg wash. Pour the sesame seeds onto a plate. Using the scraps, roll out two 12-inch-long ropes to make the lines for the football. Gently roll the strips in the sesame seeds to coat. Press the ropes on the sides of the football widthwise, so they are about 9 inches apart. Roll out one 9-inch-long rope and then roll in the sesame seeds. Place the rope lengthwise in between the two widthwise ropes. Roll out three 3-inch-long ropes then roll them in the sesame seeds. Place the ropes equidistance apart on top of the 9-inch rope.  Mix the butter with the garlic salt and brush the entire football. Bake until the dough is a deep golden brown and completely cooked through, 55 to 60 minutes. Let cool for 10 minutes and serve with the remaining marinara sauce.  Source: foodnetwork.com/recipes/food-networkkitchen/meatball-stuffed-football-bread-5386270

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NUTRITION Santa Hat Crispy-Treat Cheesecake Squares 3 tbsp. unsalted butter 5 oz. mini marshmallows (about 1 cup tightly packed) 2 tsp. honey 1 tsp. pure vanilla extract Kosher salt 4 cups crispy rice cereal 1/4-oz. package unflavored powdered gelatin

Portzelky (New Year’s Cookies) 1 tsp. white sugar 1/2 cup lukewarm water Active dry yeast (1/4-oz. package) 2 cups raisins 3 eggs 1 cup lukewarm milk 1/2 tsp. salt 3 cups all-purpose flour, or as needed 1 qt. vegetable oil, for frying 2 tbsp. confectioners’ sugar, for dusting or as needed Dissolve sugar in lukewarm water in a large bowl and sprinkle yeast over the top. Let yeast activate until it forms a creamy layer on top of the water, about 10 minutes. Rinse raisins and pat dry with paper towels. Stir raisins into yeast mixture; beat eggs, lukewarm milk, and salt into yeast mixture. Beat flour into liquid ingredients until dough is smooth. If dough is too sticky, beat in 1/4 cup more flour. Cover dough and set aside in a warm place to rise until doubled, about 1 hour. Heat vegetable oil to 375 degrees in a large saucepan or deep fat fryer. Scoop up dough by tablespoon and drop, a few at a time, into the hot oil. Fry until lightly browned; drain on wire racks set over paper towels. Dust with confectioners’ sugar. Source: allrecipes.com/recipe/230522/portzelky-new-yearscookies

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Cream cheese (two 8-oz. packages), room temperature 1 cup sour cream 1 cup confectioners’ sugar 1 tbsp. fresh lemon juice 25 medium strawberries, hulled Frosting 2 tbsp. unsalted butter, room temperature 2 tbsp. cream cheese, room temperature 1/2 cup confectioners’ sugar, sifted 1/4 tsp. vanilla extract Piping bag

Line a 9-inch square pan with foil, leaving a 2-inch overhang on two sides. Lightly coat the foil and a wooden spoon with cooking spray. Melt the butter in a medium saucepan over medium heat. Add the marshmallows, honey, 1/2 teaspoon vanilla and a pinch of salt, and stir with the wooden spoon until the marshmallows have completely melted, 4 to 5 minutes. Add the rice cereal, stir until the mixture is fully combined. Transfer the mixture to the prepared pan, press into an even layer while warm. Let sit at room temperature until firm, about 20 minutes. Combine the gelatin with 2 tablespoons water in a small microwave-safe bowl; set aside to soften, about 5 minutes. Beat cream cheese on medium-high speed with an electric mixer until completely smooth, about 1 minute. Scrape down the sides of the bowl. Add sour cream, sugar, lemon juice, remaining 1/2 teaspoon vanilla and a pinch of salt; beat on medium-high speed until smooth, about 1 minute. Microwave the gelatin in 10-second increments, stirring as needed, until it dissolves, 30 to 50 seconds. Pour the gelatin into the cream cheese mixture; beat on medium-high speed until incorporated, about 30 seconds. Pour cream cheese mixture over the cooled crispy treat layer; spread out evenly with an offset spatula or butter knife. Wrap the pan loosely with plastic wrap; refrigerate until the cheesecake layer is set, about 2 hours or up to overnight. For the frosting, whisk together the butter and cream cheese by hand in a medium bowl. Add the sugar and vanilla and whisk until smooth and creamy. Cut the cheesecake bites into 25 squares, measuring 1-3/4 inches. Transfer frosting to a piping bag or resealable plastic bag. Cut a 1/4-inch hole in the corner of the piping bag. Pipe a circle of frosting on the top of each square, about the diameter of the base of a strawberry. Place a strawberry cut side-down on top of each frosting circle, pushing down gently so that the frosting comes up around the bottom of the strawberry and resembles the base of a Santa hat. Pipe a ball of frosting on the tip of each strawberry for a pom-pom. Source: foodnetwork.com/recipes/food-network-kitchen/santa-hat-crispy-treat-cheesecake-squares-3561251

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The Power of One is Here.

Pain Relief in a Single Injection

DUROLANE is a single-injection hyaluronic acid (HA) treatment that has proven: • Greater reduction in knee pain vs. Synvisc-One® (hylan G-F 20)1* • Longer-lasting knee pain relief vs. steroid2 • Clinically equivalent performance to five-injection HA therapy3,4

*Some patients were treated with a three-injection Synvisc® regimen. A three-injection Synvisc regimen is equivalent to one injection of Synvisc-One. Summary of Indications for Use: DUROLANE is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative non-pharmacological therapy or simple analgesics, e.g. acetaminophen. Do not inject DUROLANE in patients with knee joint infections, skin diseases, or other infections in the area of the injection site. Do not administer to patients with known hypersensitivity or allergy to sodium hyaluronate preparations. Risks can include transient pain or swelling at the injection site. DUROLANE has not been tested in pregnant or lactating women, or children. Full prescribing information can be found in product labeling, at www.DUROLANE.com, or by contacting Bioventus Customer Service at 1-800-836-4080.

Active Healing Through Orthobiologics

References: 1. McGrath AF, McGrath AM, Jessop ZM, et al. A comparison of intra-articular hyaluronic acid competitors in the treatment of mild to moderate knee osteoarthritis. J Arthritis. 2013;2(1):108. doi:10.4172/21677921.1000108. 2. Leighton R, Åkermark C, Therrien R, et. al. NASHA hyaluronic acid vs methylprednisolone for knee osteoarthritis: a prospective, multi-centre, randomized, non-inferiority trial. Osteoarthritis Cartilage. 2014;22(1):17-25. 3. Zhang H, Zhang K, Zhang X, et al. Comparison of two hyaluronic acid formulations for safety and efficacy (CHASE) study in knee osteoarthritis: a multicenter, randomized, double-blind, 26-week non-inferiority trial comparing Durolane to Artz. Arthritis Res Ther. 2015;17:51. doi: 10.1186/s13075-015-0557-x. 4. DUROLANE [package insert]. Durham, NC: Bioventus LLC; 2017. Bioventus, the Bioventus logo and DUROLANE are registered trademarks of Bioventus LLC. Synvisc and Synvisc-One are registered trademarks of Genzyme Corporation. ©2019 Bioventus LLC SMK-002435

AR-GCI0293730-01

10/19


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

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