CORE Ink - Summer 2017

SUMMER 2017

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

Meet the ‘A’ Team of Orthopedics Innovations Elevate Shoulder Surgery Techniques Patient Finds Relief From Decades of Pain

Out of Darkness, Into the Light

Living With, and Managing, Post-Concussion Syndrome

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WELCOME VOLUME 8, ISSUE 1 – SUMMER 2017

FROM THE CHAIRMAN

Expanding to Save Those in Need Bone health is of major importance to our treasured patients, as a lack of bone health leads to increased risk of fracture and increased risks of complications after many surgical procedures. The CORE Institute is pleased to announce that its Bone Health Program has expanded to include a clinic in Mesa, Arizona. This will be The CORE Institute’s fourth location in Arizona to offer the program, which is currently operating at the North Phoenix, Sun City, and Sun City West clinic locations. The Bone Health Program focuses on prevention, diagnosis and treatment of metabolic bone diseases, particularly osteoporosis, with emphasis on patient care, research and teaching. To learn more about our Bone Health Program, or any other specialties, please visit our website.

In this edition of CORE Ink, we share the experience of a patient living with post-concussion syndrome, and how The Sports Neurology Clinic in Michigan brought her out of the darkness and into the light. We share a patient story about “Skip”, who found relief after an ankle replacement following decades of pain.

In this issue, we answer questions on treatment of IT (iliotibial) band syndrome, discuss our new Physician Hospital Organization (PHO) with Banner Health, and explain how our participation in cutting edge research is helping patients who suffer from back pain. In addition, we welcome two new providers to the Arizona market.

The transformation of healthcare delivery is the sport, constant change is the field on which we must play, and providing world-class care to every patient, every time, is how we define leading. We will never stop improving and we will continue to deliver best-in-class patient care for you, your family, and our community.

Keep Life in Motion!®

David J. Jacofsky, MD Chairman & CEO

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

CREATED BY REPUBLIC MEDIA CUSTOM PUBLISHING FOR THE CORE INSTITUTE

General Manager: Cami Kaiser/ cami.kaiser@pni.com Creative Development Director: Isaac Moya/ imoya@republicmedia.com

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Contents

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COVER STORY

Out of Darkness, Into the Light Living With, and Managing, PostConcussion Syndrome. See page 10.

PATIENT CARE

10

‘I Have My Life Back’ Patient Finds Relief After Decades of Pain.

See page 15.

D E PART M E N T S

20 connect with us 1.866.974.2673

Ask the Expert

Specialty Spotlight

8 How to Treat IT Band Syndrome.

19 Innovations Elevate Shoulder Surgery Technique.

What’s New?

Nutrition

9 The CORE Institute is pleased to introduce new physicians to the CORE team.

20 Move Aside, Chips…

Fruits and Veggies Are the Snack of Choice.

Research

Trends

18 For Some Patients with Back Pain, a Chance to be Part of a Clinical Study.

22 Banner Health and The CORE Institute Expand Partnership for Integrated Orthopedic Care.

www.thecoreinstitute.com

7

ASK THE EXPERT

Q&A

‘What is IT band syndrome anyway?’

By Pat Whitney Iliotibial (IT) band syndrome is the most common cause of lateral knee pain in runners and bicyclists. We asked orthopedic physical therapist James Watson PT, OCS at The CORE Institute, to explain: Q: “I’ve been feeling tightness and soreness along the outside of my leg, and I think it might be IT band syndrome. How will I have to adjust my training? What can I do to treat the injury in the meantime?”

A: As soon as you start to feel any pain in the outside of the knee, decrease mileage or take a few days off to rest. Pushing through the pain can increase inflammation and make the problem worse or last longer. Cross training like swimming is a great way to stay in shape while you rest from your normal workout. Avoid stair climbing.

8

Q: “What activities are most likely to cause IT band syndrome?”

A: IT band syndrome affects beginners as much as advanced athletes. Running is the most common cause. Running on cement, down hills or on banked tracks magnifies the potential for IT band syndrome. If you do run on a banked track, switch directions frequently to decrease stress on the knee. Wearing worn-out shoes allows the foot and lower leg to rotate inward, which can lead to IT band syndrome.

Q: “What treatments are most beneficial to treat pain and inflammation?”

A: Because IT band syndrome is an overuse issue, rest and ice are best. With early detection and rest, the issue typically resolves in a few weeks. Surgery is rare. If rest and physical therapy does not resolve the problem, your physician may recommend a cortisone shot to decrease the inflammation.

Q: “Can I be predisposed to this issue?”

A: The cause of IT band syndrome is repeated inward rotation of the lower leg.

Women tend to have wider hips, which increases the angle of the femur, causing the rest of the leg to rotate inward. Flat feet result in the same inward leg rotation.

If you have flat feet, you should consult a podiatrist to determine if orthotics would be beneficial.

Q: “After my pain decreases, how can I keep the tightness from returning?”

A: Maintaining a balance of strength and flexibility helps keep you healthy after the pain goes away. Since the IT band is a tendon, you can’t stretch it out like a muscle. This is where foam rollers come in. The pressure of the roller breaks up any knots that may be in the IT band and loosens it, reducing pressure on the knee.

I personally feel that a good warm up before running and foam roller after running is the most beneficial.

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WHAT’S NEW NEW PROVIDERS ARIZONA

The CORE Institute is pleased to announce additions to our provider team.

JEFFREY HOLMES, DPM Dr. Holmes is a fellowship-trained foot and ankle surgeon specializing in advanced foot and ankle reconstruction, sports medicine, total ankle replacements, trauma and limb salvage.

NILOOFAR DEHGHAN, MD Dr. Dehghan is a fellowship-trained orthopedic surgeon, specializing in orthopedic trauma and upper extremity surgery.

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COVER STORY

Out of Darkness, Into the Light Living With, and Managing, Post-Concussion Syndrome B Y J O D I E VA L A D E

| PHOTOS BY RICK D’ELIA

When Jill Spiess went for a walk with her husband and dog near their Lansing, Michigan, home one spring day in 2015, she had no idea she would still be feeling the effects of that stroll 15 months later. While the couple was walking, their dog, Kona, suddenly stepped in front of Jill. Matt Spiess followed, and as he attempted to move the leash behind his wife to prevent her from tripping, his elbow collided with Jill’s head.

10

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Immediately, Jill knew something was wrong. She felt dizzy and sick to her stomach.

Matt, a high school athletic trainer, examined her and confirmed what she already suspected: She had suffered a concussion.

But even after the typical concussion duration of a few days to two weeks, her symptoms didn’t improve. In fact, they continued to get worse.

For Jill, that meant constant headaches, a sensitivity to light and sound, trouble sleeping, anxiety and difficulty reading and focusing.

Six months after seeing Dr. Jeffrey Kutcher at The Sports Neurology Clinic at The CORE ® Institute , and seeing her symptoms alleviate exponen-

tially, Jill has one regret: “If I could go back and tell the old Jill something before the injury took place, I would say, ‘You need to find the experts in post-concussion syndrome and seek out their advice and recommendations; that there is light at the end of the tunnel.’”

FIRST, THE DARKNESS As a lifelong athlete who played volleyball collegiately and continued to be active with distance running, Jill, had suffered injuries before.

She attempted to carry on life as usual with this injury, as she had done so many times before.

Not wanting to miss a day at her job at a large manufacJill Spiess and her dog, Kona.

Jill Spiess was taking her dog for a walk one spring day in Michigan when her husband’s elbow accidentally collided with her head as the couple’s dog stepped in front of them.

Months later, still feeling the affects of a concussion, Jill visted The Sports Neurology Clinic, where she received the care she needed to make a full recovery.

11

COVER STORY

turing facility, Jill tried to go straight to work after her 2015 concussion diagnosis and manage her symptoms on her own.

She didn’t last the day. She asked for the next day off and rested over the weekend.

When she drove to the office the following Monday, she kept all the windows down and turned off the radio because she felt nauseated.

Over the course of the week, her symptoms became worse, not better.

Finally, when she could not make sense of what people were saying to her, she realized something was very wrong.

“I ran into the bathroom and started crying uncontrollably,” Jill said. “I was really scared.”

POST-CONCUSSION SYNDROME Jill had sustained a concussion, but what she was suffering from now was postconcussion syndrome.

“One of the most common areas of confusion is understanding the difference between concussion and post-concussion syndrome,” Dr. Kutcher said. “Concussion is an injury that is temporary, it goes away. It is something that is the direct result of a force that a person has experienced, during a practice or a game, for example.

“Post-concussion syndrome is not a long concussion. Postconcussion syndrome is just

12

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that -- the concussion is over and there is a continuation of symptoms for another reason.

It’s very important to know the difference because you treat concussion and post-concussion syndrome differently.”

Many concussions do not occur as a result of athletics, of course, and Jill’s accidental elbowing highlighted that head injuries can occur at any time.

ENDURING THE PAIN As the months passed, Jill remained dizzy and so nauseated that she was afraid to drive at all. Headaches from the slightest bit of light required her to wear sunglasses indoors. She began wearing ear plugs whenever she ventured outside the house because the smallest noise could cause the pain in her head to start, again; she vividly remembers the sound of dishes clinking as she unloaded the dishwasher caused excruciating pain.

She couldn’t read or look at computer screens. Working was out of the question.

“A typical post-concussion syndrome patient is one that shows up with a series of symptoms that are really debilitating,” Dr. Kutcher said.

“They have affected people’s lives, so they can’t produce as much academically, professionally, socially or athletically.

These patients are complex.

There’s always multiple factors going on with post-concussion syndrome, that we have to identify and treat comprehensively.”

But that didn’t happen, at first. The initial doctor Jill saw instructed her to continue to rest.

She did, but the symptoms became worse. Headaches, nausea, extreme sensitivity to light and sound -- none of it got better. As a lifelong athlete, she was depressed that she couldn’t even go to a weekly yoga class. The symptoms were unyielding.

“Some days, I couldn’t even get out of bed,” Jill said.

Jill endured about 15 months of treatment, including speech therapy, physical therapy, vision therapy and psychotherapy to train her brain, gain cognitive strategies and improve symptoms.

None of it really worked.

THE SPORTS NEUROLOGY CLINIC As Jill was wondering if her symptoms ever would alleviate, her husband, Matt, heard Dr. Kutcher speak at a conference about the benefits of exercise for those suffering from post-concussion syndrome.

“Matt thought this could be the key to my recovery,” Jill said.

They immediately made an appointment with Dr. Kutcher at The Sports Neurology Clinic. Both were relieved to learn that an internationally recognized expert in concussion was so close to them in Michigan. Dr. Kutcher was an expert who had a unique approach to care with proven results—and Jill didn’t even have to travel across the country to see him.

13

“One of the most important things to know about post-concussion syndrome is that it is treatable in the right hands and with a personalized approach to each patient.”

— Jeffrey Kutcher, M.D.

patients are given up on when they have post-concussion syndrome,” Dr. Kutcher said.

“It is assumed that they just need to rest and time will heal and things will sort of get better on their own. When the reality is they won’t unless they’re cared for appropriately. At The Sports Neurology Clinic, we take every patient, understand every aspect of their problem and treat them as a total person to make sure

DR. KUTCHER’S PRESCRIPTION? EXERCISE. On her first visit to The Sports Neurology Clinic, Jill went on a stationary bike and performed interval training. The next visit, she was running on the treadmill.

“It just felt so good to be back in the driver’s seat of my recovery and my health,” Jill said. “It was so exciting to be encouraged to get after it again, dig deep the way that I did when I was an athlete. It’s made such a world of difference in my spirit and mood— and of course, symptom reduction.”

14

Every patient is different, so the activities that Dr. Kutcher prescribes to help alleviate post-concussion symptom vary. But they can range from interval training on a bike to balancing on an unstable surface and juggling or hitting ping-pong balls.

“One of the most common problems we see is that

they can get back to their life just as they were before their injury.”

ing, again, and walks with her dog and husband through her neighborhood. She hopes to return to work soon.

Most of all, she feels as if she is in control of her improvement.

“One of the most important things to know about postconcussion syndrome is that it is treatable in the right hands and with a personalized approach to each patient,” Dr. Kutcher said.

“We understand that all our patients deserve to have their lives back, to have their sense of identity, their purpose and their productivity.”

For Jill, being able to be active again has meant all the difference in not only alleviating her symptoms, but also in allowing her to regain her sense of self.

“When I was able to get back out there and run again, I just felt like I was getting back to the old Jill,” she said, “that I was becoming much more like myself again.”

BACK TO LIFE Just six months after seeing Dr. Kutcher for the first time, Jill feels as if she is regaining her life. She is exercising again, running 13 miles recently. She’s enjoying read-

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PATIENT CARE

‘I Have My Life Back’ Thanks to The CORE Institute, Patient Finds Relief From Decades Of Pain By Kristine Burnett “I just put up with the pain.

It was all I knew.”

Sun City Grand, Arizona resident Lindon “Skip” Onstad spent 50 years living with the aftermath of a leg injury that left him with limited ankle mobility and near-constant pain. Now, more than six months after undergoing ankle replacement surgery at The CORE Institute, the 75-year-old reflects on his accident and the procedure that has him walking almost pain free for the first time in more than a half-century.

“I was skiing on New Year’s Eve 1965 when I fractured my right tibia and fibula just above the ankle,” Onstad explained.

He spent the next six months with his right leg in a full cast. Unfortunately, the two bones fused together during the healing process. When the cast came off, his foot was permanently pointed slightly inward.

THE AFTERMATH With little time for rehabilitation or further medical intervention, Onstad returned almost immediately to active duty status with the Coast Guard. He spent the next 50 years trying to tolerate lingering ankle pain and mobility issues stemming from the injury, and he slowly began scaling back on physical activities.

15

“I had a bad ankle from the day the cast came off in June 1966,” he commented.

Walking on what he says

 

felt like a plaster of Paris ankle that could disintegrate at any time, Onstad continued to be as active as possible. Then the

pain became unbearable.

“For the most part, I put up with the pain until about the mid 1980s,” he said. “I skied and jogged, and I would take a good dose of ibuprofen if I overdid it. When the residual pain got to be too much, I just stopped altogether.”

PAIN GROWS WORSE As time passed, Onstad’s ankle flexibility lessened, his mobility diminished and he developed painful bone spurs and arthritis. The resulting contracting of his Achilles tendon further intensified the pain.

Onstad sought the advice of an orthopedic surgeon about four years ago, but declined treatment when ankle fusion surgery was the recommended approach.

The procedure would have permanently locked Onstad’s ankle, preventing all future movement of the joint.

“The doctor didn’t feel ankle replacement was right for me at that time, and I wasn’t

willing to have my ankle fused,” Onstad said. “So, I decided to continue living with the pain.”

However, while vacationing in Rocky Point, Mexico in spring 2016, Onstad came to the realization that surgery was a certainty.

“After meeting with Dr. McAlister, I was totally convinced that he knew what he was doing and that my chances of a successful outcome were high.”

— Lindon “Skip” Onstad

“I was walking on the beach and my leg would give out,” he said. “It felt like I was being stabbed in the ankle. That happened enough times over the course of four or five days that that I got a referral from my family doctor to see another orthopedic surgeon.”

RETURN OF HOPE Onstad was referred to Jeffrey McAlister, DPM, a fellowship trained and board certified Foot and Ankle Surgeon at The CORE Institute.

“Since meeting with the first doctor four years ago, my limited research indicated that techniques and experience with ankle replacement surgery had progressed and success rates had improved,” Onstad said. “After meeting with Dr. McAlister, I was totally convinced that he knew what he was doing and that my chances of a successful outcome were high.”

Onstad underwent outpatient ankle arthroplasty in October 2016, at Banner Del E. Webb Medical Center in Sun City West.

He wore a splint-like cast and later an orthopedic boot, and he walked on crutches for a month with instructions to not put any weight on his foot. After reaching the one-month milestone, Onstad completed two months of structured, well-planned physical therapy at The CORE Institute.

“In many respects, I have my life back,” Onstad said of the surgery. “Now, 95 percent of my pain is gone. I get a bit of residual pain at times when I’m walking, but that’s to be expected. It’s part of the normal healing process.”

Dr. McAlister used the STAR™ Ankle, a three-piece mobile bearing implant device manufactured by Stryker.

‘SOLID AS A ROCK’ For the first time in 50 years, Onstad says he can walk without thinking about his ankle or noticing pain. Signaling a big shift in mindset, the ankle he once likened to being as fragile as plaster of Paris is one that he now considers “solid as a rock.”

Onstad credits Sue, his wife of 49 years, with much of his successful recovery.

“She put a lot of her life on hold for the first month or so to help me when I needed it, drive me to doctors’ appointments and help with other activities,” he shared.

Onstad says he still gets a little swelling a night, but he admits

that walking three miles most mornings, playing golf, and taking part in physical fitness stability ball classes to improve core strength and balance may have something to do with it.

The only notable downside for Onstad is that his shoes have become considerably more costly.

“I wear expensive shoes now,” he joked. “I went from wearing $25 tennis shoes to protective shoes that run $150 - $200 a pair.

I didn’t realize good shoes wear out so quickly.”

To learn more about ankle replacement surgery or to find an orthopedic surgeon in your area, visit thecoreinstitute.com.

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RESEARCH

through the MORE Foundation. The MORE Foundation (Musculoskeletal Orthopedic Research and Education) is a 501(c) (3) non-profit organization.

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MORE conducts over 30 clinical and scientific research studies annually.

Back Together For Some Patients with Back Pain, a Chance to be Part of a Clinical Study

By Debra Gelbart Once again, The CORE Institute is ahead of other research organizations studying ways to relieve back pain.

In a nationwide clinical study to evaluate patients with sacroiliac (SI) joint pain, an orthopedic surgeon at The CORE Institute is currently the national leader in enrollment of patients.

At press time, 64 patients are enrolled in the study nationally. The CORE Institute’s Ali Araghi, D.O. has enrolled 11 of these patients—nearly 20 percent of the current enrollment—from the Phoenix metropolitan area. Currently, 16 centers across the U.S are participating in the study. Eventual total enrollment is estimated at 250 patients.

NEXT PHASE OF TREATMENT? For those suffering from this form of low back pain, Zyga Technology Inc.’s

18

“EVoluSIon Study” allows researchers to evaluate fusion and pain reduction of the sacroiliac joint and provide valuable data for further advancement of patient care.

“Because of Dr. Araghi’s leadership, we’re thrilled that so many of our patients will be participating in the EVoluSIon Study to better understand sacroiliac joint pain reduction, not only for themselves, but hopefully for thousands of patients after them,” said Marc Jacofsky, Ph.D., Chief Science and Technology Officer at The CORE Institute in Phoenix.

“The CORE Institute and its talented physicians are always seeking the best techniques to care for our patients, and the opportunity to participate in important studies such as this only further enhances our reputation for being a national leader in orthopedic care.”

The CORE Institute participates in numerous research studies

BETTER VERSION OF JOINT FUSION This particular study focuses on patients who have pain originating in their sacroiliac joint (SIJ) where the pelvis and spine meet in the lower back. In some cases, the best course of treatment for this pain is to fuse the joint together, thereby reducing motion between the bones. Subjects who are indicated for this procedure and meet the inclusion/exclusion criteria will receive the commercially available “SImmetry” implant.

“The SImmetry procedure involves preparing the SI joint surface, placing a bone graft, and implanting threaded devices across the joint to provide stability for fusion within the joint,” Dr. Araghi explained. “During the course of the clinical study, SIJ pain reduction and radiographic evidence of SIJ fusion will be collected to evaluate clinical performance of the fusion system.”

Patients diagnosed with SIJ pain and deemed to be candidates for SIJ fusion will continue to be recruited. Men and women 18 years or older can be eligible for the study. The estimated study completion date is December 2019. Final data collection for primary outcome measure is projected to occur in December 2017.

GET BACK AT IT To learn more about this study and The CORE Institute, please visit www.thecoreinstitute.com.

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SPECIALTY SPOTLIGHT

Innovations Elevate Shoulder Surgery Techniques 3D Imaging and Customized Tools Enhance Precision

By Joan Westlake Being able to help change people’s lives dramatically is what Jason Scalise, MD, says drew him to his orthopedic specialty.

The CORE Institute’s renowned specialist in reconstructive surgery of the shoulder said increasing his ability to achieve lifechanging results are innovations elevating surgical procedures to impressive new levels.

He explained that over the past decade, there have been major advances in joint replacements. The CORE Institute has been pioneering the use of dynamic new techniques such as the use of computer technology in surgical navigation; surgical simulations in planning; and the creation of surgical tools customized for the patient.

“The orthopedic community is buzzing about how powerful these innovative approaches we have been using are,” said Dr. Scalise. “It raises the bar of achieving surgical goals and allows us to address damage that previously might have been too challenging to attempt.”

One of the cutting-edge changes revolves around the surgical plan. Dr. Scalise explains that traditionally, when shoulder surgery is needed, the surgical plan is based on a CT scan to decide the implant required and the surgical procedure.

“The leap forward has been to import the CT scan into a computer that creates a three-dimensional model of the shoulder, which is very different than looking at a two-dimensional image. Then, we take that 3-D model and put it through soft-

ware that essentially does the surgery in a virtual environment to determine which implant fits optimally and the best orientation for the surgery. Being able to virtually ‘practice’ the surgery allows us to map it for the most efficiency.”

Another major advantage of this 3-D model is that it can be used with software that utilizes 3-D printers to make customized tools for each, individual patient to be used for extremely precise implant placement during the surgery.

At the heart of these innovations are the patients who emerge with new lives.

Dr. Scalise said his patient Don Mahoney had a shoulder that was so damaged by

arthritis that without the new technology, the surgery might not have been proposed.

A resident of Sun City, Arizona, Mahoney said, “It felt like a miracle. I was in so much pain that I couldn’t stand it anymore. I couldn’t even lie down to sleep because of the pain and bruising under my skin, all down my side. When I woke up from the surgery, the pain was gone.

Everything works perfectly now.”

As to the future, Dr. Scalise says The CORE Institute continues to pioneer innovations and partner with technology firms to find ways to optimize life-changing results.

JASON SCALISE, MD Jason Scalise, MD, is a board certified and internationally fellowshiptrained specialist in reconstructive and arthroscopic surgery of the shoulder with The CORE Institute. He is a national leader in the fields of shoulder replacement surgery, revision shoulder replacement surgery, shoulder fracture surgery and rotator cuff surgery.

19

NUTRITION

A Better Way to Snack

Move Aside, Chips…

Fruits and Veggies Are the Snack of Choice

By Michelle Jacoby It’s mid-morning. The breakfast you enjoyed hours before is fast becoming a distant memory, but it’s way too soon to even think about what’s for lunch. Hunger pangs are beginning to set in and all you can think of is, “Where’s the closest snack?”

While the urge to make a beeline for a bag of chips, a package of cookies or a handful of candy may be all consuming, opt instead for a fresh change of pace with a snack of fruits and vegetables. The variety, taste and, of course, health benefits may surprise you.

“Fresh fruits and vegetables make for the perfect snack,” says Laurie McDonald, a registered dietician at Banner Baywood Medical Center in Mesa. “They’re low in calories, high in fiber, and rich in vitamins and minerals.

Plus, they’re a great way to meet your daily nutrition requirements.”

MORE BANG FOR YOUR BUCK There’s no better time than now to begin incorporating fresh produce into your snack regiment, says McDonald.

“This time of year is great for fresh fruits and vegetables, most of which are nutrient dense,” she says. “These are foods that give you the most nutrients for less

20

VEGETABLE-FRIENDLY SNACKS TOAST WITH HUMMUS & VEGGIES

Spread on rice cakes and sprinkle on coconut.

2 tbsp. hummus 3 medium radishes, thinly sliced

3 large cucumbers 1 small red onion, finely diced 1 tsp. chaat masala 1/2 tsp. hot red chili powder Flaked sea salt (like Maldon), to taste Small handful finely chopped cilantro 1 lime, quartered, to serve

2 slices sprouted-grain bread, toasted

1/4 cup cucumber slices Pinch sprouts or microgreens Salt and pepper to taste 1 to 2 lemon wedges to serve Toast the bread and add hummus to each slice. Add the veggies to the hummus-topped toast, and serve with salt and pepper and lemon wedges.

RAW AVOCADO LIME MOUSSE

1 large Hass avocado (or two smaller varieties) Juice from 1 lime Zest from 1/2 lime 3 tbsp. raw agave nectar 1/2 tsp. vanilla 1/4 tsp. salt Unsweetened, shredded coconut for garnish Rice cakes

SPICED CUCUMBER STICKS WITH CHAAT MASALA

Peel and halve the cucumbers. Scoop out the seeds using a melon baller or a grapefruit spoon. Slice the cucumber into sticks and dry them thoroughly with paper towel. Meanwhile, place the finely diced onions in a bowl, and cover with cold water. Let sit for about 15 minutes, then drain and pat dry. Place the cucumber on a serving plate and sprinkle with onions, chaat masala, chili powder, and a crumble of flaked salt. Garnish with the chopped cilantro and squeeze with a little lime juice before serving.

Source: Kitchn.com

In a medium sized bowl, mash the avocado with the back of a fork until smooth. Stir in lime juice, zest, agave, vanilla and salt until combined. Cover with plastic wrap and chill for about an hour.

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NUTRITION

calories, and have little or no saturated fat, sodium and added sugars.”

McDonald also credits produce high in fiber to helping you feel full, aiding in bowel health, and maintaining healthy cholesterol levels. And, according to the Academy of Nutrition and Dietetics, eating fruits and vegetables is linked to a lower risk of many chronic diseases, and may help protect against certain types of cancer.

IN SEASON When it comes to choosing fruits and vegetables as a healthy snack option, McDonald recommends buying fresh vegetables that are in season. They cost less, and are likely to be at their peak flavor. Also consider adding a lot of color to your plate.

“Different colors typically mean foods have different vitamins and minerals,” McDonald says. “Eating foods of different colors can help ensure we get the variety we need.”

For instance, red, orange and yellow produce are packed vitamin A, vitamin C, manganese and fiber. Greens contain lutein, which helps with eyesight, and folate, which helps in cell reproduction.

Blues and purples are packed with antioxidants that help transport oxygen to cells, remove waste, protect joints and organs, and promote healthy skin.

FILL YOUR PLATE The “Dietary Guidelines for Americans” recommend filling half your plate with vegetables and fruit. To help meet the recommended daily require-

ments, here are some tips on adding more produce to your meals: Keep frozen, canned and dried fruit and vegetables on hand, especially when fresh produce isn’t in season. Buy canned fruit that’s packed in juice for less added sugars and calories, and choose low-sodium canned vegetables.

Try new types of fruits and vegetables and prepare them in different ways. Texture is everything when it comes to snacks, so experiment with such things as raw cucumber, avocado slices or pickled carrots.

Many children and young adults drink more than half of their fruit as juice, which often contains a significant amount of added sugar. Whole fruit contains fiber and other nutrients. When drinking juice, make sure it’s 100-percent juice, without the added sugars.

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Meet the ‘A’ team of orthopedics Banner Health and The CORE Institute expand partnership for integrated orthopedic care

By Brian Sodoma Healthcare providers set themselves apart by offering the best care at the right price while delivering optimal outcomes.

Banner Health and The CORE Institute’s six-year partnership has demonstrated just that. Now, the effort is expanding to benefit more patients, hospitals, physicians and payors.

CONSISTENCY, VALUE The expanded partnership, referred to as a Physician Hospital Organization (PHO), offers the most comprehensive integrated orthopedic care for Arizonans regardless of which institution in the Banner Health Network a patient visits. The fully integrated network combines providers, facilities, ancillary programs and technology solutions to manage and deliver care that reduces variations and costs while improving quality across the entire musculoskeletal continuum of care.

The PHO model also helps to control healthcare costs, as membership groups pay one single fee per member per month, while an outside third-party entity manages any financial downside risks.

Simply, if care costs increase, payors like insurers, patients or employers, do not incur added costs themselves.

“At end of the day, this is about bringing together all orthopedic providers— hospitals, physicians, physical therapy —into one highly-integrated network and putting the money where our mouth is,” said DeLyle Manwaring, Executive Vice President Of Health System Integration for The CORE Institute.

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LEARN MORE For more information, visit www.thecoreinstitute.com.

BUILDING ON EXISTING STRENGTHS Seeing the expansion as a “natural opportunity,” Carri Kelly, interim Senior Director Of Network Management for the Banner Health Network, emphasized the PHO offering reflects both The CORE Institute and Banner Health’s similar strategic goals to improve quality and control costs.

“The PHO is highly aligned with Banner Health Network initiatives, and will demonstrate a commitment to the clinical programs that will allow us to reach the Triple Aim, which is to improve quality outcomes, improve the patient experience and control costs,” she said.

Started in 2011 with one single location, the Banner CORE Center for Orthopedics was established at the Banner Del E. Webb Medical Center in Sun City West. The Banner Care Center partnership has grown to

now serve Banner University Medical Center in Phoenix, Banner Thunderbird Medical Center in Glendale, Banner’s Desert Medical Center in Mesa, Estrella Medical Center in West Phoenix, in addition to Banner’s Boswell, Baywood, Ironwood and Casa Grande medical centers.

“Expanding and transforming the successful joint venture between Banner Health and The CORE Institute in this way will help patients receive the highest quality, integrated, medical care, while also helping physicians and their practices succeed in an increasingly complicated healthcare business environment,” said David J. Jacofsky, MD, CEO of The CORE Institute.

“We encourage orthopedic surgeons to consider being a part of this innovative care delivery model to provide ‘the right care, at the right time, at the right place’ for their patients.”

www.thecoreinstitute.com

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