Summer 2013

Free Publication – Please Take One

Feature StoriesMeet the Newest Patients Behind

Our My Scar Means Campaign

Also in this issue:OrthoIndy and IOH Named

One of the Top Places to Work in Indianapolis

Chief Executive Officer, OrthoIndy and IOHJane Keller

President of OrthoIndyTimothy Dicke, MD

EditorKasey Prickel, Director of Marketing

Graphic DesignerJackie Bilskie

Contributing WritersMishay EllisJudy M. Porter, RDKasey PrickelMichael Shea, MDMegan Skelly

Contributing PhotographersJackie BilskieZach Dobson

What doesyour scar mean?

Are you an OrthoIndy and IOH patient?

Tell us your story at MyScarMeans.com.

Letter from the CEO

At OrthoIndy and IOH, we are committed to our patients. That's why we have created the semi-annual publication, Beyond Your Bones. We hope that you find the information in this publication resourceful.

In this issue, learn about OrthoIndy and IOH's advertising campaign called, "My Scar Means." This campaign allows our patients to tell others about his or her experience at our facilities. Additional stories include nutrition information, corporate updates and a number of uplifting patient testimonials.

We hope you find the information in this issue educational. We welcome suggestions and comments by emailing us at suggestions@orthoindy.com.

Best wishes and good health,

Jane KellerChief Executive Officer

Insta

Want to know more?

Give us a call at:

(317) 802-2000or follow us on:

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Table of Contents 4. Back to What I Love Former Butler basketball player continues his career

7. The KineSpring System

9. OrthoIndy and IOH Named One of the Top Places to Work in Indianapolis

10. OrthoIndy Helps Someone Else Give Back

13. Reporting for Duty OrthoIndy and IOH help firefighter return to work

16. Walk a Mile in Someone Else's Heel's What happens to your feet when you slip on your favorite high-heels

18. Shedding the Weight Total hip replacement surgery motivates patient to lose 200 pounds

20. Nothing Can Stop Us Snow storm doesn't delay surgery from starting on time

22. Jingle Bell Run/Walk 25 years of fighting arthritis

23. Getting Back in the Game Two brothers with the same diagnosis return to sports

25. Ask the White Coat

28. In the Blink of an Eye Traumatic car accident changes one woman's life forever

31. OrthoIndy Walk-In Clinic

32. Operation Walk USA 2012 Providing free hip and knee replacements

34. Healthy Hydration

On The CoverMeet Ronald, one of our newly featured patients in our My Scar Means campaign

4 | Summer 2013

Former Butler basketball player, Ronald Nored

| 5 | 5

Back to What I Love: OrthoIndy and IOH help former Butler basketball player continue his career

In Indiana, basketball is a tradition. You can’t live in the state without getting swept up in the Hoosier Hysteria.

Most Hoosiers remember the 2010 and 2011 college basketball seasons, when Butler University’s basketball team made it to the NCAA championship game two years in a row, becoming the smallest school to play for a national championship since 1985.

One of the team’s most noticeable players was #5, Ronald Nored.

Ronald started playing basketball in the second grade because most of his friends joined the team. While Ronald says he wasn’t very good when he started, he didn’t have trouble for too long, as he earned a spot as point guard for Butler University’s basketball team.

While Ronald was excelling at his sport, he was playing in pain. Ronald started experiencing shin splints at the high school level, which continued to be bothersome while at Butler.

“Basketball was something I did every day, so experiencing that pain every day was difficult,” he said. “Running hurt. Jumping hurt. But it hurt more the day after.”

Ronald continued to play through the pain and treated his shin splints with activity restrictions, bracing and orthotics. When the pain didn’t get better, he thought it was time to see if his condition was more serious than shin splints. Ronald went to OrthoIndy to meet with Dr. David Brokaw, orthopaedic trauma and foot/ankle surgeon. Ronald’s suspicions were accurate. An MRI determined it was more serious than shin splints; he had stress fractures in his left and right tibias.

“Part of me was a little nervous cause there was one crack in my left shin that had almost split my tibia in half,” said Ronald.

Stress fractures are an over use injury that can occur in sports related activities. When muscles become fatigued from overuse, it’s unable to absorb added shock, which eventually transfers the overload of stress to the bone, causing a tiny crack. Increasing the amount or intensity of an activity too rapidly typically causes a sports-related stress fracture.

According to Dr. Brokaw, “stress fractures are more common in elite athletes, such as basketball players, runners and gymnasts. Basketball players are no more prone to this type of stress fracture than other athletes, but these are the type of athletes that can get it.”

Surgery was needed to correct his condition, which Ronald decided to schedule during the offseason. He was nervous about surgery, but was confident in OrthoIndy and IOH.

“You want to feel safe, you want to feel like you are going to be taken care of when you come into a place and you want to feel like you’re doing it with the right people. I felt comfortable and welcome at OrthoIndy,” said Ronald.

Dr. Brokaw performed an intramedullary nailing of Ronald’s left and right tibias. “The treatment involves surgically placing a titanium rod down the middle of the marrow cavity of the tibia and locking it with cross

By: Kasey Prickel

MyScarMeans

You want to feel safe, you want to feel like you are going to be taken care of when you come

into a place and you want to feel like you’re doing it with the right

people. I felt comfortable and welcome at OrthoIndy.

6 | Summer 2013

locking screws,” said Dr. Brokaw. “This stabilizes the stress fracture and allows it to heal, and then allows the patient to minimize the stress across the bone that is causing the fracture pain.”

With this type of procedure, recovery takes anywhere from six to eight weeks to allow the fracture to heal. “The timing of Ronald’s surgery was calculated to allow him to return prior to doing conditioning,” said Dr. Brokaw. “He was an ideal patient and his recovery was textbook, as you know, he did quite well.”

Ronald is thankful for the care he received at OrthoIndy. “I’m not sure that I would have made it the last two years of college without my surgery because my shins were in such bad shape.”

Because of his care, Ronald was able to compete in two NCAA championship games after his surgery. Dr. Brokaw was impressed with Ronald’s recovery and enjoyed working with him. “Ronald was a joy to work with,” he said. “He was very compliant and hard working at rehab. Before we fixed him, he could barely compete, and afterwards, he and his teammates brought Butler into the final four on two subsequent occasions. That is a miraculous recovery.”

Both Ronald’s sophomore and junior years were an experience he will never forget. “We went to the championship game both years and ended up losing,” he said, “but it was an amazing experience that I wouldn’t trade for anything.”

Ronald was the head coach for Brownsburg High School's boy's basketball team for one year and is now on the staff of South Alabama's basketball team.

Dr. Brokaw has no doubt that Ronald will succeed as a basketball coach. “I could tell through our interactions that he’d be a phenomenal basketball coach. He has a very long and successful career in front of him.”

The care Ronald received at OrthoIndy has allowed him to continue his collegiate basketball career and now a collegiate coaching career. He has two small scars, which remind him of his journey from high school to today.

“When I see my scar, I’m thankful everything went smoothly,” he said. “My scar means… I can do what I love."

Scan the QR code to watch Ronald's full story or visit MyScarMeans.com.

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Research By: Megan Skelly

Dr. Jack Farr, an OrthoIndy physician specializing in knees, with a direct focus in cartilage restoration and sports medicine, also spends a lot of his time doing orthopaedic research. Currently, Dr. Farr is working on a study of the KineSpring® System as the chief primary investigator. The KineSpring System is intended to treat symptoms of pain and loss of function caused by medial compartment knee osteoarthritis.Right now, doctors at five other sites in the United State are working with Dr. Farr on this clinical research study, the SOAR Clinical Trial, to evaluate the safety and effectiveness of the KineSpring System for the treatment of knee osteoarthritis.

Osteoarthritis is a common degenerative disease af-fecting joints, such as knees, hips, hand and back. It causes the joint’s cartilage to break down, resulting in pain and loss of motion. Initially, osteoarthritis can be treated with various conservative measures including medication, bracing and activity modification. Some-times, joint replacement surgery is also recommended.

“I wanted to get involved with the study because of my interests in early intervention knee procedures ranging from the ReNu amniotic membrane and cell suspension injection to operative procedures with car-tilage restoration, knee realignment and partial knee replacement,” said Dr. Farr. “There were still a group

of patients who either did not optimally fit or like these options. As a result, I sought out new potential treatments for my patients.”

The KineSpring System is an implantable device intended to treat the symptoms of pain and loss of function caused by medial compartment knee osteo-arthritis. It is designed to work by carrying a portion of the weight that would normally be carried by the natural knee.

Use of the KineSpring System requires surgery. The implant is placed under the surface of the skin along-side your knee joint and is attached to the side of your femur (thigh bone) and tibia (shin bone) using bone screws. To move with the natural knee, the implant has two ball and socket joints, one on the femoral and one on the tibial side. A spring placed between the ball and socket joints causes some of the weight in your knee to be transferred to the implant when the spring is compressed.

“The KineSpring System works by decreasing the weight on the inside (medial) portion of the knee that has moderate arthritis,” said Dr. Farr. “The bone is not cut. Patients with inside (medial) knee pain who have bowed (varus) knees have often been placed in an

KineSpring® System

the

8 | Summer 2013

unloader (off loader) knee brace. Many of these patients like the decreased knee pain with the brace, but don’t like the way the brace fits or the brace itself is uncomfortable. Some braces slide on the limb and some patients don’t like applying the brace and re-moving it on a regular basis. The relief they feel with the brace is similar to what they would experience with the KineSpring System—only the KineSpring is always in place.”

The KineSpring System is implanted during a short surgical procedure (approximately one hour). “Obviously, as it requires open surgery, there will be pain, but the pain is managed by oral medications as there are no bone cuts. This allows the patient to return home in less than 23 hours after surgery,” said Dr. Farr. “My staff teaches the patient the home rehabilitation program and makes sure they are safe with crutches. During the first week, swelling and controlled pain are expected. Gentle motion and strengthening exercises are performed at home. Gradually, weight bearing is increased. Some patients are off crutches without limping by three weeks others may take six to eight weeks to fully wean off crutches. Interestingly, patients note that their “arthritis pain” is either greatly diminished or gone when they become full weight bearing. The soft tissue discomfort usually takes three to six months to gradually resolve.”

The KineSpring System is an investigational device in the United Sates. There have been three clinical studies: two in Australia and one in Europe to evaluate the KineSpring System. A total of 100 patients were treated in these three studies, and 18 of these patients were implanted with the version of the device that is being used in the new SOAR Clinical Trial conducted in the United States.

If a patient chooses to participate in the SOAR Trial, they will meet with Dr. Farr to discuss their knee pain and medical history to make sure the study is appro-priate for them. If they are eligible for the study and choose to continue, Dr. Farr will perform the Kine-Spring Procedure at no cost to the patient. Following the procedure, patients will be asked to meet with the study team four times over the next 12 months, and then once a year for the next five years.

The study sponsor covers not only the cost of the implant, but also the hospital charges. There are no additional charges to the patient or insurance com-pany once enrollment is complete. There are standard fees and charges during the initial screening evaluation. If the patient decides they want the implant removed, the sponsor also pays for that procedure. Upon removal, the knee joint proper is as it was before the procedure.

To see if you are a good candidate for this study visit www.soartrial.com and answer a few initial questions. Delays in participation occur if the candidate has had a knee cortisone/viscosupplement injection or arthroscopic surgery—patients need to wait three months after these interventions to participate in the study.

To schedule an appointment with Dr. Farr, please call (317) 884-5163.

| 9

OrthoIndy and Indiana Orthopaedic Hospital (IOH) are pleased to announce that both companies have been selected as one of The Indianapolis Star Top Workplaces.

Top Workplaces are determined solely on employee feedback. The employee survey is conducted by WorkplaceDynamics, LLP, a leading research firm on organizational health and employee engagement. WorkplaceDynamics conducts regional Top Workplac-es programs with 37 major publishing partners and recognizes a list of 150 National Top Workplaces. Over the past year, more than 5,000 organizations and 1 in every 88 employees in the U.S. have turned to WorkplaceDynamics to better understand what’s on the minds of their employees.

Sixty-five companies have been selected for the Top Workplaces award. “OrthoIndy and IOH is thrilled to be named a Top Workplace by The Indianapolis Star,” said Jane Keller, CEO of OrthoIndy and IOH. “We would like to congratulate our employees for this honor and thank them for their hard work and dedication to our mission.”

For more information about the Top Workplaces lists and WorkplaceDynamics, please visit www.topworkplaces.com and www.workplacedynamics.com.

OrthoIndy and IOH:One of the top places to work in Indianapolis

Awards By: Kasey Prickel

10 | Summer 2013

Patient Journey By: Megan Skelly

Giving back to the community has always been a top priority for OrthoIndy and IOH. What makes it especially unique is when OrthoIndy and IOH can give back to someone who has dedicated his or her life to charity. Dr. Dave Brokaw, an OrthoIndy physician, and his wife, Chris, are members of Holy Spirit Catholic Church on the east side of Indianapolis. Holy Spirit is paired with a church in Texiguat, Honduras — San Francisco de Asís. Chris has visited the parish three times; last June, she and their daughter, Mattie, spent two weeks in Honduras.

“There is no sanitation system in Texiguat, Honduras,” said Chris. “Most homes have electricity, but there is no air conditioning. Some people have electric stoves, but I have stayed with people who only have wood-burning, adobe stoves in their homes. There are chickens, pigs, horses and donkeys that just walk the streets. It’s a really noisy place with all of the livestock roaming about. Honduras is one of the poorest coun-tries in Central America, and the people who live in the mountains are some of the poorest in the country.”

In November 2011, Holy Spirit parish hosted two visitors from San Francisco de Asís: Sor (Sister) Dorly Maria Costa and Padre (Father) Douglas Omar Viera. Sor Dorly stayed with the Brokaw family during their visit.

“I met Sor Dorly the first time I went to Honduras,” said Chris. “When Mattie and I went we stayed with her and taught English at the school. She is a very busy person between serving the religious needs of her parish and running a medical clinic.”

Sor Dorly’s clinic has about 15 to 20 people visit there every week, but it is very small with only one exam table. She also travels one or two times a month to see patients in surrounding villages and she sees about five to six people on those days. Most times Sor Dorly and her group are able to ride in a truck to make their visits; however, every now and then they are forced to get out and walk or travel on horses or donkeys.

OrthoIndy Helps Someone Else Give Back

“Sor Dorly works in the clinic alone,” said Chris. “There is a doctor in the town, but he works about one day a week and often sends his patients to her. For many, she is the only health care professional they will ever see.”

Sor Dorly finds out through word of mouth when she goes to Mass in the villages who needs her help. She also carries her own backpack when she’s headed out, in case people ask for her help or she needs to do visits while she is in the area.

“I see a lot of people with vision problems; people who can’t walk, people with arthritis, people with high blood pressure and amputees,” said Sor Dorly “I also have a lot of patients with respiratory problems because it gets very dusty here in the summer season.”During the course of her visit with the Brokaws they learned that Sor Dorly had been suffering from sciatica pain, which was limiting her ability to do her job as a nurse to the village and surrounding communities of Texiguat.

“She didn’t even say anything about her pain,” said Chris. “It was Father Douglas who accompanied her that brought it up. She was having trouble even get-ting dressed so traveling was especially painful, which is essential to the work she does. She needs to be able to physically walk over rocky fences and on mountain passes.”

12 | Summer 2013

Sciatica is pain in the lower extremity resulting from irritation of the sciatic nerve. Sciatica causes pain, a burning sensation, numbness or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. The result is lumbar pain, buttock pain, hip pain and leg pain. Sometimes the pain radiates around the hip or buttock to feel like hip pain.

While sciatica is often associated with lower back pain, it can be present without low back pain. Severe sciatica can make walking difficult if not impossible. Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down.

While sciatica is most commonly a result of a lumbar disc herniation directly pressing on the nerve, any cause of irritation or inflammation of the sciatic nerve can reproduce the symptoms of sciatica.

Treatment options for sciatica include addressing the underlying cause, medications to relieve pain and inflammation, such as oral and injectable cortisone, relax muscles and physical therapy. A variety of low back conditioning and stretching exercises are employed to help people recover from sciatica. Surgical procedures can sometimes be required for persisting sciatica that is caused by nerve compression at the lower spine.

Within the next few days, thanks to the willingness and prompt response of many OrthoIndy doctors, nurses and staff, Sor Dorly received a spinal injection and was able to return to Honduras pain-free.

“I have no pain,” said Sor Dorly. “I can walk, ride horses and cross the river on foot. I have little pains now and then, but I do the exercises the physical therapist gave me every night and it helps a lot. I am very grateful for the help I got from OrthoIndy. Thanks to the care I received, I am able to serve the people of Texiguat and the surrounding villages.”

Mattie and Chris hope to visit Texiguat and Sor Dorly again sometime. On their last visit the group brought eyeglasses and equipment to measure vision. They also distributed readers, sunglasses and prescription glasses.

“Mattie has a heart for service,” said Chris. “She, like everyone who ever takes a trip like this, returned a changed person. We get to know our brothers and sisters in Honduras, live in their homes, eat their food, celebrate Mass with them and enjoy their music and culture.”

When asked what the most rewarding part of her job was, Sor Dorly replied, “visiting the sick and poor in their homes.” When she was asked what the hardest part of her job was, “Nothing. It’s not difficult. It’s wonderful, rewarding work.”

Sports Injury? We’ll fix it.Official Orthopaedic

Provider of the Indiana Pacers

OrthoIndy.com

| 13

Back pain is the second most common reason for medical visits in the United States. Almost everyone will experience lower back pain in their life. Back pain varies from mild to severe and short-term to long-lasting. However, no matter the pain length or severity it can limit someone from easily performing their day-to-day activities.

That’s why it is no surprise that Chuck Benslay, a firefighter serving the Indianapolis area for over 18 years, wanted relief to the pain he was expe-riencing in his back. Chuck had injured his back while moving bags of sand and mortar at a part-time job. He was overseeing some remodeling at his church’s youth center and felt a twinge of pain in his lower back unloading the items from the back of his truck.

“I didn’t think much about it at the time and continued to unload more bags,” said Chuck. “Later in the day my back began to ache a lot more. A couple days later I went to a see a chiro-practor and he was able to relieve some of the pain; however, the pain kept coming back and it was only getting worse.”

Three weeks after his injury Chuck went to see his primary care physician, had an X-ray taken and was told he needed to do some physical therapy. After six weeks of therapy the pain in his back continued to disrupt Chuck’s comfort level. That’s when his primary care physician referred him to OrthoIndy and Chuck met Dr. Robert Huler, an orthopaedic spine surgeon.

Reporting for Duty: OrthoIndy and IOH help firefighter return to work

By: Megan Skelly

14 | Summer 2013

“Dr. Huler ordered an MRI and reviewed the results with me. I had a herniated disk lum-brosacral – no myelopathy or in laymen’s term, a bulging disk between L5 and S1. After consulting with Dr. Huler, we decided that surgery was my only option to relieve the pain. I scheduled my first surgery for three weeks later.”

Sometimes called a slipped or ruptured disk, a herniated disk most often occurs in your lower back. It is one of the most common causes of low back pain, as well as leg pain. Although a herniated disk can be very painful, most people feel much better with just a few weeks or months of nonsurgical treatment. However, that was not the case for Chuck.

“I was unable to sit, stand or lay down in one position for a very long time. The pain was radiating down my right leg all the way to my toes. I remember ‘sitting’ in the pew at church by lying on my left side with my legs extended under the pew in front of me and my arms over the top of the pew.”

A disk begins to herniate when its jelly-like nucleus pushes against its outer ring due to wear and tear or, like in Chuck’s case, a sudden injury. This pressure against the outer ring is what causes the lower back pain. If the disk is very worn or injured, the jelly-like center may squeeze all the way through.

“I was very concerned that my injury would force me to be retired under a medical pension. I was unable to wear an air pack, pull the weight of a charged houseline, assist lifting patients and even at times I was unable to climb up into the fire truck, all things necessary for a firefighter. “

In most cases, a herniated disk is related to the natural aging of your spine. However, there are some risk factors that can increase your chance: If you are a man between the ages of 30 and 50; improper lifting; weight; repetitive activities that strain the spine; frequent driving; smoking; and an inactive lifestyle.

Chuck had microsurgery for the lumbar spine on the disk between L5 and S1 twice. This surgery involves removing the herniated part of the disk and any frag-ments that are putting pressure on the spinal nerve.

“The staff at OrthoIndy was terrific. They were always there if I had a question about my medications, billing concerns or to re-schedule appointments. The staff at IOH was terrific as well. They explained everything to me and my wife and took really good care of me. I was surprised to learn that I would not have to stay the night in the hospital. They checked on me regularly and monitored my pain level constantly. They kept my wife up-to-date on my recovery and eased her anxiety a lot. They even gave me a get well card signed by all my nurses!”

Regardless if you choose a nonsurgical or surgical treatment, there is a chance of the disk herniating again.

I feel great! I don’t know how many people I have assisted since

my surgery, but Dr. Huler has been a part of helping all of them.

| 15

“Unfortunately, I had one of the complications Dr. Huler discussed. He explained that there was a ten percent chance of a re-herniated disk. I had a re-herniation and had to have a second surgery about four months after the first one.”

Most patients notice improvement over the first several weeks following surgery, but also continue to feel improvement over several months. Pain is the first symptom to improve, followed by improve-ment in overall strength of the leg. Most patients will slowly resume normal daily activities over the first several weeks following surgery.

“I had a great experience at OrthoIndy and IOH. Dr. Huler was very professional and explained every-thing to me. He is very knowledgeable was able to explain everything to me in a way that made sense. Because of my complications, I spent a lot of time with him and the more I got to know him the more I liked him.”

Ten months after Chuck’s initial injury he was fully released. Now Chuck is able to go hiking and camp-ing with his wife. He has been on several hikes over 10 miles at the Indiana State Parks and in the Smokey Mountains near Gatlinburg. He is also currently training to compete in the Firefighter Combat Challenge, an obstacle course for firefighters, something he was unable to do for 15 years.

“I feel great! I don’t know how many people I have assisted since my surgery, but Dr. Huler has been a part of helping all of them. Without OrthoIndy and IOH I don’t think I would still be a firefighter. I have used my experience to caution other people and firefighters about proper lifting techniques. If I can help someone else avoid everything I went through, then it will be worth it. If hear about someone having back pain, I refer them to OrthoIndy! My scar means...I can serve my community.”

Scan the QR code to watch Chuck's full story or visit MyScarMeans.com.

Practice Focus:Pediatric Spinal Disorders ScoliosisSpondylolisthesis KyphosisPediatric Spinal Tumors Spinal CancerAdult Spinal Disorders FracturesInfection Spinal Cord Injuries and Deformity

• Scoliosis• Kyphosis• Spondylolisthesis

Disc Herniations• Cervical• Thoracic• Lumbar Spine

Located At:OrthoIndy Northwest OrthoIndy at8450 Northwest Blvd. St.Vincent CarmelIndianapolis, IN 46278 13450 N. Meridian St. Suite 355OrthoIndy West Carmel, IN 460327950 Ortho Ln.Brownsburg, IN 46112

Contact: To schedule an appointment with Dr. Huler, please call (317) 802-2876.

Robert Huler, MD

16 | Summer 2013

Physician Tips By: Michael Shea, MD

Although I cannot comment from personal experi-ence, high-heeled shoes have become a modern-day necessary evil. My caveman ancestors first put on rabbit-skin pelts to protect their feet from the environ-ment. As man evolved, so did his shoes, to allow better functioning and protection, such as snowshoes and chain-mail slippers. The first high-heels can be traced to early Persian horse riders. The high-heel provided increased stability of the foot in the stirrup and pre-vented it from slipping forward. Functionality of shoes gave way to fashion. In the sixteenth century, royalty began wearing heels to make themselves appear taller and more prestigious. This gave way to a person of authority or wealth being known as “well heeled.”

Today, heels are worn typically by women for aesthetic/ fashion reasons and not considered practical. High-heels tend to give the appearance of longer, shapelier legs. My friends, Jimmy Choo and Gucci, describe the low-heel as less than two and a half inches, a moder-ate-heel between two and half and three and a half inches and a high-heel greater than three and a half inches. Anything greater than five inches is considered “foot jewelry” and not a shoe.

The biggest problem with high-heels is that they cause contracture, shortening of the Achilles tendon, calf muscle. This changes the entire biomechanics of the foot and ankle. The marvelous foot and ankle was created to absorb shock, propel us forward, balance on uneven ground and provide equal weight distribution. High-heels disrupt all of these mechanisms and create health problems.

High-heeled shoes are a true conundrum. Women wear them for various reasons, i.e., fashion statements, aesthetics, obligated/mandated, etc. However, 72 percent of women feel they have some type of shoe-related problem. Sadly, 42 percent said they would wear a shoe they liked, even if it was painful. Ladies, listen to your bodies, pain is telling you something is not right. Although not limb-threatening, high-heels can cause annoying, as well as significant, health issues. These problems occur when you are wearing the high-heel, as well as when you are not.

Normally when standing, weight is balanced 50 percent on the heel and 50 perfect on the ball or forefoot. As your heel rises up in a high-heel, weight

Walk a Mile in Someone Else’s Heels:

What happens to your feet when you slip on your favorite high-heels

To schedule an appointment with Dr. Shea, please call (317) 802-2821.

is transferred more to your forefoot. This increased load causes metatarsalgia, pain in the ball of the foot, inflammation, synovitis of the toe joints, inflamed nerves producing neuritis or even neuroma and possi-bly even ligament rupture or stress fractures. If the toe box is pointed, then every step forcefully drives your normal foot into a constrained toe box, which leads to bunions and bunionettes. These issues may progress requiring surgical intervention if painful enough.

The muscle strength and motion are also balanced. The muscles in front of the leg pull the ankle, foot and toes upward while the calf muscle creates push off and flexes the toes and the foot for balancing. A high-heeled shoe shortens the calf muscle. The shortened/contracted calf muscle causes the anterior muscles to work harder to keep the foot and ankle balanced. In doing so, this may lead to tendinitis, but more com-monly it creates hammertoe and claw toe deformities as the tendons to the toes try to pull up against the overpowering forces to the bottom of the foot; again, all created from a contracted Achilles tendon.

The position of the foot in a high-heel not only causes the Achilles tendon to shorten, but also the plantar fascia, a strong ligament in the bottom of the foot that runs from the heel out into the toes and supports the arch of your foot. Planta fasciitis is generally not symp-tomatic when wearing the heel as the position of the heel takes the stress off the plantar fascia; however, it becomes very painful when one tries to wear a flat shoe.

Another difficulty with a contracted Achilles tendon is that it limits the in and out or sideways motion of your hind foot, the joint below the ankle. This motion nor-mally allows the foot to accommodate uneven ground and all shock absorption. When you decrease the ability to accommodate uneven ground, your tendons need to work harder to keep the foot balanced. This may lead to tendinitis and subsequent tendon degen-eration. A tight Achilles tendon will also worsen the pain associated with a flat foot deformity and increase the instability in a high-arched foot due to the con-sequences of the muscle imbalances. The shortened Achilles tendon may also make it difficult to treat flat feet and high-arched feet with orthotics, which may necessitate one having surgery.

People who wear high-heels also have a shorter and more forceful stride with less shock absorption. The raised heel also alters gait mechanics, which may lead to knee arthritis and back pain. High-heels also pro-duce instability and balance issues. When the small heel of the high-heeled shoe contacts the ground, it usually causes a wobbling thrust on both your ankle and knee, which can lead to tendinitis and osteoarthritis. Due to the shape of the ankle bone (talus) when you wear a heel, there is less inherent stability in the ankle joint. This makes it easier to sprain your ankle, even when walking on a level surface. Lastly, when wearing high-heels, it would be difficult to run away from or defend one’s self from an attacker.

As an advocate for truth, high-heels do have two health benefits. They increase the tone of the pelvic floor, which may decrease urinary incontinence and they also may help shorter people function in a world designed for normal-height individuals.

Even after stating the obvious downside of wearing high-heels, women will wear them. For you, I have a few words of advice. First, try to wear a high-heel less than one-third of the time you are on your feet. Also, please try to maintain an Achilles tendon stretching program, as this is the basis for the majority of the problems. Secondly, please listen to and answer your body when it complains of pain. Thirdly, if you must wear heels, there are a few characteristics of an accept-able high-heel: A wedge is better than the more stylish drop-off type of heels, a thicker and more stable heels is better and open-toed high-heels are better than closed-toed. If you have to wear a closed-toed shoe, get one that fits you snugly so that your foot doesn’t slide into the toe box. Lastly, any type of cushioning underneath the forefoot would help.

If all else fails, give me a call!

Michael Shea, MD

18 | Summer 2013

Shedding the Weight: Total hip replacement surgery motivates patient to lose 200 poundsBy: Megan Skelly

Unable to walk for more than ten minutes at a time, Karma Malcom couldn’t stop gaining weight. She was uncomfortable and becoming depressed. All of her greatest joys in life were nearly impossible to do. Play-ing with her new granddaughter, volunteering at the church and just being active caused too much pain in her hip for her to bear.

“I experienced hip pain for several years and just got to where I couldn’t be mobile at all. I was stationary and stayed in the house. I wasn’t outgoing at all and it hurt my lifestyle.”

After being told by another orthopaedic physician that he wouldn’t do the surgery because of her weight, Karma was disheartened and afraid she would have to live the rest of her life immobile and in pain.

“I had a new granddaughter and wanted to be able to do things with her when she got older. Anything and everything to volunteer at I am the first one there. That’s my joy in my life is giving back and I couldn’t even do that. I was at the end of my rope, thinking I would have to live with this the rest of my life.”

Karma decided to give one more physician a visit and went to visit Dr. Edward Hellman an OrthoIndy surgeon. Dr. Hellman diagnosed Karma with osteoar-thritis of her hip and informed her that she needed a total hip replacement.

Like other joints that carry your weight, your hips may be at risk for “wear and tear” arthritis called osteoar-thritis, the most common form of arthritis. Osteoarthri-tis occurs when the smooth and glistening covering on the ends of your bones, that helps your hip joint glide, wears thin.

You are more likely to get osteoarthritis if you are elderly, obese, have an injury that puts stress on your hip cartilage or if you have a family history of the disease. However, you can still develop it if you do not have any risk factors.

The first sign may be a bit of discomfort and stiffness in your groin, buttock or thigh when you wake up in the morning. The pain usually flares when you are active and gets better when you rest. If you do not get treatment for osteoarthritis of the hip, the condition keeps getting worse until resting no longer relieves the pain. The hip joint gets stiff and inflamed. Occasionally bone spurs will build up at the edges of the joint.

When the cartilage wears away completely, bones rub directly against each other. This makes it very painful to move. Sometimes you lose the ability to rotate, flex or extend your hip. If you become less active to avoid the pain, the muscles controlling your joint get weak and you may start to limp.

While you cannot reverse the effects of osteoarthritis of the hip, early nonsurgical treatment may help you avoid a lot of pain, disability and will slow the progres-sion of the disease. Surgery can help if your condition is already severe, as in Karma’s case.

Dr. Hellman per-formed a total hip replacement surgery on Karma. To perform a total hip replace-ment, an incision is required that allows the surgeon to enter and dislocate the hip joint. The femoral head is removed to allow access to the socket of the hip. A metal cup is placed in the socket and will have a modular bearing that articu-lates with a modular femoral ball.

The femur is prepared for a stem (reaming, broaching or both) and trial components are used to assess the joint stability, leg length and range of motion. The real implants are then placed into the bones and the mod-ular cup liner and femoral ball are put in place. The hip is put back together and the wound is closed. Any muscles or important tissues that have been released are usually repaired at the time of closure.

“I was scared because I didn’t know what was going to happen with this kind of surgery and everything went just fine. I felt completely at ease with everyone.”The recovery from a total hip replacement takes 6 to 12 weeks. This is the time it takes for the soft tissues to heal, bone to grow into the implants and for the patient to regain a normal sense of well being. The pain relief is usually early and after four to six weeks,

most patients have little if any hip pain. They may be on protected weight bearing for a few weeks after the surgery depending on surgeon directions, but usually can walk without a cane, crutch or walker within a few weeks. The muscles regain strength also within four to six weeks.

“As soon as I got home, it was painful at first, but noth-ing I couldn’t bear. I kept thinking one more day you are closer to walking, one more day and you can walk a marathon, help with the church all the time or chase my granddaughter around. That was my motivation to get out of the house and get moving.”

If you have early stages of osteoarthritis of the hip you may not need surgery immediately. Nonsurgical treatment options include: resting your hip from overuse; following a physical therapy program; using nonsteroidal anti-in-flammatory medications like ibuprofen for pain; getting enough sleep each night; and losing weight if you are over-weight.

“My surgeon at IOH was wonderful. I prom-

ised him that if he would do my surgery I would lose 100 pounds the first year and I did. Now, I’ve lost 200 pounds since I have had my surgery. My life is great I go to the gym five days a week and I can get down on the floor and play with my granddaughter, who is the joy of my life. I walk in 5Ks. I can volunteer more, which is my goal to help others. Having the surgery and losing all the weight proved that I was in charge of myself and when I got my life back nothing was going to hold me back. My scar means...I have my life back.”

Scan the QR code to watch Karma's full story or visit MyScarMeans.com.

I experienced hip pain for several years and

just got to where I couldn’t be mobile at all. I was stationary and stayed in the house. I wasn’t outgoing at all and it

hurt my lifestyle.

Lisa Maxey was diagnosed with scoliosis when she was 11 years old. It was not severe enough at that time for surgery; however, it was too late for bracing. In her adult years Lisa started to experience pain in her hip and lower back. So she decided to visit Dr. John Dietz, an OrthoIndy spine surgeon, for a check-up.

“The pain was beginning to affect my daily activities, even bending for short periods of time,” said Lisa. “But more importantly Dr. Dietz said that long term effects would be harmful to my lungs. The top of the ‘S’ curve of my spine was approaching 90 degrees and would start affecting my lung/breathing capacity.”

Curves over 80 degrees squeeze on the heart and lungs and may cause respiratory insufficiency. If Lisa didn’t have her scoliosis fixed by surgery it would continue to get bigger and eventually cause cardiopulmonary failure. Rather than treating a relatively simple curve, hers was over 90 degrees requiring a much larger operation with greater risk of paralysis, blood loss and anesthetic complications.

“We spent several months carefully planning surgery which would correct the scoliosis with the least amount of risk,” said Dr. Dietz. “This was expected to be an extremely large surgery lasting 10 to 12 hours and posing significant risk to her.

Lisa was scheduled to have a spinal fusion of 13 vertebrae T4-L4.

“We were all set to do her surgery on December 21 when the intra operative CT scanner broke the day before surgery,” said Dr. Dietz. “Parts to repair the machine were immediately sent by the shipping company and an engineer locally was prepared to do the repair so there was a good chance we could complete the surgery. However, we got about eight inches of snow the night before surgery and everything was shut down. The patient, surgery team and I all arrived on schedule. But the delivery truck was behind schedule so we didn’t have the parts and the engineer who was supposed to fix the machine couldn’t get out of his driveway because of the snow.”

Patient Journey By: Megan Skelly

Nothing Can Stop Us:Snow storm doesn’t delay surgery from starting on time

20 | Summer 2013

Before

After

Lisa needed to have the surgery that day because she had scheduled it three months in advance using vaca-tion time and holidays. Her husband had made the same plans so he could take care of her. The potential delay of her surgery would have dramatically changed that planning, plus there was the emotional stress of being ready after the long wait.

“OrthoIndy had called the night before and told me there would be about an hour delay because the machine was being worked on,” said Lisa. “We also knew about the weather but didn't really think that was a factor in my surgery. I didn't know until after my arrival that a part for the machine got caught in the storm and was somewhere on a truck.”

Dr. Dietz discussed with Lisa that they had two options: sit and wait for the part to arrive or do the surgery the older way using fluoroscopy. However, surgery with the second option would take longer and had a few more risks.

“I’m a mechanical engineer and understand that equipment breaks down, “said Lisa. “So after Dr. Dietz came in that morning and explained what was going on, we talked about the options. I told him I wanted the best machinery and technology available. So we agreed to wait until the latest time the surgery could be started that day for the part to be installed and the repair to be completed.“

That is when a lot of extraordinary people did a lot of extraordinary things.

First, the shipping company was contacted. They don’t normally give out information about where a package is located after it passes through their distribution cen-ter. But the company realized this situation warranted extra care. The truck was already out trying to deliver packages in the snow. They found out where the truck was located and contacted the driver.

Medtronic Navigation is the local distributor in charge of the machine that needed repaired. They sent some-one all the way to where the truck was located. The driver and the rep unloaded the truck in the snow to find the one package we needed.

“That morning I received a call explaining the issue at hand, and we coordinated on how we could best get the surgery going,” said Seth Helbert R.N., Clinical Specialist at Medtronic Navigation. “I immediately went to the nearest shipping office and had them locate the package for me. They contacted the driver and we determined a place to meet up. When I arrived to meet the driver, he had filtered through all of his packages in the snow, pulling out all of ours. After I had the packages, I headed to deliver them.”

At the same time another Medtronic Navigation employee drove to the snowbound engineer’s house and helped him find a way to get down to IOH. The parts and the engineer arrived at about the same time.

“We had a large roadblock, being that our engineer that was scheduled to fix the machine was snowed in and it was going to take him a couple of hours to get on site to facilitate the process,” said Natalie Tunks, Clinical Specialist at Medtronic Navigation. “I was an hour away from the engineer that morning, fortunately I was able to pick him up and bring both of us on site.

By noon that day the machine was fixed and had been tested. By 1 p.m. the surgery was getting started and was completed in less than eight hours, with no complications.

“The first week after surgery was a little rough,” said Lisa. “But this was a major surgery! Since then prog-ress has been good. If I think back to how much help I needed then to what I can do now it's amazing. I'm still on bending, lifting and twisting restrictions so there is a lot I can't do, but I am walking for exercise and that is getting easier. Also he has released me to start using the elliptical trainer so I'll be able to work out at home which will make that easier.”

“I'm grateful to everybody who went above and beyond on the day of my surgery,” said Lisa. “From the delivery man, to the repair man, the anesthesiologist, the whole surgery team and the staff on the hospital floor when I finally made it to my room. Everyone was professional, helpful, and very friendly. Dr. Dietz is awesome. He takes time to explain what the issues are, the options, then what he's going to do, answers all the questions we have, couldn't ask for more!”

| 21

22 | Summer 2013

Community Involvement

This year marks the 25th Anniversary of The Arthritis Foundation’s Jingle Bell Run/Walk for Arthritis present-ed by OrthoIndy. It’s a great way to start off the holi-day season with family, friends and coworkers. Form a team, raise funds and organize your very own holiday-themed costumes. Everyone is encouraged to tie jingle bells to their shoelaces for some extra holiday spirit.

Thousands of runners/walkers participate every year to do their part in fighting arthritis. The Jingle Bell Run/Walk not only raises awareness for this disability, but it also raises funds desperately needed for research, health education and government advocacy.

The Jingle Bell Run/Walk is the nation’s largest holiday run/walk event. It features a 10K run and 5K run/walk with activities for the entire family. The day is filled with costume judging, a 1K children’s “Santa Chase," the run/walk and post–event festivities with awards and prizes.

For more information, please visit IndyJingleBellRun.com. To sign up for the 2013 Jingle Bell Run, simply scan this QR code.

By: Megan Skelly

25 Years ofFighting Arthritis

| 23

Getting Back in the Game: Two brother with the same diagnosis return to sports By: Megan Skelly

Austin and Eli Brown’s lives, like most young men, revolve around sports and staying active. Most boys in high school and middle school are meeting their friends after school for a certain sport’s practices, to shoot some hoops or play some catch. For Austin and Eli it was hard to imagine spending a lot of time doing anything else.

Unfortunately, both Austin and Eli started experiencing pain in their knees after any kind of physical activity, such as competing in sports, working out and even just running around with friends.

“The pain kept me from doing all the things I love,” said Eli. “I couldn’t play soccer or even just run around with my friends without experiencing pain.”

Dr. Corey Kendall, an OrthoIndy physician, diagnosed both Austin and Eli with osteochondritis dissecans, a joint condition in which a piece of cartilage, along with a thin layer of the bone beneath it, comes loose

from the end of a bone. Patients generally notice knee pain and swelling. Often times there may be symptoms of locking or catching. The diagnosis is made with an X-ray or MRI scan.

Osteochondritis dissecans is most commonly found in males between the ages of 10 and 20. Sports that involve jumping, throwing and rapid changes in direction may increase your risk of osteochondritis dissecans.

“We don’t know for sure what causes this to happen,” said Dr. Kendall. “It has been hypothesized that this disease is the result of minor trauma, genetics or local

vascular factors, among other reasons. Ultimately, the bone loses its blood supply, and undergoes a process called necrosis. The cartilage however is generally preserved.”

Osteochondritis dissecans can increase your risk of eventually developing osteoarthritis in that joint. While there is no way to prevent osteochondritis dissecans it can be treated.

“Initial treatment is centered upon activity modifica-tion,” said Dr. Kendall. “Basically, we try to get the bone to heal. A patient may be placed on weight bearing restrictions and activity restrictions during this time. However, if the lesion is unstable, surgery may be necessary. The lesions can be stabilized with screws, nails or osteochondral plug transfers. The osteochon-dral plug transfers are my preferred technique because they decompress the area, provide live bone graft and provide stabilization.”

24 | Summer 2013

Austin and Eli both had surgery at OrthoIndy and Indiana Orthopaedic Hospital (IOH).

“My experience at OrthoIndy was great. The doctors were very nice and took good care of me,” said Eli. “I really like my physician. He asked for my opinion about my knee and the surgery, not just my parents. I also liked that he was con-fident he could fix the problem I had.”

Both boys are now pain free, although the road to recovery was tough.

“I’ve changed a lot since my surgery,” said Austin. “God planned this for a reason; you just need to keep pushing forward on with your life and focus on the good rather than the bad. With the problem I have with my knee, not a lot of surgeons knew how to fix it and I’d already seen three other surgeons.”

Austin’s trainer and coaches recom-mended that he visit OrthoIndy and Dr. Kendall was the fourth physician he saw.”

“I didn’t know what to think when I went in. I’d previously been told I would never play sports again, and when he said he could fix it, which put a smile on my face, I knew he was the right doctor to do this surgery. He was confident he could fix it, which made all the differ-ence. It’s been ten months since I was diagnosed with OCD, and two months since my surgery, and I know I’m on my way back to doing the things I love. My scar means...I can play sports.”

24 | Summer 2013

The pain kept me from doing all the things I love. I couldn’t play soccer or even just run around with my friends without experiencing pain.

Scan the QR code to watch Austin and Eli's full story or visit MyScarMeans.com.

| 25

Ask the White Coat

Answer: Degenerative disc disease is not actually a disease, but a term used to describe the normal wear and tear that occurs as part of aging.

The disc itself is a very unique structure in the spine. It acts as a shock absorber in the spine allowing it to twist, bend and flex but strong enough to resist tremendous forces in various planes of motion. A normal disc has two components: a tough outer ring called the annulus fibrosus, which is innervated by nerves in the very outer portion and the nucleus pulposus, the jelly like core of the disc.

As we all get older, discs begin to deteriorate or degenerate, which may result in degenerative disc disease in some people. Some of these changes to the disc may cause a loss of fluid in the disc, which decreases the discs ability to act as a shock absorber and reduces flexibility. There can also be small tears or cracks in the outer layer of discs, the annulus, that can result in the jelly like nucleus to be forced out through those cracks to cause bulging or breakthrough the outer layer causing a rupture or herniation.

Disc degeneration can cause a variety of symptoms. However, most people that have disc degeneration are usually not symptomatic. Some people with the same amount of degeneration can have severe pain that may limit their activities. The location of the pain is also dependent on which discs are degenerated. If there is a painful disc in the cervical spine, it may be associated with neck pain or arm pain. If the painful disc is in the lumbar spine, it can be associated with back, buttock or leg pain. In most cases, pain from a degenerated disc is usually associated with certain activities with periodic flare up of pain, but eventually returns to a mild pain level or resolve completely.

Diagnosis of degenerative disc disease starts with a thorough history and physical exam by your doctor. Particular attention will be paid to your symptoms, current and past injuries or illnesses, and any previ-ous treatment. A physical exam will be geared toward evaluating the flexibility and pain caused by motion, and any nerve related issues such as weakness, numb-ness or tingling and diminished reflexes. Your doctor may also assess for possible fracture, infections or tumors related to the spine. If indicated, your doctor may order imaging studies, such as an X-ray or an MRI of the affected area for further evaluation.

Question: What is degenerative disc disease?

Question: Why does my shoulder still feel “loose” after it dislocated?

Answer: After being treated for an initial disloca-tion or subluxation of your shoulder, you may find that it feels like it’s about to dislocate periodically. Or your may not have had an injury, but your shoulder feels extremely loose and causes pain. This feeling of giving-way is called glenohumeral instability or subluxation.

Glenohumeral instability refers to a condition in which the humeral head in the shoulder repeatedly slips out of the joint, or seems to nearly slip out.

The shoulder blade and humerus, or upper arm, form the glenohumeral joint. This is what you would normally think of as your ‘shoulder joint’. The gleno-humeral joint is a ball-and-socket joint, consisting of the head of the humerus, or upper arm, and the glenoid fossa, which is formed by a slightly hollowed portion of the end of the shoulder blade. The head of the humerus maintains very little contact with the glenoid itself during movement, however. Instead, the shoulder relies on a group of ligaments, muscles and tendons to help keep the humerus in the proper place, and to provide stability to the joint.

As the arm moves in any direction, these ligaments and muscles maintain the proper position of the humeral head in the socket. During forceful motion or injury, however, these tissues can be stretched or torn, and the head can “slip out” of the socket, or dis-locate. Your doctor may also use the term “subluxate”, meaning that it has only partially dislocated.

Dislocations are most commonly anterior, meaning that the head of the humerus slips forward out of the

Treatment usually starts with conservative therapies, which is often enough to treat the symptoms the patient may be experiencing. Non-steroidal anti- inflammatory medications such as ibuprofen or naproxen or other medications such as Tylenol may also be beneficial. Your doctor may choose to prescribe alternative medications if needed. Physical therapy and home exercises to help strengthen the back and also to stretch the muscles are often recom-mended as well. If the above treatment modalities are not effective, an epidural steroid injection or pain block may be more effective at reducing symptoms. In some cases, if the disc degeneration has resulted in a herniation, a narrowing of the spinal canal, also known as spinal stenosis or other neurological deficits, surgery may be recommended.

Prasanth Nuthakki, MD

Practice Focus: • Physiatry • Interventional Pain

Management • Spine Disorders

• Peripheral Disorders

Located at • Fishers• Lafayette

• Northwest • West • OI at St.Vincent Carmel

To schedule an appoint-ment with Dr. Nuthakki,

please call (317) 802-2483.

joint. An injury where the arm is turned outwards and away from the body, such as a fall sideways on the arm can cause an anterior dislocation. Occasionally a dislo-cation can be posterior, where the humeral head slips backwards out of the joint. This usually occurs from a different type of injury, in which the arm is struck while is rotated inwards. Additionally, your shoulder can be extremely loose and cause pain without having an injury. This scenario may represent multidirectional instability.

Unfortunately, once you’ve dislocated your shoulder, the chances are high that it will happen again, par-ticularly if you are under the age of 30. That makes it all the more important that you follow your doctor’s healing and rehabilitation program carefully. In gle-nohumeral instability, patients are unable to keep the humeral head centered in the glenoid socket.

Patients with glenohumeral instability report that their shoulder continually slips out of joint, especially when they throw an object or possibly bump into some-thing. Physicians should ask patients if they can volun-tarily make their shoulder dislocate, which is an obvi-ous indicator of glenohumeral instability. Your doctor will classify the instability as either acute or chronic, depending on the symptoms and how long you’ve had them. Instability is classified as chronic if it lasts for more than a few months. For some people, pur-posely dislocating their shoulder may be a source of amusement or entertainment. However, it only makes it more difficult to maintain stability when you need it, and can contribute to a condition where the instability cannot be resolved.

Physicians will diagnose glenohumeral instability by gently moving the patient’s shoulder until it starts to slide out and cause the patient too much pain to move it any further.

Chronic instability is treated first by attempting to strengthen the muscles in the shoulder, to compen-sate for the loose ligaments. Your doctor, physical therapist or certified athletic trainer can suggest some exercises that will isolate these muscles. While exercise may be tried initially, to try to prevent further dislocations, surgery may be necessary if the shoulder cannot be stabilized sufficiently.

There are many different surgical procedures to repair the instability of recurrent shoulder dislocations.Because one common cause of instability is a tear in the ligaments that attach to the socket, or glenoid, surgery is often done to repair this damage. By return-ing the ligaments to their original position, tension-ing as close as possible, and then letting them heal completely, the joint can be restored to a more stable condition. This surgery is known as a Bankart repair for the specific type of tear in the ligaments or “Bankart lesions.” The surgeon may make a small incision on the front of the shoulder, or may use an arthroscope, which is a small camera that is inserted through a much smaller incision. Surgical instruments can also be inserted through tiny incisions, and the camera used to visualize the structures while the repair is performed.

After surgery and time for the repaired ligaments to heal, a rehabilitation program designed to strengthen the muscles will be started.

Scott Gudeman, MD Practice Focus: ShoulderKneeSports Medicine

Located at South

To schedule an appointment with Dr. Gudeman, please call (317) 884-5161.

28 | Summer 2013

| 29

In a single moment your life can change forever, leaving you vulnerable to the world and weak beyond all rec-ognition. Your dreams are ripped from you, your goals are left unreached and before you have a chance to heal you feel the sting of reality as life goes on. It is in these raw and fragile moments that you find out who you really are. The decision looms before you: give up or move on?

Melissa Burns knows this all too well. Traveling to Saint Pete Beach in Florida for an annual spring break family vacation Melissa and her family were involved in an accident with a semi.

“Up until that point I remember being turned around backwards in the seat tending to my children,” said Melissa. “After that point I have no recollection of what happened until seven days later when I woke up out of a coma and faced some of my greatest fears.”

Melissa was struck with the news that her husband had passed away in the accident. At the age of 29 Melissa became a widow who was left to take care for their two children, five and two. Fortunately, her children were okay and were back home in

Indianapolis.“ I remember vividly thinking even though I had so much grief, pain, suffering and heart-ache, that I had to overcome. I had to make Brent, my husband, proud, I had to make my kids proud and I had to recover to make the best life possible for all of us.”

Melissa was referred to OrthoIndy from her team of doctors in Macon, Georgia. She had suffered severe in-juries to her right leg. She had a right knee dislocation; MCL, PCL and LCL total tears; right open ankle fracture with four inch bone loss of the right tibia; and a total right ankle fusion.

“My injuries have been life changing. I was wheelchair bound for several months and then I was required to use an assistive device to walk for months after that. I used a walker, crutches, leg and foot braces, knee braces and everything else.”

Melissa was treated by Dr. Joe Baele, an OrthoIndy trauma surgeon.

“Melissa’s story is heartbreaking but truly inspiring,” said Heather Gregg RN, BSN, CNOR and nurse for Dr. Baele. “I believe that she is one of the strongest people I know. She has lived everyone’s worst nightmare.

In the Blink of an Eye: Traumatic car accident changes one woman’s life forever By: Megan Skelly

I believe that the biggest takeaway for me from this experience and trying time in my life is to be a testimony to those around me, to prove that life can move forward and does go on. It’s just about hard work and determination.

30 | Summer 2013

I cannot imagine experiencing what she has been through. She has a strong faith, a positive attitude and is determined to provide for her boys and live life to the fullest. I admire her strength and feel privileged to have been involved in her care.”

After months of extensive physical therapy at IOH and several surgeries, Melissa learned to adapt to activities of everyday life.

“My life before physical therapy was difficult. Rehab was very gruesome; but I have a strong will and desire to get better, so I knew that at the end of the day if I saw even a little bit of progress I was getting that much closer.”

OrthoIndy and IOH have four outpatient physical or occupational therapy locations.

“My experience with IOH and Outpatient Physical Therapy has been nothing short of the best. As much as I have a will and desire to get better, they have a will and desire to make and help me get better as well. They truly care and love their patients. My physician and his assistant have been extremely attentive to my needs, encourage me to ask questions and participate in their care and treatment. They have become my biggest cheerleaders and even life-long friends.”

Although Melissa is still under the care of Dr. Baele, her life has been better than she ever thought it would be after having devastating injuries to her right leg, knee and ankle. She is able to live a very active life with her kids, participate in activities that once seemed impossible and continue to move forward with her life.

“I believe that the biggest takeaway for me from this experience and trying time in my life is to be a testimony to those around me, to prove that life can move forward and does go on. It’s just about hard work and determination. Although my injuries have been life changing, I have been forever blessed with a new outlook on life. A life that involves sharing my story, living life but never forgetting where I have been and what I have been blessed with. My scar means...it's not who I am, but where I've been.”

Scan the QR code to watch Melissa's full story or visit MyScarMeans.com.

Visiting the emergency room is usually a very long and frustrating process. No one wants to sit and wait for three hours for a minor injury, just to be seen by a doctor who doesn’t spe-cialize in his or her particular needs. Instead, go to the OrthoIndy’s Walk-In Clinic, where you can find friendly and knowledgeable orthopaedic specialists.

There are three conveniently located Walk-In Clinics at OrthoIndy intended for patients with recent injuries, sprains, broken bones or fractures. The OrthoIndy Walk-In Clinics allow immediate access to orthopaedic care eliminating the emergency room wait and cost.

“Patients can expect quick access to the provider,” says Bryan McFarland, physician assistant at the OrthoIndy Walk-In Clinic. “Typically our Walk-In Clinic patients are treated before someone waiting in an ER would even be seen.”

Bryan is a physician’s assistant at OrthoIndy’s south location and most commonly sees ankle and knee injuries.

You might not be sure of what to expect when you arrive at the Walk-In Clinic, but OrthoIndy makes it easy. Upon your arrival, you will be checked-in and seen by a physician’s

assistant who is supervised by an orthopaedic surgeon. Sometimes X-rays may be necessary, in which case you will be taken back to our imaging department. Next, you may be given a cast, splint or boot with instructions, depending on your injury. After your visit, you may need to schedule a follow-up appointment with an orthopaedic surgeon.

It’s important to remember that you will not be treated at the Walk-In Clinic if you have an open, bleeding or ooz-ing wound, animal bites, vomiting or other non-orthopaedic related condi-tions. Please visit an emergency room if you have any of these conditions.

“Unfortunately people are going to get hurt,” said Bryan. There are a lot of facility options for treatment; however, patients don’t want to sit in a waiting room for hours. The OrthoIndy Walk-In Clinic gives patients an opportunity to be seen by a specialist quickly and get the treatment they need.”

As of May 13th, our West Walk-In Clinic hours are Monday thru Friday 8:30 a.m. to 5 p.m. For extended hours, please visit our Northwest or South locations, open Monday thru Friday from 8 a.m. until 8 p.m. and Saturdays from 9 a.m. to noon.

Walk-In Clinic By: Mishay Ellis

OrthoIndy Northwest8450 Northwest Blvd.

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OrthoIndy’s Walk-In Clinics Eliminate Emergency Room Wait and Cost

32 | Summer 2013

Dr. David Fisher, an OrthoIndy surgeon at IOH, provided free hip and knee replacements to three patients on December 7, 2012 as part of Operation Walk USA 2012. Operation Walk USA began in 2011 following the tremendous success of Operation Walk, an international volunteer medical service organiza-tion that provides treatment for patients with arthritis and joint conditions throughout the world. To date, more than 6,000 patients have received new hips and knees through the International Operation Walk.

“Operation Walk created a lot of excitement from IOH employees who consistently mention that it feels good to be part of a charitable program here at IOH,” said Nina Whalen RN, APN-C, Manager of Clinical

Outcomes at IOH. “There has been great support from administration and staff that are involved, as well as any department I asked for donations or support.”

While more than one million hip and knee replace-ments are performed in the U.S. each year, countless men and women continue to live with severe arthritis pain and immobility because they cannot afford joint replacement surgery.

Operation Walk USA 2012 provided all aspects of treatment – surgery, hospitalization and pre-and post-operative care – at no cost to participating patients.

Community Involvement By: Megan Skelly

IOH Provides Free Hip and Knee Replacements

as Part of Operation Walk USA 2012

| 33

Nell Boards received hip replacement surgery through Operation Walk USA 2012. Before surgery Nell was in so much pain that she could hardly do anything, including simple tasks such as driving. Now Nell is pain free.

“I am wonderful now, thanks to Operation Walk and Dr. Fisher,” said Nell. “I am in absolutely no pain. I am driving, getting groceries by myself and my life is back to normal. It’s a blessing that Operation Walk and Dr. Fisher came into my life.”

Through Operation Walk USA 2012, 109 orthopaedic surgeons across the U.S. provided free hip or knee re-placements to more than 200 individuals in 29 states. IOH surgeon, Dr. Fisher was proud to be one of those participating orthopaedic surgeons.

“I have always done charity care and provided total joint services to people who are in severe pain from joint conditions that could benefit from total joint replacement,” said Dr. Fisher. “Operation Walk USA is a continuation of my mission to provide joint replace-ment procedures to those in need, regardless of ability to pay. I am happy and honored to have been able to provide this life changing technology to those in need.”

Arthritic disease is the most common cause of disability in the U.S., affecting approximately 48 million Americans, or more than 21 percent of the adult population. The debilitating pain of end-stage hip or knee degenerative disease often makes work-ing, or completing even the simplest of daily tasks, excruciatingly painful or impossible. Hip and knee replacement surgeries are the most cost-effective and successful of all orthopaedic procedures, elimi-nating pain and allowing patients to resume active, productive lives.

“I could barely walk before surgery,” said Beverly Gorby who received knee replacement surgery from Dr. Fisher as part of Operation Walk. “It was so painful that I cried every day. Walking, standing and sleeping were all excruciating tasks for me. I had come to a point where it was either knee surgery or quit my job. Now, I feel 100 percent better than I did before. I can do a lot more and I am not even fully healed yet. I don’t even know how to put it into words how thankful I am.”

Operation Walk USA 2012 is a collaborative effort between three orthopaedic organizations and 49 participating hospitals, including IOH. Jodine Stand-ers was another patient who received hip replacement surgery by Dr. Fisher through Operation Walk USA.

“Before surgery the pain was so severe I was constantly limping around. I couldn’t even sit up straight. It was deteriorating so fast that I was beginning to think I was heading towards life in a wheelchair which was mak-ing me unbelievably depressed. Now I feel fabulous. I can go out, walk up and down stairs and I am not limping anymore. I feel 100 percent better and I am ready to start exercising again. I have had a complete attitude turnaround now that the pain is gone.”

For more information visit www.opwalkusa.com.

David Fisher, MD

Specialties:Total Joint, Knee and Hip

To schedule an appointment with Dr. Fisher, please call (317) 802-2828.

Located at:Orthoindy Northwest

34 | Summer 2013

Nutrition By: Judy M. Porter, RD

It is obvious that Americans have a bit of a drinking problem. According to a recent Gallup Poll (July 2012), nearly half of Americans are drinking at least one glass of soda/day. Among those who drank soda, the aver-age daily intake was two glasses per day. For these in-dividuals, they’re taking in at least 250 empty calories a day. This can add up to a pound of weight gain every two weeks or a 26 pound gain in one year!

It seems obvious to me that sugary drinks are a major contributor to the obesity epidemic. As it stands, two out of three adults and one out three children are either overweight or obese. As obesity has increased so has our consumption of sugary beverages. In the 1970’s sugary drinks made up four percent of the US daily calorie intake and rose to nine percent by 2001. It is not slowing down as it is not uncommon to see values set on beverages 32 and 42 ounces in size.

Every 12 ounce can of cola contains approximately ten teaspoons of sugars. With half of America taking in at least 20 teaspoons of sugar from drinks alone there’s no doubt in my mind that it is contributing to our weight problem along with other health concerns such as diabetes and heart disease.

Why is hydration important?Water is arguable the most essential of nutrients although it doesn’t provide energy. Water restriction can result in death in as little as three days. Hydration is important because it nourishes the body and pre-vents dehydration. Water helps transport nutrients to the cells and carries waste away from the body cells. It also helps maintain a stable body temperature. Inadequate daily intake could lead to fatigue, increased appetite, cravings and poor athletic performance.

Healthy Hydration

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How much fluid do I need each day?The amount of fluid you need daily depends on a vari-ety of factors. The Institute of Medicine has set an ad-equate intake of 125 ounces (about 15 cups) for men and 91 ounces (about 11 cups) for women. These daily recommendations reflect total water consumption from drinking water as well as from other beverages containing water and from solid foods. We should aim for 80 percent of this total from fluids and 20 percent from solids.

Based on these total water recommendations, men should be consuming approximately 13 cups per day and women should aim for about nine cups per day. This fluid should be low in calories or contain no calories at all.

Timing fluid around exercise:Having a plan for hydrating around exercise improves performance by keeping body core temperature and heart rate down. The goal is to come as close to matching what you lose through sweat.

Before: • Two hours before exercise consume two to three cups (16 to 24 ounces). • Ten to twenty minutes right before exercise consume one cup (8 ounces). During: • Every ten to twenty minutes drink seven to ten ounces After: • Optimally, weigh yourself before and after exercise and drink three cups (24 ounces) for every one pound of weight lost. If you do not have access to a scale before and after then drink four cups for every hour exercised.Examples Healthy Fluids • Water • Water with fresh squeezed citrus (lemon, lime, orange) • Water-Herb infused • Coconut water • Black tea-unsweetened • Coffee/decaf • Green tea-unsweetened • Herbal tea-unsweetened • Sparkling water with a splash of fruit juice • 100 percent fruit juice (limit to one four to six ounce serving/day) • Skim milk, low-fat soy, rice, almond or coconut milk (up to two cups per day)

What about alcohol, is it considered a healthy beverage?Alcohol can be beneficial or harmful depending on the amount consumed, your age and other characteristics. The key is to be sensible with spirits. If you choose to drink alcohol, do so in moderate amounts. Moderation is defined as one drink/day for women and two drinks/day for men. Heavy drinking offers NO health benefits and may lead to certain cancers, heart disease and cirrhosis of the liver to name a few.

What counts as a serving? • Twelve ounces of a beer or wine cooler • Eight ounces of malt liquor • Five ounces of table wine • One and a half ounces of 80 proof distilled spirits such as gin, vodka, whiskey, etc. • One ounce of 100 proof

8450 Northwest Blvd.Indianapolis, IN 46278

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at MyScarMeans.com.#MyScarMeans

Melissa Burns,OrthoIndy and IOH patient