healthy - lincoln orthopaedic center...no pain, then this is simply observed. if there is a...

Healthy Living

Volume 3 Issue 1

Lincoln Orthopaedic Center, P.C.Dedicated Surgical Expertise

Renee Tewes, PT, Owner

Dawn Bonness, MPT, CMLDT

Karen Stille, PT, MA, CSCS

Darci Fanning, MPT, CSCS

Kim Knopik, PT, MPA

Roxie Tesmer, PT

Jill Korta, MPT, ATC

Eric Schussler, MPT, ATC

Shawntae Horst, DPT

Britnee Vavra, PTA

Nicole Vyhnalek, PTA

Kristi Roddel, PTA

Adam Mailander, OT, CHT

402-436-2535www.MidwestPhysicalTherapy.com

Specialists in sports injury rehabilitation

Midwest Physical Therapy & Sports Center

Expanded HoursIncluding same-day apptsMon-Fri 7am-6pmSat 7am-Noon (A St. Only)

4 Convenient Locations6900 A Street, Ste 1022801 Pine Lake Road5790 N. 33rd St. CircleAshland - 15th & Silver

Pool Therapy available at Prairie Life and The Landing

Moving You

to WellnessTreating Patients

with Care on

North 33rd Street

Welcome Message

Inside This Issue

Lincoln Orthopaedic Center’s Healthy Living Magazine is designed and published by Custom Medical Design Group. To advertise in an upcoming issue please contact us at:

800.246.1637 or www.CustomMedicalMagazine.com. This publication may not be reproduced in part or whole without the express written consent of Custom Medical Design Group. Custom Medical Design Group does not endorse the contents of this journal.

4. LOC Introduces Dr. Brandon Seifert

6. Dupuytren’s Disease 8. Orthopaedic Physician

Assistants: Access to Care

10. Patient Story: David Torquati

11. Getting a Handle on Cycling Safety

12. Meet Our Physicians

14. Rodeo Sports Medicine

17. Care of the Aging Knee

20. Don’t Strike Out!

22. Upcoming Events Sponsored by LOC

3www.ortholinc.com

Welcome to the 3rd issue of Lincoln Orthopaedic Center –

Healthy Living Magazine. Thank you for taking the time

to pick up our publication and look through the articles

included in this issue. We hope that you find them interesting, educational and most of

all helpful. We would also like to thank our advertisers who help us make this publication

possible. Without them we would be unable to bring this information to you in this format.

Since our last publication I received the honor of being named as our Executive

Administrator for Lincoln Orthopaedic Center. I find it humbling to be able to serve in this

capacity as I follow some pretty good individuals that have served in this position since

our organization began back in 1948. From our beginning in the Sharp Building to our

time spent on the southeast corner of 13th and “E” Street, to our current location at 69th

and A Street the one constant is that our surgeons and staff have been focused on the

goal of providing excellent orthopaedic care to our patients. We have been blessed over

the years as an organization to have talented Physicians that have been leaders in the field

of orthopaedic care. They have selected and surrounded themselves with a bright and

talented group of Physician Assistants who assist them on a day to day basis in providing

this care. Our physicians care for their staff but most of all their patients. Their goal is to live

up to our tag line, “Dedicated Surgical Expertise”.

LOC has assembled a talented and dedicated staff that works very hard in their respective

roles providing care and services to our patients. I thank them for their ongoing

commitment to serve on this team and I look forward to serving with them in the future.

And to our past patients, and those who refer people in need of orthopaedic care, I thank

you for choosing LOC to serve those needs. It will continue to be LOC’s mission to provide

quality care to anyone who walks in our doors. For those of you who are not in need of

orthopaedic care, we ask that you consider LOC if a day comes when you require it.

And finally, in this 3rd issue, there are a number of contributing authors one of which is

Dr. Brandon Seifert who is completing his Sports Medicine Fellowship at the prestigious

James Andrews Institute in Birmingham, Alabama. Dr. Seifert will be joining us in August

with an emphasis in sports medicine. We are excited for him to join our team and help us

serve you.

Best Regards,

Douglas L. Wyatt

Executive Administrator

from Lincoln Orthopaedic Center

Medical

Renee Tewes, PT, Owner

Dawn Bonness, MPT, CMLDT

Karen Stille, PT, MA, CSCS

Darci Fanning, MPT, CSCS

Kim Knopik, PT, MPA

Roxie Tesmer, PT

Jill Korta, MPT, ATC

Eric Schussler, MPT, ATC

Shawntae Horst, DPT

Britnee Vavra, PTA

Nicole Vyhnalek, PTA

Kristi Roddel, PTA

Adam Mailander, OT, CHT

402-436-2535www.MidwestPhysicalTherapy.com

Specialists in sports injury rehabilitation

Midwest Physical Therapy & Sports Center

Expanded HoursIncluding same-day apptsMon-Fri 7am-6pmSat 7am-Noon (A St. Only)

4 Convenient Locations6900 A Street, Ste 1022801 Pine Lake Road5790 N. 33rd St. CircleAshland - 15th & Silver

Pool Therapy available at Prairie Life and The Landing

Moving You

to WellnessTreating Patients

with Care on

North 33rd Street

I graduated from Grand Island Northwest High School and went onto Concordia University in

Seward. While at Concordia, I was a

double major - Biology and Chemistry

and competed in Cross Country

and Track & Field. I became an All

American in both sports and won a

national championship in the indoor

mile. Next, I attended the University

of Nebraska College of Medicine

and following medical school was

accepted into the orthopaedic surgery

program at the University of Texas -

4

Dr. Seifert while providing sideline coverage for University of Alabama

football team - Fall 2011.

LOC Introduces

Dr. Brandon SeifertHello, my name is Brandon Seifert. I was born and raised in central Nebraska and will

be joining the practice at Lincoln Orthopaedic Center this August. With that said, I

am writing from Birmingham, Alabama where I am currently training with Dr. James

Andrews at top ranked American Sports Medicine Institute. Here is a glimpse into my

background, education and medical training.

5www.ortholinc.com

Cathy Dorenbach Employee Benefit Specialist

Midlands Financial Benefits, Inc.7101 S 82nd Lincoln NE 68516

(402) 434-8050 Fax (402) 434-8051www.midfin.com

Health Science Center in San Antonio, Texas.

It was during my 4th year of residency that I achieved a life long dream of being accepted into a sports medicine fellowship at the American Sports Medicine Institute with Dr. James Andrews. The experiences I have had here are incredible, to say the least.

During the Fall I had the opportunity to serve on the medical staffs for the University of Alabama, University of West Alabama, Auburn University, Troy University, and Birmingham Barons. While assisting with the University of Alabama I provided sideline coverage. I also experienced the rush of running out of the tunnel to 90,000 screaming fans with the Crimson Tide Football team. I was also on the road with the team. Some of the highlights include the BCS National Championship game in New Orleans, Troy vs Clemson game, Iron Bowl game. But the sideline coverage culminated with standing next to Dr. Andrews on the sidelines at the Rams vs Redskins game.

From a training standpoint, the operative and clinic experiences here have been second to none. The surgical volume is very high as well as the opportunity to experience very complex and difficult sports medicine cases referred here from all over the country. Our weekly schedule includes evaluating and treating multiple NFL, MLB, NCAA athletes as

well as a large number of high school and recreational athletes. We perform many shoulder and knee arthroscopic surgeries, as well as a high volume of hip arthroscopy, Tommy John elbow reconstructions, elbow arthroscopy, and cartilage transplantation.

This fellowship has also allowed me to be a part of trials for new arthroscopic equipment and techniques, working with physical therapist Kevin Wilk at Champion Sports Medicine, and athletic trainer R.T. Floyd at West Alabama.

It’s hard to believe that my training here is coming to a close. I will never forget the first day I sat next to Dr. Andrews in the operating room and assisted him with an elbow reconstruction. It was at that moment I realized the hard work, and sacrifices were paying off.

After I complete my fellowship my wife and I will be moving to Lincoln. We look forward to living in Nebraska again and starting my sports medicine practice at Lincoln Orthopaedic Center. n

To read more about Dr. Seifert go to www.ortholinc.com

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6

Dupuytren’s disease is a relatively common disorder involving the palm of the hand and fingers. There is a

tissue in the palm called “palmar fascia” that helps to support the skin in the palm. The palmar fascia holds the skin tight to deeper structures, so that skin is not mobile when we use our hands for grasping. In Dupuytren’s disease, the palmar fascia will thicken. In earlier cases this involves small nodules that are present in the palm. These are typically adherent to the skin and may be painful. In more advanced cases, the fascia can contract so severely that one will see a cord-like structure in the palm. As this progresses, the finger can be drawn into a bent position.

Early in the progression of the disease, it is difficult to predict which people will simply have nodules, and which will progress to a contracture.

The main underlying cause for Dupuytren’s disease is genetic. It is more common in people of Northern European ancestry, although, it may be seen in all races.

Dupuytren’s disease’s pattern of inheritance is called “variable penetrance.” This means that although every generation in a family may have the gene, not every generation will manifest the gene. This is why, for example, a patient may not have parents or children with Dupuytren’s disease, but may have a distant relative with the clinical manifestations.

There are several options for treating Dupuytren’s disease. If there are simply nodules in the palm, but full movement and no pain, then this is simply observed. If there is a significant contracture that is impairing function, then treatment is considered. The traditional treatment involves surgery. The surgery involves opening the palm and possibly the finger and removing the diseased tissue to facilitate straightening of the finger. This is usually outpatient, takes about an hour, and is done under regional anesthetic.

There is about a month of rehab and therapy afterwards. The results of surgery are typically good and outcomes are typically related

to the severity of the contracture before surgery. The milder the contracture, the better the results. In very severe contractures, sometimes complete correction is not obtained.

Another option is “Xiaflex” Injection. This is an injectable material that dissolves the cord. It is an in office injection. The day after injection the finger is manipulated to facilitate straightening. The early results are encouraging and are similar to traditional surgical results. Regardless of the technique, there is a chance of recurrence of the contracture, and again the chances of recurrence are based on the severity of the contracture.

This can be a challenging disorder to treat. I do offer both surgery and Xiaflex, depending on the specific medical indications and patient preferences. n

For more about Dr. Gove and hand procedures go to www.ortholinc.com

6

Dupuytren’s Diseaseby Nick Gove, M.D.Hand and Upper Extremity Surgery

7

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Lincoln Orthopaedic CenterD e d i c a t e d S u r g i c a l E x p e r t i s e

• Anterior Approach Hip Replacement

• Arthroscopic Surgery

• Sports Medicine

• General Orthopaedics

• Arthritis Surgery

• Fracture Care

• Hands/Wrist/Elbow

• Total Joint Replacement

• Spinal Surgery

• Direct Lateral Spine Fusion

Proud to be team physicians for:

Specialties include:

Specialties include: • Anterior Approach Hip Replacement • Arthroscopic Surgery• Sports Medicine• General Orthopaedics• Arthritis Surgery

Lincoln Orthopaedic Center D e d i c a t e d S u r g i c a l E x p e r t i s e



• Fracture Care• Hands/Wrist/Elbow• Total Joint Replacement• Spinal Surgery• Direct Lateral Spine Fusion

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By design, Lincoln Orthopaedic Center (LOC) physicians and physician assistants (PA) work together as a team to improve our

patient experience. Our PA’s practice medicine with physician supervision but, “supervision” does not mean the physician must always be present. LOC PA’s are trained and educated similarly to physicians therefore share similar diagnostic and therapeutic reasoning. The LOC team model is a very efficient way to provide high-quality medical care for our patients.

If you are not familiar with the rigorous medical training, coursework and care of a PA you are not alone.

Orthopaedic Physician Assistants: Access to Care

LOC physicians and physician assistants work together as a team to improve our patient experience

8

Ryan Baumert – PA-C, ATC Sam Dostal – PA-C

Chad Springer – PA-C John Ayers – PA-C Monica Hilger – PA-C

A 23 year old athlete was injured while playing soccer. This patient was seen by a PA the following day. After thorough history and physical examination, x-rays were ordered and reviewed revealing no acute bone injury. By a physical examination, a ligament injury was diagnosed. The PA ordered an MRI which did confirm a ligament tear which required surgery. The patient consulted

with his supervising physician who agreed with the PA’s findings. Surgery was scheduled along with a pre-operative evaluation by the surgeon. The PA also later assisted in the ligament reconstruction including preparation of the ligament graft, wound closure, and brace application.

A 67 year old man developed acute onset of knee pain. This patient was seen by a PA who, after history and physical examination, ordered x-rays determining advanced arthritis. Treatment options were reviewed including nonsurgical and surgical considerations. The patient elected to utilize a cortisone injection which was administered by the PA. The patient followed up 4 weeks later with the orthopaedic surgeon and had received significant symptom relief.

A 10 year old was seen in a local hospital emergency room over the weekend and referred for orthopaedic evaluation at LOC. The PA completed a thorough history, physical examination and reviewed the x-rays. A nondisplaced distal radius fracture was identified. No surgical intervention was indicated. The patient was placed in a short arm cast with follow-up examination occurring 3-4 weeks later.

Patient Care by PA’s at LOC:

Physician Assistant Education and Training:

• Acceptance into PA school is highly competitive

• The educational program for physician assistants is modeled after medical school curriculum

• There is a combination of classroom and clinical instruction for PA’s

• Coursework includes anatomy, physiology, biochemistry, pharmacology, physical diagnosis, pathophysiology, microbiology, clinical laboratory science, behavioral science & medical ethics

• PA’s must complete more than 2,000 hours of clinical rotations

• In order to maintain national certification PA’s must complete 100 hours of continuing medical education every two years and test every six years

A Physician Assistant Can:

• Perform physical exams

• Diagnose and treat illnesses

• Order and interpret lab tests

• Perform procedures

• Provide patient education and counseling

• Assist in surgery

• Make rounds in hospitals and nursing homes

Specific to Lincoln Orthopaedic Center, PA’s are able to see patients independently, order and interpret x-rays and MRI’s, complete history and physical examinations, make diagnoses, and create thorough treatment plans. Treatment plans may include medication prescriptions, return to activity plans, activity modification (short and long term), referrals to physical therapy and other specialists, as well as brace, cast, and splint applications.

Nearly all insurance plans cover medical and surgical services provided by PA’s with a few specific exceptions.

At Lincoln Orthopaedic Center, the PA’s play an integral part of patient care. PA’s provide an additional avenue for quality orthopaedic care. LOC physicians independently utilize PA’s in different ways depending upon their particular orthopaedic specialty. Some PA’s at LOC conduct independent clinic hours, while some perform a, “clinic-within-a-clinic” with their supervising physician.

LOC considers our PA’s an important part of the medical team. This team model of care between physicians and PA’s provide our patients quicker access to care. If additional care or surgery is recommended, our PA’s are able to easily access their supervising physician. n

9

For a list of LOC Physician Assistants go to www.ortholinc.com/medical-team/mlp

David with his son, Gabe, after his return from basic training.

When meeting David Torquati you would never know he has undergone many orthopaedic surgeries in his life. Some industries would call David, a “repeat

customer”. LOC calls David an inspiration and friend. Here is his story:

David Torquati is what most would consider a very active man with an equally active family. He has come to know Lincoln Orthopaedic Center and Dr. Scott Bigelow as his, “family orthopaedic surgeon”.

David began boxing in his 20’s and enjoyed this impact sport until a hyper extended knee resulted in his meniscus being removed. Next, David took to racing bicycles and stuck with this lower impact sport for 15 years. In 1993, David underwent his first orthopaedic surgery on a torn ACL and quickly returned to his love of biking and running. Not long after his first surgery, David took up competing in bi-athalons but he said, “Running took its toll on my knees which meant I needed to find something else with little or no impact. So, in 1998 I took up mountain biking and love it.” In the beginning David was able to ride, off-road with minimal pain. As David continued mountain biking he noticed increased pain in his right knee. During one particular ride his knee hurt so badly he had to get off his bike and push it through rough terrain. That day he ended up handing his bike off to a fellow rider because the pain was so severe. Then he realized it was time to call Dr. Bigelow at Lincoln Orthopaedic Center.

On December 19, 2010 Dr. Bigelow consulted David about his

medical options to alleviate the pain in his right knee. “I knew

how important it was for David to maintain his active lifestyle,”

said Dr. Bigelow. Two days later, David was scheduled for total

knee replacement at St. Elizabeth Regional Medical Center. He

had surgery on December 21st and was home on Christmas Eve.

David went to physical therapy 3 times a week and was able to

return to work within 5 weeks. In March 2011 David got back

on his mountain bike and is able to do what he loves, off-road

cycling. “What a big difference. I had very little pain since my

knee surgery.”

In addition to Davids’ orthopaedic needs, his son and daughter

have sustained sports injuries through their teens and early

twenties while competing in gymnastics and other recreational

sports. “My wife and I felt confident LOC would give them the

best medical treatment in a caring atmosphere.”

Currently David enjoys hiking, off-road cycling, the freedom to

drive his own car and riding his motorcycle — all without pain. n

For more patient stories, go to: www.ortholinc.com

Patient Story: David Torquati Enjoys Mountain Biking after Knee Replacement:

10

11

Getting a Handle on Cycling Safety

More and more children and adults are traveling the open roads on their bicycles for fun, transportation

and fitness. As people take to the school yards, bike paths and neighborhood streets, the number of injuries caused by unsafe cycling rises.

Bicycle riders of all age groups and levels of experience need to be concerned about safety,” explained James H. Beaty, MD, orthopaedic surgeon and second vice president of the American Academy of Orthopaedic Surgeons (AAOS). “Most cycling accidents are the result of falls, and occur close to home.”

The U.S. Consumer Product Safety Commission (CPSC) reports that in 2003, 1.3 million people were treated in hospitals, doctor’s offices, clinics, ambulatory surgery centers and emergency rooms for bicycle-related injuries, costing more than $32.5 billion in lost wages, pain and suffering, medical costs and other expenses. The most common cycling accidents involve colliding with a car or another bicycle; loss of control; entangling hands, feet or clothing in the bicycle; or feet slipping off the pedals.

Studies have shown that wearing a bicycle helmet can reduce head injuries by 95 percent. “Wearing a properly fitting helmet is the

single most important thing a cyclist can do to prevent injuries,” Dr. Beaty added. “Parents should not buy a helmet that is too large for a child, thinking that he/she will ‘grow into’ it.” The correct fit for cycling helmets is snug, but comfortable on the head. It should have a chin strap and buckles that stay securely fastened.

Cycling as regular, active recreation is one way to develop good exercise habits and improve fitness levels.

To ensure injury-free cycling for everyone, AAOS offers these bicycle safety tips:

• Always wear an American National Standards Institute (ANSI) approved helmet. Make sure it fits snugly and does not obstruct your vision.

• Make certain the bicycle is the proper size for the rider. Consider using training wheels for young and first-time riders.

• Ensure your bicycle is properly adjusted and well maintained. Replace broken or missing parts.

• Avoid plastic pedals that can be slippery when wet.

• Wear bright fluorescent colors and avoid biking

at night. If you have to ride your bike at night, make sure you have rear reflectors and a working headlight visible from 500 feet away.

• Stay alert and watch for obstacles in your path.

• Ride with traffic and be aware of traffic around you. Obey all rules of the road – bicycles are vehicles, too.

• Don’t ride double, attempt stunts or go too fast.

• Avoid loose clothing and wear appropriate footwear. Use pant leg clips to keep clothing grease-free and out of the bicycle chain.

• Wear knee, wrist and elbow pads to protect the bones and joints when falling.

• Avoid riding on uneven or slippery surfaces. Handbrakes may not work as well when wheels are wet and require more distance to stop. n

200

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Source:

More tips for sports medicine are available at www.ortholinc.com

John C. Yeakley, m.d.General Orthopaedics

matthew C. Reckmeyer, m.d.Joint Replacement

Arthroscopic SurgerySports MedicineHip Resurfacing

douglas P. Tewes, m.d.Sports Medicine

Arthroscopic SurgeryKnee and Shoulder

Reconstruction

Nicholas K. Gove, m.d.Hand and Microsurgery

Wrist and ElbowReconstruction

Bruce miller, m.d.Orthopaedic Surgeon

Robert A. Vande Guchte, m.d.Spinal Disorders and Reconstruction

Trauma SurgeryDisc Arthroplasty

Meet Our Physicians

Scott d. Bigelow, m.d.Joint Replacement

Arthroscopic SurgerySports Medicine

Anterior Approachto Hip Replacement

Meet Our Physicians

Dedicated Surgical Expertise

Keith W. Lawson, m.d.Joint Replacement

Arthroscopic SurgeryGeneral Orthopaedics

Sports Medicine

douglas A. Koch, m.d.Joint Replacement

Arthroscopic SurgerySports Medicine

Anterior Approachto Hip Replacement

Rodeo is a sport that has a very high risk of injury. Frankly, the question is not IF a rodeo athlete will be injured but WHEN. From riders to rodeo clowns, orthopaedic care

plays its role in rodeo arenas.

As professional bull rider Chas Skillett knows, eight seconds is plenty of time to sustain an injury. The 30 year old cowboy, who has competed in bull riding events for 16 years, has suffered many significant injuries. Some include; a punctured lung, ruptured spleen, hip dislocation, groin muscle tear and a femur fracture in 2007. The femur fracture required surgery at Lincoln Orthopaedic Center by surgeon Matthew Reckmeyer. Since his surgery, Chas’s broken femur has healed and allowed him to continue his bull-riding career.

Because rodeo is a highly dangerous sport Dr. Keith Lawson began collaborating with the Extreme Sports Medicine Team. This is a volunteer group of practitioners that provide medical care at rodeo competitions all over the Midwest. Chas says he and his pro rodeo competitors, “really appreciate having orthopaedic coverage at the rodeos.”

2012 marks the year Chas is retiring from the pro bull riding circuit. As he enters a new occupation and recreational activities Chas plans to keep in contact with Dr. Lawson and Lincoln Orthopaedic Center for musculoskeletal and sports injury care. n

For more information please go to www.ortholinc.com

Rodeo Sports Medicine

Professional bull rider Chas Skillett rides a bull in competition with the metal rod still in his femur in 2008.

Phot

o ©

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14

15

For adults with Dupuytren’s contracture when a cord can be felt,

a nonsurgical alternative is at hand.

Your hand is an important tool.If you have Dupuytren’s contracture, prescription XIAFLEX® may be able to help.

XIAFLEX® (collagenase clostridium histolyticum) is a prescription medicine used to treat adults with Dupuytren’s contracture when a “cord” can be felt. Over time, the thickening of this cord in your hand can cause one or more fingers to bend toward your palm, so that you cannot straighten them. XIAFLEX® helps to break down the cord that is causing the finger to be bent. XIAFLEX® should be injected into the cord by a healthcare provider who is experienced in injection procedures of the hand and treating people with Dupuytren’s contracture.

IMPORTANT SAFETY INFORMATION XIAFLEX® can cause serious side effects, including:

• Tendon or ligament damage. Receiving an injection of XIAFLEX® may cause damage to a tendon or ligament in your hand and cause it to break or weaken. This could require surgery to fix the damaged tendon or ligament. Call your healthcare provider right away if you have trouble bending your injected finger (towards the wrist) after the swelling goes down or you have problems using your treated hand after your follow-up visit.

• Nerve injury or other serious injury of the hand. Call your healthcare provider if you get numbness, tingling, or increased pain in your treated finger or hand after your injection or after your follow-up visit.

• Allergic reactions. Allergic reactions can happen in people who have received an injection of XIAFLEX® because it contains foreign proteins. Call your healthcare provider right away if you have any of these symptoms of an allergic reaction after an injection of XIAFLEX®: hives; swollen face; breathing trouble; or chest pain.

Before receiving XIAFLEX®, tell your healthcare provider if you have had an allergic reaction to a previous XIAFLEX® injection, or have a bleeding problem or any other medical conditions. Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Be sure to tell them if you use blood thinners such as aspirin, clopidogrel (Plavix®), prasugrel hydrochloride (Effient®), or warfarin sodium (Coumadin®).

Common side effects with XIAFLEX® include: swelling of the injection site or the hand, bleeding or bruising at the injection site; and pain or tenderness of the injection site or the hand, swelling of the lymph nodes (glands) in the elbow or underarm, itching, breaks in the skin, redness or warmth of the skin, and pain in the underarm.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see Brief Summary of the Full Prescribing Information on adjacent page. XIAFLEX® is a registered trademark of Auxilium Pharmaceuticals, Inc. Plavix® is a registered trademark of Sanofi Aventis/Bristol-Myers Squibb. Effi ent® is a registered trademark of Daiichi-Sankyo/Eli Lilly and Company. Coumadin® is a registered trademark of Bristol-Myers Squibb.

© 2011 Auxilium Pharmaceuticals, Inc. All rights reserved. 1211-017.a

Within reach

Common side effects with XIAFLEX®Common side effects with XIAFLEX®®Common side effects with XIAFLEX include: swelling ® include: swelling include: swelling ®

Co-pay Program

Take advantage of our

For more information,

call1-877-XIAFLEX or visit XIAFLEX.com To sign up for additional information and updates, register online at XIAFLEX.com

DRAFT FCB HealthCareFile Name: N0044D_8_375x10_875_AD.inddLocation: PrePress ServerClient: AUXILIUMProduct: XIAFLEXJob #: 2AUX_XIAF_N0044DLive Area: 7” x 10”Small Trim: 8.375" x 10.875"Bleed Area: 8.75” x 11.167”Colors: 4/C

CAD RouterArt Director: Jayson S. (x 3329)Production: Bob I. (x2419)Traffi c Person: Trent O. (x2492)Mac Operator: PaulDate: 2.28.12Time: 1:10 pmRound: 2

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SIGN-OFF Date Time OK Correx QueryStudio ManagerTraffi cVisual QCEditorCopywriterCopy SupervisorArt DirectorArt SupervisorAcct. ExecutiveAcct. ExecutiveProduction

PUBLICATIONS: Greater Hartford Ortho

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B:8.75”B

:11.167”

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16

Visit us online at: www.lincolnpt.org

Professional, Friendly Staff3 Convenient Lincoln Locations

NORTH 27th & Superior 476-2600

EAST70th & Van Dorn 483-4709

SOUTH14th & Pine Lake 421-2700

Several Board Certifi ed Specialists in Hand,

Orthopaedic and Sports

Important Product Information

XIAFLEX® (Zï a flex) (collagenase clostridium histolyticum)

What is the most important information I should know about XIAFLEX?

XIAFLEX can cause serious side effects, including:

• Tendon or ligament damage. Receiving an injection of XIAFLEX may cause damage to a tendon or ligament in your hand and cause it to break or weaken. This could require surgery to fix the damaged tendon or ligament. Call your healthcare provider right away if you have trouble bending your injected finger (towards the wrist) after the swelling goes down or you have problems using your treated hand after your follow-up visit.

• Nerve injury or other serious injury of the hand. Call your healthcare provider if you get numbness, tingling, or increased pain in your treated finger or hand after your injection or after your follow-up visit.

• Allergic Reactions. Allergic reactions can happen in people who take XIAFLEX because it contains foreign proteins.

Call your healthcare provider right away if you have any of these symptoms of an allergic reaction after an injection of XIAFLEX:

• hives

• swollenface

• breathingtrouble

• chestpain

What is XIAFLEX?

XIAFLEX is a prescription medicine used to treat adults with Dupuytren’s contracture when a “cord” can be felt.

In people with Dupuytren’s contracture, there is thickening of the skin and tissue in the palm of your hand that is not normal. Over time, this thickened tissue can form a cord in your palm. This causes one or more of your fingers to bend toward the palm, so you cannot straighten them.

XIAFLEX should be injected into a cord by a healthcare provider who is skilled in injection procedures of the hand and treating people with Dupuytren’s contracture. The proteins in XIAFLEX help to “break” the cord of tissue that is causing the finger to be bent.

It is not known if XIAFLEX is safe and effective in children under the age of 18.

What should I tell my healthcare provider before starting treatment with XIAFLEX?

XIAFLEX may not be right for you. Before receiving XIAFLEX, tell your healthcare provider if you:

• havehadanallergicreactiontoaprevious XIAFLEX injection.

• haveableedingproblem.

• haveanyothermedicalconditions.

• arepregnantorplantobecomepregnant.Itisnotknown if XIAFLEX will harm your unborn baby.

• arebreastfeeding.ItisnotknownifXIAFLEXpasses into your breast-milk. Talk to your healthcare provider about the best way to feed your baby if you receive XIAFLEX.

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Especially tell your healthcare provider if you use:

a blood thinner medicine such as aspirin, clopidogrel (PLAVIX®), prasugrel hydrochloride (EFFIENT®), or warfarin sodium (COUMADIN®). If you are told to stop taking a blood thinner before your XIAFLEX injection, your healthcare provider should tell you when to restart the blood thinner.

How will I receive XIAFLEX?

Your healthcare provider will inject XIAFLEX into the cord that is causing your finger to bend.

After an injection of XIAFLEX, your affected hand will be wrapped with a bandage. You should limit moving and using the treated finger after the injection.

Do not bend or straighten the fingers of the injected hand until your healthcare provider says it is okay. This will help prevent the medicine from leaking out of the cord.

Do not try to straighten the treated finger yourself.

Keep the injected hand elevated until bedtime.

Call your healthcare provider right away if you have:

• signsofinfectionafteryourinjection,suchasfever, chills, increased redness, or swelling

• numbnessortinglinginthetreatedfinger

• troublebendingtheinjectedfingeraftertheswelling goes down

Return to your healthcare provider’s office as directed on the day after your injection. During this first follow-up visit, if you still have the cord, your healthcare provider may try to extend the treated finger to “break” the cord and try to straighten your finger.

Your healthcare provider will provide you with a splint to wear on the treated finger. Wear the splint as instructed by your healthcare provider at bedtime to keep your finger straight.

Do finger exercises each day, as instructed by your healthcare provider.

Follow your healthcare provider’s instructions about when you can start doing your normal activities with the injected hand.

What are the possible side effects of XIAFLEX?

XIAFLEX can cause serious side effects. See “What is the most important information I should know about XIAFLEX?”.

Common side effects with XIAFLEX include:

• swellingoftheinjectionsiteorthehand

• bleedingorbruisingattheinjectionsite

• painortendernessoftheinjectionsiteor the hand

• swellingofthelymphnodes(glands)intheelbow or underarm

• itching

• breaksintheskin

• rednessorwarmthoftheskin

• painintheunderarm

These are not all of the possible side effects with XIAFLEX. Tell your healthcare provider about any side effect that bothers you or does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

General information about XIAFLEX

Medicines are sometimes prescribed for purposes other than those listed here. This is a summary of the most important information about XIAFLEX. If you would like more information, talk to your healthcare provider. You can ask your healthcare provider for information about XIAFLEX that is written for health professionals.

For more information visit www.XIAFLEX.com or call 1-877-663-0412.

© 2011 Auxilium Pharmaceuticals, Inc. For US residents only.

40 Valley Stream Parkway Malvern, PA 19355 www.auxilium.com 1211-017.a

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Call 402.488.4421 For A Complimentary Assessmentwww.lincoln.rightathome.net

17

Care of the Aging Knee: Baby Boomers May Need Lifestyle Changes

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Many people in the “baby boomer” generation are staying active as they age. This is healthy. But playing team sports, jogging or doing other high

impact activities that repeatedly pound, twist and turn the knees can stress aging joints. Highly active, middle-aged patients may develop painful knees as a result of osteoarthritis (OA). This painful condition happens when the cartilage lining on the ends of bones gradually wears away. It can affect one or both knees.

• Symptoms: You may experience pain when standing or going up and down stairs. The knee may buckle and give way, lock in place, or become stiff and swollen.

• Patients: Most people with OA of the knee are over age 55 and/or obese and/or have a family history of OA. Younger, highly active people may also develop OA if their knee suffered a significant injury.

• Diagnosis: See your doctor for diagnosis and treatment. The doctor will consider your comprehensive medical history, perform a physical examination and possibly order tests and/or imaging studies before recommending a course of treatment.

Extending The Life Of The Middle-Aged Knee

Increasingly, baby boomers with OA of the knee are asking for total knee replacement surgery. But first they should try making changes to their lifestyles. Mayo Clinic orthopaedic surgeon Arlen D. Hanssen, MD presented a briefing on “Our Aging Population” at the 2002 Annual Meeting of the

American Academy of Orthopaedic Surgeons (AAOS). He said many highly active patients in their 40s and 50s feel inspired by advertising and news reports about the success of knee replacement surgeries. But often they refuse to change their lifestyles to extend the life of their natural knees.

“They come in and say, ‘fix me,’” Dr. Hanssen explained, and they hope for a complete end to their symptoms without making any changes in their activities. In reality, doctors use a complex medical process to determine whether total knee replacement is appropriate for a patient - considering age, activity demands and other factors. Long-term results of joint replacement are less certain in younger patients.

For middle-aged people, the earlier a doctor diagnoses OA of the knee, the more likely conservative treatment may help. If OA of the knee is in its early stages, your doctor may recommend low impact activities and other non-operative treatments that can delay or

eliminate the need for surgery. In some cases, activity modification may be the only treatment a middle-aged patient needs. “In other cases when surgery is eventually needed, the patient still has to modify activities first to preserve the replacement joint,” Hanssen advises.

Substitute Smooth, Low Impact Activities

Moderate physical activity lessens joint pain and improves flexibility and function. Baby boomer patients with OA of the knee should continue exercising, but change the forms of their activities:

• Stop doing high impact activities that twist and turn the joints. This includes running, tennis, racquetball, basketball, baseball, etc.

• Start doing smooth, low impact activities that are easier on the joints. Recommended activities include stretching, swimming, water aerobics, cycling, walking on a treadmill or outside, playing golf, etc.

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• Physical therapy: The doctor may give you a balanced fitness program including physical / occupational therapy to improve joint flexibility, increase range of motion, strengthen muscle, bone and cartilage tissues and reduce pain. It may also help to ice the affected joint for short periods, several times a day.

• Mechanical aids: You may need supportive or assistive devices such as an elastic bandage, splint, brace, cane, crutches or walker. n

For more information, go to www.ortholinc.com

Other Conservative Options

Other options that may extend the life of your natural knee include medications, steroid injections, physical therapy and mechanical aids.

• Medications: The doctor may prescribe non-steroidal anti-inflammatory medications to help reduce inflammation. Certain dietary supplements may also help. Glucosamine stimulates formation and repair of articular cartilage, and chondroitin sulfate prevents cartilage from degrading. (Note: The U.S. Food and Drug Administration does not test dietary supplements. These compounds may cause negative interactions with other medications or excessive bleeding during surgery. Always consult your doctor before taking dietary supplements.)

• Injections: The doctor may inject the knee joint with strong anti-inflammatory medications called corticosteroids. This can relieve pain and swelling for awhile.

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Don’t Strike Out!

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Orthopaedic surgeons provide tips to prevent youth baseball injuries.

The crack of the bat, smell of the leather mitt and running of the bases are a few of the things players love about baseball and softball. More than 33 million Americans play

organized baseball and softball each year, with nearly 6 million of these players being children from 5 to 14 years old. According to the U.S. Consumer Product Safety Commission, in 2003 more than 200,000 of these kids were treated in hospitals, doctors’ offices, clinics, ambulatory surgery centers and hospital emergency rooms for baseball-related injuries. That is why the American Academy of Orthopaedic Surgeons recommends that children use caution when partaking in youth baseball, particularly year-round.

“We have seen a tremendous increase in the number of youth baseball injuries over the last five years. The reason is that kids are now playing 12 months out of the year and are overusing their bodies during the season,” explained James Andrews, MD, orthopaedic surgeon, founding member of the Alabama Sports Medicine and Orthopedic Center (ASMOC) and chairman and medical director of the American Sports Medicine Institute (ASMI) in Birmingham, Alabama and AAOS fellow. “Children involved in overhead throwing and hitting sports should actively rest from such activities for two to three months out of the year. It is also important that children cross-train and change sports throughout the year to prevent one area from becoming overworked and stressed.”

The American Academy of Orthopaedic Surgeons offers the following tips to help keep your child off the injured list:• Always take time to warm up and stretch before and after play.

Research studies have shown that cold muscles are more prone to injury.

• If a child is pitching, he should concentrate on stretching his arm and back muscles.

• If a child is catching, the focus should be on the legs and back.

• Children should not be encouraged to play through pain. It is important that they take breaks if tired.

• Limit the number of teams your child is playing on in one season. Kids who play on more than one team are especially at risk for overuse injuries.

• Equipment should fit each player properly and be worn correctly.

• A batting helmet should be worn at the plate, when waiting a turn at bat and when running bases.

• Facial protection devices that are attached to batting helmets should be worn by children, when available. These devices can help reduce the risk of a serious facial injury if you get hit by a ball.

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Players should wear molded baseball shoes with cleats that fit comfortably.

• Players should wear molded baseball shoes with cleats that fit comfortably.

• Children need to wear the appropriate mitt in each position.

• Catchers should always wear a helmet, face mask, throat guard, long-model chest protector, protective supporter, a catcher’s mitt and shin guards.

• Inspect the playing field for holes, glass and other debris.

• Drink plenty of fluids.

• Supervising adults should be prepared for emergency situations and have a plan to reach medical personnel to treat injuries such as concussions, dislocations, elbow contusions, wrist or finger sprains, and fractures.

• To prevent sliding injuries, install breakaway bases in the playing fields and an extra large first base to avoid the runner stepping on the first baseman’s foot.

While there is no concrete guideline for the number of pitches allowed, reasonable limits are 80 to 100 pitches in a game and 30 to 40 pitches in a single practice session, depending on the child’s skeletal maturity, muscle strength and pitching techniques. Additional pitching recommendations for young baseball players include:

• 8-10 year olds should only throw from 37 to 67 pitches in approximately 1.4 to 2.6 games per week.




• 17-18 year olds should only throw from 90 to 122 pitches in approximately 1.4 to 2.6 games per week. n

For more information, go to www.ortholinc.com

22

Thank You to Our SponsorsCopic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

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HK Financial Services . . . . . . . . . . . . . . . . . . . 7

Husker Rehabilitation & Wellness Center . . . . . . . . . . . . . . . . . . . . . . 7

Lincoln Physical Therapy Associates . . . 16

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Orthovisc / Depuy Mitek . . . . . . . . . . . . . . 23

Right at Home In Home Care & Assistance . . . . . . . . . . . . 16

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XIAFLEX . . . . . . . . . . . . . . . . . . . . . . . . . . .15, 16

Upcoming Events Sponsored by LOC

2012 Arthritis Walk

East High School

Saturday, May 19

http://www.arthritis.org

Community Blood Bank

Lincoln Orthopaedic Center

Thursday, May 24

**Schedule your donation:

[email protected]

http://www.ncbb.org

Lincoln Saltdogs Baseball

Haymarket Park

May 10 – September 3

http://www.saltdogs.com

NSATA Summer Education Conference

Concordia University

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Bryan Health - Golf Clinic

Lifepointe

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Ortho Open Golf Event

Hillcrest Country Club

Friday, June 8

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Thursday, July 19

**Schedule your donation:

[email protected]

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LOC Saturday Sports Clinics


August 25 – October 27

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Annual Orthopaedic Conference

St. Elizabeth Regional Medical Center

Monday, September 17

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9401 Andermatt DriveLincoln, Nebraska 68526

www.southlakevillagerehab.comA Proud Member of the

Vetter Health Services Family

C A L L F O R A T O U R T O D A Y !

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a n d S h o r t - Te r m R e h a b i l i t a t i o nAt Southlake Village we offer thecare and comfort you or yourloved one needs and deserves...• Physical, Occupational, Speech,

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Quality Life, Quality Care, Quality Reputation...

between science and nature.

Restoring the balance

• ORTHOVISC® High Molecular Weight Hyaluronan is the only non-avian hyaluronic acid (HA) with up to 26 weeks of effi cacy1

• ORTHOVISC® demonstrated statistically and clinically signifi cant symptom improvement in patients with knee osteoarthritis1

ORTHOVISC® has

50-88% more HA2-6

than any available viscosupplement

1-800-382-4682 | www.orthovisc.com | www.orthoviscline.com

Important Safety InformationORTHOVISC® High Molecular Weight Hyaluronan is indicated in the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative nonpharmacologic therapy and to simple analgesics, e.g. acetaminophen. In clinical studies, the most commonly reported adverse events were arthralgia, back pain, and headache. Other side effects included local injection site adverse events. ORTHOVISC® is contraindicated in patients with known hypersensitivity to hyaluronate formulations or known hypersensitivity (allergy) to gram positive bacterial proteins. ORTHOVISC® should not be injected in patients with infections or skin diseases in the area of the injection site or joint. Strict aseptic technique should be used. The effectiveness of more than 1 course has not been established.

References: 1. Brandt KD, Block JA, Michalski JP, et al. Effi cacy and safety of intraarticular sodium hyaluronate in knee osteoarthritis. Clin Orthop Relat Res. .341-031:583 ;10022-6. Manufacturer’s full prescribing information for ORTHOVISC®, Synvisc®, Synvisc-One®, Hyalgan®, Supartz®, and Eufl exxaTM.

Hyalgan is a registered trademark of Sanofi -Synthelabo; Supartz is a registered trademark of Seikagaku Corporation; Synvisc and Synvisc-One are registered trademarks of Genzyme Corporation; Eufl exxa is a trademark of Ferring Pharmaceuticals, Inc.

ORTHOVISC® is manufactured by and is a registered trademark of Anika Therapeutics, Inc., Bedford, MA 01730.

© DePuy Mitek, Inc. 2010. All rights reserved. Printed in USA.

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LOC Outreach Locations

Auburn Outreach Clinic Nemaha County Hospital 2022 13th StreetAuburn, NE 68305Phone: (402) 274-4366

Beatrice Outreach Clinic 103 S. 9th StreetBeatrice, NE 68310Phone: (402) 228-5969

David City Outreach ClinicButler County Health Care CenterOutpatient Department372 South 9th StreetDavid City, NE 68632Phone: (402) 367-1265

Henderson Health Care Services1621 Front StreetHenderson, NE 68371Phone: (402) 723-4512

6900 A Street • Lincoln, Nebraska 68510 • Phone: (402) 436-2000 • Fax: (402) 436-2085

Marysville Outreach Clinic Community Memorial Healthcare 708 N. 18th StreetMarysville, KS 66508Phone: (785) 562-2314

Nebraska City Outreach Clinic St. Mary’s Hospital 1314 3rd AvenueNebraska City, NE 68410Phone: (402) 873-3321

Seward Outreach ClinicMemorial Hospital300 N. Columbia AvenueSeward, NE 68434Phone: (402) 643-2971

Tecumseh Outreach ClinicJohnson County Hospital Specialty Clinic202 High StreetTecumseh, NE 68450Phone: (402) 335-6372

Wahoo Outreach ClinicSaunders Medical Center1760 Country Road JWahoo, NE 68066Phone: (402) 443-4191

York General Specialty ClinicYork County Hospital2222 N. Lincoln AvenueYork, NE 68467Phone: (402) 362-0420

Outreach Clinic Locations Wahoo

For more information email: [email protected]

healthy - lincoln orthopaedic center...no pain, then this is simply observed. if there is a...

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