Why Knee And Hip Replacement Surgery Is On The Rise

Regular exercise boosts energy and cognitive skills, aids sleep, and enhances the ability to cope with stress. These benefits hinge on regular exercise; the boomers who tend to forget their body’s age while exercising or playing too rigorously, too often, may end up damaging hip and knee joints in particular.This activity and its ensuing injuries and joint damage have even brought about the coinage of a new term in the orthopedic world—“boomeritis”—created by Dr. Nicholas DeNubile, an orthopedic surgeon at the Hospital of the University of Penn.It’s the condition with which many middle- aged patients become afflicted when they’ve over-stressed their aging body parts to the point of requiring drastic treatments.

A few of the maladies diagnosed in association with boomeritis include tendinitis, bursitis, and arthritis—all conditions further exacerbated by continued activity if left untreated.Osteoarthritis, or degenerative joint disease, can be particularly debilitating and often requires replacement surgery. Until now, both knee and hip replacement surgeries used to be primarily associated with the Medicare population.That’s changing with boomeritis on the rise, according to an article by Dr. Matthew Boes, a Raleigh, N.C., sports medicine specialist. Over the last 10 years he says there was a threefold increase in knee replacements among the 45- to 64-year-old age span.Such statistics beg the question: How do you get the exercise required for maximum health and avoid trading in your human joints for manufactured ones?

Orthopedic surgeon Dr. Seth Baublitz, with Orthopaedic Specialists of Central PA, whose emphasis is on sports medicine/arthroscopic surgery, suggests that boomers be proactive in their approach to healthy joints by strengthening the muscles around the knee through low-impact fitness programs. He recommends avoiding most exercises that involve high impact and deep knee bending.“Walking,” he says, “is a simple exercise that has been shown to reduce pain associated with knee arthritis.”Biking, treadmill walking, using the elliptical machine, and swimming are also examples of low-impact exercise. A daily stretching routine that focuses on back, hips, knees, and calf muscles aids in maintaining greater flexibility to muscles and tendons that stiffen and “creak” with age and become more prone to injury.

If diagnosed with degenerative joint disease in the knee, several treatment strategies have been proven to alleviate pain and improve function, at least in the short term. Baublitz says that conservative alternatives are usually the first approach for arthritic knee pain. They include a combination of the following: patient education, weight loss, physical therapy, medications, and bracing.When these treatments are exhausted and the patient’s daily pain level affects quality of life, replacement surgery needs to be considered. Baublitz’s explanation for the rise in replacement surgery among boomers is this: “Knee arthritis can be extremely debilitating and interfere with even the basic activities of daily living. Rather than suffer with knee pain, baby boomers realize that a knee replacement typically relieves pain and facilitates a return to a healthy, active lifestyle.”He says that a return to athletic activities, such as golf, bowling, dancing, and bicycling, is very realistic; those that put stress on the knee—running, jumping, squatting—should be avoided. As far as postsurgical recovery, he says patients report “significant satisfaction in terms of pain relief around the nine- to 12-month timeframe.”

Dr. Raymond Dahl, a practicing partner of Orthopedic Institute of Pennsylvania, specializes in joint replacement and spinal surgery. Promoting preventative measures as the recipe for healthy living, he says that you can eliminate or at least put off the necessity for a knee or hip replacement by maintaining a healthy weight and exercising regularly.“The best exercise,” he says, “is low-impact aerobic activity for endurance, range of motion exercise to maintain flexibility, and strength/pain training for muscle tone.”Dahl also explains that the increase in hip and knee replacements for the boomer generation is the result of the 45-64 age group’s desire to be more active than any previous generations. Consequently, many of them continue to participate in sports and gym workouts with the same intensity they demonstrated in their 20s and 30s.“Rather than waiting,” Dahl says, “these patients are opting for hip and knee replacements at a much earlier onset of osteoarthritis to maintain their active lifestyle.” Dahl indicates that because of this, the total number of replacements performed each year is rising dramatically.Both hip and knee surgeries are executed to replace the weight-bearing surfaces of these joints. The surgeon cuts away damaged bone and cartilage and replaces it with an alloy of cobalt, chrome, or titanium and a plastic compound called polyethylene. Dahl says it’s the polyethylene that makes a difference in today’s joint replacement procedures, compared to 10 years ago; the new plastics are designed to comprise much better wear characteristics, which in turn improves the longevity of the prosthesis.“Unless you get an infection or have an accident,” says Dahl, “the longevity of the prosthesis is at 15 to 20 years. The first-year failure rate for total joint replacement is less than 1 percent.”Dahl adds that total hip replacement “is the best surgery we do, period. It has the highest satisfaction rate of all surgery and affords a less painful recovery than knee surgery.”

According to the American Academy of Orthopaedic Surgeons, “Hip replacement procedures have been found to result in significant restoration of function and reduction of pain in over 90 percent of patients.”Most hip and knee surgeries are for complete or total replacements versus partial replacements. That’s true for the knee, since it’s the largest joint and the most easily injured. Because it’s broken up into three compartments, it’s rare that only one compartment is diseased.Dahl says that the actual number for partial knee replacements is about 5 percent of all surgeries done. But for those 5 percent, the benefits include quicker recovery times, hospital stays, and rehabilitation.“Partial knee replacement,” says Baublitz, “is less invasive and requires minimal violation of the bone and soft tissue around the knee. Rehabilitation is usually accelerated, and patients often report that their replacement knee feels very much like their native knee.”However, he also notes that many patients who seek treatment for the pain caused by knee arthritis are not candidates for the less invasive surgery, since they exhibit more than one diseased knee compartment. Baublitz says that additional factors a surgeon must consider for partial knee replacement include the patient’s motion, stability, and degree of knee deformity.In the end, he says, “For reduction of pain and restoration of function, total knee replacement remains the gold standard for the treatment of knee osteoarthritis and pain involving all parts of the knee.”According to Dahl, a very narrow population may benefit from hip resurfacing—an alternative to total hip replacement for arthritis of the hip. He says that typical candidates for this procedure include younger (60 and under), thinner males. The advantage offered by this interim treatment is that it “preserves enough healthy bone to allow for future total hip replacement.”Ultimately, whether it’s through injury, excessive weight gain, osteoarthritis, or as a result of genetic factors, the degree of daily pain in either of your knees or hips will dictate your decision for replacement surgery.Joint replacement is “a surgery you ask for,” Dahl says. When your quality of life is so compromised by pain that even your sleep is disrupted, then you’re probably ready for it.

A Parent’s Guide to Youth Sports

Grab the baseball bat, goggles and soccer ball — the spring/summer sport season is here.Signing up your child for a little league team can be intimidating, especially for someone with no intramural experience. For those wondering what to expect and how to keep their kids safe, coaches and physical therapists have the answers.Change up the sports: Most of the injuries Rich Harris, director of sports performance at Cumberland Physical Therapy and Dr. Matthew Kelly, orthopedic surgeon at the Orthopedic Institute of Pennsylvania, encounter are because of overuse of certain muscles. This can be prevented by rotating sports throughout the year. So instead of playing baseball every day for an entire year, take at least one season off.Encourage stretching: “The worst thing [kids] can do is to go from doing nothing to doing their sport,” Harris said. Be sure your child is stretching before practice kicks into gear, or before a game to ensure she is warmed up and ready to go.Prepare for the season: For the more serious child athletes, consider prepping for the sport before league sign-ups. Harris recommends doing strength and flexibility training three months before the sporting season begins. The more physically fit children are, the less risk they run of hurting themselves while playing.Consider weight training: This is only for those ages 8 and older, and only to be done with caution. Kids should not be lifting too much weights, and never to the point of being exhausted. “They should be focusing more on technique, on how the lifts are done,” Harris said.Focus on agility: One of the most important areas for kids to focus on is agility and dexterity, Kelly and Harris said. Kids between ages 8 and 12 are not in control of their body movement as much as teens and adults, Harris said. “The better their agility, the better their body control, the better they’ll perform,” he said. In edition to better performance, being more agile can prevent injuries, especially ACL (anterior cruciate ligament) ones, Kelly said.Choose a technique-based program: “Kids should be taught the sport properly,” Kelly said. “If a person is taught to swim a stroke properly or throw a baseball properly there is less of a chance of them having an injury.”Don’t wear them out: While your child might seem like an inexhaustible bundle of energy, truth is that he tires out, too. Children should never get totally exhausted while playing a sport. Once they are fatigued they run more of a risk of getting injured, Harris said.
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What to expectTechnique training: Rome wasn’t built in a day and neither are good athletes. A lot of practices will be devoted to learning simple techniques, especially for those just starting a sport. Rusty Owens, swim teacher at Colonial Golf and Tennis Club and International Swimming Hall of Fame award winner, spends many practices just teaching kids proper strokes and breathing techniques, which might seem tedious for parents who just want to see their kid racing around a pool.Exercises in patience: Kids don’t have the longest attention span and so chances are they will not be fully focused during the big game. “Parents can expect to see them dig in the dirt, picking the dandelions,” Rob Shaffner, president of the Susquehanna Twp. Baseball Association, said. The coach and their volunteers will be doing their best to have them pay attention, but sometimes it can be a losing battle.Investments in equipment: Many local leagues try to make the sport as inexpensive as possible but be prepared to pay for necessities. Susquehanna Twp. Baseball Association provides a jersey for the athletes but parents are expected to purchase a glove. When it comes to swimming, Owens asks his students to have non-baggy swim suits and good goggles.Position rotations: Intramural sports and little leagues are all about providing new experiences for kids. So don’t expect your young child to have an exclusive position. “Johnny may be first base in the first inning, but left field in the second,” Shaffner said. “That gets them to know the other positions.” As children get older they will become more specialized. But when they start out, it’s all about trying every position out.Time spent at practices: This is especially true with younger children. Shaffner prefers parents to be at practices rather than simply dropping their children off. That’s because practices vary on end times (Shaffner bases it on the child’s energy levels and focus abilities). But the important thing is to be there if a child is hurt. “If a player gets injured they’re looking for their parents,” Shaffner said.Lots of fun: As cheesy as it sounds, fun is the name of the game when it comes to kid sports. “The kids have to have fun,” Owens said. “They have to want to go to practice, especially young kids. I want them to be happy.”
Story ContributorsRich Harris, director of sports performance at Cumberland Physical Therapy.Matthew Kelly, orthopedic surgeon at the Orthopedic Institute of Pennsylvania.Rusty Owens, swim teacher at Colonial Golf and Tennis Club and International Swimming Hall of Fame award winner.Rob Shaffer, president of the Susquehanna Twp. Basball Association.

On the Disabled List?

If you think you broke it or sprained, bruised, pulled or somehow hurt it, local urgent care sports medicine facilities can get you back in the game without the time and expense of an emergency room. At least four facilities in the midstate help injured athletes of all stripes – from competitive and scholastic athletes to recreational players and home gardeners – receive immediate attention for their sports-related injuries.The five-day-a-week, 12-hour-a-day Orthopedic Institute of Pennsylvania’s Injury Clinic on the West Shore makes same-day appointments and takes evening walk-ins, while the East Shore is home to the once-aweek walk-in Rapid Access Sports Medicine operated by Aspire Urgent Care and Family Medicine.In York, Orthopaedic and Spine Specialists offer a seven-day-a-week walk-in Orthopaedic Urgent Care Center with sports medicine specialists on staff. Wellspan also staffs an orthopedic injury clinic that’s open six days a week.”It’s an offshoot of urgent care that’s more specialized. It’s less red tape, less waiting usually,” said Dr. David Joyner, director of Aspire’s venture, part of its plan to create a “home for wellness” focusing on urgent care, preventive medicine and fitness.”It really does cut down on the time from injury to defined treatment,” said Dr. Curtis Goltz of OIP. “We can do everything here from a sprain to a complex fracture, an MRI, a brace, a cast, surgery. We take care of it all.” Avoiding a trip to the emergency room can save on time and costs – insured patients’ copays are typically lower at a doctor’s office or urgent care center instead of at an emergency room-but the ability to see sports medicine professionals on injury day is often the draw for local athletes.OSS opened its clinic as area orthopedic practices became “overloaded, constantly getting calls the same day, calls from athletic trainers saying, ‘see my athletes,'” said Dr. William Ulmer, one of its sports medicine physicians.Goltz added, “One of the first questions I ask is, ‘Are you an athlete. what do you play, when is your next practice and next game?’ You have to be cognizant of that.” “We know what kids can play through, when they need to be sat out and how to get a kid back to a game in a timely fashion,” Ulmer said.Treatment without a sports focus might result, for instance, in athletes being given basic instructions of rest, ice and Motrin, said Dr. David White, Aspire’s co-owner.
“It really does cut down on the time from injury to defined treatment. We can do everything here from a sprain to a complex fracture, an MRI, a brace, a cast, surgery. We take care of it all.”
“For someone actively training, that can set them into an unnecessary world of panic,” since they might be able to continue training during therapy, he said. “Our goal. is to keep people functioning at the highest level possible in the context of their injury or illness.” In fact, Joyner, with a long history in sports medicine including a stint as head physician to the U.S. teams at the 1992 Winter Olympics, described sports medicine as “a way of thinking” more than anything else.”I want to keep you active while protecting you sometimes from yourself. I understand and empathize with the fact that you define what your life needs to be rather than the physician,” he said. “Whether they’re young or old or competitive, they’re interested in keeping going. You have a motivated patient population.” It doesn’t mean, though, that doctors allow a athlete’s desire to play to trump an injury that will worsen or cause long-term complications with game time.”It’s not uncommon that you’re standing in front of a family and athlete with states coming up and, oh, they so want to be there,” Goltz said. “Sometimes I have to remind them. there will always be another tournament, another game. It’s not always about the next game. That’s tough.” While the facilities see all levels and ages of athletes and a variety of injuries, they’ll soon hit a busy cycle with November’s Harrisburg Marathon, which Aspire is sponsoring this year, and the official start of school fall sports.”A week from now we’ll be overloaded with sport injuries,” said Ulmer, who readily works extra hours the first two weeks of the season. “That’s my favorite part of the year. They’re great patients.” Goltz agreed, noting that OIP started its clinic because it hated turning away injured patients at the close of typical office hours.”Everyone we see is in pain; it was so hard to say no,” Goltz said. “Now it’s funny, they are probably our happiest patients.” All of the facilities are looking to expand either hours or locations as people budget their time and health care dollars but want expert care quickly.”As long as there’s a need they’ll exist,” Goltz said of urgent care centers and their offshoots. “It’s [like] tapping the finger while you watch microwave popcorn. People need to be seen today.”

Going Deep

He played baseball and football in high school, took up tennis as an adult, and played competitive baseball well into his forties.But at age 47, Dr. Jack Frankeny realized a change was in order.”I looked at my wife and said, ‘I’d rather be hiking at 70 than rebuilding my knees,” said Frankeny, an orthopedic surgeon at the Orthopedic Institute of Pennsylvania.So he decided to give up competitive sports, and segway into a more leisurely set of athletic activities.Dr. Jack Frankeny put away competitive sports at age 47 and now focuses on activities such as lifting and running.”Giving up the rush of competing was hard, but I think when I’m 70, I’ll be glad I did,” Frankeny said. “As a orthopedic surgeon and an aging athlete, I realize you get only so many beats to your heart and definitely only so much pounding on your joints.”Today, Frankeny runs, bikes and lifts weights on a regular basis, but tempers his routine based on how his body feels.At 55, he now cycles more and runs less because he’s hindered by an occasionally sore back, and some nagging arthritis in his hip.”I was lucky enough to get good advice from my dad: When you turn 40, God gives you a pain, and it never really goes away. It just moves around, depending on the latest problem,” Frankeny said, laughing.Still, the good doctor is hoping to set an example for all: “keep exercising till you die, but adapt what you can do.”Yes, it is possible to age gracefully if you listen to your body.”An athlete is basically anyone performing a physical function, whether it is competitive or not,” Frankeny said. “Some compete against each other, others compete against themselves. There’s a tremendous genetic component to [a person’s] ability to be a master’s athlete.”Some people are built in a way that allows them to perform for a long time, and in spite of the greatest willpower, you may not be able to do that. So you have to have a certain flexibility if you want to continue exercising and competing.”With 43 percent of the population in Pennsylvania now aged 45 and older, dozens of aging athletes file in and out of Frankeny’s office regularly with an assortment of different maladies.Welcome to the era of Boomeritis, otherwise defined as the study of injuries to older athletes, often those part of the baby boomer generation, now aged 55-70.”Those of us from the boomer generation, we were raised as athletes, different from previous generations,” Frankeny said. “We’re much more athletic than our parents were, and we try to stay more active than our parents ever did.”There’s a whole bunch of literature out there on boomeritis – aging boomer athletes and what’s happening to us now.”As University of Pittsburgh Medical Center orthopedic surgeon Vonda Wright puts it, the aging body isn’t just “a bad sequel of your 20-year-old self.” Aging changes the body, but aging athletes frequently fail to pay attention to these subtle nuances.”We think we’re still young, and sometimes we try to continue performing as though we were young,” Frankeny said. “Then many of us are astounded when something goes wrong. “Basically we overdo it, over train and over-exercise.”
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Secrets to staying activeThe effects of aging include a decrease in the amount of air the lungs can hold (that’s why it takes more energy to breathe as you get older), a decline in maximum heart rate, a loss of bone density, and rise in body fat composition.The good news is that regular exercise can help to slow the aging process. The trick lies in finding the right combination of frequency, intensity and activity.From a musculoskeletal standpoint, overuse injuries are common in older athletes because muscles and tendons become less flexible as the body ages.”After the age of 30, strength and muscle mass decreases at a rate of 1 percent per year,” Frankeny said. “At 25, you can get away with anything, but at 45, you’ll most certainly get hurt if you overdo it.”Bone strength peaks at about 30, then declines. By the time a person is in his or her late forties, Frankeny says the body’s innate ability to heal itself has also declined. Common ailments at that point include rotator cuff problems and other shoulder issues, especially in athletes from sports such as softball, baseball, tennis and swimming, where the overhead motion is crucial.As people hit their sixties and seventies, arthritis starts to kick in. Still, there are ways for athletes to stave off the effects of aging.Wright, who founded the Performance and Research Initiative for Masters Athletes (PRIMA) out of UPMC, recommends a total body approach to conditioning for all masters athletes. “I call it ‘facing’ your future,” she said.To make an easy-to-remember slogan, Wright has broken her “F.A.C.E” approach into four categories: Flexibility, aerobic exercise, carrying a load, and equilibrium and balance. Muscle fibers shrink and get tighter with age, and tighter muscles limit a person’s range of motion while also making an athlete more susceptible to injury, so flexibility is crucial for the older athlete.To maintain flexibility, Wright recommends that athletes under 65 stretch each muscle group for 30 seconds every day. Athletes 65 and above should hold each stretch for a full minute. In terms of aerobic exercise, Wright stresses that while any kind of activity will benefit your body, you could do much better than a leisurely walk after dinner. The idea is to challenge your body and get your heart rate up.”You need intense exercise every other day,” Wright said. “So if you’re going to walk, you’re going to walk at 90 percent effort for three minutes, then back off and recover for a minute and then rev it back up.”The “C” in the acronym stands for “carry a load” and invokes the benefits of weight bearing exercise. Research has shown that weight training can help seniors slow the rate of muscle atrophy, and to maintain bone density. Wright stresses functional movement exercises and free weights over weight machines.”Weight machines are ridiculous because they move your muscles in one plane of motion and do not involve gravity,” Wright said. “They are totally non-functional.”In the PRIMA program, UPMC director of sports performance Ron DeAngelo stresses body weight exercises, and the use of resistance bands.”You can build strength using your own body weight,” DeAngelo said. “And when you are able to master that, that’s when you add weight to whatever you’re doing. “You want to train the way you’re going to use your body.”Maintaining equilibrium and balance is equally important.As Frankeny puts it, “I’m 55, and I can attest that my coordination and ability to protect myself from falling has clearly declined.”According to Wright, a person’s sense of balance starts to decline age 25, and after the age of 65, one in three people will fall as they go through their day-to-day activities.”Neuromuscular pathways between our brain and muscles degrade so that our ability to tell where we are in space declines,” Wright said. “So we just need to retrain our balance every day.”As I tell my patients, stand on one leg and brush your teeth or wash the dishes. It’s just a matter of getting the body to challenge itself balance-wise.”AdaptingBut as Frankeny has demonstrated, aside from making sure you maintain your overall fitness level, choice of activity also goes a long way toward preserving your body’s physical longevity.”I see folks who retire at 65 and say, ‘We want to do the skiing we didn’t have time to do before,” Frankeny said. “I hear that and I think, ‘Oh God, let me just tattoo my name on your back.’Older skiers are more likely to fall and break something because of the decline in coordinator and neuromuscular control, and the doctor has treated plenty of skiing injuries in his time.”I think there should be a law that says no one should be able to ski after 60. How about sledding or tobogganing? It’s the same thrill, but it’s so much safer. Gear down and switch to what an aging body can do,” Frankeny said. “If you have an aerobic gift and you adapt to another sport, you can probably achieve the same degree of accomplishment and keep the juices going.”Frankeny recommends that older athletes avoid sports that require any sort of impact – like basketball, for instance – and controlled falling.”Sports that involve more than one competitor in the same space, where they can trip each other, should also be avoided,” Frankeny said.Instead, aging athletes should look into taking up sports where they can control as much of their environment as possible – where you ride or run, what shoes you wear, what terrain you do. That’s why running, biking and swimming attract many older competitors, and tennis and golf have long been established as lifelong activities.Of course, switching sports doesn’t guarantee that you’ll avoid injury completely. The road rash all over the right side of Frankeny’s body is the result of an ugly spill he took on his road bike recently as he was trying to make a tight turn.It is testament to the fact that accidents happen, and if you play sports, you have to resign yourself to the fact that you’re going to get hurt.In his humorous, self-deprecating way, Frankeny wonders aloud whether he would have been coordinated enough to complete the turn and avoid the fall 10 years ago.”Probably yes,” he says. “But despite the fact that I’m still purple, I’m OK.”Senior athlete status or not, he’s still moving, and in a pretty functional manner. At the end of the day, that’s really all that matters.

Renovated Orthopedic Department Looks Good and Delivers Positive Outcomes

Holy Spirit’s newly renovated orthopedic unit is a well-kept secret that is meant to be shared far and wide, according to William Polacheck, M.D. The hospital’s Chief of Orthopedics wants the community to know that the sixth floor dedicated unit offers private rooms, boasts low rates of infection and re-admission, and provides a comprehensive pain management program that uses less narcotics, while delivering more comfort and fewer complications.“Holy Spirit’s orthopedic unit is a beautiful facility,” he says. “They have done a lot to improve the patient experience, including providing dedicated orthopedic nursing.”The 23 patient rooms (most are private) are spacious, bright and feature large windows, private bathrooms, and 32-inch flat screen TVs.“The rooms are large enough to accommodate orthopedic equipment and visitors and still allow for the patient to move around easily,” says Jynae Foulk, RN, MSN, CLNC, Orthopedic Service Line Manager.Possibly more important than the renovated unit, are the Orthopedic department’s low infection rates. In 2008 the rate of infection for both total knee and total hip procedures was about one for every 100 procedures performed.“Our numbers in Orthopedics have been great for years and nobody knows that,” says Dr. Polacheck. “We need to get it out in the community that our [infection] rates are excellent by any standards.”The department’s successes began with an experienced team of physicians, including surgeons and anesthesiologists, who have practiced with Holy Spirit for many years. Jesse Hoover, MD, whose anesthesia group provides comprehensive pain management, meets with patients prior to surgery and explains their options for anesthesia, including the use of different anesthesia techniques and medications, which make a tremendous difference in both post operative pain and nausea.“We focus on anesthesia from many directions,” says Dr. Hoover. “Instead of relying on a large amount of one drug, we give smaller amounts of several drugs that work together to provide greater pain control and less post operative nausea, which is something patients really appreciate.”The department also offers an optional educational program known as the Total Joint Experience. The class is led by Nancy Hoffman, RN, who walks patients through everything they can expect with joint replacement surgery, prior to entering the hospital.“The nurse leading the class discusses routine procedures, pain control, equipment, even what to expect from a nursing assessment,” explains Lisa Lewis, MSN, RN, NEA-BC, Vice President, Patient Care Services. “The session makes it possible for patients to prepare things at home prior to surgery and think about what will help them with the healing process.”They also view a video that features Holy Spirit therapists discussing the role physical and occupational therapy will play in their recovery. The video also helps to relieve anxiety prior to surgery, according to Chris Bodle, MSPT,Clinical Manager of Inpatient Therapy Services.“Many times, the patients will see the same face [in the video] that they will see after surgery,” he says. “They know what to expect and folks seem to progress better.”
“We do a lot of procedures where we go through the abdomen to the front of the lumbar spine and then turn the patient and do a reconstruction on the back of the spine,” explains Dr. Wolf.
That continuity of care also is prevalent in the therapy services provided after surgery, both at thebedside and in the satellite clinic on the orthopedic floor. The therapy staff rotates every eight weeksthrough the satellite clinic.“We get good continuity of care and develop relationships with the physicians,” adds Bodle.Patients who undergo joint replacement surgery receive physical therapy twice a day, seven days a week. Care begins at the bedside, but as soon as appropriate, the patient moves to the clinic to work on activities such as stairs and balance exercises.“The occupational therapists work with patients in the satellite clinic as well,” he adds. “There the patients can simulate their home routine.”Seeing total joint replacement patients every day means function improves more quickly and patients return home sooner, according to Bodle.“Once a patient is sent home, Comfort Care Home Health picks up the care until they progress to where we can see them in one of our many outpatient rehab clinics in the community.”All of the Orthopedic services and amenities came out of the work of an advisory committee formed to increase communication between hospital administration, orthopedic surgeons, nursing, therapy and other clinicians.“It gives us very strong clinical and administrative collaboration,” explains Lewis. “It really is an interdisciplinary way to look at the quality and outcomes of our program and continually improve.”

Heroes Among Us: Part 2

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Even after being there and witnessing the devastation firsthand it is still hard to fathom the depth of loss and grief. In the two weeks that I was there I learned more than I ever thought I would about Haiti and myself. The images and stories are haunting. As we passed through the marketplace of Port au Prince on our way back to the airport there were signs of life returning to “normal.” I couldn’t help but think that it was all a facade of the true underlying corruption and suffering of this tiny land.There were 271 patients living in tents and each was permitted to have one family member live with them. Inevitably, the number of family members was usually more than one, so at any given time there were about 600 displaced people living in the tents. I was assigned tent row 10 and was responsible for the nursing care of 36 patients. The injuries were varied but most included external fixation, infections, grafts, failed grafts and amputations along with some internal medicine patients. As you can imagine, Post Traumatic Stress Disorder, in varying degrees, was very common.I was lucky enough to be included as a nurse volunteer representing Operation Smile at a field hospital in Fond Parisien, Haiti, a village forty five miles east of Port-au Prince.My friend, Robin Kingston, a pediatric nurse practitioner at Hershey Medical Center, and I lived, worked, cried, laughed and prayed at the camp located on the Love a Child Orphange grounds for twelve days. The hospital was founded just days after the earthquake of January 12 in a joint venture by the Dominican Republic, Harvard Humanitarian Initiative, Operation Smile and Love a Child.
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There were volunteer health care workers from around the world, each one of us working out of our comfort zones professionally and personally. The heat was oppressive, the sun unrelenting, until the evening when a refreshing breeze would usher in perfect sleeping conditions for our weary bones. We slept on the ground in sleeping bags in ample sized Eddie Bauer tents. Our showers were cold bucket showers behind tarps while looking up at the most beautiful night sky I have ever seen. We were provided one hot meal daily that was beans, rice and special sauce of the day, which usually included sardines!Before the quake, life in Haiti was more difficult than any of us could ever imagine. Now, they face an even more uncertain future buoyed by their unwavering faith and tenacious spirit. It was an honor and my pleasure to serve the gracious, resilient, lovely citizens of Haiti. I hope to return one day. Please pray for Haiti and its people.

Heroes Among Us: Part 1

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The ecological difference between Haiti and the Dominican Republic is starkly visible from 32,000 feet.The Dominican Republic on the eastern half of the island the two Caribbean countries share, is beautifully green. It’s neighbor to the west, Haiti, is brown, thanks to clear cut forests and decimated ecosystem.This was the first thing Dr. Jack Frankeny and his wife, Beverly, noticed. The Greenwood Twp. Juniata County, couple landed in Haiti’s capital, Port-au-Prince, on April 9 to serve as surgical volunteers. The closer they got to Carrefour, a Port-au-Prince suburb where the Adventist hospital was located, the more they saw the effect of the January 12 earthquake.“We’d get closer and closer and closer and closer, and we’d start to see the shanties and the tent camps,” Jack explained. “ We noticed a lot of blank faces; traumatized, vacant stares.”From April 9 through 16, the Frankenys helped Haitians with surgical issues,which ran the gamut from tumors to arthritis to amputations. Half of those the Frankenys assisted were victims of the earthquake, and the other half were people who never before had access to medical care.After the earthquake, the Haitian government offered free treatments to anyone in need, not just those injured by the quake. Some would come into the hospital and pretend to be a victim in order to receive care. The Frankenys did everything to reassure those in need that they would receive care.”You could just tell based on their appearance [that some weren’t affected by the earthquake],” Jack said. “All you could do was reassure them that they were going to receive care.”Jack is an orthopedic surgeon at the Orthopedic Institute of Pennsylvania. He first learned of the World Surgical Foundation, the Harrisburg-based group the Frankenys traveled with, through a colleague, Dr. Dom Alvear, the group’s founder.
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When Jack approached Beverly, an orthopedic nurse, about going to Haiti, she put aside her reservations and was all for it. “We had done small donations, but I prefer to be hands-on,” she said.They had three weeks to prepare for the trip and arrange for someone to take care of their hobby farm. Several inoculations later, they were ready to go.Despite the hardships the couple saw, there were moments of happiness. Beverly’s camera became a favorite of the Haitian children, who enjoyed having their photos taken.”You would take the photo, and they would want to see it. Once they saw it, their faces lit up,” Beverly said.Many of those photos made their way to Beverly’s blog, ImagesofHaiti.Blogspot.com, and each tells a story—some sad, some of hope. One of the photos was of new life.”Jack delivered his first baby,” Beverly said. It wasn’t something the doctor expected, but Jack said, “We did whatever was required.”The conditions weren’t optimal. In surgery, an attendant would use an electric fly swatter to keep insects away. Implements, gloves, gowns and other supplies often were recycled due to depletion fears.It bothers the Frankenys that they had to leave without being able to follow up to make sure some of the surgeries were a success, but they would be able to follow up with doctors there.The trip to Haiti made the couple grateful for what they had. “Nothing could justify unhappiness” after what they were privy to witnessing.”They’re nice people,” Jack said. “They are a positive, loving people—it’s innocence in hell.”

Running & Health Over 40

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It’s not a sprint; it’s a marathonThat age-old adage is underscored when listening to mid-state runners older than 40 who regularly participate in the region’s toughest races.Some can tell their running pace has slowed. Others admit they need more time to bounce back after a race than they did at a younger age. And yet others go full-steam ahead after crossing the finish line – enjoying dinner, doing laundry and even packing for vacation right after they compete.All run with a passion but pay particular attention to the needs and limits of their changing bodies.”My brain keeps saying go faster but my body says hell no,” laughed Hap Miller, who has participated in 33 of 35 Harrisburg – area marathons and still shoots to run one race each year. “The minute I stop then I’m going to feel old. Running helps you hold on to that younger feeling.” That age-old adage is underscored when listening to mid-state runners older than 40 who regularly participate in the region’s toughest races.Perhaps there’s truth to that. “People say I look a lot younger. They are surprised to hear I’m 64,” he said. Miller has competed in 27 other races, including nine Boston Marathons.”I now average about an hour slower than 20 years ago, but I like to get under four hours. I hope to get back (to Boston) within the next year or two,” said the Carlisle retiree. “I can’t put it off too much longer.”As Miller and other Harrisburg-area marathons adjust their running goals during their later years, they remain humble about their accomplishments, reverent about the positive changes that the sport has brought them and determined to keep running as that benchmark 40th birthday fades in the distance.Body changesRunners typically peak in their performance between age 25 an 35, said Matt Silvis, a primary care sports medicine physician with Penn State Milton S. Hershey Medical Center. “After that, you are looking at someone who no longer is going to perform at the same level.”Muscles and tendons tighten with age. Adults older than 40 start to lose bone mass and will see cartilage change in their joints. On top of that, runners often ignore nagging injuries, compounding the consequences. “It starts to add up,” Silvis said. “It can affect your performance and heighten your risk of having injuries.”Silvis cited a recent study showing that those over 40 had more muscle, hamstring, quad and calf strains than those under 40. Up to 90 percent of people preparing for a marathon will suffer training injuries that cause them to miss part of their training, he said.That’s no surprise to the folks pounding the pavement.”I get a little stiffer than what I used to,” said Marjorie Lebo, 47 of New Cumberland. “I take my fair share of Advil. I’m definitely a little slower, but I’m OK with that. …All of us are darn lucky to be running.”Lebo, a certified registered nurse practitioner at Hershey Medical Center, has been running for 30 years, with 27 marathons – including 11 in Harrisburg – under her belt. While lifting free weights combats her time loss and maintains core strength, she has adjusted her training over time. She used to run five to six days a week; now it’s four. Other runners say they’ve made changes, too. Miller cut back on weekly miles and scheduled more brisk walking.Silvis stressed that the over-40 crowed must stretch regularly, maintain good flexibility and even take off a week. “I’d rather be 90 percent in shape than 100 percent injured,” said William Demote, 55, of Hummelstown, who started marathon running 10 years ago.But why run when it can be so tough?It’s so addictiveJim Hon, 44 of Dillsburg regularly runs 80 miles a week, logging 80,000 miles over the years.”If I were a car, I’d be trading myself in right now,” joked Hon, who has racked up 78 marathons in 27 years and runs eight to 10 a year. “My doctor always told me there are only so many marathons that any one person has in his body, and I’ve already blown that curve.”Hon started running in high school to lose weight. “I fell in love with it. It totally became an addiction and part of my life.’ He hoped to compete 50 marathons before he turned 40; he did so within a month of that birthday. “So I thought, let’s see if I can double that in the next 10 years” (100 marathons before 50), he said.Hon and his wife often plan winter vacations around marathons, in scenic warm-weather climes like California’s Big Sur Marathon, billed as “Running truly has been a blessing.”Everyone began running for different reasons. With Honchar, it was weight. Miller listed weight and smoking. It served as a moms’ social activity for Elizabeth DeSousa, 45, of West Hanover Twp., until she decided to leave a legacy of sorts.Area medical professionals and marathoners offer these tips to lead you to the finish line for the first time:Get a full physical.Consider pre-training counseling with a pro who deals with runners, like sports medicine physicians.Consult www.runnersworld.com for beginner training programs.Seek quality running shoes at local shoe stores that work with runners.Build up your mile counts slowly, over four months to a year depending on your comfort level. Initially set goals at a few miles a week and include time to walk.Start with shorter races and work up to a marathon.Get involved in a running club (such as Harrisburg Area Road Runners Club) for weekly runs, support and pointers. Seewww.harrc.org for details.Eat sensibly and stay hydrated.Vary running routes to maintain interest and prevent injuries from running the same grades, ruts and bumps repeatedly.Take a day off each week from running.Getting older, Changing goalsWhile SeSousa and Honchar have yet to notice the aging process, chances are their running goals will change as they grow older.”I went from just finishing to qualifying for the Boston marathon – and today I’m back to crossing the finish line,” said Andrew O’Donnell, 62, of Hummelstown, who has run about 46 marathons since 1978, including three in Boston. “It’s back to the future.””You have to slow down as you get older,” he added. “I made a conscious decision years ago not to run for a time any more but just for the pleasure of crossing the finish line.”DeMuth started marathon running with the goal of qualifying for Boston, he said, He missed it his first time by eight minutes. “At the time it was like climbing a mountain those last few minutes,” said Demuth, who has run Boston three times and wants to qualify again. “It is physically harder. Our bodies can’t generate the speed we did years before.””I wish age didn’t make a difference, ” he lamented. “Once you hit 50, for most of us our performance will slowly decrease because our tissue changes. The biggest change is that you have to listen to your body.”Bodies speak loudly. “I learned from practical experience,” said Demuth, an orthopedic surgeon with Orthopedic Institute of Pennsylvania. “I did too much, and got injured.”Road to recoveryRecovery after a race is as individual as the runner, but growing older can change that routine, too.”The old body is sore a lot longer,” Miller said. “Sometimes it’s only a day or two recovery when you’re young. When you’re older it’s considerably longer. You lose flexibility, the soreness lingers. it’s inevitable; 26 miles of anything is taxing.”DeSousa envisions her recovery plan while running. “Once I’m through the chutes, I shower, have a margarita and steak dinner. I think about that as I run – go to that margarita in front of me.”Leaving youth behindAlthough runners compete in age groups during events, they’re all on the same course at the same time. Honchar gets a kick out of passing those half his age. “You give a nice smile and a “Hey how are you doing?” and you look like you’ve just run your first mile. They look at you like, “You’ve got to be kidding me.’ It’s a nice payback,” he said.Lebo said she would check her competition’s progress years ago. Now, she’s competing against herself to qualify for Boston, she said. “I’m far less competitive. I can be more encouraging now to other runners than I was 25 years ago.”DeMuth “just loves to be up there running,” but, he admitted, “If everyone around me looks younger than me, then that’s a pretty good day.”Finish lineRegardless of the individual goals and the hurdles overcome, crossing the finish line retains tremendous impact for marathoners.”It’s an incredible feeling of accomplishment, elation and joy,” Honchar said. “You have a feeling that you can’t be more alive at that point.”In the last few Harrisburg marathons, Lebo’s sons have run the final mile with her for moral support. “It’s such a good feeling of accomplishment, knowing you’ve got so much going on in your life and you’ve able to do this,” she said. “Knowing my kids are going to be there, I wouldn’t want to not show up. Oh, the embarrassment that would be.”While family support is crucial, marathon running is very individualized sport. “I don’t want anyone to think that running a marathon is a family event,” said O’Donnell, a part-time annuitant for the state Public Utility Commission. “Try to imagine a family coming to watch for four hours in the pouring rain. It’s important to have support but don’t expect participation.”Those adverse conditions can make the finish sweeter. “The harder it is, the move you’re going to be glad to cross the finish line” O’Dennell added.Reaping rewards after a raceLebo has channeled her love of the sport into helping others. Through the Harrisburg Area Road Runners Club, she serves as a race director, setting up 5K runs for Domestic Violence Services of Cumberland and Perry County. She has done the same to raise funds for colon cancer prevention with Hershey Medical Center.The marathoner’s confidence has carried into Honchar’s professional and personal life. “It has helped me manage emotions and really have a lot of self-esteem,” he said. “It’s let me really be thankful for every day I’m alive.””It has literally changed my life,” DeMuth concurred. “I have an intense sense of accomplishment for doing it. If you had goals that seemed insurmountable, the discipline… is instrumental in reaching those goals. It carries over into other things.”