Coordinated Health Magazine Sept/Oct 2010 Issue

YOUR PRESCRIPTION FOR BETTER HEALTH

The Magazine

THUMB PAIN? We’ve got the solution

CONCUSSIONS

What you need to know to keep your kids safe on the field

Rehab 101 How to rehab after an ankle sprain or ACL reconstruction

Foot Health

Find the fit your feet will love

Anatomy of a Hospital Bill WWW.COORDINATEDHEALTH.COM

Sept/Oct 2010

2010 Sept/Oct

L

ETTER  FROM THE EDITOR



Dear Patients, We are excited to share our new Coordinated Health Magazine with you.

In this issue, find out what a leading knee surgeon in the Lehigh Valley, Dr. Thomas Meade, thinks of Omega 3s and what these fatty acids can do for your body.

If you have an athlete in your family, you don‟t want to miss our look at Concussion care and treatment. See how ImPACT testing can give you piece of mind about your athlete‟s on the field safety.

Go behind the scenes with Mike Price, PT as he explains what to expect in physical therapy after an Ankle Sprain or ACL Reconstruction.

Dr. Christopher Wagener discusses how Minimally Invasive Spine Surgery benefits patients who think they have no other treatment options.

When you think anatomy, I bet you don‟t consider the Anatomy of a Hospital Bill. Valerie Banotai, the Director of our Central Billing office breaks down what you can expect to see in a typical surgery bill. Hear what Coordinated Health patients, just like you, have to say in our “My Story” column. You also have the opportunity to submit your story.

We appreciate you as a patient and are excited to share our educational resources with you.

Be sure to vote for a Featured Physician fill out the short online survey at the end of the Magazine. We‟d love to hear what you think, after all this Magazine is for you!

Amanda Boyce

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Sept/Oct 2010

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The Magazine

in every issue

10 The Call Center

2 Editor‟s Letter

6

features

Contributing Team

Our hidden resource to expedite your care

12 Newer Solutions for

7 Q&A The answers to your most common questions

Older Spines

15 Concussions

8 Feature Physician:

How to keep your kids safe on and off the field. Learn how to protect your kids when it matters most!

Dr. Emil DiIorio

the scoop 27 Who‟s New at CH 39 What‟s New at CH 52 In the Community

issue

1

56 My Story Experience CH from a patient perspective WWW.COORDINATEDHEALTH.COM

2010 2010 Sept/Oct 3

features 24 Oh, My Aching Thumb!

Does thumb pain affect you from doing what you love? You don’t have to live in pain. Find out your treatment options

32 Foot Health Common solutions to common problems

36 Orthopedics & Omega 3 What can these essential fatty acids do for you?

42 Anatomy of a Hospital Bill Your guide to understanding who you pay and why

44 Rehab 101 Rehab basics for ankle sprains and anterior cruciate ligament (ACL) tears

50 Making an ImPACT Learn how the nation’s leading Concussion testing and management program can take the guesswork out of treating your athlete

54 Osteoporosis Discover simple lifestyle changes you can make today to lower your risk of this life altering condition

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CARE on CALL Your answer to Occupational Health Services and Workers Compensation It’s hard enough to do business (and keep an eye on your bottom line) without having to handle all your work related injuries and occupational health needs. Let Coordinated Health take the hassle and guesswork out of how to care for your employees.

Wellness exams and preventative medicine Immunizations and laboratory testing Laceration repair Concussions with Impact and Neurological Testing Musculoskeletal injury care

CARE on CALL physicians are available 24/7 to provide your company occupational health services and to handle all your work related injuries. Our health service case managers facilitate communication between physicians, employers, employees, and insurance providers to expedite a safe return to work for your employees.

You no longer need to send injured employees to the ER or all over town for care. Available 24/7 and backed by Coordinated Health's entire healthcare network, CARE on CALL provides:

Work-related injury care

In-house diagnostic testing (X-ray, MRI, CT) School and Sports Physicals

Your business is complicated enough without having to deal with unexpected medical emergencies or navigating the employer healthcare system. Let Coordinated Health make your job a little easier with CARE on CALL.

Call (877) 247-8080 for immediate 24/7 access to our physicians and solutions to your Occupational Health and Workers Compensation problems.

Drug and Alcohol Screening (pre-employment, DOT, post accident) Routine medical care (colds, cough, flu) Physical Exams (pre-employment, DOT, return to work) WWW.COORDINATEDHEALTH.COM

2010 Sept/Oct 5

OUR CONTRIBUTING TEAM

The Magazine

Amanda Boyce Editor in Chief

Orthopedic Surgeon

Thomas Meade, MD

Christopher Wagener, MD

Orthopedic Surgeon

Orthopedic Spine Surgeon

Mike Price, PT

Melissa Trader, OTR/L, CHT

Physical Therapist

Occupational & Hand Therapist

Sandy Gregor, OTR/L, CHT

Deb Moyer, L. Esth.

Occupational & Hand Therapist

Cosmetic Patient Coordinator

Ramia Atiyeh, CPT

David Bower, COTA/L

Pulse Performance Coach

Occupational Therapy Assistant

Jennifer Fisher, DPT, CLT Physical & Lymphedema Therapist

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Jennifer McGouldrick

Valerie Banotai

Call Center Director

Central Business Office Director

Sept/Oct 2010

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Q: What

is an MRI?

A: An MRI or Magnetic Resonance Imaging uses radio waves and a strong magnetic field to provide clear, detailed pictures of your soft tissues.

While an X-ray shows damage to your bone, An MRI allows your doctor to evaluate for any damage to your muscles, tendons, ligaments, or other soft tissues.

Q: Where

do I go for my surgery?

A: We have two hospitals conveniently located in Allentown (Cedar Crest Blvd.) and in Bethlehem (Highland Ave.).

Q: What

are the advantages to using Care on Call?

A: You see our doctors quickly - no more waiting in a crowded ER.

Q: Do

you have therapy available on weekends?

A: To give you more scheduling options, we offer therapy every Saturday from 7am-3pm. Our therapists see patients on Saturdays in our locations in: Allentown,

No emergency room deductibles.

Leave with a plan of care in place and any necessary appointments scheduled. We take the guesswork out of your follow-up care.

Bethlehem (Schoenersville Rd.) Easton Brodheadsville

Got a Question?

East Stroudsburg

Click Here to submit your question.

Your question and the answer may be featured in an upcoming issue

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2010 Sept/Oct 7

Featured Physician:

DR. EMIL DIIORIO Q: What is your role at Coordinated Health?

A: I am an Orthopedic Surgeon and the Medical Director. As an Orthopedic Surgeon I specialize in surgeries of the shoulders, hips, and knees.

Q: What is Coordinated Health’s mission?

A: Our goal is to ensure a positive patient experience while tightly managing the quality and costs associated with this experience.

Q: What do you mean by a “Positive Patient Experience”?

A: A patient experience is positive when a patient can answer „yes‟ to each of these three questions: 1. Did I get my problems solved?

2. Was it done efficiently and cost-effectively?

3. Was I treated with respect and dignity?

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Vote Here Next M Featured Ph

Q: How do you see healthcare changing in the next few years?

e to Pick Month’s hysician!

A: Electronic Medical Records or EMR‟s will become commonplace in physician offices over the next several years. Patients will have greater accessibility and portability of their healthcare information.

I think you will also see patients taking a stronger role in their own healthcare. They will be more actively involved in coordinating the details of their care as well as educating themselves on solutions to their problems and pain.

Q: What is Coordinated Health doing to change with it?

A: We are currently transitioning to Electronic Health Records. By the end of this year, each of our locations, providers, and specialties will be fully transitioned. Our imaging studies, X-rays, MRI‟s and CT scans, are already now 100% digital.

The direction healthcare is moving towards is mobility and portability, especially since healthcare is more accessible to patients now than ever before. We are working on several exciting, new ways to give our patient‟s better access to their healthcare.

We are also listening to what our patients are asking for and giving them the resources they need to make the most educated decisions regarding their care.

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2010 Sept/Oct 9

“Good Morning, Coordinated Health.

This is Mary, how may I help you?”

I

t‟s likely this is how your first conversation begins whenever you call us. But have you ever thought about who answers your call? These days, how can you even be sure your call isn‟t outsourced?

All of our locations and services are linked by a single information network. One of the hubs of this network is the Call Center. Our goal is to respond to all incoming calls with little or no transferring.

For us, outsourcing is not an option. Our communication with you is vital to your experience here.

The person answering your call is a patient service representative from our dedicated Call Center*. The Call Center is an extension of all our locations and was created to assist you faster.

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Sept/Oct 2010

I know what you‟re thinking now, “How can the Call Center help me? How am I supposed to get my questions answered if you don‟t transfer me to the right person?”

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If you have any questions or comments, please don‟t hesitate to contact us.

Contributing Author: Jennifer McGouldrick

It‟s the Call Center‟s job to know the answer! We even have a Physician Assistant on staff to quickly respond to your medical and prescription needs. We understand you‟re busy enough without having to deal with long wait times or be sent to voicemail. Your time is valuable and we don‟t want to waste it.

You may hear a brief message from us at the beginning of your call, but we promise you‟ll quickly be speaking to one of our patient service representatives.

We‟re continually working on better ways to meet your needs. We will keep you posted on our new efforts to make access to your doctors, services and treatment even faster and easier!

WE CAN HELP YOU:

1

Make, cancel, or reschedule any appointment - with any of our physicians, in any of our offices

2

Provide addresses, directions, phone, and fax numbers

3

Address your medication requests

4

Communicate with your doctor regarding your care

5

Handle your medical record requests

*Full service Call Center hours are 7am - 6pm After 6 pm you have access to our staff for medical and prescription needs and all other calls will be handled through our automated system.

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2010 Sept/Oct 11

Newer Solutions for Older Spines

A

ccording to the World Health Organization, the proportion of people aged over 60 years old, is growing faster than any other age group.

While this may be a success story for medicine and prevention of disease, it presents our society with challenges relating to preservation of physical function and quality of life issues for this group.

In short, patients are living longer with increasing expectations that they will live their lives productive and painless. Unfortunately, time, occupational hazards, and old injuries take their toll on the spine.

This results in unique clinical problems for the aging spine including Disc Degeneration, Lumbar Spinal Stenosis, Osteoporotic Compression Fractures, and Spondylolisthesis.

Advances in medicine and technology are working specially with this patient population to improve lives through Minimally Invasive Spine Surgery (MISS).

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Sept/Oct 2010

Contributing Author: Christopher Wagener, MD

“Just like you get wrinkles on your face, you get „wrinkles‟ on your spine,” says minimally invasive spine surgeon Dr. Christopher Wagener, M.D. “It is part of the normal aging process.

However, there are options today that were unavailable even a few years ago to help us combat the pain and disability that was previously thought to go hand in hand with aging.” The benefits of Minimally Invasive Spine Surgery include less pain, less bleeding, shorter hospitalization, and earlier return to function.

For patients that are experiencing symptoms in their back and neck, a complete history and physical exam should be performed by a qualified medical professional. Imaging studies such as X-rays, MRI or CT may provide additional information with

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regard to diagnosis, disease progression, and treatment options.

In nearly every instance, non-operative treatment options are available. However, for those who are have certain conditions or exhausted conservative measures, MISS is often the best option.

recognize is that inactivity often causes them to gain weight, lose function and can worsen heart and lung conditions.

The end result is a sicker patient with more disability. “I am operating on more and more patients in their 80‟s.

Sometimes they do better than their much younger counterparts.

Because I have a less invasive option, people who were once thought of as poor surgical candidates are now ideal patients for these procedures.”

“Many patients do not even think they could even be a surgical candidate so they live in severe pain,” says Dr. Christopher Wagener, M.D. What they often do not

ur o y t u o ab e r o m n r u o To lear h c t wa , n i a p back y l l a m i in M n o s e y r seri e g r u eS n i p S e Invasiv ck a B d n a WATCH NOW Pain.

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2010 Sept/Oct 13

Concussion Fact A concussion is a brain injury that frequently involving physical as well as cognitive symptoms.

About 10% of all athletes in contact sports suffer a concussion during their season.

Proper management of the injury is a critical step in avoiding long term complications.

Fiction?

Recovery can take days or weeks.

Individuals often experience dizziness, headaches, double vision, memory problems, nausea, vomiting, irritability, and depression.

Premature return to play following a concussion can lead to potentially serious consequences.

All these statements are FACTs about concussions‌Did you get them all right?

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Sept/Oct 2010

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CONCUSSIONS

I

n the past, concussions were referred to as ―getting your bell rung‖ or ―getting dinged‖.

Maybe you’ve even overheard coaches tell athletes to ―toughen up – it’s part of the game‖, but head injuries are serious business and should not be taken lightly.

Concussions are injuries to your brain resulting from an impact to the head, either directly or indirectly. Your head collides with a hard surface or a hard surface collides with your head, either way the end result is the same – a concussion.

The force of collision causes your brain to slap up against the inside of your skull, scattering your senses like balls on a pool table. Too many collisions = permanent brain damage.

Contrary to popular belief, loss of consciousness (getting ―knocked out‖) usually doesn’t follow a concussion. Studies show less than 10% of athletes lose consciousness after a concussion. If that doesn’t happen, here are just of few of signs and symptoms that you can expect to experience:

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2010 Sept/Oct 15

HEADACHE

LOSS OF BALANCE

NAUSEA

LOSS OF MEMORY

VOMITING

DIZZINESS

TINNITUS (RINGING IN YOUR EARS)

INCOHERENCY

UNEQUAL PUPILS

IRRITABILITY

LOSS OF APPETITE

LIGHT SENSITIVITY

Sounds like a bad day, right?

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Concussion

Concussion

Recognition

Evaluation

Just recognizing a concussion is half the battle. While it’s true one in ten sports injuries are concussions, studies also show only 47% of concussions in high school athletes are reported. That means in youth athletics less than half of concussions sustained are even reported!

Why is it such a big deal to report and evaluate concussions? Maybe your only symptoms were a headache and a little loss of memory. Doesn’t sound too bad, right? Heck, even on good days I still get headaches or forget something.

The problem is an often overlooked component of concussions called Second Impact Syndrome. It’s exactly as the name implies. Your brain receives a second blow before it’s fully recovered from the first.

Athletes can suffer from permanent brain damage from repeated concussions, even minor ones, because the effects from multiple concussions tend to be cumulative. Youth athletes often take more time to recover from concussions than adults because - smart as they think they are – their young brains are still developing.

Now that you understand why it’s so important to encourage athletes to report concussions, let’s talk about how we evaluate their signs and symptoms.

Concussion symptoms can be difficult to evaluate because the majority of signs are subjective – they vary from person to person. We have to depend on what you (the athlete) can tell us.

Let’s role play for a second. You’re a quarterback, the game’s tied at the beginning of the fourth quarter, it’s first and ten. The ball is snapped and out of no where a defensive lineman breaks tackle and plows into you. Next thing you know, five people are standing over you. You’re flat on your back wondering how you got there – remember the balls on a pool table.

Nothing’s broken and you’re walking off the field feeling a little dizzy – insisting you go back in to finish the game. For the sake of our role playing game, you have a Certified Athletic Trainer on the sideline who evaluates you.

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Continued on next page

2010 Sept/Oct 17

If concussion management is subjective, how can you be sure you’re getting the best assessment possible? Here are a few tips to help:

Concussion Management Sounds simple, doesn’t it? Remember 3 words you’ve known since you were five, it’s not rocket science.

This is where subjectivity of concussion signs comes into play. We have to assume that you, on a good day, could remember these 3 words after 20 minutes.

Unfortunately, not everyone can – it varies from person to person. Concussion evaluations measure many subjective components, but if we do not have your baseline for comparison then there are limitations in the overall assessment and management of your concussion.

1

Make sure a qualified medical professional such as a physician or Certified Athletic Trainer (ATC) is available on the sidelines to assess and treat medical injuries.

2

If a medical professional is unavailable and you have to wing it as a parent or coach - Here’s for a handy 3 step guide to concussion recognition.

As part of your recovery and return to play evaluations, we subjectively measure the neurocognitive functional effects of your concussion. Basically we’re testing your brain’s ability to function.

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If you suspect an athlete has a concussion, this guide walks you through 3 easy steps to quickly assess if your athlete needs urgent medical attention. Trust me, you don’t want to get caught on the sidelines without it!

3

Have your athlete or athletes tested preseason to obtain baseline neurocognitive measurements.

Baseline tests minimize the subjective component of concussions by measuring your normal brain function. When you sustain a concussion, your doctor has a normal measurement for comparison.

Baseline testing is a simple precautionary step can make a phenomenal difference in concussion management. Computerized

baseline testing is widely becoming the norm for athletes participating in competitive contact sports.

If you are interested in baseline testing Coordinated Health offers ImPACT – a computerized baseline neurocognitive (brain function) test for athletes of all ages.

Click here to find out more details on ImPACT testing.

We hope you never have a head injury, but if you do – follow these three tips to protect your athletes from serious, long term problems.

By the way – do YOU remember the 3 words? No cheating!

Author: Amanda Boyce, ATC, CSCS

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2010 Sept/Oct 19

AFTER A CONCUSSION

SEEK TREATMENT IF YOU: Have a headache that gets worse Are drowsy and can‟t be woken up Can‟t recognize people or places Have repeated vomiting Behave unusually or seem confused and irritable Have seizures (arms and legs jerk uncontrollably) Have weak or numb arms and legs Are unsteady on your feet Have slurred speech

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AT HOME CONCUSSION MANAGEMENT Rest Avoid Strenuous Activity for at least 24 hours Do not use Aspirin or Anti-inflammatories Do not drive Do not train or play sports until cleared by a doctor No sleeping pills No alcohol

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2010 Sept/Oct 21

CARE on CALL Your alternative to crowded ER's These days, who has time to sit around and wait in a crowed ER? Your busy lifestyle demands immediate solutions to your urgent medical problems. We know you don't have time to waste waiting in line. You need answers to your medical questions, you need treatment now. Your family's health is your top priority and it's ours too.

What if you no longer had to wait?

At Coordinated Health, we give you the opportunity to skip to the front of the line.

We’re excited to offer our patients exclusive access to our time-saving, convenient alternative to the ER: CARE on CALL.

Designed to eliminate the headache and hassles of the ER, our physicians are available 24/7 to answer all your medical questions and provide you with any necessary treatment.

Simply call (877) 247-8080 for immediate physician access Care on Call is ideal for patients who have had a recent surgery, been hurt or injured...whether at home, on the field, or on the job.

We know your life is complicated enough without having to deal with unexpected injuries or pain. Let Coordinated Health make your life a little easier and give you the piece of mind you deserve with CARE on CALL.

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Hand Facts Did You Know?

2/3 of all upper extremity

1 /3

injuries occur to individuals during their working years.

seen in the ER involve the upper extremity.

1 /4

of all acute injuries

Almost of all athletic

80%

are at the greatest

risk for crushing and burning injuries of the hand.

1

out of

6

of men in

the age group 75-79 years have x-ray evidence of osteoarthritis in their hands.

Children under the age

6

of

women and

injuries involve the hand and wrist.

of

90%

The most common disabling work injuries in the United States involve the upper extremities, accounting for

disabling work

injuries involve the fingers, most often due to the finger striking or being struck against a hard surface.

Contributing Author: David Bower, COTA/L WWW.COORDINATEDHEALTH.COM

over

1 /4

of all

disabling work injuries.

2010 Sept/Oct 23

“OH, MY ACH steoarthritis, unfortunately, affects most of us as we age. The joint at the base of your thumb (or the CMC joint) is most commonly affected. Women especially tend to be vulnerable to osteoarthritis.

Symptoms generally begin with an aching at the base of the thumb joint or stiffness and pain in the mornings. While osteoarthritis cannot be “cured”, many non-surgical treatment options are available to prevent the painful process from worsening. Your options include:

Splinting: Custom made splints provide rigid stabilization to the CMC joint of your thumb. This allows you to move the other joints of your thumb, while the base of your thumb stays immobilized. Flexible, prefabricated neoprene thumb splints also provide support to your thumb during normal daily use.

Joint protection: When you grip an object, the CMC joint at the base of your thumb takes on a significantly greater force than the force exerted through the tip of your thumb. Using objects with a wider grip

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Sept/Oct 2010

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HING THUMB!” pain and aggravation to your joint. Try using wider grip pens/pencils, Good Grips utensils, softer/wider grips for golf clubs or other sports equipment.

Energy conservation:

Take frequent breaks during an activity.

Breaks decrease the pain you feel after activity. For example – After 20 minutes of activity take a 5 minute break to rest your joint. Your activities take a little longer, but the decrease in pain makes it worth your time.

Occupational/Hand Therapy:

Ask your

doctor to make an appointment to meet with an Occupational Therapist. We take a close look at your specific daily activities. After we evaluate your needs, we provide education, tips on activity modification, and helpful hints to decrease your pain. Therapy – including heat, massage, ultrasound treatments and exercise is beneficial to decrease your arthritis pain.

Don‟t wait until your symptoms affect everything you do…early intervention may help prevent surgery later.

Contributing Author: Melissa Trader OTR/L, CHT WWW.COORDINATEDHEALTH.COM

2010 Sept/Oct 25

DO YOU NEED AN OCCUPATIONAL THERAPIST?

“I

didn’t get hurt at work. Why am I seeing an Occupational Therapist?‖ This is a common question that confuses many patients.

An Occupational Therapist (OT) treats injuries or problems with your upper extremity (fingers, hand, wrist, elbow, or shoulder). But don’t think of ―occupational‖ as just your job.

In terms of therapy, occupation refers to anything you do that ―occupies‖ your time.

Occupations break down into 3 categories:

1 2 3

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DAILY LIVING ACTIVITIES – bathing, eating, dressing, cleaning, and writing WORK ACTIVITIES – driving, typing, cooking, and production line work RECREATIONAL ACTIVITIES – crocheting, woodworking, gardening, hunting, fishing, bicycling, skiing, and even video gaming

Sept/Oct 2010

Injuries or problems to your upper extremity occur from each of these categories.

OTs and Occupational Therapy Assistants (COTAs) work in a variety of healthcare settings including – neonatal units, psychiatric hospitals, prisons, schools, nursing homes, hospitals and outpatient facilities (like Coordinated Health). Patients of all ages benefit from occupational therapy.

As an Occupational Therapist, my job is to help you be fully independent, functional and pain free with all of your activities. We give you the tools you need to get back to doing the activities you love.

Contributing Author: Sandy Gregor, OTR/L, CHT

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Whoâ€&#x;s new at CH? Dr. CHARLES NORELLI Physical Medicine & Rehab (PMR) physician. He treats spine and sports medicine injuries, and non-operative musculoskeletal injuries Dr. Norelli treats patients in our Allentown location DR. NICOLE CHIAPETTA Rheumatology Dr. Chiapetta will begin seeing patients in our Bethlehem (Highland Ave.) location in October

DR. SETH BURKEY Emergency Medicine with Sports Medicine Fellowship Care on Call physician Dr. Burkey treats patients in our East Stroudsburg and Brodheadsville locations

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2010 Sept/Oct 27

Who‟s new at CH?

ADAM MCFARLAND, PT

KIIRA JOHNSON, PTA

Bethlehem Schoenersvile Rd.

Easton

GREG GAURONSKY, PTA Brodheadsville ANTHONY CARUSOTTO, PT Bethlehem Schoenersville Rd.

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JED SCHOENBERGER, PTA Bethlehem Schoenersville Rd. JEFF KUPSTAS, PTA Allentown

LORI CUSHNER, PT Bethlehem Highland Ave.

SUE MALINOWSKI, PT East Stroudsburg

IAN WALSH, PT Bethlehem Schoenersville Rd.

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2010 Sept/Oct 29

October is

National Physical Therapy Month This yearâ€&#x;s focus is on the importance of physical activity for individuals of all ages and abilities in preventing and managing obesity and its consequences.

Physical Therapists are experts in restoring and improving motion in peopleâ€&#x;s lives. They can help teach you to prevent and manage obesity and its effects by:

Designing physical activity programs for children and adults that protect against obesity Devising exercise programs for children and adults with physical limitations According to the Centers for Disease Control and Prevention, nearly 34% of adults and 17% of children and adolescents are obese.

Research shows that overweight or obesity increases the risk for other conditions such as Type 2 Diabetes.

Developing safe and effective exercise programs and behavior modification for those who are already overweight or obese Providing exercise programs for people with Type 2 Diabetes

The incidence of Type 2 Diabetes, which accounts for approximately 90 - 95% of the 17.9 million diagnosed cases of diabetes, is also increasing as obesity rates climb.

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Keep your Family Active Plan weekend family activities involving physical activity such as hiking, biking, or bowling.

Have your kids brainstorm a “rainy day” game plan of indoor fitness activities like Wii Fit or Dance Dance Revolution.

Be your child‟s “exercise buddy”. Plan daily walks or bike rides. Set goals together for increasing physical activity rather than losing weight.

Provide positive feedback about your child‟s lifestyle changes. Remember not to focus on the scale - for you or your child.

As you schedule your child‟s extracurricular activities, remember to plan time for physical activity as a priority for the entire family. Don‟t just “squeeze it in”.

Discourage snacking or eating meals while watching TV.

Parents and children can do simple exercises while watching TV (or at least during commercials) such as sit-ups or running in place.

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2010 Sept/Oct 31

Physical Therapy and

Foot Health FOOT HEALTH IN RUNNERS Feet come in all different shapes and sizes and are prone to many problems, especially when running is involved. Physical therapists can provide a detailed analysis of your feet and running style to help you prevent and treat the foot problems that often result from running.

FOOT FUNCTIONS Feet provide your base – they play an important role in balance and support.

Feet absorb shock – their flexibility helps to minimize impact when your foot hits the ground.

Feet propel you forward – in addition to its role as a flexible “shock absorber,” the foot stiffens at a certain point in the running cycle to help move you forward.

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Sept/Oct 2010

COMMON FOOT PROBLEMS Physical therapists often see foot problems related to the way a runner‟s foot is built: A very flat foot typically has too much mobility and not enough support. Individuals with flat feet (low arches) are often more at risk for pain in the tendons on the inside of the ankle, pain on the inside of the knee, or pain in the arch of the foot near the heel (plantar fasciitis).

A foot that is too stiff usually has a high arch and is likely to be poor at absorbing forces from running. Pain in the arch and heel (heel spurs and plantar fasciitis) can result from poor shock absorption. If the foot is poor at absorbing shock then that shock often affects the individual‟s low back, knees, or hips.

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COMMON SOLUTIONS Proper shoe choice is important for the most efficient foot function: Individuals with poor shock absorption (stiff feet with high arches) typically need more cushion in their shoes.

Those who have highly flexible feet (usually low arches) often require a stiffer shoe with more support and control.

People who have more severe problems may be candidates for orthotics (shoe inserts designed to support weak or ineffective muscles or joints and to provide necessary mobility) which are purchased over-the counter or customized.

HOW A PHYSICAL THERAPIST CAN HELP Physical therapists are experts at analyzing a bodyâ€&#x;s structure, alignment and movement. For foot pain, this involves a detailed examination of your foot and how it relates to the rest of your body.

Many physical therapists can recommend proper footwear and orthotics. A physical therapist can provide a detailed analysis of your running style.

Recommended modifications to get back to running after an injury may include special exercises to improve strength and muscle balance as well as proper shoe choice.

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2010 Sept/Oct 33

HOW A PHYSICAL THERAPIST CAN HELP YOU

Ph

Back

A physical therapist can help you choose a proper backpack and fit it specifically for your child. Children come in all shapes and sizes, and some have physical limitations that require special adaptations.

Physical therapists can help improve posture problems, correct muscle imbalances, and treat pain that results from improper backpack use.

Not the Right Way to Wear a Backpack!

LIGHTEN THEIR LOAD Keep the load at 10-15% or less of your childâ€&#x;s bodyweight. Carry only the items that are required for the day.

Be sure to organize the contents of the backpack by placing the heaviest items closest to their back.

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hysical Therapy and

kpack Safety WEAR BOTH STRAPS Using only one strap causes one side of the body to hold the weight of the backpack.

Make sure your child wears both shoulder straps, so weight of the backpack is more evenly distributed.

USE THE STRONGEST MID-BACK MUSCLES Pay close attention to the way your childâ€&#x;s backpack is positioned on their back. It should rest evenly in the middle of their back. Shoulder straps should be adjusted to allow your child to put on and take off the backpack without difficulty, as well as allow free movement of their arms. Straps should not be too loose, and the backpack should not extend below their low back.

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2010 Sept/Oct 35

Orthopedics and Omega-3’s Contributing Author: Thomas Meade, MD

M

ost patients I see, as an orthopedic surgeon, seek care because of pain. The source of most of my patient’s pain ultimately comes from inflammation.

The sources of inflammation reside in your cell membranes – which form an outer protective covering around your cell.

Each cell in your body has one of these protective membranes. To help build a stronger membrane, your body pulls essential nutrients out of food you consume.

The more toxic your diet, the fewer essential nutrients your body has available to help protect your cells. The higher the amount of fructose corn syrup you consume, the more obese you can become. The more arachidonic acid (precursor to inflammation) you harbor, the more diseases you are susceptible to.

Pesticides and toxins can accumulate in your fat causing an increased risk of:

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Developing asthma Diabetes Autoimmune diseases Cardiac diseases Alzheimer’s disease Attention deficit disorder Depression Impotence

Most chronic diseases of aging, including those listed above, are due to an inflammatory process. As you can see, your quality of life is largely affected by the quantity and quality of food you consume.

As most of my patients know, the best anti-inflammatory nutrient you can consume is Omega-3 Fatty Acids.

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OMEGA-3 FATTY ACIDS ARE FOUND IN: Nuts Dark green vegetables Spring greens Cabbage Brussel sprouts Parsley Fresh cold water fish such as salmon, trout, herring, mackerel, sardines, eel, clipper Fish oil supplements

There is more evidence based research documenting the effectiveness of Omega-3 fatty acids for global health benefits, than there is for most pharmaceutical drugs on the market.

On top of that, the side effects of Omega-3’s are virtually non-existent. Be sure to check the label and make sure your fish oil brand has been tested and proven free of mercury and other heavy metals.

Fish oil decreases platelet ―stickiness‖ by making it less likely for a patient to clot without increasing risk of bleeding.

Because of this, I recommend all my patients continue taking fish oil supplements up to and after their orthopedic surgeries. There is no documented evidence of an increased bleeding risk and virtually no risk for those patients consuming fish oil below 300mg of EPA and DHA (the active ingredient in fish oil).

Omega 3 essential fatty acids also improve dry eye conditions, cholesterol, triglyceride health, mental performance, athletic recovery, and much more.

HOW DO YOU KNOW IF YOUR BODY IS IN A STATE OF CHRONIC INFLAMMATION? CHRONIC INFLAMMATION IS PRESENT

IF YOU

HAVE ONE OR MORE OF THE FOLLOWING CONDITIONS:

Overweight Obesity Tobacco dependency Chronic pain Fibromyalgia Osteoarthritis Rheumatoid arthritis Lupus Low back pain Psoriasis Lymphedema Cellulitis Gum disease Heart disease Type 2 Diabetes Joint pain Reflex Sympathetic Dystrophy (RSD) Sciatica Asthma Peripheral Vascular disease

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2010 Sept/Oct 37

Lymphedema Therapy Lymphedema is an accumulation of lymphatic fluid that causes swelling, typically in your arms or legs. The accumulation of fluid occurs from deficits in your lymphatic system. These deficits prevent your lymph fluid from draining correctly.

Your lymphatic system is closely linked with your immune and circulatory systems. In order to determine the best treatment, it is important to determine if your swelling is due to venous insufficiencies or lymphedema.

Lymphedema is either primary or secondary. It occurs on its own (Primary Lymphedema) or is caused by another disease or condition (Secondary Lymphedema).

As fluid builds up, your swelling persists.

There is no cure for Lymphedema, but it can be managed with several treatment techniques.

PRIMARY LYMPHEDEMA CAUSES Milroy's disease (congenital lymphedema) Meige's disease (lymphedema praecox) Late-onset lymphedema (lymphedema tarda)

SECONDARY LYMPHEDEMA CAUSES Surgery Radiation Treatment for Cancer Cancer Cells Infection

TREATMENT FOR LYMPHEDEMA INCLUDES Exercises Compression wrapping/bandaging Manual lymphatic drainage (superficial massage) Skin Care

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Contributing Author; Jennifer A. Fisher, DPT, CLT

NEW OPTION IN FACIAL FILLER: JUVE‟DERM XC

VENOUS DUPLEX ULTRASOUNDS With the addition of our new Vascular Technologist, patients and referring physicians now have improved access to Venous Duplex Ultrasounds.

Juve’derm Facial Filler has been available for the last few years and works beautifully for plumping up lips and facial lines. We now have Juve’derm available with Lidocaine - a mild numbing agent.

We perform same day evaluations for blood clots and your physician is able to immediately initiate treatment.

What does this mean for you? Your treatment is less painful and more comfortable than ever before. Not only is Juve’derm a great way to smooth lines and wrinkles, it also lasts for up to one year!

Contact Deb Moyer for more information at (877) 247-8080 ext. 8238

What‟s new at CH?

LYMPHADEMA THERAPY Now available in our Allentown location. Patients will be treated by Jennifer A. Fisher, DPT, CLT. For an appointment, call (877) 247-8080

IMPACT CONCUSSION TESTING The most widely used concussion management program in professional, collegiate, and high school sports is now available at Coordinated Health.

ImPACT is a computer based test measuring the cognitive (brain) function of a concussed athlete. The test includes word discrimination, design memory, cognitive function, symbol matching, color matching, and reaction time. It is available for athletes of all sports and ages.

X-RAYS ARE 100% DIGITAL The latest facility renovations in our Schoenersville Rd. location mark the completion of our transition to digital X-rays.

Your imaging studies can be viewed by any of our physicians in any of our locations - ensuring the fastest communication possible regarding your treatment!

To schedule call (877) 247-8080 ext. 5201 Find out more about Concussions Find out more about ImPACT Testing WWW.COORDINATEDHEALTH.COM

2010 Sept/Oct 39

Dreaming of a Different Look?

A

sk any person you know if they’d like to change something about their appearance. Chances are good you’ll hear in hushed tones a carefully considered list of ―improvements‖ they’d like to make.

Most people have one of these lists. We devour any information we find on the latest creams, lotions, and potions to make ourselves look more youthful.

investigated long before the decision to have any done is made. In some cases it takes years of that ―voice in your head” saying, ―I hate how my legs look….my stomach feels so fat….I can’t stand the skin under my chin…my breasts have changed so much…my skin looks dull and I can see all my wrinkles!”

I’m sure you love the feeling of self confidence you have when you look your best. It’s completely normal because looking good and feeling great go hand in hand.

Cosmetic surgery is considered for a long time - for many reasons. Sometimes it’s financial, but more often it’s due to the deeper questions we ask ourselves. Such as, ―If I do this, what will people think of me?‖, ―Will my family approve?‖, ―What if someone finds out?‖, and surprisingly, the most common is ―Am I that vain?”.

Most of people do not wake up one morning and decide to have cosmetic surgery. Procedures are thought about and

I was curious about the exact meaning of the word vain, so I decided to look it up in the dictionary. Here’s what I found:

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Vain: 1. Unsuccessful; futile (no, not what I’m looking for)

most patients are down to earth people who just want to feel better about their body image.

That’s really what cosmetic surgery is about - looking better, feeling better, and gaining back the self confidence you’ve lost along the way. Thankfully we live in a time when cosmetic procedures are very much accepted.

2. Conceited; vanity

Vanity: 1. Excessive pride; conceit

Over the past 15 years as I’ve educated hundreds of patients, I rarely see someone who I believe is vain or conceited.

Patients who come searching for cosmetic procedures are typically not suffering from excessive pride – in fact, it’s quite the opposite!

You can spend a fortune on makeup, clothes, and shoes to feel and look better. Most of these items you wear a couple of times or it quickly goes out of style. But your body never goes out of style!

The skin care industry alone is a multi billion dollar business. Clearly we think about how we look.

Is using a wrinkle reducing or anti aging cream vain or is that a daily habit of addressing a problem area?

In my experience, a person who is vain is vain with or without cosmetic surgery. Is it vain to want to restore your appearance or improve a disproportionate area?

Just think about it for a second. The pure fact that someone is concerned about being ―too vain‖ usually means they are far from it! Now, a few people are like this, but

Your body image is improved by dieting, going to the gym, and working on your emotional growth. Each of these improvements impacts the quality of your life in a positive way. Investing in yourself is a great way of looking and feeling fantastic for years to come!

Cosmetic procedures are a natural next step to consider.

When you look in the mirror, what do you think about? If you find yourself pondering that nagging ―list‖ in your head and the improvements you’d like to see, you deserve to have all the facts about today’s cosmetic procedures. You’re worth it to find out more.

Contributing Author: Deb Moyer, L. Esth.

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2010 Sept/Oct 41

Anatomy of a Hospital Bill

P

atients frequently ask ―Why do I receive so many separate bills for a single hospitalization?‖ This is often very confusing for patients and I would like to explain what you would expect to see in a typical surgery bill.

Bills for inpatient surgery fall into one of two categories:

PHYSICIAN ELEMENT what your insurance company calls a ―professional component‖

FACILITY ELEMENT What

your insurance company calls a ―technical component‖

As part of the physician element you will receive bills for: Pre-Admission testing (administering chest x-rays, EKGs and lab work), Surgeon, Anesthesia, Hospitalist, and Pathologist.

As part of the facility element, you will receive bills for taking the x-ray, administering the EKG or processing of the lab work. The physician who reads the x-ray or EKG or interprets the lab work will bill separately for their professional services.

Physicians who perform surgery or attend to you at your bedside during an inpatient

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hospitalization will bill for the appropriate services rendered. This is separate charge from the facility or Pre-Admission testing.

The anesthesiologist who administers anesthesia or provides pain management will also bill separately for their services. Certified Registered Nurse Anesthetists (CNRAs) also work with the anesthesiologists to provide the highest level of care. Your anesthesia bill is separate from the facility, Pre-Admission testing or the surgeon’s services.

The facility at which your surgery was performed will provide a comprehensive bill that includes all other aspects of your hospitalization. This can include OR time, recovery room time, room and board, implants, medications (oral and injectable), physical therapy and miscellaneous supplies.

It is important to remember that your healthcare needs are unique and the services we provide vary from patient to patient. If you have questions about a bill, please don’t hesitate to contact the billing representative listed on the statement. We are here to help you.

Contributing Author: Valerie Banotai

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Below is a SAMPLE bill, showing the types of charges that are often on a typical surgery bill. In an ACTUAL bill, the charges are billed separately and not listed n a single bill.

Patient Account * **************Charge Summary********************

Description Anesthesiologist Surgeon

Amount

Units

600.00 5000.00

Hospitalist

300.00

Pathologist

250.00

PC Chest x-ray

150.00

PHYSICIAN ELEMENTS

Anesthesia

1200.00

2.00

OR Services

3000.00

2.00

783.47

79.00

1748.00

5.00

Pharmacy

343.62

10.00

Recovery

700.00

3.00

Total Charges

14075.09

Med-Surg Supplies Implants

FACILITY ELEMENTS

*Not an actual bill

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2010 Sept/Oct 43

Rehab 101 WHAT IS THE ACL? Your ACL is the Anterior Cruciate Ligament.

This ligament is one of four stabilizing ligaments in your knee. It forms a diagonal cross with another ligament (the Posterior Cruciate Ligament) in the knee. The ACL runs from the back of the thigh bone to the front of the shin bone

HOW IS IT INJURED? Your ACL’s job is to stop your shin bone from moving forward on your thigh bone as well as prevent your knee from twisting. A torn ACL usually occurs by a twisting force being applied to your knee while your foot is firmly planted on the ground or when landing. An ACL tear can also happen from a direct blow to the knee, usually from the outside.

WHAT WENT WRONG? Your knee is made up of three bones – femur (or thigh bone), tibia (or shin bone), and the patella (or kneecap).

With ACL injuries we are only looking at the joint between the shin bone and thigh bone.

The ACL and other ligaments of your knee act like seatbelts. They stop the joint from moving in directions it’s not supposed to move. Much like a seatbelt restricts us from moving in the seat of our car.

Your ACL stops the shin from moving forward on the thigh. When the ACL is initially injured, our body’s response is to pump blood to the injured knee. This increase in blood flow causes your joint to swell. Human nature is to protect a newly injured body part so you start to move your injured knee less and less. You may even walk differently after the injury. Swelling and lack of movement cause your knee to become stiff and difficult to straighten.

WHAT DOES PHYSICAL THERAPY DO? Physical Therapy alone cannot heal your ACL. If your goal is to get back to sports or recreational activities, you’ll likely need surgery to fix your ACL. After surgery, the initial goals of therapy are getting the swelling in your knee down and get it moving again.

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- ACL Tears The MOST important thing to do after injuring your ACL is to get your leg straight again - as soon as possible. If your leg can straighten all the way, you’ll be able to walk normally and your muscles will function normally. This helps prevent your muscles from shrinking (atrophy). It is important to get your knee bending, but your recovery won’t go well if you can’t get your knee straight again.

Therapy also strengthens the muscles around your knee. If the ligaments in your knee are your seatbelts then the muscles are your airbags. No one wants to drive without a seatbelt, but if you had to you would feel better knowing you had the best airbags possible. For this reason you have to restore muscle strength around the knee.

The muscle on the front of your thigh is called a quadriceps. This muscle shrinks quickly after your injury or surgery. This muscle propels you up stairs and out of chairs and is essential in all sports. This is the reason your quad must be strengthened after an ACL injury.

The muscle on the back of your thigh is your hamstring. It attaches on the back of your shin bone and acts as a secondary

Contributing Author: Mike Price, PT

restraint to your shin moving forward. After an ACL injury, your hamstring needs to be strengthened to give your knee as much stability as possible.

The reason you strengthen your muscles is to give yourself the best airbags possible since your seatbelt is faulty (your ACL is torn). After your ACL surgery and recovery, you’ll no longer have a faulty seatbelt.

You’ll have the best of both worlds, great airbags AND seatbelts.

Ligaments not only hold bones together but they also give your body a sense of where it is positioned in space. We call that sense “proprioception”. Therapy also teaches you exercises that challenge your balance to help you regain your sense of balance so you can get back to sports and higher level functional activities.

WHAT CAN I EXPECT FROM PT? Therapy after ACL surgery is fairly consistent. You need 2-3 visits of therapy per week for the first 12 weeks or so after your surgery. You also need to commit to a workout routine for at least 6 months after the surgery to continue rehabilitating your knee.

The most important part of your recovery is your faithfulness and diligence in your home exercise program. With proper the rehab, you can expect a full recovery and return to most sports activities in 6-9 months after your surgery.

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2010 Sept/Oct 45

Rehab 101 - A WHAT IS AN ANKLE SPRAIN? Ankle sprains are injuries to one or more of the ankle ligaments. Ligaments are rubber band like structures that connect bones together, providing stability to your joints.

When ligaments are overstretched, injuries occur. Sprains most commonly occur on the outside of the ankle.

HOW DOES IT HAPPEN? Ankle sprains occur with sudden twists, falls, or forces that stretch the ligaments out of their normal position.

talus is in the dome. In this position, your ankle joint is least stable.

The inside of your joint is protected by a thick ligament called the deltoid ligament.

The outside of your joint is protected by three smaller ligaments. Because of this set up, we are most prone to spraining the outside ligament(s). You can injure one, two, or all three of the outside ligaments.

Sprains usually happen when your foot turns inward while your toes are pointed down.

WHAT WENT WRONG? Your ankle joint is made up of three bones – Tibia, Fibula, and Talus.

The tibia and fibula form a dome over top of the third bone, the talus. The front of your talus is wider than the back of the talus. So when your toes are pulled up toward the shin, the wider side of the talus is in the dome.

When the toes are pointed down, the narrower side of the talus is in the dome. In this position you can move your toes in and out more because that narrower side of the

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After the initial injury, your brain receives a message from your body that something has gone wrong, and as a result, your body will increase blood flow to the injured ankle.

This increase in blood flow causes your ankle to swell. Because your ankle is in

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Ankle Sprains pain after the sprain, our instincts are to protect the painful joint. So we stay still and don’t move our ankle too much.

Blood is a naturally sticky substance. As it collects in the injured area, your ankle joint becomes more “sticky”. Combine that with the fact you’ve stopped moving your ankle now it’s become really stiff.

Contributing Author: Mike Price, PT

WHAT DOES PHYSICAL THERAPY DO? Therapy goals are to reduce your pain and swelling as well as improve range of motion, strength and balance. If your ankle joint moves correctly and has sufficient strength, your ankle will function the way you want to and be significantly less likely to be injured again.

Since you’ve stopped moving your ankle it gets weaker from lack of use. Your ankle ligaments and muscles can’t support the normal “workload” required of them.

Lastly, ankle sprains will impair your sense of balance.

Ligaments not only hold or bones together but they also give your body “proprioception”, or a sense of self. This means you can sense the position your joint without touching it. If you’re wondering how this works just close your eyes. Now bend and straighten your elbow.

Stop.

You can feel if your elbow is bent or straight without looking – that’s proprioception. When we sprain the ligament in our ankle, the ligaments ability to give feedback to our brain about the position it is in is impaired, thus decreasing your balance and stability.

WHAT CAN I EXPECT FROM PT? If you begin therapy within a week of the sprain, daily treatment will initially get rid of the swelling faster. More often you’re in therapy two to three times per week for about 2-4 weeks depending on the severity of your sprain.

The most important part of your treatment is participating in your individualized home exercise program. We only see you a couple of times a week. You have to be responsible for assisting in achieving therapy goals. After finishing your rehabilitation, you should expect a full recovery and the ability to resume your normal activities.

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2010 Sept/Oct 47

ITCHING TO GET BAC

BE SURE YOU‟R The most frequently asked question by injured athletes and other patients is “When can I return to sports or physical activities?” There‟s never a standard answer, because different parts of the body heal at different rates. Also, some people heal faster than others.

A good way of understanding that every person and each injury is different is to look at injuries like fingerprints. Everyone has a different set. Injuries must be treated on an individual basis.

For example, knee injuries can be very similar in two individuals. The treatment can be identical, but the return to play can vary from one week for one patient and two weeks for the other.

Your physical therapist or certified athletic trainer will try to increase the healing process by improving the healing environment. Time remains the only constant. All injuries take time to heal, it‟s just a matter of how long before you can return to activity safely.

While recovering from an injury, try to maintain your fitness levels by performing an activity that does put your injury at risk. For example, if you have a shoulder injury, you might be able to ride a stationary bike.

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CK TO SPORTS?

RE

READY! to keep you in good shape while you rehabilitate your injury. For example, if you have had knee surgery, part of your therapy may be doing exercises in a pool.

Your physician or athletic trainer will evaluate your injury and can suggest a method of treatment to return to your activity safely and soundly. Without the advice of a professional, you‟re taking a gamble by returning to your activity on your own after an injury.

If you‟re in doubt about when you should return to playing your sport, consult your physician, physical therapist or certified athletic trainer before you start.

To help you understand this return to play concept a little better, let‟s look at some basic guidelines you can use to determine if you can return to activity.

1

PAIN-FREE: The injured area must be pain-free during rest or movement.

2

SWELLING: If there is swelling present, you should not exercise.

3

RANGE OF MOTION: Someone once said, “Common sense isn‟t so

If you begin activity while pain is present, you‟re going to risk causing further damage to that area.

common.” If you begin activity and do not develop pain, you can gradually increase your intensity and duration. Remember, if you develop pain, STOP the activity.

Contributing Author: Emil DiIorio, MD

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2010 Sept/Oct 49

Concussion Testing Makes an

ImPACT in the

Lehigh Valley ImPACT is a computerized program that evaluates and documents several components of neurocognitive (brain) function after a concussion, including:

1. Verbal memory

Athletes can have preseason baseline testing and when a concussion is suspected, during the season, a followup test is given to see if the results have changed from the baseline measurements.

2. Visual memory

The comparison helps your doctor diagnose and manage your concussion more effectively. We can continue to track your recovery with follow-up tests given over the days and weeks following a concussion.

3. Attention span, 4. Brain processing speed 5. Reaction time 6. Post-concussive symptoms With a user-friendly injury documentation system, this enables our physicians and Certified Athletic Trainers (ATC’s) to track your injury from the field and through the entire recovery process.

ImPACT is a research based computer test developed to help doctors evaluate an athlete’s recovery following concussion. It’s a 20 minute neurocognitive test battery that is scientifically validated to measure the effects of sports related concussions.

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ImPACT helps us answer difficult questions about your readiness to return to play – which helps us protect you against potentially serious consequences of returning too soon.

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The comparison helps your doctor diagnose and manage your concussion more effectively. We can continue to track your recovery with follow-up tests given over the days and weeks following a concussion.

ImPACT helps us answer difficult questions about your readiness to return to play – which helps us protect you against potentially serious consequences of returning too soon.

Traditional imaging studies – like MRIs and CT scans, are useful in identifying serious brain injuries such as skull fractures and hematomas (bleeding on the brain).

Unfortunately, they are ineffective at identifying the functional effects of concussion.

What are some of the test we use to measure cognitive function? ·

Word discrimination

·

Design memory

·

Visual attention span

·

Symbol matching

·

Color matching

·

Reaction time

In the past, doctors and ATC’s must often rely on subjective observations or patient self reports to diagnose and track a concussion.

This is where ImPACT can make a big difference.

Conducting baseline and post-injury testing using ImPACT helps us objectively evaluate an athlete’s cognitive status to prevent the

cumulative effects of a concussion. Even if you haven’t performed baseline testing, ImPACT has databases of thousands of non-injured athletes which can be used for effective evaluations and comparisons.

ImPACT is the gold standard of concussion measurement and management at the high school, collegiate, professional sports levels throughout the world.

Our communication among our doctors and ATC’s allows us to quickly assess your cognitive function and assist with return to play decisions.

Baseline testing is available at Coordinated Health for athletes of all ages. Your cost for a baseline test is $25. If additional tests are needed after a head injury, those tests are covered by most insurance plans.

Call (877) 247-8080 ext. 5201 to schedule a baseline ImPACT test for your athlete. We can also schedule testing for an entire team.

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2010 Sept/Oct 51

COORDINATED HEALTH IN THE COMMUNITY October is National Breast Caner Awareness Month Hello. My name is Ramia Atiyeh and I work at Coordinated Health as a PULSE Performance Coach.

I have taken on an incredible challenge. I'll be participating in a very special event called the Susan G. Komen 3-Day for the Cure.

Starting October 29th, I’ll be walking 60 miles over the course of three days, camping out at night with thousands of other women and men taking this journey with me.

I was asked if I would like to participate in this event by a friend who is now in her 25th year of remission and it’s my 25th birthday. It

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is an excellent opportunity to raise money for a good cause.

Net proceeds from the Susan G. Komen 3-Day for the Cure™ are invested in community-based breast health programs and breast cancer research. The research funded focuses on decreasing breast cancer incidence and mortality in the next decade.

I've agreed to raise at least $2,300 in donations. I've set my personal goal at $2,500. So I am asking for your help. Please consider making a donation.

I'm walking far and training hard to participate. You can also participate by donating online or by calling 800996-3DAY to donate over the phone.

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Sports Medicine Partnerships Without a cure, one person will die of breast cancer every 13 minutes in the United States.

That is why I'm walking so far. To do something BOLD about breast cancer. I hope that you will share in this incredible adventure with me - by supporting me in my fundraising efforts.

One in eight women in the U.S. will be diagnosed with breast cancer in her lifetime.

I want to walk in this event so I never have to say I lost a mother, sister, aunt, or friend to breast cancer! Everyone deserves a lifetime.

Thank you for your generosity!

Sincerely, Ramia C. Atiyeh To Donate Click Here

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2010 Sept/Oct 53

Osteoporosis

O

steoporosis is a bone disease that affects the density, thickness and overall health of your bones. It is most common in women after menopause.

Heredity also plays a role in the development of osteoarthritis. If a family member has osteoporosis, chances are higher you will too.

If untreated, your bones weaken and your fracture risk increases. Fractures commonly occur in your hip, ribs, vertebral column, and wrist. Multiple vertebral fractures lead to a stooped posture, loss of height, chronic pain, and a decrease in mobility.

The good news is you can decrease your risk of osteoporosis with lifestyle changes and medications.

Lifestyle changes include: weight bearing exercise (for strength and balance), fall prevention (remove loose carpets, cords, or other obstacles), reduce protein intake, limit alcohol consumption, quit smoking Medications include: Bisphosphonate drugs (Fosamax, Actonel, Boniva), Calcium, Vitamins D, A, K, E, C, or Hormone replacement therapy

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If you are considering testing for osteoporosis, the most common diagnostic test we use to measure bone density is called a DEXA scan. A DEXA scan uses conventional X-ray and measures your bone mineral density (BMD). We often need to evaluate for underlying causes of osteoporosis so blood tests are also obtained.

While Osteoporosis has no specific symptoms, the main consequence is a higher risk of bone fractures. Some fractures require surgery and all fractures affect the quality of your life. Simple testing and lifestyle modifications may be all you need to limit the risk of osteoporosis and improve the quality of your life.

Osteoporosis Facts:

1

Over 1.5 million reported bone fractures per year are directly related to osteoporosis

2

Nearly 45 million Americans are suffer from osteoporosis – that’s 55% of people 50 years or older

3 4 5

Spine fractures resulting from osteoporosis can lead to death Osteoporosis can lead to loss of height European or Asian ancestry predisposes you for developing osteoporosis

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2010 Sept/Oct 55

MY STORY By

Kelly Cron

I was at my wits end with chronic neck pain. Just about the time I thought I could no longer bear any more pain I was introduced to Dr. Christopher Wagener. To my good fortune, a dear friend offered Dr. Wagener’s cell phone number to me and implored me to call him for an opinion.

I phoned the doctor early on a Tuesday morning expecting to reach voicemail. Much to my surprise, Dr. Wagener answered his cell phone and I managed to stutter and stammer the reason for my call. Still more shocked, he asked if I could be at his Bethlehem office at 3:00 pm that same day. Wow!!

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He performed spinal fusion surgery the following Monday.

When I woke up in recovery, I could sense the chronic pain had ceased. Truly amazing.

Four months into my recuperation , I realize now what a phenomenal experience I have endured. I am so thankful this doctor cared enough to listen to my complaints. I’m grateful this doctor had a logical and modern approach for treatment.

Most importantly, I found a physician willing to spend more than 10 minutes with me and who reassured me what I was dealing with was real and not just in my head.

I simply want to ask, to plea, that you raise awareness in the Lehigh Valley of the hidden gem located at your facility. His name is Dr. Christopher Wagener. Please help others find him too.

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2010 Sept/Oct 57

MY STORY By

Will Reich

After blowing out my ACL, MCL, LCL and Meniscus before my senior football season at Worcester Academy in Worcester, Massachusetts, I wondered what my future would look like.

Depending heavily upon recruiting to go to college, I was overcome with grief, confusion and doubt.

Luckily for me, despite my injury and consequential ACL reconstruction surgery, many schools including Lehigh University still pursued me.

I had my first ACL reconstruction in October of 2007, and upon completion of my rehabilitation schedule provided to me by my UMass surgeon, I would be ready to go for my first year of college football. I committed to Lehigh in late November of 2007 and was looking forward to getting back on the field in an even more competitive environment.

I arrived at Lehigh in the summer before my freshman year to train with the team and go through even more rehab on my ―brand new‖ left knee. About a month into the

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season, after noticing some significant instability in recent weeks, my left ACL ruptured again. And again, I faced another reconstructive surgery.

After reviewing my MRI results, which I knew would reveal the bad news, Dr. Wayne Luchetti confirmed my belief. At that point I was excited to just get the surgery over with and just get back to playing football… again.

I had my second ACL surgery with Dr. Luchetti in November of 2008. The disparity between my treatment at UMass and Coordinated Health was incredible.

Coordinated Health’s superior post-surgical treatment was clear to me when my surgeon, Dr. Luchetti, came to my hospital room around 11pm the night of my surgery to check in on me and explain how the upcoming months would play out. Nurses came to my room what seemed like every 15 minutes to make sure I was comfortable.

The chef also swung by my room to personally take my order (which consisted of scallops, green beans, clam chowder, Caesar salad and cheesecake—a much appreciated break from college food).

Though at the time I didn’t really think about the excellent treatment I was getting

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(probably because of the morphine and the pain), I realized soon after that the nurses, therapists, surgeon and everyone else involved seemed like they were looking after me and making sure that this normally ―sucky‖ experience was as enjoyable as possible.

I had been to the Boston Children’s Hospital and various UMass Medical locations for procedures, two of the best hospitals in the country. However, I never left them feeling like I had received the amount of attention, care and expertise that I did when I crutched out of Coordinated Health’s hospital in October of 2008.

After surgery, I began the long rehabilitation process yet again. They started me off with Mike Price, a physical therapist at Coordinated Health who just happened to be a fellow Mountain Hawk (Lehigh class of 1999). Working specifically with Mike and Ramon Pedraza, I not only felt like I was making progress on my knee but I also felt like I could talk to them about almost anything. The training staff always had some sort of funny debate going whether it be about sports, the office fantasy football league or oldies music trivia.

Entering my sophomore year, after another long year of rehab, I was finally ready to get back on to the field and play some football. My new knee was doing well and I really only had some minor pain and soreness, nothing that wasn’t expected.

Practicing for two months, trying to get back into the swing of things after over two

years of no football, I felt confident that I could finally make an impact.

Again, it was not meant to be. My left shoulder was injured during practice. Trying to play through it with a brace for stabilization did not work. Dr. Luchetti examined me, sent me for another MRI, and in the end, the labrum in my shoulder was torn almost entirely around.

I had Labral surgery in early January of 2010 with Dr. Luchetti at Coordinated Health and I am currently working on getting back into football shape and looking forward to the 2010 Lehigh football season.

Though athletically, I have had a tough time staying healthy, the treatment and individual care I have received from Coordinated Health has made the experiences easier, simpler and more comfortable.

our y l l e t o t ant Do you w ou r y e r a h story? S lth a e H d e t a Coordin r the o f s u h t ce wi n e i r e p x E red in u t a e f e ob chance t azine g a M g min an upco bsite. e w r u o d on n a e u s s i mit b u S o t ere Click H ory your St

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ON THE FIELD CONCUSSION GUIDE Concussions should be suspected in the presence of any one or more of the following: symptoms (such as headache), or physical signs (such as unsteadiness) or impaired brain function (like confusion) or abnormal behavior.

1S

YMPTOMS

Presence of any of the following signs & symptoms may suggest a concussion.

2

MEMORY FUNCTION

Failure to answer all questions correctly may suggest a concussion.

3

BALANCE TESTING

Instructions for a tandem stance

Loss of consciousness

Sensitivity to Light

Nervous

Seizure or convulsions

Sensitivity to Noise

Anxious

Amnesia

Feeling slowed down

Sadness

Headache

Feeling like “in a fog”

More emotional

“Pressure in head”

“Don‟t feel right”

Neck Pain

Fatigue or low energy

Difficulty concentrating

Dizziness

Confusion

Blurred Vision

Drowsiness

Balance Problems

Irritability

Difficulty remembering

1. “What venue are we at today?”

2. “Which half is it now?”

3. “Who scored last in this game?”

4. “What team did you play last week/game?”

5. “Did your team win the last game?”

“Now stand heel-to-toe with your non-dominant foot in back. You weight should be evenly distributed across both feet. You should try to maintain stability for 20 seconds with your hands on your hips and your eyes closed. I will be counting the number of times you move out of position. If you stumble out of this position, open your eyes and return to the start position and continue balancing. I will start timing when you are set and have closed your eyes.”

Observe the athlete for 20 seconds. If they make more than 5 errors (such as lift their hands off their hips; open their eyes; lift their forefoot or heel; step, stumble, or fall; or remain out of the start position for more than 5 seconds) then this may suggest a concussion.

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We hope you enjoyed the Sept/Oct 2010 issue of Coordinated Health Magazine Cast your online vote now for the Doctor you would like to see next as our Featured Physician and be sure to tell what topics you’d like to read more about!

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Network Locations

Hospital Locations

2775 SCHOENERSVILLE RD.

2301 HIGHLAND AVE.

BETHLEHEM, PA 18017

BETHLEHEM, PA 18045

1503 N. CEDAR CREST BLVD.

1503 N. CEDAR CREST BLVD.

ALLENTOWN, PA 18014

ALLENTOWN, PA 18014

2300 HIGHLAND AVE. BETHLEHEM, PA 18020 400 S. GREENWOOD AVE. EASTON, PA 18045 505 INDEPENDENCE RD, SUITE A EAST STROUDSBURG, PA 18301

Phone

RTE. 115 & SWITZGABLE DR.

(877) 247-8080

BRODHEADSVILLE, PA 18322

(610) 861-8080

50 MOISEY DRIVE, SUITE 202 HAZLETON PA 18202

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2010 Sept/Oct 63

Dear Patients,

Did you know we offer:

Healthcare is rapidly changing. Whether you think changes are good or bad, I know you can agree that you deserve to have quick, convenient, accessible healthcare. You not only deserve it, but you should expect it from your healthcare providers.

Prolotherapy Trigger Finger Releases Knee Replacements Diabetic Foot Care Primary Care That’s exactly why we created the Coordinated Health Magazine. To give you access to educational Botox Arthrograms Laser Therapy Kinesiotaping resources regarding your care. You shouldn’t have to spend your hard earned healthcare dollars just to learn about your pain, treatment options, and the latest healthcare news.

Visco-supplementation Injections Endoscopic We’re excited to share our knowledge with you. In this issue, find out what the leading knee surgeon in Tunnel Platelet Rich Plasma theCarpal Lehigh Valley, Dr. ThomasReleases Meade, thinks of Omega 3s and what these fatty acids can do for your body. If you have an athlete in your family, you don’t want to miss our look at Concussion care and Reverse Total Replacements Hammertoe treatment.

See how ImPACT Shoulder testing can give you piece of mind about your athlete’s on the field safety.

GoSurgery behind the scenesComprehensive with Mike Price, PT as he explains what to Evaluations expect in physical therapySport after an AnSpinal kle Sprain or ACL Reconstruction. Dr. Christopher Wagener explains how Minimally Invasive Spine Surgery benefits patients who think they have no other treatment options. Regenerative Specific Exercise Programs EMG‟s When you think anatomy, I bet you don’t consider the Anatomy of a Hospital Bill. The director of our Tissue Injections X-rays Facet Joint Injections Central Business Office breaks down what you can expect to see in a typical surgery bill. Hear what Coordinated Health paients, just like you, have to say in our ―My Story‖ column.

Deformity Corrections of the Foot & Ankle Orthotic Be sure to tell us what you want to know more about in the survey at the end of the Magazine. I’d love Hip Replacements Neural Scans Nail to Fittings hear what you think, after all this Magazine is for you.

Care Total Ankle Replacements Ultrasound guided Trigger Point Injections Bunion Surgery Elbow Reconstructions Fracture Care Total Shoulder Replacements MRI‟s Breast Reconstructions Juve‟derm Spine Stimulators Chiropractic Manipulation Minimally Invasive Spine Surgery At Coordinated Health, we are passionate about giving you better access. What kind of access do I mean? Access to educational information you need to make better healthcare decision, access to your health records, access to your doctors and the services you need, when you need them most.

Rotator Cuff Repairs Intra-discal Decompressive (IDD) Therapy 64

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