SPORTS MEDICINE Neck MRI WRIST HIP Physical Therapy … Ortho v7i1.pdfmoderate sedation, which helps control pain after your surgery. ... as weight loss, increasing low-impact activities,

Volume 7 • Issue 1

Innovations

rthopaedics:A Tidewater Update

ANKLE

SPORTS MEDICINE

HIP

Joint ReplacementNeck

WRISTMRI

Physical Therapy

COASC is the Peninsula’s only dedicated orthopaedic ambulatory surgery center. Our surgeons are fellowship trained, receiving an additional year of sub-specialty training in orthopaedic surgery. At COASC, we do not operate on patients with active infections, allowing us a much lower infection rate than the national average.

We work with a highly skilled team of anesthesiologists, who perform regional blocks and moderate sedation, which helps control pain after your surgery.

COASC is conveniently located within the Sentara CarePlex Hospital campus in Hampton, Va.

For more information about how COASC is leading the way in orthopaedic care in Hampton Roads, call 757-736-4100.

3000 Coliseum Drive | Hampton, VA 23666careplexortho.com

Colin M. Kingston, M.D.Robert M. Campolattaro, M.D.

Michael E. Higgins, M.D. Nicholas A. Smerlis, M.D.Nicholas K. Sablan, M.D.

Paul B. Maloof, M.D.Jonathan R. Mason, M.D.

Loel Z. Payne, M.D.

Why Choose CarePlex Orthopaedic Ambulatory Surgery Center?

WelcomeI am proud to introduce the latest edition of Orthopaedics—

a Tidewater Update. Although forever a time of renewal, this spring will certainly be a season of change for our group. Con-

struction begins in earnest on our new office in Williamsburg. This spacious facility, close to our New Town location, will afford our patients with even more comfortable access to our state-of-the-art care. Stem cell injection therapy, introduced through our sports division, blends the latest in biologic innovation with already cutting-edge treatment. In addition, an experienced subspecialty physician assistant joins the only two board-certified hand surgeons in the area, further expanding the singular and premiere hand

center in the region. Outpatient joint replacement moves from reality to routine in our dedicated orthopaedic ambulatory surgery center, another unique institution in Hampton Roads.

However, some things remain constant. Although we are the oldest orthopaedic group on the Peninsula, we remain the only practice dedicated to the contemporary model of subspecialty care. No longer a practice paradigm for the future, this model has been firmly embraced as the standard of care of today. Our fellowship-trained surgeons focus their talents exclusively on their area of expertise, whether it be hand/wrist, foot/ankle, shoulder/knee, sports medicine, or adult reconstruction and spine. Through such training and focus, they have cultivated the knowledge and technical skill necessary to implement new technology to the benefit of our patients. Both the responsible stewardship of medical advancement and the delivery of consistent quality care flow naturally from a subspecialty focused model.

This issue highlights the balance of innovation with the timeless commitment to patient care that remains the defining element of our group. In addition to the flowers of spring, please enjoy the service and expertise that are always in bloom at Tidewater Orthopaedics.

Warm Regards,

Robert M. Campolattaro, MDPresident, Tidewater Orthopaedics

Hampton Office901 Enterprise Parkway, Suite 900

Hampton, VA 23666

Williamsburg Office5208 Monticello Avenue, Suite 180

Williamsburg, VA 23188

Main Number(757) 827-2480

www.tidewaterortho.com

Our Mission:To provide the best patient experience through the highest quality of specialty orthopaedic care - blending sound medical ethics, technical excellence, integration of team members, and a commitment to leadership.

Contributing Writers:Michael E. Higgins, MD

Colin Kingston, MDEva-Maria Klenner, MBA, CMPE

Loel Payne, MDNicholas K. Sablan, MD

Terri Shipley, OTR/L, CHTJan R. Stahmer

Beverly S.N. Vanover, RT-R

Orthopaedics - A Tidewater Update is an educational and informational resource for physicians and the pub-lic. The magazine will introduce the physicians, their staff and facilities. In addition, it will provide updates on new achievements in orthopaedics, as well as articles on orthopaedic-related injuries and treatments.

Cutting Edge Therapy for Patients with Cartilage Damage

The Confusing World of Insurance Language

New Tools That Promote Accuracy and Safety

Outpatient Shoulder Replacement at the CarePlex Orthopaedic Ambulatory Surgery Center

From Our Patients

Changes in Medicare for Hip and Knee Replacement

Making Old New Again!

A New PA in Town

Complex Regional Pain Syndrome — The “Mystery Disease”

Hoop Dreams

Physicians & Medical Staff

Haiti Mission Trip, June 2015

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14.16.

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Inside This Issue

Orthopaedics: A Tidewater Update is designed and published by Custom Medical Design Group. To advertise in an upcoming issue please contact us at: 800.246.1637 or CustomMedicalDesignGroup.com. This publication may not be reproduced in part or whole without the express written consent of Custom Medical Design Group.Medical

tidewaterortho.com • 3

CuttIng EdgE thErapy for Patients with Cartilage Damage

TREATMENT for patients with cartilage damage presents a unique challenge to physicians. Dr. Colin Kingston, a specialist

in sports medicine, general orthopaedic surgery, and joint replacement, discusses those challenges as well as new treatment options.

What’s unique about cartilage damage?Unlike other tissues of the body that receive nutrition from blood, cartilage derives most of its nutrition from synovial fluid. Synovial fluid is the gel-like fluid that lubricates the joints. The cells that line the joints generate more synovial fluid with motion. That means motion in our joints is crucial to maintaining healthy cartilage.

What are traditional treatments for cartilage damage? Basic treatment includes the acronym RICE—rest, ice, compression, elevation—as well as such things as weight loss, increasing low-impact activities, and physical therapy that will improve range of motion. Then there are anti-inflammatory medications, acetaminophen, pain medication such as tramadol, steroids, topical medication such as capsaicin, and viscosupplementation, which includes Euflexxa and Synvisc.

how successful are those treatments?They have had varying degrees of success in treating the symptoms of arthritis and limited success in slowing down the progression of damaged cartilage. None of them stop or reverse cartilage damage, and so they have very little biomodulation.

What’s biomodulation?Biomodulation is any agent or method that reacts with or adjusts the biochemical or cellular status of an organism. This is the newest technique to regenerate normal cartilage and potentially return normal function of a joint without surgery.

By Colin M. Kingston, MD

4 • Orthopaedics: A Tidewater Update


how successful is surgery? There are techniques such as abrasion chondroplasty, microfracture, autologous chondrocyte implantation, mosaicplasty, as well as allograft implantation. These all have varied outcomes and at times come close to replicating normal cartilage. But surgery is limited in the attempt to regenerate cartilage.

What about joint replacement?That’s been by far the most successful operation in returning function and ability to stay mobile. Joint replacements are very successful—but they’re not without complication. For example, the joints can wear out, and they have a much higher coefficient of friction than normal cartilage.

What newer options are on the horizon?A significant amount of research is addressing questions such as, What if the damage to the cartilage could be actually reversed with biomodulation? What if something could actually regenerate normal cartilage and potentially return the normal function of a joint?

Is that actually possible?Research is looking into techniques that could do this, but it’s in its infancy stage right now. The goal is to restore normal tissue— not scar tissue—and to enhance the body’s innate ability to accelerate healing in a clinically relevant time.

how does prolotherapy factor into this?Prolotherapy is defined as an injection into tissue or a joint designed to regenerate that tissue. Over the past several years, there are several prolotherapy techniques implemented in ortho-paedics. They have grown in popularity and demand due to recent TV shows such as “Dr. Oz” and “The Doctors.” But more importantly, peer-reviewed literature has backed up the claims.

What are some examples of prolotherapy?Prolotherapy includes such things as platelet rich plasma (PRP), bone marrow aspirate (BMA), liposuction aspirate (LSA), and amniotic stem cell therapy.

how successful is platelet rich plasma?It’s been used very effectively in the treatment of tendon problems such as “tennis elbow,” and more recently it has been employed in the treatment of arthritis. PRP comes from taking a vial of one’s blood, spinning down to concentrate one’s own growth factors, and injecting these growth factors into the damaged tissue or joint with the hopes of stimulating healing and regenerating the damaged tissue. A recent study with horses has shown some promise, along with six studies on humans showing some short-term promise for mild to moderate arthritis.

how does bone marrow aspirate work?Bone marrow aspirate is taking a patient’s bone marrow and spin-

6 • Orthopaedics: A Tidewater Update 6 • Orthopaedics: A Tidewater Update

ning it down to concentrate stem cells and growth factors. I have used this with difficult fractures that are not healing otherwise. The treatment has recently been used in the treatment of arthri-tis, with mixed reviews. A study looking at horses with arthritis suggests that the addition of these cells may actually induce bone formation in the damaged cartilage. More studies are coming.

What about liposuction aspirates?Liposuction aspirates are predominantly being done by our plastic surgeon colleagues. They take the fat tissue, spin it down, concentrate the stem cells and growth factors, and then inject them into damaged tissues with the goal of regenerating tissue. It’s becoming more common, and more studies are pending.

and stem cells?Stem cells are cells that can be turned into any specialized cell—a process called differentiation—and can divide into more stem cells through mitosis. There are three different types of stem cells: totipotent, pluripotent (embryonic), and multipotent (adult).

how do these differ from one another?Totipotent stem cells are the first cells that occur after the sperm fertilizes the egg and can be turned into anything. These are the cells used where animals can be cloned into another genetically identical being. Research is limited because of the ethical implications with totipotent cells.

What about pluripotent cells?These are found in the embryo and can be turned into most cells and tissues, but they cannot clone another being.

and multipotent cells?These are the cells found in our blood, fat, and bone marrow. They can be turned into more specific cells. Bone marrow aspirate (BMA) and liposuction aspirate (LSA) attempt to concentrate these cells and growth factors to enhance our healing ability. Unfortunately, as we age, the number of these adult stem cells continues to diminish. So the ability to concentrate these biomodulators is limited in the population that needs it the most—the elderly. Medications and illness also can have a negative effect on the number of adult stem cells one has.

What’s amniotic stem cell therapy?Amniotic stem cell therapy is derived from cells taken from the amnion side of donated placentas. The amnion side is the infant’s side and does not have biological markers on the cells, making the ability to donate these cells and their growth factors and tissue possible without the risk of rejection from our immune system.

Tissue donated from one human to another is called allograft. Tissue donated from one part of one’s body and placed into another part of that person’s body is called autograft. PRP, BMA, and LSA are autografts. Amniotic stem cell therapy is an allograft, and therefore has to meet all of the laws and handling of allograft. For tissue to regenerate effectively it needs stem cells (the younger the greater ability to differentiate into a greater variety of cells), growth factors, and scaffold (tissue that acts like a trellis for new growth). ASCT is the only treatment modality that offers all three essential components, and there is no invasive procedure performed on the patient to harvest it.

What do you see as to the future of these therapies? The future of medicine will be evolving towards the use of biomodulation with an emphasis on curing rather than just treating disease. A Japanese orthopaedic surgeon who won the Nobel Prize for medicine in 2012 was able to take mouse mature skin cells and turn them back into embryonic stem cells. This has greatly improved our ability to study stem cells without the ethical dilemmas imposed by the use of embryos. In 2013, the same doctor and a researcher in Wisconsin were able to do the same thing with human skin cells. The implications are astounding.

What treatment options do you offer?I currently offer PRP, BMA, and ASCT as part of a clinical regimen in the treatment of arthritis, fracture non-unions, and tendinopathy. Because this is cutting-edge treatment, more research is needed to determine what long-term impact these will have on outcomes. Currently these treatments aren’t covered by insurance and there is an out of pocket expense. Hopefully as this continues to gain in popularity with the demand continuing to grow exponentially, insurance companies will start to cover these expenses as they currently do for cortisone injection and viscosupplementation.

What’s been the outcome so far in your experience?Out of the ACST injections that I’ve performed, all but one had a positive response. There were no adverse effects. One patient even felt more energized and painted his entire house. At the same time, not every patient is a candidate for prolotherapy treatment, and there is still a great deal of research that needs to be done. Patients with bone on bone arthritis and patients who have had partial knee replacements may not be good candidates. Using this technique in other joints other than the knee may also be feasible in the future. Stem cells are the future for finding medical cures.

Colin M. Kingston, MD, FAAOS, CAQSM, is a specialist in Sports Medicine, General Orthopaedic Surgery, and Joint Replacement. He attended medical school at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and his residency at the Uniformed Services Health Consortium in San Antonio, Texas. Dr. Kingston earned his undergraduate degree from State University of New York at Albany. He has been with Tidewater Orthopaedics since 2003.

The future of medicine will be evolving towards the use of biomodulation with an emphasis on curing rather than just treating disease.”

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The Confusing World of InsuranCE LanguagE

PATIENTS often have difficulty understanding the complex world of medical insurance terminology. Here are a few terms that each patient should be familiar with:

Co-payWhat it is: The fixed amount that a patient must pay each time he or she visits the doctor.

What you should know: Usually, the co-pay is lower for visits to the primary care physician (PCP) than for visits to a specialist. The amount of your particular co-pay can be found on your insurance card.

deductibleWhat it is: The amount of money an insured person pays before the insurance company covers the remainder of the claim.

What you should know: Most medical insurance plans have a deductible, which is similar in nature to car insurance. The amount

of the deductible is unique to your plan and starts over at the beginning of each benefit year.

Co-insuranceWhat it is: A percentage of a service other than the doctor’s visit that the patient will owe.

What you should know: Many patients owe a 20-percent co-insurance on diagnostic services such as x-rays or blood draws. Both the percentage and the fee for each service are set by the insurance carrier.

The doctor’s office usually does not know which services are subject to a co-insurance, since each insurance plan is different. The office determines if there is a co-insurance obligation when payment is made by the insurance carrier.

ChargesWhat it is: The cost for each service offered by a medical office.


By Eva-Maria Klenner, MBA, CMPE • CEO Tidewater Orthopaedics

What you should know: Each medical office can set their own charges for the services they offer. Patients are often confused because they think that this is the amount that will be paid by their insurance. But with health care—unlike with a grocery store, which charges each of their customers the same price—the actual “price” is determined by the insurance carrier. So no matter how high a doctor’s office charges are, the doctor will only get paid the pre-negotiated price, or “fee.”

Fee/allowableWhat it is: The pre-negotiated payment table that the insurance companies pay providers for a specific service (such as an office visit, x-ray, surgery, etc.).

What you should know: The fee schedule varies from one insurance plan to another.

adjustment/Write offWhat it is: The difference between a doctor’s charges and the amount that the insurance company will pay that doctor.

What you should know: A contractual relationship exists that binds all three parties—the doctor, the insurer, and the patient —to issue and accept a certain payment and to write off the difference.

EOB (Explanation of Benefit)What it is: An important document issued by the insurance carrier. It lists the date(s) of service and the service performed. The EOB outlines the following:

• the doctor’s charges for each service,

• the fee the insurance carrier will “allow” (allowable) for it,

• the adjustment or write-off amount,

• the amount the insurance carrier paid to the doctor’s office,

• the amount the patient owes.

What you should know: In some cases an EOB is sent in the

mail; in other cases it is delivered electronically. You can always request a copy of the EOB to be mailed to you. Check with your insurance provider to find out details.

“how Much Will It Cost?”Our patients often ask: “How much will that x-ray cost me?” or “What is my financial responsibility for this surgery?” We would love nothing more than to be able to tell each patient on each visit the exact cost for the services that will be received. Unfortunately, however, our healthcare system is not that transparent. In the majority of cases we provide services without knowing if, when, or how much we will get paid, because in addition to the above rules there are many exceptions in how charges are processed. And, of course, they vary from carrier to carrier, from plan to plan.

The rules that govern payments for health care services are very complex. There is great variation between commercial insurers as well as government plans such as Medicare and Medicaid.

Patients and health care providers alike are often frustrated when they cannot easily understand the rules. However, patients can educate themselves so that they can ask the right questions of their insurance companies—and their doctor’s office—so that they can better understand what they are paying in addition to their monthly premiums.

Our goal at Tidewater Orthopaedics is to make bill-paying as smooth an experience as possible. We have 13 members in our billing office and 4 staff members who are devoted to helping our patients get the most benefit under their insurance coverage.


...patients can educate themselves so that they can ask the right questions of their insurance companies—and their doctor’s office—so that they can better understand what they are paying in addition to their monthly premiums.”


“OUT with the old and in with the new.” That saying—quite popular at the beginning of each year— describes what Tidewater Orthopaedics’ Imaging

Department accomplished this year! We replaced both of our X-Ray suites with two cutting-edge digital systems: The Samsung GF60 and GF50.

These new tools improve the accuracy of the diagnosis—as well as patient safety—by generating high-resolution images while producing only a small amount of radiation. The simple, easy-to- use software has even decreased the average exam time!

The gF60 is a U-arm design and has “Smart Stitch”—a feature that allows us to take an X-Ray of a patient’s entire leg (hip to ankle) and “stitch” that image into one continuous film. Seeing the entire leg in one film is a tremendous aid in the surgical placement of certain implants. “Smart Stitch” can also be used to image the entire spine, which helps us detect scoliosis and other abnormalities.

The gF50 is the workhorse of this Samsung series. The wireless cassette and the mobility of the X-Ray stand makes imaging much easier for our less mobile patients. For example, patients can have an exam performed on them while still in their wheelchair or stretcher.

safety FirstEfficiency is important at Tidewater Orthopaedics, but safety is of even greater concern. That poses a challenge with typical X-ray suites. Why? Because radiation doses are cumulative.

Therefore, decreasing dosage where possible benefits the health and welfare of the patient.

Our new Samsung machines are designed to minimize unnecessary radiation exposure by lowering the dosage. Image quality is not lost with the use of this radiation lowering system. “From workflow to dose management, Samsung’s digital X-ray technology balances science with purpose, without jeopardizing image quality,” says Jake Thompson, COO of X-Ray Visions and Samsung’s Regional Sales and Service Partner. “Tidewater Orthopaedics offers innovative care, and this hospital-grade x-ray technology further enhances its capabilities, which will have a positive impact on patient care.”

Tidewater Orthopaedics is committed to providing high-quality images, low radiation doses, and better patient experiences. I believe that we are achieving those objectives with these new X- Ray suites, the Samsung GF60 and GF50. Tidewater Orthopaedics will continue to look for ways to remain on the cutting edge of new Imaging technology.

Beverly S.N. Vanover, RT-R is a registered Radiologic Technologist with 30 years of experience. She has been with Tidewater Orthopaedics for 26 years and currently serves as its Clinical Director.

nEW tOOLs that prOMOtE Accuracy and SafetyBy Beverly S.N. Vanover, RT-R


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SHOULDER replacement surgery has advanced significantly in the 20 years since I began practicing

medicine. Back then, surgery typically took more than three hours. Preparing the bone to accept the replacement prosthesis required extensive carpentry skills, such as drilling and rasping. There weren’t many size options, so in order to fit everything correctly the bone had to be extensively contoured. Most shoulder implants were designed similar to hip replacements, even though the shoulder joint is much different. It wasn’t unusual to replace only part of the shoulder— the ball—because it was so difficult to replace the socket.

Patients usually had significant pain, and they would be in the hospital for up to three days. Some patients were even given a blood transfusion.

Fast forward to the present. Now, shoulder replacement surgery can be done as an outpatient procedure, and surgery time is typically just two hours—sometimes less! The implants are designed specifically for the shoulder with multiple size options available to fit all patients. Recent advancements are “stemless,” which means that they

no longer require drilling and rasping to prepare the bone. (See accompanying image of the Tornier Simpliciti prosthesis.) This

OutpatIEnt shOuLdEr rEpLaCEMEnt at the CarePlex Orthopaedic Ambulatory Surgery CenterBy Loel Payne, MD

Tornier Simpliciti prosthesis


Dr. Loel Payne attended undergraduate school at Duke University and medical school at the University of North Carolina Chapel Hill. He completed his residency and internship at Yale University before completing his fellowship training in shoulder surgery and sports medicine at The Hospital for Special Surgery in New York, New York. In his spare time, Dr. Payne enjoys golfing and spending quality time with his family.

preserves bone and reduces postoperative pain and bleeding. Both the ball and socket are routinely replaced, thus eliminating arthritis in the shoulder.

Advances in pain management allow the anesthesiologist to numb the shoulder with a nerve block. The shoulder and arm remain numb for 12 to 18 hours. A newer, long acting type of novacaine (Exparel) can be injected during surgery, significantly reducing pain for several days. Patients are able to return home within a few hours after surgery and they can usually resume their daily activities more quickly. They are able to sleep in their own bed and wear their comfortable clothes.

The CarePlex Orthopaedic Ambulatory Surgery Center (COASC) is an excellent location for shoulder replacement surgery. The center performs only outpatient orthopaedic surgery. In this setting, risk of infection is markedly reduced. The staff is specialty trained for orthopaedic surgery, which improves efficiency and reduces surgery time. The anesthesiology staff is well trained on

ultrasound guided nerve blocks. This technique dramatically improves their success rate. Finally, the entire staff is friendly and professional. I consistently receive compliments on how well my patients are treated at this facility. Their pain was well controlled and their anxiety is relieved by the caring staff.

My hope is that one day all shoulder replacements will be done as an outpatient procedure. Unfortunately, some insurance companies don’t yet realize the reduced cost and improved outcomes of outpatient replacements. Some will not reimburse the center for the cost of the implant, and they require that the procedure be done at the main hospital. Even Medicare doesn’t recognize shoulder replacement as an outpatient procedure and will not pay for the surgery unless the patient stays overnight. As we know, the government can be slow to change. However, continued success of the outpatient shoulder replacement patients will force them to reconsider.

My hope is that one day all shoulder replacements will be done as an outpatient procedure.”


From Our Patients

ON March 5, 2004, I was in a motorcycle accident that shattered my tibia in so many places that the doctors stopped

counting. I also had a compound fracture of the fibula. I was told that I probably would always be in a wheelchair, or walk with a cane at best. It took six surgeries to put my leg back together. And finally, on the seventh surgery, the last of the hardware was removed.

With a lot of physical therapy and an equal amount of determination, I was able to get out of my wheelchair and limit my use of the cane. I had some stiffness, but for the most part everything was good. I couldn’t walk far and hills were a challenge, but I was walking—and satisfied.

By February 2014, however, walking had become difficult. If I went to the grocery store, I was done for the day. It was painful to walk up and down the stairs at home—a major problem, since my bedroom is on the second floor. I was starting to take my pain medication more often. (Since the accident of 2004, I had been on a standing refill for my bad days.) I made an appointment with my family doctor, who referred me to a local podiatrist. The podiatrist told me that he could fix my ankle and that I could potentially gain movement. Also, I would no longer have any pain.

So on July 24, 2014, I went in for surgery. But almost immedi-ately after surgery I had problems. I had major swelling and I started having nerve pain. In fact, I had so much pain that the doctor had to rewrap my dressing. After I was released from the hospital, I developed a fever. When I went back to get my stitches removed, that’s when I saw that my incision had been stapled. It looked terrible.

I didn’t start physical therapy until about eight weeks after surgery, and by that time my ankle was locked. Even after months of treatment, the therapist was unable to get any movement from my ankle. Then I started seeing a medical massage therapist. She too couldn’t get any movement from my ankle.

At this point I could no longer get into my shoes because it was too painful. In fact, I had to buy a very flexible sneaker that was a size larger than what I normally wore. Needless to say, my quality of life didn’t improve. The only option, the doctor told me, was for him to cut my tendon. That didn’t make sense to me. I asked him, “Is it possible that I have scar tissue that needs to be removed?” He dismissed the idea. So I started looking for another doctor.

My massage therapist referred me to Dr. Paul Maloof, because

she had been to one of his conferences where he talked about ankle replacement, and she was very impressed by him. After my initial appointment, Dr. Maloof suspected that the replacement I had received was a bit too large for me, and not centered at that. He also said that I probably had a lot of scar tissue that would need to be removed. I told him that I had a few more appointments with my other physicians, and that I would let him know what I decided.

What impressed me was that Dr. Maloof’s office called me (without my commitment to be a patient) to schedule more tests, and they wanted me to come back to talk to the doctor again. I did. On my second appointment, Dr. Maloof told me that he had consulted with his colleagues at Duke University—another good impression. His plan, if I agreed, was to remove the bottom and middle portion of the ankle replacement, put in a smaller one, and clean up the scar tissue. Dr. Maloof gave no promises, but he said that he thought he could fix my ankle.

On April 23, 2015, I went in for my second ankle-replacement surgery. I came out of the procedure virtually pain-free. The first thing I noticed was that my toes weren’t swollen. When it came time to remove my stitches, again there was no significant swelling. I started therapy and my ankle moved!

I can now walk up and down the stairs, and I can go shopping in more than one store. I can walk a few miles instead of less than a mile. I can fly fish in a river, walking up and down the embankments. For the first time in years, I was able to go horseback riding. I’m back to my normal-size shoe and I have not needed to take any more Vicodin. I am forever grateful for Dr. Maloof’s compassion and his drive to fix me. I would highly recommend him to anyone who needs ankle-replacement surgery. He has given me my life back!

As told by Donna Villarino

getting Back My Life


I’m Jack—an engineer by trade, a sailor by passion. (My older sister taught me how to sail when I was just eight years old!) As an engineer, I traveled extensively throughout the world; as a sailor, I traveled from the Caribbean to Canada.

Having retired in 2001 from Siemens Automotive in Newport News, Virginia, I lived and traveled with my wife Beverly on our sailboat “Chessie” until 2008. Living out a dream of seeing exotic far-off shores, we returned to Hampton. We could have taken up residency in any of the beautiful places we visited, but Hampton—with its mild climate yet distinct seasons, great facilities, and low cost of living—could not be beaten.

I was less than a block from my home in Hampton when I had the first major accident of my life. At 70 years of age, I guess I shouldn’t complain.

I was riding my bike on the sidewalk around our community. It had rained overnight and the sidewalks were still wet. Taking a right-hand turn, the bike went out from under me. My left arm went down to break the fall, and the forward momentum of my body sheared it. Scrapes and bruises on my right side were insignificant compared to the broken left arm. The ulna was protruding from the skin and the radius had no structure.

I sat up, cradled my left arm with my right, got up, and walked back home. Ringing the doorbell with my shoulder, I got Beverly’s attention and we went to Sentara CarePlex hospital.

The doctor on staff took a look at the arm and said, “We need to call in a specialist. You’re in luck. One of the best elbow-to-hand specialists works in our area. His name is Nicholas Smerlis.”

The most painful part of the recovery would have been when the ulna was put back inside the arm. But for that procedure, I was anesthetized. A metal bar had been inserted that connected the hand and upper radius. That was in June 2015.

Fast-forward to the following November. Needless to say, I had missed a summer of sailing and a host of planned activities. But thanks to Dr. Smerlis and Tidewater Orthopedics’ therapist Michael Burgos, slowly but surely I’m getting back the use of my left hand, going from 15-percent function after the accident to 85-percent function now. The metal bar is still in place, so I have no wrist movement yet. And because the radius refused to heal on its own, I had to have a bone graft, which Dr. Smerlis preformed. My saga to get back the use of my left hand continues, as I look forward to the 2016 sailing season. Since the writing of this article the bridge plate stabilization has been removed and Mr. Lorraine has been released to full activity without restrictions.

As told by Jack Lorraine

a smooth-sailing recovery

Sailing the Beverly dinghy (my first sailboat) on Seals Bay, Maine. Beverly D traveled with us on Chessie and enabled us to explore many beaches, coves, and creeks

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CHANgeS iN MeDiCAre fOr hip and Knee replacementBy Michael Higgins, MD

HIP and knee replacements are the most common inpatient surgery for Medicare beneficiaries, and they can require lengthy recovery and rehabilitation periods. There were

more than 400,000 hip and knee replacement procedures in 2014 at a cost of more than $7 billion for hospitalizations alone.

Despite the high volume of these surgeries, quality and costs of care still vary greatly among providers. In fact, the rate of post-surgery complications (such as infections or implant failures) can be more than three times higher at some facilities than others. This increases the chances that the patient may be readmitted to the hospital, raising the cost of care even higher. As a result, the average Medicare expenditure for surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas.

As you can see, the cost of business-as-usual is quite high,

particularly given the aging baby boomer generation (more of these procedures are forecasted in coming years). Furthermore, results of these surgeries vary too much from one institution to another.

The Center for Medicare and Medicaid Services (CMS) is developing a plan to control costs while promoting uniform high-quality outcomes. It is called the Comprehensive Care for Joint Replacement (CJR). This model will hold hospitals accountable for the quality of care they deliver to Medicare beneficiaries for hip and knee replacements.

Under this model, hospitals with low complication rates and low cost of care may be rewarded. More importantly, hospitals that have poor outcomes and spend more money per procedure will be penalized, and they may end up owing money to Medicare at the end of each year.

Michael E. Higgins, MD, FAAOS, is a fellowship-trained hip and knee replacement specialist. He did his undergraduate studies at the State University of New York at Geneseo and went on to medical school at Upstate Medical University at Syracuse. Dr. Higgins did his orthopaedic residency at the University of Buffalo and did an additional year of specialty training focused on complex hip and knee replacement at the Roanoke Orthopaedic Center. He joined Tidewater Orthopaedics in 2006.


The goal of the CJR model is to give hospitals a financial incentive to work with physicians, home health agencies, skilled nursing facilities, and other providers to make sure patients receive coordinated, cost-effective care. CMS will provide spending and utilization data to help hospitals compare themselves to each other to promote improved care delivery and coordination.

These changes ultimately will benefit the patient, as changes needed for hip and knee replacements will be expedited. For example, hospital stays for healthy patients will continue to decrease and outpatient hip and knee replacements will become much more common. Patients will participate in outpatient physical therapy sooner and have shorter courses of home therapy—or even forego home therapy altogether. Treatments that have become ingrained but don’t improve outcomes will be eliminated. All of this will improve the quality of care and stretch Medicare dollars so that more patients can benefit from these amazing life-changing procedures.

Left unchecked, the CJR model will be little more than a system that mandates hospitals to ration health care. After all, who will want to provide hip and knee replacement surgery to a patient who is less healthy and more likely to have complications if there is a penalty for this? However, we want to make sure that the majority of these “higher-risk” patients benefit just as much from hip and knee replacement as their healthier peers. I am proud to serve on the American Association of Hip and Knee Surgeons Advocacy Committee, which is tasked with ensuring that CJR does not penalize hospitals for treating those with the greatest needs. There is formal pushback by orthopaedic surgeons on behalf of our patients.

This model will be phased in over the next five years, giving time for adjustments to be made. We are pushing for recognition of patients preexisting health conditions in the CJR formula as a counterbalance to “cherry picking” healthy patients to ensure that hip and knee replacement surgery continues to benefit as many Americans as it currently does.

Many changes are underway in hip and knee replacement surgery. Those considering surgery in the near future will likely take a different recovery path than they might have just a few years ago. While some of these changes may seem daunting, I am optimistic they will result in better results for our patients. That, as always, is the goal.


EPOC CONSTRUCTION is pleased once again to collaborate with Tidewater Orthopaedics. Our last enterprise consisted of an interior build-out for

Tidewater Orthopaedics’ Physical Therapy department in their Hampton facility. Our new venture is Tidewater Orthopaedics’ Williamsburg office—an extensive remodel of an existing 12,000-sq.-ft. office and warehouse.

The initial meeting between EPOC and Tidewater Orthopaedics was in June of 2015. Its purpose was to determine if an existing building that their realtor (Hamner Development) found would be sufficient to meet Tidewater’s needs for a medical office. A construction estimate had to be established to see if costs were within budget. Based on EPOC’s positive assessment, with some assumptions, Tidewater Orthopaedics decided to proceed and had a contract on the property within 30 days.

At that point, Tidewater Orthopaedics had just a 60-day window to verify several items during the “Feasibility Period.” A daunting list of factors had to be considered, including municipality

codes, zoning, surveys, engineering studies, parking and drainage analysis, plus building renovations, space planning, and hard construction costs.

Fortunately, the project appeared acceptable to the county and EPOC stayed within their original budget, so Tidewater Orthopaedics closed on the property within the 60-day time frame. EPOC started the project in December and Tidewater Orthopaedics intends to move into this new location in October of 2016.

EPOC Construction, Inc. is a preferred choice of many clients—including Tidewater Orthopaedics. In construction, as in medicine, we leave the stable structural bones but reconstruct the damaged or outdated material to make the system function like new again!

Existing office/warehouse space

MAkiNg OlDnew again!

Rendering of Tidewater Orthopaedics on Ironbound Road, Williamsburg, Virginia


Count on

High treatment compliance1 >> + Successful fracture

healing outcomesProven clinical effectiveness2-4

*Summary of Indications for Use: The EXOGEN Ultrasound Bone Healing System is indicated for the non-invasive treatment of established non unions† excluding skull and vertebra. In addition, EXOGEN is indicated for accelerating the time to a healed fracture for fresh, closed, posteriorly displaced distal radius fractures and fresh, closed or Grade I open tibial diaphysis fractures in skeletally mature individuals when these fractures are orthopaedically managed by closed reduction and cast immobilization. There are no known contraindications for the EXOGEN device. Safety and effectiveness have not been established for individuals lacking skeletal maturity, pregnant or nursing women, patients with cardiac pacemakers, on fractures due to bone cancer, or on patients with poor blood circulation or clotting problems. Some patients may be sensitive to the ultrasound gel. Full prescribing information can be found in product labeling, at www.exogen.com, or by calling customer service at 1-800-836-4080.

†A non-union is considered to be established when the fracture site shows no visibly progressive signs of healing.

References: 1. As demonstrated in a non-union population of 101 patients. Schofer MD, Block JE, Aigner J, Schmelz A. Improved healing response in delayed unions of the tibia with low-intensity pulsed ultrasound: results of a randomized sham-controlled trial. BMC Musculoskelet Disord. 2010;11(1):229. 2. Heckman JD, Ryaby JP, McCabe J, et al. Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound. J Bone Joint Surg [Am]. 1994;76(1):26−34. 3. Kristiansen TK, Ryaby JP, McCabe J, et al. Accelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound. A multicenter, prospective, randomized, double-blind, placebo-controlled study. J Bone Joint Surg [Am]. 1997;79(7):961−973. 4. Nolte PA, van der Krans A, Patka P, et al. Low-intensity pulsed ultrasound in the treatment of nonunions. J Trauma. 2001;51(4):693−703.

© 2015 Bioventus LLC EXOGEN is a registered trademark of Bioventus LLC.

GABRIELLE LANzETTA, MSPAS RPA-C, a native of Long Island New York, has been with Tidewater Orthopaedics Hand Center since November 2015. Gabrielle, an experienced subspecialty physician assistant joins the only two board certified hand surgeons in the area, Dr. Campolattaro and Dr. Smerlis,

further expanding the singular and premiere hand center at Tidewater Orthopaedics. Ms. Lanzetta attended Syracuse University where she earned a Bachelor of Science in Psychology. Upon graduating, she earned a Master of Science in Physician Assistant studies from Touro College and received the prestigious Maimonides Award. She is a member of the Physician Assistants in Orthopaedic Surgery Society.

Prior to joining Tidewater Orthopaedics, Gabrielle spent six years working with two prominent hand surgeons in a private Manhattan New York practice, specializing in hand, wrist and elbow surgery. She maintained an affiliation with New York University Hospital for Joint Diseases and was a surgical first assist. Tidewater Orthopaedics and the patients we serve will be greatly enhanced as she brings her patient centered approach and experience dealing with complex hand and wrist issues to our practice. Patients have expressed their pleasure and satisfaction with her treatment and demeanor. Gabrielle is familiar with the diagnosis and treatment of upper extremity conditions, including Carpal Tunnel Syndrome, Cubital Tunnel Syndrome, Fractures, Arthritis, Tendonitis, Athletic Injuries, Congenital and Vascular Disorders, and Dupuytren’s Contracture.

In 2015, her lifelong dream of living at the beach became a reality after the recent engagement to her fiancé, a Virginia Beach native. Gabrielle currently resides in Virginia Beach and enjoys walking her dog Stewie on the beach and paddle boarding in her free time.

a nEW pa In TOwn

ANY traumatic injury to an extremity is stressful, but it can be further complicated by the development of a mysterious disease process known as Complex Regional

Pain Syndrome (CRPS). The International Association for the Study of Pain (IASP) defines CRPS as ongoing pain after injury, hypersensitivity or allodynia (pain to the touch), and edema (swelling) or abnormal sudomotor activity (sweating in the extremity). This neurological disorder can complicate the rehabilitation process.

What causes CRPS? Current opinion is that the disruption to healing is caused by damage to (or malfunction of ) the peripheral and central nervous systems. CRPS is rare, but it has been reported more in women between the ages of 40 to 49. Upper extremity injuries are affected twice as much as lower extremity injuries. Symptoms can occur in many types of trauma- or surgery- related injuries to the extremities, but the highest incidence of CRPS has been shown to occur in severe wrist fractures. Since hand therapy usually is initiated 3 to 5 days after surgery, the hand therapist must be aware of the symptoms of CRPS and initiate protocol as soon as possible.

Signs of CRPS may include the following:

1) Pain “out of proportion” to the injury

2) Discoloration of the skin

3) Edema (swelling of the upper extremity/hand)

4) Increase hair growth

5) Abnormal skin texture

6) Surface temperature changes of the hand

7) Hyperhydrosis (sweaty palms)

If some or all of these symptoms are noted, hand therapy will initiate treatment to decrease swelling using elevation, compression, and retrograde massage. Fluidotherapy is used as well to assist with the desensitization of the sensory nerves via dry heat, which forces the suspension of cellulose particles against the surface of the hand (figure 1).

Exercises for range of motion are performed to the hand and

upper extremity. This is done within the patient’s pain tolerance, so as not to increase pain and inflammation. A stress-loading program is also initiated as tolerated by the patient. This program is known as the “scrub and carry” protocol, which uses traction and compression exercises. A stress loading program promotes active movement and compression of the affected joints for a minimum of 3 to 5 minutes, three or more times per day. Studies have shown this program to be effective in improving strength and mobility while providing pain relief.

Another modality used by hand therapists is the mesh TENS glove (figure 2). Compared to standard self-adhesive electrodes, the TENS glove electrodes provide a larger contact area with the

Complex regional pain syndrome— The “Mystery Disease”


By Terri Shipley, OTR/L, CHT • Hand Therapy Director

Figure 1A: Patient in Fluidotherapy

Figure 1B: Hand in Fluidotherapy


skin to allow the unit to stimulate more nerve fibers of the hand. Studies have been performed on the use of the TENS glove on stroke patients to assist with improving the peripheral and central mechanisms in order to decrease spasticity and facilitate voluntary movement of the hand. This has had positive effects.

However, currently no research study has been performed with CRPS patients. It is assumed that increasing the afferent nerve input to suppress spasticity and initiate movement by stimulating the nervous systems with stroke patients may also be beneficial in treating CRPS symptoms.

The use of the TENS glove has been known to help improve circulation and sensation of the hand and decrease pain. The glove is administered by being dampened and applied to the affected hand with a large ground electrode patch applied to the patient’s back. The unit can be set on different modes in accord with the patient’s tolerance and is set for 15 minutes with the intensity slowly increased based on the patient’s pain threshold.

Many of our patients received a home unit so that they can continue to benefit from the use of the TENS glove throughout the day. Some patients will utilize the glove before going to bed to allow them to sleep through the night.

CRPS is a mysterious disease, to say the least. Patients not only benefit from hand therapy to improve function and control their symptoms, but may also be seen by pain management for medications and/or sympathetic ganglion nerve blocks. Having a multidisciplinary team approach—including the hand therapist and surgeon—is the ideal combination for the best outcomes. Hand surgeons and hand therapists are knowledgeable in the identification and treatment of CRPS. If any symptoms or issues arise during our patients’ rehabilitation process that may indicate CRPS, the physician is notified and the CRPS protocol is initiated immediately by the therapist. The team approach within our Tidewater Orthopaedics Hand Center makes for an optimum setting for the specialized needs of your hands.

tidewater Orthopaedics is the only orthopaedic practice on the peninsula to provide board certified hand surgeons coupled with a hand therapy department.

MELODY FORTUNE

Medical Staffing Group

MSG Director

11835 Canon Blvd Ste A101

PO Box 12177

Newport News, VA 23612-2177

757.873.5900 • 800.945.9095

fax: 866.597.0055

[email protected] • www.ctrc.com

MELODY FORTUNE


MSG Director


PO Box 12177


757.873.5900 • 800.945.9095

fax: 866.597.0055


MELODY FORTUNE


MSG Director


PO Box 12177


757.873.5900 • 800.945.9095

fax: 866.597.0055


Melody FortuneMedical Staffing Group

MSG Director

11835 Canon Blvd., Ste A101PO Box 12177

Newport News, VA 23612-2177757.873.5900 • 800.945.9095

fax: 866.597.0055


Terri is a native of Nebraska and a graduate of Creighton University in Omaha in Occupational Therapy. She also has a teaching degree from Chadron State in Nebraska as well as a Masters in Exercise Physiology from James Madison University. Terri previously had taught middle school science before pursuing her Occupational Therapy degree. She worked several years at Riverside Regional Medical Center in Newport News in acute, psych and outpatient settings before joining Tidewater Ortho in 2005.

Figure 2: TENS glove

Hanger Clinic helps turn dreams into reality through advanced orthotic and pprosthetic solutions.

To experience what’s ‘Possible’ at Hanger Clinic visit HangerClinic.com or call:

Newport News/Hampton: 757.873.1984Norfolk: 757.461.0671

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HOOP drEaMs

AS an Orthopaedic Surgeon who specializes in Sports Medicine, one of the most gratifying parts of my job is giving people the opportunity to return to a normal,

active life. Although it can be heartbreaking to tell an athlete that he or she will need surgery, it’s great to see them return to their respective sports. I enjoy helping all people—from weekend warriors to collegiate athletes—to return to their activities. But a particularly memorable case involves a young athlete from a local high school.

When I first met Alexsis Grate, she was a 16-year-old basketball player for Bethel high school who had already signed a college scholarship to play at George Mason University. Alexsis was the reigning Daily Press Player of the year in girls’ basketball. She was entering her senior year and was excited about the prospects of playing one final year with some of her closest friends at Bethel.

During a summer AAU tournament, Alexsis’ shoulder had dislocated completely out of its socket. Despite a period of rest, she suffered several episodes of recurrent instability. I initially spoke to Alexsis and her mother by phone, as she plays for Boo Williams AAU basketball team and had just re-injured her shoulder. We quickly ordered an MRI, which showed a tear of Alexsis’ labrum and a small fracture. I explained to Alexsis and her mother that given her young age, active lifestyle, and injury, Alexsis would have been at an extremely high risk for recurrent instability episodes if she did not have surgery. We talked about a plan, and we felt that if we could arthroscopically fix Alexsis’ shoulder quickly, we would likely be able to get her back for her senior year.

Surgery was performed at the CarePlex Orthopaedic Ambulatory Surgery Center (COASC), a surgery center managed by Tidewater Orthopedics. Because of this, the staff and equipment are com-pletely focused on the care of Orthopaedic injuries. The surgery was successful, and using new advanced techniques I was able to repair Alexsis’ large tear and bony fracture arthroscopically.

Unfortunately, Alexsis started off working with an outside physical therapist, and her initial rehab was complicated by significant stiffness. When I did a routine follow-up, I knew that Alexsis needed close attention by a physical therapist who is well-versed in taking care of athletes. Tidewater Orthopedics has a dedicated physical therapy department devoted to caring for our patients. Matt DeRoja, from our therapy department, began working closely with Alexsis, and in a very short period of time he was able to get her motion back.

Alexsis was back playing basketball just four months after surgery, and currently she is playing at an extremely high level. She feels better than ever and is excited about the opportunity to end her

high school career with a state championship. Alexsis’ family is equally excited about her speedy recovery.

I am very blessed to have the tools available to me to take care of our local athletes. All of our physicians have advanced training in the various subspecialties of Orthopedic Surgery. We have a mod-ern surgery center that allows us to use cutting-edge techniques. We have a physical therapy department that we work closely with, which allows us to individualize our patients’ needs.

Alexsis’ mother, Andrea, states: “Without Dr. Sablan and the caring physical therapy staff there’s no way Alexsis would have been cleared and released at such an alarming rate of four months! Thank you Dr. Sablan, Matt, and the staff at the CarePlex for helping Alexsis reach her goal of returning to basketball sooner than later. People are saying that Alexsis has a bionic arm!”

By Nicholas K. Sablan, MD

Nicholas K. Sablan, MD, FAAOS, completed his residency in orthopaedic surgery at the Univer-sity of Connecticut, and a fellowship in orthopae-dic sports medicine in the Kerlan Jobe clinic in Los Angeles. In Los Angeles, Dr. Sablan served as assistant team physician to the Lakers, LA Kings, Anaheim Ducks, Los Angeles Dodgers and PGA Tour as well as college and high school sports teams. He joined Tidewater Ortho in 2011 because he shares their same commitment to providing excellent subspecialty care.


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Individual results vary. Not all patients will have the same post-operative recovery and activity level. See your orthopaedic surgeon to discuss your potential benefits and risks. Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Stryker. All other trademarks are trademarks of their respective owners or holders. It may be time to get moving again.

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livingwithpain-directanteriorhip-half1 SC 7.625x4.9.indd 1 2/5/15 3:26 PM



Nicholas K. Sablan, MD, FAAOS, a board-certified orthopaedic surgeon who completed a fellowship in orthopaedic sports medicine at Kerlan Jobe Clinic in Los Angeles, has served as assistant team physician for the Los Angeles Lakers, the LA Dodgers, the LA Angels, and the PGA Tour, among others. He is the author of published multimedia on various shoulder topics including rotator cuff and AC joint injuries, as well as peer-reviewed publications and a book chapter on arthroplasty of the hip.

Nicholas k. Sablan, MD* • Shoulder and Sports Medicine

Nicholas Smerlis, MD, FAAOS, CAQSH, is a board-certified, orthopaedic surgeon with subspecialty certification in surgery of the hand. He completed a fellowship in hand and upper extremity at Wake Forest University Baptist Medical Center and has been with Tidewater Orthopaedics since 2007 practicing solely on the hand & wrist.

Nicholas A. Smerlis, MD* • Hand and Wrist

Robert Campolattaro, MD, FAAOS, CAQSH, is a board-certified, orthopaedic surgeon. He completed a fellowshipin hand and upper extremity at Wake Forest University Baptist Medical Center and has a practice that solely focuses on the treatment of hand and wrist conditions. Dr. Campolattaro is the current President of Tidewater Orthopaedics and was named “Top Doc of Hampton Roads” by Hampton Roads Magazine in 2013.

robert M. Campolattaro, MD* • Hand and Wrist

Dr. Maloof attended New Jersey Medical School for medical school and his residency, where he served as Administrative Chief Resident in one of the busiest level one trauma centers on the east coast. He has completed his fellowship training in Foot & Ankle Surgery at Duke University. Duke is known as a pioneer in ankle replacement surgery and has brought this procedure to Hampton Roads along with numerous other cutting-edge treatments for various foot and ankle disorders.

Paul B. Maloof, MD • foot & Ankle Orthopaedic Surgeon

Colin Kingston, MD, FAAOS, CAQSM, is a board-certified, orthopaedic surgeon. He completed medical school and his residency while serving in the United States Air Force. He has served in both gulf wars in Operation Southern Watch, Operation Enduring Freedom and Iraqi Freedom. He is also certified for Additional Qualification (CAQ) and CAQSM-Certificate of Added Qualifications in Sports Medicine. Dr. Kingston was named “Top Doc of Hampton Roads” by Hampton Roads Magazine in 2013 and 2014.

Colin M. kingston, MD* • Sports Medicine and Joint replacements

Michael Higgins, MD, FAAOS, is a board-certified, orthopaedic surgeon. He completed a fellowship in joint replacement and reconstruction at the Roanoke Orthopaedic Center. He has written articles and lectured on hip and knee replacement. He has been named a Top Doctor by U.S. News & World Report. Dr. Higgins serves as the Orthopaedic Medical Director of the region’s only dedicated orthopaedic hospital.

Michael e. Higgins, MD* • Joint replacements and reconstruction

Amanda Watkins, PA-C

Amanda earned her undergraduate degree in Biology from the University of Nebraska where she was also a member of the Nebraska Army National Guard. During her time in the National Guard she deployed for Operation Iraqi Freedom where she joined a medivac unit as a flight medic. Amanda completed her Masters in Physician Assistant Studies at Massachusetts College of Pharmacy and Health Sciences. Following Graduate School Amanda joined Dartmouth Hitchcock focusing on Orthopaedics prior to moving to Hampton Roads to join Tidewater Orthopaedics in 2010.



John McCarthy, MD, FAAOS, is a board-certified orthopaedic surgeon. He specializes in hip and knee replacements and has an interest in hand surgery. He completed a fellowship at the Hand Rehabilitation Center in Philadelphia. While practicing in Pittsburgh, PA, he served as a team physician for the Pittsburgh Penguins professional hockey team.

John J. McCarthy iii, MD* • Joint replacement and general Orthopaedics

* Board-Certified Orthopaedic Surgeon • FAAOS - Fellow of the American Academy of Orthopaedic SurgeonsCAQSM - Certificate of Added Qualifications in Sports Medicine • CAQSH - Certificate of Added Qualifications in Surgery of the Hand

gabrielle lanzetta, MSPAS rPA-C

Gabrielle, a native of Long Island New York, has been with Tidewater Orthopaedics Hand Center since November 2015. Gabrielle attended Syracuse University where she earned a Bachelor of Science in Psychology. Upon graduating, she earned a Master of Science in Physician Assistant studies from Touro College and received the prestigious Maimonides Award. Prior to joining Tidewater Orthopaedics, Gabrielle spent six years working with two prominent hand surgeons in a private New York City practice, specializing in hand, wrist and elbow surgery. She maintained an affiliation with New York University Hospital for Joint Diseases and was a surgical first assist. In 2015, her lifelong dream of living at the beach became a reality after the recent engagement to her fiancé, a Virginia Beach native. Gabrielle currently resides in Virginia Beach and enjoys walking her dog Stewie on the beach and paddle boarding in her free time.

Loel Payne, MD, FAAOS, is a board-certified, orthopaedic surgeon who focuses his orthopaedic care on the treatment of the shoulder and knee. Dr. Payne attended undergraduate school at Duke University and medical school at the University of North Carolina Chapel Hill. He completed a fellowship in shoulder surgery and sports medicine at the Hospital for Special Surgery in New York. Dr. Payne has written multiple articles and book chapters and lectured nationally on shoulder conditions and has been with Tidewater Orthopaedics for almost 20 years.

loel Z. Payne, MD* • Shoulder and knee

Dr. Mason, a Norfolk, Virginia native, returns to Hampton Roads and joins the team of subspecialists at Tidewater Orthopaedics. He completed his residency training at the University of Virginia and his fellowship training at Twin Cities Spine Center in Minneapolis, Minnesota. Dr. Mason sees patients in both office locations and performs surgery at the Orthopaedic Hospital at Sentara CarePlex. Dr. Mason brings minimally invasive outpatient spine surgery to Tidewater Orthopaedics and many other cutting edge treatments for spine problems.

Jonathan r. Mason, MD • Spine


ON a cold night in January, I attended a meeting about a mission trip to Haiti. Before

I could make a decision, a ticket was purchased in my name. I sent away for my passport, visited the international travel clinic for vaccinations, and put in for vacation at Tidewater Orthopaedics. Fundraisers were scheduled and my team began to collect medical and school supplies to donate.

To prepare for our trip, we purchased battery-powered fans, air mattresses, mosquito tents, and hand-sanitizer. All the details fell into place without a hitch. I read the information about Haiti: The employment rate was 77 percent and it was considered to be the poorest third-world country. Without seeing the conditions for myself, I could never explain the utter turmoil.

When we landed in Port-au-Prince on Saturday, a team from Pray-ing Pelican Missions met us. The Haitians speak Creole. We had two Haitian translators, a driver and a facilitator. Praying Pelicans pro-vided meals, lodging, transportation, and bottled water.

We drove 45 minutes to our compound. It was an acre of land enclosed by a 12-foot by 12-foot cinderblock wall and an armed guard. There was an orphanage with approximately 60 children and juveniles. There was sporadic electricity, primitive plumbing, well-water, and neither refrigeration nor air conditioning. We chose to sleep outside with the cool breeze and what seemed to be a large tarantula that we discovered in the scorched field.

Sunday morning we rode across town to our church service. My church, Next Level, had partnered with this congregation. They had donated the funds and provided the workforce to build

an office addition. The church build-ing was a small wooden structure. It was filled with people from the village. The live band played worship songs as the congregation joined in. What a joy to listen to the message and feel the spir-it. Our weekday mornings were spent painting, sifting sand, shoveling, pass-ing water buckets and mixing concrete. Before lunch, we divided into two groups and went on a prayer walk. We random-ly chose homes and prayed with each family. What a delight to interact and

spread the word. Our afternoons were spent playing with the children at the orphanage. We read stories, had object lessons, col-ored, sang, danced, and learned new words in Creole. Ironically, these orphans were fortunate to be entitled to an education. Else-where, the villagers had to pay to attend school.

We ended each day with a group meeting where we would share memories. Our last day was recreation day. We visited the Haitian Museum, lunch at the Haitian McDonald’s and went to Bora Bora beach. The water was crystal blue and the surrounding mountains were magnificent.

Although I witnessed extreme poverty, government corruption, excessive filth, horrible sanitary conditions, and total chaos on the roads, I chose to see the love that I witnessed between the Haitians. The children’s laughter, the minister’s grateful heart and the small difference we made within that community was precious. Some said that I would be forever changed after this trip. I have to agree with that. I am extremely thankful for my many blessings, grateful that I am gainfully employed at Tidewater Orthopaedics’ and appreciative that I had the opportunity to minister in Haiti.

Na we pita Ayiti … (“See you later Haiti …”)

The children’s laughter, the minister’s grateful heart and the small difference we made within that community was precious.”

Haiti Mission Trip, June 2015By Jan R. Stahmer

Jan Stahmer has been a loyal employee @ Tidewater Orthopaedics since April 2010. She serves as a hand therapy technician in our hand therapy clinic in Hampton. Jan has been a productive member of the hand therapy team, performing clerical, custodial and supportive assistance to the hand therapists and the TOA organization.

We are very proud of her support to her church and her missionary work in Haiti. Keep up the good work Jan!

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Retirement Living CommunityThe Arbors at Port WarwickLeave the responsibilities of home ownership behind and live in a charming apartment in the Peninsula’s most elegant residence for active seniors.

Assisted Living CommunityThe Huntington at The NewportThe Huntington is a thriving Assisted Living Community, combiningthe security of health care service programs with the advantages ofapartment living.

Convalescent & Rehabilitation FacilitiesJames River, The Newport, Northampton, Coliseum, York,Walter Reed and LancashireProviding care for patients needing extensive rehabilitative therapy or24 hour nursing care. Skilled care is available.

Rehabilitation ServicesVirginia Health RehabState-of-the-art outpatient facility located in the heart of Port Warwick. Providing patient centered Physical, Occupational & Speech therapy.

Medical Equipment and SuppliesVirginia Health Medical SalesMeeting your needs for durable medical outpatient equipment,delivered to your door.

Home Health CareVirginia Health Home CareOur newest level of service. VHHC provides a wide variety of help formost any challenge you might face in order to provide your loved onewith the best care possible, without leaving the home.

Pharmaceutical ServicesVirginia Pharmaceutical ServicesA comprehensive pharmacy that offers a full array of services to meet each individual clients needs. VPS supports various types of health care environments, including assisted living communities,convalescent and rehabilitation facilities.

240 Nat Turner Blvd., Newport News, VA 23606 757.596.6268 | vahs.com

Tidewater Orthopaedics901 Enterprise Pkwy, Suite 900Hampton, VA 23666

SPORTS MEDICINE Neck MRI WRIST HIP Physical Therapy … Ortho v7i1.pdfmoderate sedation, which helps control pain after your surgery. ... as weight loss, increasing low-impact activities,

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