The OA Update 3

The OA Update is published by Oser-Bentley Custom Publishers, LLC, a division of Oser Communications Group, Inc., 1877 N. Kolb Road, Tucson, AZ 85715. Phone (520) 721-1300, fax (520) 721-6300, www.oser.com.Oser-Bentley Custom Publishers, LLC specializes in creating and publishing custom magazines. Editorial comments: Karrie Welborn, karrie_w@oser.com. Please call or fax for a new subscription, change of address,or single copy. This publication may not be reproduced in part or in whole without the express written permission of Oser-Bentley Custom Publishers, LLC. To advertise in an upcoming issue of this publication, pleasecontact us at (520) 721-1300 or visit us on the Web at www.oser-bentley.com. October 2010

6. Providing Outstanding CarePhysician Assistants and Nurse PractitionersBernadette Shaw explains what PhysicianAssistants and Nurse Practitioners do, how they are different and what you need to know to experience this excellent level of care.

8.Take the PlungeTraining for a Triathlon SwimDetermine the best way to train for atriathlon swim. Then read about one teenswimmer who has won medals as a resultof her training.

10. Dupuytren’s DiseaseWhat it is. How to treat it.An explanation of this condition of the hand.

13. Be Brave Now...and Proud LaterFacing Haiti’s TraumaA medical team from OA Centers and Konbit Sante, a Portland, Maine nonprofitorganization spent several days in Haitihelping the injured.

19. Childhood ObesityA Growing ProblemChildhood obesity is a growing concern for both families and medical personnel. Dr. Lucien Ouellette details some options to forestall this condition in your children.

FEATURESIn This Issue

DEPARTMENTS 5. OA in Motion: What’s New? News and notes on people, places and happenings in the organization.

4 The OA Update

Opening RemarksThis latest issue of the OA Update includes a variety of topics including an article on childhood

obesity as well as an article sharing the experiences of a medical team who volunteered their time ona Haiti medical mission trip. This article provides a sobering view of health care in an underdevelopedcountry in the midst of recovery from a major disaster, and also gives insight into the strength of thepeople who live there.

We hope that you find these articles to be helpful and informative. If there is a particular topicyou’d like to learn more about, we’d love to hear from you.

Sincerely,The Physicians at OA Centers for Orthopaedics

OA is the premier orthopaedic practice in Maine.Our 23 highly specialized physicians are experi-enced in the latest techniques and innovations. OAspecialty centers include sports medicine; handsurgery; joint reconstruction of the hip, knee andshoulder; foot and ankle surgery; and complex frac-ture treatment. OA—Experience in Motion!

The information contained in this publication is notintended to replace a physician’s professionalassessment. Please consult your physician on mat-ters related to your personal health.

OA Centers for Orthopaedics33 Sewall St.Portland, Maine 04102(207) 828-2100 • (207) 828-2190 faxinfo@orthoassociates.com

John Wipfler Chief Executive Officer

Satellite Locations:

Saco Office15 Lund RoadSaco, ME 04072(207) 282-4210

Windham Office4A Commons Ave. Rte. 302Windham, ME 04062(207) 893-1738

Specialty CentersJoint Replacement CenterOrthopaedic Trauma CenterHand CenterFoot and Ankle CenterSports Medicine CenterSpine CenterMRI CenterOrthopaedic Surgery CenterPhysical Therapy CenterPerformance Center

The OA Update 5

OA in MotionDr. McGrory PublishedBrian McGrory, MD of the OA JointReplacement Center, led an impressive groupof authors in publishing a total hiparthroplasty article in the Journal of the American Academy of Orthopaedic Surgeons (May, 2010). The article reviewed the indications, effectiveness, and failure rates of metal-on-metal hip resurfacing.Accomplishing this kind of prestigiousachievement in a busy private practice is anenormous undertaking.

Dr. Heinz Appointed to Advisory CommitteeWilliam Heinz, MD has been asked to serveon the Sports Medicine Advisory Committeefor the National Federation of State HighSchool Associations. Dr. Heinz will be able toleverage his sports medicine expertise for thedevelopment of policy and rules, which willaffect the safety and playing experience ofmost high school students around the countryinvolved in sports activities. The NFHS serves its 50-member state high schoolathletic/activity associations, plus the Districtof Columbia. Among other things, the NFHSpublishes playing rules in 16 sports for boysand girls competition. It provides a variety ofprogram initiatives that reach the 18,500 highschools and more than 11 million studentsinvolved in athletic and activity programs.

Weekend Sports Injury ClinicOA Sports Medicine Center will again offerSaturday morning walk-in clinics for athleteswith acute sports injuries. This will begin at9:00 a.m. on Saturday, September 4 throughOctober 23rd. Please call us at (207) 828-2100 for more information.

National Youth Performance Testing DayHow fast are you? How high can you jump?How strong are you? Come find out at ournext National Youth Performance Testing Dayon Thursday, October 28 at 6:00 p.m. in the

OA Performance Center. The event is open tothe public ages 7-21 and is FREE! More than70 kids attended our last event, which washeld in June 2010. Those participating testtheir speed, strength, agility, quickness, andpower. To register for the event, call (207) 710-5509 or sign up on our Facebook page: OAParisi School.

Physical Therapy and Occupational Therapy in Windham OA is pleased to announce the opening ofphysical and occupational therapy services atour Windham facility. The physical therapyclinic features an open concept, which allowsthe treatment of a variety of musculoskeletaldisorders. The clinic is staffed by Ryan Brown,PT, FAAOMPT and Eric Bouchard, PT, whobring to the clinic many years of experiencetreating both surgical and non-surgicalpatients. Our hand therapy center features

Catherine Morrell, OTR/L, CHT whospecializes in the treatment of surgical andnon-surgical rehabilitation of the hand.

OA Moves to Electronic Medical Records (EMR)After 10 years of research and considerationregarding a number of EMR programs, OA’steam is now planning and preparing for theimplementation of electronic records and thephasing out of paper charts. This transitionwill enhance our team’s ability to respond toour patients’ questions and concerns byimproving access to the patient record. Theanticipated go-live date is in November.

OA Welcomes New ProvidersTo better serve the needs of our patients, thefollowing midlevel providers have joined theclinical team at OA: Michelle Stirling, FNP;Kristen Schroeder-Cyr, FNP; and SarahLavoie, PA-C (per diem). OA PhysicalTherapy Center also welcomed MatthewSomma, DPT; Joshua Bailey, DPT; OwenLennon, DPT; and Eric Bouchard, PT.

Yarmouth Clam Festival

Photo Credit: John Pineu

OA Cyclemania controls the peloton at the 30th AnnualYarmouth Clam Festival race, which includedparticipants such as the U.S. National Cycle-Crosschampion. Photo Credit: Dan Levesque

6 The OA Update

OA is proud to employ Physician Assistants(PAs) and Nurse Practitioners (NPs) who work aspart of an experienced medical team to provideoutstanding care to our patients. PAs and NPsare licensed health care professionals who aretrained to diagnose and treat a wide range ofhealth problems. At OA, the PA/NP works witha physician to treat patients in a style developedand directed by the supervising physician.

The average physician assistant has amaster’s degree and four-and-a-half years ofhealth care experience prior to entering a PAprogram. Nurse practitioners obtain a master’s

degree and clinical training beyond registerednurse training. The typical rigorous training fora PA/NP takes two to three years to completeand is comprised of essential medical sciencessuch as anatomy, physiology and microbiology.The academic studies are followed by clinicalrotations in hospital and private practicesettings. All graduates sit for a nationalcertification exam.

As part of their role in the orthopaedicpractice a PA/NP is qualified to:

• Perform comprehensive and problem-focused medical histories and physical exams

• Order and interpret diagnostic assessmentssuch as X-rays, MRIs, CT scans, ultrasounds orlaboratory studies

• Perform diagnostic and therapeuticprocedures including joint and bursal aspirations,closed reduction of fractures or dislocations andinjection of joints

• Diagnose illness• Develop treatment plans• Assist in surgery• Conduct hospital rounds, write orders and

formulate and implement a treatment plan forhospitalized patients

Providing Outstanding CarePhysician Assistants and Nurse PractitionersBy Bernadette Shaw, PA-C

The OA Update 7

• Order, prescribe, dispense and administermedication

• Instruct and counsel patients

You may see the physician and PA/NP atthe same visit or separately. The physicianassistant and nurse practitioner will discuss orreview your case with their supervising physician.

PAs/NPs are known for their accessibility andfocus on health promotion and disease prevention.Our PAs/NPs are excellent health educators whotake pride in answering your orthopaedic questions.Whether it is getting you ready for surgery,administering a joint injection or following youthrough your hospital stay, we are dedicated toproviding you with a positive OA experience.

OA currently employs more than 17 PAsand NPs. To learn more about our providers,visit the OA team at www.orthoassociates.com.

Bernadette Shaw, PA-C, is a physician assistant andclinical research coordinator who works in the OA Sports Medicine Center.

• Initial visit

• Follow-up care

• Pre-operative or post-operative visit

• Phone discussion regarding care

• Cast room visit

• Emergency room visit

• Hospitalization

• At the time of your surgery

When would you see a PA/NP at OA?

8 The OA Update

Whether you are an experienced triathlete or afirst-time racer, the swimming portion of atriathlon is often the least favorite and the mostintimidating. There are several easy steps you cantake to make the swim more enjoyable andimprove your overall triathlon experience.

Prepare in the pool during the preseasonSports-specific cardiovascular training is impor-tant, especially when it comes to swimming. Some of the most in-shape land athletes feel hopelessly out of shape when they starttraining in the pool. It is also important to workon stroke technique in order to become moreefficient in the water and conserve energy for therest of the race. Taking a formal swim clinic orincorporating stroke drills into your regular swim routine is a good way to accomplish this.

First, concentrate on getting maximumdistance per stroke. This means keeping a longbody line, focusing on hip and shoulder rotation,developing a steady rhythm and minimizingresistance. Try counting the number of strokes ittakes you to get to the end of the pool. This is agood task to do regularly during a workout,particularly as you tire and your stroke shortens.

Catch-upTo improve stroke lengthening and body positionyou can incorporate the catch-up freestyle drill intoyour workout. Start with your hands in astreamlined position out in front of you. Pull withone arm at a time following the regular freestyle

stroke pattern. One arm is always extended forwardtowards your destination while the other armperforms the stroke. When the arm performing thestroke moves forward and “catches-up” with thestationary arm they change places.

Strength trainingUpper body strength is essential to swimmingsuccess and injury prevention. This can beaccomplished by several strength trainingsessions a week, focusing on shoulder stabili-zation and muscle balance. An easy exercise toperform is the wall push-up.

Wall push-up Keep shoulder blades down and back, and startwith your hands at shoulder level. Slowly loweryour shoulders towards the wall and return tostart position. Avoid shrugging your shoulders.Progress to table-end push-ups and finally tofloor push-ups.

Train in your race environmentWhen the weather allows, it is important to gainsome familiarity with your triathlon swimmingvenue. If your race is in the ocean or a lake,wearing a wetsuit may be recommended orrequired. Spend time swimming in your wetsuitso you are comfortable and have a proper fit. It isalso essential to test out the cap and goggles youplan to use on race day. Practice sighting buoys orobjects when you train in the ocean or lake. Inorder to make sure you stay on track, try lifting

Take the PlungeTraining for a Triathlon SwimBy Bernadette Shaw, PA-C

The OA Update 9

your eyes just high enough off the water everyfive to six strokes and spot your target.

Race DayOn race day, get to the event a little early tocheck out the water conditions. Spend some timeon the beach taking note of tides and currents.Review the course entry and exit, paying specialattention to details such as rocks, wave actionand beach slope. Get in the water, test out yourgear and warm up. Keep in mind that it can bedifficult to catch your breath during the firstseveral minutes of the race due to the cold waterand chaotic environment of other swimmers andcrashing waves. Take comfort in knowing thatyour swimming heat will spread out. Focus ongetting into your own rhythm.

Most importantly, have fun!

Bernadette Shaw, PA-C, is a physician assistant andclinical research coordinator who works in the OA Sports Medicine Center. She enjoys competingin local triathlons and open water swim races.

Jenni Roberts is a high school senior who has beentraining at the OA Performance Center sinceFebruary of 2009. Over the past year Jenni hasput a large emphasis on the Total Conditioningand Strength Training classes we offer in ourmembership program to improve her relativestrength and prevent shoulder problems that haveplagued her in the past. By dedicating herself totraining three days a week year-round she madeher 2009-2010 swim season one of the mostimpressive individual seasons ever by a Maineathlete. This past year she swam in four individual

events at the State Championships and not onlydid she win all four events, but she broke staterecords in every event and became All-Americanin all four events! She then went on to theYMCA Nationals and placed 6th in the 200backstroke, 4th in the 100-yard backstroke, 3rdin the 200 butterfly, and went on to become theNational Champion in the 100 butterfly! Herimpressive performance earned her a fullscholarship to the University of Maryland, oneof the top college swimming programs in thecountry. Congratulations, Jenni!

It pays to train!

10 The OA Update

Dupuytren is a disease involving the palmarsurfaces of the hand, and very seldom, the feet.The tissue just below the surface of the skin,called the fascia, thickens abnormally, causingfirm lumps or cords that can extend from thepalm out to one or more fingers in the affectedhand. Over a period of time these thickenedcords can shorten, pulling the finger(s) downinto the palm and making it difficult to performmany functions such as shaking hands, wrapping the hand around a glass, wearinggloves, or putting the hand into a pants pocket.Fortunately, the deeper structures of the handincluding arteries, veins and tendons are notdirectly involved. Nerves can be intertwined with the cord, making it a difficult dissection ifsurgical excision is elected. The cause of thedisease is not known but it does tend to run in families—particularly those of NorthernEuropean descent. It is also common in men overthe age of 40.

Many times the facial thickening starts andthen remains a small, painless bump in the palm.If this is the case, then no intervention is

necessary. However, if the nodule progresses intoa cord that begins to pull the finger(s) down intothe palm, resulting in a functional deficit, thenreferral to a hand specialist should be considered.This process of tethering and contracting usuallytakes months, if not years, to advance, thusleaving plenty of time to consider if and whenanything needs to be done.

Treatment options depend on the severityof the disease. As mentioned above, an isolatedpainless nodule in the palm needs no moretreatment than a watchful eye. Even a moreadvanced cord needs no treatment if it is notinterfering with hand function. Concern fortreatment arises when daily life activities areaffected and improvement in finger extension isdesired by the patient. Surgery, along with thenewly approved collagenase injections from theFederal Drug Administration (FDA), are two ofthe options available.

Collagenase is injected by a hand specialistinto the tissue. This dissolves the cord over aperiod of 24 hours, allowing it to be manipulatedand straightened. Splinting and therapy follow.

Unfortunately, this treatment is not covered bymost insurance carriers and needs to be paid forout of pocket, which makes it too expensive formost patients.

Surgical excision of the cord(s) removes thediseased tissue and allows the finger(s) tostraighten and function normally. This procedurecan typically be completed as an outpatientsurgery. It takes between one to two hours toperform the surgery, depending on the severity ofthe disease. A post-operative splint is worn forseveral weeks post-surgery, to keep the finger(s) inan extended position. Therapy is recommended toassure optimal post-operative success.

The disease can reoccur over time despite allattempts. Keeping this as well as the operative and injection risks in mind, overall goals andexpectations should be discussed thoroughly witha hand surgeon prior to any invasive procedure.

Sacha Matthews, MD, is a hand surgeon in the OA Hand Center. Sarah C. Starbird, PA-C, is a physician assistant who works in the OA HandCenter with Dr. Matthews.

by Sacha Matthews, MD, and Sarah C. Starbird, PA-C

Dupuytren’s DiseaseWhat it is. How to treat it.

The OA Update 13

Be Brave Now...and Proud LaterBy Linda Ruterbories, ANP and Joanne Leblanc, BSN, RNFacing Haiti’s Trauma

Haiti, the poorest country in the Western Hemisphere, hadchallenges long before the January 12th earthquake devastated theisland. Konbit Sante, a nonprofit organization based in Portland,Maine, has been dedicated to the medical needs of Haiti, specificallynorthern Haiti, since 2000. The organization’s name comes fromtwo Creole words konbit, which means “working together” andsante, which means “health.” Konbit Sante works with local medicalprofessionals at the Justinian Hospital, a medical training facility inCap-Haitien. This location was not directly in the earthquake zone,but both the city and Justinian Hospital have welcomed and aidedthe injured, displaced and lost.

14 The OA Update

Members of the team arriving in Haiti for the first timewere simply not prepared for the reality of the povertyand the distressing living conditions.

The OA Update 15

Forming the teamOA Centers for Orthopaedic’s CEO John Wipfler, learned of KonbitSante’s plan to send a team to Haiti through Mary Anne Ringle, aprogram specialist at Konbit Sante. Ringle previously worked forWipfler on the Maine Health and Finance Commission. Wipfler askedthe OA Centers physician board if there was interest in participating inKonbit Sante’s team, and when the response was positive, OA, inconjunction with Maine Medical Center, formed a seven-personvolunteer team. Team members included:

OA Centers for OrthopaedicsMatt Camuso, MD, Orthopaedic Trauma Surgeon Linda Ruterbories, ANP, Director of OA Surgery CenterJoanne Leblanc, RN, Director of Clinical Services

Maine Medical CenterBrad Cushing, MD, Chief of SurgerySamuel Broaddus, MD, Chief of UrologyMarch Truedsson, RN, wound care nurseMarieta Atienza, RN, wound care nurse

OA’s Ruterbories and Maine Medical’s Broaddus spearheaded thesurgical and wound care team. Dr. Broaddus, who has been travelingto Haiti since before Konbit Sante was formed, has been affiliated with

the non-profit since its inception. Since 1994, Dr. Broaddus has visitednorthern Haiti nine times.

The team members believed they could offer services that wereneeded, and that the connections in place through Konbit Sante andthe Justinian would expedite the team’s mission—to offer theircolleagues at Justinian Hospital specific surgical services in orthopedicsand trauma care. The team also agreed that nurses with wound careexpertise would be of particular value.

Culture shockMembers of the team arriving in Haiti for the first time were simplynot prepared for the reality of the poverty and the distressing livingconditions. The sheer mass of people surviving not just the earthquake,but an obviously status quo poverty, was a devastating sight. From themoment of arrival through the team’s departure, it was apparent thatthere was neither space nor resources to accommodate the largenumbers of residents. It was clear that no public waste disposal systemexisted in the country. Garbage is simply left on the side of the roads.Occasionally it’s burned to create more space. Housing consists of one-room metal buildings with openings for windows and doors, butno coverings across the openings. Many of these homes are built into

the mountainside. Mud slides are inevitable due to the weather and thetin homes are often swept away. Yet the most surprising contrast theteam saw was that no matter how impoverished the people were,

The team arrives in Cap-Haitien.

Dr. Pierre Louis and Dr. Matt Camuso discuss the instruments OA bought to Haiti.

16 The OA Update

Haitians in Cap-Haitien were consistently dressed in their Sunday best,impeccably white and pressed. The Haitian people are proud of theirappearance no matter where they are going or what they are doing.

A cultural reality that was more pleasant, visually, was Haitiantransportation. The primary source of travel within the city is in theback of pickup trucks or on mopeds, three or four people at a time. Forgreater distances the solution is both unique and colorful—andsomewhat unsettling as well. Haiti has no official transit system. Longdistance travel is facilitated by individually-owned, brilliantly-coloredand artfully decorated vehicles called Tap Taps. These vehicles, primarilybuses, do not have schedules or regular destinations. There are no seatbelts and the roads are bumpy. The Tap Taps travel only when a vehicleis full and they transport chickens and goats as well as humans—all atthe same time. The name comes from the fact that passengers tap on themetal of the bus or truck to signal that they want to stop.

Establishing relationshipsUnderstanding the importance of building relationships in Haiti wasthe key to the team’s success. Dr. Broaddus, over his 16 years ofvolunteer experience in Haiti has established successful methods forbuilding relationships. His extensive experience gave the team valuableinsights in breaking down language barriers and understanding culturaldifferences. Nate Nickerson, Executive Director of Konbit Sante, hasalso spent considerable time immersed in the Haitian culture. He ledthe team through the process of making initial contact with Dr. PierreLouis, the sole orthopaedic surgeon in Cap-Haitien.

Dr. Louis and Dr. Camuso in surgery.

Haitian transportation called Tap Taps.

The OA Update 17

Dr. Camuso partnered with Dr. Louis. Together, they performedseveral surgeries, including a difficult lower leg fracture repair on ayoung woman, a dancer, who refused to have her leg amputated despitethe difficult, long road ahead of her during recovery from herdevastating injury. Dr. Louis expressed his gratitude to Dr. Camuso forproviding their facility with the modern fracture instrumentation andimplants that the team brought with them from the United States. Thetwo physicians spent several hours together, discussing cases as Dr. Louismastered his new tools. Dr. Camuso’s personality and his finesse withinthe OR facilitated a trusting bond between the two surgeons. The teamfelt that the goal, which was to provide assistance and surgical expertisewithin limited resources, had been well met. Dr. Camuso’s expertise asa trauma surgeon was instrumental in preparing Dr. Louis by providinghim with the knowledge and training he would need to operate on casesthat might otherwise have been seen as hopeless or inoperable.

ReflectionsWhen it was time to leave Haiti and return to their regular jobs in theUnited States, the team experienced frustration and sadness. Althoughmuch had occurred, it seemed to the team as though very little had beenaccomplished. They felt they could have done more, saved more, andbeen more help. Limiting factors such as sterilization issues, inadequatestaffing resources, time constraints and the inability to perform as manysurgical procedures as were needed, contributed to the team’sdepression. The consensus was that they had not, as hoped, really madea difference in the days they had been in Cap-Haitien. It was painful toleave patients behind. As team members transitioned back into the landof plenty, it was difficult to forget the faces of those patients andtroubling to realize they might never know the outcome of the surgeriesthat did take place.

In an effort to offset the frustration and depression these thoughtsbrought to the team, Nickerson made a point of expressing his gratitudeand emphasizing the value of the visit. He made it clear that in spite ofthe overwhelming and difficult reality of Haiti (before or since thequake), the team’s contributions were in fact, invaluable.

Future plansIn the short term, Haiti has been supplied with resources that were notavailable to them prior to the earthquake. However, manyimprovements made prior to the tragedy are now complicated by aninflux of short-term solutions that obscure many more substantial long-term solutions. Even so, there is hope that as tragic as the situation is,it may prove to have a silver lining. By bringing Haitians more optionsfor working together, (konbit) and improving the quality of living forits population through health (sante) and knowledge, long-term changeswill become more viable.

The goal of Konbit Sante is to participate in the creation of asystem that encourages the Haitian people to take care of their own,through increased knowledge and the ongoing ability to improve skilllevels. There is a focus on high-impact solutions with minimal resourcerequirements. That is, how do you learn to do things differently with

the same limited resources?The number of people critically injured by the quake is

overwhelming. Many of the patients at the Justinian were transportedfrom Port-au-Prince to Cap-Haitien. Orthopaedic fractures and woundswere complex. Recovery for the injured will be long and arduous,complicated by a lack of rehabilitation medicine. Living in Haiti is achallenge in and of itself; becoming a paraplegic or an amputee as aresult of the quake simply compounds the magnitude of survival.

The assessments completed by Konbit volunteers identified theneeds to be addressed. However, they also illustrated that the realchallenge, given the current reality, is to determine how to introduceand maintain the changes. Are the changes that need to take place evenfeasible in Haiti? Will those outside of Haiti continue to support theefforts that surely will need to continue for decades? The long-termoutcome of this catastrophic event is impossible to predict. Yet for theOA and MMC team sponsored by Konbit Sante, the efforts ofcollaboration and relationship building will continue. The team plansto return to Haiti in the fall of 2010.

Linda M. Ruterbories, ANP, is the Director of Surgical Services and Pro-gram Development at OA. Joanne T. LeBlanc, BSN, RN, is the Directorof Clinical Services.

18 The OA Update

The OA Update 19

By Adam Tielinen BS, CSCS and Lucien R. Ouellette, MD, FAAP

Childhood ObesityA Growing Problem

What is one of the largest growing epidemics ourcountry is facing each and every day, month andyear? If you look around at different schools,playgrounds, malls or any place a child may be,the answer is clear—childhood obesity. Accordingto the Centers for Disease Control (CDC), overthe past 20 years, the number of children who areoverweight has doubled for those aged 2-5 andtripled for those 12-19 years old. Children whoare obese have an 80 percent chance they willremain obese as adults. Most people are aware ofthe issue, but what is being done about it? Whatare we doing to fight this ongoing problem withour youth? At the current pace, our children willbe the first generation of Americans in nearly acentury to die younger than their parents.

Researchers have found many factorsassociated with childhood obesity:

•Transportation (riding rather than walking)•Sedentary activity (video games, computers, television)

•Large portion sizes, high-calorie drinks and food

•Genetics.

In addition, there are endless consequencesinvolving all facets of life:

•Decreased performance in school•Increased behavior issues at school and home•Adult-type illnesses at younger and

younger ages• Increased rate of depression and

poor self-esteem.

No part of life can escape the consequencesof childhood obesity.

So why are our children “growing?” Whatare parents, teachers and society doing to combatchildhood obesity? What examples are theysetting in their personal lives? How do we “thindown” our children?

There is no easy answer to any of these

questions. The simple explanation of balancingyour energy intake (food) with your energyoutput (activity) is easy to understand, but muchharder to apply to each choice we makethroughout the day. For a lasting answer,children need to learn lifelong skills regardingwhat the healthy choices are in the two majorareas of nutrition and activity.

Our society has molded itself into a quickservice, fast food and a constant entertainmentculture. It is very easy to access oversizedportions of calorie-dense, nutritionally poorfood or drink multiple times a day, without everleaving your car. The average daily calorie needfor an adult woman is 1,200-1,500, and for anadult man 2,000-2,500. Kids need less, but withthe average McDonald’s Cheeseburger HappyMeal having 550 calories, it doesn’t take long tosurpass this daily amount. Did you know thathealthy meals can be convenient as well?Planning and preparing meals ahead of time,

20 The OA Update

packing healthy snacks in the car and inlunchboxes, and most importantly, setting agood example by eating healthy meals andsnacks can go a long way in educating ourchildren about healthy choices. Show the childthat healthy food does taste good and can berefreshing. Keep children involved in mealselection and preparation so they understand thechoices they have in food selection. Have themhelp you prepare a healthy meal or pick outfruits and vegetables at the supermarket. Schoolshave started implementing the 5-2-1-0 model,which is easily adaptable to the homeenvironment as well. This model promotes fiveservings of fruits and vegetables each day, nomore than two hours of screen time per day (TV,computer, video games), one hour of physicalactivity each day, and no sugar sweetenedbeverages. This is an easily adaptable model thatincorporates both the nutrition and activity sideof the puzzle.

One of the biggest ways to preventchildhood obesity is to get the child moving, and

it doesn’t have to be complicated or expensive.Society again has created an environment wherefree play has disappeared and organized sportsare everywhere. In the case of healthy living andweight control, free play is best! Children need tobe outside moving and learning about theirbodies through tag, chase, made-up sports,riding bikes, jumping rope, climbing, crawling,etc. Most importantly, do it with them! Showthem how much fun exercising can be, so theydevelop lifelong skills they can use later in life.Exercise doesn’t have to be painful, but the initialtransition to an active lifestyle will be met withsome resistance. Start easy with family walks afterdinner, short trips to the park to play catch, usestairs instead of the elevator, park farther awayfrom stores to get the extra walk, and drink waterto stay hydrated instead of sports drinks that aremade for endurance athletes. Any challenge iseasier as a family!

At OA Centers for Orthopaedics, we areaware of childhood obesity and are taking stepsto fight this serious problem. With the addition

of the OA Performance Center, home of theParisi Speed School, we strive to empowerAmerica’s youth through sport and exercise.Programs are aimed towards teaching kids how to eat healthy and use proper exercisetechniques at an appropriate frequency throughmentoring and personal commitment. Inaddition, kids are taught how to set goals andlearn habits they can carry with them intoadulthood. With this positive personalenvironment, they can create healthy lifestylesand strength in character. Now that seems likethe right kind of growth for any child!

Lucien R. Ouellette, MD is a Board Certified Pediatrician and holds a Certificate of Added Qualification in sports medicine. Dr. Ouelletteworks within the OA Sports Medicine Center.Adam Tielinen BS, CSCS is a Performance Coachat the OA Performance Center. He is a memberand a Certified Strength and Conditioning Specialist (CSCS) with the National Strength andConditioning Association (NSCA).

The OA Update 21

22 The OA Update

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The OA Update 23

OA Centers for Orthopaedics33 Sewall St.Portland, Maine 04102