May/June 2012
Coordinated Health The Magazine
What’s Inside: Everything You Need to Know About Lyme Disease The Truth About Statins Golfing Injuries Therapy Dogs - Pawsing to Make a Difference A Healthy and Delicious Grilling Recipe And Much More! Remember Father’s Day - June 17th
“Your Prescription for Better Health” Feel free to take this magazine home! coordinatedhealth. com
The Most Experienced Foot & Ankle Team in the Lehigh Valley
Coordinated Health Foot and Ankle
Having foot and ankle pain does not have to limit your quality of life. With proactive treatment or surgery, you can often make a full and speedy recovery within a short time, resume the activities you love, and get back to enjoying your life. Whether you need a change in footwear, a non-surgical solution, or a surgical procedure; the Coordinated Health Foot & Ankle team works together to develop a custom solution that fits your needs.
Our foot and ankle team consists of: • Orthopedic Surgeons Fellowship Trained in Foot & Ankle Surgery • Podiatric Surgeons • Musculoskeletal Radiologists • Physical Therapists
Allentown • Bethlehem • Easton • Wind Gap • Phillipsburg • Brodheadsville • Lehighton • Hazleton • East Stroudsburg
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May/June 2012
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Letter From the Editor Managing Editor Amanda Boyce
Editor
Hannah Ropp
Design and Layout Rick Woods
Contributing Authors Dale Bautista, MD Primary Care
Nicole Chiappetta, DO Rheumatology, Arthritis & Osteoporosis
David Scoblionkio, MD Cardiology & Hypertension
Stephen Ksiazek, MD Cardiology & Hypertension
Mohamed Salem, MD Cardiology & Hypertension
Bruce Kaufmann, MD Gynecology
Mark A. Gittleman, MD Breast Care & Breast Imaging
Brett P. Godbout, MD Orthopedic Surgeon
Lisa Culp, PT Physical Therapy
Lori Cusher, PT
Summer is a great time to get out and enjoy the great outdoors with your family. Since everyone wants to take advantage of the warm weather. But, just like with any other season, you should always be cautious of common summer injuries and illnesses. In this issue, we have everything you need to get your summer started on the right foot. If you plan on spending time outdoors this summer, you won’t want to miss our article on Lyme disease. Lyme disease is a growing problem in our area, but Rheumatologist, Dr. Nicole Chiappetta, and Primary Care Physician, Dr. Dale Bautista, offer some tips on how to protect your family and what you should look for if you suspect Lyme disease. Shoulder impingements can happen anytime, but the repetitive activity of yard work and sporting activities can make it more likely to occur. Orthopedic Surgeon, Dr. Brett Godbout, explains the symptoms of shoulder impingement and lets you know what your treatment options are. Many women who are dealing with menopausal hot flashes may be dreading the summer months or the warmer temperatures that go along with summer, but, Gynecologist, Dr. Bruce Kauffman, has some advice that can help. Almost everyone deals with some type of back pain. We’ll introduce you to our featured physician, Dr. Chris Wagener. He’s a fellowship trained spinal surgeon and a pioneer in minimally invasive spine surgery. Breast Surgeon Dr. Mark Gittleman also takes you through some of the latest advances in gene therapy, which are helping women with breast cancer. In honor of Father’s Day, we also have some tips on how to make sure you’re grilling up some healthier fare! In addition, we also have some ideas on avoiding heat related illnesses and how one athletic trainer is using her therapy dog to build morale among her team members!
Debra Phillips, ATC
As always, we hope you enjoy this issue of Coordinated Health’s magazine and that it provides you with some useful information to keep your family safe and healthy during this busy time of year. v
Certified Athletic Trainer
Amanda Boyce
Physical Therapy
Kristine Roeder, ATC Certified Athletic Trainer
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What You Need to Know About Lyme Disease May/June 2012
Rheumatologist, Nicole Chiappetta, DO and Primary Care Physician Dale Bautista, MD, tell you about some of the signs and symptoms of Lyme Disease and how to prevent it ............................ 6
Golfing Injuries
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Find out how you can improve your game and prevent injuries with proper mechanics ............................................................ 8
Controlling Inflammation
Don’t let inflammation slow you down. What you can do to speed up your recovery ........................................................ 12
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Menopause
Hot flashes can be a problem for women going through menopause Gynecologist, Bruce Kaufmann, MD, has some tips on how to handle hot flashes and other menopause symptoms .................................................. 14
The Truth About Statins
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Coordinated Health Cardiologists give you all the facts about statins ............................................................... 16
Shoulder Impingement
Orthopedic Surgeon, Brett Godbout, MD, discusses shoulder impingement and treatment options ...................... 20
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Therapy Dogs
Check out how dogs are helping people recover even faster ......... 22
Heat Related Illness
32 Features
Featured Physician
Spine Surgeon Christopher Wagener, MD
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What our Patients are Saying
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With the temperatures rising, we’ve got some advice to keep you safe this summer ...................................................... 24
Plantar Fasciitis
Find out more about this painful foot condition ................................ 26
Breast Cancer Gene Testing
Breast Specialist, Mark Gittleman, MD, says women have more individualized treatment options for breast cancer thanks to gene testing. Find out how these tests can help you ......................................... 30
Get Grilling
Get some tips to make sure you’re grilling up some healthy food for your family ............................................. 32 coordinatedhealth. com
Welcomes Bruce Kaufmann, MD and
Amy Scott, WHNP-BC and their patients Dr. Kaufmann and Amy Scott are joining Coordinated Health’s expanding Women’s Health Gynecology team at our Bethlehem Campus on Highland Ave.
Now Accepting New Patients Women’s Health services available at:
Bethlehem Campus at Highland Ave. 2300 Highland Ave. Bethlehem, PA 18020
(877) 247-8080 | coordinatedhealth.com | (610) 861-8080 coordinatedhealth. com
Lyme
Disease
What You Need to Know About
If you’re like most people you probably want to spend as much time as possible outdoors this summer. However, all that time outdoors may leave you more susceptible to contracting common summer conditions, including the tick borne illness Lyme disease.
approximately 50% of those infected with Lyme disease. The rash begins at the tick bite and gradually expands over time and can reach up to 12 inches across. Part
Lyme disease is a bacterial infection that is transmitted when a tick attaches itself to a person to feed. It presents as an inflammatory disease that affects the skin, joints and nervous system and in rare cases other organs like the heart. Lyme disease was first diagnosed in 1975 when a mysterious outbreak of rheumatoid arthritis started to affect children near Lyme, Connecticut. Researchers knew that symptoms developed during the summer months, but it wasn’t until 1981 that the cause of Lyme disease was actually linked to ticks. Lyme disease is the most common tick borne disease in North America and the fastest growing infectious disease in the United States with over 250,000 cases being reported since 2000. Experts believe that eastern Pennsylvania is expected to see a sharp increase in Lyme disease this year because many of the small animals that ticks normally feed on didn’t make it through the winter due to a decreased food supply. Therefore ticks will be looking for a new food source leaving people and pets at risk. “Lyme disease is most common throughout the northeastern area of the United States, but it’s rampant right here in Pennsylvania,” explains Primary Care Physician, Dr. Dale Bautista. He says he sees an increase in suspected Lyme disease cases during the summer and fall months. Dr. Bautista says some symptoms of Lyme disease include joint pain, fatigue, fever, chills, headache and a “bull’s eye” rash. The most commonly recognized symptom of Lyme disease is the “bulls eye” shaped rash called erythema migrans, which occurs in
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Rythema Migran (“Bulls-Eye” Rash) of the rash may clear as it enlarges, which causes its “bulls-eye” appearance. The rash may feel warm to the touch, but is rarely painful or itchy and can appear on any part of the body. According to Rheumatologist, Dr. Nicole Chiappetta, diagnosing Lyme disease can be tricky. “The CDC recommends a two step process. First we would do the Lyme ELISA and if that’s positive we would then go to the western blot,” says Dr. Chiappetta. The Lyme ELISA (Enzyme-linked immunosorbent assay) is a rapid test used to identify Lyme disease antibodies and is the most common and sensitive screening process for Lyme disease. It detects a certain antibody found in Lyme disease, however, it can return false positive results because these antibodies can be found in other bacterial infections. The Western Blot is another blood test used to detect antibodies and confirms the diagnosis of Lyme disease. In order to be diagnosed with Lyme disease, both tests need to come back positive. According to Dr. Bautista, you should see a doctor if you find a tick, but aren’t sure how long it has been attached. Since it generally takes at least 24 to 48 hours for a tick to transmit Lyme disease, if you find a tick and know it has been there for only a few hours, you are generally fine.
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Dr. Chiappetta says the treatment for Lyme disease varies depending on the severity of the condition. “The standard treatment for patients who have acute symptoms, or have been diagnosed within the first few weeks of exposure can generally be treated with a two to four week course of Doxycycline for chronic Lyme disease or if more severe symptoms occur, IV antibiotics can be used.” says Dr. Chiappetta. Only about 10 to 20% of people who have been treated for Lyme disease have recurring symptoms and are considered to have post treatment Lyme disease syndrome. In those cases lingering symptoms of fatigue, pain and joint and muscle aches can last up to six months or longer. Lyme disease can be prevented. Dr. Bautista recommends wearing protective clothing like long-sleeved shirts, long pants and headgear if you are going to be in a tick infested area. That includes wooded areas and fields. He also suggests wearing an insect repellant containing 10 to 30 percent DEET on your clothing and doing a close check of your body when you get home to make sure you aren’t harboring any ticks.
Lyme disease is the most common tick borne disease in North America and the fastest growing infectious disease in the United States with over 250,000 cases being reported since 2000.
Some other tips for preventing tick bites include walking in the center of the trail and making sure not to brush up against weeds and checking yourself every two to three hours. If you do find a tick make sure to remove it promptly with tweezers. Firmly pull the tick straight out without twisting or jerking it. Ticks can be properly disposed of by placing them in a container with soapy water or alcohol or flushing them down the toilet.
After removing the tick, be sure to wash your hands thoroughly with soap and water and apply an antiseptic to the site of the bite. If you have any unexplained illness with fever, contact a physician. Be sure to tell your physician if you have been outdoors in areas where ticks are present or traveled to areas where tick borne diseases are common. If you suspect you have been infected with Lyme disease call Coordinated Health at (610) 861-8080. v
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Golfing Injuries by Lisa Culp, PT
Are you a golfer? Then you, like most golfers, have probably recently purchased new equipment to improve your game. But, did you know the easiest way to improve your game is actually by focusing on you, not the equipment. Golfers spend hundreds of dollars on equipment each year, but often overlook the most essential piece of equipment, their body. Focusing on your body will decrease the risk of injury and improve your performance. Injuries, although not as traumatic as those seen in high impact sports such as football, do occur in golfers. These injuries tend to come in the form of overuse syndromes, tendonitis, bursitis, strains, and sprains. Lumbar spine injuries are most common, followed by cervical, shoulder, thoracic, wrist, elbow, and lower extremity injuries. Factors that contribute to golf injuries are poor body mechanics, too many swings during practice, a limited exercise conditioning routine, and behavior factors such as poor diet and smoking. Treatment for injuries is approached through stretching, strengthening, aerobic exercise, balance exercises and facilitating and retraining the neuromuscular system to perform the correct movement. Once you have worked through these fundamentals, golf specific exercises and a progression to resume play is provided.
Backswing
Downswing
Your swing is broken down into the backswing, downswing and follow through and requires flexibility in your hip, shoulder and spine, single leg balance, and strength both to drive through the swing and then to slow the swing at the end of the follow through. A common injury that occurs in the backswing is epicondylitis, which is also known as tennis elbow. During the downswing your abdominal muscles may sustain strain from vigorous trunk rotation and the inability of the muscles to decelerate the swing, which can lead to compression within the spine and excessive stress to the shoulder ligaments and rotator cuff muscles of the shoulder. A large percentage of your swing is affected by posture when addressing the golf ball. A rounded spine and shoulders will limit the available rotation of the spine. Maximum rotation of the spine occurs when the spine is neutral with the shoulders and scapula retracted and adducted. In order to assume this posture, you will need flexibility in the spine and shoulders and the ankles, knees and hips. You can stand sideways in front of a mirror in the address posture and place the shaft of a club along your back, running the club from the back of your head to your low back. The club should touch the back of your head, thoracic spine and sacral spine; it should not touch the back of the cervical spine or lumbar spine.
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Follow Through
Stretching the correct muscles allows for symmetry in your posture, an increase in your joint motion and flexibility in your swing. Adding balance, and posture training in the new flexible posture will reset the muscles so that the new posture feels normal and no longer awkward. Then you can begin to control your swing positioning. Strengthening and conditioning will allow for improvement in muscular strength, power and endurance. Cardiovascular conditioning may seem inappropriate; however, since muscles utilize oxygen for performance, some more than others, cardiovascular training leads to fewer biomechanical breakdowns and injuries. To prevent lumbar injuries work on attaining correct posture, stretching, strengthening of the core muscles, aerobic exercise and speed control with trunk rotation. To prevent shoulder injuries work on scapular stability, thoracic flexibility and strength, eccentric strengthening to decelerate at follow through and shoulder flexibility and rotator cuff strengthening. To prevent wrist and elbow injury, decrease grip tension, loosen elbows, decrease excessive wrist motion, and attain good balance, flexibility and strength. Many problems can be prevented by a year round conditioning program. A short practical pre-game warm-up will also decrease risk of injury. v
Pre-round Warm-up Exercises
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Featured Physician Christopher Wagener, MD Coordinated Health Spine Surgeon
Coordinated Health Spine Surgeon Dr. Christopher Wagener Helps Pioneer New Back Procedures Back surgery used to be a major ordeal. It meant dealing with a risky surgery, months off from work, a lengthy recovery and unsightly scarring. However, Spine Surgeon, Dr. Christopher Wagener is making back surgery easier to deal with thanks to the minimally invasive procedures that he performs. Dr. Wagener is a pioneer in the field of minimally invasive spine surgery. He is one of only 200 spine surgeons worldwide to be elected into the Society of Minimally Invasive Spine Surgery, an honor that is limited to those who demonstrate strong commitment and skill to the complicated and emerging technique. “Today’s patients want to remain active. They don’t want a big surgery that’s going to cause them to be out of work for a long time. The minimally invasive procedures allow them to get back to doing the things they want to do even earlier,” says Dr. Wagener. He explains that the traditional open procedures often came with more pain, bleeding and a much longer recovery time. Minimally invasive procedures allow patients less bleeding and a shorter recovery time. Some conditions that may benefit from minimally invasive procedures include spinal stenosis, bulging discs, bone spurs, sciatica, leg pain and arm pain. Many of these conditions are degenerative and occur as a result of everyday wear and tear.
Before considering surgery, Dr. Wagener says that most patients should consider a conservative approach. That approach includes anti-inflammatory medications, physical therapy and various types of injections. He also says few patients will actually need surgery. Minimally invasive procedures involve making small incisions and then the muscle is dilated, which spares the tissue. A tube is then inserted and like an endoscopic or arthroscopic procedure the surgery is done through the tube. He uses an operating microscope to get the visualization that he needs. According to Dr. Wagener, the procedures can take anywhere from 30 minutes to a few hours, but overall it takes less time than a traditional open surgery. Following a minimally invasive procedure, Dr. Wagener says that patients are typically up and walking either the same day or at the very latest, the next day. He recommends they walk every day, refrain from physical labor, avoid repetitive twisting, bending or turning and lifting anything over five or ten pounds. Physical therapy generally begins around three or four weeks after surgery. For more information on minimally invasive spine procedures or to make an appointment with Dr. Wagener, please visit www.coordinatedhealth.com or call (610) 861-8080. v
According to Dr. Wagener, the first thing he does with all new patients is perform a comprehensive physical exam, where he assesses strength, gait and sensation. He also checks flexibility, which he says helps him determine the site of the pain. If he suspects a problem, he says he will often order an MRI. “An MRI is a roadmap for what the surgeon might need to see when they are performing a surgery,” explains Dr. Wagener.
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P.R.I.C.E. is right for
Controlling What you can do to speed your healing by Lori Cushner, PT
Inflammation is the body’s response to injury. It provides blood flow to heal injured areas and signals the sensation of pain to your brain, acting as a protective mechanism so you avoid further injury and are encouraged to rest. Imagine rolling your ankle and seeing it swell, feeling pain, and not wanting to walk on it. This is your body’s way of telling you to rest and allow your ankle to heal. Excessive inflammation, however, can delay healing time and limit your joint’s range of motion. In some cases, chronic or persistent inflammation in joints can play a role in the severity of pain, the length of time this severe pain lasts, and the progression of arthritis and joint degeneration. Inflammation that is systemic, or throughout your body, has even been linked to chronic diseases and cancer, in addition to increasing the amount of time it takes for wounds and injuries to heal.
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There are a number of well-known ways to reduce inflammation, especially in the first 3-7 days after injury or surgery. These are commonly referred to as “PRICE”:
P R I C E
Protection: Protecting a joint ensures that it is not harmed further, including avoiding inadvertent motion. This might mean using a brace or splint.
Rest: Rest allows your muscles and joints to relax so your body can heal. Rest might also involve using an assistive device, like crutches or a cane, if the affected joint is unable to tolerate activities like walking.
Ice: Cold constricts the blood vessels and impedes excessive blood flow to an area that has been injured or undergone surgery.
Compression: Certain wraps, sleeves, or stockings can provide a mechanical restriction to the amount
of swelling allowed at a joint. This can be beneficial in preventing an excess of inflammation, especially in joints that would be affected by gravity’s pull, e.g. knees and ankles.
Elevation: Elevation uses gravity to the joint’s advantage. If the affected area is elevated above the level of the heart, gravity acts to pull the fluid back toward the rest of the body.
There are also lifestyle changes you can make that encourage lower levels of inflammation at the joint as well as throughout the entire body.
discomfort, increase energy levels, reduce arthritic symptoms, improve sleep patterns and skin, and speed up healing.
1. Drink water
3. Move!
Water retention is often the first sign of dehydration. Your body needs water to carry out all functions, and when it senses that stores are low, it may act to conserve water. This can appear as swelling in the hands, feet, or in injured joints. Staying hydrated throughout the day and avoiding excess sodium and salt in the diet are key steps in preventing unnecessary swelling. Beverages that are especially helpful include water, 100% fruit juice, and herbal tea.
2. Avoid inflammatory foods
Certain foods and drinks, especially those that increase acidity in your body, also increase inflammation. Unfortunately, many of these are heavily emphasized in the Standard American Diet; they include processed items, foods with chemical additives, refined sugars, refined flours, fried foods, caffeine, alcohol, and meat and dairy products. Aiming for a diet consisting of 80% fresh fruits, vegetables, beans, nuts, and grains can assist the body in maintaining a proper acid/base balance and reducing inflammation. An effort to make this lifestyle change can also promote weight loss, reduced stomach
The main function of your muscles is to help you move by pulling at your bones to create movement. Another function, however, is to act as pumps. The force of muscle contractions in the body helps the veins and the lymph vessels pump fluid against gravity toward the heart. When you rest too much and allow too much fluid to accumulate, movement can be progressively more difficult. Muscles can then get weak and joints become stiff and painful. Even simple exercises like moving your ankles or wrists in circles or squeezing your fingers or toes can help with pumping out fluid. It is important to talk with your doctor and/ or physical therapist about how much you’re able to move and what exercises to do to alleviate swelling and move more easily. Even someone without an injury who makes changes to stay hydrated, exercise, and eat better can notice improvements. It’s especially important, however, for someone who has been injured or undergone surgery. Talk to your doctor or physical therapist about how you can decrease inflammation and get back to living an active, healthy life. v
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What You Can Do to Alleviate Menopause Symptoms While menopause is a fact of life that every woman goes through, it’s still a taboo topic that is frequently misunderstood. Media and society often associate menopause with irrational mood swings, unbearable hot flashes and weight gain. However, according to Gynecologist Dr. Bruce Kaufmann, with proper education and treatment there is no need for women to suffer from the side effects of menopause they did in the past. He says that in order to deal with menopause, you first need to understand exactly what it is. “Menopause is the time when the ovary runs out of eggs. It generally takes about three years from start to finish and is complete when you go for twelve consecutive months without a period,” says Dr. Kaufmann. The median age for menopause is 51.8, but Dr. Kaufmann warns there is no normal when it comes to menopause. He says that some women may begin menopause earlier, in their forties, while others may not begin noticing symptoms until their fifties. Menopause under the age of forty is often referred to as premature menopause and happens to only a small number of women. Some risk factors for premature menopause are smoking; high body mass index, illness, chemotherapy or radiation and the removal of the uterus and/or both ovaries. Nearly 70% of women will have some type of symptoms linked to menopause. Some of the most common symptoms include worsening periods, hot flashes, heart palpitations, insomnia, sexual dysfunction and vaginal dryness.
Menopause is the time when the ovary runs out of eggs. It generally takes about three years from start to finish and is complete when you go for twelve consecutive months without a period.
“Women experience menopausal symptoms because of fluctuating hormone levels,” explains Dr. Kaufmann. He says the treatment for menopausal symptoms varies. “If a woman comes to me and mentions that she is experiencing some symptoms, but doesn’t seem bothered, then we don’t need to do anything. But, if a woman comes in and says she isn’t sleeping and can’t function because of the symptoms, then we need to take action,” says Dr. Kaufmann.
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There are two forms of hormone therapy used to treat menopause symptoms, estrogen replacement therapy and hormone therapy, which includes both estrogen and progesterone. Dr. Kaufmann says that estrogen therapy is only used in women who have had a hysterectomy. Estrogen influences how a woman’s body uses calcium and keeps the vagina healthy. Lower levels of estrogen during menopause may cause symptoms like hot flashes and even lead to osteoporosis. Progesterone reduces the risk of endometrial cancer by making the endometrium shed each month, which results in bleeding. A combination of estrogen and progesterone, which would be known as hormone therapy, is generally recommended for women who have menopausal symptoms. It can help alleviate night sweats, dry and itchy skin, improve mood and reduce the risk of both colon cancer and osteoporosis. Hormone therapy can be taken in the form of a pill, patch or in some cases a cream. Since osteoporosis and osteopenia is a concern for women going through menopause, Dr. Kaufmann suggests taking extra vitamin D. “We’ve found that most people are vitamin D deficient and it’s beneficial in decreasing the risk of certain cancers and osteoporosis since it helps with calcium absorption. It’s almost impossible to overdose on vitamin D, you just can’t have too much of it,” he says. Dr. Kaufmann also recommends living a healthy lifestyle by getting plenty of exercise, not smoking or overindulging in alcohol. Since menopause increases women’s risk of developing certain conditions, Dr. Kaufmann says it’s important to be seen by your gynecologist if you suspect menopause. He says that your gynecologist will be able to give you an idea of what is normal and what you should be aware of. Many women take menopause as a sign that their life is winding down, but Dr. Kaufmann claims that is far from true. “A woman today that reaches 50 without heart disease or cancer has a life expectancy of 93. The key is to be able to live those remaining 40 years as productively and healthy as possible,” he says. For more information about menopause or to make an appointment with Dr. Kaufmann, please call (610) 861-8080 or visit www.coordinatedhealth.com. v
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The TRUTH About Statins
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Heart disease is the number one killer of both men and women in the United States so it’s no surprise that statins, which are used to lower “bad” cholesterol and prevent the progression of atherosclerosis and new cardiac events are the most prescribed drug class in the country. In fact, an estimated 20 million Americans are taking a statin. However, these “miracle drugs” have recently become the center of controversy because of potential serious side effects. Some doctors and other healthcare advocates are also claiming that they are overprescribed. According to Cardiologist Dr. Stephen Ksiazek, statins work by blocking an enzyme in your liver, where cholesterol is made. Cholesterol is a waxy, fatlike substance found in certain foods like meat, dairy and eggs. Your body only needs a limited amount of cholesterol to produce hormones, Vitamin D and the acids needed to digest fat. When your body makes too much of it, you are at a higher risk of developing coronary heart disease (CAD). Since high cholesterol has been linked to atherosclerosis and heart disease, statins are generally given to people with high cholesterol to prevent the onset or progression of heart and vascular diseases, particularly if you have diabetes, smoke or have a family history of CAD. Some commonly prescribed statins include Lipitor, Crestor and Zocor, or their generic equivalents.
made up of several factors including LDL, HDL and VLDL. In most cases, levels over 200 are considered high; however, it depends on the breakdown of your LDL or “good” cholesterol vs. your HDL or “bad” cholesterol. Cardiologist, Dr. Mohamed Salem, also warns people to be aware of their triglycerides and low HDL. “High triglycerides have been linked to heart disease, diabetes and pancreatitis. Low HDL is also a risk factor for heart disease and atherosclerosis. These specific conditions wouldn’t be best treated with statins, but rather another class of medication,” he says. Statins have long been associated with side effects like fatigue and muscle aches, but recently the FDA also added a warning about developing Type 2 diabetes and memory loss. The new warnings have some questioning whether the risks are worth the rewards. “Trials have suggested that statins could be related to about 1 in 200 developing diabetes and prevents a cardiac event in approximately 1 in 150 so it’s definitely a careful clinical judgment as to whether or not a patient should be taking a statin for primary prevention. However, it is definitely most beneficial when used for people with established heart or vascular disease,” says Dr. Salem. Chief Cardiologist, Dr. David Scoblionko agrees. “There has been much commentary and review in academic and nonacademic literature about the potential effect statins have on cognitive function, but these effects remain uncertain at worse and appear to be reversible. Further study will be important,” he says.
An estimated 20 million Americans are taking a statin
While there is little doubt that statins are beneficial to many, much of the controversy surrounds who should be taking statins. Dr. Ksiazek says that studies have shown that statins are most beneficial to those who have the highest risk of developing coronary heart disease.
“The issue is picking out the people who are at the highest risk for developing disease. Just because you have high cholesterol doesn’t mean that you need to be on a statin,” he says. Dr. Ksiazek explains that your total cholesterol is
Dr. Scoblionko also notes that some of the other side effects that have been commonly associated with statins, like, muscle aches and fatigue can often be controlled by adjusting the dosage of medication when the potential benefits of treatment warrant persistent efforts. He also notes that some people, Continued on next page
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Continued from previous page however, simply cannot tolerate statins, which he claims is pretty much true of any drug class. “I think it is also very important to understand that there is an abundance of medical trials that have demonstrated a clear benefit of statin therapy in patients who have existing CAD, prior heart attack, or stroke and in patients with diabetes and vascular disease, despite concerns about statins elevating blood sugars. This same concern is true for beta blockers, which are among the most commonly used and beneficial drugs used in the treatment of heart disease,” says Dr. Scoblionko. According to Dr. Ksiazek, decreasing cholesterol levels may not be the whole story as to how statins work. Statins may actually help decrease inflammation in blocked arteries. “Atherosclerosis occurs when you get fatty buildup in the lining of the arteries. When the lining of the arteries is inflamed, the plaque itself is more likely to crack and cause the arteries to clot off, which could lead to a heart attack or stroke,” he says. Inflammation in the heart and blood vessels have been shown to cause blood vessel walls to become “sticky”, attracting additional blood cells, which forms plaque and adds onto the plaque deposits that already exist. This can block the flow of blood and oxygen and lead to a heart attack or stroke. This is why people who are considered high risk or believe they are actually having a heart attack are often told to take aspirin. If you have high cholesterol, it can be tempting to try to control it yourself; however, Dr. Ksiazek says that it is best to see your doctor who can decide the best course of treatment. He also says that statins can be beneficial depending on the situation. “Taking a statin is like wearing a bullet proof vest. If you’re on the police S.W.A.T team you’ll want that vest, but if you’re just going about your daily business it may not be as helpful. If you are considered high risk, you’ll want to consider a statin, otherwise, there may be other options, which you can discuss with your doctor,” sums up Dr. Ksiazek. For more information or to make an appointment with one of Coordinated Health’s cardiologists, please call (610) 861-8080 or go to www.coordinatedhealth.com. v
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Don’t Let Shoulder Pain Keep All the Facts about Shoulder Impingement and How You Can Treat It
Your shoulder is one of the most moveable joints in the human body. The shoulder can abduct, rotate and move through a full 360 degrees. However, this tremendous range of motion also makes the shoulder extremely unstable, and far more prone to injury than other joints. “Shoulder injuries are very common, especially shoulder impingements. I see at least six to eight patients a day with that diagnosis,” says Orthopedic Surgeon, Dr. Brett Godbout. Dr. Godbout explains that shoulder impingement is a condition in which the shoulder is inflamed and also involves the rotator cuff and spurs that you may have developed over time. Some of the symptoms include difficulty reaching behind your back, pain with the overhead use of your arm and weakness of your shoulder muscles. He says night pain and some form of injury to the rotator cuff are also common. “Shoulder impingement can be caused by a number of factors. A lot of it is just wear and tear over time,
“Shoulder injuries are very common, especially shoulder impingements. I see at least six to eight patients a day with that diagnosis,” says Coordinated Health Orthopedic Surgeon Dr. Brett Godbout 20
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repetition, frequent overhead use. Most patients don’t remember one specific event. It usually occurs over time,” says Dr. Godbout. Shoulder impingements are often diagnosed through a combination of a history and physical and sometimes even an MRI, depending on the severity. According to Dr. Godbout, shoulder impingements are generally graded on a scale of one to three. A grade one strain may cause some inflammation of the tendon and pain with activity. Grade two occurs when the rotator cuff is torn, even partially. People may notice some increased night pain and loss of strength with a grade two strain. Grade three strains include a full tear where the rotator cuff has become perforated. People will notice severe pain and loss of strength with a grade three strain. Dr. Godbout says the treatment plan for shoulder impingement depends on the severity of the strain. “For a grade one, I’m going to treat that very conservatively with physical therapy and a cortisone injection if there is night pain and discomfort. The partial tears and grade two’s, I do treat them in therapy to a point and look to see if there is any improvement, the grade three’s with the full tears, those are the ones we treat surgically,” says Dr. Godbout. Oral anti-inflammatory medications like aspirin, naproxen, or ibuprofen are commonly used to treat pain in minor shoulder impingements, according to Dr. Godbout. However, in order for the medication to work most effectively they need to be taken for nearly eight weeks. While anti-inflammatory drugs may relieve symptoms for a short period of time, it doesn’t treat the underlying problem and symptoms are likely to come back.
coordinatedhealth. com
You from Enjoying Your Life
coordinatedhealth. com
May/June 2012
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Therapy Dogs
Pawsing to Make a Difference by Christina T. Wise, M.S., ATC
“The dog has been esteemed and loved by all the people on earth, and he has deserved this affection, for he renders services that have made him man’s best friend.” ~Alfred Barbou It’s been said that the only creature capable of true unconditional love is the dog. For this reason, it is easy to understand why therapy dogs can be valuable in the rehabilitation process. Dogs don’t judge our actions and can see past our human flaws and faults; they are the perfect listeners and always make us feel important. Those who have had limited exposure to dogs will often find that dogs can boost morale, even among those who feel defeated. Therapy dogs are used in a variety of settings, and are not to be confused with service dogs, who are mainly used as guides for those who are physically handicapped or visually impaired. According to the Therapy Dogs International website:
“The dog has been esteemed and loved by all the people on earth, and he has deserved this affection, for he renders services that have made him man’s best friend.” ~Alfred Barbou 22
May/June 2012
The use of canines to help mankind is known throughout the world. They have been used for guarding flocks, tracking, hunting, search and rescue, leading the blind, and in assisting the deaf and physically challenged. The bond between dog and man dates back to early history, but it wasn’t until recently that a correlation was acknowledged between this bond and the emotional health of humans. Studies have shown that a person holding or petting an animal will cause a lowering of blood pressure, the release of strain and tension, and can draw out a person from loneliness and depression. It isn’t difficult to see how dogs can boost our spirit. Just think, when you come home from a long day at work and are greeted at the door by your furry friend wagging his tail and jumping up and down with excitement. Immediately you feel welcomed, comfortable, loved, and at peace. I find that when I’m away from home and happen to see a dog playing in their yard, out for a walk, or going for a ride in the car, I am overwhelmed with positive feelings, and I smile just a little bigger even if only for few moments. Imagine what those positive feelings can do for someone who is frustrated in their rehabilitation process and dealing with not only physical pain, but also emotional issues such as loss of confidence and lack of motivation. A visit from a therapy dog can lift patient’s spirits and help them feel more confident in their physical therapy. Just that little nudge forward can help people find the strength they need to work through setbacks and power through a difficult recovery.
coordinatedhealth. com
Aside from nursing homes, therapy dogs lend their services to hospices and home visits, hospitals and physical therapy centers, schools, shelters, and libraries. Dogs have also come to the emotional rescue of those in need after they have suffered through traumatic events like 9/11, Hurricane Katrina, the Oklahoma City bombings, and tornado ravaged Tuscaloosa. It is truly heartwarming to know what these dogs have done for those who needed them in their darkest hour. Dogs have also helped children with learning disabilities find security and comfort in reading. In addition they can also relieve stress in the workplace and can improve relationships by lowering blood pressure and allowing for increased patience when dealing with coworkers. People throughout the world can become happier and healthier just by incorporating some canine interaction into their lives. I’ve seen this firsthand in the few nursing home visits I’ve made with my own therapy dog (recently certified!) Milo, and the few times I was able to take him to visit some of my athletic teams. Athletic Trainers are licensed medical professionals skilled in the management, diagnosis, and rehabilitation of sports injuries, and sometimes it takes me days to get through to athletes and make a difference with them; yet Milo did it in ten short minutes. I found that the athletes were more relaxed in their environment, yet more upbeat and spirited, and his presence made them more communicative with each other, which I’d like to think could contribute to improved teamwork and bonding. Humans have bonded with dogs throughout the ages, and strengthening those bonds while improving learning skills and receptiveness to therapy can only benefit the field of rehabilitation, subsequently leading to an improved relationship between patient and therapist. Not to mention, they’re cute and cuddly, and can make any day better in just a blink of their comforting eyes. v If you’d like to learn more about Therapy Dogs, please feel free to visit the link below. Therapy Dogs International: www.tdi-dog.org
Therapy Dogs Moose & Milo, at
Barnes & Nobles for their first outing, and their loving owners Francine Crivellaro (MRI Technician)
and Christina Wise (ATC) from Coordinated Health.
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Heat Related Illness in Sports by Kristine Roder, ATC
With the constant rise in temperature and record setting highs, heat related illness among athletes are a serious problem that shouldn’t be taken lightly. Exercising in an environment where the conditions are hot and humid can cause heat syncope, heat rash, heat cramps, heat exhaustion and heat stroke as well as several other potentially dangerous conditions. According to the CDC, heat related illness has caused over 5,900 people to visit the emergency room and if left untreated, could even lead to death. Two of the most important illnesses to prevent are heat exhaustion and heat stroke. These two illnesses are caused by the body failing to cool itself off. When an individual sweats it evaporates from the skin, which keeps the body cool. On a hot and humid day the evaporation process is slowed down due to excess moisture in the air, which in turn can cause the body temperature to rise. Heat exhaustion and heatstroke both share similar signs and symptoms, however, heatstroke is much more serious than heat exhaustion. Heatstroke can cause damage to the organs and brain and in some cases could even be fatal. Symptoms of these illnesses include dizziness, confusion, fatigue, nausea, headache and heart palpitations. The difference between heat stroke and heat exhaustion is that with heatstroke the internal body temperature reaches 104oF and there is a lack of sweat on the body whereas heat exhaustion will cause profuse sweating. If you are an athlete suffering from heat exhaustion, you should get out of the heat immediately, drink plenty of fluids and take a cool bath. If conditions don’t get any better after 30 minutes, you should contact a doctor. If left untreated, heat exhaustion can advance to heat stroke. On the other hand, if you are an athlete suffering from heatstroke you should go to the hospital immediately. If you need to wait for an ambulance, find shade or an air conditioned room to try and cool off. Ice packs can be placed under the arm pits, groin, back and neck to try and cool off quickly. To prevent heat related illnesses you should stay indoors if the heat index is high. If this is not possible due to an outdoor sporting event, there are still ways of preventing a trip to the hospital. It is important drink eight ounces of water every hour for six hours before practice or a game to stay properly hydrated. Wearing light colored clothing and light weight material along with use of sunscreen can also help prevent heat related illnesses. If there is shade in the area take as many breaks as possible to keep cool. Most importantly keep hydrated during exercise. You may even want to try a sports drink as they can help regulate the proper amount of salt needed in the body in order to absorb water. v
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Choose a Location Near You: 1503 N. Cedar Crest Blvd. Allentown, PA 18104 877-247-8080 Hours: Monday-Friday 7am-11pm Saturday/Sunday 8am-8pm
2310 Highland Ave. Bethlehem, PA 18020 877-247-8080 Hours: Monday-Friday 7am-11pm Saturday/Sunday 8am-8pm
1097B N. Church St. Hazle Township, PA 18202 877-247-8080 Hours: Mon. 8am - 11am Tues., Wed., & Fri. 8am - 4:30pm Thurs. 1pm - 4:30pm
511 VNA Rd. East Stroudsburg, PA 18301 877-247-8080 Hours: Monday-Friday 7am-11pm Saturday/Sunday 8am-8pm
1411 Jacobsburg Rd. Wind Gap, PA 18091 877-247-8080 Hours: Monday-Friday 7am-11pm Saturday/Sunday 8am-8pm
239 N. First St. Lehighton, PA 18239 877-247-8080 Hours: Monday 1pm - 4:30pm Thursday 8am - 11am
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May/June 2012
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PLANTAR FASCIITIS by Debra Phillips, PTA
“Why do I have a stabbing pain in my foot? Why does my foot hurt when I first get out of bed in the morning? Why does the pain subside when I am off my feet and return with a vengeance when I stand up again?” Does this sound familiar? Have you been thinking about seeing a doctor for one of these problems? If so, you may have plantar fasciitis. Plantar fasciitis is a painful inflammation of the bottom of the foot between the ball of the foot and the heel. This is the most common cause of heel pain. The pain is usually worse in the morning, with stair climbing, when standing or sitting for long periods of time, or with increased activity. The main symptom of plantar fasciitis is heel pain when you walk. It develops gradually and can occur in one foot or both feet at the same time. You may feel no pain when you are sleeping because during rest you position your feet in a manner that allows the fascia to shorten and relax. Some possible causes of plantar fasciitis: • Improper shoes
Plantar fasciitis is a painful inflammation of the bottom of the foot between the ball of the foot and the heel. This is the most common cause of heel pain.
• Weight gain • Occupations that are physically demanding that may require prolonged standing • Being flat-footed, having a high arch, or having an abnormal gait pattern • It is more common to develop plantar fasciitis between the ages of 40 and 60 • Women are more likely than men to develop plantar fasciitis • Certain types of exercise and activities such as long-distanced running, ballet and dance, and aerobics
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Before going to the doctor, write a list of some basic questions and have a list of medications and dietary supplements that you take. Some questions you may want to ask, include: • What is causing my symptoms or condition? • Do I need any tests to confirm the diagnosis? • What can I do now to relieve my symptoms? • What treatment do you recommend? • Should I see a podiatrist? • Do you have any brochures or other reading material that I can review at home? Your doctor will also ask you some questions and being prepared to answer them may help save time for other pertinent points you want to discuss during this appointment. The following list of questions will help prepare your answers. • What are your symptoms and when did you first notice them? • What type of shoes do you wear? • Does your work involve prolonged standing? • What worsens and what improves your symptoms? • Do you participate in sports or are you a runner? • What medications including vitamins or supplements are you taking? • Do you have a chronic illness? • Have you experienced any injuries to your feet and do you feel pain in any other part of your body? Your physician will physically examine your feet and review your medical history. An X-ray or MRI may be ordered to make sure that you do not have a stress fracture, bone spur, or a pinched nerve. An examination of your ankle joint and foot will include testing for muscle strength, reflexes, muscle tone and sense of touch, balance, and coordination. Statistics show that 90% of people who have been diagnosed with plantar fasciitis recover with conservative treatments in just a few months. There are several courses of treatment for plantar fasciitis. The medications may include anti-inflammatory drugs such as Advil, Motrin and naproxen (Aleve). Physical therapy may also be recommended. If so, a physical therapist will evaluate you and instruct you with exercises that will help you stretch your plantar fascia and Achilles tendon. Exercises will be chosen to strengthen your legs and help stabilize your ankles and heels. The use of night splints may be recommended in order to stretch the calf and arch of your foot while you are sleeping. This will help to lengthen and facilitate overnight stretching. Your doctor may recommend custom-fitted arch supports or arch supports that will help distribute pressure evenly to your feet. You may find that the pain is worse over time. If you received treatment Continued on next page coordinatedhealth. com
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Continued from previous page shortly after noticing your pain, it may only take a couple of weeks for the pain to subside. If, however, you have experienced pain for a long time, it may take many weeks or months for the pain to subside. To treat plantar fasciitis symptoms at home, put your feet up and stay off your feet when the pain is severe. Use ice 15 to 20 minutes several times a day or try ice massage. To do that, fill a small paper cup with water and freeze. Roll the ice over the painful site for five to seven minutes. This will reduce the pain and inflammation. You can also do exercises to stretch your arches and calf muscles. You can prevent plantar fasciitis by avoiding repeated jarring to your heel, maintaining a healthy weight and not wearing worn-out athletic shoes. Runners need to purchase new shoes after 500 logged miles of use. For more information about plantar fasciitis go to the Where Does it Hurt section of coordinatedhealth.com. v
Welcomes
Dr. Michael A. Palermo
and his patients to our newest location in the Greater Hazleton Area To schedule an appointment with Dr. Palermo call:
(610) 861-8080 or (570) 459-1110
Coordinated Health - Hazleton Campus 1097B North Church St. (Church Hill Mall) Hazle Township, PA 18202 28
May/June 2012
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For you, your family, and your friends
Coordinated Health Imaging
X-ray • MRI (Open and High Field) • MRI Arthrogram CT Scan • CT Scan Arthrogram • Vascular Ultrasound • DEXA
Allentown • Bethlehem • Easton • Wind Gap • Phillipsburg Brodheadsville • Lehighton • Hazleton • East Stroudsburg (877) 247-8080 | coordinatedhealth.com | (610) 861-8080 coordinatedhealth. com
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Dr. Gittleman says that there are ways for those who test positive for the BRCA1 or BRCA2 mutation to lower their risk of developing breast cancer. Some of those options are more radical and include a prophylactic mastectomy and/or the removal of both ovaries. Alternatively, chemoprevention with drugs such as Tamoxifen can be used to reduce the likelihood of breast cancer by 30-35%. Another category of gene testing is gene profiling, which assesses the cancer related genes of the patient’s individual cancer and the risk of metastatic disease or spread to other parts of the body in the future. Dr. Gittleman says these tests are helping doctors treat breast cancer more effectively. “These tests are done to better enable us to treat the patient more appropriately. We no longer want to use ‘shotgun’ therapy, but rather a more targeted approach that individualizes patient treatment to optimize results,” says Dr. Gittleman. If the cancer is found to have a relatively low risk of metastasizing or recurring following initial local therapy (surgery with or without radiation), then systemic treatment with hormone therapy alone may be indicated, avoiding chemo. However, if the cancer is found to be at a high risk of metastasizing than a more aggressive approach using chemotherapy would be indicated. Both of these tests, risk assessment analysis and gene expression profiling are being offered by Dr. Gittleman and the team at Breast Care Specialist at Coordinated Health. For more information or to make an appointment, go to www.coordinatedhealth.com or call (610) 366-7333 v
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Get This Grilling Summer Nothing says summer like a meal cooked on the grill. The grill can be a great way to cook healthy meals. Vegetables, seafood, lean meats, poultry, and even some fruits grill beautifully. Here are some basic grilling tips to help you get fired up this summer. 1. Choose lean cuts of meat or for a boost of heart healthy omega-3’s skip the beef and grill your favorite fish. Salmon does great on the grill. 2. Don’t leave out the veggies! A lot of summer vegetables are great on the grill. Mushrooms, zucchini, squash, onions and bell peppers are great choices. You can either grill them in a specially designed basket for the grill or in foil. Another great way to incorporate vegetables in your meal is to add them to your ground meat for some extra zing. 3. Make some mouthwatering marinades. Marinades add flavor to your food and can help prevent them from becoming burnt. There are a variety of marinades available on the market or try making your own with herbs, spices, vinegar and vegetable oil. 4. Cook your meats to the appropriate temperature. Grilling meats can be tricky since the outside can be blackened before the inside is fully cooked. Use a meat thermometer to make sure your meat is fully cooked. Poultry should be no less than 165 degrees and beef shouldn’t be less than 145 degrees. 5. Clean your grill after each use! Cleaning your grill ensures that you don’t ingest food particles that have been sitting on your grill collecting bacteria and could prevent illness.
Healthy Chicken Kabob Recipe Ingredients • • • • • •
4 skinless, boneless chicken breast halves - cubed 1 large green bell pepper, cut into 2 inch pieces 1 onion, cut into wedges 1 large red bell pepper, cut into 2 inch pieces 1 cup barbeque sauce Skewers
Directions
1. Preheat grill for high heat. 2. Thread the chicken, green bell pepper, onion, and red bell pepper pieces onto skewers alternately. 3. Lightly oil the grill grate. Place kabobs on the prepared grill, and brush with barbeque sauce. Cook, turning and brushing with barbeque sauce frequently, for 15 minutes, or until chicken juices run clear. v coordinatedhealth. com
June 17
th
Happy Father’s Day From the entire Coordinated Health family
Join Coordinated Health’s
Free VIP Program* Register now to receive:
• Subscription to Coordinated Health’s new online Magazine - we make it easy to understand your medical injuries, conditions, and treatment options • All-access pass to Coordinated Health TV - be a part of our growing online community as we educate and inform on the medical topics that interest you • The latest Coordinated Health news - be the first to know the latest healthcare news and how it affects your care • Priority access to our educational seminars and events you’ll be first in line to register for all our special events • Updates from your physicians on the services and treatments that matter most to you and your family
To register go to: coordinatedhealth.com *Coordinated Health’s VIP Program is a Spam Free Zone. Your email will NEVER be made available to anyone, for any reason. coordinatedhealth. com
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W h at o u r pat ie nts a re s ay i r company u o y t a t n ie t a pa t your East I have been a , ff a a z t z s a e M h t n t e tha Dr. Stev encounter. ve to tell you r a e h v e I . e 1 v 1 a 0 h 2 I / est a since 3/10 among the b e r a e I saw him, y it im il t c t s fa r g fi u e b h s t d e c Strou en Mazza, sin Mazza takes v e r. t D S . r. d e D h y s ll li tab Scpecia ding and the eutic was es n p e a r m e o h c t e e r iv is it e sh ver y pos na e procudure h t in la a is indead a p z x z e a o M t e r. D im . t s ed ion the t I recomend recomendat a is h t h r im fo h g h in it in nce w reso coel so confide fe I r. o friends and t r c e o h d t o d n g reat a ife psychiatric a is e if him to my w w y M workers. ot Dr. Brigido is my favo urse and is n n r it e CH physic sely able to get ian. I’m impresed ea an appointm ase ent when n on time w eeded. He’s In closing ple ith his app ointments, waiting. If no excessiv let him know not appare e m nt what the MRI neede w g ratefull I’ o issue is (ie h d), he expla . es ins what he issue is the for his servic b e li e ves the n takes the t, in steps need Once confi and also tha ed to confi r med, he g r m. ives you all opinion he is y address th m th e o ptions to e cond itio n. Once ag t to your e s s a n a to fo llow th r e e d to, it’s ea e steps req sy uired to im company. the problem p r o v e or fix . The plan Francis C. is cle
ar and done in th e rig ht amount of time, not too sh ort or too long. I would recommen d Dr. Brigido to anyone that is loo king for a great po d iatrist. Maria V.
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My daughter has seen quite a few doctors at Coordinated Health. Each of them has great qualities. Dr.DiIorio was so thourough to explain everything about her first knee surgery he really put our minds at ease. For the second surg ery we were so informed we felt like we knew everythi ng to expect. Dr. Kooch was so entergetic and explai ned everything about scoliosis that we couldnt ev en come up with any questions. He sent us to Dr . Wagener, who also was so charming and honest about her needs. Dr. Duffy remembers everything about yo ur prior conversations and makes you feel totally at ease. To pick just one Physician would be hard. I am so glad that we chose Coordinated Health. I recomm end your team to everyone I meet! Thanks! Julie K. coordinatedhealth. com
i n g a b o u t o u r p h ys i c i a n s n has bee a t t e p p le Chia FUL. I Dr. Nico R E D N O hort of W s g in ry h t no nd am ve a ly e t le r comp ke trust he ecialist li p s A R a to have l u f k n a th h Valley! ig h e L e th t here in h ig r r e h . Lauren S
Dr. Rudolph - I have be en happy with all of the Coordinated Heal th Drs but I have to admit that my confide nce was high enough in Dr. Rudolph of EOG to not only recommend him to my friends for their son’s knee surgery but also bring my hu sb and to him for a severe Our rotator cuff surgery and arthritic hi ps. He is generous, favorite has been kind and straight forwar d. Over the pa ll. ro st ar year, I have seen him a Dr. McC lot! 2 ankle surgeries later, I am ex actly where he He is patient promised I would Dr. Terp and great at stra, He be. Walking is to t h e p ng oint in di explaini without pain agnosing my condition or a limp. . He is ab everything. l e t o my quest answer Thank yo u i o n s a n d Tara K. takes th time to d Dr. Rudolph e o so. He gives a f Amy E. assessme air nt of the condition and prog fered f u s n I o s , is for re och o k covery. c K H a . r e b a voids bui D y m h t lding any wi s r false a h e o p y e s r y or cures n fo a m . nd a s P a u m l e R l . rob as
p w I l i t n u , doctors He . m i h t ie ou told ab and also Lesl nt. est e b m e t h r t a s i dep y p a r e h in the t . eV n e l r a M
To share thoughts about your favorite Coordinated Health physician visit
coordinatedhealth.com We’d love to hear from you!
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May/June 2012
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(610) 861-8080
coordinatedhealth.com
(877) 247-8080
Allentown
1503 N. Cedar Crest Blvd. Allentown, PA 18104
Phillipsburg
123 Roseberry St., Suite A Phillipsburg, NJ 08865
1611 Pond Rd., Suite 102 Allentown, PA 18104
Brodheadsville
Rte 115 & Switzgable Rd. Brodheadsville, PA 18322
250 Cetronia Rd. Suites 102, 110 & 302 Allentown, PA 18104
East Stroudsburg
505 Independence Ave. East Stroudsburg, PA 18301
Bethlehem
2775 Schoenersville Rd. Bethlehem, PA 18017
ASC
511 VNA Rd. East Stroudsburg, PA 18301
2300 Highland Ave. Bethlehem, PA 18020
Hazleton
1097B N. Church St. Hazle Township, PA 18202
2597 Schoenersville Rd. Bethlehem, PA 18017
Lehighton
239 N. First Street Lehighton, PA 18235
2030 Highland Ave. Bethlehem, PA 18020
Wind Gap
Easton
400 S. Greenwood Ave. Easton, PA 18045
1411 Jacobsburg Rd. Wind Gap, PA 18091
Hospitals
1503 N. Cedar Crest Blvd. Allentown, PA 18104
2310 Highland Ave. Bethlehem, PA 18020
3101 Emrick Bivd., Suite 112 Bethlehem, PA 18020