A PUBLICATION OF THE CORE INSTITUTE
Reducing reliance on opioids for post-surgery pain
Trends Healing at home
Partial Knee, Full Enjoyment
New approach to knee replacement restores Michigan man’s active lifestyle
Satisfaction patients deserve. Assurance you can trust. Hip fractures affect a substantial proportion of the ageing population1, have a high mortality rate2-5 and are associated with high rates of morbidity, severely impacting patients’ mobility and daily living.1,6
of patients exhibit a decline in activities of daily living1
of patients exhibit a decline in ﬁne motor skills1
of patients exhibit a decline in mobility1
of patients exhibit a decline in self-reported health1
of patients live with reduced ability to walk following fracture union6
Comparison between pre-hip fracture and post-operative scores.
The TRIGEN INTERTAN Hip Fracture System is clinically proven to provide improved clinical outcomes compared with other IM nails to ensure you live Life Unlimited5 TRIGEN INTERTAN signiﬁcantly reduced the risk of revision/ reoperation by
Mean rate was 3.7% and 10.2% for TRIGEN INTERTAN and comparators, respectively (p<0.0001)
TRIGEN INTERTAN signiﬁcantly reduced the risk of implant failure by
Mean rate was 4.7% and 21.2% for TRIGEN INTERTAN and comparators, respectively (p<0.0001)
TRIGEN INTERTAN signiﬁcantly reduced the risk of hip and thigh pain by
Mean rate was 5.8% and 11.2% for TRIGEN INTERTAN and comparators, respectively (p=0.0004)
Visit us at www.smith-nephew.com to learn more. References 1. Bentler SE, Liu L, Obrizan M, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 2009;170:1290-1299. 2. Hossain M, Andrew JG. Is there a difference in perioperative mortality between cemented and uncemented implants in hip fracture surgery? Injury 2012;43:2161-2164. 3. Mundi S, Pindiprolu B, Simunovic N, et al. Similar mortality rates in hip fracture patients over the past 31 years. Acta Orthop 2014;85:54-59. 4. Okike K, Chan PH, Paxton EW. Effect of Surgeon and Hospital Volume on Morbidity and Mortality After Hip Fracture. J Bone Joint Surg Am 2017;99:1547-1553. 5. Smith+Nephew 2021. A systematic literature review and meta-analysis comparing INTERTAN and other intramedullary nails for the treatment of AO OTA 31-A fractures. Internal Report. EA/TRAUMA/ INTERTAN/003/v1 6. Tang VL, Sudore R, Cenzer IS, et al. Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study. J Gen Intern Med 2017;32:153-158. ◊ Trademark of Smith+Nephew. 30493 V1 05/21. AR-GCI0770537-01
NATIONALLY RECOGNIZED NATIONALLY RECOGNIZED SPECIALISTS SPECIALISTS IN IN ORTHOPEDIC ORTHOPEDIC & & SPINE SPINE CARE CARE NATIONALLY NATIONALLY RECOGNIZED RECOGNIZED SPECIALISTS SPECIALISTS IN IN ORTHOPEDIC ORTHOPEDIC & & SPINE SPINE CARE CARE
The The CORE CORE Institute Institute Specialty Specialty Hospital Hospital is is a a physician-owned physician-owned and and operated operated orthopedic orthopedic and and spine spine The CORE Institute Specialty Hospital is a physician-owned and operated orthopedic and spine The CORE Institute Specialty Hospital is a physician-owned and operated orthopedic and spine specialty hospital that is a destination center for patients across Arizona, the U.S and internationally. The CORE Institute Specialty Hospital is a physician-owned and operated orthopedic and spine specialty hospital that is a destination center for patients across Arizona, the U.S and internationally. specialty hospital that is a destination center for patients across Arizona, the U.S and internationally. specialty hospital that is is a ais destination center for for patients patients across Arizona, the the U.S andsurgical internationally. The state the nationally for orthopedic and spine outcomes specialty that center across Arizona, and internationally. The state of ofhospital the art art facility facility isdestination nationally recognized recognized for superior superior orthopedic andU.S spine surgical outcomes The state of the art facility is nationally recognized for superior orthopedic and spine surgical outcomes The state of the art facility is nationally recognized for superior orthopedic and spine surgical outcomes and outstanding patient experience. The entire center is dedicated to orthopedic and spine care and The of the artpatient facility experience. is nationallyThe recognized for superior orthopedic and spine surgical outcomes andstate outstanding entire center is dedicated to orthopedic and spine care and and outstanding patient experience. The entire center is dedicated to orthopedic and spine care and ™ and outstanding patient experience. The entire center is dedicated to orthopedic and spine care and assisted surgery system and utilizes the latest surgical technologies, including the Mako ™ robotic-arm and outstanding patient experience. The entire center is dedicated to orthopedic and spine care and utilizes the latest surgical technologies, including the Mako™ robotic-arm assisted surgery system and robotic-arm assisted surgery system and utilizes the latest surgical technologies, including the Mako ™ ™ robotic-arm assisted surgery system and utilizes the the latest latest surgical surgical technologies, technologies, including the Mako the Xenex LightStrike Germ-Zapping Robot. robotic-arm assisted surgery system and utilizes including the Mako the Xenex LightStrike Germ-Zapping Robot. the Xenex LightStrike Germ-Zapping Robot. the Xenex LightStrike Germ-Zapping Robot. the Xenex LightStrike Germ-Zapping Robot. Everything Everything from from the the personalized personalized approach approach to to nursing nursing care, care, who who are are only only focused focused on on Everything from the personalized approach to nursing care, who are only focused on Everything from the personalized approach to nursing care, who are only on musculoskeletal care, to the in-house chef and bistro menu has been designed to Everything from theto personalized nursing care, are only focused focused on musculoskeletal care, the in-houseapproach chef andto bistro menu haswho been designed to provide provide musculoskeletal care, to the in-house chef and bistro menu has been designed to provide musculoskeletal to the in-house chef and bistro menu has been designed to provide the best surgical experience anywhere in Arizona. musculoskeletal care, care, to the in-house chef and bistro menu has been designed to provide the best surgical experience anywhere in Arizona. the best surgical experience anywhere in Arizona. the the best best surgical surgical experience experience anywhere anywhere in in Arizona. Arizona. 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WELCOME VOLUME 12, ISSUE 3 – FALL 2021
FROM THE CHAIRMAN
ith autumn in the air, winter fast approaching, and the bustling holiday season upon us, we head into the most celebratory time of year for most of our treasured staff. As we emerge from a challenging year for all, The CORE Institute has much to celebrate during this holiday season. That is why we are excited to share with you all of the ways The CORE Institute is working to Keep Life in Motion® this season. In this edition of CORE Ink, our cover story features Dennis, a 48-year old Michigan-based CrossFit enthusiast who said “goodbye” to knee pain and “hello again” to his active lifestyle. After a partial knee replacement, Dennis is back to golfing, running, and even box jumping! Plus, we share the inspiring story of Jeanne, an Arizona resident. She faced the frightening possibility of amputation of her right leg after what she thought was a simple scratch on her leg. Thanks to Dr. Tharesh Udupa, who found the root cause of her poor healing and saved her from amputation. Jeanne also worked with a vascular specialist when it was discovered she had an underlining vein condition, which leads us to our next story.
This September, The CORE Institute launched its first-ever Vein Health Center. In this article, you will hear from Dr. Jonathan Marshall on the importance of vein health, as well as the symptoms of Chronic Venous Insufficiency and the associated treatment options. In other news, The MORE Foundation also shares exciting findings from it’s current study of the FDA-approved drug, DSUVIA, which may lead to faster discharges after surgery. We also welcome seven new providers to the Arizona and Michigan markets and will hear from Dr. John Stevelinck on how to prevent falls, this Fall. This will be our last edition of CORE Ink in 2021, and we hope you enjoy it! Thank you for the opportunity to serve you, our treasured patients, and our community. We wish you and your families joy, health, and happiness during this holiday season. Happy Holidays and Happy New Year!
Keep Life In Motion!®
David J. Jacofsky, MD
CREATED BY REPUBLIC MEDIA CUSTOM PUBLISHING FOR THE CORE INSTITUTE Editor: Jim Williams, JLWilliams@republicmedia.com Design: DesignIQ
12 COVER STORY
Partial Knee, Full Enjoyment New approach to knee replacement restores Michigan man’s active lifestyle 8
DE PA RT ME NTS What’s New? 6
The CORE Institute is pleased to introduce several new physicians
12 After amputation scare, The CORE Institute physician guides retiree back to good health
CONNECT WITH US 866.974.2673 TheCOREInstitute.com
15 Reducing reliance on opioids for post-surgery pain
16 New Vein Health Center solves quiet healthcare issues millions face
Ask the Expert
18 Preventing falls can protect your feet
19 Healing at home
20 Warm, cozy, healthy and delicious!
WHAT’S NEW NEW PROVIDERS ARIZONA Michael Duran, MD, is a Fellowship-Trained Orthopedic Surgeon specializing in adult and pediatric musculoskeletal oncology, primary and revision joint replacement surgery of the hip and knee and is a limb salvage specialist. Before joining our team at The CORE Institute, Dr. Duran completed his fellowship in musculoskeletal oncology at the University of Texas MD Anderson Cancer Center. During his fellowship at the world-renowned institution, he led orthopedic treatments and care for benign, malignant and soft tissue tumors. Dr. Duran completed his residency program at the University of Arizona. At the time of his residency, Dr. Duran conducted clinical research in multiple orthopedic surgery sub-specialties. Prior to his residency he received his Doctorate at the University of Colorado School of Medicine, where he did research on carpal tunnel syndrome and trigger point syndrome. Dr. Duran is also an alumnus of the esteemed United States Military Academy, West Point, where he earned his undergraduate degree. Top of his class, he was awarded the Dean’s List and the Superintendent’s Award for academic, military, and physical achievements. As a decorated officer of the United States Military, Dr. Duran has served in the Army and National Guard. During his time in the service, he was awarded two Valorous Combat Awards, a Bronze Star Award, a Combat Infantry Badge, as well as a Ranger Tab and Airborne Tab for his acts during his tours in Iraq. He has worked with veterans, participating in multiple community service projects like Team Red, White and Blue; a national non-profit organization focused on supporting wounded veterans. Jonathan Marshall, DO, is a Board-Certified Radiologist and Fellowship-Trained Interventional Radiologist specializing in the diagnosis and treatment of chronic vein disease. He is experienced in minimally invasive venous treatments including radiofrequency ablation, phlebectomy and VenaSeal Closure. Before joining The CORE Institute, Dr. Marshall served as Chief of Vascular and Interventional Radiology at a Level 1 Trauma Medical Center, as well as a Medical Imaging facility, and was Co-director of the University
of Buffalo Radiology Residency in New York. Dr. Marshall completed fellowships in Body Imaging and Vascular and Interventional Radiology at the University of Western Ontario. He completed his internship and diagnostic radiology residency at St James Hospital and Health Centers. Dr. Marshall obtained his doctoral degree from Midwestern University and his undergraduate degree from Niagara University. Dr. Marshall currently serves as the Chairman of Radiology at HonorHealth Deer Valley Medical Center.
Paul Sousa, MD, MBA is a Board-Certified and Fellowship-Trained Orthopedic Surgeon, who is passionate about improving the quality of life of his patients. He specializes in adult joint reconstruction, primarily focusing on joint replacement for the knee, hip and shoulder. Before joining our team at The CORE Institute, Dr. Sousa completed a research fellowship and his orthopedic residency training at the prestigious Mayo Clinic in Rochester- Minnesota. During his fellowship, Dr. Sousa had a keen interest in articular cartilage injuries of the knee, hip and shoulder, diagnostic and therapeutic modalities for femoral acetabular impingement, and knee dislocations. Throughout his residency, he further specialized with a focus on hip and knee replacements. Following residency he developed advanced skills for minimally invasive approaches to the hip and knee, robotics and computer navigated surgery, and revision total hip and knee replacements. Prior to his time at the Mayo Clinic, Dr. Sousa was an astute academic, earning his doctoral degree from Drexel University College of Medicine, his graduate degree from Cornell University College of Management and his undergraduate degree from Franklin and Marshall College, amassing multiple honors at every level of his education. Dr. Sousa is an accomplished medical professional, academic and humanitarian. Having previously taken an active role as Chief Organizer of the humanitarian project- Ascovme. The successful mission in Cameroon oversaw 600 consultations and over 100 surgeries performed in the rural African villages. He has received many honors and awards for his accolades, such as Best Poster at the Arthroscopy Association of North America, Humanities Scholar, Junior Inductee of the Alpha Omega Alpha Medical Honor Society, and Medical Scholar for Gross Anatomy.
WHAT’S NEW continued page 7 >>
NEW PROVIDERS ARIZONA William C. Thompson IV, MD, FASA is a Double Board-Certified Anesthesiologist and Pain Medicine Specialist. He is also Fellowship-Trained in Pain Medicine. Dr. Thompson has been caring for patients as a Pain Medicine Physician in Arizona for more than 10 years and previously served as Chief of the Pain Division at Valley Anesthesiology and Pain Consultants. Dr. Thompson completed his Pain Medicine Fellowship Training from Harvard University’s Beth Israel Deaconess Medical Center. He received his residency training from UCLA Medical Center, serving as Chief Resident. Dr. Thompson received his doctoral degree from the Medical College of Wisconsin. During his time at the Medical College of Wisconsin, Dr. Thompson was elected into the Alpha Omega Alpha Honor Medical Society. He graduated from McGill University, where he was awarded Great Distinction for his undergraduate education. Dr. Thompson is an active member of the medical and public service communities. He is the current Vice President of the Arizona Medical Association, President of the Arizona Society of Anesthesiologists, and Vice President of the Arizona Society of Interventional Pain Physicians. He has served on numerous government and public health task forces, including groups formed to address the opioid epidemic.
NEW PROVIDERS MICHIGAN Marc Bonanni, DPM is a Board-Certified Foot and Ankle Specialist specializing in non-surgical and surgical treatments of foot and ankle conditions. Dr. Bonanni joins The CORE Institute after a long history of working with local podiatric group practices perfecting his high-quality treatment approach tailored to the needs of each individual patient. Dr. Bonanni obtained his residency training with The Cambridge Hospital, where he was given the honor of Chief Resident. He earned his doctoral degree from Dr. William M. Scholl College of Podiatric Medicine. Dr. Bonanni has also served as a Staff Podiatrist at Detroit Medical Center and Henry Ford Health System. Dr. Bonanni is active in the medical community, holding memberships with the American College of Foot and Ankle Surgery, the American Board of Podiatric Surgery, the American Podiatric Medical Association, and the Michigan Podiatric Medical Association. Danielle Meyka-Blanchard, DPM is a Board-Certified Foot and Ankle Specialist specializing in non-surgical and surgical treatments of foot and ankle conditions. Before joining The CORE Institute, Dr. Meyka-Blanchard worked as part of a private podiatry practice caring for patients with conditions or injuries of the foot and ankle.
Dr. Meyka-Blanchard earned her residency training from St. John Oakland Hospital and earned her doctoral degree from Ohio College of Podiatric Medicine. Dr. Meyka-Blanchard is active in the medical community, holding memberships with the American College of Foot and Ankle Surgeons, American Podiatric Medical Association, and the Michigan Podiatric Medical Association. John M. Stevelinck, DPM is a Board-Certified Foot and Ankle Specialist specializing in non-surgical and surgical treatments of foot and ankle conditions as well as diabetic conditions of the foot. Before joining The CORE Institute, Dr. Stevelinck worked as part of a private podiatry practice caring for patients with podiatric conditions. He also serves as the Section Head for the Department of Podiatry at St. Joseph Mercy. Dr. Stevelinck completed his residency training at Kaiser Permanente Medical Center-Oakland and earned his doctoral degree from Ohio College of Podiatric Medicine. Dr. Stevelinck is active in the medical community, holding memberships with the American Academy of Podiatric Sports Medicine, the Association of Extremity Nerve Surgeons, the American Podiatric Medical Association and the Michigan Podiatric Medical Association. He is also a fellow of both the American College of Foot and Ankle Surgeons and the American Professional Wound Care Association.
PARTIAL KNEE, FULL ENJOYMENT
New approach to knee replacement restores Michigan man’s active lifestyle By Elise Riley
ennis Murphy had tried everything. Cortisone shots. Gels. Responsible strength training. He’d already altered his lifestyle and being mobile was becoming too painful to bear. The searing pain in both of his knees was a constant presence. It’s a familiar pattern of decline for anyone who’s faced the prospect of joint replacement. At what point is the pain too unbearable? When is the right time to consider surgery? But Murphy, 48, found out he had more than the binary choice of pain or total knee replacement. Dr. Jefferey Michaelson, a Board-Certified and Fellowship-Trained Hip and Knee Surgeon of The CORE Institute presented Murphy with a third option: partial knee replacement.
“This probably won’t be the last surgery I have, but it drastically changed my life,” Murphy said. In October and December of 2020, Dr. Michaelson performed a partial knee replacement on Murphy’s left and right knees. Murphy, who had naturally bowed legs, had severe arthritis in the inner half of each of his knees. But, thanks to his active lifestyle, Murphy had essentially healthy knees otherwise. Rather than replace the entire joint, Dr. Michaelson recommended the partial replacement to target just the severely damaged area. “With partial replacement we’re only resurfacing the one compartment that’s
“You have to think about not only the next 10-15 years, but beyond that as well. It’s still a joint replacement and it has longevity but the less high-impact sports you do with it, the longer it’ll last.” – Dr. Jefferey Michaelson
bad,” Dr. Michaelson said. “At the same time we do that, I can leave the alignment in a better mechanical position. I remove a lot less bone. The recovery is easier. The post-operative recovery is easier and the range of motion is substantially greater.”
Dr. Jefferey Michaelson
Utilizing robotic-assisted technology, Dr. Michaelson can target one of three compartments – inside, outside, or kneecap – with a partial knee replacement. It allows him to only address the damaged part of the joint while also restoring stability to the entire joint. Three weeks after his surgeries, Murphy was running again. Six weeks post-op, he was back at CrossFit doing box jumps. Although Murphy faced challenges in the early days after the surgeries, he’s definitely pleased with the results. “It was painful at the beginning, but it was a pretty quick recovery,” Murphy said. “They have you up, moving around, and walking stairs before they’ll release you. Then you’re in physical therapy the next day.”
Murphy not only dedicated himself to physical therapy after the surgeries, but he also worked on strengthening his knees before the replacements.
“If you can, go and make sure you’re working out prior to getting surgery,” he said. “Especially strengthen the joint as much as possible. There’s a lot you can do. If you do pre-hab, you’re going to be in pretty good shape. Re-hab becomes exponentially easier.” Today, Murphy is back playing 18 holes without pain – precisely the type of recovery Dr. Michaelson envisioned for a partial knee replacement like Murphy’s. But even a partial replacement is a replacement. These implants do wear out over time, which means it’s important to think about your health and mobility today, 20 years from now, and potentially 40 years from now or even longer. “Someone with a partial knee replacement can water ski, they can play tennis, they can do light running,” Dr. Michaelson said. “You have to think about not only the next 10-15 years, but beyond that as well. It’s still a joint replacement and it has longevity but the less high-impact sports you do with it, the longer it’ll last.”
MAKING A DIFFERENCE
This evolution of partial knee replacements gives an option to people who previously had none. Dr. Michaelson tells his patients they may need to need a full replacement eventually – possibly 20 years in the future. “The research shows that a partial knee replacement will usually last 15 to 20 years,” Dr. Michaelson said. “Depending on the progression of the arthritis, some patients will need a conversion to a total knee replacement. With a conversion from a partial (knee) to a total (knee), there’s excellent longevity.”
The Journey Back
After amputation scare, The CORE Institute physician guides retiree back to good health By Brian Sodoma
eanne Przekota, 67, is an outgoing Valley retiree known in her neighborhood for always being out and about. She frequently tends to her yard and even sweeps her cul de sac to keep her West Valley retirement community looking beautiful. But in May of this year, neighbors noticed her home was unusually quiet, and she hadn’t been seen or heard from in a couple of weeks. They would soon learn that Przekota was on a frightening health journey. At one point, it would even involve potentially amputating her right leg. However, thanks to one physician’s expertise and steady hand, she is now back to enjoying life again. “This was something I never anticipated in my entire life,” she said, “and I’m so grateful to The CORE Institute. They were simply amazing.”
MINOR ACCIDENT, MAJOR CONCERNS
After retiring from a career as an escrow officer in 2018, Przekota quickly settled into enjoying her home, tending to her garden, and doing volunteer work in the community. She
also picked up work as a part-time e-commerce clerk for a nearby grocery store. On May 15, while at work, she inadvertently bumped into a shopping cart, leaving a small cut on her ankle about the length of a dime. There was some pain, but she passed it off as nothing and finished her shift. That evening, however, she felt sick to her stomach and could not work the next day. The following day, when she reported for a shift, her ankle swelled to the point where she couldn’t walk.
A WILD RIDE
An emergency room X-ray found no fracture, but the swelling would not subside, and her white blood cell counts were high. The ER team assumed Przekota had an infection and sent her home with antibiotics and pain medication. After the swelling wouldn’t stop a few days later, another hospital visit revealed even higher white blood cell counts, suggesting a worsening infection. One physician brought up the potential need for amputation. Instead of deciding right away, Przekota asked if she
“This was something I never anticipated in my entire life,” she said, “and I’m so grateful to The CORE Institute. They were simply amazing.” – Jeanne Przekota
could spend a couple of days at home to consider her next steps. “With all the pain medications, I was not in the best shape mentally, so I really wanted to come home so I could think about this,” she said.
A CORE INSTITUTE PHYSICIAN TAKES CHARGE
In early June, Przekota visited Dr. Tharesh Udupa, a podiatrist and wound care specialist at The CORE Institute. By then, the swelling had increased to an area roughly 10 inches long by 5 inches wide and the enlarged cut had scabbed over. Dr. Udupa’s first goal was to initiate proper wound care. Przekota needed to keep the area moist and covered so it could heal. Dr. Udupa had also noticed compromised blood flow in the leg. “When a wound like this scabs over, it hides things, and it never really heals. Pulling off scabs is fine as a kid when you have good blood flow, but as you get older, you need to protect the wound,” Dr. Udupa explained. After a couple of weeks of wound care, he did not see the progress he’d hoped for and referred Przekota to a vascular specialist. There, an ultrasound confirmed peripheral artery disease (PAD). Her case required an angioplasty to place a stent to open up her femoral artery, increasing lower leg blood flow. After the successful procedure, healing began almost “instantaneously,” Dr. Tharesh Udupa Przekota said.
THE ROAD BACK
With the wound healing well, Dr. Udupa ordered physical therapy twice a week and a home health nurse to the home for wound dressing changes. Confined to a wheelchair and unable to drive, neighbors and friends checked in on Przekota daily, and she was determined to regain her physical abilities. “I did my PT at home eight hours a day. I needed to get well and take matters into my own hands,” she recalled. “Dr. Udupa told me, ‘if you do your part, I’ll do mine.’ I really respect how he was always very professional. He didn’t sugarcoat anything.” Przekota was officially back to her old self by mid-November, six months after the incident. With her life back to normal, Dr. Udupa says that his determined patient’s story shows how important it is to pay attention to leg wounds that won’t heal. “You don’t want to wait and let a month go by,” he said. “However, a growing infection can lead to much larger problems and can worsen rapidly without the correct treatment.”
To learn more about The CORE Institute’s wound care services, visit TheCOREInstitute.com or call 866.974.2673.
REDUCING RELIANCE ON OPIOIDS FOR POST-SURGERY PAIN Trial to evaluate medication to help patients ambulate faster and get home sooner after surgery By Brian Sodoma
pioids have long sample population at The down to the question of ‘does this medbeen used for CORE Institute Specialty ication allow the patient to ambulate pain management Hospital earlier this year; faster and go home sooner?’” after surgery. But initial results were positive. So far, that answer could be “yes.” as we know, these powerful Marc Jacofsky, Ph.D., ExecDr. Thompson said patient pain scores drugs can be addictive. utive Director of Research were low and cognition was good. He One study published by the and Education for the MORE saw “prolonged pain relief over 24 to 48 International Anesthesia Foundation, heard about hours, which ultimately decreased the Research Society found that Dr. Marc Jacofsky the preliminary analysis and patient’s dependence on other narcot7.7 percent of surgery pasaw the opportunity to further ics.” Some even started ambulating in as tients who had not taken opioids in the test the drug with the gold standard of little as an hour after surgery, past were more likely to still use them research, a randomized controlled trial. Hauns noted. “Both stressed that these one year after their operation. Under the MORE Foundaearly findings are prelimiToday, the MORE Foundation is tion’s grant-funded study, nary and much more study partnering with The CORE Institute to half the patients will use the and analysis of the data will conduct a study that hopefully improves standard opioid regimen and be required to understand that statistic. Together, the organizations the other half the DSUVIA the true effectiveness and will conduct a prospective randomized regimen. The CORE Institute potential role for this controlled trial that could help to miniteams will focus on patient medication.” mize the need for opioids after surgeries care while MORE Foundation The partnership between and offer the same pain relief needed to researchers monitor results. The CORE Institute, its Dr. John Thompson get patients back in motion faster. A medical safety board will be specialty hospital, and the created to monitor and address any safety MORE Foundation is an interdisciplinary ABOUT THE STUDY concerns. collaboration that can benefit all orthoThe MORE Foundation is currently pedic patients around the nation. enrolling up to 150 orthopedic surgery POTENTIALLY A NATIONAL STANDARD “These efforts can help patients patients in a trial using the FDA-apJoshua Hauns, Pharm.D, a pharmabeyond The CORE Institute. If we’re able proved drug, DSUVIA, or sufentanil. It’s cist and the Senior Clinical Director at to demonstrate this medication reduces a pain medication placed under the The CORE Institute Specialty Hospital, overall opioid use, it could become a tongue at pre and post-oppartnered with The CORE national standard.” Dr. Jacofsky added. erative stages to test if less Institute’s hip and knee sur“This study shows how effective collabopioid medication is needed geon, Dr. John Thompson, oration between clinicians, hospitals throughout the surgery to test the DSUVIA regimen and researchers is critical to achieving process and on through to earlier this year. our mission—to continually define the discharge. It’s the first trial of “We’re trying to find that standard of musculoskeletal care.” its kind involving orthopedic sweet spot between what resurgery participants. lieves pain but doesn’t knock To learn more, visit The FDA-approved mediyou out,” Hauns emphasized. more-foundation.org. cation was tried on a smaller Joshua Hauns, Pharm.D “Ultimately, this all comes
New Vein Health Center solves quiet healthcare issues millions face By Brian Sodoma
o your legs itch and feel heavy? Are you restless at night when you sleep? Like millions of others, you may suffer from chronic venous insufficiency (CVI). According to the National Institutes of Health (NIH), the condition affects 25 to 40 percent of women and 10 to 20 percent of males, and could be a sign of underlying circulatory problems. Not life-threatening, many with CVI also have varicose veins. With this problem, valves in the vein don’t work well, allowing blood to pool and create bulging veins in the leg. In some cases, CVI and varicosities could lead to minor swelling and pain. “There’s a real spectrum of what can occur with venous insufficiency. More importantly, it can also affect your quality of life,” said Dr. Jonathan Marshall, an Interventional Radiologist and Director of The CORE Institute’s new Vein Health Center in Phoenix.
culty with wound healing, and in extreme cases, can lead to amputation when not treated properly. “By addressing vascular issues, this new program at The CORE Institute is another way we are addressing the entire spectrum of musculoskeletal care for our patients,” Dr. Marshall added.
FAST TREATMENT, SHORT RECOVERY TIME
Dr. Marshall is trained in several minimally invasive, image guided procedures to diagnose and treat vein and artery problems. Common treatments The Vein Health Center offers include: • Atherectomies (plaque removal from arteries) • Stenting (expanding the vessel to improve flow) • Venous closures to close off damaged veins and re-route blood flow to healthy ones Vein procedures usually take about 20 minutes, and patients are surprised to learn their recovery time is minimal as well. “We encourage people to be more active, so they have good blood flow to the lower extremities. In most cases, there’s THE VEIN HEALTH CENTER AT THE CORE INSTITUTE really no downtime at all, and people often comment on how OFFERS SOLUTIONS great their legs feel afterwards,” Dr. Marshall said. The Vein Health Center at The CORE Institute opened in If you have any of the following symptoms, the physician August to serve Valley residents trying to address a wide range encourages an evaluation: of vascular issues. Known for orthopedics and • “Heavy” feeling in legs musculoskeletal medicine, many may not associ• Varicose veins ate The CORE Institute with vascular health, but • Restless leg syndrome the health of your veins and arteries can also factor • Itchy skin on the lower legs into successful orthopedic surgery outcomes and • Leg swelling overall musculoskeletal health. • Leg cramping during activity Patients who take care of venous disease before • Pain in the thighs or calves when resting a lower extremity surgery, like a knee or hip re“The most important thing to remember with placement, lower the risk of developing deep vein vascular issues is that identifying the problem early thrombosis (DVT) or a blood clot in a deep vein, Dr. Jonathan Marshall always makes treatment easier,” Dr. Marshall said. during orthopedic surgery, Dr. Marshall noted. The new center also treats peripheral artery disease (PAD), a more acute condition that could bring diffi-
More info? Call The Vein Health Center, call 866.974.2673.
ASK THE EXPERT
Preventing falls can protect your feet
By Julie Maurer
illions of people are treated in emergency departments each year for fall-related injuries. According to John Stevelinck, DPM, a Board Certified Foot and Ankle Specialist at The CORE Institute, ankle sprains can be common with falls. However, injuries to the foot and ankle due to a fall can be even more severe, including fractures. “A simple fall as someone ages can sometimes lead to a metatarsal fracture, which can require surgical intervention, prolonged recovery, and physical therapy,” Dr. Stevelinck said. He offered his top tips in how to not only reduce vulnerability to falls, but to prevent them by making home safety improvements. Dr. John Stevelinck
Some medications can cause lightheadedness or dizziness, especially narcotic pain medications, according to Dr. Stevelinck. Those who have neuropathy, which in and of itself can cause instability and imbalance, may also experience lightheadedness on their medications for the condition. “If a person is prescribed narcotics, it’s very important to talk with their doctor about proper dosing to prevent that side effect,” Dr. Stevelinck said.
PREPARING THE HOME
There are several regular household hazards that can cause falls, and a little prevention can go a long way to keeping upright. Dr. Stevelinck recommends the following:
• Reduce clutter in walkways and hallways • Avoid too many throw rugs, especially as one ages, as they are light and can often slip • Install handrails • Utilize walking assisted devices if suggested by a doctor When it comes to handrails in the home, Dr. Stevelinck said that many people are sensitive about putting them in, but they can be essential for stabilization. “You also need to make sure that the rails on your stairs are secured to the wall and not loose, and that the stair casing is stable and in good condition,” Dr. Stevelinck said. “People with balance issues or injuries should try to avoid the stairs if they are able to.” The stairs are also a common place for clutter to gather in the home because people will make piles on the bottom step to carry up later and then forget about them. If going up the stairs is necessary for those prone to falls, he recommends having a spotter to make sure it is done safely, or to try going up and down in a sitting position on one’s backside.
BALANCING THE BODY
“Falls don’t always occur during walking; sometimes they happen while sitting or standing up,” Dr. Stevelinck said. Balance training can be helpful in improving stability, and most physical training facilities offer it along with gait training. Other tips to improving balance include: • Ankle bracing • Stiffer soled shoes • Balance exercise at home • Other exercises to engage lower extremity muscles to keep them strong “Hold on to each side of a doorway and stand on one leg at a time for a few seconds and then alternate,” Dr. Stevelinck said. “Doing that a few times a day can really help with balance retraining.”
HEALING AT HOME
Outpatient surgery centers offer lower infection rates and the convenience of recovering at home
By Elise Riley s the saying goes, there’s no place like home. That’s true for timeless movies, holiday traditions, and, it turns out, even recovering from surgery. Outpatient surgical centers offer patients procedures from highly specialized physicians in an environment that is often more cost-effective. Dr. Michael Rose, a Fellowship-Trained Sports Medicine Specialist with The CORE Institute, performs the majority of his surgical procedures at outpatient centers, including The CORE Institute Specialty Hospital in Phoenix. From rotator cuff or labrum repairs to mending a torn ACL or meniscus, he says that more and more of these procedures are being performed in outpatient surgical centers. “I mostly operate on the shoulder, hip, and knee,” Dr. Rose said, “and these procedures definitely can be done on an outpatient basis. The trend has been moving more and more toward outpatient surgery. Even some joint replacements that traditionally required a 24-48 hour hospital stay, can now be done outpatient.” The emergence of surgery centers is a win-win for surgeons and patients and comes with practical but significant benefits: Dr. Rose says outpatient facilities are typically smaller and do not have patients who are there with chronic illnesses or infections. Also, many of these facilities, like The CORE Institute Specialty Hospital, are physician led, which means there are less ad-
ministrative hurdles for patients. The logistics are much simpler. Additionally, the reality is that staying overnight in a hospital simply can’t compete with your best four-legged friend, your preferred comfort food, or your favorite pillow. “It’s really important to be able to recover at home if that is possible,” Dr. Rose said. “You’re in an environment you’re familiar with. A hospital is foreign; it can be chaotic, and it isn’t always easy to rest and relax there.” Dr. Rose explained the process for keeping patients safe and comfortable post-surgery. “Nerve blocks – which we call regional anesthesia – allow us to get people home the same day of surgery,” Dr. Rose said. “Our nurses go over everything in the recovery room. We’ll do a formal session with a patient’s caregiver and we provide an on-call number. There’s always Dr. Michael Rose someone available who can answer the patient’s questions.” Dr. Rose explained the most important consideration is matching the patient and their planned treatment with the correct setting. Some patients will be best served by treatment in a hospital. “But when indicated, I discuss with the patient the benefits of surgery in an outpatient facility,” he said. Dr. Rose advised doing some preparations in the home well before surgery: knowing who might be available to help for a couple of days initially, addressing practical considerations like sleeping arrangements or bathing, obtaining necessary medical equipment, and making sure errands like trips to the grocery store are delegated for several days. “Most people are happy when they hear a procedure is outpatient, especially now with COVID,” Dr. Rose said. “No one really wants to stay in a hospital.”
Warm, cozy, healthy and delicious! By Michelle Jacoby
s fall fades into winter, the saying “to everything, there is a season” rings true, especially when it comes to healthy eating. While cool, crisp salads; fresh-caught seafood; and foods laden with bright citrus and seasonal fruit may make you think summer is the only time you can maintain a healthy diet, think again. Late fall is filled with a bounty of foods packed with vitamins and nutrients that are great for your overall health. When it comes to healthy fall foods, the one thing to keep top of mind is what’s in season. Here are just a few examples of foods that aren’t only ripe for the picking, but good for you, too.
Perhaps the quintessential holiday fruit, cranberries pack a nutritional punch. Filled with fiber and vitamin C, they’re a heart-healthy food that can potentially improve blood pressure and cholesterol, according to the American Heart Association. In addition, the anthocyanins that give cranberries their red color may help reduce oxidative stress, which is tied to a number of diseases including Alzheimer’s and diabetes.
Did you know that a medium apple contains almost 4.4 grams of fiber, nearly 16 percent of your daily value? Experts recommend leaving the skin on as it increases your vitamin C intake. Other benefits include a lower risk for heart disease and type 2 diabetes. In addition, a 2020 study published in The American Journal of Clinical Nutrition shows that flavonoids found in apples might potentially lower the odds of developing Alzheimer’s disease.
Harvested primarily in the fall, this seasonal staple is made up mostly by butternut, spaghetti and acorn squashes. There are 5,920 micrograms of beta-carotene—the plant pigment that gives the vegetable its orange color—in one cup of squash. When eaten, it’s converted by the body into vitamin A, according to the National Institutes of Health. This is beneficial for eye health and helps maintain the heart, lungs and kidneys.
Like squash, pumpkin contains beta-carotene. Add to that a boost of potassium and you’ve got yourself a fall food powerhouse. One cup provides 394 micrograms of potassium, as well as 10.4 micrograms for vitamin C. Experts recommend choosing small pumpkins, which are less stringy and more flavorful, for cooking.
Similar to carrots in texture, this root vegetable becomes sweeter as it’s exposed to cold weather—making it a great time to experiment with it in the kitchen. Parsnips are rich in fiber, vitamin K (which helps blood clot and keeps bones healthy), and vitamin C. They also contain folate, beneficial to women who are pregnant or planning on becoming pregnant to prevent neural tube defects in babies, according to the National Institutes of Health.
Creamy Mushroom Chicken 2 chicken breasts, large Flour, for dredging 1 tbsp. olive oil 2 tbsp. butter, divided 12 oz. mushrooms, sliced 1 dash Italian seasoning
3 cloves garlic, minced 1/2 cup chicken broth 1/2 tsp. lemon juice 1/2 tsp. Dijon mustard 1 cup heavy whipping cream Salt and pepper, to taste
Cut chicken breasts in half lengthwise to make four thinner cutlets. Coat them in flour. Add the oil and 1 tablespoon butter to a skillet over medium-high heat. Once the pan is hot, add the chicken. Cook for 4 to 5 minutes per side until golden. Remove the chicken from the pan and set aside. Chop mushrooms. Add remaining butter to the pan and let it melt. Add the mushrooms and Italian seasoning. Once the mushrooms begin to release water, add the garlic to the pan. Continue cooking until all the water is cooked off.
Turn to page 22 for more delicious recipes!
Remove the mushrooms; add chicken broth, lemon juice and Dijon mustard to the pan. Stir until the mustard dissolves and let it reduce for 3 to 4 minutes. Add cream to the pan, along with the chicken and mushrooms. Cook for another 5 minutes or until the chicken is cooked through and the sauce has thickened. Season with salt and pepper, as needed. Source: https://www.saltandlavender.com/creamy-mushroom-chicken/
Chewy Vegan Pumpkin Oatmeal Cookies 1-1/2 cups rolled oats 1-1/2 cups all-purpose flour 1/2 tsp. baking soda 2 tsp. ground cinnamon 1 tsp. ground ginger 1/2 tsp. nutmeg 1/2 tsp. kosher salt 1/2 cup refined coconut oil, at room temperature 1/2 cup brown sugar, packed
1/2 cup granulated sugar 3/4 cup pumpkin puree 1 tbsp. vanilla Icing 3/4 cup confectioners’ sugar 1-1/2 tbsp. almond milk
In a medium bowl, combine rolled oats, all-purpose flour, baking soda, cinnamon, ginger, nutmeg, and kosher salt. In the bowl of a stand mixer, mix the coconut oil, brown sugar, and granulated sugar on medium-high for about 30 seconds, scraping the bowl as necessary, until well combined.
in two batches (refrigerate the dough in between baking). Allow to cool to room temperature, about 30 minutes. To make the icing, stir together the confectioners’ sugar and almond milk until smooth and all lumps are dissolved. Place the cookies on parchment paper, dip a fork into the glaze and drizzle in a zigzag pattern. Let the cookies sit at room temperature until the glaze is dry, about 20 minutes. Store at room temperature in a cookie tin for up to three days or freeze for up to three months. Source: https://www.acouplecooks.com/chewy-pumpkin-oatmealcookies/
Healthier Pumpkin Spice Latte
Add in pumpkin and vanilla and blend on low for a few seconds until fully combined. Gradually add in the bowl with the dry ingredients, mixing on low, until combined into a dough. Place the bowl in the refrigerator to chill for 30 minutes.
8 oz. almond milk (unsweetened) 2 tbsp. pumpkin puree (canned or fresh) 2 tsp. maple syrup
Preheat the oven to 375 degrees. Line two baking sheets with parchment paper. Remove the bowl with the dough from the refrigerator. Make 24 tablespoon-sized balls (a size 40 cookie scoop) and place them onto the baking sheet. Lightly flatten the tops of each cookie with your hand. Bake for 11 minutes until lightly browned on the bottom.
Mix everything but the coffee together in a small pot and cook on medium-low heat. When the milk begins to boil, take off the heat and add to a blender. Add your freshly brewed coffee and blend for 10s, or until smooth and frothy. Pour into a mug, top with a hint of whipped cream and nutmeg powder.
Remove from the oven and allow to set on the baking sheet. After two minutes, transfer to a wire baking rack. For best results, bake
1/2 tsp. pumpkin pie spice 1/2 tsp. vanilla extract 2 to 4 oz. strong coffee (espresso)
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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
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