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
The CORE Institute Helps MMA Athlete Return to Competition Robotic Joint Replacement: Innovation Defined Joint Restoration Innovations Bring Hope
‘I Can Do It All!’
Robotic-Arm Assisted Procedure Keeps Patient’s Life in Motion!
You cannot diagnose what you cannot see! 2D Mammogram
Up to 1 in 3 cancers are not visible on 2D Mammography! 3D mammography ﬁnds signiﬁcantly more cancers! 3D mammography finds more of the invasive, harmful breast cancers, and saves many women the unnecessary anxiety and costs of a return for additional imaging for what turns out to be a false alarm.
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Call today 602-730-3315 to schedule your mammogram † AJR 2014 Jun 13 [Epub ahead of print] *JAMA. 2014;311(24):2499-2507. doi:10.1001/jama.2014.6095.
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REAL PATIENTS. REAL EXPERIENCES. Watch Chuck talk about his journey with Mobi-C® Cervical Disc replacement. “This totally changed my life because I was back to how I was before any of this happened. I could move around anyway I wanted.” - Chuck, two-level Mobi-C patient April 2006
Visit cervicaldisc.com/ real-experiences to watch Chuck’s story The opinions expressed are solely those of the individual patient and are unique to his experience. This information is for educational purposes only and should not take the place of discussions with your health care provider. For complete risk information, visit cervicaldisc.com/aboutyourneck.
WELCOME VOLUME 8, ISSUE 1 – SPRING 2017
FROM THE CHAIRMAN
Happy New Year! Another year has passed. Like so many before, so quickly — yet like those before with overcome challenges and landmark successes! We have come so very far. It through determination and a positive paradigm of thinking that our company has grown from five employees in 2006 to over 800 in 2016. Whether in the form of an article written about The CORE Institute in the Harvard Business Review, our patients voting us the #1 orthopedic group in Arizona yet again, or being voted a fastest growing company — we have proven that the trail we are blazing is now gathering followers in our rear view mirror. It is with the hard work of our physicians and staff, perseverance, and faith that we have accomplished so much. Both in the Arizona and the Michigan market, people know we are making a difference in healthcare — and that we are here to stay. In this edition of CORE Ink, we share the experience of a patient who received the first total knee replacement using robotic-assisted arm technology in not only Arizona but the Southwestern United States. We also share a patient story about his experience with anterior cruciate ligament (ACL) reconstruction, the importance of bone health, and the MORE Foundation’s charitable efforts in the Arizona community. Also, 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 winning. 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
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‘I Can Do It’
COVER STORY: Robotic-Arm Assisted Surgery Keeps Patient’s Life in Motion! See page 12.
PATIEN T CARE
Back in Fighting Shapee The CORE Institute Helps MMA Athlete Return to Professional Competition. See page 16.
D E PART ME N TS Ask the Expert
8 Innovation Defined: Mako TM Robotic-Arm Assisted Surgery
20 Strength in Wisdom: Exercise is Critical to Bone Health As We Age.
9 New providers at The CORE institute.
21 Cheers to a Healthy New Year: Staying Fit is a Year-Round Commitment
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18 Never Forget: Ride N’ Raise Boosts Vet Transport Program
Specialty Spotlight 1.866.974.2673
19 Go the Distance: Joint Restoration Innovations Bring Hope.
CORE Candid 22 Employees at The CORE Institute are “Keeping Life in Motion ®.”
ASK THE EXPERT
Innovation Defined MakoTM Robotic-Arm Assisted Surgery System Revolutioninzing Results By Debra Gelbart If you are in need of a total hip replacement or a partial knee replacement, a robotic-assisted surgical procedure available at The CORE Institute may give you better results than conventional surgery. Mako™ robotic-arm assisted surgery is a surgical procedure developed by the MAKO Surgical Corp. to “improve the accuracy and precision of sizing and placement of joint implant components,” explained S. Douglas Werner, DO, a fellowship-trained orthopedic surgeon specializing in primary and revision joint arthroplasty of the hip and knee. He is an expert in the field of computer-assisted and robotic joint replacement. “The process begins with a preoperative CT scan of the involved extremity from which the individualized surgical plan is made,” Dr. Werner said. “Before the patient’s surgery actually begins, the surgeon knows what size implants are needed and exactly how they need to be aligned to optimize their function.” In the operation, he added, the surgeon
“registers” the patient with the software, essentially telling the computer where the patient’s extremity is in space. He or she can then execute the preoperative plan using the Mako™ robotic-arm. Currently, he said, the Mako™ roboticarm assisted surgery technology is only available for total hip and partial knee replacements. In October 2016, initial trials began for total knee replacements. HOW THE SURGERY PROCEEDS The Mako™ robotic-arm has a controlled high-speed burr that smooths the joint surfaces for the implants, Dr. Werner explained. “As the burring is performed, the monitor provides real-time, threedimensional graphical representation of the surgery. The Mako™ technology prevents the surgeon from veering away from the parameters of the surgical plan, thereby minimizing human error and improving surgical safety.” Once the bone is prepared, a trial placement is performed, “allowing the surgeon to objectively measure and optimize joint range of motion, balance, and stability,” Dr. Werner said. “After ‘trialing’ is complete, the final joint components are implanted. The Mako™ technology offers significant advantages over more
FOR MORE INFORMATION about Mako™ robotic-arm assisted surgery, please call 866-974-2673.
traditional joint replacement techniques, ideally translating into successful joint replacements that perform well and last a lifetime.” UNDERSTANDING THE REAL ADVANTAGES It may sound as though the robotic approach makes recovery from surgery easier. Not necessarily, cautions Dr. Werner. “The Mako™ robotic-arm assisted surgery does not promise to speed a patient’s recovery or lessen their post-operative pain,” he said. “Early recovery from Mako™ robotic-arm assisted surgery surgery is essentially equivalent to more traditional surgical procedures. The distinct advantage of Mako™ robotic-arm assisted surgery lies not in easing post-operative recovery but in optimizing the long-term function and longevity of the joint replacement. Knee and hip replacements perform better, and for longer, when they are precisely sized, aligned, and balanced.” ACHIEVING OPTIMAL RESULTS The best patient candidates for Mako™ robotic-arm assisted surgery are those in need of a hip or partial knee replacement. “These are patients who have advanced arthritic conditions of the hip or knee for whom comprehensive conservative treatment has failed,” Dr. Werner said. “The patient’s candidacy for surgery is an individualized determination under the guidance of their surgeon.” The joint replacement surgeons at The CORE Institute “continually strive to improve patient outcomes through safe incorporation of the latest medical technologies in our practices,” Dr. Werner said. “The Mako™ robotic-arm assisted surgery procedure demonstrates how applied technology can optimize surgical precision and minimize human error to improve surgical outcomes, and ultimately provide significant long-term benefits to the patients we serve.”
WHAT’S NEW NEW PROVIDERS The CORE Institute is pleased to announce these additions to our provider team.
SIMON GÖRTZ, MD Simon Görtz, MD is a fellowship-trained orthopedic sports medicine surgeon, specializing in reconstruction of the knee and shoulder, with a focus on cartilage restoration and joint preservation.
GREGORY A. ZAKAS, DO Gregory A. Zakas, DO is a fellowship-trained physician specializing in interventional spine. He is experienced in physical medicine and rehabilitation and pain management.
DISCOVER INSPIRED SOLUTIONS TO GET YOUR PATIENTS BACK TO MOVING FORWARD. DePuy Synthes Spine is continuously improving clinical and economic value across all spinal pathologies through a procedural solutions approach. We deﬁne solutions differently – solutions are not conﬁned to the surgical suite at the time of surgery, but encompass a comprehensive product portfolio, world class education, evidence generation and support of research initiatives that are driven by a greater understanding of spinal care. .
www.depuysynthes.com ©DePuy Synthes Spine, a division of DOI 2014. All rights reserved. DSUS/SPN/0314/0063a
Medication Guide XIAFLEX® (Zī a flex) (collagenase clostridium histolyticum) For injection, for intralesional use Read this Medication Guide before you receive XIAFLEX for the treatment of Dupuytren’s contracture and each time you get an injection. There may be new information. This Medication Guide does not take the place of talking with your healthcare provider about your medical condition or treatment. What is the most important information I should know about XIAFLEX for the treatment of Dupuytren’s contracture? XIAFLEX can cause serious side effects, including: 1. Tendon rupture or ligament damage. Receiving an injection of XIAFLEX may cause damage to a tendon or ligament in your hand and cause it to break or weaken. This could require surgery to ﬁx the damaged tendon or ligament. Call your healthcare provider right away if you have trouble bending your injected ﬁnger (towards the wrist) after the swelling goes down or you have problems using your treated hand after your follow-up visit. 2. Nerve injury or other serious injury of the hand. Call your healthcare provider right away if you get numbness, tingling, increased pain, or tears in the skin (laceration) in your treated ﬁnger or hand after your injection or after your follow-up visit. 3. Hypersensitivity reactions, including anaphylaxis. Severe allergic reactions can happen in people who receive XIAFLEX, because it contains foreign proteins. Call your healthcare provider right away if you have any of these symptoms of an allergic reaction after an injection of XIAFLEX: • hives, swollen face, breathing trouble, chest pain, low blood pressure, dizziness or fainting What is XIAFLEX? XIAFLEX is a prescription medicine used to treat adults with Dupuytren’s contracture when a “cord” can be felt. It is not known if XIAFLEX is safe and effective in children under the age of 18. Who should not receive XIAFLEX? Do not receive XIAFLEX if you: • are allergic to collagenase clostridium histolyticum, or any of the ingredients in XIAFLEX, or to any other collagenase product. See the end of this Medication Guide for a complete list of ingredients in XIAFLEX. Talk to your healthcare provider before receiving this medicine if you have any of these conditions. What should I tell my healthcare provider before receiving XIAFLEX? Before receiving XIAFLEX, tell your healthcare provider if you: • have had an allergic reaction to a XIAFLEX injection in the past, have a bleeding problem, have received XIAFLEX to treat another condition, have any other medical conditions, are pregnant or plan to become pregnant. It is not known if XIAFLEX will harm your unborn baby. • are breastfeeding or plan to breastfeed. It is not known if XIAFLEX passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby if you receive XIAFLEX. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Using XIAFLEX with certain other medicines can cause serious side effects. Especially tell your healthcare provider if you take: • medicines to thin your blood (anticoagulants). If you are told to stop taking a blood thinner before your XIAFLEX injection, your healthcare provider should tell you when to restart the blood thinner. Ask your healthcare provider or pharmacist for a list of these medicines, if you are not sure. Know the medicines you take. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine. How will I receive XIAFLEX? • XIAFLEX should be injected into a cord by a healthcare provider who is experienced in injection procedures of the hand and treating people with Dupuytren’s contracture. If you have more than 1 contracture, your healthcare provider may give you 2 injections in 1 of your hands during your visit. • Your healthcare provider will inject XIAFLEX into the cord that is causing your ﬁnger to bend. • After an injection of XIAFLEX, your affected hand will be wrapped with a bandage. You should limit moving and using the treated ﬁnger after the injection.
— Do not bend or straighten the ﬁngers of the injected hand until your healthcare provider says it is okay. This will help to keep the medicine from leaking out of the cord. — Do not try to straighten the treated ﬁnger yourself. Keep the injected hand elevated until bedtime. Call your healthcare provider right away if you have: — signs of infection after your injection, such as fever, chills, increased redness, or swelling, numbness or tingling in the treated ﬁnger, trouble bending the injected ﬁnger after the swelling goes down Return to your healthcare provider’s ofﬁce as directed 1 to 3 days after your injection. During this ﬁrst follow-up visit, if you still have the cord, your healthcare provider may try to extend the treated ﬁnger to “break” the cord and try to straighten your ﬁnger. Your healthcare provider will provide you with a splint to wear on the treated ﬁnger. Wear the splint as instructed by your healthcare provider at bedtime to keep your ﬁnger straight. Do ﬁnger exercises each day, as instructed by your healthcare provider. Follow your healthcare provider’s instructions about when you can start doing your normal activities with the injected hand.
What are the possible side effects of XIAFLEX? XIAFLEX may cause serious side effects, including: • See “What is the most important information I should know about XIAFLEX?” • increased chance of bleeding. Bleeding or bruising at the injection site can happen in people who receive XIAFLEX. Talk to your healthcare provider if you have a problem with your blood clotting. XIAFLEX may not be right for you. The most common side effects with XIAFLEX for the treatment of Dupuytren’s contracture include: • swelling of the injection site or the hand, bruising or bleeding at the injection site, pain or tenderness of the injection site or the hand, swelling of the lymph nodes (glands) in the elbow or armpit (axilla), itching, breaks in the skin, redness or warmth of the skin, pain in the armpit Tell your healthcare provider if you have any side effect that bothers you or does not go away. These are not all of the possible side effects with XIAFLEX. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. General information about the safe and effective use of XIAFLEX. Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. This Medication Guide summarizes the most important information about XIAFLEX. If you would like more information, talk to your healthcare provider. You can ask your healthcare provider or pharmacist for information about XIAFLEX that is written for health professionals. For more information, go to www.XIAFLEX.com or call 1-877-663-0412. What are the ingredients in XIAFLEX? Active ingredient: collagenase clostridium histolyticum Inactive ingredients: hydrochloric acid, sucrose, and tromethamine. The diluent contains: calcium chloride dihydrate in 0.9% sodium chloride This Medication Guide has been approved by the U.S. Food and Drug Administration. Manufactured and distributed by: Auxilium Pharmaceuticals, LLC. Malvern, PA 19355 US License No. 1816 US Patent Nos. 7,811,560 and RE39,941 PL-1109-001.h Approved: 08/2016
For adults with Dupuytren’s contracture when a “cord” can be felt
XIAFLEX® is the only FDA-approved nonsurgical treatment Injection of XIAFLEX and the finger extension procedure can be performed: ®
Since 2010, it is estimated that more than
have been treated with XIAFLEX® through June 2016
• In your healthcare professional’s (HCPs) office • By a hand specialist with training specifically for XIAFLEX® • With no general anesthesia required
I can’t straighten my fingers because I have Dupuytren’s contracture. THERE’S A NONSURGICAL TREATMENT OPTION THAT COULD HELP ADULTS WITH A DUPUYTREN’S “CORD” THAT CAN BE FELT
What is XIAFLEX®?
XIAFLEX is a prescription medicine used to treat adults with Dupuytren’s contracture when a “cord” can be felt. It is not known if XIAFLEX® is safe and effective in children under the age of 18. ®
Important Safety Information for XIAFLEX®
Do not receive XIAFLEX® if you are allergic to collagenase clostridium histolyticum or any of the ingredients in XIAFLEX®, or to any other collagenase product. XIAFLEX® can cause serious side effects including tendon rupture (break) or ligament damage which could require surgery, nerve injury or other serious injury of the hand, allergic reaction or hypersensitivity reactions, including anaphylaxis and increased chance of bleeding. Call your healthcare provider right away if you have trouble bending your injected finger after the swelling goes down, problems using your treated hand, pain, tingling, numbness, increased pain, or tears in the skin (laceration) in your treated hand. Call your healthcare provider right away if you get hives, swollen face, breathing trouble, chest pain, low blood pressure, dizziness or
fainting. It’s important to tell your doctor if you have had a previous allergic reaction to XIAFLEX®. Bleeding or bruising at the injection site is common in people who receive XIAFLEX®. It’s important to tell your doctor if you have a bleeding problem or use a blood thinner. XIAFLEX® may not be right for you. Other common side effects include swelling, pain or tenderness at injection site or hand, swelling of glands in the elbow or armpit, itching, breaks or redness or warmth in the skin, and pain in the armpit. Tell your doctor if you have any other medical conditions and about all the medications you take. XIAFLEX® should be injected into the cord by a healthcare provider who is experienced in injection procedures of the hand and treating people with Dupuytren’s contracture. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please see the Medication Guide on the adjacent page.
Visit XIAFLEX.com/core to find specialists nearest you. Rx Only XIAFLEX® is a registered trademark of Endo International plc or one of its affiliates. © 2016 Endo Pharmaceuticals Inc. All rights reserved. Malvern, PA 19355 XD-04667/July 2016 www.xiaflex.com 1-800-462-ENDO (3636)
Rose Beneteau works with her therapist, Physical Therapy Assistant Lavon Whitby at The CORE Institute in Gilbert.
Robotic-Arm Assisted Technology Gives Surgeons a Higher Level of Precision B Y M E G H A N N F I N N S E P U LV E D A | P H O T O S B Y R I C K D ’ E L I A
‘I Can Do It All!’ People who suffer from chronic knee pain, usually a result of an injury or arthritis, can now benefit from robotic-arm assisted total knee replacement surgery at The CORE Institute. This innovative approach, which utilizes a robotic arm to assist orthopedic surgeons, is significantly improving the quality of life for patients. IDENTIFYING CANDIDATES Pain, stiffness, swelling and inflammation that limit a person’s ability to participate in daily activities are common reasons why people undergo a total knee replacement. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States, which are considered one of the most successful procedures in medicine. Often, these patients have been unsuc-
cessful in managing pain or finding an effective nonsurgical treatment. Last October, The CORE Institute began offering robotic-arm assisted total knee replacements. “The utilization of computers in medicine has evolved over the last decade,” said Steve Myerthall, MD, an orthopedic surgeon who specializes in knee and hip reconstruction at The CORE Institute. “Today, robotic-assisted surgery gives us more precision when placing the implant.”
AFFECTING QUALITY OF LIFE Rosemary Beneteau was the first patient at The CORE Institute to receive a total knee replacement utilizing robotic-arm assisted surgery in the Southwestern United
States. At 80, she had been suffering from severe knee pain that significantly affected her quality of life. “After retirement, I played tennis for many years which was hard on my knees,” she said. “The pain became so
Rose Beneteau works on her flexibility and stretching with her therapist, Physical Therapy Assistant Lavon Whitby who measures the range of motion at The CORE Institute in Gilbert.
Rose Beneteau works on decsending stairs on her new knee with her therapist, Physical Therapy Assistant Lavon Whitby at The CORE Institute in Gilbert. Beneteau is on her last joint replacement, her left knee, after having her right knee done as well as both her hips in the last year. Bottom: Rose Beneteau works on her flexibility and stretching with her therapist, Physical Therapy Assistant Lavon Whitby at The CORE Institute in Gilbert.
excruciating that I could barely go up and down the stairs.” Beneteau, who also had a total hip replacement at The CORE Institute several years ago, tried medication injections and physical therapy to reduce the pain in Steve Myerthall, MD her knees, but neither approach was successful. Eventually, she turned to Dr. Myerthall for help. “He asked if I would be ok with a robotic-assisted total knee replacement and I immediately said yes,” she said. “I was happy to receive the latest, most effective procedure.” To date, Dr. Myerthall has performed approximately 35 robotic-arm assisted total knee replacement surgeries at The CORE Institute Specialty Hosptial. Patients of all ages, usually
“He asked if I would be ok with a roboticassisted total knee replacement and I immediately said yes. I was happy to receive the latest, most effective procedure.” — Rose Beneteau
between 50 and 80, who are active and healthy with no significant medical issues are considered good candidates for the procedure. BREAKTHROUGH TREATMENT As opposed to traditional knee replacement surgery, orthopedic surgeons like Dr. Myerthall who utilize roboticarm assisted surgery, have access to three-dimensional imaging which provides an exact location to place the implant. “After reviewing the results of a patient’s CT scan, we can plan and execute accordingly,” Dr. Myerthall said. He also takes measurements to determine the appropriate size of the implant and which angle and position would be the best fit. During surgery, the robotic-arm is locked into place before making a cut into the bone. “The incision is smaller than
traditional surgery and there is usually much less trauma to the surrounding tissue which release hormones and act as an inflammatory pathway, reducing pain and helping with overall recovery,” Dr. Myerthall said. Dr. Myerthall then positions the implant, cements it into place and closes the wound. The procedure takes approximately 60 minutes. After a brief hospital stay and eight weeks of recovery including physical therapy, most patients can undergo a second knee replacement on their other knee if needed. EFFECTIVE APPROACH More than 90 percent of people who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living, according to the American Academy of Orthopaedic Surgeons.
Today, Beneteau, a Chandler resident who also maintains a home in Michigan, is finishing up physical therapy. She is looking forward to spending more time with her
grandchildren and resuming an active, pain-free lifestyle. “I love to go shopping, do yardwork and take walks in the neighborhood,” she said. “I can now do all of that with ease.”
Failure is Not an Option We’ll help you get back in the swing of things with the right physical therapy plan designed speciﬁcally for you. Because with Team Rehab in your corner it isn’t over ‘til you say so.
GET MOVING To learn more about robotic-arm assisted total knee replacement surgery, visit www.thecoreinstitute.com.
Find a location near you at
BACK IN FIGHTING SHAPE The CORE Institute Helps MMA Athlete Return to Professional Competition By Elise Riley
“I heard a pop.” It’s a sentence uttered by just about anyone who’s experienced a joint injury. It’s a sound that indicates not just the occurrence of an injury, but possibly, also the end to a hobby or a career. Darrell Denslow, an MMA fighter, heard a pop and knew it was serious. But thanks to Dr. Tony Nguyen and The CORE Institute, Denslow is back to ® keeping life in motion . LIFE OF AN ATHLETE Training is critical for an MMA athlete, and Denslow was no exception. His regimen includes training five days a week – sometimes twice a day – which can take a toll on the body. “The amount of stress on the body is pretty high, especially in MMA when you’re on the ground, standing, kicking, punching, rolling, wrestling, jiujitsu, joint manipulation, chokes,” he said. “A lot of
To hear more from Denslow about his experience with The CORE Institute, visit The CORE Institute’s YouTube page.
different aspects that you need to be prepared for. Thankfully I didn’t have any joint problems, and have been pretty fortunate.” Denslow has been active his whole life. A 6-foot-7 athlete who started training in the military, his career and the intensity of his workouts evolved over time. And for a professional fighter, Denslow had been remarkably healthy. But like many athletes, a lifetime without injury can change very quickly. Denslow
around because it’s hard to move. It’s very tight. But I advanced pretty quickly. I got out of crutches in a couple of days and out of a brace in a couple days.” Denslow’s rehabilitation with The CORE Institute was personalized for his injury and his ultimate goal of returning to competition. After a couple of months of therapy, he felt ready to compete. “These guys are very well trained,” he said. “There are
can be a career-ender for a professional athlete,” he said. “Thankfully, Dr. Tony Nguyen’s got the hands of an angel and did the exact graph that I needed, the exact surgery I needed. And actually, the knee feels better than it did before I blew it to be honest.” But when Denslow looks back at his rehabilitation and healing, it’s not just about his ability to continue fighting. He’s still the active man he was before. On weekends, he
“Thankfully, Dr. Tony Nguyen’s got the hands of an angel and did the exact graph that I needed, the exact surgery I needed. And actually, the knee feels better than it did before I blew it to be honest.” was an invited guest at a jiujitsu class. About 15 minutes into the class he heard the pop and felt his body change. He had suffered a stage 3 ACL rupture. Soon, he was getting an MRI to confirm the injury, and talking to Dr. Nguyen. Within a week, Denslow had his knee surgically repaired. RECOVERY AFTER SURGERY Denslow was in physical therapy less than a week after surgery. His goal was to not just heal physically, but also to have confidence in his knee so he could continue to compete. “The ACL is much tougher than I thought to come back from,” he said. “A lot of laying
hours and hours and hours of sparring, so you need to be very sure of yourself and very sure of your reconstruction to be able to get in there because you’re not thinking about your knee when you’re getting punched in the head. You have to feel confident that it’s strong and going to hold up.” BACK TO MOTION Denslow calls his knee “custom-made.” He credits The CORE Institute and Dr. Nguyen for getting him back to fighting shape. “Blowing your ACL…
hikes with his children in the McDowell Mountains. Many athletes can point to a moment when their career ended. But for Denslow, his experience was just the opposite. “It got me back to my passion and a sport that I love,” he said. “I got a great outcome. I’m very thankful that I got Dr. Nguyen and The CORE Institute. Everything I had heard about them was definitely proven true on my end. He understood what my athletic ability was and where I wanted to go.”
FOUNDATION “Someday, I may be in their shoes and need help. I hope someone will be there for me.”
‘Ride N’ Raise’ Boosts Vet Transport Program
Never Forget By Pat Whitney Cyclists assembled the night of Nov. 10 at Harley-Davidson of Scottsdale weren’t out for joy rides. Instead, they joined a large group from the local medical community in a shared focus— 300 in all — to help the toooften-forgotten veteran. And help they did. The first annual “Ride N’ Raise” event, sponsored by the MORE Foundation’s Veterans’ Transportation Assistance Program (V-TAP), raised more than $10,000. The proceeds will fund 200 rides, said Marc Jacofsky, PhD, MORE Foundation executive director of research and education and The CORE Institute chief scientific officer. V-TAP contracts Quality Transportation Services of Arizona (QTS) to transport the veterans. QTS charges the foundation a discount rate.
Fundraising pays the rest. Don Hansen was one of the first to ride for free. DRIVER AND VETERAN FORMS BOND Don Hansen walks with a cane. He’s blind but has the awareness of someone with keen sight. He’s an independent guy who cares for his own yard outside his mobile home and doesn’t like to ask for help. His driver, Matt Matthews, 38, is a burly sort at six feet tall. He took the job five years ago, about the same time Hansen first sought assistance. On his day off, Matthews visits Hansen to read him his mail. Sometimes, they grab a burger.
“Don’s my buddy,” said Matthews who appreciates the opportunity to give back to those who have served their country. One veteran, confined to his home, was transported to the doctor, pharmacy and, through Matthews’ generosity, got a new pair of shoes. Compassion is a key component of the program, said QTS managing director Dana McWilliams. “We try to treat people for who they are, not their consequences.” Matthews, who grew up tough in a rough Detroit neighborhood, admits his job has awakened a sense of compassion he never knew he had.
NEED A LIFT? Military veterans may receive help with transportation to medical appointments by calling QTS directly at 602-371-1000 to request V-TAP assistance. To date, 303,495 veterans live in Maricopa County, according to the Arizona Coalition for Military Families.
V-TAP ON UPWARD SPIRAL Since July, 2015, the foundation’s charitable arm has reached out to 450 veterans in Maricopa County. Most are wheelchair-bound or on gurneys. Many are elderly. “The Core Institute’s medical community was first to identify that a large number of veterans were missing appointments,” Dr. Jacofsky said. “When veterans miss routine and followup care, it can cause a small issue to become much more significant.” “About midway every month, we have to turn people away. The VA does a good job getting veterans to a VA facility, but the new Choice cards allowing veterans to see outside providers have created a need for alternate transportation—especially for those who can’t afford to pay.” Veterans qualify for free transport assistance when they have no other means of travel or financial means to get to their medical appointments. V-TAP now approves veterans’ trips to the pharmacy, grocery, visits to an ill spouse and to attend a funeral. Which events like Ride N’ Raise will guarantee. “Our mission is to empower individuals to ‘Keep Life in Motion’,” Dr. Jacofsky said. “Going public as more funds are needed gets people in motion to support the vet community.” “Our goal is to serve 1200 veterans in 2017 and not turn anyone away.”
SPECIALTY SPOTLIGHT patient to return to their pre-injury level of function and to delay or even eliminate the need for joint replacement later in life. COMPREHENSIVE APPROACH Patients are the sum of their “Our entire paradigm of treatment is now based on a different understanding of the joint as an organ, not just a collection of individual tissues that you injure in isolation,” explained Dr. Görtz. “We look at the symbiotic relationship of those tissues as part of our root cause analysis of an injury. When you tear your ACL, you can also hurt your meniscus that protects the cartilage and so you may eventually injure that. We also look at the skeletal alignment, and other biomechanical and neuromuscular factors that affect the joint environment.
Go the Distance Joint Restoration Innovations Bring Hope to Young Actives
BIOLOGIC SOLUTION An emerging solution for these youthful damaged joints is the use of donor cartilage in what is known as biologic restoration of the joint. Although these transplants date back to the early 20th Century, they were not commonly used until the end of the century but have seen increased popularity since then. Starting in 2005 Dr. Görtz was involved in pioneering work at the University of California, San Diego, which optimized storage capacity of these so called allografts and standardized the most effective surgical techniques. He is among a select fellowship in the international community with the experience required for this joint restoration approach. The transplant approach differs from prosthetic replacement because the grafted tissue becomes a living, self-renewing part of the body, optimally allowing the
By Joan Westlake It seems like cruel irony that those who are active in their youth too often start paying the price of declining joint health far sooner than those who are sedentary. While joint replacement is an appropriate solution for seniors, athletic limitations and the inevitable wear of materials makes it less acceptable for people in their 30s or 40s. The joint problem often begins as early as high school with a sports injury or repetitive-use damage, according to Simon Görtz, MD, a renowned international expert in cartilage restoration and joint preservation. A common example is the high school or college athlete with an anterior cruciate ligament (ACL) in the knee that becomes over stretched or torn. Another is a tear in the meniscus, a C-shaped cushion of cartilage in the knee joint. When the joint becomes loose or the cushion is compromised, articular cartilage can become SIMON GÖRTZ, MD injured, and persistent knee pain and arthritis often begin to develop.
INNOVATIVE TECHNIQUES “For example, with a cartilage lesion, you can go in and plug the hole but you really need to ask how it got in that condition in the first place. It would be like having a bald front tire on one side replaced. If you don’t correct your front end alignment, the tire will wear out again for the same reason. If your joint is not aligned properly or is unstable, you can repair the cartilage or meniscus but if you didn’t address the underlying root cause, what makes you think your repair tissue will fare better under the same circumstances?” For those even as young as high school who are having activity-related knee pain, swelling, instability, “catching” and other symptoms, Dr. Görtz recommends coming in for an evaluation sooner rather than later. “Don’t wait until you’ve had a second surgery that isn’t solving the problem,” he said. “With innovative techniques and state-of-the-art care, we can improve your quality of life and help restore the active lifestyle you want to enjoy.”
Simon Görtz, MD is a fellowship-trained orthopedic sports medicine surgeon, specializing in reconstruction of the knee and shoulder, with a focus on cartilage restoration and joint preservation. He completed a sports medicine fellowship at Washington University in Saint Louis, Missouri and has served as a team physician for the Saint Louis Rams and St. Louis Blues. He completed his orthopedic surgery residency and post-graduate research fellowship at the University of California, San Diego and was recognized numerous times including the prestigious AAOS Kappa Delta Award. Dr. Görtz earned his medical degree from Julius-Maximilians-University in Würzburg, Germany
T R EN DS
Strength in Wisdom By Brian Sodoma More than 2.1 million bone fractures as a result of osteoporosis occur in the U.S. annually; and without bone healthcare after age 50, one in two women and one in four men are likely to experience fragility fractures. However, an active lifestyle with certain precautions in place can go a long way in the bone health conversation, says Debra Sietsema, RN, director of Bone Health Clinical Operations at The CORE Institute. “It is consistent with The CORE Institute’s theme of Keeping Life in Motion,” she said. “Staying flexible while maintaining good balance is really key to prevent falls and subsequent fractures.” KEEPING BONES STRONG Sietsema emphasizes the importance of two types of exercise: weight-bearing and muscle strengthening. Both bring critical physiological benefits to help the aging population avoid fractures. Typical weight-bearing exercises
include, but are not limited to, walking, jogging, aerobics, dancing, hiking and tennis. These activities involve bearing, or holding up, the body’s full weight and actually help to build bone strength, in particular, the trabeculae, or interwoven bands in the bone. “The trabeculae serve as the architectural strength of the bone,” Sietsema explained. Muscle strengthening exercises can involve free weights, weight machines, exercise bands and calisthenics. These exercises do not improve bone strength but instead support balance, core strength, proper walking and gait. “As we age, balance is important. These muscle strengthening exercises won’t build the bones, but they can help with preventing falls, which can result in fragility fractures,” she also noted. For frequency, three times a week is a good baseline for both weight-bearing and muscle-strengthening exercises, Sietsema added. If you’re new to muscle
BE HEALTHY To learn more about The CORE Institute’s Bone Health Program, call 866.974.2673 or visit www.thecoreinsitute.com/ bone health.
Exercise is Critical to Bone Health As We Age strengthening work and are concerned about proper form or over doing it, consult a physical therapist or athletic trainer. PRECAUTIONS, TESTING For everyday living as well as exercise, Sietsema uses the acronym BLT (bending, lifting, twisting) to help her patients maintain awareness of potential bone fracture or muscle straining trouble zones. Bending the knees to pick up objects should be a squat or lunge rather than a forward bend, she explains. Lifting should be done from the front of the body with the object near the chest and one should avoid twisting, particularly with heavier items. Carelessly twisting, in general, she adds, even without picking up objects, could cause a compression fracture when the spine has low bone mass. When bones are fragile, everyday activities may result in a fracture without proper body mechanics. Avoid lifting from a twisted/ sideways position and from a forward stooped/imbalanced position. Certain osteoporosis risk factors like calcium deficient diets, insufficient Vitamin D, lack of weight bearing exercise, medication history (such as steroids), certain medical conditions, smoking, and alcohol abuse can have a negative impact on bone health and can create fragility fracture concerns as early as age 50 for women and age 60 for men. If someone does not have these risk factors, bone density scans, referred to as the DEXA (dual-energy x-ray absorptiometry) test, should be conducted at age 65 for women and 70 for men. “The reality is, however, only about 20 percent of the people in the U.S. are actually receiving these screenings,” Sietsema emphasized. The CORE Institute will close this gap in Phoenix with a Bone Health Program to prevent osteoporosis, promote bone health, minimize the risk of a fragility fracture, and accelerate fracture healing.
Take Charge of Your Nutrition By Michelle Jacoby For many of us, keeping those wellintentioned resolutions is challenging. We’ve just come off that wonderful time of year when we have an excuse to overindulge a little bit. Another glass of wine? Don’t mind if we do. A heaping helping of mashed potatoes? Yes, please! That extra slice of Grandma’s pie? It would be rude to say no. Now, it’s time to stick to your plan, and there are certainly ways to stay healthy and make good food choices. BE MINDFUL That doesn’t mean you can’t eat nutritiously when getting together. “The most important thing to do when it comes to eating and drinking is to be mindful,” says Nicole Hahn, clinical nutrition senior manager at Banner Boswell Medical Center in Sun City. “It’s okay to enjoy what’s being served, just keep mindful tabs on what you’re eating.” When attending family or sports gatherings, Hahn suggests bypassing the bowls of chips and dip, and making a beeline for the fruit, vegetable and crudité plate. You can also fill up on leafy green salad and sip on water with lemon. If you know you’re going to a party, preparation is key, Hahn says. “If you’re attending a gathering that is at night, cut back on sugar and carbohydrates during the day, and maintain a balanced intake of proteins and vegetables” she says, adding the
most important thing to do to prepare for a party is to not starve yourself and go to the party hungry. “That’s when portion control and overeating go out the window,” Hahn says.
To lighten up beverages, make your wine go a long way by spritzing it with mineral water or seltzer. And instead of serving sugary sodas and juices, consider offering unsweetened teas with honey or sugar cane juice.
KEEP IT CLEAN If you’re entertaining friends and family, there are simple things you can do to make your dishes healthier, such as swapping out whole grains for refined ones. You can also choose low-fat dairy products, and using minimally processed sugars like honey or dehydrated cane juice sugar over granulated sugars. Another good tip is to reduce ingredient amounts and substitute ingredients, says Hahn. “When making desserts, use half the sugar the recipe calls for. Or replace it with Stevia,” she says. “You can also used mashed bananas or applesauce as sweeteners. Chia, which is packed with omega 3 fatty acids, is also a good substitute for eggs.”
WALK IT OFF Eating healthy goes hand in hand with staying active. While the hustle and bustle of the daily life can throw a wrench in your fitness schedule, Hahn says sticking with your normal routine as best you can is key to keeping fit and healthy. “Keep up with your daily regiment, whether it’s walking, weights, yoga or cardio. Consistency is still key,” says Hahn, who also suggests making exercise a social affair. “You’re already surrounded by friends and family. Why not gather everyone together after the meal and go for a walk around the neighborhood or at a nearby park? It’s a great way to socialize while being active.”
CORE CANDID What Does ‘Keeping Life in Motion’ Mean to You
KELLEY YOUNG, BUSINESS DEVELOPMENT DIRECTOR
We keep life in motion by participating in active family challenges, like Flagstaff Xtreme Ropes course and skiing in Colorado.
VERONICA HARRISON, SURGERY SCHEDULER
We keep life in motion by enjoying the snow at Bearizona in Williams, Az.
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