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ISSUE 2

TEAMING UP WITH LOCAL ATHLETES

A PUBLICATION FOR

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CONTENTS

6TEAMING UP WITH LOCAL ATHLETESDr. John Noble and Dr. Geoffrey Collins arriving on the sidelines at a recent MSU football game.

COVER

FEATURES

CONTENT

In Motion MagazinePublication of Center for Orthopaedics

CONTACT US:CENTER FOR ORTHOPAEDICSLake Charles Sulphur DeRidder 1747 Imperial Blvd.Lake Charles, LA 70605(337) 721-7236 or email us at:info@centerforortho.com About CFOCenter for Orthopaedics, an affiliate of Imperial Health, is the largest musculoskeletal group in Southwest Louisiana and Southeast Texas. The group was founded 18 years ago and has offices in Lake Charles, Sulphur and DeRidder. For more information about CFO, visit www.centerforortho.com.

6 Teaming Up With Local Athletes

3 Imperial Health Phreesia Technology4 Foot Notes5 Shoulder Smarts12 Back Talk13 Helping Hands

8 Bare Bones Facts10 News Briefs14 CFO DME Store 15 Patience Puzzles

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Center for Orthopaedics has joined forces with over 40 local doctors to create Imperial Health; the region’s largest, independent, physician-owned, multispecialty medical group. Imperial Health is a network of primary care physicians and medical specialists working together to deliver exceptional care in Southwest Louisiana. The unique structure of Imperial Health, according to John Noble, Jr., MD, with Center for Orthopaedics, allows physicians to keep patient’s health and well-being the top priority. “It’s no secret that the business of medicine has become more complicated. Expenses—related to regulations, technology, our aging population and other factors – continue to increase, while reimbursement continues to decrease. By pooling our resources in key areas on the business side of our practices, we are able to improve our productivity and spend more time on patient care, which, after all, is why we all became doctors in the first place.” For Center For Orthopaedics patients, the new name formation will not result in any changes to their established relationship with their doctor. “Our logo and parent company name has changed; but other than that you can expect the same doctors, staff members and quality services you have relied on and trusted for many years ,” Dr. Noble adds. In addition to the doctors of Center for Orthopaedics, members of the Imperial Health physician team include:

NEW PATIENT CHECK-IN TECHNOLOGY UNVEILED

THERE IS A NEW NAME IN HEALTH CARE.

A new self-service patient check-in system, called Phreesia, has been unveiled in most Imperial Health medical offices and ancillary service centers around the area. Imperial Health is the only medical-based organization in Southwest Louisiana, and one of only a few in the state, to offer this advanced comprehensive technology. Phreesia digitizes the patient check-in process by replacing the traditional patient clipboard and all paper forms with the wireless, touch-screen PhreesiaPad. Phreesia pads collect and update critical patient information, verify patient insurance and collect co-payments and balances with ease during the patient check-in process. “Phreesia helps us update patient information, eliminate manual and redundant work and it also helps us reduce the amount of paper forms we produce and use,” says Lisa Conner, Imperial Health Business Office Director. “It also allows our medical practices to run more smoothly, and, most importantly, helps us deliver better service to our patients.

CARDIOLOGYCarl P. Fastabend, M.D.Richard M. Gilmore, M.D.

DERMATOLOGYMaureen A. Olivier, M.D.

ENDOCRINOLOGYTimothy R. Gilbert, M.D.

EAR, NOSE & THROATEugene M. Louviere, M.D.

FAMILY MEDICINEJohn A. DiGiglia III, M.D.Thomas E. LeBeau, M.D.Jason R. Morris, M.D.Keane T. O’Neal, M.D.Todd A. Peavy, M.D.Arthur W. Primeaux, M.D.Melissa L. Rasberry, M.D.Richard D. Sanders, M.D.Mary H. Sherk, M.D.Steve F. Springer, M.D.Errol P. Wilder, M.D.Benjamin B. Williams, M.D.

GASTROENTEROLOGYGerald W. Byrd, M.D.P. Hooper Nichols III, M.D.

GENERAL SURGERYRichard T. Shimer, M.D.

GENERAL, VASCULAR & THORACIC SURGERYRonald S. Kober, M.D.

INTERNAL MEDICINENishi Gupta, M.D.Michael Lafuente, M.D.Hezekiah Sobomowa, M.D.

INTERNAL MEDICINE& PEDIATRICSYoko Broussard, M.D.

NEUROLOGYAlan C. Sconzert, Ph.D, M.D.

PULMONARY DISEASES & CRITICAL CAREJohnny M. Belenchia, M.D.Albert J. Chinn, M.D.Luke M. Williams, M.D.

RHEUMATOLOGYRaul E. Varela, M.D.

ORTHOPAEDIC SURGEONSGeoffrey J. Collins, M.D.David Drez Jr., M.D.Jonathan L. Foret, M.D.Steven S. Hale, M.D.John W. Noble Jr., M.D.James D. Perry, M.D.George “J.” Trappey IV, M.D.

PHYSICAL MEDICINE & REHABILITATION SPECIALISTSWilliam J. Lowry Jr., M.D.Craig G. Morton, M.D.

FOOT & ANKLE SPECIALISTSTyson E. Green, D.P.M.J. Kalieb Pourciau, D.P.M.

HAND & WRIST SURGEONAndrew L. Foret, M.D.

The touch-screen PhreesiaPad.

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For more than four million people, a painful foot ailment called a bunion prevents them from wearing the shoes they want or from being as active as they would like. A bunion occurs when the inner portion of the joint at the base of the big toe becomes enlarged. Combined with the misalignment of the big toe, bunions can become quite a painful problem. Although men and women can both develop bunions, women suffer from them 10 times more often than men. Contrary to popular belief, bunions are not caused by wearing tight shoes or the wrong type of footwear. Dr. Tyson Green, foot and ankle specialist with Center for Orthopedics, explains that the musculoskeletal structure in the foot of certain people make it more likely that they will develop a bunion. “It’s an inherited condition, although tight-fitting shoes, especially high heels and narrow-toed shoes, increase the risk for the formation of bunions if you are genetically predisposed, and can lead to earlier and possibly more severe problems, including joint instability and early arthritis if not corrected.” Lisa Morgan of Lake Charles experienced pain that would wake her up at night. “I was a runner and didn’t really notice pain when running, but I started having sharp pain in the middle of the night in my right foot.” She saw a doctor, had an X-ray and the diagnosis was a bunion. “My dad had bunions and corrective surgery years ago, so I wasn’t surprised to find out I had the same thing.”

Lisa was reluctant to have bunion surgery, however, because her dad’s experience was not a good one. “I put off seeking treatment, but a friend of mine had had a successful experience with Dr. Green, who uses a newer technique, so so I decided to give it a try.” Dr. Green says surgery for a bunion is not always necessary. “It depends on each individual case. If someone has a bunion with no pain then there is no need for surgery. We always try conservative treatment options first.” Nonsurgical treatment options include rest, anti-inflammatory medications, padding and taping the bunions, physical therapy, orthotics and injections. When surgery is needed, a bunionectomy is performed. Dr. Green says there are about 16 types of bunionectomy techniques today. “Today, technological advances allow us to customize the procedure for each patient based on changes that have taken place in their foot. Our patients experience great results with these newer, customized options.” In Lisa’s case, she was so happy with the outcome on her right foot that she had Dr. Green perform the same procedure on her left foot just a few months later. “Foot pain is something people often take in stride, believing it’s normal, or will just go away over time,” Dr. Green says. “Pain is not normal and there are often simple solutions that can you get you moving without pain again. You should see a doctor for any foot pain to prevent more serious problems.”

BATTLING BUNIONS

[FOOT NOTES]

GIVE FOOT PROBLEMS THE BOOTSuede or leather? Knee or ankle? Classic or contemporary? Rain or snow? Gray, black or brown?

Boots are one of the hottest fashion trends for fall and winter, but with the wide range of styles, materials and colors to choose from, finding the perfect pair can be a challenge. CFO foot and ankle specialists say it’s worth taking some time with your decision to prevent foot problems. They offer these guidelines:

STYLE Sleek Classic Cowboy Slouch Ankle Rain Snow

CHOOSE Natural materials like leather that

allow proper airflow and keep

feet dry

A natural, flexible material with as

wide a toe as possible

A lower or stacked heel for support

A heel no more than two inches in height

and plan on standing/walking in these for only

short periods of time

Styles with arch supports or add cushioned arch

supports

Rubber soled styles with grooves for

proper traction

AVOID Synthetic materials trap

in heat and moisture

Wearing for long periods of

time. Narrow toe styles can cause

blistered and cramped toes

Narrow and/or very high heels

will transfer weight onto the ball of the foot, resulting in pain and numbness

High, narrow heels which,

combined with the lack of ankle

support, can cause imbalance

Rigid shapes which limit natural foot

movement and provides no arch

support

Smooth, slick soles

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Although shoulder joint replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain. For Mable Moore, 67, of Moss Bluff, years of work in a school cafeteria and as a janitor caught up with her after she retired. She had severe arthritis in both of her shoulders. “The pain was so bad I could barely lift my arms. I knew I couldn’t wait any longer to do something.” Moore had not just one, but both of her shoulders replaced over the course of two years. Geoffrey Collins, MD, orthopaedic surgeon with Center for Orthopaedics, performed a relatively new procedure called the reverse shoulder replacement on Moore. He explains that this technique is designed to eliminate pain and restore function in people with severe shoulder arthritis who also have a tear in the rotator cuff. “The rotator cuff is essentially a cushion that prevents cartilage from rubbing on bone while at the same time providing an attachment for four muscles that are necessary for raising the arm. When it is damaged, pain and loss of mobility result.” The conventional replacement joint uses a metal ball on the top of the arm bone, and a plastic socket

on the shoulder blade; thus the ball-and-socket joints are replaced. The reverse shoulder replacement uses a ball-and-socket joint as well, but the ball is placed on the shoulder blade and the socket is placed on top of the arm bone—opposite of the normal anatomy. “Before reverse shoulder replacement, we could relieve pain, but normal motion was not restored to satisfactory levels. With a reverse procedure, we’re able to relieve pain and restore motion. Patients report a big improvement and are able to enjoy life again,” explains Dr. Collins. Moore is one of those happy patients. “The entire experience was much better than I expected and I recovered quickly. I was more than eager to have the second arm done. I have full use of my shoulders again and am back to doing everything I need to do.” Dr. Collins has 15 years of experience in shoulder surgery, and is specifically trained in reverse shoulder replacement.

[SHOULDER SMARTS]

Your shoulders carry the weight of the world, so it’s not surprising that shoulder pain is a common problem. Shoulders are composed of several joints that combine with tendons and muscles to allow a wide range of motion to the arm. Shoulder injuries can be caused by sports activities that involve excessive overhead motion like swimming, tennis, pitching and weightlifting, and by everyday activities like washing walls, hanging curtains, and gardening. Most shoulder problems involve the soft tissues such as muscles, ligaments and tendons. The most common causes of shoulder pain are tendinitis, bursitis, injury or arthritis. You can’t always tell if the pain is actually in the joint or in the tendon or other tissue surrounding the joint. “The best advice is to see a physician to determine the cause and treatment recommendations,” says George “J.” Trappey IV, MD, orthopaedic surgeon with Center for Orthopaedics. “Seeking treatment early can reduce the risk of permanent joint damage and the potential need for surgery.”

Dr. Trappey says 90 percent of patients with shoulder pain will respond to non-surgical treatment options, which include:

If shoulder pain continues or becomes worse after non-surgical treatment, surgery may be recommended. Dr. Trappey says if this is the case, there are many new surgical options that are less invasive and provide quicker recovery than shoulder surgery in the past. “Our first goal is to treat the problem without surgery, but there are times when surgery is the most effective way to relieve pain and restore normal function, but the patient is the boss when it comes to making this decision. They know when their pain and limited activity have reached the point where they are ready to have surgery.”

REVERSE REPLACEMENT TECHNIQUE REVERSES PAIN

Mable Moore

When You Can’t Shrug Off Shoulder Pain

LIFESTYLE CHANGES• Doingrecommended exercises for strength and

flexibility• Avoidingoveruse• Alteringactivities• Notsmoking

MEDICATION FOR PAIN AND INFLAMMATION• Over-the-counter

medications such as aspirin, acetaminophen or non-steroid anti-inflammatory drugs (NSAIDs), such as ibuprofen

• Prescriptionmedications• Corticosteroidinjections

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Center for Orthopaedics offers national-level sports medicine expertise right here in Southwest Louisiana. Our team of doctors and support staff provide experienced, hands-on care to get athletes back in action whether you’ve been injured on the field, at a gym or in your own backyard. Our physicians have worked as team physicians for collegiate as well as professional teams and have experience ranging from Little Leaguers to weekend warriors to professional athletes.

MCNEESE STATE UNIVERSITYCenter for Orthopaedics and Rehab One have provided the sports medicine program for McNeese State athletics since mid-2011, and according to athletic director Tommy McClelland, the relationship has been a very beneficial one for McNeese athletes. “The expertise and commitment that these groups offer our student athletes is superb. We couldn’t be more pleased with their services and the confidence of knowing our athletes are receiving the best possible medical care. We look forward to a long relationship with this sports medicine team. ” The 12 doctors of CFO serve as the team physicians for all McNeese athletes. Over the past year, Dr. Noble says they have put many new programs in place to enhance communication between the coaches and the sports

medicine staff. One of these is the Coaches’ Portal. This technology allows coaches to log in under a secure password and get immediate information regarding the treating physician’s impression of an injury, treatment plan, and expected time to return to sport. It makes communication between the medical team and the coaching staff more efficient and convenient.

CENTER FOR ORTHOPAEDICS NAMED SPORTS MEDICINE PROVIDER FOR CAMERON PARISH SCHOOLS The Cameron Parish School Board has chosen Center for Orthopaedics as the exclusive provider of athletic training services for their student athletes. CFO will provide physician and athletic trainer coverage for Cameron Parish high school athletic events. The staff will also work with the school’s coaches and student trainers on injury prevention and concussion protocols. In addition, Cameron Parish athletes will have access to Saturday morning sports clinics and a wide variety of educational opportunities throughout the year. Cameron Parish athletes will now receive the same quality care as McNeese athletes, according to Dr. Geoffrey Collins, CFO’s high school athletic program medical director.

PUT OUR TEAM ON YOUR ATHLETE’S TEAMThe same expertise that Center for Orthopaedics offers to McNeese athletes is available to all youth athletes in the region. The group can work with any athlete from any school or sport team. Call (337) 439-7220, our sports medicine hotline, to get access to expert sports medicine services. We also offer Saturday morning appointments for athletes to accommodate busy schedules.

TEAMING UP WITH AREA ATHLETES FOR EXCELLENCE IN SPORTS MEDICINE CARE

Jason Rodriquez, MS, ATC, LAT, works with an injured athlete on the sidelines at a Grand Lake High School game.

Drs. Green and Noble on stand-by at a McNeese State University game.

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FOOTBALLDamage to the ACL – the anterior cruciate ligament in the knee – is a common injury in football. Although typically thought of as an injury that damages the careers of NFL superstars, athletes as young as nine or ten have now become susceptible to ACL damage; training drills that require balance, power and agility are crucial. Jumping and balance drills improve athletes’ muscular reactions, which has shown to cause a decrease in the risk of ACL damage. Make sure such drills are part of the athlete’s conditioning program.

CHEERLEADINGOne of the more typical injuries is wrist pain because weight is constantly being put on the wrists to execute flips, lift fellow athletes, and other athletic demands. It’s easy to forget about the wrists during stretching exercises, but it’s crucial that both hands and wrists get conditioned during warm-up. If wrist pain becomes constant, seek the advice of a medical professional. If left untreated, wrist injuries can worsen.

BASKETBALL“Jammed fingers” are common because fingers and thumbs are constantly being utilized and hit. Symptoms include pain, swelling, discoloring and immobility. Sometimes finger joints can become dislocated. If a joint becomes dislocated, do not allow anyone but a trained medical professional to restore it. In the case of a swollen or sore finger, ice should be applied as soon as possible and continued in 12-minute intervals with 20-minute breaks between ice applications. Elevate the injured finger. You can compress the finger also, but make sure the compression isn’t too tight and is not left on for too long.

BASEBALL/SOFTBALLThere has been a rapid increase in arm injuries among young pitchers, which is usually the result of overuse and improper technique. Make sure the team adheres to pitching limits, preferably those set forth by the American Sports Medicine Institute. Dr. Collins says parents of young pitchers should familiarize themselves with these limits and make sure the coaches follow them. Young athletes should also make sure they learn and understand proper throwing techniques and condition themselves adequately before game play.

For a quarterback, aches and pains are just as much as part of the game as touchdowns and tackles. But for Seth Bohannon, quarterback for the Sulphur High School Golden Tor football team, the pain in his hip wasn’t the result of a hard hit or overuse. It was the result of an abnormality within his hip joint called FAI. FAI (femoro-acetabular impingemet) is a relatively common condition defined in simple terms as too much friction in the hip joint. According to Dr. John Noble, orthopaedic surgeon at Center for Orthopaedics, patients with FAI experience a sharp, stabbing pain when they turn, twist or squat. It may also be a constant, dull ache. “The condition can lead to numerous pain-causing conditions, including cartilage damage, labral tears, early hip arthritis, hyperlaxity, sports hernias, and low back pain.” In Bohannon’s case, the painful friction resulted from an aspherical shape of the femoral head, meaning it was more elliptical than round as it should be, explains Dr. Noble. “This created a ‘cam’ lesion, or an elliptical prominence, where the ball meets the neck, which

damaged the labrum, the ring of cartilage that surrounds the edge of the bony socket of the joint.” Bohannon says he had experienced pain in his hip for a while. “I saw

Dr. Noble after football season ended my sophomore year. He explained the problem and what I needed to do.” Dr. Noble says minimally invasive arthroscopic surgery is usually the best option for FAI correction and this is what he performed on Bohannon’s hip. “With just a few small incisions, we were able to go in and remove the prominence and prevent future problems by smoothing the joint surface and reshaping the femoral head to eliminate the friction. We also released some tension in a tendon that was adding to Seth’s problem.” Although Dr. Noble had told him what to expect,

Bohannon was still worried about being back in top form for the new season. “The procedure and recovery weren’t a big deal and I was ready by the time practice started. I have more mobility and I’m playing without hip pain this year.”

SPORT-SPECIFIC INJURY PREVENTION FOR YOUNG ATHLETESThirteen-year-old pitchers with sore shoulders, 14-year-old cheerleaders with aching wrists, basketball stars with throbbing heels – virtually every young adult sport has a risk of injury and statistics indicate those risks have been realized at an increasing rate. According to the American Academy of Pediatrics, more than 3.5 million athletes under the age of 15 seek medical treatment for sports-related injuries each year. “There are more children playing competitive sports and many of them are playing year-round. The benefits of sports are substantial, but so is the risk of injury if proper precautions aren’t taken,” said Geoffrey Collins, MD, orthopaedic specialist with Center for Orthopaedics . “Obviously it’s important for coaches and team staff to understand prevention and treatment of these injuries, but it is also extremely important for parents to understand the risks.” Sprains and strains are the most common injuries, making it crucial that parents and supervising adults have a full understanding of how to prevent and treat them. “A sprain involves the stretching or tearing of a ligament. A strain involves stretching or tearing of the muscle or tendon structures. Both can cause limited mobility, pain and swelling. If minor, they often heal quickly using the RICE technique – rest, ice, compression and elevation,” Dr. Collins said. “Early medical attention is wise when pain is severe or causes immobility, but in many cases, these youth injuries can be treated with adequate rest and home care.” Although all youth sports present opportunities for sprains and strains, certain sports do carry specific risks at a higher rate than others, according to Dr. Collins. Here are some of the more common injuries for the sports that are linked to the most injuries in young athletes:

SACKING HIP PAIN

Seth Bohannon,Sulphur High quarterback

Drs. Green and Noble on stand-by at a McNeese State University game.

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CENTER FOR ORTHOPAEDICS WELCOMES NEW PHYSICIANOrthopaedic surgeon Jonathan Foret, MD, has joined the physician staff of Center for Orthopaedics. Originally from Lake Charles, Dr. Foret is a graduate of St. Louis High School. He earned a Bachelor in General Studies from Louisiana State University and his Medical Degree from the Louisiana State University School of Medicine in New Orleans. He completed an orthopaedic surgery residency at Greenville Hospital System University Medical Center in Greenville, South Carolina. Dr. Foret is a member of the American Academy of Orthopaedic Surgeons. Dr. Foret sees patients at the Center for Orthopaedics’ offices in Lake Charles, Sulphur and DeRidder. To schedule an appointment, call 721-7236.

DR. WILLIAM LOWRY EARNS BOARD CERTIFICATIONWilliam Lowry Jr., MD, Physical Medicine and Rehabilitation Specialist with Center for Orthopaedics, has been awarded Certification by the American Board of Physical Medicine and Rehabilitation (ABPMR), one of the 24 certifying boards of the American Board of Medical Specialties. Originally from Lake Charles, Dr. Lowry received a Bachelor of Science from McNeese State University. He earned a Master’s Degree in Natural Science from Louisiana State University in Baton Rouge and a Medical Degree from American University of the Caribbean. Dr. Lowry completed an internship in Preliminary Medicine at LSU Medical Center in Shreveport, and a residency in Physical Medicine and Rehabilitation at the University of Alabama in Birmingham. Dr. Lowry specializes in treating injuries or illnesses of the nerves, muscles and bones that affect movement. He treats a wide range of problems from back pain to arthritis, with the goal of decreasing pain and enhancing performance without surgery. Dr. Lowry sees patients in the Lake Charles, Sulphur and DeRidder offices of Center for Orthopaedics.

DR. DAVID DREZ HONORED BY LSU SCHOOL OF MEDICINEDavid Drez, Jr., M.D., orthopedic surgeon and sports medicine specialist with Center for Orthopaedics, was honored by the Department of Orthopaedic Surgery at Louisiana State University School of Medicine in New Orleans at their recent orthopeadic residency graduation ceremony. Dr. Drez has served as a clinical professor of orthopedics for the Medical School for 28 years. The award was given in recognition of his “sustained and compelling record of excellence in teaching and learning, and his ongoing commitment to excellence in instructing LSU orthopaedic residents.”

DR. ANDREW FORET’S WORK PUBLISHED IN NATIONAL JOURNALAn article co-written by Dr. Andrew Foret, hand surgeon with Center for Orthopaedics, was published in a recent issue of the Journal of Hand Surgery, the peer-reviewed journal of the American Society for Surgery of the Hand. The article evaluated the best course of treatment for volar retinacular ganglion cysts, fluid-filled masses that form on the palm side of the fingers. These cysts form when the tissue that surrounds the tendon bulges out of place. In the article, Dr. Foret explains that the cysts are benign and may resolve spontaneously without treatment. If the patient desires medical intervention, he recommends needle aspiration, followed by surgical removal if the cysts recur. Dr. Foret is a fellowship-trained hand surgeon who joined Center for Orthopaedics in 2011. He sees patients in the group’s Lake Charles, Sulphur and DeRidder offices. For more information, visit www.centerforortho.com.

ATHLETIC TRAINER JOINS CFOCertified Athletic Trainer Jason Rodriguez, MS, ATC, LAT, has joined the Center for Orthopaedics’ Sports Medicine Staff. Originally from Houma, Louisiana, he earned a Bachelor of Science in Athletic Training from Southeastern Louisiana University in Hammond, and a Master of Science in Health and Human Performance with a concentration in Exercise Physiology from McNeese State University. Rodriguez has six years of experience in his field and is both nationally certified and state-licensed as an athletic trainer. He has worked with athletes in high school and college athletic programs. In his new position with Center for Orthopaedics, he will be responsible for the group’s athletic training program for Cameron Parish high schools.

DR. J. TRAPPEY EARNS BOARD CERTIFICATIONGeorge “J.” Trappey IV, MD, orthopaedic surgeon with Center for Orthopaedics, has been awarded certification by the American Board of Orthopaedic Surgery, one of the 24 certifying boards of the American Board of Medical Specialties. Originally from New Iberia, Louisiana, Dr. Trappey received a Bachelor of Science from Louisiana State University in Baton Rouge and earned his Medical Degree from LSU Health Sciences Center in Shreveport. He completed an Orthopaedic Surgery Residency at Carolinas Medical Center in Charlotte, North Carolina, and a Fellowship in shoulder and elbow reconstruction surgery at the University of Texas Health Science Center at Houston Medical School. Dr. Trappey joined Center for Orthopaedics, an affiliate of Imperial Health, in 2010.

FOOT NOTES[WHAT’S NEW AT CFO]

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DR. JOHN NOBLE NAMED PRESIDENT ELECT OF LOA BOARDJohn Noble Jr., MD, orthopaedic surgeon with Center for Orthopaedics, has been named president elect of the Louisiana Orthopaedic Association (LOA). LOA is the state society of orthopaedic surgeons and is an affiliate of the American Academy of Orthopaedic Surgeons. Dr. Noble is originally from Lake Charles and has over 16 years of experience in his field, the last 11 of which have been at Center for Orthopaedics, the largest, independent musculoskeletal group in Southwest Louisiana. He is board certified by the American Board of Orthopaedic Surgeons, serves as the Head Team Physician for McNeese State University’s Athletic Department and is a Clinical Instructor of Orthopaedics for LSU School of Medicine. Dr. Noble is also a Board Member of the Louisiana Emergency Response Network, which is responsible for the development of a statewide trauma system. Dr. Noble is actively involved in numerous research projects and is a frequent speaker at conferences across the country. He will assume the presidency of LOA in 2013.

CFO PART OF SPECIAL OLYMPIC’S HEALTHY ATHLETE PROGRAMSDr. Tyson Green, foot and ankle specialist with Center for Orthopaedics, performed foot screenings for athletes through the Healthy Athletes Fit Feet program at the Special Olympics Louisiana state games held in the spring, and the regional games held in the fall of 2012. In 2011, Dr. Green completed his certification at the Special Olympics Training Center in Boston and now serves as a Clinical Coordinator for games in the region. He supervises the organization’s Fit Feet program, a free podiatric screening for Special Olympics athletes. Many Special Olympic athletes suffer from foot and ankle pain or deformities that impair their performance, and they are not always fitted with the best shoes and socks for their particular sport. Through Fit Feet, foot and ankle screenings for athletes are provided, along with education for athletes and their family members about proper shoes and socks. If indicated, the athletes are referred to foot care providers in their community. Fit Feet is conducted in partnership with the International Federation of Podiatrists (FIP) and the American Academy of Podiatric Sports Medicine. Dr. Green has organized a team of volunteers, including CFO employees, to travel with him to Special Olympic events both in Louisiana and across the country. Dr. Green also secured a grant from Lock Laces, which gave every athlete at the state games a pair of their special laces that won’t come untied during competition.

CENTER FOR ORTHOPAEDICS NAMES DIRECTOR OF BUSINESS DEVELOPMENTFormer McNeese State University running back coach Carlos McGee is the new Director of Business Development for Center for Orthopaedics. Originally from Port Barre, Louisiana, McGee attended McNeese where he played football for four years and earned a degree in Speech. He was a member of the McNeese football coaching staff for 12 years, working as a tight end coach and defensive backfield coach before taking the helm as running back coach in 2002. In his new position with Center for Orthopaedics, McGee will work to strengthen the group’s relationships throughout the community and into neighboring parishes. He brings a breadth of experience rarely seen in the healthcare arena.

DR. DAVID DREZ APPOINTED TO AOSSM EDUCATION COMMITTEEDavid Drez, Jr., MD, orthopedic surgeon and sports medicine specialist with Center for Orthopaedics, has been asked to serve on the American Orthopaedic Society for Sports Medicine’s (AOSSM) Self Assessment Committee. This group plans, develops, and evaluates the AOSSM Self Assessment and Board Review examination. The 40 committee members are chosen from among specialists across the country based on their experience and contributions to the field of orthopaedic sports medicine and each serves a four-year term.

CENTER FOR ORTHOPAEDICS EXPANSION PROJECT NEARING COMPLETION Center for Orthopaedics began construction on a additions and renovations to their Lake Charles office in mid-2012. The addition will add 5600 square feet to the facility’s current 34,500 square foot footprint. The main lobby will be expanded and 16 new exam rooms will be added to meet the group’s growing patient population. As part of the construction, 900 existing square feet are being renovated for a new C-arm imaging suite for musculoskeletal injections. The Lake Charles office has been open for three years, but the group has grown rapidly, from just four doctors in 2009, to 12 doctors today, making it the region’s largest, independent musculoskeletal group. Construction will be completed in early 2013.

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[BACK TALK]

sound and light. Experts estimate that approximately 3.2 million people in the United States have chronic migraines. Craig Morton, MD, physical medicine and rehabilitation specialist with Center for Orthopaedics, explains that someone with chronic migraine experiences this type of pain 14 or more days each month, affecting every aspect of their lives – family, work, social life and sleep. “Treatment options available before now typically provided short-term relief. Botox gives us a new option for longer-term pain relief,” he said. The Botox formulation, approved by the FDA for chronic migraines, is the same as the formulation used in the treatment of facial wrinkles. When it comes to migraine relief, Botox seems to do more than just block nerve impulses to muscle,” says Dr. Morton. “The theory is that it also blocks the nerve impulses that transmit pain.” For migraine treatment, tiny amounts of Botox are injected in precise muscle locations in the forehead and neck. Results are felt within 72 hours and usually provide relief for three to six months. Repeat injections are likely needed for ongoing migraine pain management. “Botox gives us an effective treatment tool that can help those with chronic migraine get back to pain-free living,” he says.

Botox, well-known for its ability to battle wrinkles, can also be used to successfully fight a different enemy: chronic migraine headaches. Migraines are extreme, debilitating headaches that cause intense throbbing or pulsing pain, nausea and sensitivity to

One area of specialization available at Center for Orthopaedics is physical medicine and rehabilitation, or PM&R. This field focuses on improving the functional ability and quality of life of people who have injuries or conditions that limit their movement. Our specialists in this area treat problems that touch upon all systems of the body, including arthritis, tendinitis, work and sports-related injuries, muscle spasticity, and neck and back pain. The main goal is to provide non-surgical management and treatment that restores pain-free movement and function. Having PM&R specialists as part of the physician team at Center for Orthopaedics is a natural fit, giving patients an additional medical resource at all stages of the treatment process. For more information, log on to www.centerforortho.com.

Sometimes the biggest advances in healthcare are smaller. Many people with lower back pain dread the thought of surgery so much that they delay seeking treatment and suffer for years. Thankfully, the road to back pain relief is smoother and shorter than it used to be, as a result of improved surgical techniques that expedite recovery. Dr. James Perry, orthopaedic spine surgeon with the Center for Orthopaedics, says “The microsurgery revolution has impacted virtually every surgical field, including spine surgery. A big challenge faced in the past was not having the right equipment to work in and around the delicate nerves and structures of the spine, but in recent years, tools and instruments have been refined for minimally invasive spine techniques. “Our goal is always to choose the most conservative treatment option and fortunately, most back pain can often be relieved without surgery,” says Dr. Perry. However, when surgery is determined to be the best recommendation, minimally invasive procedures have replaced traditional ‘open’ back surgery for many back problems.” Dr. Perry is specially trained in the use of minimally invasive surgical techniques and has been performing them for 11 years. He cautions that every case is different, and a minimally invasive procedure may not be an option for everyone, “but we are committed to making this technology available to help our patients return to productive, active, pain-free lifestyles.”

TAKE A SHOT AT ELIMINATING MIGRAINES

WHAT IS PM&R?

SMALL INCISIONS CAN LEAD TO BIG RELIEF FOR BACK PAINn n n n n n n n n

Dr. Morton injects Botox to ease migraine symptoms.

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They may be specialists in different extremities, but Dr. Andrew Foret and Dr. Tyson Green with the Center for Orthopaedics, an affiliate of Imperial Health, worked as a team to restore sensory function for a patient whose hand was badly injured in an industrial accident. Dr. Foret, a hand and wrist surgeon, responded to a call from a local hospital after the initial emergency room treatment. The patient’s hand had been caught in manufacturing machinery, resulting in a jagged, half-inch hole through the center of his right hand. “This was a very traumatic injury, with severe

damage to the soft tissue, nerves, tendons and bones of the hand,” says Dr. Foret. “Imagine a gunshot wound straight through the hand. The base of the patient’s index and middle fingers were gone. He also lost the sensory nerves to his thumb, index finger and middle finger as well as the main tendons that allow wrist extension. We would have to carefully reconstruct his hand if he was to have any hope of future hand function. The only other option was to completely remove the damaged fingers and a portion of the palm. This man works with his hands every day. We wanted to give him a chance to do so again.” Over the course of four surgeries and several weeks, Dr. Foret worked to recreate the structures within the patient’s hand using the patient’s own tissue and metal implants. “First we had to wash out and stabilize the structures that remained for reconstruction. After we were satisfied that the wound was infection-free, and that good blood flow existed, we reconstructed the bones of the hand with pieces of the patient’s own iliac crest bone from the hip and small metal plates. We also harvested a portion of one of the damaged wrist tendons to help reconstruct the remaining wrist tendon. This will allow the patient to extend his wrist.” Once the repair of the these structures was complete, the patient still had no feeling in his hand because the digital nerves that normally provide sensory information to the palm and fingers had been damaged in the accident. The next challenge for Dr. Foret was replacing these nerves, and he thought a sural nerve graft would provide the best solution for restoring sensation. He turned to Dr. Tyson Green, foot and ankle specialist, for assistance.

Dr. Green explains that sural nerve grafting is essentially a nerve transplant. “The sural nerve runs along the back and outside of the lower leg, to the ankle and the top of the foot. It is a sensory nerve that is not going to be missed once it is removed from the leg, making it a good choice when certain types of nerves in other parts of the body need to be repaired or replaced. In this case, the patient would be sacrificing some

sensation in the top of his foot in the hope of restoring sensation in the palm of his hand and fingers where he needed it more for day-to-day function.”

The two surgeons worked together in the operating room. Once Dr. Green had removed a 9

cm section of the sural nerve with branches, Dr. Foret transplanted it into the patient’s hand, connecting the nerve graft to the median nerve and to the remaining distal ends of the digital nerves that provide sensation to the fingers. The explanation sounds simple, but there is quite a bit of microsurgical skill involved in both parts of this procedure,” says Dr. Foret. “It’s important to harvest a quality nerve graft. It is also important to harvest a graft with adequate length so that there is no tension on the nerve. This also allows us to position and attach the nerve graft properly in order to optimize the chance of a successful graft. In this case, everything worked well and ideally he will experience return of his sensation over the next year.” Dr. Foret adds that the patient is doing well two months after the injury, but still has months of recovery and rehabilitation ahead of him. “While his hand will never be exactly the same as it was before the accident, having an intact hand that may eventually regain function and sensation gives him more hope than if he had lost half of his hand.” The use of a sural nerve graft in the hand is one of only a few cases in the state that have been performed. “Providing innovative treatment options is one of the main reasons we choose to have different types of specialists within our group,” says Dr. Green. “This approach is definitely an advantage for us when we need collaboration outside our area of specialization, and for our patients who benefit from having a team of experienced specialists working together to improve their care.”

[HELPING HANDS]

CENTER FOR ORTHOPAEDIC DOCTORS PERFORM INNOVATIVE FOOT-TO-HAND NERVE GRAFT

Dr. Foret (left) and Green (right) during the nerve harvest and graft procedure.

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ORTHOTICS AND DURABLE MEDICAL EQUIPMENT AVAILABLE AT CFOWe offer a full-service DME (durabel medical equipment) service, with a certified orthotic fitter, for our patients’ convenience in our Lake Charles office.

We have over 400 products avaialble, including:

Pneumatic walking bootsSlingsWrist and thumb splintsPost op shoesControl motion braces for the knee and elbowACL bracesKnee ImmobilizersShoulder ImmobilizersAnkle BracesShort-hinged knee bracesKnee sleevesBack bracesTENS units and electrodesDiabetic shoesPre-fab and custom orthotics for the footNight splintsCrutchesWalkersCanesQuad base canesRental wheelchairs and roll-abouts For more information about our orthotics and medical equipment options, call (337) 721-7245.

James D. Perry, M.D.Orthopaedic Surgeon

John W. Noble Jr., M.D.Orthopaedic Surgeon

Geoffrey J. Collins, M.D.Orthopaedic Surgeon

Steven S. Hale, M.D.Orthopaedic Surgeon

George “J.” Trappey IV, M.D.Orthopaedic Surgeon

David Drez Jr., M.D.Orthopaedic Surgeon

Jonathan L. Foret, M.D.Orthopaedic Surgeon

Craig G. Morton, M.D.Physical Medicine andRehabilitation Specialist

William J. Lowry Jr., M.D.Physical Medicine andRehabilitation Specialist

Tyson E. Green, D.P.M.Foot and Ankle Surgeon

J. Kalieb Pourciau, D.P.M.Foot and Ankle Surgeon

Andrew L. Foret, M.D.Hand and Wrist Surgeon

CFOD O C T O R S

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Collins LowryDrez MortonForetForetNoblePerryPourciau GreenHale Trappey

[PATIENCE PUZZLES]

DOWN CLUES1. Smaller bone in the lower leg2. Upper arm bone3. Lower jaw bone4. Bones that go around the

lungs, stomach, etc6. Ankle bones8. Chest bone9. Hip bones10. Hand bones11. Bigger bone in the lower leg13. Wrist bones

ACROSS CLUES1. Thigh bone5. Shoulder bone7. Head10. Foot bones12. Collar bone14. Knee cap15. Toes and Fingers16. Bigger bone in the

lower arm

OURSKELETON

CREWLocate and circle the names of our

doctors in the word find below.

One name will be found twice

because we have two

Dr. Forets.

NO BONES ABOUT IT!Use the clues below

to complete the crossword puzzle.

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Joint ReplacementKnee SurgeryHip SurgeryShoulder SurgeryBack & Neck Pain Spine & Neck SurgeryFoot & Ankle Surgery

James Perry, MDJohn Noble Jr., MD Geoffrey Collins, MDCraig Morton, MD Tyson Green, DPM Steven Hale, MD

Our range of services includes:

Hand & Wrist Surgery Podiatric MedicineSports MedicineArthritis TreatmentOccupational InjuriesFracture ExpressBone Health Central

William Lowry Jr., MD George “J.” Trappey IV, MD David Drez Jr., MDAndrew Foret, MDKalieb Pourciau, DPMJonathan Foret, MD

At the Center for Orthopaedics, Southern hospitality is our first specialty. That’s because all of our doctors were born and raised right in here in Louisiana, and we’re proud of it. We’re also proud to be the region’s largest, independent musculoskeletal group. This allows us to provide our patients with the type of care they expect and deserve – care that is courteous, respectful of their time, and of the highest quality.

We’ve dedicated ourselves to bringing the latest technological advances to Southwest Louisiana so that our patients won’t have to leave home to get the orthopaedic care they need. After all, we have a vested interest in keeping our community healthy: it’s our home too.

Louisiana Proud

(337) 721-7CFO • www.centerforortho.comLAKE CHARLES • SULPHUR • DERIDDER

OUR DOCTORS: