Down to the Bone - Blue Ridge Surgery Center

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Down to the Bone - Blue Ridge Surgery Center

Founded 1982www.broa.comBlue Ridge Orthopaedics Associates, PA10630 Clemson Blvd., Ste. 100Seneca, SC 29678Phone: (864) 482-6000Fax: (864) 482-7000Blue Ridge Surgery Center10630 Clemson Blvd., Ste. 200Seneca, SC 29678Phone: (864) 482-5100Fax: (864) 482-9100Blue Ridge Orthopaedics Associates, PAAnMed Cardiology &Orthopaedic Center100 Healthy Way, Ste. 1200Anderson, SC 29621Phone: (864) 260-9910Fax: (864) 328-1451Opening RemarksDear Friends,IRidge Orthopaedics. Our opening issue was met with consid-erable praise and approval from our audience of wonderful patients and the localmedical community, and it goes without saying that your support is integral in ourcontinued success in providing quality orthopaedic care in the region.In this issue, we continue to produce articles of interest. We also take this opportunityto introduce you to some very important members of our team, our physician assistants,as well a new addition to our orthopaedic surgery staff.Thank you again for your continued support and generous praise of our efforts withthis magazine. We remain dedicated to providing the highest standard of care for ourpatients. We hope you enjoy this issue of Blue Ridge Orthopaedics.Sincerely,It is with great pleasure that the physicians and staff of BlueRidge Orthopaedics introduce you to our second issue of BlueFounderLarry S. Bowman, MDPresidentSean McCallum, MDSecretary/TreasurerJohn H. Murray, MDP. Sean McCallum, MDBlue Ridge Orthopaedics is an educationaland informative resource for physicians,health care professionals, employergroups, and the general public. BlueRidge Orthopaedics’ goal for this publicationis to introduce its staff and facilitiesand provide a forum for communicatingnews and trends involving orthopaedicrelatedinjuries and treatments, as well asother health-related topics of interest.The information contained in this publicationis not intended to replace aphysician’s professional consultationand assessment. Please consult yourphysician on matters related to yourpersonal health.Blue Ridge Orthopaedics is published by QuestCorpMedia Group, Inc., 885 E. Collins Blvd., Ste. 102,Richardson, TX 75081. Phone (972) 447-0910 or (888)860-2442, fax (972) 447-0911, www.qcmedia.com.QuestCorp specializes in creating and publishing corporatemagazines for businesses. Inquiries: Victor Horne,vhorne@qcmedia.com. Editorial comments: BrandiHatley, bhatley@qcmedia.com. Please call or fax for anew subscription, change of address, or single copy.Single copies: $5.95. This publication may not be reproducedin part or in whole without the express writtenpermission of QuestCorp Media Group, Inc.4681113In This IssueDown to the BoneArthritis treatments aim to relieve painAnesthesia TodayTraining, techniques, and monitoring reduce complicationsA Biologic Method of Cartilage RepairNew therapies help heal damaged knees‘ReSTORing’ VisionBreakthrough technology provides clarity without glassesHelping HandsPhysician assistants improve many medical servicesBlue Ridge Orthopaedics3


Down to the BoneArthritis treatments aim to relieve painBy W. Bruce Richmond II, MDArthritis simply means painful joint.There are many known and suspectedcauses of arthritis, but the most commontype is osteoarthritis, also known asdegenerative joint disease. Osteoarthritisaffects more than 40 million people inthe United States and is a leading causeof physical disability. In the next 15years, the number of people affectedby osteoarthritis is expected to increaseto more than 60 million people. Osteoarthritismainly affects load-bearing joints,such as those in the knees, hips, and spinebut can affect any joint in the body.The exact cause, or causes, of osteoarthritisis unknown. In the past, manyphysicians regarded it as an inevitableresult of aging. Little could be doneexcept for using a cane and taking aspirinor acetaminophen. The results of recentresearch provide physicians with manynew therapies and options for treatingosteoarthritis. When a painful joint failsto respond to simple over-the-counterremedies such as acetaminophen, topicalcreams, glucosamine, or nonsteroidalanti-inflammatory drugs, it is time toseek professional help.Causes, Symptoms, and DiagnosisNormal healthy joints are composed ofsmooth surfaces on the ends of bonescalled articular cartilage, joint fluidcalled synovial fluid, and the joint capsulelined by synovial cells. The articularcartilage lacks a blood supply and gets itsnourishment from the synovial fluidsecreted by the synovial cells of the jointcapsule. In joints affected by osteoarthritis,the articular cartilage begins todegrade and break down. The joint fluidbecomes less oily due to the decrease inhyaluronic acid (more on this later), andthe joint capsule becomes inflamed.The patient may experience joint paindescribed as a dull ache with sharp painon sudden movements, swelling, and/orstiffness, especially after a period ofimmobilization such as riding in a car,sitting in a movie theater, or getting outof bed.Arthritis symptoms usually come ongradually over several weeks or months.Sometimes the pain may be brought onby a recent fall or twisting.The physician’s first priority is to makean accurate diagnosis because not all4 Blue Ridge Orthopaedics


joint pains are caused by osteoarthritis.Tendinitis, bursitis, infection, stress fractures,avascular necrosis, meniscus tears,herniated disc in the spine, and cancer(rarely) can also cause joint pain. Yourphysician will need to take a detailedhistory, perform a physical exam, andpossibly order diagnostic tests (x-rays,lab tests, CT scans, or MRI scans) toform a diagnosis.Treatment OptionsIn reality, there is no cure for osteoarthritisbecause the exact cause or causes areunknown. The focus of treatment is onrelieving pain and stress and reducingdamage to the articular cartilage.Weight reduction of as little as 20 lb cansignificantly relieve arthritis pain. Lowimpactexercises such as water aerobics,walking, and swimming help keep thejoint fluid healthy to provide needednutrients to the articular cartilage. Somepatients are candidates for specialunloading braces to shift weight to lessinvolved areas of the joint.New surgical techniquesand refined implantsare improving the qualityof life of patients withosteoarthritis.Medial management ranges fromacetaminophen for mild osteoarthritisto nonsteroidal anti-inflammatorydrugs (NSAIDs) for moderate tosevere osteoarthritis.The effectiveness of the over-the-countersupplements (neutraceuticals) glucosamineand chondroitin sulfate arecontroversial. Some medical studiesclearly showed improvements in painand stopped cartilage breakdown.Others studies were either inconclusiveor showed no benefit. In another study,vitamin C (150 mg/day) reducedosteoarthritis progression more thanthree-fold compared to a placebo.Topical agents such as capsaicin creamsand Aspercreme can reduce pain but donot affect the progression of arthritis.Note the gradual loss of space between thebones in the images above. This loss of jointspace occurs when the articular cartilagewears away.Steroid injections (cortisone) combinedwith a local anesthetic can provide dramaticpain relief due to their powerfulanti-inflammatory properties. However,the duration of relief varies tremendouslyfrom patient to patient.Viscosupplementation is the weeklyinjection of hyaluronic acid (the substancethat makes joint fluid more oily)in the knee joint for a total of up to fiveinjections. Hyaluronic acid helps lubricatethe joint, and a physician can repeatthe injections every six months if needed.This treatment is effective in up to 75%of patients.Surgical AlternativesWhen nonoperative treatment fails, surgerymay be indicated. An orthopaedicsurgeon is a physician specializing insurgical treatment of bone and joint diseaseand injury. Surgical options includemany minimally invasive or less invasivesurgeries such as arthroscopy andjoint replacement. New surgical techniquesand refined implants areimproving the quality of life of patientswith osteoarthritis.The physicians and staff at Blue RidgeOrthopaedics are committed to providingproven, top-quality care for pain due toosteoarthritis and many other painful ordebilitating conditions of the bones andjoints. Blue Ridge surgeons emphasizeminimally invasive techniques for jointreplacement, tendon repair, and fracturecare. We welcome the opportunity to discussthese treatment options with you atour Seneca and Anderson offices. BRW. Bruce Richmond II, MD, earned his medicaldegree from the Medical University of SouthCarolina. He completed medical training atErlanger Medical Center of the University ofTennessee College of Medicine, ChattanoogaUnit, with an orthopaedic surgery residency andan orthopaedic trauma fellowship. He is boardcertified by the American Board of OrthopaedicSurgery and is a member of the South CarolinaMedical Association, the South CarolinaOrthopaedic Association, and the AmericanAcademy of Orthopaedic Surgeons.Prosthesis MaterialsOver the past 50 years, there havebeen many advances in total jointarthroplasty. Orthopaedic surgeonscan replace painful, stiff hips withdurable prostheses made of metalalloys, high-grade plastics, and polymericmaterials. All materials used intotal hip replacements have fourcharacteristics in common:1. They are biocompatible, meaningthey won’t create a local or a systemicrejection response.2. They are durable, meaning they areresistant to corrosion, degradation,and wear and will retain their strengthand shape for a long time.3. They are functional, meaning theyhave mechanical properties thatduplicate the replaced structures,such as the strength to handleweight-bearing loads, the flexibility tobear stress, and the ability to glideagainst each other.4. They are high quality, meaningthey meet the highest fabricationstandards at a reasonable cost.Source: American Academy ofOrthopaedic SurgeonsBlue Ridge Orthopaedics5


AnesthesiaTodayBy Henry H. Salzarulo, MDTraining, techniques, and monitoringreduce complicationsHow safe is your anesthetic? In the early20th century, one in 1,000 surgicalpatients was expected to die. When Ibegan residency training in 1970, thegenerally accepted figure was betweenone in 4,000 and one in 5,000. Today,however, we expect less than one fatalityper quarter million uses of anesthetic.Many changes have taken place toaccount for this startling difference.Improved training and credentialingrequirements have gone a longway toward making anesthetic safer.Board-eligible or board-certified anesthesiologistsor certified registerednurse anesthetists now attend allanesthetic uses, as well as many proceduresrequiring sedation.The introduction of continuous oxygenmeasurement in both the inhaled gasmixture and the patient’s blood, as wellas continuous carbon dioxide monitoringin the patient’s exhaled breath, havereduced death and neuralgic damagefrom esophageal intubations to nearzero. The elimination of this complicationis an attainable goal. No advanceshave proven as important as these technologiesin reducing preventable morbidityassociated with surgery.The ChangingAnesthetic EnvironmentWhen I was a resident at the University ofPennsylvania, a top training center, electrocardiogram(ECG) monitoring wasavailable only for open heart surgery,and blood pressure monitoring was consideredunnecessary for pediatricpatients. We have come a long way sincethen in assuring patient survival by simplyrequiring observation of the effects ofthe surgical and anesthetic trespass.Every surgical patient is now monitoredwith frequent blood pressure6 Blue Ridge Orthopaedicsdeterminations, continuous ECG screening,and oxygen and carbon dioxideobservation. Most patients who receivegeneral anesthesia have their inhaled gasmixtures constantly measured. If the oxygenfalls too low or the carbon dioxide oranesthetic gas rises too high, alarms soundand lights flash. Today’s anesthetic environmentis a far cry from the “seat-ofthe-pants”experience of years past.Dramatic ImprovementsNew drugs are introduced frequently,and older agents that caused renal orhepatic damage were eliminated. Greaterunderstanding of the lingering effects ofmuscle relaxants has reduced the incidenceof silent death in the postanestheticunit. Explosive anesthetics wereremoved decades ago.Improved training andcredentialing requirementshave gone a longway toward makinganesthetic safer.Equipment has improved dramatically.Anesthetic machines can no longerdeliver a gas mixture without oxygen.When an oxygen tank went empty andthe anesthesiologist failed to notice,renowned pop artist Andy Warhol died.A few years earlier, the lead singer of apopular rock group died during a relativelysimple ear procedure. Disposabletubes and breathing tubes have replacedreusable ones, reducing the spreadof infection.Regional AnesthesiaThe contribution of the increasing useof regional anesthetic is controversial.Some benefits are clear, while others aremore intuitive and less established.Regional anesthesia clearly reduces therisk of postoperative complications inmajor orthopaedic and general surgicalprocedures. There is no evidence that itreduces major preoperative complicationsin the healthy, outpatientpopulation — the group we treat atBlue Ridge Orthopaedics.To be sure, patients experience lesspostoperative pain and are much lesslikely to suffer nausea and vomitingwith regional anesthesia. The recoveryperiod is shorter, the discharge is usuallyquicker, and the first 24 hours aremore pleasant. For these reasons, weadvocate the use of regional anesthesiaat our surgery center.We must weigh these benefits againstthe serious, potentially lethal outcome ifthe local anesthetic is incorrectly injected— an outcome no less catastrophicthan that of a poorly administeredgeneral anesthetic.In the hands of well-trained, skilled professionalsusing modern anesthetic techniquesand state-of-the-art monitors, therisk of life-threatening complicationsapproaches zero. It is difficult to getmuch better than that, but we keep trying.And we will continue trying untilevery preventable death and major complicationis eliminated in every hospitaland surgery center in America. BRHenry H. Salzarulo, MD, earned his medicaldegree from the Indiana University School ofMedicine. Upon completion of an internship atLetterman General Hospital, Dr. Salzarulotrained in anesthesiology while serving in theU.S. Army in Yokohama and Camp Zama,Japan. He then completed his residency inanesthesiology at the University of Pennsylvania.Dr. Salzarulo is board certified by the AmericanSociety of Anesthesiology and is a member ofthe South Carolina State Medical Society.


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A Biologic Methodof Cartilage RepairNew therapies help healdamaged kneesBy Brian J. Redmond, MDEach year, more than two millionAmericans injure their knee cartilage.Blue Ridge Orthopaedics’ surgeons performed2,000 knee surgeries last yearand more than 6,000 during the pastthree years. Whatever the cause, theresult is the same — pain that can hinderan active life. Many people live with kneepain for years. Simple activities like playingwith children or grandchildren andgetting in and out of a car are often challengingobstacles.There are many different knee problemsthat can cause these symptoms, butwhatever the diagnosis, without a remedy,every day may begin and end in pain.Fortunately, there are treatment alternatives— some only available in the lastseveral years — that may effectivelyrepair damaged knee cartilage andrelieve pain.Now a Biologic Treatment OptionIn March 1995, the field of bioorthopaedicswas introduced in theUnited States when the first patient wastreated with a new option, Carticel ®(autologous cultured chondrocytes). InAugust 1997, the Food and DrugAdministration (FDA) issued a biologicslicense that approved Carticel for therepair of articular cartilage defects in themedial and lateral femoral condyle andtrochlea regions of the knee.Carticel was the first product approvedunder the FDA’s proposed approach toregulating human tissue and cell therapyproducts. In January 2000, the Carticelindications were modified to include usein patients who have had inadequateresponses to prior arthroscopic or otherThe first surgical procedure required for Carticel implantation is an arthroscopic outpatient procedureto remove a biopsy for culturing. Often, the biopsy is taken during the initial evaluationprocedure, reducing the number of surgeries from three to two.surgical repair procedures. Since articularcartilage does not repair itself, Carticelprovides orthopaedic surgeons with a“biologic option” to treat appropriatepatients. Surgeons at Blue RidgeOrthopaedics are trained in this highlyspecialized procedure. Blue RidgeOrthopaedics is one of only a few practicesin South Carolina to offer Carticelas one of the many options for treatmentof cartilage damage in select individuals.Knee AnatomyThe knee has the difficult task of transferringthe weight-bearing load of thebody while allowing rapid change indirection and speed. This necessary twistingand rotating adds to the stress thejoint endures. With certain activities, theknee is subjected to nearly 10 times thebody’s weight.The knee joint is made of three bones,four major ligament groups, and twotypes of cartilage. The bones in the kneeare the femur, tibia, and patella. Thefemur has two separated prominencescalled condyles. The inner condyle is themedial femoral condyle, and the outer isthe lateral femoral condyle. The tibiameets the femur at the knee with twoareas on which the two femoral condyles“ride.” These are the medial and lateraltibial plateaus. The patella, or kneecap,rides in a shallow groove (sulcus) overthe front part of the femur calledthe trochlea.Ligaments are tough, fibrous bundlesthat are strong but only slightly elastic.Each ligament connects the femur to thetibia or fibula at a different point. Theligaments in the knee are the medial andlateral collateral ligaments (MCL and8 Blue Ridge Orthopaedics


LCL) and the anterior and posterior cruciateligaments (ACL and PCL).The two types of cartilage in the knee aremeniscal and articular. Meniscal cartilageis best described as C-shaped pads foundbetween the femur and tibia, one at eachside. They are attached to the top of thetibia or tibial plateaus and serve to cushionand transfer joint force by distributingjoint forces over a larger area of thejoint, transferring force from the curvedfemoral condylar margins to the flattertibial plateaus.Articular cartilage is the glistening whitetissue that covers the ends of the bonesat the knee joint. It is both tough andresilient. It has the consistency of firmrubber but is actually a mixture of collagenand special, large, sponge-like molecules,all maintained by living cartilagecells (chondrocytes). With normal jointfluid, the surface is more slippery thanice on ice. This cartilage structure allowsfor normal, smooth, and easy jointmotion and also “softens” the impactduring loading, much the same as ashock absorber.Articular cartilage may not appear alive,but in fact, it is. The number of chrondrocytesresiding in the tissue is small(approximately 5%), but chondrocyteshave the job of keeping the matrixaround them healthy. Think of the cellsas a few marshmallows suspended in aJell-O mold. As with most body tissues,there is constant wearing out andreplacement activity of this matrix.Unfortunately, the cells do not replicate.Once they are damaged or lost, the surroundingmatrix gradually degenerates.Without help, the body is unable torepair these articular cartilage defects,which can lead to a more serious conditionknown as osteoarthritis.Cartilage DamageArticular cartilage is often damaged bysports, traumatic injuries, work injuries,and daily wear and tear. This damageoften occurs in conjunction with damageto another area of the knee, such asinjury to the ACL or meniscus. It isimportant to note that early interventionmay help prevent damage fromspreading to surrounding healthy cartilageand further deterioration to thejoint surface. There are various surgicaltreatment options to address articularcartilage loss, including those for painrelief and cartilage replacement. Morecommon options to treat cartilage injuryinclude the following:• Arthroscopic chondroplasty ordebridement. This procedureinvolves using an arthroscopicapproach to locate the damagedchondral tissue and trim away orstabilize the area. Chondroplastymay relieve pain for a short periodof time, but it does not repair thecartilage defect.• Microfracture or marrow stimulation.This procedure is used as anattempt to repair a small cartilagedefect using the body’s own marrowstem cells. These cells enter throughsmall holes made through the boneby abrasion, drilling, or using asmall pick to create microfractures.Think of this process as repairing apothole in the road — filling in thehole prevents it from widening andinvolving the entire road. Thesetechniques are successful in addressingsymptoms in some patients.• Osteochondral transfer. With thistechnique, the surgeon removes asmall section of the patient’s owncartilage and the underlying boneplug. It is obtained from an areathat does not bear a lot of weight.The size of the defect treatable withthis method is usually between 1and 2 cm, or the size of a thumbnail.These are several options for regenerationand/or repair of damaged articularcartilage. Your physician will determineFive Steps of Carticel1 2 3 4 5Images courtesy of Genzyme Corporation1. An initial biopsy of normal joint surface is removed from the non–weight-bearing portion of the knee. 2. The biopsy is sent to a Genzyme lab, whereit is cultured and grown into a solution of the patient’s cartilage cells. 3. During the second procedure, the surgeon makes an incision in the knee andremoves any damaged cartilage. 4. A piece of lining is then removed from the adjacent upper tibia bone and sewn over the defect. 5. This creates awater-tight membrane to contain the cultured cartilage cells. The patient’s cells are then injected into the defect.Blue Ridge Orthopaedics9


which option is right for you, based onthe type and extent of your knee injury.How Carticel Can HelpCarticel is a biologic product using yourown (autologous) cultured chondrocytesto repair the articular cartilage defects inthe knee that are greater than 2 cm.Receiving Carticel is a two-stage process.If your surgeon thinks you are a candidatefor Carticel, the first step is toobtain a small amount of your cartilage.Your physician will perform anarthroscopy on your knee specifically toobtain the biopsy, or he or she mayobtain the cartilage biopsy while performinganother arthroscopic procedureon your knee.The biopsy is shipped to GenzymeBiosurgery, where the cells are culturedto increase the number of cells from afew hundred thousand to more than 10million. Once the cell-culturing process iscomplete, Genzyme Biosurgery returnsthe cells to your physician for the secondstage — autologous chondrocyte implantation.Your surgeon implants these culturedcells in your knee during a secondsurgery to repair and restore the surfaceof your articular cartilage. Carticel hasthe advantage of restoring a normal cartilagesurface instead of a scar tissuepatch that other techniques, likemicrofracture, create.The recovery time following Carticelgoes through many phases, depending onadditional procedures needed. Initially,you will walk with crutches for six toeight weeks and will use a continuouspassive motion machine to gently moveyour knee at home. In three to sixmonths after surgery, you will likely walkwithout crutches and resume most normaldaily routines. If light-duty work isavailable, you may return to that, as well.You are given specific exercises; however,no sports, cutting, or twisting activitiesare allowed. During the second sixmonths, the repair will become moresolid, but full activities and many sportswill have to wait until nine to 12 monthsafter surgery.Although the number of patients who arecandidates for Carticel treatment is relativelysmall, Blue Ridge Orthopaedics surgeonsare experts in the latest technologicaladvances for the knee and all othermajor joints. Each person and injury isunique; therefore, treatment for eachinjury is individualized. Our orthopaedicsurgeons can discuss these and otheroptions with you and help you decidewhich treatment will serve you best. BRBrian J. Redmond, MD, is board certified by theAmerican Board of Orthopaedic Surgery. He is afellow of the American Academy of OrthopaedicSurgeons and the American Orthopaedic Societyfor Sports Medicine. He is also a member of theSouth Carolina Medical Association and theAmerican Medical Association. In 1998, Dr.Redmond received the Young Investigators Awardfrom the American Orthopaedic Society of SportsMedicine for best clinical research by a fellow.10 Blue Ridge Orthopaedics


‘ReSTORing’ VisionBreakthrough technology providesclarity without glassesBy Scott C. Massios, MD, FACSSight is by far one of our most valuablesenses. Without our vision, we would beunable to experience the beauty of a sunsetor see the face of a loved one. Withoutsight, everyday tasks like driving andreading would be impossible.Our eyes are complex machines thatdeliver a clear picture of the worldaround us, communicating the simplestof colors, shapes, and textures. When oursight is compromised, it affects not onlyour lives but also the lives of those closeto us.Cataract surgery provides the restorationof this sight and has undergonetremendous technological advancessince the days of your parents andgrandparents, resulting in one of thesafest, most effective types of surgery.It’s also one of the most successful [1] .This year, millions of patients willchoose to have both their sight and theirlifestyles restored thanks to this lifechangingmedical procedure.CataractsA cataract is a “clouding” of the lens inthe eye. Located just behind the iris, orthe colored part of your eye, the eye’slens works like that of a camera. It picksup images and then focuses the lights,colors, and shapes on the retina, thetransmitter located at the back of youreye that sends the images to your brain.In a normal eye, light passes through thelens and is focused on the retina. To helpproduce a sharp image, the lens mustremain clear.What Cataracts Are NotA cataract is not a “film” over the eye,and neither diet nor lasers will make it goaway. The best way to treat a cataract isto remove the old, clouded lens and providea replacement.In its early stages, a cataract may notcause a vision problem. The cloudinessmay affect only a small part of the lens.Over time, the cataract may grow largerand cloud more of the lens, sometimescausing sharp images to appear blurredor making seeing things at night moredifficult. It may also be why eyeglasses orcontact lenses that used to help you seeor perform other simple tasks no longerseem to help.There are several causes of cataracts,including aging, smoking, diabetes, andexcessive exposure to sunlight. Cataractscan also develop soon after an eye injuryor even years later. In more than 90% ofcases, however, cataracts are caused bythe aging process [2] . Unfortunately,cataracts are not preventable, but theyThe ReSTOR IOL allowsthe patient to read the typeon items such as prescriptionbottles, magazines,and newspapers while alsohaving the ability to driveor go on a sightseeing tour— all without dependingon glasses or bifocals.are easily corrected through a simplesurgical procedure.Once the cataract makes an impact on anindividual’s quality of life, surgery maybe needed to improve vision. This treatmentinvolves removing the cloudy lensand replacing it with an artificial lens.Each year, approximately 2.7 millioncataract surgeries are performed in theUnited States; and globally, 9 millionReSTOR IOL ImplantationAqualase TM lens removal Injection of ReSTOR implant ReSTOR implant in the capsular bagImages courtesy of Alcon Labs, Inc.Blue Ridge Orthopaedics11


cataract surgeries are performed. Today,cataract surgery involves removing thecloudy lens and replacing it with an artificiallens, often a monofocal intraocularlens (IOL). A monofocal lens typicallyprovides patients with only one focalpoint, most commonly far away, leavingpatients dependent on glasses for upclosetasks such as reading or knitting.New Multifocal SolutionThanks to new, revolutionary technology,the AcrySof ® ReSTOR ® IOL allowspatients to see a full range of vision,near through distance, using patentedapodized diffractive technologydesigned to provide visual freedom forthe patient.Simply speaking, the ReSTOR lens isdesigned to improve vision at all distancesand was created for patients whowish to have a full range of vision oncetheir cataract lenses are removed.With the introduction of the ReSTORlens, IOL technology has taken a giantleap forward. No longer is the objectiveof cataract surgery to simply restoreyour distance vision while leaving youdepending on reading glasses for smallprint. The ReSTOR IOL allows thepatient to read the type on itemssuch as prescription bottles, magazines,and newspapers while also having theability to drive or go on a sightseeingtour — all without depending onglasses or bifocals.In fact, U.S. Food and Drug Administration(FDA) clinical studies havedemonstrated that 80% of patientsnever needed to wear glasses or bifocalsagain with the ReSTOR lenscompared to 8% of patients with regularmonofocal lenses. BRScott C. Massios, MD, FACS, is one of the firstsurgeons in South Carolina chosen to implantthe revolutionary AcrySof ReSTOR lens. He wasthe chief of the Department of Ophthalmology atEglin U.S. Air Force Regional Hospital and was amember of the U.S. Air Force’s MobileOphthalmic Surgical Team. His distinguishedand decorated career spanned 13 years in theU.S. Air Force from 1988 to 2001. Dr. Massioshas been in the upstate for the past five yearsand is Director of Blue Ridge Eye Center inSeneca, South Carolina. He has been a memberof the Blue Ridge Surgery Center Staff sinceJanuary 2005, bringing the latest in intraocular(cataract and glaucoma) and eyelid surgery tothis state-of-the-art facility.References:[1] Facts About Cataract. National EyeInstitute, National Institutes ofHealth, Department of Health andHuman Services. June 2004.[2] Lang GK. Ophthalmology. NewYork, NY: Thieme New York; 2000.12 Blue Ridge Orthopaedics


Helping HandsPhysician assistantsimprove manymedical servicesPhysician assistants (PAs) are highlyskilled, licensed health professionals whoprovide medical services that are otherwiseperformed by physicians. For example,PAs assist in surgery, take medicalhistories, perform physical examinations,diagnose and treat illnesses, order andinterpret laboratory tests, perform minorsurgery, and, in South Carolina, prescribemedications. Patient education and counselingare also important aspects of a PA’sdaily activities. PAs practice virtuallyevery medical specialty — from familymedicine to surgery.EducationPhysician assistants graduate from programsaccredited by an independentorganization supported by theAmerican Medical Association,American Academy of FamilyPhysicians, American Collegeof Surgeons, American Academyof Physician Assistants,and other nationalorganizations.Most PAs have a bachelor’sdegree and morethan four years ofhealth care experiencebefore admission. Thetypical PA programlasts 24 months andconsists of twophases. The first phase includes classroomand laboratory instruction in basicmedical sciences, including anatomy,physiology, pathology, microbiology, andpharmacology, as well as behavioral scienceand medical ethics.The second phase consists of structuredclinical rotations, providing studentswith direct patient contact. They areteamed with medical students, functionsimilarly, and are taught by physicians.The rotations are intensive, hands-onlearning experiences in private andinstitutional settings in medical disciplines,such as family practice, internalmedicine, obstetrics and gynecology,pediatrics, surgery, and orthopaedicemergency medicine.CredentialingBefore they can practice, graduates ofaccredited PA programs must pass asingle national certification exam developedby the National Board ofExaminers and administered by theNational Commission on Certificationof Physician Assistants. Only thoseindividuals with current certificationmay use the designation “PhysicianAssistant-Certified,” or “PA-C.” Theyare licensed by the South Carolina StateBoard of Medical Examiners and teamwith their supervising physicians toprovide comprehensive medical care.To maintain certification, PAs must earn100 hours of continuing medical educationevery two years and sit for a recertificationexam every six years. Theserequirements keep them abreast ofmedical advances.Meet Our Physician AssistantsC. Stephen Jackson, PA-C,received his training atCreighton University inOmaha, Nebraska, whileserving in the U.S. Army.He also earned a MedicalMaster’s of Science degree from SaintFrancis University in Loretto, Pennsylvania.Jackson is board certified by theNational Commission on Certificationof Physician Assistants (NCCPA) and isa member of the American Academy ofPhysician Assistants, the Society ofArmy Physician Assistants, the SouthCarolina Academy of PhysicianAssistants, and the Physician Assistantsin Orthopaedic Surgery.G. Emmitt Carter III, PA-C, trained at MethodistCollege in Fayetteville,North Carolina. He isboard certified by theNCCPA and earned specialrecognition in surgery. He is also aBlue Ridge Orthopaedics13


member of the American Academy of Physician Assistantsand the South Carolina Academy of Physician Assistants.Frank Mlinar, PA-C, received his Bachelor ofScience degree in nursing from Alfred Universityin New York and graduated as a nurse practitionerfrom Albany Medical College, also in NewYork. In 1979, he passed his physician assistantexam. Mlinar is NCCPA certified and is amember of the American Academy of Physician Assistants,the South Carolina Academy of Physician Assistants, and thePhysician Assistants in Orthopaedic Surgery.Wallace S. Liggett, PA-C, graduated from thephysician assistant program at MountainState University, Beckley, West Virginia. He isNCCPA certified and is a member of theAmerican Academy of Physician Assistants andthe South Carolina Academy of PhysicianAssistants. He also served in the U.S. Navy as Master ChiefHospital Corpsman. BRBlue Ridge OrthopaedicsWelcomes New PhysicianA native of New Orleans, James C. Mills III,MD, joined Blue Ridge Orthopaedics in 2005.Dr. Mills earned his medical degree fromTulane University School of Medicinein New Orleans and completed an orthopaedicsurgery residency program at that school’sDepartment of Orthopaedics, also in New Orleans. Dr. Millscompleted a sports medicine, arthroscopy, and joint replacementfellowship at the Hughston Orthopaedic Hospital inColumbus, Georgia.Dr. Mills is board certified by the American Board ofOrthopaedic Surgeons. He is a member of the ArthroscopyAssociation of North America, the American Academy ofOrthopaedic Surgeons, the Southern Medical Association,the South Carolina Medical Association, the EasternOrthopaedic Association, the American College of Surgeons,and the Southern Orthopaedic Association.Local Independent PharmacyRob Hubbard • Ron YoungServing the Clemson CommunityFor over 30 Years864-654-1771402 College Avenue • Clemson, SCTrust, Service, DependabilityClemson ApothecareCompounding PharmacySpecializing in CustomPrescription Compounding864-654-9120103 Knox Road • Clemson, SC14 Blue Ridge Orthopaedics


Advertiser DirectoryBlue Ridge OrthopaedicsAssociates thanks:AccountantsErwin & Duncan CPA Firm, PA . . . . . . . . . . . . . . . . . . . . . . . . . . see page 15ArchitectsPazdan-Smith Group Architects200 E. Broad St., Ste. 300 • Greenville, SC 29601(864) 242-2033 • (864) 242-2034 Faxwww.pazdan-smith.comComputer ServicesComplete On-Site Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .see page 15Financial ServicesUBS Financial Services Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . see page 7Home Health ServicesInterim Healthcare Inc. . . . . . . . . . . . . . . . . . . . . . . . . . see inside front coverOrthopaedic Implants & SuppliesBiomet Orthopedics, Inc.1061-B Sparkleberry Ln. Ext. • Columbia, SC 29223(803) 462-0504 • (803) 462-0097 FaxDePuy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .see page 10OrthoPro, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .see page 12Smith & Nephew . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .see page 15Zimmer, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . see page 7PharmaciesSammeth Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .see page 12The Hubbard/Young Pharmacy, Inc. . . . . . . . . . . . . . . . . . . . . . .see page 14Physical TherapyClemson Sports Medicine and Rehabilitation . . . . . . . . .see back coverRadiologyMountainview Medical Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . .see page 14SourceOne Healthcare Technologies, Inc. . . . . . . . . . . . . . . . . . .see page 7In Business since 1990Providing IT ConsultingSales & Service• IT Support• TurnKey Installations• Medical Network Systems• LAN & WAN Connectivity• HIPAA Compliance• PACS• Practice Management• Software Implementation189 Beaver Lake Dr • West Union, SC 29696(864) 985-7700 phone • (864) 638-1969 faxrickdavis@on-sitesolutions.net


Blue Ridge Orthopaedics Associates, PA10630 Clemson Blvd., Ste. 100Seneca, SC 29678PRSRT STDUS POSTAGEPAIDSENECA, SCPERMIT NO. 501

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